Abstracts

Rationale: In Ontario, Canada s most populous province (population ~13 million), there exists one referral and surgical centre where children with medically refractory epilepsy (MRE) who are candidates for epilepsy surgery are waiting between 5 and 8 months between decision for epilepsy surgery and surgery, with a total time from surgical evaluation to surgery of over 1.5 years. We propose a reorganization of services to improve access to care by decreasing wait times to surgical evaluation and surgery through the use of systems modeling. This approach combines the patient flow pathway and system resource capacity constraints to derive operationally efficient solutions that focus upon the patient. We developed and validated such a systems model to evaluate strategies to decrease wait times for children with MRE in Ontario.Methods: In collaboration with the Hospital for Sick Children (SickKids) in Ontario we mapped the patient flow, collected resource data (e.g. surgery scheduling, epilepsy monitoring unit (EMU) scheduling/bed availability) and estimated model inputs from a retrospective chart review. Using this information, a systems model was built with computer simulation. Model validation included consultation with SickKids and goodness-of-fit with the system. We conducted scenario analyses to determine the best alternative resource configurations to meet wait time benchmarks proposed by SickKids.Results: Through patient flow mapping, clinical care was described by four modules: EMU (entry point for diagnostic evaluation), multimodal diagnostic assessment, multidisciplinary seizure conference, and surgery. Based on the analyses of different resource capacities the following increases in resources were found to meet the institution s goals: 2 additional EMU beds (wait time decrease of 88 days), 2 additional invasive monitoring surgeries per year (wait time decrease 150 days), and 6 non-invasive monitoring surgeries (wait time decrease 140 days) per year and limiting the number of repeat seizure conferences.Conclusions: By using systems modeling it is possible to inform the allocation of resources to decrease wait times and increase access to care without conducting expensive and timely delivery redesigns which may be ineffective. We also identified a larger system issue that was leading to increased wait times: repeat seizure conferences. The information derived from this analysis can be used to help inform institutional decisions about operations management and bottlenecks in the care pathway.