Managing uncertainty in orthopaedic trauma theatres

The management of acute healthcare involves coping with a large uncertainty in demand. This uncertainty is a prevailing feature of orthopaedic care and many scarce resources are devoted to providing the contingent theatre time for orthopaedic trauma patients. However, given the variability and uncertainty in the demand much of the theatre time is not used. Simulation was used to explore the balance between maximising the utilisation of the theatre sessions, avoiding too many overruns and ensuring a reasonable quality of care in a typical hospital in the United Kingdom. The simulation was developed to examine a policy of including planned, elective patients within the trauma session: it appears that if patients are willing to accept a possibility of their treatment being cancelled, substantially greater throughputs can be achieved. A number of approximations were examined as an alternative to the full simulation: the simpler model offers reasonable accuracy and easier implementation. (C) 2003 Elsevier B.V. All rights reserved.