Table 1.
Input parameters for simulation models
| Parameter | Resources | Mean and (SD) | Data source/comments | |
| VFC Steps | VFC arrival rates (33% discharged ED) | 12 patients per day | Historical data analysis- patients discharged at ED figure 1 One-third of patients discharged at ED so only 12 at VFC | |
| Admin 1 | Admin | 1.06 min (0.64) | Direct observation | |
| Nurse Prep | Nurse | 1.61 min (0.7) | ||
| VFC consultant review | Consultant | 1.75 min (0.95) | ||
| Nurse | ||||
| Nurse calls | Nurse | 8 min (4) | ||
| Admin 2 | Admin | 2.5 min (1.7) | ||
| Admin letters and appointments | Admin | 2.9 min (1.35) | Around one-third of patients will still follow the traditional pathway. All others have been discharged. | |
| Discharge advice letters | Admin | 2.33 min (0.5) | Direct observation | |
| Helpline call arrival rate | Nurse | 2.6 per day | ||
| Helpline call duration | Nurse | 4.5mins (0.15) | ||
| VFC decision point Discharged | 50% | Historical data analysis | ||
| Referred to consultant clinic | 40% | |||
| Referred to N/L clinic | 10% | |||
| Staffing: Consultants | 1 | |||
| Nurses | 1 | |||
| Admin | 2 | |||
| Typists | 1 | |||
| TFC Steps | ED/MIU arrival rates | 18 patients per day | Historical data—all patients (figure 2) | |
| X-ray | 14 min (5) | Historical data | ||
| Nurse prep | Nurse | 1.61 (0.7) | ||
| Consultant consultation | Consultant | 12 min | Observation | |
| Second consultation | Consultant | 3 min | Expert opinion/observation | |
| Nurse consultation | Nurse | 20 min | ||
| Discharge admin | Admin | 6 min | ||
| Assessment routing: Admitted | 1% | Expert opinion: Much of these routing values are based on the clinical mix of patients and therefore does not warrant sensitivity analysis. As stated in the text, one limitation of this work is that the clinical mix for the new virtual pathway is that these routings are likely to be different as the simplest injuries have been discharged. | ||
| X-ray | 3% | |||
| Treatment | 72% | |||
| Discharge | 24% | |||
| Treatment routing | ||||
| X-ray | 6% | |||
| Second consultation | 93% | |||
| Discharge routing | ||||
| Discharged | 36% | |||
| Return appointment | 64% | |||
| Staffing: Consultants | 3 | Sensitivity analysis was necessary here in terms of the number of staff required to ensure all patients were seen within the allocated session time. These values represent the necessary staffing required. | ||
| Nurses | 3 | |||
| Admin | 2 | |||
| Typists | 4 | |||
| BOTH | Shifts Admin1 (VFC) | 07:30–08:15 | For printing off lists only | |
| Admin 1 (TFC) | 07:45–09:00 | Longer shift as higher volume of patients | ||
| Consultant (14) | 09:00–13:00 | 4-hour consultant session | ||
| Nurse (8) | 08:00–16:00 | Average Full Time nurse working hours | ||
| Typists | 09:00–17:00 | Discharge letters to General Practitioner and patient (Mon–Fri) | ||
| Admin 2 | 11:00–16:00 | For issuing letters only | ||
| Hourly rates GRI consultant | £62.91 | Average for GRI orthopaedic consultants. Obtained from GGC finance dept. for 2014/15. Include 23% employer costs | ||
| Nurse | £20.96 | Based on April 2014 figures. They have 23% employer costs added and are then divided by 42 weeks. GRI staffing levels based on average of 8 nurses (B7, B6 and B5×6). | ||
| Admin | £12.74 | Average | ||
| Admin 2 | £16.22 | Average | ||
| Efficiency | 85% | Sensitivity analysis shows the effects of this on cost | ||
| Clock | Hours | 1 year as we had historical data for this time period | ||
| Warm-up period | 168 hours | Tests completed to ensure model in steady state73 |
ED, emergency department; GRI, Glasgow Royal Infirmary; MIU, minor injuries unit; TFC, traditional fracture clinic; VFC, virtual fracture clinic.