Emergency and On-Demand Healthcare: Modeling a Large Complex System

  • S. C. Brailsford
  • V. A. Lattimer
  • P. Tarnaras
  • J. C. Turnbull
Part of the The OR Essentials series book series (ORESS)


This paper describes how system dynamics was used as a central part of a whole-system review of emergency and on-demand healthcare in Nottingham, England. Based on interviews with 30 key individuals across health and social care, a ‘conceptual map’ of the system was developed, showing potential patient pathways through the system. This was used to construct a stock-flow model, populated with current activity data, in order to simulate patient flows and to identify system bottle-necks. Without intervention, assuming current trends continue, Nottingham hospitals are unlikely to reach elective admission targets or achieve the government target of 82% bed occupancy. Admissions from general practice had the greatest influence on occupancy rates. Preventing a small number of emergency admissions in elderly patients showed a substantial effect, reducing bed occupancy by 1% per annum over 5 years. Modelling indicated a range of undesirable outcomes associated with continued growth in demand for emergency care, but also considerable potential to intervene to alleviate these problems, in particular by increasing the care options available in the community.


System Dynamic Model Emergency Admission Stella Model Hospital Episode Statistics Elective Admission 
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Copyright information

© Operational Research Society 2016

Authors and Affiliations

  • S. C. Brailsford
    • 1
  • V. A. Lattimer
    • 2
  • P. Tarnaras
    • 1
  • J. C. Turnbull
    • 2
  1. 1.University of SouthamptonSouthamptonUK
  2. 2.School of Nursing and MidwiferyUniversity of SouthamptonSouthamptonUK

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