Looking in the Wrong Place for Healthcare Improvements: A System Dynamics Study of an Accident and Emergency Department

  • D. C. Lane
  • C. Monefeldt
  • J. V. Rosenhead
Part of the The OR Essentials series book series (ORESS)


Accident and Emergency (A&E) units provide a route for patients requiring urgent admission to acute hospitals. Public concern over long waiting times for admissions motivated this study, whose aim is to explore the factors which contribute to such delays. The paper discusses the formulation and calibration of a system dynamics model of the interaction of demand pattern, A&E resource deployment, other hospital processes and bed numbers; and the outputs of policy analysis runs of the model which vary a number of the key parameters. Two significant findings have policy implications. One is that while some delays to patients are unavoidable, reductions can be achieved by selective augmentation of resources within, and relating to, the A&E unit. The second is that reductions in bed numbers do not increase waiting times for emergency admissions, their effect instead being to increase sharply the number of cancellations of admissions for elective surgery. This suggests that basing A&E policy solely on any single criterion will merely succeed in transferring the effects of a resource deficit to a different patient group.


National Health Service System Dynamic Model Emergency Patient Elective Patient Crisis Event 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Operational Research Society 2016

Authors and Affiliations

  • D. C. Lane
    • 1
  • C. Monefeldt
    • 1
  • J. V. Rosenhead
    • 1
  1. 1.The London School of Economics and Political ScienceUniversity of LondonUK

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