Karl Vile

Devon Partnership NHS Trust

Modelling urgent care pathways


By constructing detailed simulations, this project has shown how best to alleviate pressure in an urgent care system.

A number of factors can impact on the effective provision of emergency care, with delays, bottlenecks and demand all placing different strains on a system.

Karl Vile, Urgent Care Pathway Operational Manager and Programme Lead at Devon Partnership NHS Trust, wanted to understand how he could reduce pressure in his Trust’s mental health system and minimise the number of patients sent out of county for care.

Joining the HSMA programme with a well defined question, Karl was able to hit the ground running. He began by developing a clearer understanding of the processes taking place in the urgent care system, and collected 3 years of anonymised patient data.

With the help of his HSMA mentor, Karl then used the Simul8 software to build a detailed model of the whole emergency network. This simulation allowed him to examine different service configurations and test various scenarios.

With such a comprehensive and adaptable model, Karl could answer some pressing questions. He explored how changes in demand for beds, lengths of stay and delayed discharge each affected the system.

He found that there was significant pressure in the mental health system, and that this demand was managed by using beds at hospitals in other counties. With some wards at full capacity, Karl could also clearly spot the areas used to deal with patient overflow.

Importantly, the model showed the mental health system needs more capacity and that sending patients out of area is not an economical use of resources - the best option being to increase the number of beds available within the Trust. Karl also discovered that boosting capacity might give the trust more ‘bang for its buck’, with new beds adding more than their individual benefits.

With no ‘silver bullet’ available, the complexity of Karl’s model has allowed the team to produce a range of incremental solutions involving other areas, targeting demand, length of stay and discharge delays. It also demonstrated the importance of ensuring there is sufficient crisis care in place - to prevent people from escalating to a point that they require urgent care - and reducing delays at the point of discharge.

The skills Karl has developed through the HSMA programme are already having an impact on other projects within Devon Partnership Trust, allowing him to build models that are feeding into multi-million pound business cases.