| Object | Description | Procedures called | Resources | Enter from | Exit to |
|---|---|---|---|---|---|
| Start points | |||||
| Walk_amb | Arrival mode. One batch of patients enter per week. Arrival mode captured by label. | None | None | n/a | set wait |
| Referrals | Arrival mode. One batch of patients enter per week. Arrival mode captured by label. | None | None | n/a | set wait |
| Direct admissions | Arrival mode. One batch of patients enter per week. Arrival mode captured by label. | None | None | n/a | set wait |
| Pre-admission - general | |||||
| set wait | Sets wait time until arrival into hospital sampled from arrival hour distribution dependent on ED or ambulatory arrival. | None | None | Start points | pt info |
| pt info | Calculate if patient will be admitted (admit includes movement to CDU, discharge includes movement to ambulatory AMU), patient age and patient NEWS. Route out on arrival mode label. | None | None | set wait | Pre-admission locations |
| Pre-admission locations* | |||||
| ED | Preadmission route (preadmission, admitted wards, discharge locations). ED length of stay. Counts if patient breaches 4 hour target. Labels patient as direct admission. |
Proc_PreAdmRoute Proc_LOS | ED Bed. Assigned in workstation. Wait in queue if not available. | pt info | Route |
| AMUamb | Decides whether admitted or discharged (0.84 calculated from data, meaning 84% discharged). Sets discharge area based on ED discharge locations. Those that are admitted go to AMU. Counts number of admissions and gives patient an admitted patient number. Labels patient as direct admission. | None | AMUamb Bed. Assigned in bed workstation. Wait in queue if not available. | pt info | Route |
| CDU | Preadmission route (preadmission, admitted wards, discharge locations). CDU length of stay. Labels patient as direct admission. |
Proc_PreAdmRoute Proc_LOS | CDU Bed. Assigned in bed workstation. Wait in queue if not available. | pt info | Route |
| Admissions - general | |||||
| Route |
Moves patient to next location. Routes out using lbl_route, which was assigned at previous destination. Re-categorises those in data who were medical outliers as GMW. | None | None | Preadmission locations Admission locations | Preadmission locations Admission locations Discharge locations Death |
| Admission locations* | |||||
| AMU | Calculate next destination, LOS, changing NEWS. Counts number of AMU patients and AMU overall LOS. |
Proc_route Proc_LOS Proc_NEWS | AMU Bed. Assigned in bed workstation. Wait in queue if not available. | Route | Route |
| GMW | Calculate next destination, LOS, changing NEWS. |
Proc_route Proc_LOS Proc_NEWS | GMW Bed. Assigned in bed workstation. Wait in queue if not available. | Route | Route |
| Outlier | Calculate next destination, LOS, changing NEWS. Counts number of medical outliers created in the simulation. |
Proc_route Proc_LOS Proc_NEWS | Outlier Bed. Assigned in bed workstation. Wait in queue if not available. | Route | Route |
| Rehab | Calculate next destination, LOS, changing NEWS. |
Proc_route Proc_LOS Proc_NEWS | Rehab Bed. Assigned in bed workstation. Wait in queue if not available. | Route | Route |
| ICU | Calculate next destination, LOS, changing NEWS. |
Proc_route Proc_LOS Proc_NEWS | ICU Bed. Assigned in bed workstation. Wait in queue if not available. | Route | Route |
| HCU | Calculate next destination, LOS, changing NEWS. |
Proc_route Proc_LOS Proc_NEWS | HCU Bed. Assigned in bed workstation. Wait in queue if not available. | Route | Route |
| Change bed | Changes resource used for patients waiting for a rehab ward bed when determined by decision rule. | None | Change from current bed to GMW bed | Queue to rehab | Queue to rehab |
| Discharge locations | |||||
| Non-medical | Discharge location. Records discharge location and runs end procedures. |
Proc_Longterm Proc_End | None | Route | end |
| Care home | Discharge location. Records discharge location and runs end procedures. |
Proc_Longterm Proc_End | None | Route | end |
| Usual res | Discharge location. Records discharge location and runs end procedures. |
Proc_Longterm Proc_End | None | Route | end |
| NHS service | Discharge location. Records discharge location and runs end procedures. |
Proc_Longterm Proc_End | None | Route | end |
| Other discharge | Discharge location. Records discharge location and runs end procedures. |
Proc_Longterm Proc_End | None | Route | end |
| Death | End location. Records end location and runs end procedures. | None | None | Route | end |
Each pre-admission and admission location has two workstations (e.g. AMU and AMU bed); one to pick up the bed and a second that performs the other calculations.
From: Chapter 41, Cost-effectiveness analyses
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