Title: Right cot right place right time. Using neonatal care data and computer simulation to improve the design and organisation of neonatal care networks.
Funder: Department of Health (England)

Abstract: The model is based on discrete event simulation. In this type of simulation each infant exists as an independent object in the model and has associated details (such as gestational age at birth entry level of care home hospital etc). The simulation runs through time and takes into account the variability experienced in the system (e.g. random occurrence of births with varying needs fluctuating availability of staff). The simulation is animated; infants may be seen in different levels of care at each hospital and can be seen being transferred between hospitals when necessary. Each hospital of a network will be presented in the model. For each hospital the number of cots and the highest level of care each cot is capable of supporting will be specified. Care levels will be classified by Intensive Care High Dependency Care and Special Care. These will be defined by the interventions being carried out and the level of nursing support required (according to BAPM guidelines). Though some hospitals may class levels of care slightly differently we will aim for a consensus and will be transparent about how the model has classified the level of care. Additionally each unit may have further limitations such as the gestational age they may support or specialist interventions that are not possible in a particular unit (surgery for example may only be possible in one unit in a network or infants may have to go outside of the network for surgery). Each unit will have a specified number of nurses. Infants are born at random in the hospitals in the model requiring care (it is possible to have hospitals with births but with limited or no neonatal care facilities). The distribution of gestational age and level of care initially required will be as observed in the historic data set. The model then seeks to find a suitable cot in the following example order (rules may be changed):•Cot in hospital of birth (or preferred hospital where hospital of birth has no neonatal care facilities).•Closest available cot in network.•Closest cot outside of network.In order for a hospital in the model to accept an infant there must be an available cot capable of the level of care required and sufficient nursing staff. Infants stay at a defined level of care for a given time (sampled from a distribution based on their gestational age) before transitioning to another level of care or exiting the network. There are opportunities to move infants closer to their home hospital when space becomes available.A proof of concept model has been developed (more detail is given in the attached project description). The data used in the proof of concept came from an old Excel-based DoH model. Though people have expressed doubts about the quality of data in the DoH spreadsheet it was sufficient to indicate that modelling of a neonatal network in Simul8 could be achieved.Data requirementsThe following data will be obtained from the data sets used (Badger & The Neonatal Survey).* Number of births at each hospital requiring neonatal care* Number of ICU HDU & SCU cots at each hospital* Number of nursing staff at each hospital(including ratio of qualified in speciality and non-qualified in speciality). Model will allow for ‘base case’ and also for maximum flexed resourcing at peak demand. * Earliest gestational age that may be treated at each hospital* Location of each hospital (used to find nearest available cot)* Network affiliation of hospital (the model will combine multiple networks if required)* Estimated cost of nurses & cots* Distribution of weight/gestational age of babies requiring care* Entry point (ICU HDU SCU) of babies according to weight/gestational age* Length of stay in ICU HDU SCU and next destination according to weight/gestational age* % twins in care* Target nurse:cot ratios for ICU HDU & SCU cots (using BAPM standards)* Maximum permitted over-utilisation of nurses before closure of unit to new infants(ICU HDU & SCU will be applied as defined in the BAPM 2011 Categories of Care guidelines).30 months of data will be used (24 months as a training set of data and 6 months as a test-set to compare model output to actual data not used to train model).Data analysisThe model will output the following:* ICU HDU & SCU cot utilisation at each hospital and in network* Staff utilisation at each hospital and in network and % time over BAPM guidelines* % of time that hospital/network is closed to further ICU HDU or SCU admissions* Number of ICU HDU & SCU episodes at each hospital* % of demand met locally or and in network (and average distance when displaced)* Number of transfers required (and total miles of transfers) within or outside of network* % episodes when no cot available (and average wait when this happens)* Number of episodes where infant in higher grade cot (e.g. HDU care infant blocking a ICU cot)* Total cost of nurses & cotsEconomic analysis: The primary economic analysis will focus on costs on neonatal care using differing network configurations. A secondary analysis will consider ways in which this analysis might be developed to look at longer-term economic impact of differing models of care (See attached project plan document for more detail).


Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING;8.2 HEALTH AND WELFARE ECONOMICS
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH