Cost comparison of orthopaedic fracture pathways using discrete event simulation in a Glasgow hospital

BMJ Open. 2017 Sep 7;7(9):e014509. doi: 10.1136/bmjopen-2016-014509.


Objective: Healthcare faces the continual challenge of improving outcome while aiming to reduce cost. The aim of this study was to determine the micro cost differences of the Glasgow non-operative trauma virtual pathway in comparison to a traditional pathway.

Design: Discrete event simulation was used to model and analyse cost and resource utilisation with an activity-based costing approach. Data for a full comparison before the process change was unavailable so we used a modelling approach, comparing a virtual fracture clinic (VFC) with a simulated traditional fracture clinic (TFC).

Setting: The orthopaedic unit VFC pathway pioneered at Glasgow Royal Infirmary has attracted significant attention and interest and is the focus of this cost study.

Outcome measures: Our study focused exclusively on patients with non-operative trauma attending emergency department or the minor injuries unit and the subsequent step in the patient pathway. Retrospective studies of patient outcomes as a result of the protocol introductions for specific injuries are presented in association with activity costs from the models.

Results: Patients are satisfied with the new pathway, the information provided and the outcome of their injuries (Evidence Level IV). There was a 65% reduction in the number of first outpatient face-to-face (f2f) attendances in orthopaedics. In the VFC pathway, the resources required per day were significantly lower for all staff groups (p≤0.001). The overall cost per patient of the VFC pathway was £22.84 (95% CI 21.74 to 23.92) per patient compared with £36.81 (95% CI 35.65 to 37.97) for the TFC pathway.

Conclusions: Our results give a clearer picture of the cost comparison of the virtual pathway over a wholly traditional f2f clinic system. The use of simulation-based stochastic costings in healthcare economic analysis has been limited to date, but this study provides evidence for adoption of this method as a basis for its application in other healthcare settings.

Keywords: costs; fracture clinic; orthopaedics; outpatients; patient outcomes.

Publication types

  • Comparative Study

MeSH terms

  • Computer Simulation
  • Costs and Cost Analysis*
  • Critical Pathways*
  • Emergency Service, Hospital / standards
  • Fractures, Bone / economics*
  • Fractures, Bone / therapy*
  • Hospitals
  • Humans
  • Retrospective Studies
  • Standard of Care
  • United Kingdom