Ambulatory care and orthopaedic capacity planning.

Ambulatory Care facilities (often referred to as diagnosis and treatment centres) separate the routine elective activity from the uncertainty of complex inpatient and emergency treatment. Only routine patients with predictable outcomes should be treated in Ambulatory Care. Hence the centre should be able to plan its activities effectively. This paper considers the consequences for the remaining elective inpatient bed and theatre requirements. Computer models are used to simulate many years of activity in an orthopaedic department at a typical District General hospital. The adoption of Ambulatory Care will increase the proportion of day case treatment but the reduction in the overall bed requirement will be relatively small (at most 10%). Separating the elective theatre activity into day case and inpatient sessions will tend to produce inpatient theatre sessions with a disproportionate number of longer procedures. This can reduce overall theatre utilisation by up to 15%, which implies the need for an increase of up to 18% in the number of theatre sessions if waiting times are to be maintained.