A Reusable Discrete Event Simulation Model for Improving Orthopedic Waiting Lists


Public hospital orthopedic services are difficult to provide in a timely manner due to high demand and constraints on hospital resources. Consequently, patients can remain on waiting lists for extended periods of time. This problem has been exacerbated by frequent cancellations of elective surgeries due to the reprioritization of services during the COVID-19 pandemic. Delays in receiving treatment can be associated with adverse outcomes for patients, for example, prolonged pain, lower mobility, and weight fluctuation due to an inability to exercise.

In this study, researchers investigated the process of orthopedic treatment in an Australian health service, from the point of referral to surgical intervention. In a number of cases, surgical intervention could be avoided through participation in community-based rehabilitation programs.

Simulation model

The model was built using AnyLogic software. This was chosen so that the model could be accessed and reused by anyone via the freely available personal learning edition and because the visual interface would facilitate communication of the model findings with stakeholders in the healthcare system. The model logic was developed through iterative consultations with healthcare staff and stakeholders. The combination of expert opinion and hospital data was used to develop the model logic and to populate the model parameters.


In this study, a new discrete-event simulation was developed to model an orthopedic treatment pathway in Australia. The modeling demonstrated how various strategies could be used to reduce the initial waiting list and highlighted that further interventions would need to be made downstream in the system. It further showed that the introduction of community-based rehabilitation could reduce pressure on the system while improving outcomes for patients. The results from scenario experimentation were used to advise the health service on the expected improvement in queue length and waiting times through various interventions, and this modeling was used to support a business case for increased resources.

Conceptual model of musculoskeletal (orthopedic) services from Comans et al
Conceptual model of musculoskeletal (orthopedic) services from Comans et al. (2017)

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