Mount Sinai Hospital, Toronto has used SIMUL8 software to simulate its maternity unit and improve services for expectant mothers.
Dr. Eileen Pepler, The Pepler Group &
Simone Atungo, Director, Community Development & Integration, Mount Sinai Hospital
With a diverse population, Mount Sinai treats a high number of patients experiencing complications related to delivery. To improve patient care, in particular amongst vulnerable communities, SIMUL8 Corporation’s Scenario Generator software was used to simulate the maternity unit with a view to developing prenatal services for uninsured women who have restricted access to services, compared to those who are insured.
Using Scenario Generator, Mount Sinai Hospital was able to model maternity services looking at a number of scenarios surrounding insured vs. uninsured women and the impact of service changes on patient care, bed capacity and cost.
Consequently, many women are not receiving the appropriate level of prenatal care, so essential for the health and well-being of mother and infant. For this group of uninsured women, it is not uncommon for them to first enter the healthcare system via the emergency room towards the end of their term, when health implications tend to be more critical. This not only heightens risk to the mother and child, but also increases the cost of services as this group has a higher rate of C-sections which impacts upon Length of Stay (LOS) in Hospital. In addition there is the increased likelihood of clinical complications in newborns.
Mount Sinai wanted to develop an early intervention strategy that would monitor the pregnancies of this vulnerable community and recognise any problems at an early stage, rather than waiting until the latter stage of pregnancy when problems would be more advanced. The intention was to start a prenatal clinic for uninsured women and the challenge was to come up with the evidence to support the initiative.
Fig. 1: Table showing age-banded population & fertility rates
Fig. 2: Graph showing insured vs. uninsured women
Using the simulation, Mount Sinai Hospital ran a number of scenarios looking at insured vs. uninsured patients to see the impact on bed utilization and costs. By simulating this, they were able to determine the number of beds they would need to plan for in order to ensure availability when patients needed them.
Using population data from the Toronto Central Local Health Integration Network (LHIN), Mount Sinai Hospital used female age-banded population and fertility rates to calculate expected conceptions.
From the birth rate, Mount Sinai Hospital could then calculate the percentage of births expected to attend the hospital within the insured group (41.85%), and those births from the uninsured group (0.35%). This data was then entered into the simulation modeling the pathway of women through the maternity unit. Population projections showed the likely increase of births over the next 5 years – from 6500 to 6855.
Fig. 3: Mount Sinai Hospital patient pathway model
Fig. 4: Patient pathway model (cont.d)
Using accurate data from Toronto Central LHIN, the simulation provided evidence-based results that helped shape decision making by senior staff on the need for the service. By running various scenarios to understand what the implications of changes would be, Mount Sinai could test the benefits of introducing the service on patients’ wellbeing, along with longer-term cost reductions.
Following completion of the project, Mount Sinai Hospital has attracted partners who are interested in working with them to implement the new service. In addition, the hospital has been able to attract a private donor interested to support Mount Sinai by providing funds and resources to start up a pre-natal clinic for uninsured, pregnant women.
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