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Emergency departments at hospitals across the UK experience a seasonal rise in emergency attendances every winter, but in autumn 2020 there was additional pressure to face. The country was approaching the second wave of COVID-19 and two-metre+ social distancing guidelines were in place to save lives and protect the NHS.
Trusts often face capacity challenges, but adhering to social distancing posed new risks. Would they have the capacity to safely manage the seasonal increase in patients whilst maintaining necessary social distancing? The health of patients, and the safety of staff and the public, rested on the answer.
Arup approached Whittington Health NHS Trust with a proposal - to model different capacity scenarios as the Trust planned for winter to build a more robust understanding of capacity and avoid overcrowding. Carried out in collaboration with the Trust, our people-modelling study simulated emergency department patient attendances to identify opportunities that would mitigate risks and improve their resilience in managing higher patient numbers.
Project Summary
89,000 unique patient data analysed
250%of waiting capacity we calculated would be reached during peak times
Generating insights from historical data
There is no simple method that tells hospitals or building owners how much capacity they need. With many healthcare buildings stretched beyond their limit, particularly during the pandemic, we set out to;
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Understand how busy Whittington’s waiting rooms might be in winter 2020
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Establish how social distancing impacted capacity
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Review potential interventions and advise on options to create additional waiting space.
Working closely with the hospital, we analysed historical patient attendance data for the emergency department for the whole of 2019. We took this data and used it to;
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Create a visualisation of patient demand using Power BI
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Input into a MassMotion simulation model to show individual patient journeys.
Using the insights drawn from the Power BI dashboard, we identified the busiest day and busiest month to make clear comparisons across a full year. With an understanding of peak demand, we could move on to the pressing question, could social distancing be maintained within the emergency department on a busy day?
Visualising socially distanced journeys using MassMotion
Taking Whittington’s granular, anonymised patient data from attendance records, we used a 2D AutoCAD plan as a basis to develop an accurate 3D digital model. This digital model was then inputted into our pedestrian modelling software, MassMotion, to predict and visualise the movements of patients throughout the emergency department.
Developed in-house by Arup based on pioneering research into the science of people movement, MassMotion allowed us to model different patient journeys, incorporating variables such as triage categories, a distinction between adult and paediatric patients and those who arrived with a companion, to improve resilience in the clinical environment.
Developed in-house by Arup based on pioneering research into the science of people movement, MassMotion allowed us to model different patient journeys, incorporating variables such as triage categories, a distinction between adult and paediatric patients and those who arrived with a companion, to improve resilience in the clinical environment.
The model provided insights that traditional data analysis could not achieve. We determined that if no action was taken, the temporary socially distanced capacity of the waiting area would exceed 250% of its capacity - with more than twice the current amount of space needed for the adult waiting area.
Improving the occupant experience
Drawing on the evidence from our analysis and modelling, we presented the Trust with a range of options, from operational changes to spatial interventions, that would help safely manage the demand of patient attendances under socially distanced conditions.
We modelled these potential improvements to allow the hospital team to assess how the overall experience for patients and staff could be improved throughout the year within the stringent requirements enforced in response to COVID-19.
Our work did more than establish that the Trust’s concerns were valid, it supported informed decision making about how to tackle the problem. The modelling and analysis supported the hospital to build an evidence-rich business case to successfully apply for additional central government funding to expand or redesign their waiting space.
“Arup’s work added value to our business case which successfully received funding… and their approach could be beneficially applied to other hospital departments and patient journeys when reviewing and managing healthcare capacity-related challenges during the Covid pandemic, and beyond. ” Jonathan Gardner Director of Strategy and Corporate Affairs, at Whittington Health NHS Trust.
Future application
Our approach, combining the power of data analysis with MassMotion modelling and our healthcare expertise, is easily replicable. And there is a huge opportunity for hospitals to interrogate and make better use of their rich data.
When refurbishing existing departments or estates, visualising existing data in this way helps enable more informed design and operational decisions. For new-build hospitals, such as the 40 planned for delivery by 2030, it would deliver efficiencies in patient journeys, capacity planning, and clinical adjacencies, transforming the experience of patients and staff.
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