Design and implementation of a simulation tool to study wait times in cataract surgery

Eye cataracts are a common problem for senior people. Long wait times for cataract surgery degrade the patients' quality of life. Reduction in long wait times in eye cataract surgery has got importance as one of the five major priority areas in the health care systems in Canada. The main contribution of this thesis is to design and develop a discrete event simulation tool in JAVA to study the wait times (wait time 1 and wait time 2) for patients in cataract surgical procedure. Two cataract surgical procedures are simulated in the simulation tool Northern Health Cataract Surgical Model (NHCS Model) and Cataract Surgery Generic Model (CSG Model). Two alternative patient referral methods (refer patients to the surgeon with the least number of patients and uniform distribution of patients) are proposed and compared to the existing method to examine which method results in reduced wait times. The impacts of changing the resources (surgeon and OR) on wait times were analysed. The Manitoba Cataract Waiting List Program (MCWLP) priority system is simulated and compared to the existing FCFS policy to see whether the scheduling of patients for surgery based on priority improves wait times. Experimental results show that the two proposed methods significantly reduce wait times. It is found that Northern Health would meet the target wait time 2 (16 weeks) if one more OR (total of two ORs) is allocated for cataract surgery. The use of priority scheduling did not show any improvement in wait time 2. Increasing budget or number of resources is not always easy for any health care authority. This thesis suggests that, if Northern Health authority changes the existing patient referral method, it would definitely reduce wait times for patients.