Exploratory analysis using discrete event simulation modelling of the wait times and service costs associated with the maximum wait time guarantee policy applied in a rheumatology central intake clinic

Adherence to wait time benchmark targets for the diagnosis and initiation of interventions for rheumatoid arthritis is crucial in altering the disease trajectory. We analysed the impact of the maximum wait time guarantee (MWTG) policy for routing referrals for the initial rheumatologist consults on the waiting and service costs. We modelled a central intake system for a rheumatology clinic as a discrete event simulation (DES) model. Using data from a central intake and rheumatology clinic as input to the model of the system, we simulated the arrival of referrals and rheumatologist visits of patients. We demonstrated the impact of the referral policy on system performance and compared the system costs in an MWTG policy and first-available-appointment policy scenarios. MWTG policy is an option for a wait time management strategy but comes with essential cost considerations. Healthcare managers and policymakers should consider the DES approach to support referral decision policy choices.