The False Economy of Seeking to Eliminate Delayed Transfers of Care: Some Lessons from Queueing Theory

Background:
It is a stated ambition of many healthcare systems to eliminate delayed transfers of care (DTOCs) between acute and step-down community services.

Objective:
This study aims to demonstrate how, counter to intuition, pursual of such a policy is likely to be uneconomical, as it would require large amounts of community capacity to accommodate even the rarest of demand peaks, leaving much capacity unused for much of the time.

Methods:
Some standard results from queueing theory—a mathematical discipline for considering the dynamics of queues and queueing systems—are used to provide a model of patient flow from the acute to community setting. While queueing models have a track record of application in healthcare, they have not before been used to address this question.

Results:
Results show that ‘eliminating’ DTOCs is a false economy: the additional community costs required are greater than the possible acute cost saving. While a substantial proportion of DTOCs can be attributed to inefficient use of resources, the remainder can be considered economically essential to ensuring cost-efficient service operation. For England’s National Health Service (NHS), our modelling estimates annual cost savings of £117m if DTOCs are reduced to the 12% of current levels that can be regarded as economically essential.

Conclusion:
This study discourages the use of ‘zero DTOC’ targets and instead supports an assessment based on the specific characteristics of the healthcare system considered.