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


  • Richard M. Wood

    (UK National Health Service (BNSSG ICB), NHS Bristol, North Somerset and South Gloucestershire Integrated Care Board
    University of Bath
    South West Better Care Partnership)

  • Alison L. Harper

    (University of Exeter
    South West Better Care Partnership)

  • Zehra Onen-Dumlu

    (University of Bath
    South West Better Care Partnership)

  • Paul G. Forte

    (UK National Health Service (BNSSG ICB), NHS Bristol, North Somerset and South Gloucestershire Integrated Care Board
    South West Better Care Partnership)

  • Martin Pitt

    (University of Exeter
    South West Better Care Partnership)

  • Christos Vasilakis

    (University of Bath
    South West Better Care Partnership)


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.

Suggested Citation

  • Richard M. Wood & Alison L. Harper & Zehra Onen-Dumlu & Paul G. Forte & Martin Pitt & Christos Vasilakis, 2023. "The False Economy of Seeking to Eliminate Delayed Transfers of Care: Some Lessons from Queueing Theory," Applied Health Economics and Health Policy, Springer, vol. 21(2), pages 243-251, March.
  • Handle: RePEc:spr:aphecp:v:21:y:2023:i:2:d:10.1007_s40258-022-00777-2
    DOI: 10.1007/s40258-022-00777-2

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    References listed on IDEAS

    1. Linda Green, 2006. "Queueing Analysis in Healthcare," International Series in Operations Research & Management Science, in: Randolph W. Hall (ed.), Patient Flow: Reducing Delay in Healthcare Delivery, chapter 0, pages 281-307, Springer.
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