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Hospitals are complex systems and optimising their function is critical tothe provision of high quality, cost effective healthcare. Nevertheless, metricsof performance have to date focused on the performance of individual elementsrather than the system as a whole. Manipulation of individual elements of acomplex system without an integrative understanding of its function isundesirable and may lead to counter-intuitive outcomes and a holistic metric ofhospital function might help design more efficient services. We aimed tocharacterise the system of peri-operative care for emergency surgicaladmissions in our tertiary care hospital using network analysis. We usedretrospective electronic health record data to construct a weighted directionalnetwork of the system. For this we selected all unplanned admissions during a3.5 year period involving a surgical intervention during the inpatient stay andobtained a set of 16,500 individual inpatient episodes. We then constructed andanalysed the structure of this network using established methods from networkscience such as degree distribution, betweenness centrality and small-worldcharacteristics. The analysis showed the service to be a complex system withscale-free, small-world network properties. This finding has implications forthe structure and resilience of the service as such networks, whilst beingrobust in general, may be vulnerable to outages at specific key nodes. We alsoidentified such potential hubs and bottlenecks in the system based on a varietyof network measures. It is hoped that such a holistic, system-wide descriptionof a hospital service may provide better metrics for hospital strain and serveto help planners engineer systems that are as robust as possible to externalshocks.

Characterising complex healthcare systems using network science: The small world of emergency surgery