Simulation of the COVID-19 patient flow and investigation of the future patient arrival using a time-series prediction model: a real-case study

Patient flow management in biological events: a scoping review

INTRODUCTION

Biological Events affect large populations depending on transmission potential and propagation. A recent example of a biological event spreading globally is the COVID-19 pandemic, which has had severe effects on the economy, society, and even politics,in addition to its broad occurrence and fatalities. The aim of this scoping review was to look into patient flow management techniques and approaches used globally in biological incidents.

METHODS

The current investigation was conducted based on PRISMA-ScR: Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. All articles released until March 31, 2023, about research question were examined, regardless of the year of publication. The authors searched in databases including Scopus, Web of Science, PubMed, Google scholar search engine, Grey Literature and did hand searching. Papers with lack of the required information and all non-English language publications including those with only English abstracts were excluded. Data extraction checklist has been developed Based on the consensus of authors.the content of the papers based on data extraction, analyzed using content analysis.

RESULTS

A total of 19,231 articles were retrieved in this study and after screening, 36 articles were eventually entered for final analysis. Eighty-four subcategories were identified,To facilitate more precise analysis and understanding, factors were categorised into seven categories: patient flow simulation models, risk communication management, integrated ICT system establishment, collaborative interdisciplinary and intersectoral approach, systematic patient management, promotion of health information technology models, modification of triage strategies, and optimal resource and capacity management.

CONCLUSION

Patient flow management during biological Events plays a crucial role in maintaining the performance of the healthcare system. When public health-threatening biological incidents occur, due to the high number of patients, it is essential to implement a holistic,and integrated approach from rapid identification to treatment and discharge of patients.

Towards reliable forecasting of healthcare capacity needs: A scoping review and evidence mapping

BACKGROUND

The COVID-19 pandemic has highlighted the critical importance of robust healthcare capacity planning and preparedness for emerging crises. However, healthcare systems must also adapt to more gradual temporal changes in disease prevalence and demographic composition over time. To support proactive healthcare planning, statistical capacity forecasting models can provide valuable information to healthcare planners. This systematic literature review and evidence mapping aims to identify and describe studies that have used statistical forecasting models to estimate healthcare capacity needs within hospital settings.

METHOD

Studies were identified in the databases MEDLINE and Embase and screened for relevance before items were defined and extracted within the following categories: forecast methodology, measure of capacity, forecast horizon, healthcare setting, target diagnosis, validation methods, and implementation.

RESULTS

84 studies were selected, all focusing on various capacity outcomes, including number of hospital beds/ patients, staffing, and length of stay. The selected studies employed different analytical models grouped in six items; discrete event simulation (N = 13, 15 %), generalized linear models (N = 21, 25 %), rate multiplication (N = 15, 18 %), compartmental models (N = 14, 17 %), time series analysis (N = 22, 26 %), and machine learning not otherwise categorizable (N = 12, 14 %). The review further provides insights into disease areas with infectious diseases (N = 24, 29 %) and cancer (N = 12, 14 %) being predominant, though several studies forecasted healthcare capacity needs in general (N = 24, 29 %). Only about half of the models were validated using either temporal validation (N = 39, 46 %), cross-validation (N = 2, 2 %) or/and geographical validation (N = 4, 5 %).

CONCLUSION

The forecasting models' applicability can serve as a resource for healthcare stakeholders involved in designing future healthcare capacity estimation. The lack of routine performance validation of the used algorithms is concerning. There is very little information on implementation and follow-up validation of capacity planning models.

Seasonality of influenza-like illness and short-term forecasting model in Chongqing from 2010 to 2022

BACKGROUND

Influenza-like illness (ILI) imposes a significant burden on patients, employers and society. However, there is no analysis and prediction at the hospital level in Chongqing. We aimed to characterize the seasonality of ILI, examine age heterogeneity in visits, and predict ILI peaks and assess whether they affect hospital operations.

METHODS

The multiplicative decomposition model was employed to decompose the trend and seasonality of ILI, and the Seasonal Auto-Regressive Integrated Moving Average with exogenous factors (SARIMAX) model was used for the trend and short-term prediction of ILI. We used Grid Search and Akaike information criterion (AIC) to calibrate and verify the optimal hyperparameters, and verified the residuals of the multiplicative decomposition and SARIMAX model, which are both white noise.

RESULTS

During the 12-year study period, ILI showed a continuous upward trend, peaking in winter (Dec. - Jan.) and a small spike in May-June in the 2-4-year-old high-risk group for severe disease. The mean length of stay (LOS) in ILI peaked around summer (about Aug.), and the LOS in the 0-1 and ≥ 65 years old severely high-risk group was more irregular than the others. We found some anomalies in the predictive analysis of the test set, which were basically consistent with the dynamic zero-COVID policy at the time.

CONCLUSION

The ILI patient visits showed a clear cyclical and seasonal pattern. ILI prevention and control activities can be conducted seasonally on an annual basis, and age heterogeneity should be considered in the health resource planning. Targeted immunization policies are essential to mitigate potential pandemic threats. The SARIMAX model has good short-term forecasting ability and accuracy. It can help explore the epidemiological characteristics of ILI and provide an early warning and decision-making basis for the allocation of medical resources related to ILI visits.

The Inflow, Throughput and Outflow of COVID-19 Patients in Dutch Hospitals: Experiences from Experts and Middle Managers

At the beginning of 2020, the large and unforeseen inflow of COVID-19 patients had a deep impact on the healthcare operations of Dutch hospitals. From a patient flow logistics perspective, each hospital handled the situation largely in its own particular and improvised way. Nevertheless, some hospitals appeared to be more effective in their dealing with this sudden demand for extra care than others. This prompted a study into the factors which hindered and facilitated effective operations during this period. We provide an overview of actions and measures for organizing and managing the inflow, throughput and outflow of COVID-19 patients within Dutch hospitals from various types of departments in a large number of hospitals in The Netherlands, based on interviews with nine experts and twelve hospital managers. Ten actions or measures have been identified, which have been divided into the following three dimensions: Streamlining of the underlying in- and external processes, reducing unnecessary or undesirable inflow of patients and increasing or making more adequate use of the available (human) capacity. The main lessons learned are the importance of integral tuning in the care process, giving up habits and self-interest, good information provision and the middle manager as a linking pin.

Assessing the value of integrating national longitudinal shopping data into respiratory disease forecasting models

The COVID-19 pandemic led to unparalleled pressure on healthcare services. Improved healthcare planning in relation to diseases affecting the respiratory system has consequently become a key concern. We investigated the value of integrating sales of non-prescription medications commonly bought for managing respiratory symptoms, to improve forecasting of weekly registered deaths from respiratory disease at local levels across England, by using over 2 billion transactions logged by a UK high street retailer from March 2016 to March 2020. We report the results from the novel AI (Artificial Intelligence) explainability variable importance tool Model Class Reliance implemented on the PADRUS model (Prediction of Amount of Deaths by Respiratory disease Using Sales). PADRUS is a machine learning model optimised to predict registered deaths from respiratory disease in 314 local authority areas across England through the integration of shopping sales data and focused on purchases of non-prescription medications. We found strong evidence that models incorporating sales data significantly out-perform other models that solely use variables traditionally associated with respiratory disease (e.g. sociodemographics and weather data). Accuracy gains are highest (increases in R2 (coefficient of determination) between 0.09 to 0.11) in periods of maximum risk to the general public. Results demonstrate the potential to utilise sales data to monitor population health with information at a high level of geographic granularity.

A simulation model for predicting hospital occupancy for Covid-19 using archetype analysis

COVID-19 pandemic has sent millions of people to hospitals worldwide, exhausting on many occasions the capacity of healthcare systems to provide care patients required to survive. Although several epidemiological research works have contributed a variety of models and approaches to anticipate the pandemic spread, very few have tried to translate the output of these models into hospital service requirements, particularly in terms of bed occupancy, a key question for hospital managers. This paper proposes a tool for predicting the current and future occupancy associated with COVID-19 patients of a hospital to help managers make informed decisions to maximize the availability of hospitalization and intensive care unit (ICU) beds and ensure adequate access to services for confirmed COVID-19 patients. The proposed tool uses a discrete event simulation approach that uses archetypes (i.e., empirical models of trajectories) extracted from empirical analysis of actual patient trajectories. Archetypes can be fitted to trajectories observed in different regions or to the particularities of current and forthcoming variants using a rather small amount of data. Numerical experiments on realistic instances demonstrate the accuracy of the tool's predictions and illustrate how it can support managers in their daily decisions concerning the system's capacity and ensure patients the access the resources they require.

An enhanced grey wolf optimizer boosted machine learning prediction model for patient-flow prediction

Large and medium-sized general hospitals have adopted artificial intelligence big data systems to optimize the management of medical resources to improve the quality of hospital outpatient services and decrease patient wait times in recent years as a result of the development of medical information technology and the rise of big medical data. However, owing to the impact of several elements, including the physical environment, patient, and physician behaviours, the real optimum treatment effect does not meet expectations. In order to promote orderly patient access, this work provides a patient-flow prediction model that takes into account shifting dynamics and objective rules of patient-flow to handle this issue and forecast patients' medical requirements. First, we propose a high-performance optimization method (SRXGWO) and integrate the Sobol sequence, Cauchy random replacement strategy, and directional mutation mechanism into the grey wolf optimization (GWO) algorithm. The patient-flow prediction model (SRXGWO-SVR) is then proposed using SRXGWO to optimize the parameters of support vector regression (SVR). Twelve high-performance algorithms are examined in the benchmark function experiments' ablation and peer algorithm comparison tests, which are intended to validate SRXGWO's optimization performance. In order to forecast independently in the patient-flow prediction trials, the data set is split into training and test sets. The findings demonstrated that SRXGWO-SVR outperformed the other seven peer models in terms of prediction accuracy and error. As a result, SRXGWO-SVR is anticipated to be a reliable and efficient patient-flow forecast system that may help hospitals manage medical resources as effectively as possible.

A Markovian-based fuzzy decision-making approach for the customer-based sustainable-resilient supplier selection problem

The supplier selection problem is one of the most important issues in supply chain management. So, many papers have investigated the mentioned problem. However, the related literature shows that researchers had less attention to the sustainability and resilience aspects based on the customer preferences in supplier selection problem. To cover this gap, this research tries to investigate the customer-based sustainable-resilient supplier selection problem. In this way, a Markovian-based fuzzy decision-making method is proposed. At the outset, the customer preferences are evaluated using a combination of the quality function deployment and the Markov transition matrix. Then, by combining the transition matrix and the fuzzy best-worst method, the weights of the indicators are calculated. Finally, the decision matrix is formed and the performance of suppliers is measured based on the multiplication of the decision matrix and vector of sub-criteria weights. Regarding the recent pandemic disruption (COVID-19), the importance of online marketplaces is highlighted more than the past. Hence, this study considers an online marketplace as a case study. Results show that in a pandemic situation, the preferences of customers when they cannot go shopping normally will change after a while. Based on the Markov steady state, these changes are from the priority of price, availability, and performance in initial time to serviceability, reliability, and availability in the future. Finally, based on the FBWM results, from the customer point of view, the top five sub-criteria for sustainable-resilient supplier selection include cost, quality, delivery, responsiveness, and service. So, based on these priorities, the case study potential suppliers are prioritized, respectively.

Artificial intelligence and discrete-event simulation for capacity management of intensive care units during the Covid-19 pandemic: A case study

The Covid-19 pandemic has pushed the Intensive Care Units (ICUs) into significant operational disruptions. The rapid evolution of this disease, the bed capacity constraints, the wide variety of patient profiles, and the imbalances within health supply chains still represent a challenge for policymakers. This paper aims to use Artificial Intelligence (AI) and Discrete-Event Simulation (DES) to support ICU bed capacity management during Covid-19. The proposed approach was validated in a Spanish hospital chain where we initially identified the predictors of ICU admission in Covid-19 patients. Second, we applied Random Forest (RF) to predict ICU admission likelihood using patient data collected in the Emergency Department (ED). Finally, we included the RF outcomes in a DES model to assist decision-makers in evaluating new ICU bed configurations responding to the patient transfer expected from downstream services. The results evidenced that the median bed waiting time declined between 32.42 and 48.03 min after intervention.

Exploring the Role of Industry 4.0 and Simulation as a Solution to the COVID-19 Outbreak: a Literature Review

The COVID-19 pandemic was an unexpected and disruptive event that significantly affected the performance of manufacturing systems and supply chains in various sectors. In this paper, a literature review is provided, which investigates the role that Industry 4.0 technologies and simulation tools have played in addressing the effects of the pandemic crisis. Specifically, a bibliometric analysis provides an overview of the most influential technologies through a study of the most used keywords. While a document analysis, conducted on critical papers that concern real case studies, shows that so far simulation provided support in four main areas: energy consumption, healthcare supply chain & contact tracing, food supply chain, and in general supply chain management. The main outcome of this research work is that Industry 4.0 technologies and simulation models were particularly important during the pandemic crisis and their properties deserve to be deeply exploited in the near future.

The Patient Flow Effect of Pandemic Policies: A Hybrid Simulation Study in a Norwegian Emergency Department

The COVID-19 pandemic required several interventions within emergency departments, complicating the patient flow. This study explores the effect of intervention policies on patient flow in emergency departments under pandemic conditions. The patient flow interventions under evaluation here are the addition of extra treatment rooms and the addition of a waiting zone. A predeveloped hybrid simulation model was used to conduct five scenarios: (1) pre-pandemic patient flow, (2) patient flow with a 20% contamination rate, (3) adding extra treatment rooms to patient flow, (4) adding a waiting zone to the patient flow, (5) adding extra treatment rooms and a waiting zone to the patient flow. Experiments were examined based on multiple patient flow metrics incorporated into the model. Running the scenarios showed that introducing the extra treatment rooms improved all the patient flow parameters. Adding the waiting zone further improved only the contaminated patient flow parameters. Still, the benefit of achieving this must be weighed against the disadvantage for ordinary patients. Introducing the waiting zone in addition to the extra treatment room has one positive effect, decreasing time that the treatment rooms are blocked for contaminated patients entering the treatment room.

Performance assessment and improvement of a care unit for COVID-19 patients with resilience engineering and motivational factors: An artificial neural network method

The global conflict with the new coronavirus disease (COVID-19) has led to frequent visits to hospitals and medical centers. This significant increase in visits can be severely detrimental to the body of the healthcare system and society if the physical space and hospital staff are not prepared. Given the significance of this issue, this study investigated the performance of a hospital COVID-19 care unit (COCU) in terms of the resilience and motivation of healthcare providers. This paper used a combination of artificial neural networks and statistical methods, in which resilience engineering (RE) and work motivational factors (WMF) were the input and output data of the network, respectively. To collect the required data, we asked the COCU staff to complete a standard questionnaire, after which the best neural network configuration was determined. According to each indicator, sensitivity analysis and statistical tests were performed to evaluate the center's performance. The results indicated that the COCU had the best and worst performance with respect to self-organization and teamwork indicators, respectively. A data envelopment analysis (DEA) method was also used to validate the algorithm, and the SWOT (strengths, weaknesses, opportunities, threats) matrix was eventually presented to recommend appropriate strategies and improve the performance of the studied COCU.

Decision-making algorithm and predictive model to assess the impact of infectious disease epidemics on the healthcare system: the COVID-19 case study in Italy

Until SARS-CoV-2 vaccination consolidates immunity worldwide, infectious strains will continue to cause infection, causing critical pressures on the healthcare systems and lockdowns. To improve decision-making strategies and prediction based on epidemiological data, so far biased by highly-variable testing criteria, an algorithm using unbiased morbidity parameters, i.e. Intensive Care Units (ICU) and Ordinary Hospitalization (HO), is proposed. ICU/HO acceleration and velocities are mathematically modeled using official available data to yield two thresholds, alerting on 30% ICU and 40% HO of COVID-19 daily occupancy settled by the Italian Minister of Health, as a case of study. A predictive model is also proposed to estimate the daily occupancy of ICU and HO in hospitals for each region, using a Susceptible-Infected-Recovered-Death (SIRD) epidemic model to further extend occupancy prediction in each regional district. Computed data validated the proposed models in Italy after more than one-year of pandemic obtaining agreements with the Italian Presidential Decree, regardless of the different regional trends of epidemic waves. Therefore, the decision-making algorithm and prediction model resulted valuable tools, retrospectively, to be tested prospectively in sustainable strategies to curb the impact of COVID-19, or of any other pandemic threats with any aggregate of data, on the local healthcare systems.