Taxonomic classification of planning decisions in health care: a review of the state of the art in OR/MS

We provide a structured overview of the typical decisions to be made in resource capacity planning and control in health care, and a review of relevant OR/MS articles for each planning decision. The contribution of this paper is twofold. First, to position the planning decisions, a taxonomy is presented. This taxonomy provides health care managers and OR/MS researchers with a method to identify, break down and classify planning and control decisions. Second, following the taxonomy, for six health care services, we provide an exhaustive specification of planning and control decisions in resource capacity planning and control. For each planning and control decision, we structurally review the key OR/MS articles and the OR/MS methods and techniques that are applied in the literature to support decision making

Artificial Intelligence for Emergency Response

Emergency response management (ERM) is a challenge faced by communities across the globe. First responders must respond to various incidents, such as fires, traffic accidents, and medical emergencies. They must respond quickly to incidents to minimize the risk to human life. Consequently, considerable attention has been devoted to studying emergency incidents and response in the last several decades. In particular, data-driven models help reduce human and financial loss and improve design codes, traffic regulations, and safety measures. This tutorial paper explores four sub-problems within emergency response: incident prediction, incident detection, resource allocation, and resource dispatch. We aim to present mathematical formulations for these problems and broad frameworks for each problem. We also share open-source (synthetic) data from a large metropolitan area in the USA for future work on data-driven emergency response.Comment: This is a pre-print for a book chapter to appear in Vorobeychik, Yevgeniy., and Mukhopadhyay, Ayan., (Eds.). (2023). \textit{Artificial Intelligence and Society}. ACM Pres

Online Optimisation of Casualty Processing in Major Incident Response

Recent emergency response operations to Mass Casualty Incidents (MCIs) have been criticised for a lack of coordination, implying that there is clear potential for response operations to be improved and for corresponding benefits in terms of the health and well-being of those affected by such incidents. In this thesis, the use of mathematical modelling, and in particular optimisation, is considered as a means with which to help improve the coordination of MCI response. Upon reviewing the nature of decision making in MCIs and other disaster response operations in practice, this work demonstrates through an in-depth review of the available academic literature that an important problem has yet to be modelled and solved using an optimisation methodology. This thesis involves the development of such a model, identifying an appropriate task scheduling formulation of the decision problem and a number of objective functions corresponding to the goals of the MCI response decision makers. Efficient solution methodologies are developed to allow for solutions to the model, and therefore to the MCI response operation, to be found in a timely manner. Following on from the development of the optimisation model, the dynamic and uncertain nature of the MCI response environment is considered in detail. Highlighting the lack of relevant research considering this important aspect of the problem, the optimisation model is extended to allow for its use in real-time. In order to allow for the utility of the model to be thoroughly examined, a complementary simulation is developed and an interface allowing for its communication with the optimisation model specified. Extensive computational experiments are reported, demonstrating both the danger of developing and applying optimisation models under a set of unrealistic assumptions, and the potential for the model developed in this work to deliver improvements in MCI response operations

Methodological approaches to support process improvement in emergency departments: a systematic review

The most commonly used techniques for addressing each Emergency Department (ED) problem (overcrowding, prolonged waiting time, extended length of stay, excessive patient flow time, and high left-without-being-seen (LWBS) rates) were specified to provide healthcare managers and researchers with a useful framework for effectively solving these operational deficiencies. Finally, we identified the existing research tendencies and highlighted opportunities for future work. We implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology to undertake a review including scholarly articles published between April 1993 and October 2019. The selected papers were categorized considering the leading ED problems and publication year. Two hundred and three (203) papers distributed in 120 journals were found to meet the inclusion criteria. Furthermore, computer simulation and lean manufacturing were concluded to be the most prominent approaches for addressing the leading operational problems in EDs. In future interventions, ED administrators and researchers are widely advised to combine Operations Research (OR) methods, quality-based techniques, and data-driven approaches for upgrading the performance of EDs. On a different tack, more interventions are required for tackling overcrowding and high left-without-being-seen rate

A Patient Risk Minimization Model for Post-Disaster Medical Delivery Using Unmanned Aircraft Systems

The purpose of this research was to develop a novel routing model for delivery of medical supplies using unmanned aircraft systems, improving existing vehicle routing models by using patient risk as the primary minimization variable. The vehicle routing problem is a subset of operational research that utilizes mathematical models to identify the most efficient route between sets of points. Routing studies using unmanned aircraft systems frequently minimize time, distance, or cost as the primary objective and are powerful decision-making tools for routine delivery operations. However, the fields of emergency triage and disaster response are focused on identifying patient injury severity and providing the necessary care. This study addresses the misalignment of priorities between existing routing models and the emergency response industry by developing an optimization model with injury severity to measure patient risk. Model inputs for this study include vehicle performance variables, environmental variables, and patient injury variables. These inputs are used to construct a multi-objective mixed-integer nonlinear programming (MOMINLP) optimization model with the primary objective of minimizing total risk for a set of patients. The model includes a secondary aim of route time minimization to ensure optimal fleet deployment but is constrained by the risk minimization value identified in the first objective. This multi-objective design ensures risk minimization will not be sacrificed for route efficiency while still ensuring routes are completed as expeditiously as possible. The theoretical foundation for quantifying patient risk is based on mass casualty triage decision-making systems, specifically the emergency severity index, which focuses on sorting patients into categories based on the type of injury and risk of deterioration if additional assistance is not provided. Each level of the Emergency Severity Index is assigned a numerical value, allowing the model to search for a route that prioritizes injury criticality, subject to the appropriate vehicle and environmental constraints. An initial solution was obtained using stochastic patient data and historical environmental data validated by a Monte Carlo simulation, followed by a sensitivity analysis to evaluate the generalizability and reliability of the model. Multiple what-if scenarios were built to conduct the sensitivity analysis. Each scenario contained a different set of variables to demonstrate model generalizability for various vehicle limitations, environmental conditions, and different scales of disaster response. The primary contribution of this study is a flexible and generalizable optimization model that disaster planning organizations can use to simulate potential response capabilities with unmanned aircraft. The model also improves upon existing optimization tools by including environmental variables and patient risk inputs, ensuring the optimal solution is useful as a real-time disaster response tool

Redesigning the Barranquilla's public emergency care network to improve the patient waiting time

Tesis por compendio[ES] La oportunidad en la atención es uno de los críticos de mayor relevancia en la satisfacción de los pacientes que acuden a los servicios de Urgencias. Por tal motivo, las instituciones prestadoras de servicio y las organizaciones gubernamentales deben propender conjuntamente por una atención cada vez más oportuna a costos operacionales razonables. En el caso de la Red Pública en Servicios de Urgencias de Barrannquilla, compuesta por 8 puntos de atención y 2 hospitales, la tendencia marca un continuo crecimiento de la oportunidad en la atención con una tasa de 3,08 minutos/semestre y una probabilidad del 93,13% de atender a los pacientes después de una espera mayor a 30 minutos. Lo anterior se constituye en un síntoma inequívoco de la incapacidad de la Red para satisfacer los estándares de oportunidad establecidos por el Ministerio de Salud, hecho que podría desencadenar el desarrollo de sintomatologías de mayor complejidad, el incremento de la probabilidad de mortalidad, el requerimiento de servicios clínicos más complejos (hospitalización y cuidados intensivos) y el aumento de los costos asociados al servicio. En consecuencia, la presente tesis doctoral presenta el rediseño de la Red Pública en Servicios de Urgencias anteriormente mencionada a fin de otorgar a la población diana un servicio eficiente y altamente oportuno donde tanto las instituciones prestadoras del servicio como los organismos gubernamentales converjan efectivamente. Para ello, fue necesaria la ejecución de 4 grandes fases a través de las cuales se consolidó una propuesta orientada al desarrollo efectivo y sostenible de las operaciones de la Red. Primero, se caracterizó la Red Pública de Servicios de Urgencias en Salud considerando su comportamiento actual en términos de demanda y oportunidad de la atención. Luego, a través de una revisión sistemática de la literatura, se identificaron los enfoques metodológicos que se han implementado para la mejora de la oportunidad y otros indicadores de rendimiento asociados al servicio de Urgencias. Posteriormente, se diseñó una metodología para la creación de redes de Urgencias eficientes y sostenibles la cual luego se validó en la Red Pública sudamericana a fin de disminuir la oportunidad de atención promedio en Urgencias y garantizar la distribución equitativa de los beneficios financieros derivados de la colaboración. Finalmente, se construyó un modelo multicriterio que permitió evaluar el rendimiento de los departamentos de Urgencia e impulsó la creación de estrategias de mejora focalizadas en incrementar su respuesta ante la demanda cambiante, los críticos de satisfacción y las condiciones de operación estipuladas en la ley. Los resultados de esta aplicación evidenciaron que los pacientes que acceden a la Red tienden a esperar en promedio 201,6 min con desviación de estándar de 81,6 min antes de ser atendidos por urgencia. Por otro lado, de acuerdo con la revisión de literatura, la combinación de técnicas de investigación de operaciones, ingeniería de la calidad y analítica de datos es ampliamente recomendada para abordar este problema. En ese sentido, una metodología basada en modelos colaterales de pago, simulación de procesos y lean seis sigma fue propuesta y validada generando un rediseño de Red cuya oportunidad de atención promedio podría disminuir entre 6,71 min y 9,08 min con beneficios financieros promedio de US$29,980/nodo. En último lugar, un modelo compuesto por 8 criterios y 35 sub-criterios fue diseñado para evaluar el rendimiento general de los departamentos de Urgencias. Los resultados del modelo evidenciaron el rol crítico de la infraestructura (Peso global = 21,5i garantir la distribució equitativa dels beneficis financers derivats de la col´laboració. Finalment, es va construir un model multicriteri que va permetre avaluar el rendiment dels departaments d'Urgència i va impulsar la creació d'estratègies de millora focalitzades en incrementar la seva resposta davant la demanda canviant, els crítics de satisfacció i les condicions d'operació estipulades en la llei. Els resultats d'aquesta aplicació van evidenciar que els pacients que accedeixen a la Xarxa tendeixen a esperar de mitjana 201,6 min amb desviació d'estàndard de 81,6 min abans de ser atesos per urgència. D'altra banda, d'acord amb la revisió de literatura, la combinació de tècniques d'investigació d'operacions, enginyeria de la qualitat i analítica de dades és àmpliament recomanada per abordar aquest problema. En aquest sentit, una metodologia basada en models col´laterals de pagament, simulació de processos i llegeixin 6 sigma va ser proposada i validada generant un redisseny de Xarxa la oportunitat d'atenció mitjana podria disminuir entre 6,71 min i 9,08 min amb beneficis financers mitjana d'US$ 29,980 / node. En darrer lloc, un model compost per 8 criteris i 35 sub-criteris va ser dissenyat per avaluar el rendiment general dels departaments d'Urgències. Els resultats de el model evidenciar el paper crític de la infraestructura (Pes global = 21,5%) en el rendiment dels departaments d'Urgència i la naturalesa interactiva de la Seguretat de l'Pacient (C + R = 12,771).[EN] Waiting time is one of the most critical measures in the satisfaction of patients admitted within emergency departments. Therefore, hospitals and governmental organizations should jointly aim to provide timely attention at reasonable costs. In the case of Barranquilla's Pubic Emergency Service Network, composed by 8 Points of care (POCs) and 2 hospitals, the trend evidences a continuous growing of the waiting time with a rate of 3,08 min/semester and a 93,13% likelihood of serving patients after waiting for more than 30 minutes. This is an unmistakable symptom of the network inability for satisfying the standards established by the Ministry of Health, which may trigger the development of more complex symptoms, increase in the death rate, requirement for more complex clinical services (hospitalization and intensive care unit) and increased service costs. This doctoral dissertation then illustrates the redesign of the aforementioned Public Emergency Service Network aiming at providing the target population with an efficient and highly timely service where both hospitals and governmental institutions effectively converge. It was then necessary to implement a 4-phase methodology consolidating a proposal oriented to the effective and sustainable development of network operations. First, the Public Emergency Service Network was characterized considering its current behavior in terms of demand and waiting time. A systematic literature review was then undertaken for identifying the methodological approaches that have been implementing for improving the waiting time and other performance indicators associated with the emergency care service. Following this, a methodology for the creation of efficient and sustainable emergency care networks was designed and later validated in the Southamerican Public network for lessening the average waiting time and ensuring the equitable distribution of profits derived from the collaboration. Ultimately, a multicriteria decision-making model was created for assessing the performance of the emergency departments and propelling the design of improvement strategies focused on bettering the response against the changing demand conditions, critical to satisfaction and operational conditions. The results evidenced that the patients accessing to the network tend to wait 201,6 min on average with a standard deviation of 81,6 min before being served by the emergency care unit. On the other hand, based on the reported literature, it is highly suggested to combine Operations Research (OR) methods, quality-based techniques, and data-driven approaches for addressing this problem. In this sense, a methodology based on collateral payment models, Discrete-event simulation, and Lean Six Sigma was proposed and validated resulting in a redesigned network whose average waiting time may diminish between 6,71 min and 9,08 min with an average profit US$29,980/node. Lately, a model comprising of 8 criteria and 35 sub-criteria was designed for evaluating the overall performance of emergency departments. The model outcomes revealed the critical role of Infrastructure (Global weight = 21,5%) in ED performance and the interactive nature of Patient Safety (C + R = 12,771).Ortíz Barrios, MÁ. (2020). Redesigning the Barranquilla's public emergency care network to improve the patient waiting time [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/156215TESISCompendi

Strategic Location and Dispatch Management of Assets in a Military Medical Evacuation Enterprise

This dissertation considers the importance of optimizing deployed military medical evacuation (MEDEVAC) systems and utilizes operations research techniques to develop models that allow military medical planners to analyze different strategies regarding the management of MEDEVAC assets in a deployed environment. For optimization models relating to selected subproblems of the MEDEVAC enterprise, the work herein leverages integer programming, multi-objective optimization, Markov decision processes, approximate dynamic programming, and machine learning, as appropriate, to identify relevant insights for aerial MEDEVAC operations