Operating theatre modelling: integrating social measures

Hospital resource modelling literature is primarily focussed on productivity and efficiency measures. In this paper, our focus is on the alignment of the most valuable revenue factor, the operating room (OR) with the most valuable cost factor, the staff. When aligning these economic and social decisions, respectively, into one sustainable model, simulation results justify the integration of these factors. This research shows that integrating staff decisions and OR decisions results in better solutions for both entities. A discrete event simulation approach is used as a performance test to evaluate an integrated and an iterative model. Experimental analysis show how our integrated approach can benefit the alignment of the planning of the human resources as well as the planning of the capacity of the OR based on both economic related metrics (lead time, overtime, number of patients rejected) and social related metrics (personnel preferences, aversions, roster quality)

Modelling the critical care pathway for cardiothoracic surgery

The west of Scotland heart and lung center based at the Golden Jubilee National Hospital houses all adult cardiothoracic surgery for the region. Increased demand for scheduled patients and fluctuations in emergency referrals resulted in increasing waiting times and patient cancellations. The main issue was limited resources, which was aggravated by the stochastic nature of the length of stay (LOS) and arrival of patients. Discrete event simulation (DES) was used to assess if an enhanced schedule was sufficient, or more radical changes, such as capacity or other resource reallocations should be considered in order to solve the problem. Patients were divided into six types depending on their condition and LOS at the different stages of the process. The simulation model portrayed each patient type’s pathway with sufficient detail. Patient LOS figures were analyzed and distributions were formed from historical data, which were then used in the simulation. The model proved successful as it showed figures that were close to actual observations. Acquiring results and knowing exactly when and what caused a cancellation was another strong point of the model. The results demonstrated that the bottleneck in the system was related to the use of High Dependency Unit (HDU) beds, which were the recovery beds used by most patients. Enhancing the schedule by leveling out the daily arrival of patients to HDUs reduced patient cancellations by 20%. However, coupling this technique with minor capacity reallocations resulted in more than 60% drop in cancellations

A Bayesian approach to the modelling of alpha Cen A

Determining the physical characteristics of a star is an inverse problem consisting in estimating the parameters of models for the stellar structure and evolution, knowing certain observable quantities. We use a Bayesian approach to solve this problem for alpha Cen A, which allows us to incorporate prior information on the parameters to be estimated, in order to better constrain the problem. Our strategy is based on the use of a Markov Chain Monte Carlo (MCMC) algorithm to estimate the posterior probability densities of the stellar parameters: mass, age, initial chemical composition,... We use the stellar evolutionary code ASTEC to model the star. To constrain this model both seismic and non-seismic observations were considered. Several different strategies were tested to fit these values, either using two or five free parameters in ASTEC. We are thus able to show evidence that MCMC methods become efficient with respect to more classical grid-based strategies when the number of parameters increases. The results of our MCMC algorithm allow us to derive estimates for the stellar parameters and robust uncertainties thanks to the statistical analysis of the posterior probability densities. We are also able to compute odds for the presence of a convective core in alpha Cen A. When using core-sensitive seismic observational constraints, these can raise above ~40%. The comparison of results to previous studies also indicates that these seismic constraints are of critical importance for our knowledge of the structure of this star.Comment: 21 pages, 6 figures, to be published in MNRA

Balancing operating theatre and bed capacity in a cardiothoracic centre

Cardiothoracic surgery requires many expensive resources. This paper examines the balance between operating theatres and beds in a specialist facility providing elective heart and lung surgery. Without both operating theatre time and an Intensive Care bed a patient's surgery has to be postponed. While admissions can be managed, there are significant stochastic features, notably the cancellation of theatre procedures and patients' length of stay on the Intensive Care Unit. A simulation was developed, with clinical and management staff, to explore the interdependencies of resource availabilities and the daily demand. The model was used to examine options for expanding the capacity of the whole facility. Ideally the bed and theatre capacity should be well balanced but unmatched increases in either resource can still be beneficial. The study provides an example of a capacity planning problem in which there is uncertainty in the demand for two symbiotic resources

Posterior Uncertainty Estimation via a Monte Carlo Procedure Specialized for Data Assimilation

Through the Bayesian lens of data assimilation, uncertainty on model parameters is traditionally quantified through the posterior covariance matrix. However, in modern settings involving high-dimensional and computationally expensive forward models, posterior covariance knowledge must be relaxed to deterministic or stochastic approximations. In the carbon flux inversion literature, Chevallier et al. proposed a stochastic method capable of approximating posterior variances of linear functionals of the model parameters that is particularly well-suited for large-scale Earth-system data assimilation tasks. This note formalizes this algorithm and clarifies its properties. We provide a formal statement of the algorithm, demonstrate why it converges to the desired posterior variance quantity of interest, and provide additional uncertainty quantification allowing incorporation of the Monte Carlo sampling uncertainty into the method's Bayesian credible intervals. The methodology is demonstrated using toy simulations and a realistic carbon flux inversion observing system simulation experiment