Contribution à la conception d'un système d'aide à la décision pour la gestion de situations de tension au sein des systèmes hospitaliers. Application à un service d'urgence.

The management of patient flow, especially the flow resulting from health (flu, heat waves and exceptional circumstances) is one of the most important problems to manage in the emergency department (ED). To handle the influx of patients, emergency departments require significant human and material resources, and a high degree of coordination between these resources. Under these conditions, the medical and the paramedical staffs are often confronted with strain situations which greatly complicate their task. The main purpose of this thesis is to contribute to improving the management of situations of tension occurring in the emergency department by providing a decision support system, SAGEST. This DSS allows i) a proactive control of the ED: predicting at short and/or medium-term the occurrence of potential strain situations and proposing corrective actions to prevent the occurrence of these situations, ii) a reactive control in the case of no-detection of the strain situation occurrence. A functional architecture of the SAGEST system, based on the manager’s decision making process is proposed. Used methodologies and models embedded in the main functions and the knowledge base of the SAGEST system are described. Finally, experiments and results of different models of SAGEST system applied to the paediatric emergency department (PED) of the Regional University Hospital of Lille are presented and discussed.La prise en charge des flux des patients, en particulier les flux récurrents et consécutifs à des crises sanitaires (grippes, canicules, situations exceptionnelles) est l'un des problèmes les plus importants auquel les services des urgences (SU) doivent faire face. Pour gérer cet afflux de patients, les services des urgences nécessitent des ressources humaines et matérielles importantes, ainsi qu'un degré élevé de coordination entre ces ressources. Dans ces conditions, le personnel médical se voit confronté très fréquemment à des situations de tension qui compliquent très fortement sa tâche. L‘objet de cette thèse est de contribuer à l’amélioration de la gestion des situations de tension se produisant dans un service d’urgence en proposant un système d’aide à la décision, SAGEST (Système d’Aide à la décision pour la GEstion des Situations de Tensions), permettant i) le pilotage proactif du SU : prévision à court et/ou moyen terme de l'apparition de situations de tension et l'évolution du flux patients et la proposition d'actions de correction afin d'éviter l’occurrence de ces situations et ii) le pilotage réactif dans le cas où l'occurrence de la situation de tension n'a pas été détectée. Une architecture fonctionnelle du système SAGEST, s'appuyant sur le processus décisionnel du responsable du service d'urgence, est proposée. Les méthodologies et les modèles utilisés dans la construction des principales fonctions et de la base de connaissances sont décrits. Enfin, les résultats d’application des différents modèles du système SAGEST pour le service d’urgence pédiatrique (SUP) du centre hospitalier régional universitaire du Lille sont présentés et discutés

Fault detection and isolation with robust principal component analysis

Principal component analysis (PCA) is a powerful fault detection and isolation method. However, the classical PCA, which is based on the estimation of the sample mean and covariance matrix of the data, is very sensitive to outliers in the training data set. Usually robust principal component analysis is applied to remove the effect of outliers on the PCA model. In this paper, a fast two-step algorithm is proposed. First, the objective was to find an accurate estimate of the covariance matrix of the data so that a PCA model might be developed that could then be used for fault detection and isolation. A very simple estimate derived from a one-step weighted variance-covariance estimate is used (Ruiz-Gazen, 1996). This is a 'local' matrix of variance which tends to emphasize the contribution of close observations in comparison with distant observations (outliers). Second, structured residuals are used for multiple fault detection and isolation. These structured residuals are based on the reconstruction principle, and the existence condition of such residuals is used to determine the detectable faults and the isolable faults. The proposed scheme avoids the combinatorial explosion of faulty scenarios related to multiple faults to be considered. Then, this procedure for outliers detection and isolation is successfully applied to an example with multiple faults

Fault detection and isolation with robust principal component analysis

International audiencePrincipal component analysis (PCA) is a powerful fault detection and isolation method. However, the classical PCA which is based on the estimation of the sample mean and covariance matrix of the data is very sensitive to outliers in the training data set. Usually robust principal component analysis was applied to remove the effect of outliers on the PCA model. In this paper, a fast two-step algorithm is proposed. First, the objective was to find a robust PCA model that could be used for fault detection and isolation. Hence a scale-M estimator is used to determine a robust model. This estimator is computed using an iterative re-weighted least squares (IRWLS) procedure. To initialize this algorithm a very simple estimate derived from a one-step weighted variance-covariance estimate is used. Second, structured residuals are used for multiple fault detection and isolation. These structured residuals are based on the reconstruction principle and the existence condition of such residuals is used to determine the detectable faults and the isolable faults. The proposed scheme avoids the combinatorial explosion of faulty scenarios related to multiple faults to consider. Then, this procedure for outliers detection and isolation is successfully applied to an example with multiple faults