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

Use of the AHP methodology in system dynamics: Modelling and simulation for health technology assessments to determine the correct prosthesis choice for hernia diseases

Abstract Health technology assessments (HTAs) are often difficult to conduct because of the decisive procedures of the HTA algorithm, which are often complex and not easy to apply. Thus, their use is not always convenient or possible for the assessment of technical requests requiring a multidisciplinary approach. This paper aims to address this issue through a multi-criteria analysis focusing on the analytic hierarchy process (AHP). This methodology allows the decision maker to analyse and evaluate different alternatives and monitor their impact on different actors during the decision-making process. However, the multi-criteria analysis is implemented through a simulation model to overcome the limitations of the AHP methodology. Simulations help decision-makers to make an appropriate decision and avoid unnecessary and costly attempts. Finally, a decision problem regarding the evaluation of two health technologies, namely, the evaluation of two biological prostheses for incisional infected hernias, will be analysed to assess the effectiveness of the model

Editor’s Note

This special issue has been designed with the primary objective of demonstrating the diversity of fields where AI is used and, consequently, how it is gaining increasing importance as a tool for analysis and research. In this sense, there are works related to the following topics: the use of AI with the IoT, campaign management, topic models and fusion methods, sales forecasting, price forecasting for electricity market, NLP techniques in computational medicine, evaluation of patient triage in hospital emergency settings, algorithms for solving the assignment problem, scheduling strategy for scientific workflow, driver fatigue detection mechanisms, virtual reality and specialized training, image segmentation, web service selection, multimedia documents adaptation, 3D navigation in virtual environments, multi-criteria decision-making methods and emotional states classification

A Hybrid Fuzzy Multi-criteria Decision Making Model to Evaluate the Overall Performance of Public Emergency Departments: A Case Study

[EN] Performance evaluation is relevant for supporting managerial decisions related to the improvement of public emergency departments (EDs). As different criteria from ED context and several alternatives need to be considered, selecting a suitable Multicriteria Decision-Making (MCDM) approach has become a crucial step for ED performance evaluation. Although some methodologies have been proposed to address this challenge, a more complete approach is still lacking. This paper bridges this gap by integrating three potent MCDM methods. First, the Fuzzy Analytic Hierarchy Process (FAHP) is used to determine the criteria and sub-criteria weights under uncertainty, followed by the interdependence evaluation via fuzzy Decision-Making Trial and Evaluation Laboratory(FDEMATEL). The fuzzy logic is merged with AHP and DEMATEL to illustrate vague judgments. Finally, the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) is used for ranking EDs. This approach is validated in a real 3-ED cluster. The results revealed the critical role of Infrastructure (21.5%) in ED performance and the interactive nature of Patient safety (C+R =12.771). Furthermore, this paper evidences the weaknesses to be tackled for upgrading the performance of each ED.Ortiz-Barrios, M.; Alfaro Saiz, JJ. (2020). A Hybrid Fuzzy Multi-criteria Decision Making Model to Evaluate the Overall Performance of Public Emergency Departments: A Case Study. International Journal of Information Technology & Decision Making. 19(6):1485-1548. https://doi.org/10.1142/S0219622020500364S14851548196Lord, K., Parwani, V., Ulrich, A., Finn, E. B., Rothenberg, C., Emerson, B., … Venkatesh, A. K. (2018). Emergency department boarding and adverse hospitalization outcomes among patients admitted to a general medical service. The American Journal of Emergency Medicine, 36(7), 1246-1248. doi:10.1016/j.ajem.2018.03.043Sørup, C. M., Jacobsen, P., & Forberg, J. L. (2013). 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Metaheuristic Algorithms for Spatial Multi-Objective Decision Making

Spatial decision making is an everyday activity, common to individuals and organizations. However, recently there is an increasing interest in the importance of spatial decision-making systems, as more decision-makers with concerns about sustainability, social, economic, environmental, land use planning, and transportation issues discover the benefits of geographical information. Many spatial decision problems are regarded as optimization problems, which involve a large set of feasible alternatives, multiple conflicting objectives that are difficult and complex to solve. Hence, Multi-Objective Optimization methods (MOO)—metaheuristic algorithms integrated with Geographical Information Systems (GIS) are appealing to be powerful tools in these regards, yet their implementation in spatial context is still challenging. In this thesis, various metaheuristic algorithms are adopted and improved to solve complex spatial problems. Disaster management and urban planning are used as case studies of this thesis.These case studies are explored in the four papers that are part of this thesis. In paper I, four metaheuristic algorithms have been implemented on the same spatial multi-objective problem—evacuation planning, to investigate their performance and potential. The findings show that all tested algorithms were effective in solving the problem, although in general, some had higher performance, while others showed the potential of being flexible to be modified to fit better to the problem. In the same context, paper II identified the effectiveness of the Multi-objective Artificial Bee Colony (MOABC) algorithm when improved to solve the evacuation problem. In paper III, we proposed a multi-objective optimization approach for urban evacuation planning that considered three spatial objectives which were optimized using an improved Multi-Objective Cuckoo Search algorithm (MOCS). Both improved algorithms (MOABC and MOCS) proved to be efficient in solving evacuation planning when compared to their standard version and other algorithms. Moreover, Paper IV proposed an urban land-use allocation model that involved three spatial objectives and proposed an improved Non-dominated Sorting Biogeography-based Optimization algorithm (NSBBO) to solve the problem efficiently and effectively.Overall, the work in this thesis demonstrates that different metaheuristic algorithms have the potential to change the way spatial decision problems are structured and can improve the transparency and facilitate decision-makers to map solutions and interactively modify decision preferences through trade-offs between multiple objectives. Moreover, the obtained results can be used in a systematic way to develop policy recommendations. From the perspective of GIS - Multi-Criteria Decision Making (MCDM) research, the thesis contributes to spatial optimization modelling and extended knowledge on the application of metaheuristic algorithms. The insights from this thesis could also benefit the development and practical implementation of other Artificial Intelligence (AI) techniques to enhance the capabilities of GIS for tackling complex spatial multi-objective decision problems in the future

Multi-Criteria Decision Making in Complex Decision Environments

In the future, many decisions will either be fully automated or supported by autonomous system. Consequently, it is of high importance that we understand how to integrate human preferences correctly. This dissertation dives into the research field of multi-criteria decision making and investigates the satellite image acquisition scheduling problem and the unmanned aerial vehicle routing problem to further the research on a priori preference integration frameworks. The work will aid in the transition towards autonomous decision making in complex decision environments. A discussion on the future of pairwise and setwise preference articulation methods is also undertaken. "Simply put, a direct consequence of the improved decision-making methods is,that bad decisions more clearly will stand out as what they are - bad decisions.

Development of Geospatial Models for Multi-Criteria Decision Making in Traffic Environmental Impacts of Heavy Vehicle Freight Transportation

Heavy vehicle freight transportation is one of the primary contributors to the socio-economic development, but it has great influence on traffic environment. To comprehensively and more accurately quantify the impacts of heavy vehicles on road infrastructure performance, a series of geospatial models are developed for both geographically global and local assessment of the impacts. The outcomes are applied in flexible multi-criteria decision making for the industrial practice of road maintenance and management

An integrated approach to evaluate the risk of adverse events in hospital sector: from theory to practice

Purpose: The risk of adverse events in a hospital evaluation is an important process in healthcare management. It involves several technical, social, and economical aspects. The purpose of this paper is to propose an integrated approach to evaluate the risk of adverse events in the hospital sector. Design/methodology/approach: This paper aims to provide a decision-making framework to evaluate hospital service. Three well-known methods are applied. More specifically are proposed the following methods: analytic hierarchy process (AHP), a structured technique for organizing and analyzing complex decisions, based on mathematics and psychology developed by Thomas L. Saaty in the 1970s; decision-making trial and evaluation laboratory (DEMATEL) to construct interrelations between criteria/factors and VIKOR method, a commonly used multiple-criteria decision analysis technique for determining a compromise solution and improving the quality of decision making. Findings: The example provided has demonstrated that the proposed approach is an effective and useful tool to assess the risk of adverse events in the hospital sector. The results could help the hospital identify its high performance level and take appropriate measures in advance to prevent adverse events. The authors can conclude that the promising results obtained in applying the AHP–DEMATEL–VIKOR method suggest that the hybrid method can be used to create decision aids that it simplifies the shared decision-making process. Originality/value: This paper presents a novel approach based on the integration of AHP, DEMATEL and VIKOR methods. The final aim is to propose a robust methodology to overcome disadvantages associated with each method

A MODIFIED FMEA APPROACH BASED INTEGRATED DECISION FRAMEWORK FOR OVERCOMING THE PROBLEMS OF SUDDEN FAILURE AND ACCIDENTAL HAZARDS IN TURBINE AND ALTERNATOR UNIT

The proposed work presents a novel integrated decision framework, based on Intuitionistic Fuzzy (IF)- Failure Mode & Effect Analysis (IF-FMEA), and IF-Technique for Order of Preference by Similarity to Ideal Solution (IF-TOPSIS) approaches for analysing the failure risk issues of Turbine and Alternator Unit (TAU) in a chemical treatment-based sugar process industry. The proposed novel IF-FMEA approach-based modelling overcomes the various demerits of traditional FMEA approaches which are faced during the identification of critical failure causes based on Risk Priority Number (RPN) outputs. On the basis of detailed qualitative information related to plant operation, FMEA sheet was developed and linguistic ratings were collected against three risk factors such as probability of Occurrence (O), Severity (S), and Detection (D). IF- Hybrid Weighted Euclidean Distance (IFHWED) score has been computed to rank all listed failure causes under three risk factors. The ranking results based on IF-FMEA approach has been compared with the well existed IF-TOPSIS approach for evaluating the accuracy of proposed modelling results. Sensitivity analysis has been also done for checking the robustness of the framework. The analysis results were provided to maintenance executives of the TAU unit to frame optimum maintenance plan for overcoming the problems of sudden breakdown. The analysis results are also applicable to TAU systems which are installed in other chemical process industries globally.

Designing supplier selection strategies under COVID-19 constraints for industrial environments

COVID-19 has been impacting worldwide supply chains causing interruption, closure of production and distribution. This impact has been drastic on the supplier side and, as a consequence of disruptions, strong reductions of production have been estimated. Such a circumstance forces companies to propose innovative best practices of supply chain risk management aimed at facing vulnerability generated by COVID-19 and pursuing industrial improvements in manufacturing and production environments. As a part of supply chain strategy, supplier selection criteria should be revised to include pandemic-related risks. This article aims to propose an answer to such a problem. In detail, a comprehensive tool designed as a hybrid combination of multi-criteria decision-making (MCDM) methods is suggested to manage important stages connected to the production development cycle and to provide companies with a structured way to rank risks and easily select their suppliers. The main criteria of analysis will be first identified from the existent literature. Risks related to COVID-19 will be then analysed in order to elaborate a comprehensive list of potential risks in the field of interest. The Best Worst Method (BWM) will be first used to calculate criteria weights. The Fuzzy Technique for Order of Preference by Similarity to Ideal Solution (FTOPSIS) will be then applied to rank and prioritize risks affecting suppliers. The effectiveness of the approach will be tested through a case study in the sector of automotive industry. The applicability of the designed MCDM framework can be extended also to other industrial sectors of interest