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

Big data analytics:Computational intelligence techniques and application areas

Big Data has significant impact in developing functional smart cities and supporting modern societies. In this paper, we investigate the importance of Big Data in modern life and economy, and discuss challenges arising from Big Data utilization. Different computational intelligence techniques have been considered as tools for Big Data analytics. We also explore the powerful combination of Big Data and Computational Intelligence (CI) and identify a number of areas, where novel applications in real world smart city problems can be developed by utilizing these powerful tools and techniques. We present a case study for intelligent transportation in the context of a smart city, and a novel data modelling methodology based on a biologically inspired universal generative modelling approach called Hierarchical Spatial-Temporal State Machine (HSTSM). We further discuss various implications of policy, protection, valuation and commercialization related to Big Data, its applications and deployment

Artificial Intelligence based multi-agent control system

Le metodologie di Intelligenza Artificiale (AI) si occupano della possibilità di rendere le macchine in grado di compiere azioni intelligenti con lo scopo di aiutare l’essere umano; quindi è possibile affermare che l’Intelligenza Artificiale consente di portare all’interno delle macchine, caratteristiche tipiche considerate come caratteristiche umane. Nello spazio dell’Intelligenza Artificiale ci sono molti compiti che potrebbero essere richiesti alla macchina come la percezione dell’ambiente, la percezione visiva, decisioni complesse. La recente evoluzione in questo campo ha prodotto notevoli scoperte, princi- palmente in sistemi ingegneristici come sistemi multi-agente, sistemi in rete, impianti, sistemi veicolari, sistemi sanitari; infatti una parte dei suddetti sistemi di ingegneria è presente in questa tesi di dottorato. Lo scopo principale di questo lavoro è presentare le mie recenti attività di ricerca nel campo di sistemi complessi che portano le metodologie di intelligenza artifi- ciale ad essere applicati in diversi ambienti, come nelle reti di telecomunicazione, nei sistemi di trasporto e nei sistemi sanitari per la Medicina Personalizzata. Gli approcci progettati e sviluppati nel campo delle reti di telecomunicazione sono presentati nel Capitolo 2, dove un algoritmo di Multi Agent Reinforcement Learning è stato progettato per implementare un approccio model-free al fine di controllare e aumentare il livello di soddisfazione degli utenti; le attività di ricerca nel campo dei sistemi di trasporto sono presentate alla fine del capitolo 2 e nel capitolo 3, in cui i due approcci riguardanti un algoritmo di Reinforcement Learning e un algoritmo di Deep Learning sono stati progettati e sviluppati per far fronte a soluzioni di viaggio personalizzate e all’identificazione automatica dei mezzi trasporto; le ricerche svolte nel campo della Medicina Personalizzata sono state presentate nel Capitolo 4 dove è stato presentato un approccio basato sul controllo Deep Learning e Model Predictive Control per affrontare il problema del controllo dei fattori biologici nei pazienti diabetici.Artificial Intelligence (AI) is a science that deals with the problem of having machines perform intelligent, complex, actions with the aim of helping the human being. It is then possible to assert that Artificial Intelligence permits to bring into machines, typical characteristics and abilities that were once limited to human intervention. In the field of AI there are several tasks that ideally could be delegated to machines, such as environment aware perception, visual perception and complex decisions in the various field. The recent research trends in this field have produced remarkable upgrades mainly on complex engineering systems such as multi-agent systems, networked systems, manufacturing, vehicular and transportation systems, health care; in fact, a portion of the mentioned engineering system is discussed in this PhD thesis, as most of them are typical field of application for traditional control systems. The main purpose if this work is to present my recent research activities in the field of complex systems, bringing artificial intelligent methodologies in different environments such as in telecommunication networks, transportation systems and health care for Personalized Medicine. The designed and developed approaches in the field of telecommunication net- works is presented in Chapter 2, where a multi-agent reinforcement learning algorithm was designed to implement a model-free control approach in order to regulate and improve the level of satisfaction of the users, while the research activities in the field of transportation systems are presented at the end of Chapter 2 and in Chapter 3, where two approaches regarding a Reinforcement Learning algorithm and a Deep Learning algorithm were designed and developed to cope with tailored travels and automatic identification of transportation moralities. Finally, the research activities performed in the field of Personalized Medicine have been presented in Chapter 4 where a Deep Learning and Model Predictive control based approach are presented to address the problem of controlling biological factors in diabetic patients

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

A survey of simulation techniques in commerce and defence

Despite the developments in Modelling and Simulation (M&S) tools and techniques over the past years, there has been a gap in the M&S research and practice in healthcare on developing a toolkit to assist the modellers and simulation practitioners with selecting an appropriate set of techniques. This study is a preliminary step towards this goal. This paper presents some results from a systematic literature survey on applications of M&S in the commerce and defence domains that could inspire some improvements in the healthcare. Interim results show that in the commercial sector Discrete-Event Simulation (DES) has been the most widely used technique with System Dynamics (SD) in second place. However in the defence sector, SD has gained relatively more attention. SD has been found quite useful for qualitative and soft factors analysis. From both the surveys it becomes clear that there is a growing trend towards using hybrid M&S approaches

Scheduling of home health care services based on multi-agent systems

Home Health Care (HHC) services are growing worldwide and, usually, the home care visits are manually planned, being a time and effort consuming task that leads to a non optimized solution. The use of some optimization techniques can significantly improve the quality of the scheduling solutions, but lacks the achievement of solutions that face the fast reaction to condition changes. In such stochastic and very volatile environments, the fast re-scheduling is crucial to maintain the system in operation. Taking advantage of the inherent distributed and intelligent characteristics of Multi-agent Systems (MAS), this paper introduces a methodology that combines the optimization features provided by centralized scheduling algorithms, e.g. genetic algorithms, with the responsiveness features provided by MAS solutions. The proposed approach was codified in Matlab and NetLogo and applied to a real-world HHC case study. The experimental results showed a significant improvement in the quality of scheduling solutions, as well as in the responsiveness to achieve those solutions.info:eu-repo/semantics/publishedVersio

Adaptable Spatial Agent-Based Facility Location for Healthcare Coverage

Lack of access to healthcare is responsible for the world’s poverty, mortality and morbidity. Public healthcare facilities (HCFs) are expected to be located such that they can be reached within reasonable distances of the patients’ locations, while at the same time providing complete service coverage. However, complete service coverage is generally hampered by resource availability. Therefore, the Maximal Covering Location Problem (MCLP), seeks to locate HCFs such that as much population as possible is covered within a desired service distance. A consideration to the population not covered introduces a distance constraint that is greater than the desired service distance, beyond which no population should be. Existing approaches to the MCLP exogenously set the number of HCFs and the distance parameters, with further assumption of equal access to HCFs, infinite or equal capacity of HCFs and data availability. These models tackle the real-world system as static and do not address its intrinsic complexity that is characterised by unstable and diverse geographic, demographic and socio-economic factors that influence the spatial distribution of population and HCFs, resource management, the number of HCFs and proximity to HCFs. Static analysis incurs more expenditure in the analytical and decision-making process for every additional complexity and heterogeneity. This thesis is focused on addressing these limitations and simplifying the computationally intensive problems. A novel adaptable and flexible simulation-based meta-heuristic approach is employed to determine suitable locations for public HCFs by integrating Geographic Information Systems (GIS) with Agent-Based Models (ABM). Intelligent, adaptable and autonomous spatial and non-spatial agents are utilized to interact with each other and the geographic environment, while taking independent decisions governed by spatial rules, such as •containment, •adjacency, •proximity and •connectivity. Three concepts are introduced: assess the coverage of existing HCFs using travel-time along the road network and determine the different average values of the service distance; endogenously determine the number and suitable locations of HCFs by integrating capacity and locational suitability constraints for maximizing coverage within the prevailing service distance; endogenously determine the distance constraint as the maximum distance between the population not covered within the desired service distance and its closest facility. The models’ validations on existing algorithms produce comparable and better results. With confirmed transferability, the thesis is applied to Lagos State, Nigeria in a disaggregated analysis that reflects spatial heterogeneity, to provide improved service coverage for healthcare. The assessment of the existing health service coverage and spatial distribution reveals disparate accessibility and insufficiency of the HCFs whose locations do not factor in the spatial distribution of the population. Through the application of the simulation-based approach, a cost-effective complete health service coverage is achieved with new HCFs. The spatial pattern and autocorrelation analysis reveal the influence of population distribution and geographic phenomenon on HCF location. The relationship of selected HCFs with other spatial features indicates agents’ compliant with spatial association. This approach proves to be a better alternative in resource constrained systems. The adaptability and flexibility meet the global health coverage agenda, the desires of the decision maker and the population, in the support for public health service coverage. In addition, a general theory of the system for a better-informed decision and analytical knowledge is obtained

Clairvoyance: A Pipeline Toolkit for Medical Time Series

Time-series learning is the bread and butter of data-driven *clinical decision support*, and the recent explosion in ML research has demonstrated great potential in various healthcare settings. At the same time, medical time-series problems in the wild are challenging due to their highly *composite* nature: They entail design choices and interactions among components that preprocess data, impute missing values, select features, issue predictions, estimate uncertainty, and interpret models. Despite exponential growth in electronic patient data, there is a remarkable gap between the potential and realized utilization of ML for clinical research and decision support. In particular, orchestrating a real-world project lifecycle poses challenges in engineering (i.e. hard to build), evaluation (i.e. hard to assess), and efficiency (i.e. hard to optimize). Designed to address these issues simultaneously, Clairvoyance proposes a unified, end-to-end, autoML-friendly pipeline that serves as a (i) software toolkit, (ii) empirical standard, and (iii) interface for optimization. Our ultimate goal lies in facilitating transparent and reproducible experimentation with complex inference workflows, providing integrated pathways for (1) personalized prediction, (2) treatment-effect estimation, and (3) information acquisition. Through illustrative examples on real-world data in outpatient, general wards, and intensive-care settings, we illustrate the applicability of the pipeline paradigm on core tasks in the healthcare journey. To the best of our knowledge, Clairvoyance is the first to demonstrate viability of a comprehensive and automatable pipeline for clinical time-series ML