Demand and Capacity Modelling for Acute Services using Discrete Event Simulation

This is a pre-copyedited, author-produced PDF of an article accepted for publication in Health Systems following peer review. The final publication [Demir, E., Gunal, M & Southern, D., Health Syst (2016), first published online March 11, 2016, is available at Springer via http://dx.doi.org/doi:10.1057/hs.2016.1 © 2016 Operational Research Society Ltd 2016Increasing demand for services in England with limited healthcare budget has put hospitals under immense pressure. Given that almost all National Health Service (NHS) hospitals have severe capacity constraints (beds and staff shortages) a decision support tool (DST) is developed for the management of a major NHS Trust in England. Acute activities are forecasted over a 5 year period broken down by age groups for 10 specialty areas. Our statistical models have produced forecast accuracies in the region of 90%. We then developed a discrete event simulation model capturing individual patient pathways until discharge (in A&E, inpatient and outpatients), where arrivals are based on the forecasted activity outputting key performance metrics over a period of time, e.g., future activity, bed occupancy rates, required bed capacity, theatre utilisations for electives and non-electives, clinic utilisations, and diagnostic/treatment procedures. The DST allows Trusts to compare key performance metrics for 1,000’s of different scenarios against their existing service (baseline). The power of DST is that hospital decision makers can make better decisions using the simulation model with plausible assumptions which are supported by statistically validated data.Peer reviewedFinal Accepted Versio

Brucellosis Presenting as Cholecystitis: A Case Report and Literature Review.

Brucellosis is a zoonotic disease endemic to much of the world. It most often presents with nonspecific symptoms and is a well known cause of undulant fever. Focal forms occur less frequently, with osteoarticular complications being the most common. In this study, we describe a rare case of brucellosis presenting as cholecystitis

A generic method to develop simulation models for ambulance systems

In this paper, we address the question of generic simulation models and their role in improving emergency care around the world. After reviewing the development of ambulance models and the contexts in which they have been applied, we report the construction of a reusable model for ambulance systems. Further, we describe the associated parameters, data sources, and performance measures, and report on the collection of information, as well as the use of optimisation to configure the service to best effect. Having developed the model, we have validated it using real data from the emergency medical system in a Brazilian city, Belo Horizonte. To illustrate the benefits of standardisation and reusability we apply the model to a UK context by exploring how different rules of engagement would change the performance of the system. Finally, we consider the impact that one might observe if such rules were adopted by the Brazilian system

Exploring alternative routes to realising the benefits of simulation in healthcare

Discrete event simulation should offer numerous benefits in designing healthcare systems but the reality is often problematic. Healthcare modelling faces particular challenges: genuine, fundamental variations in practice and an opposition to any suggestion of standardisation from some professional groups. This paper compares the experiences of developing a new simulation in an Accident and Emergency (A&E) Department, a subsequent adaptation for modelling an outpatient clinic and applications of a generic A&E simulation. These studies provide examples of three distinct approaches to realising the potential benefits of simulation: the bespoke, the reuse and the generic route. Reuse has many advantages: it is relatively efficient in exploiting previous modelling experience, delivering timely results while providing scope for adaptations to local practice. Explicitly demonstrating this willingness to adapt to local conditions and engaging with stakeholders is particularly important in healthcare simulation

A novel healthcare resource allocation decision support tool: A forecasting-simulation-optimization approach

© 2020 Informa UK Limited, trading as Taylor & Francis Group. This is an accepted manuscript of an article published by Taylor & Francis in Journal of the Operational Research Society on 03 Feb 2020, available online: https://doi.org/10.1080/01605682.2019.1700186.The increasing pressures on the healthcare system in the UK are well documented. The solution lies in making best use of existing resources (e.g. beds), as additional funding is not available. Increasing demand and capacity shortages are experienced across all specialties and services in hospitals. Modelling at this level of detail is a necessity, as all the services are interconnected, and cannot be assumed to be independent of each other. Our review of the literature revealed two facts; First an entire hospital model is rare, and second, use of multiple OR techniques are applied more frequently in recent years. Hybrid models which combine forecasting, simulation and optimization are becoming more popular. We developed a model that linked each and every service and specialty including A&E, and outpatient and inpatient services, with the aim of, (1) forecasting demand for all the specialties, (2) capturing all the uncertainties of patient pathway within a hospital setting using discrete event simulation, and (3) developing a linear optimization model to estimate the required bed capacity and staff needs of a mid-size hospital in England (using essential outputs from simulation). These results will bring a different perspective to key decision makers with a decision support tool for short and long term strategic planning to make rational and realistic plans, and highlight the benefits of hybrid models.Peer reviewe

The Rare Coincidence: Nonrecurrent Laryngeal Nerve Pointed by a Zuckerkandl's Tubercle

The safety of thyroid operations mainly depends on complete anatomical knowledge. Anatomical and embryological variations of the inferior laryngeal nerve (ILN), of the thyroid gland itself and unusual relations between ILN and the gland threaten operation security are discussed. The patient with toxic multinodular goiter is treated with total thyroidectomy. During dissection of the right lobe, the right ILN which has nonrecurrent course arising directly from cervical vagus nerve is identified and fully isolated until its laryngeal entry. At the operation, we observe bilateral Zuckerkandl's tubercles (ZTs) as posterior extension of both lateral lobes. The left ILN has usual recurrent course in the trachea-esophageal groove. The right ZT is placed between upper and middle third of the lobe points the nonrecurrent ILN. The coincidence of non-recurrent ILN pointed by a ZT is rare anatomical and embryological feature of this case. Based on anatomical and embryological variations, we suggest identification and full exposure of ILN before attempting excision of adjacent structures, like the ZT which has surgical importance for completeness of thyroidectomy

Relationship Between Malnutrition Risk, Activities of Daily Living, and Adaptation to Chronic Diseases in Older People with Chest Diseases

Introduction. The increased risk of malnutrition in older people may have significant impacts on chronic disease management and quality of life. This study aimed to investigate the relationship between chronic diseases, activities of daily living (ADLs), and malnutrition risk. Methods. This cross-sectional, correlational study was conducted on 352 patients over 65 years old, who had a chronic disease for at least one year and were admitted to Dr. Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, Izmir, Turkey. The data were collected using the Descriptive Information Form, Adaptation to Chronic Illness Scale (ACIS), Nutrition Risk Screening-2002 (NRS-2002), and Katz Activities of Daily Living (Katz ADL) scale. Results. The mean age of the participants was 70.65±4.18 years. All participants were at risk of malnutrition according to the NRS-2002 assessment, 29% were independent, and 35.8% were partially dependent based on the Katz ADL scale assessment. The ACIS score was 82.83±13.88. Multivariate linear regression analysis revealed that age, disease duration, perceived disease knowledge, and interference from the disease with planned activities were significant positive predictors of ACIS, while hospitalization in the last 6 months, the number of meals per day, difficulty in meeting personal care needs, and NRS-2002 were significant negative predictors of ACIS (p<0.05). Conclusions. Despite the unexpected homogeneity in malnutrition risk, the NRS-2002 score emerged as a negative predictor of chronic disease adaptation. Furthermore, recent hospital admissions, daily meal consumption, and impairment in self-care were also found to have a negative influence, while age, disease duration (in years), appropriate disease knowledge, and the absence of interference from the disease with planned activities demonstrated a positive impact on chronic disease adaptation

MYOCARDIAL AND NEUROCOGNITIVE CHANGES IN LIGHTNING STRIKE INJURY: A CASE REPORT

Lightning is a frequent natural disaster and may result in death at a rate of up to 20-30 % of affected patients. Survivors of lightning exposure can exhibit a variety of cardiac abnormalities and neurocognitive changes. In this report, we present intensive care management of a case of 15 years old boy with myocardial and neurocognitive changes after lightning strike injury