A systematic literature review of operational research methods for modelling patient flow and outcomes within community healthcare and other settings

An ambition of healthcare policy has been to move more acute services into community settings. This systematic literature review presents analysis of published operational research methods for modelling patient flow within community healthcare, and for modelling the combination of patient flow and outcomes in all settings. Assessed for inclusion at three levels – with the references from included papers also assessed – 25 “Patient flow within community care”, 23 “Patient flow and outcomes” papers and 5 papers within the intersection are included for review. Comparisons are made between each paper’s setting, definition of states, factors considered to influence flow, output measures and implementation of results. Common complexities and characteristics of community service models are discussed with directions for future work suggested. We found that in developing patient flow models for community services that use outcomes, transplant waiting list may have transferable benefits

Use of modelling to inform public health policy: a case study on the blood-borne transmission of variant-CJD

Since the identification of variant Creutzfeldt–Jacob Disease in the late 1980s, the possibility that this disease might be passed on via blood transfusion has presented challenging policy questions for Government and blood services in the UK. This paper discusses the use of mathematical modelling to inform policy in this area of health protection. We focus on the use of a relatively simple analytical model to explore how many such infections might eventually be expected to result in clinical cases under a range of alternative scenarios of interest to policy, and on the potential impact of possible additional counter measures. We comment on the value of triangulating between findings generated using distinct modelling approaches and observational data

Trombe walls with nanoporous aerogel insulation applied to UK housing refurbishments

There is an opportunity to improve the efficiency of passive Trombe walls and active solar air collectors by replacing their conventional glass covers with lightweight polycarbonate panels filled with nanoporous aerogel insulation. This study investigates the thermal performance, energy savings, and financial payback period of passive Aerogel Trombe walls applied to the existing UK housing stock. Using parametric modeling, a series of design guidance tables have been generated, providing estimates of the energy savings and overheating risk associated with applying areas of Trombe wall to four different house types across the UK built to six notional construction standards. Calculated energy savings range from 183 kWh/m2/year for an 8 m2 system retrofitted to a solid walled detached house to 62 kWh/m2/year for a 32 m2 system retrofitted to a super insulated flat. Predicted energy savings from Trombe walls up to 24 m2 are found to exceed the energy savings from external insulation across all house types and constructions. Small areas of Trombe wall can provide a useful energy contribution without creating a significant overheating risk. If larger areas are to be installed, then detailed calculations would be recommended to assess and mitigate potential overheating issues.The EPSRC, Brunel University, and Buro Happold Lt

Informing decisions on the purchase of equipment used by health services in response to incidents involving hazardous materials

Accidents involving release of chemical, biological, radiological or nuclear substances may prompt the need to decontaminate exposed casualties prior to further medical treatment. Health service workers who carry out decontamination procedures wear protective suits to avoid direct contact with contaminants. We developed an analytical framework based on queueing theory to inform UK Department of Health's decisions on the stock of protective suits that ambulance services and hospitals with emergency departments in England should hold. Our aim was to ensure that such allocation gave an accepted degree of resilience to locally identified hazards. Here we give an overview of our work and describe how we incorporated information in the public domain about local hazards with expert opinion about the patterns of demand for decontamination associated with different types of incident. We also give an account of how we worked with decision makers to inform national guidance on this topic

SNS programming environment user's guide

The computing environment is briefly described for the Supercomputing Network Subsystem (SNS) of the Central Scientific Computing Complex of NASA Langley. The major SNS computers are a CRAY-2, a CRAY Y-MP, a CONVEX C-210, and a CONVEX C-220. The software is described that is common to all of these computers, including: the UNIX operating system, computer graphics, networking utilities, mass storage, and mathematical libraries. Also described is file management, validation, SNS configuration, documentation, and customer services

Death and Emergency Readmission of Infants Discharged After Interventions for Congenital Heart Disease: A National Study of 7643 Infants to Inform Service Improvement.

Improvements in hospital-based care have reduced early mortality in congenital heart disease. Later adverse outcomes may be reducible by focusing on care at or after discharge. We aimed to identify risk factors for such events within 1 year of discharge after intervention in infancy and, separately, to identify subgroups that might benefit from different forms of intervention.Cardiac procedures performed in infants between 2005 and 2010 in England and Wales from the UK National Congenital Heart Disease Audit were linked to intensive care records. Among 7976 infants, 333 (4.2%) died before discharge. Of 7643 infants discharged alive, 246 (3.2%) died outside the hospital or after an unplanned readmission to intensive care (risk factors were age, weight-for-age, cardiac procedure, cardiac diagnosis, congenital anomaly, preprocedural clinical deterioration, prematurity, ethnicity, and duration of initial admission; c-statistic 0.78 [0.75-0.82]). Of the 7643, 514 (6.7%) died outside the hospital or had an unplanned intensive care readmission (same risk factors but with neurodevelopmental condition and acquired cardiac diagnosis and without preprocedural deterioration; c-statistic 0.78 [0.75-0.80]). Classification and regression tree analysis were used to identify 6 subgroups stratified by the level (3-24%) and nature of risk for death outside the hospital or unplanned intensive care readmission based on neurodevelopmental condition, cardiac diagnosis, congenital anomaly, and duration of initial admission. An additional 115 patients died after planned intensive care admission (typically following elective surgery).Adverse outcomes in the year after discharge are of similar magnitude to in-hospital mortality, warrant service improvements, and are not confined to diagnostic groups currently targeted with enhanced monitoring

Combining qualitative and quantitative operational research methods to inform quality improvement in pathways that span multiple settings

BACKGROUND: Improving integration and continuity of care across sectors within resource constraints is a priority in many health systems. Qualitative operational research methods of problem structuring have been used to address quality improvement in services involving multiple sectors but not in combination with quantitative operational research methods that enable targeting of interventions according to patient risk. We aimed to combine these methods to augment and inform an improvement initiative concerning infants with congenital heart disease (CHD) whose complex care pathway spans multiple sectors. METHODS: Soft systems methodology was used to consider systematically changes to services from the perspectives of community, primary, secondary and tertiary care professionals and a patient group, incorporating relevant evidence. Classification and regression tree (CART) analysis of national audit datasets was conducted along with data visualisation designed to inform service improvement within the context of limited resources. RESULTS: A 'Rich Picture' was developed capturing the main features of services for infants with CHD pertinent to service improvement. This was used, along with a graphical summary of the CART analysis, to guide discussions about targeting interventions at specific patient risk groups. Agreement was reached across representatives of relevant health professions and patients on a coherent set of targeted recommendations for quality improvement. These fed into national decisions about service provision and commissioning. CONCLUSIONS: When tackling complex problems in service provision across multiple settings, it is important to acknowledge and work with multiple perspectives systematically and to consider targeting service improvements in response to confined resources. Our research demonstrates that applying a combination of qualitative and quantitative operational research methods is one approach to doing so that warrants further consideration