Assessing the opportunities of landfill mining

Long-term estimates make clear that the amount of solid waste to be processed at landfills in the Netherlands will sharply decline in coming years. Major reasons can be found in the availability of improved technologies for waste recycling and government regulations aiming at waste reduction. Consequently, market size for companies operating landfills shrinks. Among the companies facing the problem is the Dutch company Essent. Given the expected market conditions, it looks for alternative business opportunities. Landfill mining, i.e., the recycling of existing landfills, is considered one of them. Proceeds of landfill mining are related to, for example, recycled materials available for re-use, regained land, and possibilities for a more efficient operation of a landfill. The market for landfill mining is of a considerable size – there are about 3800 landfills located in the Netherlands. Given market size Essent faces the dilemma of how to explore this market, i.e., select the most profitable landfills in a fast and efficient way. No existing methods or tools could be found to do so. Therefore, to answer to the problem posed, we propose a step-wise research method for market exploration. The basic idea behind the method is to provide an adequate, cost-saving and timely answer by relying on a series of quick scans. The method has been tested for its practical use in a pilot study. The pilot study addressed 147 landfills located in the Dutch Province of Noord-Brabant. The study made clear how method application resulted in the selection of a limited number of high potential landfills in a few weeks, involving minimal research costs.

Identifying Frequent Health Care Users and Care Consumption Patterns:Process Mining of Emergency Medical Services Data

Background: Tracing frequent users of health care services is highly relevant to policymakers and clinicians, enabling them to avoid wasting scarce resources. Data collection on frequent users from all possible health care providers may be cumbersome due to patient privacy, competition, incompatible information systems, and the efforts involved. Objective: This study explored the use of a single key source, emergency medical services (EMS) records, to trace and reveal frequent users’ health care consumption patterns. Methods: A retrospective study was performed analyzing EMS calls from the province of Drenthe in the Netherlands between 2012 and 2017. Process mining was applied to identify the structure of patient routings (ie, their consecutive visits to hospitals, nursing homes, and EMS). Routings are used to identify and quantify frequent users, recognizing frail elderly users as a focal group. The structure of these routes was analyzed at the patient and group levels, aiming to gain insight into regional coordination issues and workload distributions among health care providers. Results: Frail elderly users aged 70 years or more represented over 50% of frequent users, making 4 or more calls per year. Over the period of observation, their annual number and the number of calls increased from 395 to 628 and 2607 to 3615, respectively. Structural analysis based on process mining revealed two categories of frail elderly users: low-complexity patients who need dialysis, radiation therapy, or hyperbaric medicine, involving a few health care providers, and high-complexity patients for whom routings appear chaotic. Conclusions: This efficient approach exploits the role of EMS as the unique regional “ferryman,” while the combined use of EMS data and process mining allows for the effective and efficient tracing of frequent users’ utilization of health care services. The approach informs regional policymakers and clinicians by quantifying and detailing frequent user consumption patterns to support subsequent policy adaptations

Conceptual Modelling of Emerging Technologies - The Use of Novel Electric Aircraft for Emergency Medical Services

Implementation of new technologies in operations systems sets specific requirements on simulation conceptual modelling, relating to uncertainties with respect to their specifications, changes implied for operations systems and regulatory frameworks restricting their operation. Furthermore, modellingobjectives may have to be tailored to innovation agendas made by potential adopters of technologies. In this paper, we explore the needs for extending current frameworks to facilitate conceptual modelling of new technologies, using a case study on the introduction of novel electric aircraft (eVTOLs) for Emergency Medical Services. Extensions proposed concern the choice of modelling objectives – which should be aligned with an innovation agenda, technology representation as model content, inputs and outputs – accounting for various uncertainties, and the modelling process – requiring a careful concerting with engineering efforts

Tracing frequent users of regional care services using emergency medical services data:a networked approach

Objectives: This study shows how a networked approach relying on ‘real-world’ emergency medical services (EMS) records might contribute to tracing frequent users of care services on a regional scale. Their tracing is considered of importance for policy-makers and clinicians, since they represent a considerable workload and use of scarce resources. While existing approaches for data collection on frequent users tend to limit scope to individual or associated care providers, the proposed approach exploits the role of EMS as the network’s ‘ferryman’ overseeing and recording patient calls made to an entire network of care providers. Design: A retrospective study was performed analysing 2012–2017 EMS calls in the province of Drenthe, the Netherlands. Using EMS data, benefits of the networked approach versus existing approaches are assessed by quantifying the number of frequent users and their associated calls for various categories of care providers. Main categories considered are hospitals, nursing homes and EMS. Setting: EMS in the province of Drenthe, the Netherlands, serving a population of 491 867. Participants: Analyses are based on secondary patient data from EMS records, entailing 212 967 transports and 126 758 patients, over 6 years (2012–2017). Results: Use of the networked approach for analysing calls made to hospitals in Drenthe resulted in a 20% average increase of frequent users traced. Extending the analysis by including hospitals outside Drenthe increased ascertainment by 28%. Extending to all categories of care providers, inside Drenthe, and subsequently, irrespective of their location, resulted in an average increase of 132% and 152% of frequent users identified, respectively. Conclusions: Many frequent users of care services are network users relying on multiple regional care providers, possibly representing inefficient use of scarce resources. Network users are effectively and efficiently traced by using EMS records offering high coverage of calls made to regional care provider

Optimising acute stroke care organisation: a simulation study to assess the potential to increase intravenous thrombolysis rates and patient gains

Objectives: To assess potential increases in intravenous thrombolysis (IVT) rates given particular interventions in the stroke care pathway. Design: Simulation modelling was used to compare the performance of the current pathway, best practices based on literature review and an optimised model. Setting: Four hospitals located in the North of the Netherlands, as part of a centralised organisational model. Participants: Ischaemic stroke patients prospectively ascertained from February to August 2010. Intervention: The interventions investigated included efforts aimed at patient response and mode of referral, prehospital triage and intrahospital delays. Primary and secondary outcome measures: The primary outcome measure was thrombolysis utilisation. Secondary measures were onset-treatment time (OTT) and the proportion of patients with excellent functional outcome (modified Rankin scale (mRS) 0–1) at 90 days. Results: Of 280 patients with ischaemic stroke, 125 (44.6%) arrived at the hospital within 4.5 hours, and 61 (21.8%) received IVT. The largest improvements in IVT treatment rates, OTT and the proportion of patients with mRS scores of 0–1 can be expected when patient response is limited to 15 min (IVT rate +5.8%; OTT −6 min; excellent mRS scores +0.2%), door-to- needle time to 20 min (IVT rate +4.8%; OTT −28 min; excellent mRS scores+3.2%) and 911 calls are increased to 60% (IVT rate +2.9%; OTT −2 min; excellent mRS scores+0.2%). The combined implementation of all potential best practices could increase IVT rates by 19.7% and reduce OTT by 56 min. Conclusions: Improving IVT rates to well above 30% appears possible if all known best practices are implemented