HA 2013 Abstracts


Full Papers
Paper Nr: 3
Title:

Emergency Medical Services Modelling

Authors:

Paul Harper, Jonathan Gillard, Vincent Knight, Leanne Smith, Julie Vile and Janet Williams

Abstract: Emergency Medical Services (EMS) are facing increasing pressures in many nations given that demands on the service are rising. This paper focuses on the operations of the Welsh Ambulance Service Trust (WAST), which provides urgent care services on a day-to-day basis across the whole of Wales. Facing ever-increasing pressures to provide rapid responses, the Trust is keen to develop new initiatives to meet the response time targets set by the government. This article describes work performed at Cardiff University in collaboration with WAST, investigating a range of Operational Research (OR) methods, including computer simulation, to assist the Trust with capacity planning issues and deployment of emergency vehicles and crews.

Paper Nr: 8
Title:

An Epidemic Model of Nonmedical Opioid Use with Simulated Public Health Interventions

Authors:

Alexandra Nielsen, Wayne Wakeland and Teresa Schmidt

Abstract: We report development of a generalized epidemic model of initiation and nonmedical use of pharmaceutical opioids in the US. The study relies on historical trend data as well as expert panel recommendations that inform model parameters and structure. Derived from current policies, simulated public health interventions are assessed using the model regarding their leverage for reducing initiation and nonmedical use. Preliminary findings indicate that interventions which reduce the perceived attractiveness of opioids for recreational use may significantly reduce initiation and nonmedical use most significantly, while supply restriction effected through drug take back days and prescribing changes may have more modest effects. We argue that system dynamics is an effective approach for evaluating potential interventions to this complex system where the use of pharmaceutical opioids to treat pain is fraught with potentially undesirable distal outcomes in the public sphere.

Paper Nr: 9
Title:

Emergency Ambulance Deployment in Val-de-Marne Department - A Simulation-based Iterative Approach

Authors:

Lina Aboueljinane, Evren Sahin and Zied Jemai

Abstract: The French Emergency Medical services, known as SAMU, are public safety systems responsible for the coordination of pre-hospital care under emergency conditions throughout a given geographic region. The goal of such systems is to respond timely and adequately to population calls by providing first aid services and transferring patients, when needed, to the appropriate care facility. In this paper, we propose a multi-period version of the Maximum Expected Covering Location Problem applied to the case of the SAMU 94 responsible for the Val-de-Marne department (France). The assumption that the busy fractions are identical for all demand points is relaxed by adopting an iterative method to compute a priori estimates of these parameters in the model using an ARENA discrete-event simulation model of the SAMU 94. The solutions obtained from the mathematical model are then assessed by simulation regarding the time required to respond to an emergency call by getting to the patient location, known as response time, which is a critical aspect for the SAMU providers. Experimental results showed that the proposed method increased average percentage of most serious calls responded to within the target time of 15 minutes up to 15\% compared to the current system performance.

Paper Nr: 12
Title:

Fuzzy Cognitive Map Hierarchical Triage Decision Support for the Elderly

Authors:

Voula C. Georgopoulos and Chrysostomos D. Stylios

Abstract: Fuzzy Cognitive Maps (FCMs) is a soft computing technique that has successfully been used to model complex systems and to develop Medical Decision Support Systems for many medical discipline applications. FCMs have a great ability to handle complexity, uncertainty and abstract inference as is the case in the health care sector. In this work a Hierarchical structure is introduced within an integrated health system where the Supervisor is modelled as an abstract FCM to support the triaging procedure. At the lower level, the FCM-ESI DSS is used to estimate the Triage ESI level of every patient. This FCM-ESI DSS is developed based on a novel approach, which ensures a high degree of inferring from human experts.

Paper Nr: 14
Title:

Simulation and Optimization for Bed Re-organization at a Surgery Department

Authors:

Paolo Landa, Elena Tànfani and Angela Testi

Abstract: In this paper we focus our analysis on patient flows inside a hospital surgery department, with the aim of supporting the bed re-configuration following an “intensity of care” paradigm. The main contribution of this paper is to develop a Discrete Event Simulation (DES) model which describes the elective and emergent patient flows in a Surgery Department, and is able to evaluate the impact of re-organizing hospital resources within the Department. The model has been applied to reproduce a case study of a General Surgery Department sited in Genova (Italy). Firstly, the model has been used to quantify the impact on a set of performance indicators of the re-organization of a "traditional" stay area into an "intensity of care" one. Following this re-organization the available beds capacity is no longer divided into operating units based on the pathology and medical discipline, but into three different stay areas homogeneous with respect of the complexity of care to be delivered. Secondly, by using the “Optimizer” module, embedded in the Witness simulation software, the best number of beds to be assigned to each Intensity of Care Level (ICL) is determined in order to maximize the number of patients operated. The model development is presented and preliminary results are analyzed and discussed.

Short Papers
Paper Nr: 6
Title:

A System Dynamics Study of an Emergency Department Impact on the Management of Hospital’s Surgery Activities

Authors:

Lucia Cassettari, Roberto Mosca, Andrea Orfeo, Roberto Revetria, Fabio Rolando and J. Bradley Morrison

Abstract: In Italian hospitals equipped with an Emergency Department (ED), it is possible that patients coming from such a structure occupy beds that had previously been scheduled for other patients. This happens because of some law regulations that give these kind of patients preferential access to hospitalization, and it may cause reduction in, or even stop, scheduled surgery activities. For such a reason operating theaters, surgery teams, sterilization structure, etc., are often unable to operate in an efficient way. Regarding costs and hospital management, this issue become considerable, and maybe even more unpleasant for patients on the waiting list since their scheduled surgery date generally is delayed by a long time. Studying an ED, the authors decided to build a System Dynamics model to analyze the impact of the admission from ED on other hospital structures, and thus identify the critical threshold. Some “non trivial” corrective actions have been evaluated in order to suggest how to address the problem which is currently causing internal conflicts and, if not managed, is destined to grow over time.

Paper Nr: 7
Title:

Mobile App and Website for Major Depression Monitoring

Authors:

Àngela Nebot, Francisco Mugica and Luca Abdollahi

Abstract: One of the challenges for the patients diagnosed with major depression is not to experience relapse or reoccurrence which are very common characteristics of major depression. Providing constant monitoring of these patients during their daily life for the first year of their depression can have a significant impact on preventing these patients to experience reoccurrence and relapse. In this paper we describe an intelligent remote monitoring system that is in the process of development and present the new research done centered on the interaction between the system and the actors involved, i.e. patients, psychiatrists and primary care physicians. This interaction is done through an android application for mobile telephones and a Website. The specification and design of the information requested and submitted to system actors through both platforms is performed by the communication module, which is also described in this research.