Recently, the combination of machine learning (ML) and simulation is gaining a lot of attention. This paper presents a novel application of ML within the simulation to improve patient flow within an emergency department (ED). An ML model used within a real ED simulation model to quantify the effect of detouring a patient out of the ED on the length of stay (LOS) and door-to-doctor time (DTDT) as a response to the prediction of patient admission to the hospital from the ED. The ML model trained using a set of six features including the patient age, arrival day, arrival hour of the day, and the triage level. The prediction model used a decision tree (DT) model, which is trained using historical data achieves a 75% accuracy. The set of rules extracted from the DT are coded within the simulation model. Given a certain probability of free inpatient beds, the predicted admitted patient is then pulled out from the ED to inpatient units to alleviate the crowding within the ED. The used policy combined with adding specific ED resources achieve 9.39% and 8.18% reduction in LOS and DTDT, respectively.
Predicting patient volumes in a hospital setting is a well-studied application of time series forecasting. Existing tools usually make forecasts at the daily or weekly level to assist in planning for staffing requirements. Prompted by new COVID-related capacity constraints placed on our pediatric hospital's emergency department, we developed an hourly forecasting tool to make predictions over a 24 hour window. These forecasts would give our hospital sufficient time to be able to martial resources towards expanding capacity and augmenting staff (e.g. transforming wards or bringing in physicians…
Hellenic Open University（希腊开放大学）；Sismanogleio General Hospital（西斯马诺格利奥综合医院）；Thoracic Diseases General Hospital Sotiria（索提里亚胸科疾病综合医院）；National and Kapodistrian University of Athens（雅典国家与卡波迪斯特里安大学）
Introduction: One of the most important tasks in the Emergency Department (ED) is to promptly identify the patients who will benefit from hospital admission. Machine Learning (ML) techniques show promise as diagnostic aids in healthcare. Material and methods: We investigated the following features seeking to investigate their performance in predicting hospital admission: serum levels of Urea, Creatinine, Lactate Dehydrogenase, Creatine Kinase, C-Reactive Protein, Complete Blood Count with differential, Activated Partial Thromboplastin Time, D Dimer, International Normalized Ratio, age, gender,…
Emergency Departments (EDs) overcrowding is a well recognized worldwide phenomenon. The consequences range from long waiting times for visits and treatment of patients up to life-threatening health conditions. The international community is devoting greater and greater efforts to analyze this phenomenon aiming at reducing waiting times, improving the quality of the service. Within this framework, we propose a Discrete Event Simulation (DES) model to study the patient flows through a medium-size ED located in a region of Central Italy recently hit by a severe earthquake. In particular, our aim …
University of North Carolina at Charlotte（北卡罗来纳大学夏洛特分校）；Clemson University（克莱姆森大学）；Prisma Health - Upstate（普里斯马健康-上州分部）
Emergency Department (ED) overcrowding continues to be a public health issue as well as a patient safety issue. The underlying factors leading to ED crowding are numerous, varied, and complex. Although lack of in-hospital beds is frequently attributed as the primary reason for crowding, ED's dependencies on other ancillary resources, including imaging, consults, and labs, also contribute to crowding. Using retrospective data associated with imaging, including delays, processing time, and the number of image orders, from a large tier 1 trauma center, we developed a discrete event simulation mod…
Temple University（天普大学）；Lewis Katz School of Medicine, Temple University（天普大学刘易斯·卡茨医学院）
Optimization of patient throughput and wait time in emergency departments (ED) is an important task for hospital systems. For that reason, Emergency Severity Index (ESI) system for patient triage was introduced to help guide manual estimation of acuity levels, which is used by nurses to rank the patients and organize hospital resources. However, despite improvements that it brought to managing medical resources, such triage system greatly depends on nurse's subjective judgment and is thus prone to human errors. Here, we propose a novel deep model based on the word attention mechanism designed …
Nowadays, the increase in patient demand and the decline in resources are lengthening patient waiting times in many chemotherapy oncology departments. Therefore, enhancing healthcare services is necessary to reduce patient complaints. Reducing the patient waiting times in the oncology departments represents one of the main goals of healthcare manager. Simulation models are considered an effective tool for identifying potential ways to improve patient flow in oncology departments. This paper presents a new agent-based simulation model designed to be configurable and adaptable to the needs of on…
Background: The stochastic behavior of patient arrival at an emergency department (ED) complicates the management of an ED. More than 50% of hospitals ED capacity tends to operate beyond its normal capacity and eventually fails to deliver high-quality care. To address the concern of stochastics ED arrivals, many types of research has been done using yearly, monthly and weekly time series forecasting. Aim: Our research team believes that hourly time-series forecasting of the load can improve ED management by predicting the arrivals of future patients, and thus, can support strategic decisions i…
Contemporary patient surveillance systems have streamlined central surveillance into the electronic health record interface. They are able to process the sheer volume of patient data by adopting machine learning approaches. However, these systems are not suitable for implementation in many hospitals, mostly in developing countries, with limited human, financial, and technological resources. Through conducting thorough research on intensive care facilities, we designed a novel central patient monitoring system and in this paper, we describe the working prototype of our system. The proposed prot…
Healthcare systems are challenged to deliver high-quality and efficient care. Studying patient flow in a hospital is particularly fundamental as it demonstrates effectiveness and efficiency of a hospital. Since hospital is a collection of physically nearby services under one administration, its performance and outcome are shaped by the interaction of its discrete components. Coordination of processes at different levels of organizational structure of a hospital can be studied using network analysis. Hence, this article presents a data-driven static and temporal network of departments. Both net…
There is a limited understanding of IT's role as a crucial enabler of patient agility and the department's ability to respond to patient's needs and wishes adequately. This study's objective is to contribute to the insights of the validity of the hypothesized relationship between IT resources, practices and capabilities, and hospital departments' knowledge processes and the department's ability to adequately sense and respond to patient needs and wishes, i.e., patient agility. This study conveniently sampled data from 107 clinical hospital departments in the Netherlands and uses structural equ…
Mednition Inc.（Mednition公司）；Emergency Nurses Association（急诊护士协会）；El Camino Hospital（埃尔卡米诺医院）；San Mateo Medical Center（圣马特奥医疗中心）；Adventist Health White Memorial（复临健康怀特纪念医院）；Ascension Health（阿森松医疗）；American Osteopathic Association（美国骨科协会）
Effective triage is critical to mitigating the effect of increased volume by accurately determining patient acuity, need for resources, and establishing effective acuity-based patient prioritization. The purpose of this retrospective study was to determine whether historical EHR data can be extracted and synthesized with clinical natural language processing (C-NLP) and the latest ML algorithms (KATE) to produce highly accurate ESI predictive models. An ML model (KATE) for the triage process was developed using 166,175 patient encounters from two participating hospitals. The model was then test…
The excessive rate of patients arriving at accident and emergency centres is a major problem facing South African hospitals. Patients are prioritized for medical care through a triage process. Manual systems allow for inconsistency and error. This paper proposes a novel system to automate accident and emergency centre triage and uses this triage score along with an artificial intelligence estimate of patient-doctor time to optimize the queue order. A fuzzy inference system is employed to triage patients and a similar system estimates the time but adapts continuously through fuzzy Q-learning. T…
Emergency Department Revisit Quality Review Screening: Exploring Human Decision-Making and Artificial Intelligence Support
OSF HealthCare（OSF医疗保健）；University of Illinois College of Medicine at Peoria（伊利诺伊大学皮奥里亚医学院）；Saint Anthony College of Nursing（圣安东尼护理学院）；Thomas Jefferson University's Sidney Kimmel College of Medicine（托马斯·杰斐逊大学西德尼·金梅尔医学院）；Keylog Solutions LLC（Keylog解决方案有限责任公司）
There is still a limited understanding of the necessary skill, talent, and expertise to manage digital technologies as a crucial enabler of the hospitals ability to adequately sense and respond to patient needs and wishes, i.e., patient agility. Therefore, this investigates how hospital departments can leverage a digital dy-namic capability to enable the departments patient agility. This study embraces the dynamic capabilities theory, develops a research model, and tests it accordingly using data from 90 clinical hospital departments from the Netherlands through an online survey. The model's h…
Managing health-care records and information is an imperative necessity. Most patient health records are stored in separate systems and there are still huge paper trails of records that health-care providers must keep to comply with different regulations. This paper proposes an RFID-based system, named SIMOPAC, that integrate RFID technology in health care in order to make patient emergency care as efficient and risk-free as possible, by providing doctors with as much information about a patient as quickly as possible. Every hospital could use SIMOPAC with their existing system in order to pro…
Paramedics often have to make lifesaving decisions within a limited time in an ambulance. They sometimes ask the doctor for additional medical instructions, during which valuable time passes for the patient. This study aims to automatically fuse voice and text data to provide tailored situational awareness information to paramedics. To train and test speech recognition models, we built a bidirectional deep recurrent neural network (long short-term memory (LSTM)). Then we used convolutional neural networks on top of custom-trained word vectors for sentence-level classification tasks. Each sente…
