Academic articles

Optimizing Home Hospital Health Service Delivery in Norway Using a Combined Geographical Information System, Agent Based, Discrete Event Simulation Model


Home hospital services; provide some hospital level services at the patient’s residence. The services include for example: palliative care, administering chemotherapy drugs, changing dressings and care for newborns. The rationale of the service is that by providing high quality care to patients at their homes their experience of the care is better and hence they respond to the treatment and/or recover quicker and are less likely to need to report to hospital to receive care for more serious/expensive conditions. The aim of this study is to evaluate the effectiveness of the home hospital service, to optimize the current configuration given existing constraints and to evaluate potential future scenarios. Using a combined discrete event simulation, agent based model and geographical information system we assess the system effects of different demand patterns, appointment scheduling algorithms (e.g. travelling salesman problem), varying levels of resource on patient outcomes and impact on hospital visits.

Exploring Cannulation Process in Chemotherapy through a Computer Simulation


The aim of this study is twofold. Firstly, to demonstrate how combining computer simulation, data from multiple data sources, and statistical methods, can extend the understanding of the issues associated with process modelling and analysis in healthcare environment, and therefore contribute to improvements in resource utilisation and safety in hospitals. Secondly, to provide simple re-useable methodology for cross-validation of multiple data-sources such as interviews, hospital IT data management systems and simulation results. The insights from this study are threefold. Firstly, the accuracy of the estimates of duration of cannulation obtained through the interviews with the nurses and the chemotherapy unit manager is very high. Secondly, although the duration estimates were precise, the process descriptions obtained through interviews with nurses were oversimplified or incomplete and therefore did not realistically reflect complexity of a medical process with a significant number of relatively rarely occurring exceptions. Thirdly, by combining multiple data-sources it is possible to reduce costs associated with observation as a most expensive data-capturing approach. A detailed exposure of the methodology including step-by-step description is provided to facilitate conducting similar research in hospitals in the future.

Evaluation of discovered clinical pathways using process mining and joint agent-based discrete-event simulation


The analysis of clinical pathways from event logs provides new insights about care processes. In this paper, we propose a new methodology to automatically perform simulation analysis of patients’ clinical pathways based on a national hospital database. Process mining is used to build highly representative causal nets, which are then converted to state charts in order to be executed. A joint multi-agent discrete-event simulation approach is used to implement models. A practical case study on patients having cardiovascular diseases and eligible to receive an implantable defibrillator is provided. A design of experiments has been proposed to study the impact of medical decisions, such as implanting or not a defibrillator, on the relapse rate, the death rate and the cost. This approach has proven to be an innovative way to extract knowledge from an existing hospital database through simulation, allowing the design and test of new scenarios.

A structured approach for constructing high fidelity ED simulation


This paper presents a structured approach to building a high-fidelity simulation for an emergency department. Our approach has three key features. First, we use the concept of modules as a building block for modeling. A module is a minimum unit that has clinical or administrative meanings in ED operation, and it consists of low level operational activities. Second, we use a structured template to formally represent modules, and we adopt notations and grammars from the business process modeling notation. This provides an enhanced clarity and transparency, which proves very useful in extracting necessary data from a hospital database or from interviewing ED staff. Finally, we define an interface, specifically data structure and handler, for converting information represented in the modules into simulation languages. This interface makes it possible to seamlessly link the modeling process to the implementation process in the simulation construction.

Modeling of healthcare systems: past, current and future trends


Increasing demand for healthcare services, due to changes in demographic shifts and constraints in healthcare funding, make it harder to manage effective, sustainable healthcare systems. Many healthcare modeling exercises have been undertaken with the aim of supporting the decision-making process. This paper reviews all of the 456 articles published by the Winter Simulation Conference over the past 48 years (1967–2015) on the subject of modeling and healthcare system simulation, and analyzes the relative frequency of approaches used. A multi-dimensional taxonomy is applied to encompass the modeling techniques, problem applications and decision levels reported in the articles. One of the most significant changes in the modeling of healthcare systems is the fact that Discrete-event Simulation (DES) is no longer used as an autonomous method, but rather as an integral part of the solution. The mixed-methods, hybrid and multi-paradigm approaches feature strongly in the current direction of modeling in healthcare systems.

Hospital processes within an integrated system view: a hybrid simulation approach


Processes in hospitals or in other healthcare institutions are usually analyzed and optimized isolated for enclosed organizations like single hospital wards or certain clinical pathways. However, many workflows should be considered in a broader scope in order to better represent the reality, i.e., in combination with other processes and in contexts of macro structures. Therefore, an integrated view is necessary which enables to combine different coherences. This can be achieved by hybrid simulation. In this case, processes can be modeled and simulated by discrete simulation techniques (i.e., DES or ABS) at the meso-level. However, holistic structures can be comfortably implemented using continuous methods (i.e., SD). This paper presents a theoretical approach that enables to consider reciprocal influences between processes and higher level entities, but also to combine hospital workflows with other subjects (e.g., ambulance vehicles).

Using hybrid simulation modeling to assess the dynamics of compassion fatigue in veterinarian general practitioners


Veterinarians have experienced disturbing trends related to workplace-induced stress. This is partly attributed to high levels of compassion fatigue, the emotional strain of unalleviated stress from interactions with those suffering from traumatic events. This paper presents a three-stage hybrid model designed to study the dynamics of compassion fatigue in veterinarians. A discrete event simulation that represents the work environment is used to generate client and patient attributes, and the veterinarian’s utilization throughout the day. These values become inputs to a system dynamics model that simulates the veterinarian’s interpretation of the work environment to produce quantifiable emotional responses in terms of eight emotions. The emotional responses are mapped to the Professional Quality of Life Scale, which enables the calculation of compassion satisfaction, burnout, and secondary traumatic stress measures. A pilot study using the hybrid model was conducted to assess the viability of the proposed approach, which yielded statistically significant results.

Improving patient access to a public hospital complex using agent simulation


This paper uses agent based simulation to assess the effect of redesigning the points of access to a major public hospital complex in Chile, where nearly 15,000 people will pass through daily. The study is carried out by simulating pedestrian traffic in order to calculate density maps and service levels in hospital access and ramps. The simulation allows us to evaluate the flow of people and assess the layout performance, by identifying high patient flow areas and congested pedestrian traffic zones. By using this approach, it is possible to suggest changes to the original design and to improve pedestrian flow at hospital access points and ramps. The suggested changes reveal that pedestrian indicators could be improved, which in turn would improve the level of satisfaction of patients, relatives, and hospital personnel. A higher satisfaction level would help to reduce stress linked to hospital facilities and crowded spaces.

Harnessing advances in computer simulation to inform policy and planning to reduce alcohol-related harms


Alcohol misuse is a complex systemic problem. The aim of this study was to explore the feasibility of using a transparent and participatory agent-based modelling approach to develop a robust decision support tool to test alcohol policy scenarios before they are implemented in the real world. Methods A consortium of Australia’s leading alcohol experts was engaged to collaboratively develop an agent-based model of alcohol consumption behavior and related harms. As a case study, four policy scenarios were examined.

A multimethod computational simulation approach for investigating mitochondrial dynamics and dysfunction in degenerative aging


Research in biogerontology has largely focused on the complex relationship between mitochondrial dysfunction and biological aging. In particular, the mitochondrial free radical theory of aging (MFRTA) has been well accepted. However, this theory has been challenged by recent studies showing minimal increases in reactive oxygen species (ROS) as not entirely deleterious in nature, and even beneficial under the appropriate cellular circumstances. To assess these significant and nonintuitive observations in the context of a functional system, we have taken an in silico approach to expand the focus of the MFRTA by including other key mitochondrial stress response pathways, as they have been observed in the nematode Caenorhabditis elegans. These include the mitochondrial unfolded protein response (UPRmt), mitochondrial biogenesis and autophagy dynamics, the relevant DAF-16 and SKN-1 axes, and NAD+-dependent deacetylase activities. To integrate these pathways, we have developed a multilevel hybrid-modeling paradigm, containing agent-based elements among stochastic system-dynamics environments of logically derived ordinary differential equations, to simulate aging mitochondrial phenotypes within a population of energetically demanding cells.