A decision support system for demand and capacity modelling of an accident and emergency department

© 2019 Operational Research Society.Accident and emergency (A&E) departments in England have been struggling against severe capacity constraints. In addition, A&E demands have been increasing year on year. In this study, our aim was to develop a decision support system combining discrete event simulation and comparative forecasting techniques for the better management of the Princess Alexandra Hospital in England. We used the national hospital episodes statistics data-set including period April, 2009 – January, 2013. Two demand conditions are considered: the expected demand condition is based on A&E demands estimated by comparing forecasting methods, and the unexpected demand is based on the closure of a nearby A&E department due to budgeting constraints. We developed a discrete event simulation model to measure a number of key performance metrics. This paper presents a crucial study which will enable service managers and directors of hospitals to foresee their activities in future and form a strategic plan well in advance.Peer reviewe

Use of Rock Mass Rating (RMR) values for support designs of tunnels excavated in soft rocks without squeezing problem

Effect of the rock material strength on the RMR value and tunnel support designs were investigated within this study including site works, analytical and numerical analyses. It was found that rock material strength effect is quite limited in the RMR method to determine an accurate rock mass class to design tunnel support. Since the limitation, rock mass classes are evaluated to be usually misleading and supports designed in accordance with the RMR value are insufficient for tunnels excavated in rock masses with low strength values of rock materials. Totally, five different tunnels in Turkey have been supported using a new strength adjustment factor calculated in consideration of the in-situ stress and the uniaxial compressive strength values of rock materials. As confirmed by the field applications, analytical and numerical analyses, a newly modified RMR value (RMRus) was suggested to be used in tunnel support design works

Enabling better management of patients: discrete event simulation combined with the STAR approach

This is an Accepted Manuscript of an article published by Taylor & Francis Group in Journal of the Operational Research Society, on 1 May 2017, available online at: https://www.tandfonline.com/doi/full/10.1057/s41274-016-0029-y.Squeezed budgets and funding cuts are expected to become a feature of the healthcare landscape in the future, forcing decision makers such as service managers, clinicians and commissioners to find effective ways of allocating scarce resources. This paper discusses the development of a decision support toolkit (DST) that facilitates the improvement of services by identifying cost savings and efficiencies within the pathway of care. With the help of National Health Service and commercial experts, we developed a discrete event simulation model for Deep Vein Thrombosis (DVT) patients and adapted the socio technical allocation of resources (STAR) approach to answer crucial questions like: what sort of interventions should we spend our money on? Where will we get the most value for our investment? How will we explain the choices we have made? The DST enables users to model their own services by working with the DST interface allowing users to specify local DVT services. They can input local estimates, or data of service demands and capacities, thus creating a baseline discrete event simulation model. The user can then compare the baseline with potential changes in the patient pathway in the safety of a virtual environment. By making such changes key decision makers can easily understand the impact on activity, cost, staffing levels, skill-mix, utilisation of resources and, more importantly, it allows them to find the interventions that have the highest benefit to patients and provide best value for money.Peer reviewe

Demand and Capacity Modelling for Acute Services using Discrete Event Simulation

This is a pre-copyedited, author-produced PDF of an article accepted for publication in Health Systems following peer review. The final publication [Demir, E., Gunal, M & Southern, D., Health Syst (2016), first published online March 11, 2016, is available at Springer via http://dx.doi.org/doi:10.1057/hs.2016.1 © 2016 Operational Research Society Ltd 2016Increasing demand for services in England with limited healthcare budget has put hospitals under immense pressure. Given that almost all National Health Service (NHS) hospitals have severe capacity constraints (beds and staff shortages) a decision support tool (DST) is developed for the management of a major NHS Trust in England. Acute activities are forecasted over a 5 year period broken down by age groups for 10 specialty areas. Our statistical models have produced forecast accuracies in the region of 90%. We then developed a discrete event simulation model capturing individual patient pathways until discharge (in A&E, inpatient and outpatients), where arrivals are based on the forecasted activity outputting key performance metrics over a period of time, e.g., future activity, bed occupancy rates, required bed capacity, theatre utilisations for electives and non-electives, clinic utilisations, and diagnostic/treatment procedures. The DST allows Trusts to compare key performance metrics for 1,000’s of different scenarios against their existing service (baseline). The power of DST is that hospital decision makers can make better decisions using the simulation model with plausible assumptions which are supported by statistically validated data.Peer reviewedFinal Accepted Versio

Ultrasound evaluation of metabolic syndrome patients with hepatosteatosis

Objective: The exact incidence of hepatosteatosis in patients with metabolic syndrome (MetS) is unknown; also there is no valid, simple and inexpensive method to evaluate and follow-up for patients with MetS. In our study, we aimed to demonstrate the frequency of hepatosteatosis, and whether demonstrate presence and degree of steatosis using liver ultrasonography may provide additional benefit for evaluating and following-up in MetS patients with non-alcoholic fatty liver disease. Methods: One hundred and twelve patients with MetS were included to the study. Patients divided into three groups; control group (n= 36) consisted of patients without hepatosteatosis, group 1 (n=43) consisted of patients with grade 1 hepatosteatosis. Finally, group 2 (n= 33) consisted of patients with grade 2 hepatosteatosis. The relationship between the presence and degree of the hepatosteatosis and MetS parameters were analyzed.Results: The incidence of hepatosteatosis was found 69.4% in patients with MetS. There were significantly differences in HOMA-IR, AST, ALT and GGT levels among control group and group 1 (p<0.05 for all). There were also significantly differences in waist circumference, fasting blood glucose, fasting insulin, HOMA-IR, AST, ALT, GGT, ferritin, CRP, sedimentation, uric acid and microalbuminuria levels among control group and group 2 (p<0.05 for all). Blood pressures and lipid profiles were similar among all groups (p>0.05 for all). Besides, there were significantly differences in waist circumferences, fasting insulin, HOMA-IR, GGT, uric acid, CRP levels among group 1 and 2 (p<0.05 for all).Conclusion: Our study indicates that MetS related parameters; especially insulin resistance, were significantly different in patients with hepatosteatosis compared to patients without hepatosteatosis. Because of the different measurment of waist circumferences among groups, we recommend to use liver ultrasonography and waist circumference together to evaluate and follow-up for MetS patients with hepatosteatosis. J Clin Exp Invest 2013; 4 (2): 153-158Key words: Fatty Liver, metabolic syndrome X, ultrasonograph

The Effect of Priming Treatments on Germination and Seedling Performance of Purslane (Portulaca oleracea) Seed Lots

This study was conducted to test the effect of a priming combination on the seed germination percentage and seedling emergence performance of purslane under climate chamber and field conditions. Four purslane seed lots were treated according five different methods, which were T1: Seeds kept at a hundred percent relative humidity for four hours at 20 °C; T2: Seeds kept at a hundred percent relative humidity for four hours at 20 °C, and then soaked in distilled water for 8 hours at 5 °C; T3: Seeds kept at a hundred percent relative humidity for four hours at 20 °C, and then soaked in distilled water for 8 hours at 20 °C; T4: Seeds soaked in distilled water for 8 hours at 5 °C; T5: Seeds soaked in distilled water for 8 hours at 20 °C; and C: Control (untreated). Seed germination was calculated for 14 days at 20 °C, seedling emergence percentages were calculated in the climatically-controlled chamber for 21 days at 22 °C, and in the field for 35 days at 15-25 °C. The highest seed germination (94%) and seedling emergence in the climatically-controlled chamber (87%) and field (82%) were obtained from seeds that had been kept at a hundred percent relative humidity for four hours at 20 °C, then soaked in distilled water for eight hours at 5 °C. Results indicated that farm-priming, can be an efficient priming method in purslane seeds

Length Effect on Load Bearing Capacities of Friction Rock Bolts

Change in the load bearing capacity of the split set type friction rock bolts with variations of bolt lengths was investigated within this study. To determine a relation between the load bearing capacity and bolt length parameters, different friction bolt models with various lengths were analyzed with a numerical modelling study. In addition, a series of pull-out tests was carried out to evaluate the load bearing capacities of the split set type friction rock bolts with different lengths. The load bearing capacity of the bolts was found to decreasingly increase with the increase in the bolt length. As an outcome of this study, a relation between the load bearing capacity and rock bolt length parameters is suggested in accordance with the results obtained from both numerical and experimental studies

A decision support tool for health service re-design

Many of the outpatient services are currently only available in hospitals, however there are plans to provide some of these services alongside with General Practitioners. Consequently, General Practitioners could soon be based at polyclinics. These changes have caused a number of concerns to Hounslow Primary Care Trust (PCT). For example, which of the outpatient services are to be shifted from the hospital to the polyclinic? What are the current and expected future demands for these services? To tackle some of these concerns, the first phase of this project explores the set of specialties that are frequently visited in a sequence (using sequential association rules). The second phase develops an Excel based spreadsheet tool to compute the current and expected future demands for the selected specialties. From the sequential association rule algorithm, endocrinology and ophthalmology were found to be highly associated (i.e. frequently visited in a sequence), which means that these two specialties could easily be shifted from the hospital environment to the polyclinic. We illustrated the Excel based spreadsheet tool for endocrinology and ophthalmology, however, the model is generic enough to cope with other specialties, provided that the data are available