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Optimal control of ICU patient discharge: from theory to implementation

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  • Fermín Mallor
  • Cristina Azcárate
  • Julio Barado

Abstract

This paper deals with the management of scarce health care resources. We consider a control problem in which the objective is to minimize the rate of patient rejection due to service saturation. The scope of decisions is limited, in terms both of the amount of resources to be used, which are supposed to be fixed, and of the patient arrival pattern, which is assumed to be uncontrollable. This means that the only potential areas of control are speed or completeness of service. By means of queuing theory and optimization techniques, we provide a theoretical solution expressed in terms of service rates. In order to make this theoretical analysis useful for the effective control of the healthcare system, however, further steps in the analysis of the solution are required: physicians need flexible and medically-meaningful operative rules for shortening patient length of service to the degree needed to give the service rates dictated by the theoretical analysis. The main contribution of this paper is to discuss how the theoretical solutions can be transformed into effective management rules to guide doctors’ decisions. The study examines three types of rules based on intuitive interpretations of the theoretical solution. Rules are evaluated through implementation in a simulation model. We compare the service rates provided by the different policies with those dictated by the theoretical solution. Probabilistic analysis is also included to support rule validity. An Intensive Care Unit is used to illustrate this control problem. The study focuses on the Markovian case before moving on to consider more realistic LoS distributions (Weibull, Lognormal and Phase-type distribution). Copyright Springer Science+Business Media New York 2015

Suggested Citation

  • Fermín Mallor & Cristina Azcárate & Julio Barado, 2015. "Optimal control of ICU patient discharge: from theory to implementation," Health Care Management Science, Springer, vol. 18(3), pages 234-250, September.
    • Handle: RePEc:kap:hcarem:v:18:y:2015:i:3:p:234-250
    DOI: 10.1007/s10729-015-9320-8
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    References listed on IDEAS

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    1. Fermín Mallor & Cristina Azcárate, 2014. "Combining optimization with simulation to obtain credible models for intensive care units," Annals of Operations Research, Springer, vol. 221(1), pages 255-271, October.
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    Cited by:

    1. Emily Zhu & Beste Kucukyazici & Yasmina Maizi, 2020. "Designing Observation Units for Heart Failure Patients: Capacity and Patient Flow Considerations," Service Science, INFORMS, vol. 12(1), pages 8-25, March.
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    3. Ruoyan Sun & David Mendez, 2019. "Finding the optimal mix of smoking initiation and cessation interventions to reduce smoking prevalence," PLOS ONE, Public Library of Science, vol. 14(3), pages 1-12, March.
    4. Azcarate, Cristina & Esparza, Laida & Mallor, Fermin, 2020. "The problem of the last bed: Contextualization and a new simulation framework for analyzing physician decisions," Omega, Elsevier, vol. 96(C).

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