IDEAS home Printed from https://ideas.repec.org/a/kap/hcarem/v26y2023i2d10.1007_s10729-023-09632-9.html
   My bibliography  Save this article

A queuing model for ventilator capacity management during the COVID-19 pandemic

Author

Listed:
  • Samantha L. Zimmerman

    (Simon Fraser University)

  • Alexander R. Rutherford

    (Simon Fraser University)

  • Alexa Waall

    (Simon Fraser University)

  • Monica Norena

    (Center for Health Evaluation and Outcome Sciences)

  • Peter Dodek

    (Center for Health Evaluation and Outcome Sciences
    Division of Critical Care, Department of Medicine, Faculty of Medicine, The University of British Columbia)

Abstract

We applied a queuing model to inform ventilator capacity planning during the first wave of the COVID-19 epidemic in the province of British Columbia (BC), Canada. The core of our framework is a multi-class Erlang loss model that represents ventilator use by both COVID-19 and non-COVID-19 patients. Input for the model includes COVID-19 case projections, and our analysis incorporates projections with different levels of transmission due to public health measures and social distancing. We incorporated data from the BC Intensive Care Unit Database to calibrate and validate the model. Using discrete event simulation, we projected ventilator access, including when capacity would be reached and how many patients would be unable to access a ventilator. Simulation results were compared with three numerical approximation methods, namely pointwise stationary approximation, modified offered load, and fixed point approximation. Using this comparison, we developed a hybrid optimization approach to efficiently identify required ventilator capacity to meet access targets. Model projections demonstrate that public health measures and social distancing potentially averted up to 50 deaths per day in BC, by ensuring that ventilator capacity was not reached during the first wave of COVID-19. Without these measures, an additional 173 ventilators would have been required to ensure that at least 95% of patients can access a ventilator immediately. Our model enables policy makers to estimate critical care utilization based on epidemic projections with different transmission levels, thereby providing a tool to quantify the interplay between public health measures, necessary critical care resources, and patient access indicators.

Suggested Citation

  • Samantha L. Zimmerman & Alexander R. Rutherford & Alexa Waall & Monica Norena & Peter Dodek, 2023. "A queuing model for ventilator capacity management during the COVID-19 pandemic," Health Care Management Science, Springer, vol. 26(2), pages 200-216, June.
  • Handle: RePEc:kap:hcarem:v:26:y:2023:i:2:d:10.1007_s10729-023-09632-9
    DOI: 10.1007/s10729-023-09632-9
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s10729-023-09632-9
    File Function: Abstract
    Download Restriction: Access to the full text of the articles in this series is restricted.

    File URL: https://libkey.io/10.1007/s10729-023-09632-9?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Linda Green & Peter Kolesar, 1991. "The Pointwise Stationary Approximation for Queues with Nonstationary Arrivals," Management Science, INFORMS, vol. 37(1), pages 84-97, January.
    2. Linda V. Green & Peter J. Kolesar & João Soares, 2001. "Improving the Sipp Approach for Staffing Service Systems That Have Cyclic Demands," Operations Research, INFORMS, vol. 49(4), pages 549-564, August.
    3. Linda Green & Peter Kolesar & Anthony Svoronos, 1991. "Some Effects of Nonstationarity on Multiserver Markovian Queueing Systems," Operations Research, INFORMS, vol. 39(3), pages 502-511, June.
    4. Stef Baas & Sander Dijkstra & Aleida Braaksma & Plom Rooij & Fieke J. Snijders & Lars Tiemessen & Richard J. Boucherie, 2021. "Real-time forecasting of COVID-19 bed occupancy in wards and Intensive Care Units," Health Care Management Science, Springer, vol. 24(2), pages 402-419, June.
    5. R. Bekker & A. Bruin, 2010. "Time-dependent analysis for refused admissions in clinical wards," Annals of Operations Research, Springer, vol. 178(1), pages 45-65, July.
    6. Shlomo Halfin & Ward Whitt, 1981. "Heavy-Traffic Limits for Queues with Many Exponential Servers," Operations Research, INFORMS, vol. 29(3), pages 567-588, June.
    7. Otis B. Jennings & Avishai Mandelbaum & William A. Massey & Ward Whitt, 1996. "Server Staffing to Meet Time-Varying Demand," Management Science, INFORMS, vol. 42(10), pages 1383-1394, October.
    8. Linda V. Green & Peter J. Kolesar, 1995. "On the Accuracy of the Simple Peak Hour Approximation for Markovian Queues," Management Science, INFORMS, vol. 41(8), pages 1353-1370, August.
    9. Linda V. Green & Peter J. Kolesar, 1997. "The Lagged PSA for Estimating Peak Congestion in Multiserver Markovian Queues with Periodic Arrival Rates," Management Science, INFORMS, vol. 43(1), pages 80-87, January.
    10. Jimmie L. Davis & William A. Massey & Ward Whitt, 1995. "Sensitivity to the Service-Time Distribution in the Nonstationary Erlang Loss Model," Management Science, INFORMS, vol. 41(6), pages 1107-1116, June.
    11. Ingolfsson, Armann & Campello, Fernanda & Wu, Xudong & Cabral, Edgar, 2010. "Combining integer programming and the randomization method to schedule employees," European Journal of Operational Research, Elsevier, vol. 202(1), pages 153-163, April.
    12. Yin-Chi Chan & Eric W. M. Wong & Gavin Joynt & Paul Lai & Moshe Zukerman, 2018. "Overflow models for the admission of intensive care patients," Health Care Management Science, Springer, vol. 21(4), pages 554-572, December.
    13. Michael H. Rothkopf & Shmuel S. Oren, 1979. "A Closure Approximation for the Nonstationary M/M/s Queue," Management Science, INFORMS, vol. 25(6), pages 522-534, June.
    14. Izady, N. & Worthington, D., 2011. "Approximate analysis of non-stationary loss queues and networks of loss queues with general service time distributions," European Journal of Operational Research, Elsevier, vol. 213(3), pages 498-508, September.
    15. A. Bruin & R. Bekker & L. Zanten & G. Koole, 2010. "Dimensioning hospital wards using the Erlang loss model," Annals of Operations Research, Springer, vol. 178(1), pages 23-43, July.
    16. Alnowibet, Khalid Abdulaziz & Perros, Harry, 2009. "Nonstationary analysis of the loss queue and of queueing networks of loss queues," European Journal of Operational Research, Elsevier, vol. 196(3), pages 1015-1030, August.
    17. Richard M Wood & Christopher J McWilliams & Matthew J Thomas & Christopher P Bourdeaux & Christos Vasilakis, 2020. "COVID-19 scenario modelling for the mitigation of capacity-dependent deaths in intensive care," Health Care Management Science, Springer, vol. 23(3), pages 315-324, September.
    18. Litvak, Nelly & van Rijsbergen, Marleen & Boucherie, Richard J. & van Houdenhoven, Mark, 2008. "Managing the overflow of intensive care patients," European Journal of Operational Research, Elsevier, vol. 185(3), pages 998-1010, March.
    19. Zohar Feldman & Avishai Mandelbaum & William A. Massey & Ward Whitt, 2008. "Staffing of Time-Varying Queues to Achieve Time-Stable Performance," Management Science, INFORMS, vol. 54(2), pages 324-338, February.
    20. Jie Bai & Andreas Fügener & Jan Schoenfelder & Jens O. Brunner, 2018. "Operations research in intensive care unit management: a literature review," Health Care Management Science, Springer, vol. 21(1), pages 1-24, March.
    21. Asaduzzaman, Md & Chaussalet, Thierry J., 2014. "Capacity planning of a perinatal network with generalised loss network model with overflow," European Journal of Operational Research, Elsevier, vol. 232(1), pages 178-185.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Defraeye, Mieke & Van Nieuwenhuyse, Inneke, 2016. "Staffing and scheduling under nonstationary demand for service: A literature review," Omega, Elsevier, vol. 58(C), pages 4-25.
    2. Schwarz, Justus Arne & Selinka, Gregor & Stolletz, Raik, 2016. "Performance analysis of time-dependent queueing systems: Survey and classification," Omega, Elsevier, vol. 63(C), pages 170-189.
    3. Ran Liu & Xiaolan Xie, 2018. "Physician Staffing for Emergency Departments with Time-Varying Demand," INFORMS Journal on Computing, INFORMS, vol. 30(3), pages 588-607, August.
    4. R. Bekker & A. Bruin, 2010. "Time-dependent analysis for refused admissions in clinical wards," Annals of Operations Research, Springer, vol. 178(1), pages 45-65, July.
    5. Izady, Navid & Worthington, Dave, 2012. "Setting staffing requirements for time dependent queueing networks: The case of accident and emergency departments," European Journal of Operational Research, Elsevier, vol. 219(3), pages 531-540.
    6. J. G. Dai & Pengyi Shi, 2017. "A Two-Time-Scale Approach to Time-Varying Queues in Hospital Inpatient Flow Management," Operations Research, INFORMS, vol. 65(2), pages 514-536, April.
    7. Izady, N. & Worthington, D., 2011. "Approximate analysis of non-stationary loss queues and networks of loss queues with general service time distributions," European Journal of Operational Research, Elsevier, vol. 213(3), pages 498-508, September.
    8. Yuta Kanai & Hideaki Takagi, 2021. "Markov chain analysis for the neonatal inpatient flow in a hospital," Health Care Management Science, Springer, vol. 24(1), pages 92-116, March.
    9. Yue Zhang & Martin L. Puterman & Matthew Nelson & Derek Atkins, 2012. "A Simulation Optimization Approach to Long-Term Care Capacity Planning," Operations Research, INFORMS, vol. 60(2), pages 249-261, April.
    10. Eugene Furman & Adam Diamant & Murat Kristal, 2021. "Customer Acquisition and Retention: A Fluid Approach for Staffing," Production and Operations Management, Production and Operations Management Society, vol. 30(11), pages 4236-4257, November.
    11. Noah Gans & Ger Koole & Avishai Mandelbaum, 2003. "Telephone Call Centers: Tutorial, Review, and Research Prospects," Manufacturing & Service Operations Management, INFORMS, vol. 5(2), pages 79-141, September.
    12. Heemskerk, M. & Mandjes, M. & Mathijsen, B., 2022. "Staffing for many-server systems facing non-standard arrival processes," European Journal of Operational Research, Elsevier, vol. 296(3), pages 900-913.
    13. Niyirora, Jerome & Zhuang, Jun, 2017. "Fluid approximations and control of queues in emergency departments," European Journal of Operational Research, Elsevier, vol. 261(3), pages 1110-1124.
    14. Xi Chen & Dave Worthington, 2017. "Staffing of time-varying queues using a geometric discrete time modelling approach," Annals of Operations Research, Springer, vol. 252(1), pages 63-84, May.
    15. Wall, A.D. & Worthington, D.J., 2007. "Time-dependent analysis of virtual waiting time behaviour in discrete time queues," European Journal of Operational Research, Elsevier, vol. 178(2), pages 482-499, April.
    16. René Bekker & Paulien Koeleman, 2011. "Scheduling admissions and reducing variability in bed demand," Health Care Management Science, Springer, vol. 14(3), pages 237-249, September.
    17. Yang, Feng & Liu, Jingang, 2012. "Simulation-based transfer function modeling for transient analysis of general queueing systems," European Journal of Operational Research, Elsevier, vol. 223(1), pages 150-166.
    18. Armann Ingolfsson & Elvira Akhmetshina & Susan Budge & Yongyue Li & Xudong Wu, 2007. "A Survey and Experimental Comparison of Service-Level-Approximation Methods for Nonstationary M(t)/M/s(t) Queueing Systems with Exhaustive Discipline," INFORMS Journal on Computing, INFORMS, vol. 19(2), pages 201-214, May.
    19. Gabriel Zayas-Cabán & Mark E. Lewis, 2020. "Admission control in a two-class loss system with periodically varying parameters and abandonments," Queueing Systems: Theory and Applications, Springer, vol. 94(1), pages 175-210, February.
    20. Zohar Feldman & Avishai Mandelbaum & William A. Massey & Ward Whitt, 2008. "Staffing of Time-Varying Queues to Achieve Time-Stable Performance," Management Science, INFORMS, vol. 54(2), pages 324-338, February.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:kap:hcarem:v:26:y:2023:i:2:d:10.1007_s10729-023-09632-9. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.