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A simulation environment for the dynamic evaluation of disaster preparedness policies and interventions.

ABSTRACT: Disasters affect a society at many levels. Simulation-based studies often evaluate the effectiveness of 1 or 2 response policies in isolation and are unable to represent impact of the policies to coevolve with others. Similarly, most in-depth analyses are based on a static assessment of the "aftermath" rather than capturing dynamics. We have developed a data-centric simulation environment for applying a systems approach to a dynamic analysis of complex combinations of disaster responses. We analyze an improvised nuclear detonation in Washington, District of Columbia, with this environment. The simulated blast affects the transportation system, communications infrastructure, electrical power system, behaviors and motivations of population, and health status of survivors. The effectiveness of partially restoring wireless communications capacity is analyzed in concert with a range of other disaster response policies. Despite providing a limited increase in cell phone communication, overall health was improved.

SUBMITTER: Lewis B

PROVIDER: S-EPMC3962069 | biostudies-literature | 2013 Sep-Oct

REPOSITORIES: biostudies-literature

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A simulation environment for the dynamic evaluation of disaster preparedness policies and interventions.

Lewis Bryan B Swarup Samarth S Bisset Keith K Eubank Stephen S Marathe Madhav M Barrett Chris C

Journal of public health management and practice : JPHMP 20130901

Disasters affect a society at many levels. Simulation-based studies often evaluate the effectiveness of 1 or 2 response policies in isolation and are unable to represent impact of the policies to coevolve with others. Similarly, most in-depth analyses are based on a static assessment of the "aftermath" rather than capturing dynamics. We have developed a data-centric simulation environment for applying a systems approach to a dynamic analysis of complex combinations of disaster responses. We anal ...[more]

PMID: 23903394

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Project description:BackgroundSince operating rooms are a major bottleneck resource and an important revenue driver in hospitals, it is important to use these resources efficiently. Studies estimate that between 60 and 70% of hospital admissions are due to surgeries. Furthermore, staffing cannot be changed daily to respond to changing demands. The resulting high complexity in operating room management necessitates perpetual process evaluation and the use of decision support tools. In this study, we evaluate several management policies and their consequences for the operating theater of the University Hospital Augsburg.MethodsBased on a data set with 12,946 surgeries, we evaluate management policies such as parallel induction of anesthesia with varying levels of staff support, the use of a dedicated emergency room, extending operating room hours reserved as buffer capacity, and different elective patient sequencing policies. We develop a detailed simulation model that serves to capture the process flow in the entire operating theater: scheduling surgeries from a dynamically managed waiting list, handling various types of schedule disruptions, rescheduling and prioritizing postponed and deferred surgeries, and reallocating operating room capacity. The system performance is measured by indicators such as patient waiting time, idle time, staff overtime, and the number of deferred surgeries.ResultsWe identify significant trade-offs between expected waiting times for different patient urgency categories when operating rooms are opened longer to serve as end-of-day buffers. The introduction of parallel induction of anesthesia allows for additional patients to be scheduled and operated on during regular hours. However, this comes with a higher number of expected deferrals, which can be partially mitigated by employing additional anesthesia teams. Changes to the sequencing of elective patients according to their expected surgery duration cause expectable outcomes for a multitude of performance indicators.ConclusionsOur simulation-based approach allows operating theater managers to test a multitude of potential changes in operating room management without disrupting the ongoing workflow. The close collaboration between management and researchers in the design of the simulation framework and the data analysis has yielded immediate benefits for the scheduling policies and data collection efforts at our practice partner.

Dataset Information

A simulation environment for the dynamic evaluation of disaster preparedness policies and interventions.

Publications

A simulation environment for the dynamic evaluation of disaster preparedness policies and interventions.

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