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Can network science reveal structure in a complex healthcare system? A network analysis using data from emergency surgical services.

ABSTRACT: INTRODUCTION:Hospitals are complex systems and optimising their function is critical to the provision of high quality, cost effective healthcare. Metrics of performance have to date focused on the performance of individual elements rather than the whole system. Manipulation of individual elements of a complex system without an integrative understanding of its function is undesirable and may lead to counterintuitive outcomes and a holistic metric of hospital function might help design more efficient services. OBJECTIVES:We aimed to use network analysis to characterise the structure of the system of perioperative care for emergency surgical admissions in our tertiary care hospital. DESIGN:We constructed a weighted directional network representation of the emergency surgical services using patient location data from electronic health records. SETTING:A single-centre tertiary care hospital in the UK. PARTICIPANTS:We selected data from the retrospective electronic health record data of all unplanned admissions with a surgical intervention during their stay during a 3.5-year period, which resulted in a set of 16?500 individual admissions. METHODS:We then constructed and analysed the structure of this network using established methods from network science such as degree distribution, betweenness centrality and small-world characteristics. RESULTS:The analysis showed the service to be a complex system with scale-free, small-world network properties. We also identified such potential hubs and bottlenecks in the system. CONCLUSIONS:Our holistic, system-wide description of a hospital service may provide tools to inform service improvement initiatives and gives us insights into the architecture of a complex system of care. The implications for the structure and resilience of the service is that while being robust in general, the system may be vulnerable to outages at specific key nodes.

SUBMITTER: Kohler K

PROVIDER: S-EPMC7044848 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Can network science reveal structure in a complex healthcare system? A network analysis using data from emergency surgical services.

Kohler Katharina K Ercole Ari A

BMJ open 20200209 2

<h4>Introduction</h4>Hospitals are complex systems and optimising their function is critical to the provision of high quality, cost effective healthcare. Metrics of performance have to date focused on the performance of individual elements rather than the whole system. Manipulation of individual elements of a complex system without an integrative understanding of its function is undesirable and may lead to counterintuitive outcomes and a holistic metric of hospital function might help design mor ...[more]

PMID: 32041860

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Project description:Due to the ubiquitous nature of disruptive extreme events, functionality of the critical infrastructure systems (CIS) is constantly at risk. In case of a disruption, in order to minimize the negative impact to the society, service networks operating on the CIS should be restored as quickly as possible. In this paper, we introduce a novel network science inspired measure to quantify the criticality of components within a disrupted service network and develop a restoration heuristic (Cent-Restore) that prioritizes restoration efforts based on this measure. As an illustrative case study, we consider a road network blocked by debris in the aftermath of a natural disaster. The debris obstructs the flow of relief aid and search-and-rescue teams between critical facilities and disaster sites, debilitating the emergency service network. In this context, the problem is defined as finding a schedule to clear the roads with the limited resources. First, we develop a mixed-integer programming model for the problem. Then we validate the efficiency and accuracy of the Cent-Restore heuristic on randomly generated instances by comparing it to the model. Furthermore, we use Cent-Restore to recommend real-time restoration plans for disrupted road networks of Boston and Manhattan and analyze the performance of the plans over time through resilience curves. We compare Cent-Restore to the current restoration guidelines proposed by FEMA and other strategies that prioritize the restoration efforts based on different measures. As a result we confirm the importance of including specific post-disruption attributes of the networks to create effective restoration strategies. Moreover, we explore the relationship between a service network's resilience and its topological and operational characteristics under different disruption scenarios. The methods and insights provided in this work can be extended to other disrupted large-scale critical infrastructure systems in which the ultimate goal is to enable the functions of the overlaying service networks.

Project description:BACKGROUND:Patient prioritization is a strategy used to manage access to healthcare services. Patient prioritization tools (PPT) contribute to supporting the prioritization decision process, and to its transparency and fairness. Patient prioritization tools can take various forms and are highly dependent on the particular context of application. Consequently, the sets of criteria change from one context to another, especially when used in non-emergency settings. This paper systematically synthesizes and analyzes the published evidence concerning the development and challenges related to the validation and implementation of PPTs in non-emergency settings. METHODS:We conducted a systematic mixed studies review. We searched evidence in five databases to select articles based on eligibility criteria, and information of included articles was extracted using an extraction grid. The methodological quality of the studies was assessed by using the Mixed Methods Appraisal Tool. The article selection process, data extraction, and quality appraisal were performed by at least two reviewers independently. RESULTS:We included 48 studies listing 34 different patient prioritization tools. Most of them are designed for managing access to elective surgeries in hospital settings. Two-thirds of the tools were investigated based on reliability or validity. Inconclusive results were found regarding the impact of PPTs on patient waiting times. Advantages associated with PPT use were found mostly in relationship to acceptability of the tools by clinicians and increased transparency and equity for patients. CONCLUSIONS:This review describes the development and validation processes of PPTs used in non-urgent healthcare settings. Despite the large number of PPTs studied, implementation into clinical practice seems to be an open challenge. Based on the findings of this review, recommendations are proposed to develop, validate, and implement such tools in clinical settings. SYSTEMATIC REVIEW REGISTRATION:PROSPERO CRD42018107205.

Project description:BackgroundThe COVID-19 pandemic represents an unprecedented severe test for emergency medicine in Germany. In addition to in-hospital emergency medicine, prehospital emergency medicine has the decisive task of fully guaranteeing emergency medical healthcare. In this article the Berlin Fire Brigade shows new ways for emergency medical services to fulfil these increased responsibilities during the pandemic in prehospital emergency medicine in the State of Berlin.MethodsA systematic presentation of the challenges and conceptional responses of preclinical emergency medicine to the COVID-19 pandemic was carried out using the example of the emergency medical services in the State of Berlin.ResultsThe Berlin Fire Brigade has a dispatch center that coordinates all requests for assistance in the State of Berlin over the emergency telephone number 112. On average a total of 2565 emergency calls are received every 24 h, from which 1271 missions are generated. During the pandemic there was a striking increase in missions to patients with acute respiratory diseases (ARD). Of the missions 11% were carried out to patients with the suspicion of COVID-19. The duration of the emergency calls was extended on average by 1:36 min due to the additional questions in the pandemic protocol and the duration of the mission by an average of 17 min with the additional alarm keyword acute respiratory disease (ARD).ConclusionThe continuing pandemic reveals that tasks and responsibilities of public services in emergency rescue go far beyond the immediate medical prevention of danger to life and limb. In addition to the controller and triage functions in the integrated dispatch center of the Berlin Fire Brigade (112), the emergency and healthcare measures could be ensured. This was accomplished by comprehensive measures for situation control, situation reports and mastering situations despite the lack of alternative outpatient care options, especially in the areas of general practitioner, public health care and medical specialist practices.

Project description:ObjectiveTo evaluate the impact of an intervention improving the continuum of care monitoring (CCM) within HIV public healthcare services in São Paulo, Brazil, and implementing a clinical monitoring system. This system identified three patient groups prioritized for additional care engagement: (1) individuals diagnosed with HIV, but not receiving treatment (the treatment gap group); (2) individuals receiving treatment for >6 months with a detectable viral load (the virologic failure group); and (3) patients lost to follow-up (LTFU).MethodsThe implementation strategies included three training sessions, covering system logistics, case discussions, and development of maintenance goals. These strategies were conducted within 30 HIV public healthcare services (May 2019 to April 2020). After each training session, professionals shared their experiences with CCM at regional meetings. Before and after the intervention, providers were invited to answer 23 items from the normalization process theory questionnaire (online) to understand contextual factors. The mean item scores were compared using the Mann-Whitney U test. The RE-AIM implementation science framework (evaluating reach, effectiveness, adoption, implementation, and maintenance) was used to evaluate the integration of the CCM.ResultsIn the study, 47 (19.3%) of 243 patients with a treatment gap initiated treatment, 456 (49.1%) of 928 patients with virologic failure achieved suppression, and 700 of 1552 (45.1%) LTFU patients restarted treatment. Strategies for the search and reengagement of patients were developed and shared. Providers recognized the positive effects of CCM on their work and how it modified existing activities (3.7 vs. 4.4, p<0.0001, and 3.9 vs. 4.1, p<0.05); 27 (90%) centers developed plans to sustain routine CCM.ConclusionImplementing CCM helped identify patients requiring more intensive attention. This intervention led to changes in providers' perceptions of CCM and care and management processes, which increased the number of patients engaged across the care continuum and improved outcomes.

Project description:BackgroundThe municipalities are responsible for the emergency primary health care services in Norway. These services include casualty clinics, primary doctors on-call and local emergency medical communication centres (LEMC). The National centre for emergency primary health care has initiated an enterprise called "The Watchtowers", comprising emergency primary health care districts, to provide routine information (patients' way of contact, level of urgency and first action taken by the out-of-hours services) over several years based on a minimal dataset. This will enable monitoring, evaluation and comparison of the respective activities in the emergency primary health care services. The aim of this study was to assess incidence of emergency contacts (potential life-threatening situations, red responses) to the emergency primary health care service.MethodsA representative sample of Norwegian emergency primary health care districts, "The Watchtowers" recorded all contacts and first action taken during the year of 2007. All the variables were continuously registered in a data program by the attending nurses and sent by email to the National Centre for Emergency Primary Health Care at a monthly basis.ResultsDuring 2007 the Watchtowers registered 85 288 contacts, of which 1 946 (2.3%) were defined as emergency contacts (red responses), corresponding to a rate of 9 per 1 000 inhabitants per year. 65% of the instances were initiated by patient, next of kin or health personnel by calling local emergency medical communication centres or meeting directly at the casualty clinics. In 48% of the red responses, the first action taken was a call-out of doctor and ambulance. On a national basis we can estimate approximately 42 500 red responses per year in the EPH in Norway.ConclusionThe emergency primary health care services constitute an important part of the emergency system in Norway. Patients call the LEMC or meet directly at casualty clinics with medical problems that initially are classified as a potentially life-threatening situation, a red response.

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Can network science reveal structure in a complex healthcare system? A network analysis using data from emergency surgical services.

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Can network science reveal structure in a complex healthcare system? A network analysis using data from emergency surgical services.

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