The purpose of this article is to bring an insight into a situation we may encounter during the control of the disease, mediation, and the rehabilitation stages of the virus outbreaks…

NISHITA CHELLUN

Operations Research (OR) is a field of mathematics that is used extensively in different areas of decision-making at governmental, and corporate sectors. As its name implies it is used at the operational level in decisions for resource allocation, management of the supply chain, job/staff scheduling, flight routes, inventory control amongst others. It plays a significant role in the improvement of a number of corporate activities for the optimization of management decisions. OR was developed by Philip McCord Morse, an American physicist. Together with his colleagues made crucial contributions during World War II thereby, playing a major role in operational decisions to winning the war.

In the midst of the global COVID-19 pandemic, governments, companies, the community as a whole, and even heads of households have had to create new system designs and adjust procedures to fight the virus. Numerous issues related to ultimate enhancement of these systems and their operations can be tackled by the extension of the traditional OR by approaching them with new objectives, constraints and up to date data.

The purpose of this article is to bring an insight into a situation we may encounter during the control of the disease, mediation, and the rehabilitation stages of the virus outbreaks if there were over 1000 positive cases of COVID-19 tomorrow, which we hope we never reach. This will create a scenario of high demand of hospital beds under very tight resources. Mauritius has already started taking the pressure off the shoulders of hospitals by using hotels & other buildings for quarantine purposes.

The ultimate question that has been asked over and over is “How do we flatten the curve?” meaning how we reduce the incidence of the pandemic within the community. That is where OR comes in to help tackle this problem. OR, in simplified terms, will use data and convert the latter to actions and then move on to solutions.

During the current virus outbreak, it is important to guarantee the rehabilitation treatment of people suffering from serious chronic illnesses. Simultaneously, it is key to efficiently prevent cross-infection and intercept infections from happening within the hospital setting as well as the avoidance of over crowdedness. Unfortunately, this has already occurred owing to resource scarcity or misallocation and possibly a departure or relaxation of strict protocol. A certain queuing model with priority has to be used for proper analysis of this scenario, so that severely ill people can be treated in time while patients who present mild symptoms could be treated at home instead. This viewpoint will not only ease the bed tension in hospital wards, but also yield optimal conditions for the control and risk of cross-infection. It should be noted that the hospital bed is one of the most essential resources in a hospital. Who do we allocate a bed to? The COVID-19 patient or the person suffering from diabetic complications?

We first start by tackling this problem by dividing patients into different types. The wards for each patient type should be separated.

1)   Input data – what do we know?

Firstly, we obtain the stats about the average number of patients coming into the hospital daily. This will inevitably be approximate data since hospitals have demand variations on different days of the week and there are constantly changing scenarios with the day-to-day complexities of bed management systems within the wards. Moreover, the incoming patients have to be classified upon arrival at the hospital through triage, to determine whether they fall under the following three categories: severe patients (high priority), scheduled patients, or mild patients (low priority).

2)  Decision variables – what needs to be decided

Now, we have to create plans to gather more beds in the hospital wards where plastic sheets have to be used to separate the hospital beds particularly where treatment of COVID-19 patients is being done. Discharging patients that only have mild symptoms or who were staying at the hospital just to be under supervision and who present no complications, reducing the admission of patients who do not require non COVID-19 care, determining of how to allocate the scarce resources within the hospital. Decisions on how to assign appropriate shifts to doctors and nurses.

3)    Goals-What are the solutions?

a.      Group all patients with mild symptoms to a central quarantine place for their respective treatments.
b.      Patients who are in a relatively less critical condition are discharged early to make room for other patients who are deemed more critical (patient admission control).
c.       Scheduled patients are sent home and will be contacted for another appointment at a later date. In other words, development of patient classification and implementation of triage protocols through data collection has to be done.
d.      Proper allocation of capacity implying deciding on the number of beds and medical staff to be appointed in a particular ward.
e.      Administration and staff have to be trained more because the latter were undoubtedly never trained for this type of stressful new situation.

Bed management is a very complex matter within the healthcare system. While this scenario limits itself only to bed allocations in hospitals, OR can efficiently allocate the available beds to the high priority patients in a way that the “greatest good is achieved for the greatest number of patients.” We will not ignore the complexity of this decision problem in practice, but simple policies will work in an adequate manner. The approach will ensure that not only COVID-19 patients are treated but chronic illnesses will also be treated as a top priority when patients enter the hospital while also controlling the issue of cross infection. OR will undoubtedly improve healthcare operations whereby the issue of bed allocations was the only problem discussed, but it can also help tackle the staff planning and also tackle ambulance dispatch. Mauritius ought to sustain strict measures to control the rate of new cases and carry on upgrading our ICU surge capacity, lest we squander the possibility to prevent an Italian fate.

References

http://www-personal.umich.edu/~siqian/docs/OR-IE-for-fighting-COVID-19.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7267520/