Optimal national prioritization policies for hospital care during the SARS-CoV-2 pandemic.
Journal
Nature computational science
ISSN: 2662-8457
Titre abrégé: Nat Comput Sci
Pays: United States
ID NLM: 101775476
Informations de publication
Date de publication:
Aug 2021
Aug 2021
Historique:
received:
23
02
2021
accepted:
15
07
2021
medline:
1
8
2021
pubmed:
1
8
2021
entrez:
13
1
2024
Statut:
ppublish
Résumé
In response to unprecedented surges in the demand for hospital care during the SARS-CoV-2 pandemic, health systems have prioritized patients with COVID-19 to life-saving hospital care to the detriment of other patients. In contrast to these ad hoc policies, we develop a linear programming framework to optimally schedule elective procedures and allocate hospital beds among all planned and emergency patients to minimize years of life lost. Leveraging a large dataset of administrative patient medical records, we apply our framework to the National Health Service in England and show that an extra 50,750-5,891,608 years of life can be gained compared with prioritization policies that reflect those implemented during the pandemic. Notable health gains are observed for neoplasms, diseases of the digestive system, and injuries and poisoning. Our open-source framework provides a computationally efficient approximation of a large-scale discrete optimization problem that can be applied globally to support national-level care prioritization policies.
Identifiants
pubmed: 38217250
doi: 10.1038/s43588-021-00111-1
pii: 10.1038/s43588-021-00111-1
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
521-531Subventions
Organisme : Wellcome Trust (Wellcome)
ID : 102169/Z/13/Z
Organisme : RCUK | Medical Research Council (MRC)
ID : MR/R015600/1
Organisme : RCUK | Medical Research Council (MRC)
ID : MR/R015600/1
Organisme : RCUK | Medical Research Council (MRC)
ID : MR/R015600/1
Organisme : RCUK | Medical Research Council (MRC)
ID : MR/R015600/1
Organisme : RCUK | Medical Research Council (MRC)
ID : MR/R015600/1
Organisme : Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (Swiss National Science Foundation)
ID : P2ELP2_188028
Organisme : DH | National Institute for Health Research (NIHR)
ID : NIHR200908
Organisme : DH | National Institute for Health Research (NIHR)
ID : NIHR200908
Informations de copyright
© 2021. The Author(s).
Références
Birnbaum, M. & Morris, L. With coronavirus exploding in Europe, hospitals calculate how long until they hit capacity. The Washington Post (2 November 2020); https://www.washingtonpost.com/world/europe/covid-coronavirus-europe-hospitals-capacity/2020/10/31/fe074b56-188a-11eb-8bda-814ca56e138b_story.html
Emanuel, E. J. et al. Fair allocation of scarce medical resources in the time of COVID-19. N. Engl. J. Med. 382, 2049–2055 (2020).
doi: 10.1056/NEJMsb2005114
Coronavirus: Weston General Hospital halts admissions. BBC News (25 May 2020); https://www.bbc.co.uk/news/uk-england-somerset-52796589
Cullen, L. Covid-19: Elective surgery cancelled at Craigavon Hospital. BBC News NI (4 November 2020); https://www.bbc.co.uk/news/uk-northern-ireland-54801326
COVID-19 Rapid Guideline: Critical Care in Adults NICE Guideline No. 159 (National Institute for Health and Care Excellence, 12 February 2021); https://www.ncbi.nlm.nih.gov/books/NBK566886/
Important and Urgent—Next Steps on NHS Response to COVID-19 (NHS Improvement and NHS England, 2020); https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/urgent-next-steps-on-nhs-response-to-covid-19-letter-simon-stevens.pdf
Operating Framework for Urgent and Planned Services in Hospital Settings During COVID-19 (NHS England, 2020); https://covidlawlab.org/wp-content/uploads/2020/06/Operating-framework-for-urgent-and-planned-services-within-hospitals.pdf
Raccomandazioni di Etica Clinica per l’Ammissione a Trattamenti Intensivi e per la Loro Sospensione 207-2011 (Società italiana di anestesia analgesia rianimazione e terapia intensiva, 2020); https://www.quotidianosanita.it/allegati/allegato2675063.pdf
Cullen, L. Coronavirus: three of NI’s five health trusts cancel planned surgery. BBC News NI (12 November 2020); https://www.bbc.co.uk/news/uk-northern-ireland-54921936
Griffin, S. COVID-19: waiting times in England reach record highs. Br. Med. J. 370, m3557 (2020).
doi: 10.1136/bmj.m3557
Rosenbaum, L. The untold toll—the pandemic’s effects on patients without COVID-19. N. Engl. J. Med. 382, 2368–2371 (2020).
doi: 10.1056/NEJMms2009984
Campbell, D. NHS hospital waiting lists could hit 10 million in England this year. The Guardian (2020). at < https://www.theguardian.com/society/2020/jun/10/nhs-hospital-waiting-lists-could-hit-10-million-in-england-this-year >
Davey, M. Covid-19 Victoria: hospitals advised to reduce elective surgery as doctors warn of overcrowding. The Guardian (9 July 2020); https://www.theguardian.com/australia-news/2020/jul/09/covid-19-victoria-hospitals-advised-to-reduce-elective-surgery-as-doctors-warn-of-overcrowding
Road to recovery. NHS Confederation https://www.nhsconfed.org/news/2020/06/road-to-recovery (2020).
Hunter, D. Trying to “Protect the NHS” in the United Kingdom. N. Engl. J. Med. 383, e136 (2020).
doi: 10.1056/NEJMp2032508
Déry, J. et al. A systematic review of patient prioritization tools in non-emergency healthcare services. Syst. Rev. 9, 227 (2020).
doi: 10.1186/s13643-020-01482-8
Valente, R. et al. How to prioritise and optimise access to elective surgery in the COVID-19 pandemic: an interhospital alliance pathway based on the SWALIS 2020 model. A single-cohort feasibility and pilot study. SSRN https://doi.org/10.2139/ssrn.3622349 (2020).
Cayirli, T. & Veral, E. Outpatient scheduling in health care: a review of literature. Prod. Oper. Manag. 12, 519–549 (2003).
doi: 10.1111/j.1937-5956.2003.tb00218.x
Ahmadi-Javid, A., Jalali, Z. & Klassen, K. J. Outpatient appointment systems in healthcare: a review of optimization studies. Eur. J. Oper. Res. 258, 3–34 (2017).
doi: 10.1016/j.ejor.2016.06.064
Cardoen, B., Demeulemeester, E. & Beliën, J. Operating room planning and scheduling: a literature review. Eur. J. Oper. Res. 201, 921–932 (2010).
doi: 10.1016/j.ejor.2009.04.011
Gupta, D. & Denton, B. Appointment scheduling in health care: challenges and opportunities. IIE Trans. 40, 800–819 (2008).
doi: 10.1080/07408170802165880
Statement: The Need for National Guidance on Resource Allocation Decisions in the COVID-19 Pandemic (The Nuffield Council on Bioethics, 2021); https://www.nuffieldbioethics.org/news/statement-the-need-for-national-guidance-on-resource-allocation-decisions-in-the-covid-19-pandemic
Hospital Episode Statistics (HES). NHS Digital https://digital.nhs.uk/data-and-information/data-tools-and-services/data-services/hospital-episode-statistics (2020).
Perez-Guzman, P. N. et al. Clinical characteristics and predictors of outcomes of hospitalized patients with coronavirus disease 2019 in a multiethnic London National Health Service Trust: a retrospective cohort study. Clin. Infect. Dis. https://doi.org/10.1093/cid/ciaa1091 (2020).
Past and Projected Period and Cohort Life Tables, 2018-Based, UK (Office for National Statistics, 2020); https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/lifeexpectancies/bulletins/pastandprojecteddatafromtheperiodandcohortlifetables/1981to2068
NHS England: national cost collection for the NHS. NHS Digital https://www.england.nhs.uk/national-cost-collection/ (2020).
Statistics: bed availability and occupancy. NHS Digital https://www.england.nhs.uk/statistics/statistical-work-areas/bed-availability-and-occupancy/ (2020).
Statistics: critical care bed capacity and urgent operations cancelled. NHS Digital https://www.england.nhs.uk/statistics/statistical-work-areas/critical-care-capacity/ (2020).
Statistics: A&E attendances and emergency admissions. NHS Digital https://www.england.nhs.uk/statistics/statistical-work-areas/ae-waiting-times-and-activity/ (2020).
McCabe, R. et al. Adapting hospital capacity to meet changing demands during the COVID-19 pandemic. BMC Med. 18, 329 (2020).
doi: 10.1186/s12916-020-01781-w
Elective Letter (NHS England, 20 August 2020); https://www.england.nhs.uk/publication/elective-letter/
Campbell, D. & Quinn, B. Mass cancellations of NHS operations inevitable this winter, say doctors. The Guardian (23 October 2020); https://www.theguardian.com/society/2020/oct/23/mass-cancellations-of-nhs-operations-inevitable-this-winter-say-doctors
jdaeth274 jdaeth274/overflow_analysis: publication release. Zenodo https://doi.org/10.5281/zenodo.5079551 (2021).
Moret, S. ImperialCollegeLondon/OptimalScheduling4COVID: v1.0. Zenodo https://doi.org/10.5281/ZENODO.5071220 (2021).
Watt, T., Firth, Z., Fisher, R., Thorlby, R. & Kelly, E. Use of Primary Care During the COVID-19 Pandemic (The Health Foundation, 2020); https://www.health.org.uk/news-and-comment/charts-and-infographics/use-of-primary-care-during-the-covid-19-pandemic
Rhee, C. et al. Incidence of nosocomial COVID-19 in patients hospitalized at a large US academic medical center. JAMA Netw. Open 3, e2020498 (2020).
doi: 10.1001/jamanetworkopen.2020.20498
COVID-19 Documents (The Federation of Surgical Specialty Associations, 2020); https://fssa.org.uk/covid-19_documents.aspx
Deaths Involving COVID-19 by Local Area and Socioeconomic Deprivation: Deaths Occurring Between 1 March and 31 July 2020 (Office for National Statistics, 2020); https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsinvolvingcovid19bylocalareasanddeprivation/deathsoccurringbetween1marchand31july2020
Updating Ethnic Contrasts in Deaths Involving the Coronavirus (COVID-19), England and Wales: Deaths Occurring 2 March to 28 July 2020 (Office for National Statistics, 2020); https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/updatingethniccontrastsindeathsinvolvingthecoronaviruscovid19englandandwales/deathsoccurring2marchto28july2020
Next steps on the NHS five year forward view. Br. Med. J. https://doi.org/10.1136/bmj.j1678 (2017).
Our Principles (NICE, 2020); https://www.nice.org.uk/about/who-we-are/our-principles
Safe Medical Staffing. (Royal College of Physicians, 2020); https://www.rcplondon.ac.uk/projects/outputs/safe-medical-staffing
Staffing Levels: Advice Guides (Royal College of Nursing, 2020); https://www.rcn.org.uk/get-help/rcn-advice/staffing-levels
Soong, J. et al. Quantifying the prevalence of frailty in English hospitals. BMJ Open 5, 8456 (2015).
Statistics: COVID-19 hospital activity. NHS Digital https://www.england.nhs.uk/statistics/statistical-work-areas/covid-19-hospital-activity/ (2020)
D’Aeth, J. et al. Optimal scheduling for COVID [source code]. Code Ocean https://doi.org/10.24433/CO.0290795.v1 (2021).