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Two-Tiered Ambulance Dispatch and Redeployment considering Patient Severity Classification Errors.
J Healthc Eng. 2019; 2019:6031789.JH

Abstract

A two-tiered ambulance system, consisting of advanced and basic life support for emergency and nonemergency patient care, respectively, can provide a cost-efficient emergency medical service. However, such a system requires accurate classification of patient severity to avoid complications. Thus, this study considers a two-tiered ambulance dispatch and redeployment problem in which the average patient severity classification errors are known. This study builds on previous research into the ambulance dispatch and redeployment problem by additionally considering multiple types of patients and ambulances, and patient classification errors. We formulate this dynamic decision-making problem as a semi-Markov decision process and propose a mini-batch monotone-approximate dynamic programming (ADP) algorithm to solve the problem within a reasonable computation time. Computational experiments using realistic system dynamics based on historical data from Seoul reveal that the proposed approach and algorithm reduce the risk level index (RLI) for all patients by an average of 11.2% compared to the greedy policy. In this numerical study, we identify the influence of certain system parameters such as the percentage of advanced-life support units among all ambulances and patient classification errors. A key finding is that an increase in undertriage rates has a greater negative effect on patient RLI than an increase in overtriage rates. The proposed algorithm delivers an efficient two-tiered ambulance management strategy. Furthermore, our findings could provide useful guidelines for practitioners, enabling them to classify patient severity in order to minimize undertriage rates.

Authors+Show Affiliations

Department of Industrial Engineering, Yonsei University, D1010, 50, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea.Department of Industrial Engineering, Yonsei University, D1010, 50, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31885833

Citation

Park, Seong Hyeon, and Young Hoon Lee. "Two-Tiered Ambulance Dispatch and Redeployment Considering Patient Severity Classification Errors." Journal of Healthcare Engineering, vol. 2019, 2019, p. 6031789.
Park SH, Lee YH. Two-Tiered Ambulance Dispatch and Redeployment considering Patient Severity Classification Errors. J Healthc Eng. 2019;2019:6031789.
Park, S. H., & Lee, Y. H. (2019). Two-Tiered Ambulance Dispatch and Redeployment considering Patient Severity Classification Errors. Journal of Healthcare Engineering, 2019, 6031789. https://doi.org/10.1155/2019/6031789
Park SH, Lee YH. Two-Tiered Ambulance Dispatch and Redeployment Considering Patient Severity Classification Errors. J Healthc Eng. 2019;2019:6031789. PubMed PMID: 31885833.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Two-Tiered Ambulance Dispatch and Redeployment considering Patient Severity Classification Errors. AU - Park,Seong Hyeon, AU - Lee,Young Hoon, Y1 - 2019/12/09/ PY - 2019/07/10/received PY - 2019/11/11/accepted PY - 2019/12/31/entrez PY - 2019/12/31/pubmed PY - 2019/12/31/medline SP - 6031789 EP - 6031789 JF - Journal of healthcare engineering JO - J Healthc Eng VL - 2019 N2 - A two-tiered ambulance system, consisting of advanced and basic life support for emergency and nonemergency patient care, respectively, can provide a cost-efficient emergency medical service. However, such a system requires accurate classification of patient severity to avoid complications. Thus, this study considers a two-tiered ambulance dispatch and redeployment problem in which the average patient severity classification errors are known. This study builds on previous research into the ambulance dispatch and redeployment problem by additionally considering multiple types of patients and ambulances, and patient classification errors. We formulate this dynamic decision-making problem as a semi-Markov decision process and propose a mini-batch monotone-approximate dynamic programming (ADP) algorithm to solve the problem within a reasonable computation time. Computational experiments using realistic system dynamics based on historical data from Seoul reveal that the proposed approach and algorithm reduce the risk level index (RLI) for all patients by an average of 11.2% compared to the greedy policy. In this numerical study, we identify the influence of certain system parameters such as the percentage of advanced-life support units among all ambulances and patient classification errors. A key finding is that an increase in undertriage rates has a greater negative effect on patient RLI than an increase in overtriage rates. The proposed algorithm delivers an efficient two-tiered ambulance management strategy. Furthermore, our findings could provide useful guidelines for practitioners, enabling them to classify patient severity in order to minimize undertriage rates. SN - 2040-2309 UR - https://www.unboundmedicine.com/medline/citation/31885833/Two-Tiered_Ambulance_Dispatch_and_Redeployment_considering_Patient_Severity_Classification_Errors L2 - https://doi.org/10.1155/2019/6031789 DB - PRIME DP - Unbound Medicine ER -
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