Baek Sohye, Lee Young Hoon, Park Seong Hyeon
Department of Industrial Engineering, Yonsei University, 50, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.
Healthcare (Basel). 2020 Aug 12;8(3):266. doi: 10.3390/healthcare8030266.
Ambulance diversion (AD) is a common method for reducing crowdedness of emergency departments by diverting ambulance-transported patients to a neighboring hospital. In a multi-hospital system, the AD of one hospital increases the neighboring hospital's congestion. This should be carefully considered for minimizing patients' tardiness in the entire multi-hospital system. Therefore, this paper proposes a centralized AD policy based on a rolling-horizon optimization framework. It is an iterative methodology for coping with uncertainty, which first solves the centralized optimization model formulated as a mixed-integer linear programming model at each discretized time, and then moves forward for the time interval reflecting the realized uncertainty. Furthermore, the decentralized optimization, decentralized priority, and No-AD models are presented for practical application, which can also show the impact of using the following three factors: centralization, mathematical model, and AD strategy. The numerical experiments conducted based on the historical data of Seoul, South Korea, for 2017, show that the centralized AD policy outperforms the other three policies by 30%, 37%, and 44%, respectively, and that all three factors contribute to reducing patients' tardiness. The proposed policy yields an efficient centralized AD management strategy, which can improve the local healthcare system with active coordination between hospitals.
救护车分流（AD）是一种通过将救护车运送的患者分流到附近医院来减少急诊科拥挤程度的常用方法。在多医院系统中，一家医院的救护车分流会增加附近医院的拥堵情况。为了尽量减少整个多医院系统中患者的延误，这一点应予以仔细考虑。因此，本文提出了一种基于滚动时域优化框架的集中式救护车分流政策。它是一种应对不确定性的迭代方法，首先在每个离散时间求解作为混合整数线性规划模型制定的集中式优化模型，然后针对反映已实现不确定性的时间间隔向前推进。此外，还提出了用于实际应用的分散式优化、分散式优先级和无救护车分流模型，这些模型还可以展示使用以下三个因素的影响：集中化、数学模型和救护车分流策略。基于韩国首尔2017年的历史数据进行的数值实验表明，集中式救护车分流政策分别比其他三种政策的表现高出30%、37%和44%，并且这三个因素都有助于减少患者的延误。所提出的政策产生了一种高效的集中式救护车分流管理策略，该策略可以通过医院之间的积极协调来改善当地医疗系统。
