Trucco Paolo, Nocetti Claudio, Sannicandro Riccardo, Carlucci Michele, Weinstein Eric S, Faccincani Roberto
School of Management, Politecnico di Milano, Milano, Lombardia, Italy.
Emergency Department, Ospedale San Raffaele, Milano, Lombardia, Italy.
Disaster Med Public Health Prep. 2022 Jun;16(3):1105-1115. doi: 10.1017/dmp.2021.62. Epub 2021 May 12.
Hospitals are expected to operate at a high-performance level even under exceptional conditions of peak demand and resource disruptions. This understanding is not mature yet, and there are wide areas of possible improvement. In particular, the fast mobilization and reconfiguration of resources frequently result into the severe disruption of elective activities, worsening the quality of care. More resilient resource allocation strategies, ie, which adapt to the dynamics of the prevailing circumstance, are needed to maximize the effectiveness of health-care delivery. In this study, a simulation approach was adopted to assess and compare different hospital's adaptive resource allocation strategies in responding to a mass casualty incident (MCI).
A specific set of performance metrics was developed to take into consideration multiple objectives and priorities and holistically assess the effectiveness of health-care delivery when coping with an MCI event. Discrete event simulation (DES) and system dynamics (SD) were used to model the key hospital processes and the MCI plan.
In the daytime scenario, during the recovery phase of the emergency, a gradual disengagement of resources from the emergency department (ED) to restart ordinary activities in operating rooms and wards, returned the best performance. In the night scenario, the absorption capacity of the ED was evaluated by identifying the current bottleneck and assessment of the benefit of different resource mobilization strategies.
The present study offers a robust approach, effective strategies, and new insights to design more resilient plans to cope with MCIs. Future research is needed to widen the scope of the analysis and take into consideration additional resilience capacities, such as operational coordination mechanisms, among multiple hospitals in the same geographic area.
即使在需求高峰和资源中断的特殊情况下，医院也应保持高效运营。这种认识尚不成熟，仍有很大的改进空间。特别是，资源的快速调动和重新配置经常导致择期手术严重中断，降低医疗质量。需要更具弹性的资源分配策略，即能适应当前情况动态变化的策略，以最大限度提高医疗服务的有效性。在本研究中，采用模拟方法评估和比较不同医院应对大规模伤亡事件（MCI）时的适应性资源分配策略。
制定了一套特定的绩效指标，以考虑多个目标和优先事项，并全面评估应对MCI事件时医疗服务的有效性。采用离散事件模拟（DES）和系统动力学（SD）对医院关键流程和MCI计划进行建模。
在白天的场景中，在紧急情况的恢复阶段，逐步将资源从急诊科撤离，以便在手术室和病房重新开展常规活动，能取得最佳效果。在夜间场景中，通过识别当前瓶颈并评估不同资源调动策略的效益来评估急诊科的收容能力。
本研究提供了一种可靠的方法、有效的策略以及新的见解，以设计更具弹性的计划来应对大规模伤亡事件。未来需要开展进一步研究，扩大分析范围，并考虑同一地理区域内多家医院的其他弹性能力，如运营协调机制。
