TY - JOUR
T1 - Two-Tiered Ambulance Dispatch and Redeployment considering Patient Severity Classification Errors
AU - Park, Seong Hyeon
AU - Lee, Young Hoon
N1 - Publisher Copyright:
© 2019 Seong Hyeon Park and Young Hoon Lee.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2019
Y1 - 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 classication 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 classication 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.
AB - 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 classication 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 classication 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.
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U2 - 10.1155/2019/6031789
DO - 10.1155/2019/6031789
M3 - Article
C2 - 31885833
AN - SCOPUS:85077336725
VL - 2019
JO - Journal of Healthcare Engineering
JF - Journal of Healthcare Engineering
SN - 2040-2295
M1 - 6031789
ER -