COVID-19 Bed Management Using a Two-Step Process Mining and Discrete-Event Simulation Approach

Abstract

The sudden admission of many patients with similar needs caused by the COVID-19 (SARS-CoV-2) pandemic forced health care centers to temporarily transform units to respond to the crisis. This process greatly impacted the daily activities of the hospitals. In this paper, we propose a two-step approach based on process mining and discrete-event simulation for sizing a recovery unit dedicated to COVID-19 patients inside a hospital. A decision aid framework is proposed to help hospital managers make crucial decisions, such as hospitalization cancellation and resource sizing, taking into account all units of the hospital. Three sources of patients are considered: (i) planned admissions, (ii) emergent admissions representing day-to-day activities, and (iii) COVID-19 admissions. Hospitalization pathways have been modeled using process mining based on synthetic medico-administrative data, and a generic model of bed transfers between units is proposed as a basis to evaluate the impact of those moves using discrete-event simulation. A practical case study in collaboration with a local hospital is presented to assess the robustness of the approach. <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Note to Practitioners</i> —In this paper we develop and test a new decision-aid tool dedicated to bed management, taking into account exceptional hospitalization pathways such as COVID-19 patients. The tool enables the creation of a dedicated COVID-19 intensive care unit with specific management rules that are fine-tuned by considering the characteristics of the pandemic. Health practitioners can automatically use medico-administrative data extracted from the information system of the hospital to feed the model. Two execution modes are proposed: (i) fine-tuning of the staffed beds assignment policies through a design of experiment and (ii) simulation of user-defined scenarios. A practical case study in collaboration with a local hospital is presented. The results show that our model was able to find the strategy to minimize the number of transfers and the number of cancellations while maximizing the number of COVID-19 patients taken into care was to transfer beds to the COVID-19 ICU in batches of 12 and to cancel appointed patients using ICU when the department hit a 90% occupation rate.