Process mining leveraging the analysis of patient journey and outcomes: Stroke assistance during the Covid-19 pandemic

doi:10.34105/j.kmel.2021.13.023

Abstract

The patient journey had to be modified because of the Covid-19 pandemic, causing insecurity, especially in health conditions in a time-sensitive treatment. Identifying these changes and their consequences is essential to improving the healthcare process and guaranteeing patient safety. Process mining (PM) helps evaluate the patient journey discovering care delays, bottlenecks, and non-conformities. This paper aims to apply PM to discover and analyze the patient pathway during stroke care in two different contexts, before and after the Covid-19 outbreak, and to correlate these pathways to patient outcomes. It was a retrospective cross-sectional study including 509 analyzed event logs, employing the most relevant population-based stroke registry of Latin America. Two process models were uncovered to illustrate the patient journey before and during the pandemic. The main findings were the worsening of the patient's health status at their hospital admission, the reduction of hospitalization time, the increased delay for receiving reperfusion therapies after hospital admission, and the preference for the referral hospital instead of emergency services. PM assisted in identifying time-sensitive events and allowed the improvement of patient safety. This methodology can be replicated in other healthcare studies.

Highlights

The patient journey consists of spatio-temporal distribution of patient interactions with several care settings (Carayon et al, 2020); the trajectory in health care can be defined within this journey as "the assembling, scheduling, monitoring, and coordinating of all necessary steps to complete the work of patient care
The term trajectory refers to the pathophysiological process of a patient's disease state, and to the total organization of work done throughout all nurse and patient interactions and the impact of patient care processes on those interactions and the organization" (Alexander, 2007)
Process mining (PM) techniques made it possible to discover two processes illustrating the patient pathway during stroke care before and during the Covid-19 pandemic

Summary

Introduction

The patient journey consists of spatio-temporal distribution of patient interactions with several care settings (Carayon et al, 2020); the trajectory in health care can be defined within this journey as "the assembling, scheduling, monitoring, and coordinating of all necessary steps to complete the work of patient care. The term trajectory refers to the pathophysiological process of a patient's disease state, and to the total organization of work done throughout all nurse and patient interactions and the impact of patient care processes on those interactions and the organization" (Alexander, 2007). In this context, when patients are transferred from one care setting to another, a high-risk care process, called transition of care, occurs (Clancy, 2006). Concerns for patient safety arise if important information is incorrectly or incompletely transferred and can negatively impact patient care, such as delays in treatment and adverse events (Wears et al, 2003; Carayon & Wood, 2009)

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