Queue Management during Health Pandemics: A Queuing Theory Perspective

The era of coronavirus has called for sustained social distancing measures to minimize the spread of the viral disease. Healthcare establishments are reducing the size of their working staff; while others are running their outfits base on shift work in other to ensure protocols for social distancing. Inherent in social distancing protocol is the potential for generating waiting lines at service delivery points. Healthcare centres in many countries are already inundated with loads of patient’s attendance on daily basis for treatment off mild to severe ailments. COVID-19 has added a further burden on the already frail health systems. Whiles visits are increasing, social distancing measures are to be ensured. Quick service delivery which is an indispensable need of patients visiting hospitals for treatment is shortened. The occurrence of waiting line, an impediment to healthcare provision has become commonplace in most healthcare centres in Ghana in particular. In addition to loss of financial gains, delay and unsatisfactory healthcare could lead to loss of lives. Health units are dealing with the effective management of staff schedules to curtail the impact of COVID-19 and at the same time cover up capacity to meet the added health care delivery demands. Accordingly, efforts to reduce time spent in waiting to receive medical attention is crucial. In this paper we study the queue situation at a case Outpatient Department (OPD) by applying query theory and offer recommendations for queue management. The study was conducted in the month of May 2020. We present also, an approach to determine the optimal number of service windows required to reduce the time spent waiting for healthcare attention. Numerical analysis of the queuing situation at the case department is given also, drawing from relevant equations from queuing theory.

Download Full-text

Spectrum of genetic disorders and the impact on health care delivery: an introduction

Eastern Mediterranean Health Journal ◽

10.26719/1999.5.6.1104 ◽

1999 ◽

Vol 5 (6) ◽

pp. 1188-1195

Author(s):

v El Hazmi

Keyword(s):

Health Care ◽

Health Care Delivery ◽

Care Delivery ◽

Genetic Disorders ◽

Single Gene ◽

Medical Attention ◽

World Population ◽

Symptomatic Therapy ◽

Specialist Care ◽

The Impact

Until recently, infectious diseases and malnutrition-related disorders constituted the major cause of ill health and mortality in the world population. However, advances in treatment of such disorders and increased understanding of the molecular basis of heredity have led to genetically transmitted conditions becoming a major cause of morbidity and mortality. Several disorders, including chromosomal [Down syndrome, Turner syndrome], single-gene [sickle-cell disease, thalassaemia, glucose-6-phosphate dehydrogenase deficiency, haemophilia, inborn errors of metabolism]and multifactorial disorders [coronary artery disease, arteriosclerosis, diabetes mellitus, hypertension, obesity]are common and becoming increasingly important. As there is no agreed-upon definitive cure with acceptable risk, these disorders are a significant burden on the health care delivery system. This is because the chronic nature of genetic diseases requires lifelong medical attention, expensive supportive and symptomatic therapy and specialist care. This review outlines the genetic disorders, their impact on health care delivery systems and the general framework required to prevent and control these disorders

Download Full-text

A review on health-care acquired infections of the hospital staff during routine patient’s delivery service

Journal of Applied Sciences and Environmental Management ◽

10.4314/jasem.v25i9.6 ◽

2021 ◽

Vol 25 (9) ◽

pp. 1581-1586

Author(s):

A.A. Enaigbe ◽

C.C. Irodi

Keyword(s):

Health Care ◽

Health Care Professionals ◽

Adverse Drug Events ◽

Care Delivery ◽

Educational Interventions ◽

World Health ◽

Infection Prevention And Control ◽

Medical Attention ◽

And Control ◽

The Impact

The health-care acquired infections (HCAIs) occur world-wide among persons undergoing medical attention in health institutions and result in unexpected long-term stay, disability and financial loses. The most predominant infections are catheter associated urinary tract, central line associated, surgical site and ventilator associated pneumonia infections. The patients are prone to infections during hospitalization from varied environmental sources, hands of health-care professionals, medical equipment and other infected patients. The frequent factors affecting patients on admission are improper hand hygiene, contact with infected patients, adverse drug events and surgical complications. Patients under health-care delivery can acquire infection disseminated from food, water, aerosols and hospital wastes. The application of personal protective equipment, routine educational interventions are common approaches that can help stop HCAIs and save lives, decrease death rate and health delivery expenses. In buttressing this, the World Health Organization (WHO) enunciated guidelines to enhance hand washing practices, infection prevention and control programme, monitored use of antibiotics and its resistance. The other measures included global adoption of efficient surveillance system and the impact of relevant stakeholders in health sectors needed to prevent and control hospital acquired infections.

Download Full-text

Use of Telemedicine for Chronic Liver Disease at a Single Care Center During the COVID-19 Pandemic: Prospective Observational Study (Preprint)

10.2196/preprints.20874 ◽

2020 ◽

Cited By ~ 1

Author(s):

Maria Guarino ◽

Valentina Cossiga ◽

Andrea Fiorentino ◽

Giuseppina Pontillo ◽

Filomena Morisco

Keyword(s):

Health Care ◽

Liver Disease ◽

Observational Study ◽

Chronic Liver Disease ◽

Prospective Observational Study ◽

Care Delivery ◽

Care Center ◽

Social Distancing ◽

The Impact

BACKGROUND The COVID-19 outbreak has overwhelmed and altered health care systems worldwide, with a substantial impact on patients with chronic diseases. The response strategy has involved implementing measures like social distancing, and care delivery modalities like telemedicine have been promoted to reduce the risk of transmission. OBJECTIVE The aim of this study was to analyze the benefits of using telemedicine services for patients with chronic liver disease (CLD) at a tertiary care center in Italy during the COVID-19–mandated lockdown. METHODS From March 9 to May 3, 2020, a prospective observational study was conducted in the Liver Unit of the University Hospital of Naples Federico II to evaluate the impact of (1) a fully implemented telemedicine program, partially restructured in response to COVID-19 to include video consultations; (2) extended hours of operation for helpline services; and (3) smart-working from home to facilitate follow-up visits for patients with CLD while adhering to social distancing regulations. RESULTS During the lockdown in Italy, almost 400 visits were conducted using telemedicine; only patients requiring urgent care were admitted to a non–COVID-19 ward of our hospital. Telemedicine services were implemented not only for follow-up visits but also to screen patients prior to hospital admission and to provide urgent evaluations during complications. Of the nearly 1700 patients with CLD who attended a follow-up visit at our Liver Unit, none contracted COVID-19, and there was no need to alter treatment schedules. CONCLUSIONS Telemedicine was a useful tool for following up patients with CLD and for reducing the impact of the COVID-19 pandemic. This system of health care delivery was appreciated by patients since it gave them the opportunity to be in contact with physicians while respecting social distancing rules.

Download Full-text

475. Describing the impact of the COVID-19 pandemic on HIV care in Latin America

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.668 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S303-S304

Author(s):

Anna K Person ◽

Fernanda Maruri ◽

Ellen Brazier ◽

Juan G Sierra Madero ◽

Vanessa Rouzier ◽

...

Keyword(s):

Latin America ◽

Latin American ◽

Focal Point ◽

Care Delivery ◽

Substantial Effect ◽

Hiv Care ◽

People Living With Hiv ◽

Hiv Viral Load ◽

Social Distancing ◽

The Impact

Abstract Background The effects of the COVID-19 pandemic on people living with HIV (PWH) are unknown. Beyond SARS-CoV-2 co-infection, the pandemic may have devastating consequences for HIV care delivery. Understanding these is crucial as reduced antiretroviral therapy (ART) availability alone could lead to ≥500,000 AIDS-related deaths in 2020–2021. With Latin America now a focal point in the pandemic, we sought to describe the impact of COVID-19 on HIV care at Latin American clinical sites. Methods Caribbean, Central and South America network for HIV epidemiology (CCASAnet) and additional Brazilian HIV care sites in Argentina, Brazil, Chile, Haiti, Honduras, Mexico, and Peru were included. An electronic survey of COVID-19 effects on HIV clinic operations was administered in Spanish or English via phone and email, April 28-June 2, 2020. We also compared national COVID-19 case, mortality, and policy data from public sources. Results Brazil’s and Mexico’s epidemics appear most pronounced, with >10,000 confirmed COVID-19-related deaths (Figure 1); countries implemented “social distancing” policies at different times after initial cases, with Haiti earliest and Mexico latest (Figure 2). Nearly all 13 sites reported decreased hours and providers for HIV care. Twelve of 13 reported increased use of telehealth, suspension/postponements of routine HIV appointments, and/or suspension of HIV research. Eleven of 13 reported initiation of new COVID-19 research but suspension of community HIV testing, and nearly half provided additional ART supplies. Nearly 70% reported impacts on HIV viral load testing and nearly 40% reported personal protective equipment stock-outs (Table). All 13 sites experienced changes in resources/services in tandem with national policies; there was wide variation, however, in the number of economic and health supports implemented thus far (e.g., quarantines, tax deferrals, interest rate reductions, etc.), from 172 COVID-19-related policies in Brazil to only 30 in Mexico. Table Site Assessment of Impacts of the COVID-19 Pandemic on HIV services in Latin America at CCASAnet and Coorte Sites, N=13 Figure 1. Cumulative mortality due to COVID-19 in countries within which CCASAnet and Coorte sites are located Figure 1 footnote: Source for mortality counts: the WHO COVID-19 Dashboard, available at: https://covid19.who.int/ All data were up-to-date as of, and were accessed on, June 17th, 2020 Figure 2. Cumulative cases of COVID-19 in countries within which CCASAnet and Coorte sites are located and dates (relative to the day on which the first positive case of COVID-19 was detected) of general social distancing, public health emergency, or mass quarantine policy introduction (vertical dashed lines), 2020 Figure 2 footnote: Source for case counts: the WHO COVID-19 Dashboard, available at: https://covid19.who.int/ Source for health policy implementation: the United Nations Economic Council for Latin America & the Caribbean, available at: https://cepalstat-prod.cepal.org/forms/covid-countrysheet/index.html All data were up-to-date as of, and were accessed on, June 17th, 2020 Conclusion The COVID-19 pandemic has already had a substantial effect on daily operations of HIV clinics in Latin America. The downstream effects of these impacts on HIV outcomes in Latin America will need to be further studied. Disclosures All Authors: No reported disclosures

Download Full-text

The role of mathematical model in curbing COVID-19 in Nigeria

10.1101/2020.07.22.20159210 ◽

2020 ◽

Author(s):

Chinwendu Emilian Madubueze ◽

Nkiru M. Akabuike ◽

Dachollom Sambo

Keyword(s):

Viral Disease ◽

Control Measures ◽

Transmission Model ◽

Pharmacological Interventions ◽

Social Distancing ◽

Testing Rate ◽

Intervention Measures ◽

Strict Compliance ◽

The Impact

The role of mathematical models in controlling infectious diseases cannot be overemphasized. COVID-19 is a viral disease that is caused by Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) which has no approved vaccine. The available control measures are non-pharmacological interventions like wearing face masks, social distancing, and lockdown which are being advocated for by the WHO. This work assesses the impact of non-pharmaceutical control measures (social distancing and use of face-masks) and mass testing on the spread of COVID-19 in Nigeria. A community-based transmission model for COVID-19 in Nigeria is formulated with observing social distancing, wearing face masks in public and mass testing. The model is parameterized using Nigeria data on COVID-19 in Nigeria. The basic reproduction number is found to be less than unity( R_0<1) when the compliance with intervention measures is moderate (50%≤α<70%) and the testing rate per day is moderate (0.5≤σ_2<0.7) or when the compliance with intervention measures is strict (α≥70%) and the testing rate per day is poor (σ_2=0.3). This implies that Nigeria will be able to halt the spread of COVID-19 under these two conditions. However, it will be easier to enforce strict compliance with intervention measures in the presence of poor testing rate due to the limited availability of testing facilities and manpower in Nigeria. Hence, this study advocates that Nigerian governments (Federal and States) should aim at achieving a testing rate of at least 0.3 per day while ensuring that all the citizens strictly comply with wearing face masks and observing social distancing in public.

Download Full-text

P108 Service Evaluation - the impact and lessons learnt from the COVID-19 pandemic on a UK burns centre

BJS Open ◽

10.1093/bjsopen/zrab032.107 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

Georgina Phillips ◽

Cyrus Talwar ◽

Stanislau Makaranka ◽

Declan Collins ◽

Stanislau Makaranka

Keyword(s):

Public Awareness ◽

Service Evaluation ◽

Medical Attention ◽

Delayed Presentation ◽

Healthcare Provision ◽

Burn Care ◽

Lessons Learnt ◽

Referral Criteria ◽

The Uk ◽

The Impact

Abstract The COVID-19 pandemic has dramaticallyimpacted healthcare provision in the UK and burns services have had to adapt to ensure the continuityof a safe care. As we return to " normalit y" we reflect on lessons learnt from our response to this pandemic. A service evaluation was performed from patient notes between March 23rd and May8th 2020 and an anonymoussurveygiven to patients attending outpatient appointments. 258 patients were referred to our burns service and 148 patients completed the survey. Eleven burns were caused bytreatment or prevention of COVID-19. Patients delayed seeking medical attention due to concern of catching COVID-19 (36% adults, 8% children). There was a delayin referral of 17 patients despite them fulfilling the referral criteria. Infection rates were higher following delayed presentation (21% vs 6%). The majorityof burns were managed conservatively (237/258). Dressing changes were performed at home by32% of patients. The outreach team treated 22 patients. During the pandemic telemedicine has improved the efficiencyof outpatient burn care and outreach nurses have enabled treatment of vulnerable patients. More must be done to raise public awareness of preventable causes of burn injuryand to reassure them to seek help when burns occur.

Download Full-text

Queue Management Benchmark for Modelling Patients' Flow in Nigerian Public Hospitals

Journal of Economics Management and Trade ◽

10.9734/jemt/2021/v27i830359 ◽

2021 ◽

pp. 17-27

Author(s):

Akpan, Anietie Peter ◽

John, Efiok Nsikan

Keyword(s):

Queuing Theory ◽

Arrival Rate ◽

General Purpose ◽

Optimal Number ◽

Public Hospitals ◽

Service Rate ◽

Queue Management ◽

Managerial Implications ◽

Performance Benchmark ◽

The Mean

Although queue management in hospitals is widely researched, little is known about the benchmark for modelling patients flow in terms of the optimal number of servers required for effective service delivery. This study applied the queuing theory to the Nigerian public hospitals by setting a benchmark for modelling patients flow. A mixture of survey and observation was adopted to garner data for 30 days from patients in six public hospitals in Nigeria. Data were subjected to performance analysis via the Temporary Ordered Routine Algorithm. The computed performance values were further compared with their acceptable benchmarks for multi-server queues through the General Purpose System Simulator. We found the queuing system in the select hospitals not in congruence with the system performance benchmark; the mean service rate in each facility was low compared to the mean arrival rate; and the simulated number of doctors for were below the modelled benchmark. Managerial implications of findings were discussed.

Download Full-text

Use of Telemedicine for Chronic Liver Disease at a Single Care Center During the COVID-19 Pandemic: Prospective Observational Study

Journal of Medical Internet Research ◽

10.2196/20874 ◽

2020 ◽

Vol 22 (9) ◽

pp. e20874 ◽

Cited By ~ 1

Author(s):

Maria Guarino ◽

Valentina Cossiga ◽

Andrea Fiorentino ◽

Giuseppina Pontillo ◽

Filomena Morisco

Keyword(s):

Health Care ◽

Liver Disease ◽

Observational Study ◽

Chronic Liver Disease ◽

Prospective Observational Study ◽

Care Delivery ◽

Care Center ◽

Social Distancing ◽

The Impact

Background The COVID-19 outbreak has overwhelmed and altered health care systems worldwide, with a substantial impact on patients with chronic diseases. The response strategy has involved implementing measures like social distancing, and care delivery modalities like telemedicine have been promoted to reduce the risk of transmission. Objective The aim of this study was to analyze the benefits of using telemedicine services for patients with chronic liver disease (CLD) at a tertiary care center in Italy during the COVID-19–mandated lockdown. Methods From March 9 to May 3, 2020, a prospective observational study was conducted in the Liver Unit of the University Hospital of Naples Federico II to evaluate the impact of (1) a fully implemented telemedicine program, partially restructured in response to COVID-19 to include video consultations; (2) extended hours of operation for helpline services; and (3) smart-working from home to facilitate follow-up visits for patients with CLD while adhering to social distancing regulations. Results During the lockdown in Italy, almost 400 visits were conducted using telemedicine; only patients requiring urgent care were admitted to a non–COVID-19 ward of our hospital. Telemedicine services were implemented not only for follow-up visits but also to screen patients prior to hospital admission and to provide urgent evaluations during complications. Of the nearly 1700 patients with CLD who attended a follow-up visit at our Liver Unit, none contracted COVID-19, and there was no need to alter treatment schedules. Conclusions Telemedicine was a useful tool for following up patients with CLD and for reducing the impact of the COVID-19 pandemic. This system of health care delivery was appreciated by patients since it gave them the opportunity to be in contact with physicians while respecting social distancing rules.

Download Full-text

Role of Mathematical Model in Curbing COVID-19 in Nigeria

Communication in Biomathematical Sciences ◽

10.5614/cbms.2020.3.2.5 ◽

2021 ◽

Vol 3 (2) ◽

pp. 135-147

Author(s):

Chinwendu Emilian Madubueze ◽

Nkiru Maria Akabuike ◽

Sambo Dachollom

Keyword(s):

Mathematical Model ◽

Basic Reproduction Number ◽

Reproduction Number ◽

Viral Disease ◽

Control Measures ◽

Social Distancing ◽

Testing Rate ◽

Intervention Measures ◽

The Impact ◽

The Basic Reproduction Number

COVID-19 is a viral disease that is caused by Severe Acute Respiratory Syndrome coronavirus 2 (SARSCoV-2) which has no approved vaccine. Based on the available non-pharmacological interventions like wearing of face masks, observing social distancing, and lockdown, this work assesses the impact of non-pharmaceutical control measures (social distancing and use of face-masks) and mass testing on the transmission of COVID-19 in Nigeria. A mathematical model for COVID-19 is formulated with intervention measures (observing social distancing and wearing of face masks) and mass testing. The basic reproduction number, R_0, is computed using next-generation method while the disease-free equilibrium is found to be locally and globally asymptotically stable when R_0< 1. The model is parameterized using Nigeria data on COVID-19 in Nigeria. The basic reproduction number is found to be less than unity (R_0 < 1) either when the compliance with intervention measures is moderate (50% <= alpha< 70%) and the testing rate per day is moderate (0,5 <=alpha_2 < 0,7) or when the compliance with intervention measures is strict (alpha>=70%) and the testing rate per day is poor (alpha_2 = 0,3). This implies that Nigeria will be able to halt the spread of COVID-19 under these two conditions. However, it will be easier to enforce strict compliance with intervention measures in the presence of poor testing rate due to the limited availability of testing facilities and manpower in Nigeria. Hence, this study advocates that Nigerian governments (Federal and States) should aim at achieving a testing rate of at least 0.3 per day while ensuring that all the citizens strictly comply with wearing face masks and observing social distancing in public.

Download Full-text

A Novel Uni-directional Flow Circular Facility Layout for Effective Social Distancing

Vision The Journal of Business Perspective ◽

10.1177/0972262920984855 ◽

2021 ◽

pp. 097226292098485

Author(s):

Sini V. Pillai

Keyword(s):

Service Delivery ◽

Facility Layout ◽

Medical Attention ◽

Healthcare Facilities ◽

Social Distancing ◽

Face To Face ◽

Hospital Facility ◽

Unidirectional Flow ◽

Wide Range ◽

Functional Layout

Hospitals have a complex infrastructure with a wide range of functional units of medical services. A well-designed facility layout planning is essential for the smooth functioning as well as to provide safe and convenient services to patients at the right time. A functional layout is suggested to optimize time and resources in the process of service delivery, reducing the challenges of patients and healthcare professionals involved in patient care. This article focuses on developing a new facility functional layout that promotes convenience, comfort and economy with enhanced quality of medical care. A pathway of patient movement is effectively designed for better health outcomes, especially when there is a huge inflow of patients seeking information about the choice of healthcare facilities and subsequent medical attention. A circular hospital facility layout with unidirectional flow is proposed, which will effectively prevent face-to-face movement of incoming and outgoing patients and their bystanders, thereby preventing spread of diseases or infection and speed up the service delivery process. The authors believe that the proposed layout will substantially improve quality, service and speed of medical procedures, though the initial investment might be higher for implementing this layout. This study is of paramount importance in maintaining social distancing at hospitals as it prevents chaotic movement of patients and more specifically total avoidance of face-to-face situations between incoming and outgoing patients.

Download Full-text