Ulukus, Mehmet Yasin
(2017)
Data-Driven Management of Intensive Care Units.
Doctoral Dissertation, University of Pittsburgh.
(Unpublished)
Abstract
An Intensive Care Unit (ICU) is a specialized section of a hospital that provides comprehensive and continuous care for patients in critical conditions. Around 20% of hospital operating costs are due to ICUs, and this percentage has been increasing. Modeling patient flow through an ICU is challenging due to significant heterogeneity of patient cases and high variability of evolving patient conditions. Using a highly detailed data set of ICU patients from a single health system, we build a stochastic and dynamic model of patient physiology that can significantly improve ICU operations and predictions.
Scoring systems that assess the severity at admission or progression of severity during the stay have been used to predict the outcome (mortality or readmission). Existing scores are not sufficient to predict readmissions or mortalities after transferring to a lower level care unit. We present ICU outcome prediction models that perform better than existing models and could be used to benchmark ICU discharge policies and guide post-ICU resource needs.
We consider the transfer operations of patients to a downstream unit. In current practice, downstream beds are requested once a patient is clinically ready to be transferred. We investigate anticipative bed requests that can be made before a patient is ready for transfer. Patient health is described via a novel transfer readiness score created using our readmission prediction model that we incorporate into a Markov decision process model. Our numerical results indicate that an anticipative transfer request policy can significantly improve the system performance. We investigate the sensitivity of policy change upon cost parameter estimation errors by using robust models, and demonstrate that proactive strategies are more beneficial than reactive current policy in most scenarios.
We present an explicit stochastic length of stay model considering patient physiology modeled by the transfer readiness score as well as transfer delays. We characterize the stochastic process under certain assumptions. We show that the model demonstrates a moderate performance in fitting the underlying distribution of the length of stay, and improvements on the score will improve the predictive power of the model.
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Details
| Item Type: |
University of Pittsburgh ETD
|
| Status: |
Unpublished |
| Creators/Authors: |
| Creators | Email | Pitt Username | ORCID  |
|---|
| Ulukus, Mehmet Yasin | myu1@pitt.edu | myu1 | |
|
| ETD Committee: |
|
| Date: |
27 September 2017 |
| Date Type: |
Publication |
| Defense Date: |
21 July 2017 |
| Approval Date: |
27 September 2017 |
| Submission Date: |
25 July 2017 |
| Access Restriction: |
5 year -- Restrict access to University of Pittsburgh for a period of 5 years. |
| Number of Pages: |
104 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
Swanson School of Engineering > Industrial Engineering |
| Degree: |
PhD - Doctor of Philosophy |
| Thesis Type: |
Doctoral Dissertation |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
Operations research, Markov decision processes, simulation, statistical data
analysis, classification models, intensive care unit, hospital operations, medical decision
making |
| Date Deposited: |
27 Sep 2017 19:08 |
| Last Modified: |
19 Jul 2024 19:07 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/32875 |
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