ABSTRACT
As universities begin the return to in-person course work, uncertainty remains about the future of SARS-CoV-2 virus and its variants. In the years to come, other novel pathogens may emerge. Pandemic-driven social distancing requirements reduce the number of students in classrooms, and when these requirements are instituted mid-semester, universities must make quick changes to classroom assignments and course delivery mode. In this work, we introduce two integer programs to optimize mid-semester changes: (i) a conflict-matrix-based model that determines new classroom capacities and designs the corresponding seat map, and (ii) a hierarchical model that optimizes room assignment and course delivery mode according to prioritized objectives. We test our methods with University of Michigan's engineering course schedule for Fall 2021, under a hypothetical 3-foot social distancing requirement. We compare the performance of the models under different hierarchical objectives and room assignment assumptions and discuss the managerial implications of our results. © 2022 IISE Annual Conference and Expo 2022. All rights reserved.
ABSTRACT
Background: The COVID-19 pandemic has temporarily reduced capacity in many endoscopyunits, creating long backlogs, which have the potential to worsen patient outcomes. Aims:To evaluate the impact of two evidence-based strategies for offloading colonoscopy demandduring and after the first wave of the pandemic: (1) An “Extend” strategy, in which theinterval for low-risk adenoma (LRA) patients who are currently “due” is extended from 5years to 7 years;(2) An “Exchange” strategy, in which all referrals for screening colonoscopyare changed to fecal immunochemical testing (FIT);(3) a combination of “Extend+Exchange.”Methods: We developed a discrete-event simulation of an endoscopy unit in an integratedhealthcare system with a caseload of 110 procedures weekly. We assumed capacity initiallyfell to 5% of pre-COVID levels for 10 weeks (as a result of the pandemic), and incrementallyincreased back to 100% by 30 weeks. Each week, 113 patients were referred with thefollowing indications, in order of priority: diagnostic colonoscopy (23% of referrals) and upper endoscopy (28%), high-risk adenoma (HRA) surveillance (10%), LRA surveillance(17%), and screening colonoscopy (22%). The highest priority patients were always seenfirst, while others joined a queue. Outcomes included average wait time, number of patientsseen, and queue size at model’s end. The base unit of time was weeks. Model length was150 weeks. One-way sensitivity analyses were performed for all variables. Each strategy wassimulated 500 times in C++ and compared to a base case in which no offloading strategieswere used. Results: In the base case, 3,023 patients remained in queue at 150 weeks, andthe average wait time was 22.5 weeks overall. The wait time for screening colonoscopy was69.9 weeks. With the Extend strategy, 1,293 patients remained in queue at 150 weeks, theaverage wait time was 14.2 weeks overall, and the wait time for screening colonoscopy was41.6 weeks. With Exchange, no patients remained in queue at 150 weeks, and the averagewait time was 9.9 weeks. Because no screening colonoscopies were done, there was no waittime for this indication. The Extend+Exchange strategy yielded similar results, but the averagewait time was 5.3 weeks. In all four strategies, nearly equivalent numbers of patients wereseen for HRA surveillance (range 2,496-2,511), diagnostic colonoscopy (range 4,547-5,062),and upper endoscopy (3,749-3,759), with similar wait times. None of the strategies hadwait times for upper endoscopy or diagnostic colonoscopy exceeding 5 weeks. Conclusions:Without offloading strategies, prolonged queues and wait times developed, especially forscreening colonoscopies. Substituting FIT for screening colonoscopy (Exchange) is the singlestrategy with the greatest potential to mitigate these problems, without which patients maysuffer harm caused by limited access.(Figure Presented)Figure 1. Average wait time by indication under usual care, and three evidence-based strategies for offloading endoscopy demand during the COVID-19 pandemic.
ABSTRACT
Background The Covid-19 pandemic led to a strong government response in attempts to limit spread of this virulent infectious disease. Societal measures included social distancing, hand hygiene with 'stay-at-home' advice, colloquially referred to as 'lockdown'. Medical practice had to respond quickly, respecting these measures whilst trying to offer ongoing patient services. Objectives There has been a proliferation of virtual appointments, offered either via telephone or video call. For a paediatrics department in a major district general hospital, phone consultations were the immediately available option. Our study objective was to implement an online survey questionnaire to explore family perceptions on virtual telephone appointments. Methods 168 families who participated in general paediatric follow up telephone consultations over a two-week period in May were contacted for consent to send them an online survey comparing telephone and face-to-face consultations. This group was targeted because they had at least one face-to-face appointment previously. The online survey consisted of 10 questions to compare different modes of consultations, including satisfaction rating using the Likert scale, and open text responses. Results 40 families (response rate 44%) of 92 who consented, completed the online survey. 4 (10%) parents had a strong preference for face-to-face appointments, with roughly 25% each slightly preferring telephone or face-toface appointments (9 and 12 respectively). 35% (14) did not mind either option. Despite this, if given the choice, 12 (30%) would choose face-to-face appointments in the future as opposed to 5 (12.5%) who would chose the telephone consultation. Parents rated convenience as greater for telephone appointments (33 responses, 85%). Some parents mentioned in feedback slightly better ability to remember information and ask questions. However, there was limited possibility for involving other adults and the child or young person. Positive comments about virtual clinics included not having to pay for parking (6, 15%). Parents gave constructive feedback, saying they could be asked to be ready to provide information, for example child's current weight. Few children were involved, and this needs to be borne in mind, especially as visual ques can be missed over telephone. 3 families (8%) however did report that children were happy not to be involved in the discussions. Conclusions Parents were grateful that some efforts had been made to maintain contact in difficult times, and responses may have been different in normal circumstances. There are some limitations to telephone consultations;mainly not being able to clinically examine or talk to children. Telephone consultations may result in silencing of the child's voice, with possible mental health and safeguarding issues. Some of these issues could be addressed with video calling. Interestingly despite convenience of telephone consultations, more parents indicated a preference for physical face-to-face consultations suggesting that, as the world returns to normal, whilst both options should be made available to them, we may not see significant changes in practice. Going forwards it may be beneficial to ask parents after initial consultation and if appropriate, if they would like a telephone or physical face-to-face appointment in the future.