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Locating trauma centers considering patient safety.

Sagarkumar Hirpara1, Monit Vaishnav2, Pratik J Parikh3

  • 1Department of Industrial Engineering, University of Louisville, 304 JB Speed Building, 132 Eastern Parkway, Louisville, KY, 40292, USA.

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Optimizing trauma center locations can significantly improve patient safety. Strategic placement and redistribution of trauma centers reduce mistriages, leading to better outcomes for trauma patients and potentially saving lives.

Keywords:
Bi-objective optimizationOperations research in health servicesPatient safetyTrauma center location

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Area of Science:

  • Public Health
  • Operations Research
  • Emergency Medicine

Background:

  • Trauma is a leading cause of death and disability in the U.S. for individuals under 44.
  • Geographical maldistribution of trauma centers (TCs) increases access time, potentially impacting patient safety and outcomes.
  • Addressing trauma center accessibility is crucial for public health.

Purpose of the Study:

  • Introduce the Trauma Center Location Problem (TCLP) to optimize TC number and location.
  • Improve patient safety by minimizing mistriages (under-triage and over-triage).
  • Develop an efficient method to find near-optimal solutions for realistic TCLP instances.

Main Methods:

  • Model patient safety using mistriages: system-related under-triage (srUT) and over-triage (srOT).
  • Employ a bi-objective optimization model to account for both srUT and srOT.
  • Utilize a Particle Swarm Optimization (PSO) heuristic for efficient solution derivation.
  • Estimate srUT and srOT using a notional tasking algorithm.

Main Results:

  • Optimizing Ohio's 2012 trauma network with one additional TC reduced the objective function by over 31.5%.
  • Redistributing existing TCs led to a 30.4% reduction in the objective.
  • Solution sensitivity observed regarding weights for srUT/srOT, volume requirements, and EMS decision thresholds.

Conclusions:

  • The proposed TCLP model and PSO heuristic offer an effective approach to trauma system optimization.
  • Strategic trauma center network design can significantly enhance patient safety and reduce mortality.
  • Findings highlight the importance of considering geographical distribution and triage accuracy in trauma care planning.