A stochastic programming approach for dynamic allocation of bed capacity and assignment of patients to collaborating hospitals during pandemic outbreaks

Abstract

Sustaining regular and infectious care during an infectious outbreak requires adequate management support for patient capacity allocation. During the COVID-19 pandemic, hospitals faced severe challenges, including uncertainty surrounding the number of infectious patients needing hospitalization and too little regional cooperation. This led to inefficient usage of healthcare capacity. To better prepare for future pandemics, we have developed a decision support system for central regional decision-making on opening and closing hospital rooms for infectious patients and assigning new infectious patients to hospitals. Since relabeling rooms takes some lead time, we develop a stochastic lookahead approach using stochastic programming with sample average approximation based on scenarios of the number of occupied infectious beds and infectious patients needing hospitalization. The lookahead approach models the impact of current decisions on future costs, such as costs for bed shortages, unused beds for infectious patients, and opening and closing rooms. These decisions affect the quality of care by ensuring capacity for either infectious or regular care patients. Our simulation study of a COVID-19 scenario in the Netherlands demonstrates that the stochastic lookahead approach outperforms a deterministic approach as well as other heuristic decision rules, such as hospitals acting individually and implementing a pandemic unit where one hospital is designated to take all regional infectious patients until full. Our approach is very flexible and capable of tuning model parameters to account for the characteristics of future, yet unknown, pandemics, and supports sustaining regular care by minimizing the strain of infectious care on the available regular care capacity. We develop a stochastic direct lookahead approach using two linked stochastic programs to allocate bed capacity to infectious patients and assign infectious patients to hospitals, considering a region of collaborating hospitals during a pandemic. Our approach differs from current methods in the literature as capacity allocation and patient assignment are decided through a direct lookahead approach on a regional level, taking into account more factors of uncertainty and the lead time to make complete rooms (not single beds) available and using dynamic estimates based on regional and in-hospital data. The developed approach is applicable to pandemics or other infectious disease outbreaks. As a demonstration, we consider a case study of the COVID-19 pandemic in a region in the Netherlands. The stochastic direct lookahead approach results in fewer bed shortages for infectious patients while maximizing the number of available beds for non-infectious patients.