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Simulation Results in Multiple Queue Systems

Excel and publication: Pathogen Transmission in the Dialysis Unit
Example: Predictions for a 2 caregiver outpatient clinic
Analyses of outpatient clinics having more than 2 caregivers
Analyses of dissemination within hospital wards, hemodialysis units, and large healthcare facilities

Dialysis Unit Excel model and publication

The link above will download the Excel modelling program used to calculate the results given in the upcoming publication “Analyzing Pathogen Transmission in the Dialysis Unit”, Dr John Hotchkiss, Paul Holley, Dr Phil Crooke; Clinical Journal of American Society of Nephrology (CJASN). The results are for four concurrently operating pods in a medium sized dialysis unit.


Example: Predictions for a 2 caregiver outpatient clinic

We present results from a stochastic agent-based model that emulates a clinic with 2 caregivers, each of whom serves 20 patients per day. The simulation framework itself is an extension of that described in “Pathogen transmission and clinic scheduling.” Briefly, parallel queues are established to represent the 2 caregivers, and patients are partitioned between these queues based on an assessment of the infectious risk they pose and the containment strategy being examined. All results are normalized to the effect (or cost) of employing universal barrier precautions. We will periodically update and expand this archive.

These results illustrate interactions between containment strategies, patient scheduling policies, pathogen prevalence, and the performance characteristics of the pre-appointment screening instrument. Such interactions are also apparent in more complex models incorporating larger numbers of caregivers. More detailed or specific analyses can be arranged upon request.

Analyses of outpatient clinics having more than 2 caregivers

Analyses specifically addressing outpatient clinics with more than 2 caregivers can be provided on a limited basis, due to the computational and model configuration overhead such efforts currently require.

Analyses of dissemination within hospital wards, hemodialysis units, and large healthcare facilities

We have also undertaken simulation analyses of pathogen dissemination within small clusters of hospital wards, outpatient hemodialysis clinics, and large healthcare facilities. These simulation platforms are explicit as regards contact order, as well as the spatial and temporal aspects of the dissemination process. The user can define the amount of random “noise” in the social network of each model. Levels of individual infectiousness that vary over time and/or are associated with different modes of transmission are readily incorporated, as are the probabilities of individual decontamination, discharge, or death, and delayed detection of colonization or contamination. Each caregiver and each patient is explicitly tracked at each point in time. These results are presented to highlight the potential utility of agent-based models in analyzing dissemination within a variety of contact-intensive inpatient- or inpatient-like healthcare facilities, rather than as an exhaustive cataloguing of such models. Additional simulations may be performed on a limited basis, given the computational and configuration demands such undertakings entail.