Hospitalization forecast to inform COVID-19 pandemic planning and resource allocation using mathematical models

ABSTRACT Background The COVID-19 pandemic has put tremendous pressure on hospital resources around the world. Forecasting demand for healthcare services is important generally, but crucial in epidemic contexts, both to facilitate resource planning and to inform situational awareness. There is abundant research on methods for predicting the spread of COVID-19 and even the arrival of COVID-19 patients to hospitals emergency departments. This study builds on that work to propose a hybrid tool, combining a stochastic Markov model and a discrete event simulation model to dynamically predict hospital admissions and total daily occupancy of hospital and ICU beds. Methods The model was developed and validated at San Juan de Alicante University Hospital from 10 July 2020 to 10 January 2022 and externally validated at Hospital Vega Baja. An admissions generator was developed using a stochastic Markov model that feeds a discrete event simulation model in R. Positive microbiological SARS-COV-2 results from the health department’s catchment population were stratified by patient age to calculate the probabilities of hospital admission. Admitted patients follow distinct pathways through the hospital, which are simulated by the discrete event simulation model, allowing administrators to estimate the bed occupancy for the next week. The median absolute difference (MAD) between predicted and actual demand was used as a model performance measure. Results With respect to the San Juan hospital data, the admissions generator yielded a MAD of 6 admissions/week (interquartile range [IQR] 2-11). The MAD between the tool’s predictions and actual bed occupancy was 20 beds/day (IQR 5-43), or 5% of the hospital beds. The MAD between the intensive care unit (ICU)’s predicted and actual occupancy was 4 beds/day (IQR 2-7), or 25% of the beds. When the model was further evaluated with data from Hospital Vega Baja, the admissions generator showed a MAD of 2.42 admissions/week (IQR 1.02-7.41). The MAD between the tools’ predictions and the actual bed occupancy was 18 beds/day (IQR 19.57-38.89), or 5.1% of the hospital beds. For ICU beds, the MAD was 3 beds/day (IQR 1-5), or 21.4% of the ICU beds. Conclusion Predictions of hospital admissions, ward beds, and ICU occupancy for COVID-19 patients were very useful to hospital managers, allowing early planning of hospital resource allocation.

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