紧急医疗服务的资源配置与调度

Emergency medical service system is the frontline of providing medical care and service to the people. It consists of two inseparable parts: pre-hospital acute medical care (120 service in China) and hospital emergency department service. The goal of emergency medical services is to provide the treatment to those in need of urgent medical care with preventing the patient from transporting themselves, arrange the ambulance to timely deliver the patient to hospital emergency department, so that the patient can obtain hospital definitive care promptly. This project aims at developing new models and methodologies for the resource configuration and scheduling in emergency medical services system. First, oriented to the highly uncertain working environment the project researches the resource configuration in the pre-hospital emergency medical system using the methods such as stochastic programming, large-scale problem decomposition and coordination, and metaheuristics. Then, based on the resource configuration scheme the project studies the ambulance real-time scheduling methods for the multi-level, dynamically arrival demands. The methodologies such as the Markov Decision Process, simulation optimization will be adopted in this part of study. Next, based on the queuing theory, algorithm design and analysis theories, the project will study the recourses (e.g., doctors, nurses and medical examination equipments) allocation, planning and scheduling in the hospital emergency department facing the practical time-varying demands. Finally, case study will be performed by using the data from Shanghai 120 Medical Emergency Center, Ruijin Hospital and other hospitals. The project can help to lift the utilization of emergency medical service recourses, reduce the patients’ waiting time and improve the service level of emergency medical system.

紧急医疗服务体系是医疗事业的前沿阵地，主要包括院前120急救和医院急诊两个密切的组成部分。紧急医疗服务主要是将医疗服务快速、准确地送到病人身边给予初步诊治，继而将病人通过救护车等工具转移到医院急诊科室加以救治。本项目针对紧急医疗服务特点，研究院前和院内两部分的资源配置与调度问题。首先面向院前急救所处的高度不确定性环境，综合运用随机规划、大规模问题分解和协调、启发式算法等技术手段，研究院前急救中救护车等资源的配置管理问题。在此基础上拟针对高度动态到达的多级复杂需求，基于马尔科夫决策支持、仿真优化等方法研究资源实时调度和预留策略。同时针对院内急救面临的时变多级患者需求，基于排队论、算法设计与分析等理论研究院内急救医生、诊疗设备等资源的配置和调度问题。最后结合上海120急救中心、瑞金医院等单位进行实际案例研究。项目的研究成果对于提升我国紧急医疗服务的资源利用率，提高服务水平有重要意义。

紧急医疗服务体系是医疗事业的前沿阵地。主要包括院前120急救和医院急诊两个密切的组成部分，一般称为院前急救和院内急救。紧急医疗服务主要流程为120急救中心接收病人呼叫的急救电话，确认病人健康状况并指派某个车站的救护车前往病患处，将其送往当地医院急诊部。病人被急诊部抢救室接收后，救护车回到车站或者直接前往接下一个病人，后续病人的治疗在抢救室或者急诊部其他部门进行。本项目针对紧急医疗服务特点，研究院前和院内两部分的资源配置、调度和控制等问题。主要开展了以下内容的研究：（1）院前急救关键资源（救护车车站、救护车）的资源配置研究，面向高度时变的城市院前急救需求，探索如何对关键资源进行时变的布置和调配，使得服务更加及时和高效。（2）院前和院内急救服务的协同研究，针对院前和院内是独立主体的情况，研究如何对两个系统的资源（救护车、急诊室）进行匹配，使得在高度随机不确定的环境中两个系统的整体运作更加高效，提出了建模和求解方法。（3）医院急诊资源计划和调度研究，主要集中在床位和医生这两个最主要的资源，研究面对高度时变的急诊需求，如何对资源进行科学计划、调度和控制，采用马尔科夫链、马尔科夫决策过程、随机规划等方法对问题建模，并设计了启发式和精确算法对问题求解。（4）医疗服务水平的精确解析计算，目前对时变非稳态医疗服务排队系统的服务水平计算有待拓展，本项目提出一种新型的计算方法。项目得到了紧急医疗服务系统中一系列资源计划调度问题的数学模型和求解算法，通过大量数据计算和实验验证了所提出方法的正确性、有效性，对提升我国紧急医疗服务系统的运作水平提供了理论和方法基础。