WIA SOOM Simulators

Ukusebenza kokunakekelwa okukhulu kwesibhedlela Imodeli ephilayo

Uxhumanisa iyunithi yokunakekelwa okukhulu yesibhedlela: imibhede ye-ICU engu-20 engelulwa ibe ngu-30, abahlengikazi abayisebenzelayo, nethangi le-oksijini engamanzi eliphakela umbhede ngamunye. Lesi silingisi sokusebenza — asimodeli izinqumo zokwelapha.

Okuzofunda

Isilingisi

Isikhathi 0 h
Ukuhlala kwe-ICU 75% · Iziguli ezilindele ku-ED 0 · Isidingo se-oksijini 290 L/min · Isikhathi esisele se-oksijini ethangini 145 h🛏🛏🛏🛏🛏🛏🛏🛏🛏🛏🛏🛏🛏🛏🛏·····🚑 Iziguli ezilindele ku-ED: 0 · 👩‍⚕️ 1.5O₂290 L/min · max 600⏱ 145 h
  • Isiguli embhedeni we-ICU
  • Umbhede onabasebenzi ongenalutho
  • Umbhede ongenabasebenzi
  • Ukulinda ku-ED

Izilawuli

Umhlengikazi ngamunye angasebenzela imibhede emibili yokunakekelwa okukhulu kule modeli. Uhlu lwamashifu lunabangu-10; umhlengikazi ngamunye ongaphezu kwalokho uyisikhathi esengeziwe noma se-ejensi futhi ubalwa kwisabelomali sabasebenzi.

Kuze kube yimibhede eyengeziwe eyi-10 — iwusizo kuphela uma kunabahlengikazi abazoyisebenzela.

Hambisa iziguli ezibuyayo emagcekeni angasebenzi kakhulu masinyane (ukuhlala okufushane ngo-25 %).

Odokotela bahlosa isiphetho esiphansi sebanga elinikeziwe; kumodelwe njengesidingo esincane ngo-20 % kuphela.

Amahora phakathi kokuhanjiswa kwe-oksijini engamanzi okuhleliwe; ngakunye kugcwalisa ithangi elingu-3,000 L ngokuphelele. Umphakeli udinga isaziso samahora angu-24, ngakho isikhawu esifushane asilokothi silethe iloli elilandelayo ngaphambi kwalokho.

Igesi yokulondoloza, okungeqi ku-150 L/min — yengeza ethangini, ayikwazi ukulithatha indawo. Amabhange amabili kuphela agcwele akhona endaweni.

Kumhlinzeki omunye: umthwalo owodwa we-oksijini engamanzi ongeqi ku-3,000 L, ufika amahora angu-18 ngemva kwe-oda. Ngesikhathi sokushoda bangakwazi ukunikela ngowodwa kuphela.

Izikhombisi

Ukuhlala kwe-ICU
75%
kuvamile
Iziguli ezilindele ku-ED
0
kuvamile
Ukushoda kwe-oksijini
0L/min
kuvamile
Isikhathi esisele se-oksijini ethangini
145h
kuvamile
Isidingo se-oksijini290 L/min
Iziguli ze-ICU15
Ukulinda okude kakhulu kombhede we-ICU0 h
Amahora-mhlengikazi esikhathi esengeziwe / e-ejensi0 h
Iziguli ngomhlengikazi1.5
I-oksijini engamanzi ethangini3000 L
Ugodlo lwamasilinda0 m³

Isitayela

Ukuhlala kwe-ICU: — %1000

Izimo eziphuthumayo

Izinga 1 · Ukukhuphuka kokugula komoya

Iyunithi icishe igcwele lapho ugagasi lokugula komoya lwenza ukufika kokunakekelwa okukhulu kube ngaphezu kokuphindwe kabili usuku lonke, futhi abaningi bagula kakhulu. Faka yonke isiguli embhedeni we-ICU ngesikhathi ngaphandle kokuqhuba uhlelo lwe-oksijini ngale komkhawulo walo — futhi ngaphakathi kwesabelomali sabasebenzi bokukhuphuka.

  • Ukulinda okumaphakathi ku-ED ≤ isiguli esingu-1
  • Asikho isiguli esilinda umbhede we-ICU amahora angu-6 noma ngaphezulu
  • Akukho ukushoda kwe-oksijini nganoma isiphi isikhathi
  • Akukaze kube ngaphezu kweziguli ezingu-2 ngomhlengikazi
  • Akukho sikhathi esengeziwe / i-ejensi ngaphambi kokuba ukukhuphuka kumenyezelwe
  • Isikhathi esengeziwe / i-ejensi ≤ amahora-mhlengikazi angu-420

Izinga 2 · Ukuhanjiswa kwe-oksijini kubambezelekile

Ithangi selisele ngengxenye eyodwa kwezintathu, ukuhanjiswa okujwayelekile kulindeleke kusasa. Bese umhlinzeki uyashayela: lokho kuhanjiswa kuzokwephuza izinsuku. Gcina yonke isiguli iphakelwa kuze kufike — abekho abasebenzi abengeziwe abadingekayo kulokhu.

  • Akukho ukushoda kwe-oksijini nganoma isiphi isikhathi
  • Ithangi alikaze limile
  • Awekho amahora-mhlengikazi esikhathi esengeziwe / e-ejensi

Izinga 3 · I-vaporizer emkhawulweni wayo

Iyunithi icishe igcwele iziguli ezigula kakhulu lapho kufika ugagasi lweziguli ezibucayi — cishe esisodwa ngehora isigamu sosuku. Ngasinye sidinga ukugeleza okuphezulu kwe-oksijini, futhi i-vaporizer ingakhipha u-600 L/min kuphela. Gcina ukugeleza kuphezulu nezindlela zisobala, ngaphakathi kwesabelomali sabasebenzi.

  • Akukho ukushoda kwe-oksijini nanini
  • Ukulinda okumaphakathi ku-ED ≤ iziguli ezingu-2
  • Isikhathi sethangi asikaze sehle ngaphansi kwamahora angu-12
  • Akukho sikhathi esengeziwe / i-ejensi ngaphambi kokuba ugagasi lufike
  • Isikhathi esengeziwe / i-ejensi ≤ amahora-mhlengikazi angu-300

Isisekelo — imodeli engemuva kwezinombolo

Wonke ubudlelwano isilingisi esibusebenzisayo, nomthombo wabo. Izinto ezihlala zingashintshi ezimakwe njengokuthathelwa yizilinganiso zesibonelo.

Iziguli ezibucayi zifika ngokungahleliwe futhi zihlala isikhathi esingahleliwe (exponential, isilinganiso samahora angu-72).
arrivals ~ Poisson(λ·Δt); P(discharge in Δt) = 1 − e^(−Δt/LOS), LOS = 72 h[4][2]Okuthathelwa: ubude bokuhlala, inani lemibhede nelabahlengikazi, izabelomali zabasebenzi, osayizi bethangi, be-vaporizer nabamasilinda kanye nemibandela yomhlinzeki ophuthumayo yizinani zesibonelo zesibhedlela esiphakathi nendawo.
Ukuhlala nokulinda emugqeni: ngokufika okungahleliwe, ukubambezeleka kukhula kakhulu kudala ngaphambi kokuba igceme ligcwale ngo-100 %.
occupancy = patients / open beds; queueing delay rises steeply as occupancy → 100 %[2][3]
Umbhede ubalwa kuphela uma unabasebenzi.
staffed beds = min(open beds, 2 × nurses)[4]Okuthathelwa: ubude bokuhlala, inani lemibhede nelabahlengikazi, izabelomali zabasebenzi, osayizi bethangi, be-vaporizer nabamasilinda kanye nemibandela yomhlinzeki ophuthumayo yizinani zesibonelo zesibhedlela esiphakathi nendawo.
Izindleko zabasebenzi: wonke ihora-mhlengikazi elingaphezu kweshifu elihleliwe liyisikhathi esengeziwe noma se-ejensi. Imibhede yokukhuphuka idinga labo bahlengikazi, ngakho yiyo ethwala izindleko.
overtime/agency nurse-hours = Σ max(0, nurses − 10) · ΔtOkuthathelwa: ubude bokuhlala, inani lemibhede nelabahlengikazi, izabelomali zabasebenzi, osayizi bethangi, be-vaporizer nabamasilinda kanye nemibandela yomhlinzeki ophuthumayo yizinani zesibonelo zesibhedlela esiphakathi nendawo.
Ukulinda okude kakhulu kombhede we-ICU emnyangweni wezimo eziphuthumayo. Ocwaningweni olukhulu lwerejista, iziguli ezigula kakhulu ezilinde amahora angu-6 noma ngaphezulu zaba nezinga eliphezulu lokufa.
longest ED wait = now − time the first waiting patient arrived (first come, first served); ≥ 6 h counts as a delayed transfer[6]
Isidingo se-oksijini esivela ekugelezeni kokuhlela kwe-WHO ngesiguli ngasinye.
demand = Σ flow(patient): severe 10 L/min, critical 30 L/min[1]
I-vaporizer inciphisa ukuthi ithangi lingakhipha igesi eningakanani ngomzuzu; amasilinda engeza okuncane.
delivered = min(demand, vaporizer 600 L/min, tank) + cylinders (≤150 L/min)[1]Okuthathelwa: ubude bokuhlala, inani lemibhede nelabahlengikazi, izabelomali zabasebenzi, osayizi bethangi, be-vaporizer nabamasilinda kanye nemibandela yomhlinzeki ophuthumayo yizinani zesibonelo zesibhedlela esiphakathi nendawo.
I-oksijini engamanzi ikhula cishe izikhathi ezingu-843 ibe igesi ku-15 °C naku-1 atm (u-861 ovame ukucashunwa uyinani ku-21 °C); amahora ethangi alandela ekusetshenzisweni kwamanje.
gas litres (15 °C, 1 atm) = liquid litres × 843; tank hours = gas / (use × 60)[5]
Ezinye izinto ezihlala zingashintshi zokusebenza ezisetshenziswa imodeli.
20 base beds + up to 10 surge · 10 rostered nurses · 40 % critical at baseline · tank 3,000 L liquid, deliveries fill it to capacity; a new interval moves the next truck no closer than 24 h · vaporizer 600 L/min · 2 cylinder banks on site, 120 m³ each at ≤150 L/min · one emergency load of up to 3,000 L, 18 h after the order · step-down push shortens stay by 25 %Okuthathelwa: ubude bokuhlala, inani lemibhede nelabahlengikazi, izabelomali zabasebenzi, osayizi bethangi, be-vaporizer nabamasilinda kanye nemibandela yomhlinzeki ophuthumayo yizinani zesibonelo zesibhedlela esiphakathi nendawo.
Ukulungisa ngokucophelela njengesici sesidingo.
demand × 0.8 when conservative titration is applied[7]Okuthathelwa: ukonga okungu-20 % kuyisibonelo. Izinjongo ze-oksijini yisinqumo sokwelapha sesiguli ngasinye; lesi silingisi sibonisa kuphela umphumela ekuphakeleni.

Ukungahleliwe: i-generator ye-mulberry32 enembewu; ukusabalalisa okusetshenzisiwe — uniform, exponential (inverse CDF), normal (Box–Muller), Poisson (Knuth). Imbewu iyabonisa futhi ingabelwana.

Imithombo

  1. WHO — Oxygen sources and distribution for COVID-19 treatment centres (planning flows: severe 10 L/min, critical 30 L/min) — World Health Organization, 2020
  2. A. Bagust, M. Place, J. W. Posnett — Dynamics of bed use in accommodating emergency admissions: stochastic simulation model — BMJ 319:155, 1999
  3. N. Proudlove — The 85% bed occupancy fallacy: the use, misuse and insights of queuing theory — Health Services Management Research, 2020
  4. D. Gross, C. M. Harris — Fundamentals of Queueing Theory (M/M/c, loss systems) — Wiley, 2008
  5. NIST Chemistry WebBook, SRD 69 — Thermophysical properties of oxygen (saturated liquid at 1 atm: 1141.2 kg/m³; gas at 15 °C, 1 atm: 1.3544 kg/m³ → ≈ 843 L gas per L liquid; ≈ 861 at 21.1 °C) — National Institute of Standards and Technology
  6. D. B. Chalfin, S. Trzeciak, A. Likourezos et al. — Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit (ED stay ≥ 6 h: higher ICU and hospital mortality) — Critical Care Medicine 35(6):1477–1483, 2007
  7. BTS guideline for oxygen use in healthcare and emergency settings (target saturation ranges) — British Thoracic Society, Thorax 72, 2017

Obani abenza lokhu ukuze baziphilise

Imodeli yemfundo — hhayi yezinqumo zokusebenza. Izindawo zangempela zilinganisa yonke into ehlala ingashintshi kumishini nedatha yazo.