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Problem definition: Delays in admission to rehabilitation care can adversely impact patient outcomes. In addition, delayed patients keep occupying their acute care beds, making them unavailable for incoming patients. Admission delays are mainly caused by a lack of rehabilitation bed capacity and the time required to plan for rehabilitation activities, which we refer to as processing times. Because of non-standard bed allocation decisions and data limitations in practice, quantifying the magnitude of the two sources of delays can be technically challenging yet critical to the design of evidence-based interventions to reduce delays. We propose an empirical approach to understanding the contributions of the two sources of delays when only a single (combined) measure of admission delay is available. Methodology/results: We propose a hidden Markov model (HMM) to estimate the unobserved processing times and the status-quo bed allocation policy. Our estimation results quantify the magnitude of processing times versus capacity-driven delays and provide insights into factors impacting the bed allocation decision. We validate our estimated policy using a queueing model of patient flow and find that ignoring processing times or using simple bed allocation policies can lead to highly inaccurate delay estimates. In contrast, our estimated policy allows for accurate evaluation of different operational interventions. We find that reducing processing times can be highly effective in reducing admission delays and bed-blocking costs. In addition, allowing early transfer—whereby patients can complete some of their processing requirements in the rehabilitation unit—can significantly reduce admission delays, with only a small increase in rehab LOS. Managerial implications: Our study demonstrates the importance of quantifying different sources of delays in the design of effective operational interventions for reducing delays in admission to rehabilitation care. The proposed estimation framework can be applied in other transition-of-care settings with personalized capacity allocation decisions and hidden processing delays.

History: This paper was selected for Fast Track in the M&SOM journal from the 2022 MSOM Healthcare SIG Conference.

Funding: J. Dong was supported in part by the National Science Foundation [Grant CMMI-1762544]. V. Sarhangian was supported in part by the Natural Sciences and Engineering Research Council of Canada [Grant RGPIN-2018-04518] and the Connaught Fund.

Supplemental Material: The e-companion is available at https://doi.org/10.1287/msom.2022.0377 .

 

When having access to demand forecasts, a crucial question is how to effectively use this information to make better resource allocation decisions, especially during demand surges like the COVID-19 pandemic. Despite the emergence of various advanced prediction models for hospital resources, there has been a lack of prescriptive solutions for hospital managers seeking concrete decision support, for example, guidance on whether to allocate beds from other specialties to meet the surge demand from COVID-19 patients by postponing elective surgeries. In their paper “Optimal Routing under Demand Surge: the Value of Future Arrival Rate,” the authors present a systematic framework to incorporate future demand into routing decisions in parallel server systems with partial flexibility and quantify the benefits of doing so. They propose a simple and interpretable two-stage index-based policy that explicitly incorporates demand forecasts into real-time routing decisions. Their analytical and numerical results demonstrate the policy’s effectiveness, even in the presence of large prediction errors.

 

Queueing models that are used to capture various service settings typically assume that customers require a single unit of resource (server) to be processed. However, there are many service settings where such an assumption may fail to capture the heterogeneity in resource requirements of different customers. We propose a multiserver queueing model with multiple customer classes in which customers from different classes may require different amounts of resources to be served. We study the optimal scheduling policy for such systems. To balance holding costs, service rates, resource requirement, and priority-induced idleness, we develop an index-based policy that we refer to as the idle-avoid [Formula: see text] rule. For a two-class two-server model, where policy-induced idleness can have a big impact on system performance, we characterize cases where the idle-avoid [Formula: see text] rule is optimal. In other cases, we establish a uniform performance bound on the amount of suboptimality incurred by the idle-avoid [Formula: see text] rule. For general multiclass multiserver queues, we establish the asymptotic optimality of the idle-avoid [Formula: see text] rule in the many-server regime. For long-time horizons, we show that the idle-avoid [Formula: see text] is throughput optimal. Our theoretical results, along with numerical experiments, provide support for the good and robust performance of the proposed policy. 

Polyploidy is a major evolutionary force that has shaped plant diversity. However, the various pathways toward polyploid formation and interploidy gene flow remain poorly understood. Here, we demonstrated that the immediate progeny of allotriploid AACBrassica(obtained by crossing allotetraploidBrassica napusand diploidBrassica rapa) was predominantly aneuploids with ploidal levels ranging from near-triploidy to near-hexaploidy, and their chromosome numbers deviated from the theoretical distribution toward increasing chromosome numbers, suggesting that they underwent selection. Karyotype and phenotype analyses showed that aneuploid individuals containing fewer imbalanced chromosomes had higher viability and fertility. Within three generations of self-fertilization, allotriploids mainly developed into near or complete allotetraploids similar toB. napusvia gradually increasing chromosome numbers and fertility, suggesting that allotriploids could act as a bridge in polyploid formation, with aneuploids as intermediates. Self-fertilized interploidy hybrids ultimately generated new allopolyploids carrying different chromosome combinations, which may create a reproductive barrier preventing allotetraploidy back to diploidy and promote gene flow from diploids to allotetraploids. These results suggest that the maintenance of a proper genome balance and dosage drove the recurrent conversion of allotriploids to allotetraploids, which may contribute to the formation and evolution of polyploids.

 

Service systems are typically limited resource environments where scarce capacity is reserved for the most urgent customers. However, there has been a growing interest in the use of proactive service when a less urgent customer may become urgent while waiting. On one hand, providing service for customers when they are less urgent could mean that fewer resources are needed to fulfill their service requirement. On the other hand, using limited capacity for customers who may never need the service in the future takes the capacity away from other more urgent customers who need it now. To understand this tension, we propose a multiserver queueing model with two customer classes: moderate and urgent. We allow customers to transition classes while waiting. In this setting, we characterize how moderate and urgent customers should be prioritized for service when proactive service for moderate customers is an option. We identify an index, the modified [Formula: see text]-index, which plays an important role in determining the optimal scheduling policy. This index lends itself to an intuitive interpretation of how to balance holding costs, service times, abandonments, and transitions between customer classes. This paper was accepted by David Simchi-Levi, stochastic models and simulation.