RESUMO
Hospitals and other healthcare settings use various simulation methods to improve their operations, management, and training. The COVID-19 pandemic, with the resulting necessity for rapid and remote assessment, has highlighted the critical role of modeling and simulation in healthcare, particularly distributed simulation (DS). DS enables integration of heterogeneous simulations to further increase the usability and effectiveness of individual simulations. This article presents a DS system that integrates two different simulations developed for a hospital intensive care unit (ICU) ward dedicated to COVID-19 patients. AnyLogic has been used to develop a simulation model of the ICU ward using agent-based and discrete event modeling methods. This simulation depicts and measures physical contacts between healthcare providers and patients. The Unity platform has been utilized to develop a virtual reality simulation of the ICU environment and operations. The high-level architecture, an IEEE standard for DS, has been used to build a cloud-based DS system by integrating and synchronizing the two simulation platforms. While enhancing the capabilities of both simulations, the DS system can be used for training purposes and assessment of different managerial and operational decisions to minimize contacts and disease transmission in the ICU ward by enabling data exchange between the two simulations.
RESUMO
The COVID-19 pandemic has been particularly threatening to patients with end-stage kidney disease (ESKD) on intermittent hemodialysis and their care providers. Hemodialysis patients who receive life-sustaining medical therapy in healthcare settings, face unique challenges as they need to be at a dialysis unit three or more times a week, where they are confined to specific settings and tended to by dialysis nurses and staff with physical interaction and in close proximity. Despite the importance and critical situation of the dialysis units, modelling studies of the SARS-CoV-2 spread in these settings are very limited. In this paper, we have used a combination of discrete event and agent-based simulation models, to study the operations of a typical large dialysis unit and generate contact matrices to examine outbreak scenarios. We present the details of the contact matrix generation process and demonstrate how the simulation calculates a micro-scale contact matrix comprising the number and duration of contacts at a micro-scale time step. We have used the contacts matrix in an agent-based model to predict disease transmission under different scenarios. The results show that micro-simulation can be used to estimate contact matrices, which can be used effectively for disease modelling in dialysis and similar settings.