# The hospital manager you have been asked to help faces a difficulty: ANALYTICAL SUPPORT FOR DECISION MAKING Assignment, UOS, malaysia

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###### university of strathclyde (UOS)

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Subject

Date

###### 08/08/2022

Part 1: Exploratory analysis

All students should attempt this question

The hospital manager you have been asked to help faces a difficulty. Although O- blood is universal, in the sense that it can be used safely with virtually all patients, it is also in short supply.

Table 1 indicates that only around 7% of the UK population is O- and, by implication, only around 7% of blood donations will be O-. The manager would prefer medical staff to be using appropriately matched blood wherever possible and restrict the use of O- blood to those patients who really need it: those patients who are actually O- (since from Table 3 there are no other compatible blood types) and those patients who require emergency blood transfusion (where there is no time to check their blood type).

On the other hand, the manager does not want donated blood to be wasted, which can happen if blood is not used within its shelf life (each unit of blood is marked with an expiry date).

As a result, she has carried out some data collection in the hospital over the last six months. A record has been kept of every patient who received O- blood during that period. The following data has been collected on each patient (and is available in the accompanying Excel file for this assignment).

ID: a patient identifier
Gender: Male/Female
Age: of the patient in years
ABO: Blood group of the patient – O, A, B, AB
Rh: POS(itive) or NEG(ative)

Emergency: whether the patient was an emergency admission and so needed an Otransfusion. Y for Yes, otherwise blank

Units: total number of units of blood transfused

Reason: for patients whose blood group was not O-, the reason (if known) they were given O- blood.

• X means they were given O- blood because the blood available was close to its expiry date and would otherwise have been thrown away

• N means that the hospital blood bank had no supplies of the patient’s actual blood type in stock and so O- blood was used instead

• Z means there was some other medical reason for giving the patient O- blood;

Age of blood: the maximum age (in days) of the blood units used for transfusion. E.g. a 2 unit transfusion with age of blood equal to 15 days means that one unit is 15 days old, and the other is at most 15 days old.

Duration of Stay: the number of days for which the patient remained in hospital after the transfusion.

Note for some patients there is incomplete data and some cells may have been left blank/empty

Your first task is to conduct a thorough analysis of the data presented and to write a report for the hospital manager summarising the key findings in relation to use of O-blood within the hospital.

The manager is interested in acquiring a better understanding of hospital’s demand for blood to inform purchasing and storage decisions. Your analysis should include, but not be restricted to, analysis of demand on a daily basis as well as the aggregate demand over a 35 day period which corresponds to
shelf life.

Your analysis should give a breakdown of the demand where appropriate, but only where this is insightful and with justification provided. Appropriate visualizations should be used to support your analysis.

Part 2: Statistical analysis

Students should select only one of the following questions (choose either question 2.1, 2.2 or 2.3 – note that 2.3 has multiple parts to be answered)

Question 2.1

2.1 Info: The Manager has heard anecdotal evidence that patients who receive older blood (i.e. closer to its expiry date) are more likely to suffer adverse effects from the blood transfusion. She would like to use the Excel data described for Part 1 to determine if there is any evidence of this relationship, which could be used to identify an improved strategy to handling the blood expiry. Specifically, her question is as follows:

2.1 Task: Can the age of blood used in the transfusion be used to predict the duration of a patient’s stay? Does this relationship vary between patient blood types?

Question 2.2

2.2 Info: The Manager would like to ensure that more transfusions occur with closer matched blood types, so that the O- blood supplies are less commonly used for non-O- patients. Excess demands of blood type are assumed to represent demands that exceed the supply of the blood type (e.g. if there are 2 units of A+ supplies available, and demand is for 5 units of A+, then there is an excess demand of 3 units which need to be covered using an appropriate substitute for A+).

Assume that at present, all excess demands are fully covered by O- blood supplies, and that all transfusions of O- to other blood groups could be avoided if there were sufficient supplies of appropriate alternatives. The Manager is
considering a revision to the strategy to handle excess demands, and would like some analysis of the Excel data described for Part 1, to give a better understanding of these (see details below).

2.2 Task: How many additional units of each blood type would be required per 35 day period to ensure that required demands could be satisfied in 99.99% of cases (e.g. how many additional units of O+ blood would remove the excess demands on the O- supplies with a probability of 0.9999)?

HINT: carefully consider the role of the Central Limit Theorem in modelling aggregate demand over a 35 day period.

Question 2.3

2.3 Info: The manager would like to use available data to inform decisions on managing the blood transfusion system in the hospital. However, she is unsure about the quality of data that has been collected, and whether this can be used with confidence. In particular, she is unsure whether the Excel data sample described for Part 1 is sufficient data to give a true representation of the hospital’s blood use.

Additionally, she is unsure whether international approaches to managing blood use can be appropriately transferred to a UK hospital. See parts 2.3(i) and 2.3(ii) below.

Regarding the Excel data described for Part 1, the Manager would like to confirm that the data is actually representative of the hospital’s blood use needs. She believes that the O- supplies would be used for other blood types at rates that are equivalent to the distribution of individuals with those other blood types, and would like to check how these rates compare with the national average.

2.3 Task (i): for each blood group (except O-), is the proportion of cases in the Excel data sample different to the national average shown in Table 1 (use an appropriate confidence interval to justify your answer)? Using your answer, advise the manager on her query.

Various studies have been published which describe blood management approaches that have been effectively deployed in different countries around the world. The Manager has identified some approaches that sound applicable in her hospital, but she is unsure whether the data can be assumed to be comparable with the UK data. The Manager is aware that, as blood is inherited from parents, there are genetic differences in blood type distributions between countries, as shown with Table 2.

However, the Manager thinks that the differences in Table 2 could just be artifacts of the data collection approach in each country.

2.3 Task (ii): Is the UK proportion of O- cases statistically different to the average proportion of Ocases from the sample of other countries shown in Table 2 (use an appropriate confidence interval to justify your answer)? Using your answer, advise the manager on her query

Part 3: Decision Analysis

Students should select only one of the following questions (choose either question 3.1, or 3.2)

Part 3 General Info:

As part of a wider improvement initiative, the hospital manager is considering how the hospital’s blood bank service can be made more efficient and more effective. At present, the main blood bank, where donated blood is stored, is at a large regional hospital about 80km away. The local hospital has only a small blood bank facility where typically only a few days’ supply of blood can be safely stored.

The regional hospital routinely supplies blood on an anticipated or forecast basis and these stocks are replenished every few days or, in the event of a stock shortage at the local hospital, can be shipped through at a few hours notice (although at considerable cost).

The hospital manager is reviewing a number of options and has heard (vaguely) about the use of multi-criteria methods. She has asked you to develop an outline multi-criteria model to help her reach a decision between the options. The options under consideration are:

Option A: continue the existing system. In one sense this would be the easiest option. However, it also carries some risks as the hospital occasionally experiences times when it runs out of stocks of certain blood types and emergency supplies have to be sent across from the regional hospital. The cost of this is high (because of the specialist transportation needed) contributing to budget overspending and there are also clinical risks for patients. There have also been occasions in some winters where emergency supplies have not been able to be sent because of severe weather conditions.

Option B: expand the blood bank at the local hospital to allow it to carry its own stock requirements in full. The local blood bank would then be effectively independent which would contribute to minimizing risk to patients of blood supply shortage. However, the capital cost of this would be high (roughly estimated at about £0.75 million) and in the current economic climate might be difficult to obtain. Once built the hospital would also incur higher annual running costs (again roughly estimated at around £175,000 per year).

Option C: improve the local hospital’s Management Information System (MIS) and stock control system (SCS). At present the local hospital does little to try to predict blood use requirements or to manage its blood stocks effectively. This option would focus on two things. First, better analysis and forecasting of blood use requirements in the hospital linked to the scheduling of patient treatments and surgical operations.

It is felt that this would enable the hospital to better and more accurately predict the blood it requires. Secondly, investing in an up-to-date stock control system so that blood supplies are more effectively tracked and monitored to reduce wastage, stock levels and associated costs. Most of the effort under this option would go into the development of better IT/IS systems. Anticipated development costs are around £100,000 with ongoing costs on an annual basis of around £50,000.

Question 3.1

3.1 Info: Additional information on the improvement options is as follows:
Option B: Senior medical staff might be unhappy at the additional costs associated with this option, and have commented that the money would be better spent employing more doctors and nurses.

Option C: The exact tangible benefits from this are very difficult to quantify although the manager thinks that wastage will be reduced.

3.1 Task: Which of the improvement options (A, B or C) is preferred, when multiple criteria are used to rank the options, and multiple stakeholder perspectives are considered. Identify at least three criteria/attributes which can be used to rank the three options. Consider the perspectives of at least three potential stakeholder groups for this problem, and identify conflicting interests.

Use appropriate software to analyse the problem, and recommend a course of action. Assume values for any data that you do not have, and briefly explain your reasoning for the values that you use.

Question 3.2

3.2 Info: You have been given access to an expert in the hospital on their current blodd transfusion services. The expert has been able to provide some more detailed data on the improvement options, but for some pieces of information, the expert is unsure. The additional information on the
improvement options is as follows:

Option A: under this option there is a 10% chance that the hospital has insufficient stock per patient. Specialist transportation of emergency supplies has an average cost of £5,000. In 80% of cases, this arrives within 3 hours and on average there is no detriment to care. Of the remaining cases, 75% of the time emergency supplies arrive between 3 and 6 hours after requested, and the potential delay to treatment incurs an additional expected cost of £20,000 due to lasting health conditions.

For the remaining cases, there is a substantial risk to the patient. If the emergency supply can be delivered in time, the potential delay to treatment incurs an additional expected cost of £100,000. However, in 5% of cases, the emergency supplies do not reach the hospital in time and result in a fatality. This cost placed on this outcome is £1.83 million.

Option B: there are three options for the expansion – noted as small, medium and large. The costs described above refer to the medium expansion (£0.75 million for construction, and £175,000 per anum for maintenance). If the medium expansion is in place, the expert predicts that the increased storage capacity would reduce the likelihood of insufficient stock to 5%. The expert does not have data on the small or large expansions.

Option C: under this option, the expert predicts that improved analysis and management would of blood supplies and demand would reduce the likelihood of insufficient stock to 7%.

3.2 Task: Which of the improvement options has the lowest expected value over one year? Over 5 years? Over 10 years? Assume values for any data that you do not have, and explain your reasoning for the values that you use.

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