Introduction: Emergency teleneurology care has grown in magnitude, impact, and validation. Stroke is a leading cause of death in the US and the timely treatment of stroke results in better outcomes for patients. Teleneurology provides evidence-based care to patients even when a board-certified neurologist is not physically on site. Determining staffing demand for telemedicine consultation for a specific period of time is an integral part of the decision-making activities of providers of acute care telemedicine services. This study aims to build a forecasting model to predict consultation demand to optimize telemedicine provider staffing. Such forecasting models acquire added importance in emergency situations such as the current COVID-19 pandemic.
Materials and Methods: This study trained consultation data of SOC Telemed, a private telemedicine provider, from 411 hospitals nationwide and involving 97,593 incidents of consultations. The forecasting model analyzes characteristics including hospital size (number of beds), annual volume, patient demographics, time of consultation, and reason for consultation.
Results: Several regression techniques were used to demonstrate a strong correlation between these features and weekly demand with r2 = 0.7821. Reason for consult in the past week was the strongest predictor for the demand in the next week with r2 = 0.7899.
Conclusion: A predictive model for demand forecasting can optimize telemedicine resources to improve patient care and help telemedicine providers decide how many physicians to staff. The goal of the forecasting model is to improve patient care and outcomes by providing physicians timely and efficiently to meet consultation demand. The ability to predict demand and calculate expected volume allow telemedicine providers to schedule physicians in advance. This mitigates the clinical risk of excess patient demand.and long waiting time, as well as the financial risk of surplus of physicians.
Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D, et al. Thrombolysis with Alteplase 3 to 4.5 Hours after Acute Ischemic Stroke. New England Journal of Medicine. 2008;359(13):1317–29.
2.
Xu Q, Tsui K, Jiang W, Guo H. A Hybrid Approach for Forecasting Patient Visits in Emergency Department. Quality and Reliability Engineering International. 2016;32(8):2751–9.
3.
Kadri F, Harrou F, Chaabane S, Tahon C. Time Series Modelling and Forecasting of Emergency Department Overcrowding. Journal of Medical Systems. 2014;38(9).
4.
Afilal M, Yalaoui F, Dugardin F, Amodeo L, Laplanche D, Blua P. Forecasting the Emergency Department Patients Flow. Journal of Medical Systems. 2016;40(7).
5.
Rosychuk RJ, Youngson E, Rowe BH. Presentations to Emergency Departments for COPD: A Time Series Analysis. Canadian Respiratory Journal. 2016;2016:1–9.
6.
Zinouri N, Taaffe KM, Neyens DM. Modelling and forecasting daily surgical case volume using time series analysis. Health Systems. 2018;7(2):111–9.
7.
Calegari R, Fogliatto FS, Lucini FR, Neyeloff J, Kuchenbecker RS, Schaan BD. Forecasting Daily Volume and Acuity of Patients in the Emergency Department. Computational and Mathematical Methods in Medicine. 2016;2016:1–8.
8.
Aboagye-Sarfo P, Mai Q, Sanfilippo FM, Preen DB, Stewart LM, Fatovich DM. A comparison of multivariate and univariate time series approaches to modelling and forecasting emergency department demand in Western Australia. Journal of Biomedical Informatics. 2015;57:62–73.
9.
Bergs J, Heerinckx P, Verelst S. Knowing what to expect, forecasting monthly emergency department visits: A time-series analysis. International Emergency Nursing. 2014;22(2):112–5.
10.
Menke NB, Caputo N, Fraser R, Haber J, Shields C, Menke MN. A retrospective analysis of the utility of an artificial neural network to predict ED volume. The American Journal of Emergency Medicine. 2014;32(6):614–7.
11.
Zhang X, Kim J, Patzer RE, Pitts SR, Patzer A, Schrager JD. Prediction of Emergency Department Hospital Admission Based on Natural Language Processing and Neural Networks. Methods of Information in Medicine. 2017;56(05):377–89.
12.
Barak-Corren Y, Fine AM, Reis BY. Early Prediction Model of Patient Hospitalization From the Pediatric Emergency Department. Pediatrics. 2017;139(5):e20162785.
13.
Greenland S, Mansournia MA, Altman DG. Sparse data bias: a problem hiding in plain sight. BMJ. :i1981.
14.
Juang WC, Huang SJ, Huang FD, Cheng PW, Wann SR. Application of time series analysis in modelling and forecasting emergency department visits in a medical centre in Southern Taiwan. BMJ Open. 2017;7(11):e018628.
15.
Broussalis E. Gender Differences in Patients with Intravenous Thrombolytic and Conservative Treatment for Acute Ischemic Stroke. Journal of Neurology & Neurophysiology. 2011;02(04).
16.
Sylaja PN. Thrombolysis in patients older than 80 years with acute ischaemic stroke: Canadian Alteplase for Stroke Effectiveness Study. Journal of Neurology, Neurosurgery & Psychiatry. 77(7):826–9.
17.
Asplund K, Karvanen J, Giampaoli S, Jousilahti P, Niemelä M, Broda G, et al. Relative Risks for Stroke by Age, Sex, and Population Based on Follow-Up of 18 European Populations in the MORGAM Project. Stroke. 2009;40(7):2319–26.
18.
Karagiannis A, Tziomalos K, Mikhailidis DP, Semertzidis P, Kountana E, Kakafika AI, et al. Seasonal variation in the occurrence of stroke in Northern Greece: a 10 year study in 8204 patients. Neurological Research. 2010;32(3):326–31.
19.
Fares A. Winter cardiovascular diseases phenomenon. North American Journal of Medical Sciences. 2013;5(4):266.
20.
Cadilhac DA, Vu M, Bladin C. Experience with scaling up the Victorian Stroke Telemedicine programme. Journal of Telemedicine and Telecare. 2014;20(7):413–8.
21.
Nelson RE, Saltzman GM, Skalabrin EJ, Demaerschalk BM, Majersik JJ. The cost-effectiveness of telestroke in the treatment of acute ischemic stroke. Neurology. 2011;77(17):1590–8.
22.
Demaerschalk BM, Berg J, Chong BW, Gross H, Nystrom K, Adeoye O, et al. American Telemedicine Association: Telestroke Guidelines. Telemedicine and e-Health. 2017;23(5):376–89.
23.
Kepplinger J, Barlinn K, Deckert S, Scheibe M, Bodechtel U, Schmitt J. Safety and efficacy of thrombolysis in telestroke. Neurology. 2016;87(13):1344–51.
24.
Hess DC, Wang S, Hamilton W, Lee S, Pardue C, Waller JL, et al. REACH. Stroke. 2005;36(9):2018–20.
25.
Al Kasab S, Orabi MY, Harvey JB, Turner N, Aysse P, Debenham E, et al. Rate of Symptomatic Intracerebral Hemorrhage Related to Intravenous tPA Administered Over Telestroke Within 4.5-Hour Window. Telemedicine and e-Health. 2018;24(10):749–52.
Wechsler LR. Advantages and Limitations of Teleneurology. JAMA Neurology. 2015;72(3):349.
28.
Elson MJ, Stevenson EA, Feldman BA, Lim J, Beck CA, Beran DB, et al. Telemedicine for Parkinson’s Disease: Limited Engagement Between Local Clinicians and Remote Specialists. Telemedicine and e-Health. 2018;24(9):722–4.
29.
Saver JL. Time Is Brain—Quantified. Stroke. 2006;37(1):263–6.
30.
Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Executive Summary: Heart Disease and Stroke Statistics—2015 Update. Circulation. 2015;131(4):434–41.
31.
Fugate JE, Rabinstein AA. Absolute and Relative Contraindications to IV rt-PA for Acute Ischemic Stroke. The Neurohospitalist. 2015;5(3):110–21.
32.
Capampangan DJ, Wellik KE, Bobrow BJ, Aguilar MI, Ingall TJ, Kiernan TE, et al. Telemedicine Versus Telephone for Remote Emergency Stroke Consultations. The Neurologist. 2009;15(3):163–6.
33.
Dall TM, Storm MV, Chakrabarti R, Drogan O, Keran CM, Donofrio PD, et al. Supply and demand analysis of the current and future US neurology workforce. Neurology. 2013;81(5):470–8.
34.
Busby L, Owada K, Dhungana S, Zimmermann S, Coppola V, Ruban R, et al. CODE FAST: a quality improvement initiative to reduce door-to-needle times. Journal of NeuroInterventional Surgery. 2016;8(7):661–4.
35.
Van Schaik SM, Scott S, de Lau LML, Van den Berg-Vos RM, Kruyt ND. Short Door-to-Needle Times in Acute Ischemic Stroke and Prospective Identification of Its Delaying Factors. Cerebrovascular Diseases Extra. 5(2):75–83.
36.
Kamal N, Holodinsky JK, Stephenson C, Kashayp D, Demchuk AM, Hill MD, et al. Improving Door-to-Needle Times for Acute Ischemic Stroke. Circulation: Cardiovascular Quality and Outcomes. 2017;10(1).
37.
Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJ (Buddy), Demaerschalk BM, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke. Stroke. 2013;44(3):870–947.
38.
Adams RJ, Debenham E, Chalela J, Chimowitz M, Hays A, Hill C, et al. REACH MUSC: A Telemedicine Facilitated Network for Stroke: Initial Operational Experience. Frontiers in Neurology. 3.
39.
Harvey J, Al Kasab S, Almallouhi E, Guerrero WR, Debenham E, Turner N, et al. Door to needle time and functional outcome for mild ischemic stroke over telestroke. Journal of Telemedicine and Telecare. 2019;25(6):365–9.
40.
Gupta A, Goyal RK, Joiner KA, Saini S. Outsourcing in the Healthcare Industry. Information Resources Management Journal. 2008;21(1):1–26.
41.
Yaghi S, Harik SI, Hinduja A, Bianchi N, Johnson DM, Keyrouz SG. Post t-PA transfer to hub improves outcome of moderate to severe ischemic stroke patients. Journal of Telemedicine and Telecare. 2015;21(7):396–9.
42.
Pedragosa À, Alvarez-Sabin J, Molina CA, Sanclemente C, Martín MC, Alonso F, et al. Impact of a telemedicine system on acute stroke care in a community hospital. Journal of Telemedicine and Telecare. 2009;15(5):260–3.
43.
Lyerly MJ, Wu TC, Mullen MT, Albright KC, Wolff C, Boehme AK, et al. The effects of telemedicine on racial and ethnic disparities in access to acute stroke care. Journal of Telemedicine and Telecare. 2016;22(2):114–20.
44.
Soyiri IN, Reidpath DD. An overview of health forecasting. Environmental Health and Preventive Medicine. 2013;18(1):1–9.
45.
Brunner JO, Edenharter GM. Long term staff scheduling of physicians with different experience levels in hospitals using column generation. Health Care Management Science. 2011;14(2):189–202.
46.
Blacquiere D, Lindsay MP, Foley N, Taralson C, Alcock S, Balg C, et al. Canadian Stroke Best Practice Recommendations: Telestroke Best Practice Guidelines Update 2017. International Journal of Stroke. 2017;12(8):886–95.
47.
Araz OM, Bentley D, Muelleman RL. Using Google Flu Trends data in forecasting influenza-like–illness related ED visits in Omaha, Nebraska. The American Journal of Emergency Medicine. 2014;32(9):1016–23.
48.
Aroua A, Abdul-Nour G. Forecast emergency room visits – a major diagnostic categories based approach. International Journal of Metrology and Quality Engineering. 2015;6(2):204.
49.
Chase VJ, Cohn AEM, Peterson TA, Lavieri MS. Predicting Emergency Department Volume Using Forecasting Methods to Create a “Surge Response” for Noncrisis Events. Academic Emergency Medicine. 2012;19(5):569–76.
50.
Peck JS, Gaehde SA, Nightingale DJ, Gelman DY, Huckins DS, Lemons MF, et al. Generalizability of a Simple Approach for Predicting Hospital Admission From an Emergency Department. Academic Emergency Medicine. 2013;20(11):1156–63.
51.
McCarthy ML, Zeger SL, Ding R, Aronsky D, Hoot NR, Kelen GD. The Challenge of Predicting Demand for Emergency Department Services. Academic Emergency Medicine. 2008;15(4):337–46.
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