Consulting firm Interdisciplinary Solutions (http://www.intdsolutions.com/) used @RISK and RISKOptimizer from Palisade (http://www.palisade.com/) to help the New York City Department of Health and Mental Hygiene (NYC DOHMH) to prepare for future pandemics.

A proactive approach to risk – made possible by funds awarded by the Centers for Disease Control and Prevention - has enabled NYC DOHMH (www.nyc.gov/doh/) to develop new strategies to mitigate a severe influenza pandemic should one occur.  A key objective was to understand how essential healthcare services and their delivery would be affected.

Interdisciplinary Solutions (http://www.intdsolutions.com/) executed the quantitative side of the project using its epidemiologic Panálysis model (http://www.panalysismodel.com/). This integrates Palisade’s risk and decision analysis software @RISK and RISKOptimizer in order to account for uncertainty, and the result is a projection of healthcare demands during a pandemic to include critical product requirements and staffing needs.

Data from New York City’s 64 hospitals, along with expert opinion and peer reviewed literature, were used to define ranges for the inputs to the @RISK-based portions of the model. Interdisciplinary Solutions then generated a multitude of 'what-if' scenarios by using Monte Carlo simulation to demonstrate a range of possible outcomes.

Nurses are one of the most critical working assets employed during an emergency situation, so a core part of the risk analysis program determined nurse staffing needs during a severe pandemic.  As such, Interdisciplinary Solutions used @RISK to study the differences in potential shortage levels and the effect of interventions designed to mitigate such shortages.  For example, at one representative hospital, while on average interventions eliminated shortages, the results showed that there would be:

- A 26.5% chance that shortages would exist
-A 10% chance of shortages of 46 nurses or above
-A 5% chance of shortages of 67 nurses or above
-A 1% chance of shortages of 102 nurses of above
-A maximum potential shortage level of 149 nurses

Interdisciplinary Solutions then went on to use Palisade’s simulation optimization tool, RISKOptimizer to understand the severity of the effects of pandemics on critical resources. Different plausible scenarios were created to ascertain requirements for ICU and non-ICU beds, ventilators and emergency department capacity that New York City hospitals would need in each of those eventualities.  This allows the NYC DOHMH to take a logical scientific approach to a task that would otherwise rely heavily on guesswork due to the lack of retrospective data.

“By nature, emergency preparedness situations are speculative and therefore not predictable.  At the same time, they are extremely high risk because peoples' lives are in danger.  The key to handling such events is to acknowledge that our predictive abilities are limited and, with that in mind, to use quantitative methods to study a multitude of possibilities,” concludes Mark Abramovich, principal at Interdisciplinary Solutions.  “Palisade's @RISK and RISKOptimizer are designed to make it easy to do this, and the results generated enable organizations to plan for a wide range of scenarios.”

Building on this project, there is now potential to extend this study to include other variables in emergency preparedness such as pharmaceuticals, staff members other than nurses and supporting supplies (e.g. oxygen for ventilators) that could result in equipment not functioning properly. In addition, there is scope to analyze the effects of the geographical, spatial and temporal spread of the disease.