Ornge provides an essential service in Ontario’s highly regionalized health care system by transporting patients to definitive care in a timely manner. To do this effectively requires seamless coordination between staff in the dispatch centre, pilots, maintenance engineers, flight paramedics and physicians. Despite this, the demand for service often exceeds Ornge’s resources.
Optimizing use of existing resources is something that engineers are well-suited to do. Ornge has partnered with Professor Shane Henderson at Cornell’s University’s School of Operations Research and Information Engineering. The goal of this partnership is to find ways to improve how Ornge allocates its resources.
Providing a critical care transport system is a challenge; it combines the complexities of caring for the sick and injured with running a small airline. It is in the latter, the “small airline”, where the principles of operations research and industrial engineering come into play.
When you think of ambulances, paramedics, and critical care, you think about getting to the patient quickly and transporting them to definitive care as soon as possible. Dozens of times every day, Ornge transports some of the health care system’s sickest patients.
What is not as apparent is the need to move patients from hospital to hospital for scheduled care. As health care workers know, not every hospital has what every patient needs. For example, if a patient in a northern community breaks his or her ankle, he may be put in a cast by the doctor in the local hospital. If the patient needs surgery, he or she may be transferred to another hospital with an orthopedic surgeon. If that hospital is a long way, Ornge will be called to fly the patient to see the surgeon. While a frequent occurrence, these transports are not time-sensitive, and are referred to as “next day transfers”.
At the end of each day, a flight planner sits down to look at all the “next day” requests to plan routes and schedules, and determine the number of aircraft needed to meet these requests. No two days are alike, and the planner’s goal is to make efficient use of Ornge’s aircraft.
When we took a close look at the “next day” planning process, we found variability in how each planner did their job; as with any process, this can lead to different resource utilization and ultimately to differences in cost. Ornge’s goal was to reduce variation and find the best schedule for these transports.
This is where the partnership with engineers at Cornell University came into play. The principles used were similar to what a courier company does to plan its routes and ensure cargo Using historical data, simulation and modelling techniques, the Ornge-Cornell partnership designed a simple tool that removed the human variation from the task, allowing flight planners to do their job quicker and easier. Next-day transfers are planned quickly, in a consistent, reproducible manner, all while minimizing utilization and cost.
The application was tested and refined multiple times over a two-year period, resulting in an application that saves time in planning routes and flight schedules, and meets all transfer requests. This is a win-win situation for both patients and Ornge. During the application’s initial implementation, the average distance flown decreased by five per cent and the average cost by seven per cent. While the savings seem small, Ornge aircraft routinely fly more than 25,000 kilometers every day. Any savings translates into additional resources available to provide more service to the patients we serve. The results were published in Air Medical Journal in 2014 (full reference: RD MacDonald et al, Air Med J 2014;33(1):34-9). The application will be incorporated into Ornge’s new dispatch system, scheduled for rollout later this year.
This is just one example of the partnerships Ornge developed to produce evidence-based applications that improve efficiency and service delivery. Ornge continues to systematically examine how it delivers care, and partner with others to look for ways to improve the service it delivers to the citizens of Ontario.