Even before the pandemic, DeGroote School of Business professor Elkafi Hassini was looking for ways to help health-care systems address two major problems: Unplanned patient readmissions and allocating limited hospital resources in the most effective way.

Now, with the pandemic placing immense strain on already maxed-out health systems, that research has taken on a new urgency.

Hassini is teaming up with global health informatics giant 3M to develop ways to help hospital networks address both of those problems — not only during the height of the COVID-19 pandemic, but in its aftermath it as well.

Unplanned readmissions and patient backlogs

Hassini, a professor of Operations Management at the DeGroote School of Business, says unplanned readmissions — when a patient unexpectedly returns to a hospital within weeks of receiving treatment and must be readmitted — cost the Canadian health-care system more than $1.8 billion in 2017, according to the Canadian Institute for Health Information.

Hassini recently received a NSERC Alliance COVID-19 grant to work with 3M Canada to study and propose models and algorithms that can help with the problems of unplanned readmissions and resource allocation to address backlogs during and after a crisis.

“Studies in the U.S. show that if you carefully study unplanned readmissions and organize your resources, you can reduce the cost and make systems more efficient in terms of treatment and patient flow,” Hassini says.

“Some research has estimated that up to 25 per cent of unplanned readmissions can be avoided through initiatives like ours — something as simple as collecting data and making sure the reasons for unplanned readmissions are prevented.”

Preventing readmissions is also a matter of health equity, Hassini says: The risk of returning to hospitals for people who live in low-income neighbourhoods is 16% higher  for surgical patients.

Readmissions also add to the strain created by another problem: The huge backlog of non-urgent procedures that have been put on hold by the pandemic.

It is estimated that more than 100,000 patients across Canada have had such procedures rescheduled and it’s expected to take several years to work through the backlog, Hassini says.

“The system runs the risk of being overwhelmed when those procedures begin again, but if we help address readmissions, we will also help patients who are waiting for their procedures.”

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Hassini points out that looking at these issues has become more critical because of the pandemic.

“Ontario’s hospital systems were already working at capacity prior to pandemic,” he says. “Disruption and delays mean that the strain on resources and wait times will only get worse.”

How 3M Canada comes into it

3M is best known as a manufacturer, but the company works with thousands of hospitals in the U.S. and Canada to develop health informatics, using patient records, data on visits and readmissions.

“We’ll work together on developing solutions to help hospitals with readmission problems,” Hassini says.

They will collect and study data on patients’ medical records and hospital network resources, with an eye on identifying patients who are more likely to need readmission.

The model they develop to help lower readmission and improve patient flow through hospital networks will be used for day-to-day operations, Hassini says. “If one hospital is overloaded but another isn’t, we’ll find he best way to redistribute the load.”

But it can also help make more strategic or larger-scale decisions — whether to dedicate one hospital for COVID issues, or to have all hospitals treat COVID patients — and to study the effect of these decisions on the patient flow and the backlog of procedures.

In large outbreaks, health-care systems must balance the need to address the crisis while also planning for post- pandemic recovery. That’s why Hassini’s research will examine how the pandemic unfolded, “but we will also be thinking about the future,” he notes.

“In the case of pandemics, what is the best way to provide service under strict protocols?

“The research will look at some pandemic health care management policies and study their impact on hospital readmission management strategies. While it is important to institute and implement pandemic health and safety policies for hospitals, we have to make sure that they do not come at the expense of other health care services.”

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