Abstract
Aims
To determine if mathematical optimization of in-hospital defibrillator placements
can reduce in-hospital cardiac arrest-to-defibrillator distance compared to existing
defibrillators in a single hospital.
Methods
We identified treated IHCAs and defibrillator placements in St. Michael's Hospital
in Toronto, Canada from Jan. 2013 to Jun. 2017 and mapped them to a 3-D computer model
of the hospital. An optimization model identified an equal number of optimal defibrillator
locations that minimized the average distance between IHCAs and the closest defibrillator
using a 10-fold cross-validation approach. The optimized and existing defibrillator
locations were compared in terms of average distance to the out-of-sample IHCAs. We
repeated the analysis excluding intensive care units (ICUs), operating theatres (OTs),
and the emergency department (ED). We also re-solved the model using fewer defibrillators
to determine when the average distance matched the performance of existing defibrillators.
Results
We identified 433 treated IHCAs and 53 defibrillators. Of these, 167 IHCAs and 31
defibrillators were outside of ICUs, OTs, and the ED. Optimal defibrillator placements
reduced the average IHCA-to-defibrillator distance from 16.1 m to 2.7 m (relative
decrease of 83.0%; P = 0.002) compared to existing defibrillator placements. For non-ICU/OT/ED IHCAs,
the average distance was reduced from 24.4 m to 11.9 m (relative decrease of 51.3%;
P = 0.002. 8–9 optimized defibrillator locations were sufficient to match the average
IHCA-to-defibrillator distance of existing defibrillator placements.
Conclusions
Optimization-guided placement of in-hospital defibrillators can reduce the distance
from an IHCA to the closest defibrillator. Equivalently, optimization can match existing
defibrillator performance using far fewer defibrillators.
Keywords
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Article info
Publication history
Published online: April 05, 2020
Accepted:
March 24,
2020
Received in revised form:
February 27,
2020
Received:
January 13,
2020
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
