{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T20:07:43Z","timestamp":1772136463713,"version":"3.50.1"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T00:00:00Z","timestamp":1750291200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T00:00:00Z","timestamp":1750291200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100010025","name":"University of Derby","doi-asserted-by":"publisher","award":["PSL2324-0100"],"award-info":[{"award-number":["PSL2324-0100"]}],"id":[{"id":"10.13039\/100010025","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010025","name":"University of Derby","doi-asserted-by":"publisher","award":["PSL2324-0100"],"award-info":[{"award-number":["PSL2324-0100"]}],"id":[{"id":"10.13039\/100010025","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010025","name":"University of Derby","doi-asserted-by":"publisher","award":["PSL2324-0100"],"award-info":[{"award-number":["PSL2324-0100"]}],"id":[{"id":"10.13039\/100010025","id-type":"DOI","asserted-by":"publisher"}]},{"name":"NOETIC LTD","award":["PSL2324-0100"],"award-info":[{"award-number":["PSL2324-0100"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["npj Digit. Med."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Digital twins have been used in industries and is now gaining traction in healthcare, particularly in precision medicine. Discrete Event Simulation is a modelling methodology for simulating processes and workflows in healthcare. This paper presents a methodology that integrates these technologies to optimise critical care workflows based on real-time state changes, emphasising patient safety, operational efficiency, and sustainability. This study proposes a novel dual-layer architecture to monitor physical and conceptual entities in the Critical Care Unit. In the current scope, this study aims to establish a methodology using Azure cloud to track treatment workflows in real-time. The results indicated that by reviewing observation forms alone successfully tracked 72% of staff-performed tasks in real-time. This study underscores the potential of digital twins to transform precision care in critical care delivery by bridging the gap between actual and ideal clinical practices.<\/jats:p>","DOI":"10.1038\/s41746-025-01738-4","type":"journal-article","created":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T12:01:10Z","timestamp":1750334470000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["A health digital twin framework for discrete event simulation based optimised critical care workflows"],"prefix":"10.1038","volume":"8","author":[{"given":"Gayan Dihantha Kuruppu","family":"Kuruppu Appuhamilage","sequence":"first","affiliation":[]},{"given":"Maqbool","family":"Hussain","sequence":"additional","affiliation":[]},{"given":"Mohsin","family":"Zaman","sequence":"additional","affiliation":[]},{"given":"Wajahat","family":"Ali Khan","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2025,6,19]]},"reference":[{"key":"1738_CR1","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1136\/bmjqs-2021-014130","volume":"33","author":"DE Newman-Toker","year":"2024","unstructured":"Newman-Toker, D. E. et al. Burden of serious harms from diagnostic error in the USA. BMJ Qual. Saf. 33, 109\u2013120 (2024).","journal-title":"BMJ Qual. Saf."},{"key":"1738_CR2","unstructured":"Imperial College London. National State of Patient Safety 2024: Prioritising improvement efforts in a system under stress. https:\/\/www.imperial.ac.uk\/Stories\/National-State-Patient-Safety-2024\/ (2024)."},{"key":"1738_CR3","unstructured":"World Health Organization. Only 1 in 3 countries in the WHO European Region have an action plan on patient safety and\/or quality of care. https:\/\/qualitysafety.bmj.com\/content\/33\/2\/109 (2024)."},{"key":"1738_CR4","unstructured":"International Standard Organization. ISO 31000:2018 Risk management \u2014 Guidelines. Edition 2 https:\/\/www.iso.org\/standard\/65694.html (2018)."},{"key":"1738_CR5","doi-asserted-by":"crossref","unstructured":"Erel, M., Marcus, E.-L. & DeKeyser Ganz, F. Cognitive biases and moral characteristics of healthcare workers and their treatment approach for persons with advanced dementia in acute care settings. Front. Med. 10, 1145142 (2023).","DOI":"10.3389\/fmed.2023.1145142"},{"key":"1738_CR6","first-page":"142","volume":"18","author":"C Chetcuti Ganado","year":"2022","unstructured":"Chetcuti Ganado, C. The impact of cognitive ergonomics in everyday clinical decision making and frontline tasks. Infant 18, 142\u2013146 (2022).","journal-title":"Infant"},{"key":"1738_CR7","doi-asserted-by":"publisher","first-page":"7076","DOI":"10.1111\/jocn.16845","volume":"32","author":"S Jala","year":"2023","unstructured":"Jala, S., Fry, M. & Elliott, R. Cognitive bias during clinical decision-making and its influence on patient outcomes in the emergency department: A scoping review. J. Clin. Nurs. 32, 7076\u20137085 (2023).","journal-title":"J. Clin. Nurs."},{"key":"1738_CR8","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1136\/emermed-2023-213314","volume":"41","author":"H Squires","year":"2024","unstructured":"Squires, H., Mason, S., O\u2019Keeffe, C., Croft, S. & Millington, G. What impact would reducing low-acuity attendance have on emergency department length of stay? A discrete event simulation modelling study. Emerg. Med. J. 41, 27\u201333 (2024).","journal-title":"Emerg. Med. J."},{"key":"1738_CR9","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1038\/s41746-024-01073-0","volume":"7","author":"E Katsoulakis","year":"2024","unstructured":"Katsoulakis, E. et al. Digital twins for health: a scoping review. NPJ Digit. Med. 7, 77 (2024).","journal-title":"NPJ Digit. Med."},{"key":"1738_CR10","doi-asserted-by":"publisher","first-page":"100991","DOI":"10.1016\/j.iot.2023.100991","volume":"24","author":"GM Bisanti","year":"2023","unstructured":"Bisanti, G. M., Mainetti, L., Montanaro, T., Patrono, L. & Sergi, I. Digital twins for aircraft maintenance and operation: A systematic literature review and an IoT-enabled modular architecture. Internet Things 24, 100991 (2023).","journal-title":"Internet Things"},{"key":"1738_CR11","doi-asserted-by":"publisher","DOI":"10.1016\/j.aei.2023.101951","volume":"56","author":"Y Jiang","year":"2023","unstructured":"Jiang, Y. et al. Multi-domain ubiquitous digital twin model for information management of complex infrastructure systems. Adv. Eng. Inform. 56, 101951 (2023).","journal-title":"Adv. Eng. Inform."},{"key":"1738_CR12","doi-asserted-by":"publisher","first-page":"1021","DOI":"10.3390\/jmse11051021","volume":"11","author":"NS Madusanka","year":"2023","unstructured":"Madusanka, N. S., Fan, Y., Yang, S. & Xiang, X. Digital Twin in the Maritime Domain: A Review and Emerging Trends. J. Mar. Sci. Eng. 11, 1021 (2023).","journal-title":"J. Mar. Sci. Eng."},{"key":"1738_CR13","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1038\/s43588-024-00603-w","volume":"4","author":"F Tao","year":"2024","unstructured":"Tao, F., Zhang, H. & Zhang, C. Advancements and challenges of digital twins in industry. Nat. Comput Sci. 4, 169\u2013177 (2024).","journal-title":"Nat. Comput Sci."},{"key":"1738_CR14","doi-asserted-by":"publisher","first-page":"36","DOI":"10.3390\/asi4020036","volume":"4","author":"M Singh","year":"2021","unstructured":"Singh, M. et al. Digital Twin: Origin to Future. Appl. Syst. Innov. 4, 36 (2021).","journal-title":"Appl. Syst. Innov."},{"key":"1738_CR15","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1016\/j.ifacol.2021.10.274","volume":"54","author":"Geoffrey","year":"2021","unstructured":"Geoffrey, et al. Digital Twins in Critical Care: What, When, How, Where, Why? IFAC-PapersOnLine 54, 310\u2013315 (2021).","journal-title":"IFAC-PapersOnLine"},{"key":"1738_CR16","doi-asserted-by":"publisher","first-page":"12262","DOI":"10.3390\/ijerph182212262","volume":"18","author":"JI V\u00e1zquez-Serrano","year":"2021","unstructured":"V\u00e1zquez-Serrano, J. I., Peimbert-Garc\u00eda, R. E. & C\u00e1rdenas-Barr\u00f3n, L. E. Discrete-Event Simulation Modeling in Healthcare: A Comprehensive Review. Int J. Environ. Res. Public Health 18, 12262 (2021).","journal-title":"Int J. Environ. Res. Public Health"},{"key":"1738_CR17","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1038\/s41746-024-01392-2","volume":"7","author":"Y Penverne","year":"2024","unstructured":"Penverne, Y. et al. A simulation based digital twin approach to assessing the organization of response to emergency calls. NPJ Digit. Med. 7, 385 (2024).","journal-title":"NPJ Digit. Med."},{"key":"1738_CR18","doi-asserted-by":"publisher","first-page":"46304","DOI":"10.1109\/ACCESS.2024.3380021","volume":"12","author":"A Gorelova","year":"2024","unstructured":"Gorelova, A., Meli\u00e1, S. & Gadzhimusieva, D. A Discrete Event Simulation of Patient Flow in an Assisted Reproduction Clinic With the Integration of a Smart Health Monitoring System. IEEE Access 12, 46304\u201346318 (2024).","journal-title":"IEEE Access"},{"key":"1738_CR19","doi-asserted-by":"publisher","unstructured":"Zhong, X. et al. A Hybrid Simulation Approach for Modeling Critical Care Delivery in ICU. in 2024 Winter Simulation Conference (WSC) 1233\u20131244. https:\/\/doi.org\/10.1109\/WSC63780.2024.10838861 (IEEE, 2024).","DOI":"10.1109\/WSC63780.2024.10838861"},{"key":"1738_CR20","doi-asserted-by":"publisher","first-page":"7006","DOI":"10.1109\/LRA.2022.3180040","volume":"7","author":"H Zheng","year":"2022","unstructured":"Zheng, H., Wang, Q., Shen, J., Kong, Y. & Li, J. Modeling and Analysis of Operating Room Workflow in a Tertiary A Hospital. IEEE Robot Autom. Lett. 7, 7006\u20137013 (2022).","journal-title":"IEEE Robot Autom. Lett."},{"key":"1738_CR21","doi-asserted-by":"publisher","first-page":"4197","DOI":"10.1080\/00207543.2021.2022235","volume":"60","author":"X Zhong","year":"2022","unstructured":"Zhong, X. et al. A multidisciplinary approach to the development of digital twin models of critical care delivery in intensive care units. Int J. Prod. Res 60, 4197\u20134213 (2022).","journal-title":"Int J. Prod. Res"},{"key":"1738_CR22","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1002\/hpm.3589","volume":"38","author":"H Hassanzadeh","year":"2023","unstructured":"Hassanzadeh, H. et al. A discrete event simulation for improving operating theatre efficiency. Int J. Health Plann Manag. 38, 360\u2013379 (2023).","journal-title":"Int J. Health Plann Manag."},{"key":"1738_CR23","doi-asserted-by":"publisher","first-page":"69652","DOI":"10.1109\/ACCESS.2024.3399744","volume":"12","author":"A Balasubramanyam","year":"2024","unstructured":"Balasubramanyam, A., Ramesh, R., Sudheer, R. & Honnavalli, P. B. Revolutionizing Healthcare: A Review Unveiling the Transformative Power of Digital Twins. IEEE Access 12, 69652\u201369676 (2024).","journal-title":"IEEE Access"},{"key":"1738_CR24","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1007\/s44227-023-00011-y","volume":"11","author":"E Wang","year":"2023","unstructured":"Wang, E., Tayebi, P. & Song, Y.-T. Cloud-Based Digital Twins\u2019 Storage in Emergency Healthcare. Int. J. Networked Distrib. Comput. 11, 75\u201387 (2023).","journal-title":"Int. J. Networked Distrib. Comput."},{"key":"1738_CR25","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1049\/wss2.12101","volume":"14","author":"AK Jameil","year":"2024","unstructured":"Jameil, A. K. & Al-Raweshidy, H. Implementation and evaluation of digital twin framework for Internet of Things based healthcare systems. IET Wirel. Sens. Syst. 14, 507\u2013527 (2024).","journal-title":"IET Wirel. Sens. Syst."},{"key":"1738_CR26","doi-asserted-by":"publisher","first-page":"110779","DOI":"10.1016\/j.ijporl.2021.110779","volume":"147","author":"M Kubala","year":"2021","unstructured":"Kubala, M., Gardner, J. R., Criddle, J., Ward, A. & Richter, G. T. Utilizing process improvement strategies to generate clinic templates and improve patient flow in pediatric otolaryngology. Int J. Pediatr. Otorhinolaryngol. 147, 110779 (2021).","journal-title":"Int J. Pediatr. Otorhinolaryngol."},{"key":"1738_CR27","doi-asserted-by":"publisher","first-page":"7287","DOI":"10.1109\/LRA.2022.3183253","volume":"7","author":"W Trevena","year":"2022","unstructured":"Trevena, W. et al. Modeling of Critically Ill Patient Pathways to Support Intensive Care Delivery. IEEE Robot Autom. Lett. 7, 7287\u20137294 (2022).","journal-title":"IEEE Robot Autom. Lett."},{"key":"1738_CR28","doi-asserted-by":"publisher","first-page":"102317","DOI":"10.1016\/j.techsoc.2023.102317","volume":"74","author":"Y Han","year":"2023","unstructured":"Han, Y., Li, Y., Li, Y., Yang, B. & Cao, L. Digital twinning for smart hospital operations: Framework and proof of concept. Technol. Soc. 74, 102317 (2023).","journal-title":"Technol. Soc."},{"key":"1738_CR29","doi-asserted-by":"crossref","unstructured":"Kherbache, M., Maimour, M. & Rondeau, E. Digital Twin Network for the IIoT using Eclipse Ditto and Hono. In IFAC-PapersOnLine 55 (2022).","DOI":"10.1016\/j.ifacol.2022.08.007"},{"key":"1738_CR30","doi-asserted-by":"publisher","DOI":"10.1109\/ICTAI53825.2021.9673425","author":"P Kaushik","year":"2021","unstructured":"Kaushik, P., Rao, A. M., Singh, D. P., Vashisht, S. & Gupta, S. Cloud Computing and Comparison based on Service and Performance between Amazon AWS, Microsoft Azure, and Google Cloud. Proc. Int. Conf. Technol. Advancements Innov., ICTAI 2021 https:\/\/doi.org\/10.1109\/ICTAI53825.2021.9673425 (2021).","journal-title":"Proc. Int. Conf. Technol. Advancements Innov., ICTAI 2021"}],"container-title":["npj Digital Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41746-025-01738-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-025-01738-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-025-01738-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T12:01:11Z","timestamp":1750334471000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41746-025-01738-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,19]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["1738"],"URL":"https:\/\/doi.org\/10.1038\/s41746-025-01738-4","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-5010353\/v1","asserted-by":"object"}]},"ISSN":["2398-6352"],"issn-type":[{"value":"2398-6352","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,19]]},"assertion":[{"value":"31 August 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 May 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 June 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"376"}}