{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T14:26:27Z","timestamp":1777645587785,"version":"3.51.4"},"reference-count":46,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2021,8,13]],"date-time":"2021-08-13T00:00:00Z","timestamp":1628812800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,8,13]],"date-time":"2021-08-13T00:00:00Z","timestamp":1628812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["102169\/Z\/13\/Z"],"award-info":[{"award-number":["102169\/Z\/13\/Z"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000761","name":"Imperial College London","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000761","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000724","name":"The Health Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000724","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000265","name":"RCUK | Medical Research Council","doi-asserted-by":"publisher","award":["MR\/R015600\/1"],"award-info":[{"award-number":["MR\/R015600\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"RCUK | Medical Research Council","doi-asserted-by":"publisher","award":["MR\/R015600\/1"],"award-info":[{"award-number":["MR\/R015600\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"RCUK | Medical Research Council","doi-asserted-by":"publisher","award":["MR\/R015600\/1"],"award-info":[{"award-number":["MR\/R015600\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"RCUK | Medical Research Council","doi-asserted-by":"publisher","award":["MR\/R015600\/1"],"award-info":[{"award-number":["MR\/R015600\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"RCUK | Medical Research Council","doi-asserted-by":"publisher","award":["MR\/R015600\/1"],"award-info":[{"award-number":["MR\/R015600\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001711","name":"Schweizerischer Nationalfonds zur F\u00f6rderung der Wissenschaftlichen Forschung","doi-asserted-by":"publisher","award":["P2ELP2_188028"],"award-info":[{"award-number":["P2ELP2_188028"]}],"id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"DH | National Institute for Health Research","doi-asserted-by":"publisher","award":["NIHR200908"],"award-info":[{"award-number":["NIHR200908"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"DH | National Institute for Health Research","doi-asserted-by":"publisher","award":["NIHR200908"],"award-info":[{"award-number":["NIHR200908"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Community Jameel"},{"name":"Jan Wallanders and Tom Hedelius Foundation and the Tore Browaldh Foundation; Community Jameel"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Nat Comput Sci"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>In response to unprecedented surges in the demand for hospital care during the SARS-CoV-2 pandemic, health systems have prioritized patients with COVID-19 to life-saving hospital care to the detriment of other patients. In contrast to these ad hoc policies, we develop a linear programming framework to optimally schedule elective procedures and allocate hospital beds among all planned and emergency patients to minimize years of life lost. Leveraging a large dataset of administrative patient medical records, we apply our framework to the National Health Service in England and show that an extra 50,750\u20135,891,608 years of life can be gained compared with prioritization policies that reflect those implemented during the pandemic. Notable health gains are observed for neoplasms, diseases of the digestive system, and injuries and poisoning. Our open-source framework provides a computationally efficient approximation of a large-scale discrete optimization problem that can be applied globally to support national-level care prioritization policies.<\/jats:p>","DOI":"10.1038\/s43588-021-00111-1","type":"journal-article","created":{"date-parts":[[2021,8,13]],"date-time":"2021-08-13T10:03:06Z","timestamp":1628848986000},"page":"521-531","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Optimal national prioritization policies for hospital care during the SARS-CoV-2 pandemic"],"prefix":"10.1038","volume":"1","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9636-9886","authenticated-orcid":false,"given":"Josh C.","family":"D\u2019Aeth","sequence":"first","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6566-1334","authenticated-orcid":false,"given":"Shubhechyya","family":"Ghosal","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5249-619X","authenticated-orcid":false,"given":"Fiona","family":"Grimm","sequence":"additional","affiliation":[]},{"given":"David","family":"Haw","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6545-5546","authenticated-orcid":false,"given":"Esma","family":"Koca","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3295-3979","authenticated-orcid":false,"given":"Krystal","family":"Lau","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7716-3084","authenticated-orcid":false,"given":"Stefano","family":"Moret","sequence":"additional","affiliation":[]},{"given":"Dheeya","family":"Rizmie","sequence":"additional","affiliation":[]},{"given":"Sarah R.","family":"Deeny","sequence":"additional","affiliation":[]},{"given":"Pablo N.","family":"Perez-Guzman","sequence":"additional","affiliation":[]},{"given":"Neil","family":"Ferguson","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3138-4169","authenticated-orcid":false,"given":"Katharina","family":"Hauck","sequence":"additional","affiliation":[]},{"given":"Peter C.","family":"Smith","sequence":"additional","affiliation":[]},{"given":"Giovanni","family":"Forchini","sequence":"additional","affiliation":[]},{"given":"Wolfram","family":"Wiesemann","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5772-7740","authenticated-orcid":false,"given":"Marisa","family":"Miraldo","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2021,8,13]]},"reference":[{"key":"111_CR1","unstructured":"Birnbaum, M. & Morris, L. With coronavirus exploding in Europe, hospitals calculate how long until they hit capacity. The Washington Post (2 November 2020); https:\/\/www.washingtonpost.com\/world\/europe\/covid-coronavirus-europe-hospitals-capacity\/2020\/10\/31\/fe074b56-188a-11eb-8bda-814ca56e138b_story.html"},{"key":"111_CR2","doi-asserted-by":"publisher","first-page":"2049","DOI":"10.1056\/NEJMsb2005114","volume":"382","author":"EJ Emanuel","year":"2020","unstructured":"Emanuel, E. J. et al. Fair allocation of scarce medical resources in the time of COVID-19. N. Engl. J. Med. 382, 2049\u20132055 (2020).","journal-title":"N. Engl. J. Med."},{"key":"111_CR3","unstructured":"Coronavirus: Weston General Hospital halts admissions. BBC News (25 May 2020); https:\/\/www.bbc.co.uk\/news\/uk-england-somerset-52796589"},{"key":"111_CR4","unstructured":"Cullen, L. Covid-19: Elective surgery cancelled at Craigavon Hospital. BBC News NI (4 November 2020); https:\/\/www.bbc.co.uk\/news\/uk-northern-ireland-54801326"},{"key":"111_CR5","unstructured":"COVID-19 Rapid Guideline: Critical Care in Adults NICE Guideline No. 159 (National Institute for Health and Care Excellence, 12 February 2021); https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK566886\/"},{"key":"111_CR6","unstructured":"Important and Urgent\u2014Next Steps on NHS Response to COVID-19 (NHS Improvement and NHS England, 2020); https:\/\/www.england.nhs.uk\/coronavirus\/wp-content\/uploads\/sites\/52\/2020\/03\/urgent-next-steps-on-nhs-response-to-covid-19-letter-simon-stevens.pdf"},{"key":"111_CR7","unstructured":"Operating Framework for Urgent and Planned Services in Hospital Settings During COVID-19 (NHS England, 2020); https:\/\/covidlawlab.org\/wp-content\/uploads\/2020\/06\/Operating-framework-for-urgent-and-planned-services-within-hospitals.pdf"},{"key":"111_CR8","unstructured":"Raccomandazioni di Etica Clinica per l\u2019Ammissione a Trattamenti Intensivi e per la Loro Sospensione 207-2011 (Societ\u00e0 italiana di anestesia analgesia rianimazione e terapia intensiva, 2020); https:\/\/www.quotidianosanita.it\/allegati\/allegato2675063.pdf"},{"key":"111_CR9","unstructured":"Cullen, L. Coronavirus: three of NI\u2019s five health trusts cancel planned surgery. BBC News NI (12 November 2020); https:\/\/www.bbc.co.uk\/news\/uk-northern-ireland-54921936"},{"key":"111_CR10","doi-asserted-by":"publisher","first-page":"m3557","DOI":"10.1136\/bmj.m3557","volume":"370","author":"S Griffin","year":"2020","unstructured":"Griffin, S. COVID-19: waiting times in England reach record highs. Br. Med. J. 370, m3557 (2020).","journal-title":"Br. Med. J."},{"key":"111_CR11","doi-asserted-by":"publisher","first-page":"2368","DOI":"10.1056\/NEJMms2009984","volume":"382","author":"L Rosenbaum","year":"2020","unstructured":"Rosenbaum, L. The untold toll\u2014the pandemic\u2019s effects on patients without COVID-19. N. Engl. J. Med. 382, 2368\u20132371 (2020).","journal-title":"N. Engl. J. Med."},{"key":"111_CR12","unstructured":"Campbell, D. NHS hospital waiting lists could hit 10 million in England this year. The Guardian (2020). at <https:\/\/www.theguardian.com\/society\/2020\/jun\/10\/nhs-hospital-waiting-lists-could-hit-10-million-in-england-this-year>"},{"key":"111_CR13","unstructured":"Davey, M. Covid-19 Victoria: hospitals advised to reduce elective surgery as doctors warn of overcrowding. The Guardian (9 July 2020); https:\/\/www.theguardian.com\/australia-news\/2020\/jul\/09\/covid-19-victoria-hospitals-advised-to-reduce-elective-surgery-as-doctors-warn-of-overcrowding"},{"key":"111_CR14","unstructured":"Road to recovery. NHS Confederation https:\/\/www.nhsconfed.org\/news\/2020\/06\/road-to-recovery (2020)."},{"key":"111_CR15","doi-asserted-by":"publisher","first-page":"e136","DOI":"10.1056\/NEJMp2032508","volume":"383","author":"D Hunter","year":"2020","unstructured":"Hunter, D. Trying to \u201cProtect the NHS\u201d in the United Kingdom. N. Engl. J. Med. 383, e136 (2020).","journal-title":"N. Engl. J. Med."},{"key":"111_CR16","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-020-01482-8","volume":"9","author":"J D\u00e9ry","year":"2020","unstructured":"D\u00e9ry, J. et al. A systematic review of patient prioritization tools in non-emergency healthcare services. Syst. Rev. 9, 227 (2020).","journal-title":"Syst. Rev."},{"key":"111_CR17","doi-asserted-by":"publisher","unstructured":"Valente, R. et al. How to prioritise and optimise access to elective surgery in the COVID-19 pandemic: an interhospital alliance pathway based on the SWALIS 2020 model. A single-cohort feasibility and pilot study. SSRN https:\/\/doi.org\/10.2139\/ssrn.3622349 (2020).","DOI":"10.2139\/ssrn.3622349"},{"key":"111_CR18","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1111\/j.1937-5956.2003.tb00218.x","volume":"12","author":"T Cayirli","year":"2003","unstructured":"Cayirli, T. & Veral, E. Outpatient scheduling in health care: a review of literature. Prod. Oper. Manag. 12, 519\u2013549 (2003).","journal-title":"Prod. Oper. Manag."},{"key":"111_CR19","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.ejor.2016.06.064","volume":"258","author":"A Ahmadi-Javid","year":"2017","unstructured":"Ahmadi-Javid, A., Jalali, Z. & Klassen, K. J. Outpatient appointment systems in healthcare: a review of optimization studies. Eur. J. Oper. Res. 258, 3\u201334 (2017).","journal-title":"Eur. J. Oper. Res."},{"key":"111_CR20","doi-asserted-by":"publisher","first-page":"921","DOI":"10.1016\/j.ejor.2009.04.011","volume":"201","author":"B Cardoen","year":"2010","unstructured":"Cardoen, B., Demeulemeester, E. & Beli\u00ebn, J. Operating room planning and scheduling: a literature review. Eur. J. Oper. Res. 201, 921\u2013932 (2010).","journal-title":"Eur. J. Oper. Res."},{"key":"111_CR21","doi-asserted-by":"publisher","first-page":"800","DOI":"10.1080\/07408170802165880","volume":"40","author":"D Gupta","year":"2008","unstructured":"Gupta, D. & Denton, B. Appointment scheduling in health care: challenges and opportunities. IIE Trans. 40, 800\u2013819 (2008).","journal-title":"IIE Trans."},{"key":"111_CR22","unstructured":"Statement: The Need for National Guidance on Resource Allocation Decisions in the COVID-19 Pandemic (The Nuffield Council on Bioethics, 2021); https:\/\/www.nuffieldbioethics.org\/news\/statement-the-need-for-national-guidance-on-resource-allocation-decisions-in-the-covid-19-pandemic"},{"key":"111_CR23","unstructured":"Hospital Episode Statistics (HES). NHS Digital https:\/\/digital.nhs.uk\/data-and-information\/data-tools-and-services\/data-services\/hospital-episode-statistics (2020)."},{"key":"111_CR24","doi-asserted-by":"publisher","unstructured":"Perez-Guzman, P. N. et al. Clinical characteristics and predictors of outcomes of hospitalized patients with coronavirus disease 2019 in a multiethnic London National Health Service Trust: a retrospective cohort study. Clin. Infect. Dis. https:\/\/doi.org\/10.1093\/cid\/ciaa1091 (2020).","DOI":"10.1093\/cid\/ciaa1091"},{"key":"111_CR25","unstructured":"Past and Projected Period and Cohort Life Tables, 2018-Based, UK (Office for National Statistics, 2020); https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/birthsdeathsandmarriages\/lifeexpectancies\/bulletins\/pastandprojecteddatafromtheperiodandcohortlifetables\/1981to2068"},{"key":"111_CR26","unstructured":"NHS England: national cost collection for the NHS. NHS Digital https:\/\/www.england.nhs.uk\/national-cost-collection\/ (2020)."},{"key":"111_CR27","unstructured":"Statistics: bed availability and occupancy. NHS Digital https:\/\/www.england.nhs.uk\/statistics\/statistical-work-areas\/bed-availability-and-occupancy\/ (2020)."},{"key":"111_CR28","unstructured":"Statistics: critical care bed capacity and urgent operations cancelled. NHS Digital https:\/\/www.england.nhs.uk\/statistics\/statistical-work-areas\/critical-care-capacity\/ (2020)."},{"key":"111_CR29","unstructured":"Statistics: A&E attendances and emergency admissions. NHS Digital https:\/\/www.england.nhs.uk\/statistics\/statistical-work-areas\/ae-waiting-times-and-activity\/ (2020)."},{"key":"111_CR30","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-020-01781-w","volume":"18","author":"R McCabe","year":"2020","unstructured":"McCabe, R. et al. Adapting hospital capacity to meet changing demands during the COVID-19 pandemic. BMC Med. 18, 329 (2020).","journal-title":"BMC Med."},{"key":"111_CR31","unstructured":"Elective Letter (NHS England, 20 August 2020); https:\/\/www.england.nhs.uk\/publication\/elective-letter\/"},{"key":"111_CR32","unstructured":"Campbell, D. & Quinn, B. Mass cancellations of NHS operations inevitable this winter, say doctors. The Guardian (23 October 2020); https:\/\/www.theguardian.com\/society\/2020\/oct\/23\/mass-cancellations-of-nhs-operations-inevitable-this-winter-say-doctors"},{"key":"111_CR33","doi-asserted-by":"publisher","unstructured":"jdaeth274 jdaeth274\/overflow_analysis: publication release. Zenodo https:\/\/doi.org\/10.5281\/zenodo.5079551 (2021).","DOI":"10.5281\/zenodo.5079551"},{"key":"111_CR34","doi-asserted-by":"publisher","unstructured":"Moret, S. ImperialCollegeLondon\/OptimalScheduling4COVID: v1.0. Zenodo https:\/\/doi.org\/10.5281\/ZENODO.5071220 (2021).","DOI":"10.5281\/ZENODO.5071220"},{"key":"111_CR35","unstructured":"Watt, T., Firth, Z., Fisher, R., Thorlby, R. & Kelly, E. Use of Primary Care During the COVID-19 Pandemic (The Health Foundation, 2020); https:\/\/www.health.org.uk\/news-and-comment\/charts-and-infographics\/use-of-primary-care-during-the-covid-19-pandemic"},{"key":"111_CR36","doi-asserted-by":"publisher","first-page":"e2020498","DOI":"10.1001\/jamanetworkopen.2020.20498","volume":"3","author":"C Rhee","year":"2020","unstructured":"Rhee, C. et al. Incidence of nosocomial COVID-19 in patients hospitalized at a large US academic medical center. JAMA Netw. Open 3, e2020498 (2020).","journal-title":"JAMA Netw. Open"},{"key":"111_CR37","unstructured":"COVID-19 Documents (The Federation of Surgical Specialty Associations, 2020); https:\/\/fssa.org.uk\/covid-19_documents.aspx"},{"key":"111_CR38","unstructured":"Deaths Involving COVID-19 by Local Area and Socioeconomic Deprivation: Deaths Occurring Between 1 March and 31 July 2020 (Office for National Statistics, 2020); https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/birthsdeathsandmarriages\/deaths\/bulletins\/deathsinvolvingcovid19bylocalareasanddeprivation\/deathsoccurringbetween1marchand31july2020"},{"key":"111_CR39","unstructured":"Updating Ethnic Contrasts in Deaths Involving the Coronavirus (COVID-19), England and Wales: Deaths Occurring 2 March to 28 July 2020 (Office for National Statistics, 2020); https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/birthsdeathsandmarriages\/deaths\/articles\/updatingethniccontrastsindeathsinvolvingthecoronaviruscovid19englandandwales\/deathsoccurring2marchto28july2020"},{"key":"111_CR40","doi-asserted-by":"publisher","unstructured":"Next steps on the NHS five year forward view. Br. Med. J. https:\/\/doi.org\/10.1136\/bmj.j1678 (2017).","DOI":"10.1136\/bmj.j1678"},{"key":"111_CR41","unstructured":"Our Principles (NICE, 2020); https:\/\/www.nice.org.uk\/about\/who-we-are\/our-principles"},{"key":"111_CR42","unstructured":"Safe Medical Staffing. (Royal College of Physicians, 2020); https:\/\/www.rcplondon.ac.uk\/projects\/outputs\/safe-medical-staffing"},{"key":"111_CR43","unstructured":"Staffing Levels: Advice Guides (Royal College of Nursing, 2020); https:\/\/www.rcn.org.uk\/get-help\/rcn-advice\/staffing-levels"},{"key":"111_CR44","first-page":"8456","volume":"5","author":"J Soong","year":"2015","unstructured":"Soong, J. et al. Quantifying the prevalence of frailty in English hospitals. BMJ Open 5, 8456 (2015).","journal-title":"BMJ Open"},{"key":"111_CR45","unstructured":"Statistics: COVID-19 hospital activity. NHS Digital https:\/\/www.england.nhs.uk\/statistics\/statistical-work-areas\/covid-19-hospital-activity\/ (2020)"},{"key":"111_CR46","doi-asserted-by":"publisher","unstructured":"D\u2019Aeth, J. et al. Optimal scheduling for COVID [source code]. Code Ocean https:\/\/doi.org\/10.24433\/CO.0290795.v1 (2021).","DOI":"10.24433\/CO.0290795.v1"}],"container-title":["Nature Computational Science"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s43588-021-00111-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s43588-021-00111-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s43588-021-00111-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,3]],"date-time":"2022-12-03T21:30:26Z","timestamp":1670103026000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s43588-021-00111-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,13]]},"references-count":46,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,8]]}},"alternative-id":["111"],"URL":"https:\/\/doi.org\/10.1038\/s43588-021-00111-1","relation":{},"ISSN":["2662-8457"],"issn-type":[{"value":"2662-8457","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,13]]},"assertion":[{"value":"23 February 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 July 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 August 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"All authors have completed the Unified Competing Interest form (available on request from the corresponding author). K.L. is employed by Flatiron Health but employment started after the research finished. The other authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}