Saving lives through simulation

On a University of Pittsburgh-sponsored trip to Bogota, Colombia, in 2017, an unlikely collaboration took root that today is saving lives. Pitt industrial engineering professor Dr. Bopaya Bidanda, Pitt trauma surgeon Dr. Juan Carlos Puyana, and adjunct Pitt surgery faculty based in Kenya, Dr. Jana Macleod, struck up a conversation that evolved into BLOODSAFE – Pathways of Innovation in Blood Transfusion Systems in Kenya (PITS Kenya). The project is co-led by Dr. Pratap Kumar at Strathmore University in Nairobi, Kenya, and University College London (UCL), and it is funded by the National Heart, Lung, and Blood Institute (NHLBI).

To solve the “wicked” challenge of ensuring a safe, stable blood supply in Kenya, a transdisciplinary team of Pitt and Kenyan researchers helped develop a discrete event simulation (DES), a computer-based model, that reveals gaps in the blood transfusion continuum to help optimize the “vein-to-vein” process from collection to storage to delivery and transfusion.  

The research, which provides the first quantitative model of the blood continuum in a low- to middle-income country (LMIC), is published in the article “Simulating the blood transfusion system in Kenya: Modelling methods and exploratory analyses” (DOI: 10.1371/journal.pgph.0004587) in PLOS Global Public Health. It details a flexible model that can be adapted to multiple countries and help save lives around the world.

“The vision for this project is to develop robust supply chains to ensure safe, sufficient blood can reach Kenyans who need it,” said Bidanda, Ernest E. Roth Professor of Industrial Engineering.

An international, transdisciplinary team is using technology tools and community-based committees to achieve this vision. An essential tool has been computer modeling that can track how a system evolves in an unpredictable environment.

To develop their unique model, the team created a process map to visually represent and understand the many facets of the Kenyan blood continuum. Focusing on three distinct counties, they gathered data from local experts to ensure vital knowledge was incorporated. 

“We took a holistic approach to build a comprehensive model,” Bidanda said. “The many voices involved in every step of the blood system helped guide this effort.”

The lead author of the publication is Yiqi Tian, an industrial engineering PhD student in the Swanson School of Engineering. Tian, who received a prestigious INFORMS award for her work to develop this model, used Pittsburgh-based Simio software to simulate the Kenyan blood continuum over a 12-month period.

Tian collaborated with her academic advisor, Dr. Bo Zeng, and with Dr. Jayant Rajgopal and Bidanda to develop and test the system.

“Traditionally, DES has been used in manufacturing to optimize systems with many parts moving continuously,” said Rajgopal. “More recently, large health systems are using it.”

While creating the DES, the engineering team collaborated with a range of experts led by Kumar, project co-PI, medical doctor, neuroscientist, and health economist at Strathmore University Business School, now at the Global Business School for Health at UCL. The team included Pitt’s Puyana, project co-PI, now at the Royal College of Surgeons in Ireland; Mark Yazer, Pathology; Kristina Rudd, Critical Care Medicine; Jennifer Makin, Obstetrics & Gynecology; and Linda Barnes, social scientist. Also involved, among others, were Jana McLeod, Surgery – Kenyatta University, and Tecla Kivuli, Business – Strathmore University.      

Scalable and adaptable to other countries or regions, the model identifies how changes in blood collection, storage, demand, and other factors will affect the percentage of patients who receive blood when they need it.

“Community leaders and healthcare professionals can use this model to help make real-time decisions in policy and operations,” Bidanda said.

“By incorporating industrial engineering tools, we developed a vein-to-vein simulation model that provides practical insights to strengthen Kenya’s blood transfusion system,” said Tian. “It has been a great honor, as a PhD student, to work with such a transdisciplinary team and learn from experts across public health and clinical domains.”

Zeng added, “To save lives in Kenya, we’re harnessing the collective insight of surgeons, OBGYNs, transfusion medicine specialists, local administrators, engineers, social scientists, and the very people whose lives depend on us all getting this right.”  

Of the importance of this unique approach, Bidanda said, “Complex problems with countless variables require transdisciplinary solutions.”