{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T09:08:35Z","timestamp":1762074515594,"version":"build-2065373602"},"reference-count":73,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2022,11,5]],"date-time":"2022-11-05T00:00:00Z","timestamp":1667606400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/2.zoppoz.workers.dev:443\/https\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000266","name":"Engineering and Physical Sciences Research Council","doi-asserted-by":"publisher","award":["EP\/E019900\/1","GR\/S29874\/01","NICE-Healthcare"],"award-info":[{"award-number":["EP\/E019900\/1","GR\/S29874\/01","NICE-Healthcare"]}],"id":[{"id":"10.13039\/501100000266","id-type":"DOI","asserted-by":"publisher"}]},{"name":"University of Malta Internal Research Grants Programme\u2019s Research Excellence Fund","award":["EP\/E019900\/1","GR\/S29874\/01","NICE-Healthcare"],"award-info":[{"award-number":["EP\/E019900\/1","GR\/S29874\/01","NICE-Healthcare"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Algorithms"],"abstract":"<jats:p>The problem of hospital patients\u2019 delayed discharge or \u2018bed blocking\u2019 has long been a challenge for healthcare managers and policymakers. It negatively affects the hospital performance metrics and has other severe consequences for the healthcare system, such as affecting patients\u2019 health. In our previous work, we proposed the phase-type survival tree (PHTST)-based analysis to cluster patients into clinically meaningful patient groups and an extension of this approach to examine the relationship between the length of stay in hospitals and the destination on discharge. This paper describes how PHTST-based clustering can be used for modelling delayed discharge and its effects in a stroke care unit, especially the extra beds required, additional cost, and bed blocking. The PHTST length of stay distribution of each group of patients (each PHTST node) is modelled separately as a finite state continuous-time Markov chain using Coxian-phase-type distributions. Delayed discharge patients waiting for discharge are modelled as the Markov chain, called the \u2018blocking state\u2019 in a special state. We can use the model to recognise the association between demographic factors and discharge delays and their effects and identify groups of patients who require attention to resolve the most common delays and prevent them from happening again. The approach is illustrated using five years of retrospective data of patients admitted to the Belfast City Hospital with a stroke diagnosis.<\/jats:p>","DOI":"10.3390\/a15110414","type":"journal-article","created":{"date-parts":[[2022,11,7]],"date-time":"2022-11-07T02:43:51Z","timestamp":1667789031000},"page":"414","update-policy":"https:\/\/2.zoppoz.workers.dev:443\/https\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Phase-Type Survival Trees to Model a Delayed Discharge and Its Effect in a Stroke Care Unit"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/2.zoppoz.workers.dev:443\/https\/orcid.org\/0000-0002-3868-0481","authenticated-orcid":false,"given":"Lalit","family":"Garg","sequence":"first","affiliation":[{"name":"Faculty of Information & Communication Technology, University of Malta, MSD 2080 Msida, Malta"}]},{"ORCID":"https:\/\/2.zoppoz.workers.dev:443\/https\/orcid.org\/0000-0002-6871-3504","authenticated-orcid":false,"given":"Sally","family":"McClean","sequence":"additional","affiliation":[{"name":"School of Computing, University of Ulster, Co. Londonderry, Coleraine BT52 1SA, UK"}]},{"ORCID":"https:\/\/2.zoppoz.workers.dev:443\/https\/orcid.org\/0000-0002-2187-7405","authenticated-orcid":false,"given":"Brian","family":"Meenan","sequence":"additional","affiliation":[{"name":"Faculty of Computing, Engineering and the Built Environment, University of Ulster, Co. Londonderry, Coleraine BT52 1SA, UK"}]},{"given":"Maria","family":"Barton","sequence":"additional","affiliation":[{"name":"School of Computing, University of Ulster, Co. Londonderry, Coleraine BT52 1SA, UK"}]},{"given":"Ken","family":"Fullerton","sequence":"additional","affiliation":[{"name":"College of Medicine and Health Sciences, Queen\u2019s University, Belfast BT7 1NN, UK"}]},{"given":"Sandra C.","family":"Buttigieg","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, University of Malta, MSD 2080 Msida, Malta"}]},{"given":"Alexander","family":"Micallef","sequence":"additional","affiliation":[{"name":"Faculty of Engineering, University of Malta, MSD 2080 Msida, Malta"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,5]]},"reference":[{"key":"ref_1","unstructured":"Brown, L., Abello, A., and Thurecht, L. (2011). Length of Hospital Stay by Older Australians: Bed-Blocking or Not. 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