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A Drone Logistic Model for Transporting the Complete Analytic Volume of a

Large-Scale University Laboratory

Article in International Journal of Environmental Research and Public Health (IJERPH) · April 2021
DOI: 10.3390/ijerph18094580

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Article

A Drone Logistic Model for Transporting the Complete

Analytic Volume of a Large-Scale University Laboratory
Karl-Arne Johannessen * 1,2, Hans Comtet 1,3 and Erik Fosse 1,2

1 The Intervention Center, Oslo University Hospital, 0424 Oslo, Norway; [email protected] (H.C.);
[email protected] (E.F.)
2 Faculty of Medicine, University of Oslo, 0318 Oslo, Norway

3 The Department of Design, Norwegian University of Science and Technology, 7491 Trondheim, Norway

* Correspondence: [email protected]

Abstract: We present a model for drone transport of the complete annual analytic volume of 6.5
million analyses— (routine and emergency) between two inner-city university laboratories at Oslo
University Hospital located 1.8 km apart and with a time restriction for the analyses of no more than
60 min. The total laboratory activity was analyzed per min for the complete year of 2018. The time
from the clinical ordering of tests to the loading of the drone, drone transport time, and analysis
time after the sample arrived at the analyzing laboratory were assessed using the lead time of emer-
gency analyses of C-reactive protein, troponin, and the international normalized ratio. The activity
had characteristic diurnal patterns, with the most intensive traffic between 8 and 12 a.m. on week-
days and there being considerably less traffic for the rest of the day, at night and on weekends.
Drone schedules with departures 15–60 min apart were simulated. A maximum of 15 min between
flights was required to meet the emergency demand for the analyses being completed within 60
min. The required drone weight capacity was below 3.5 kg at all times. In multiple simulations, the
Citation: Johannessen, K.A.; Comtet, drone times were appropriate, whereas variations in the clinic- and laboratory-related time intervals
H.; Fosse, E. A Drone Logistic Model caused violations of the allowed time 50% of the time. Drone transport with regular schedules may
for Transporting the Complete potentially improve the transport time compared with traditional ground transport and allow the
Analytic Volume of a Large-Scale merging of large laboratories, even when the demand for emergency analyses restricts the maxi-
University Laboratory. Int. J. Envi-
mum transport time. Comprehensive economic evaluations and robust drone technology are
ron. Res. Public Health 2021, 18, x.
needed before such solutions can be ready for implementation.
https://doi.org/10.3390/xxxxx

Keywords: drones; unmanned aerial vehicle; transport; health care; logistics

Academic Editor: Kevin W. Li &
George Crooks

Received: 28 February 2021

Accepted: 22 April 2021 1. Introduction
Published: date Unmanned aircraft vehicles (UAVs, drones) are increasingly being adopted for trans-
portation in a variety of services and are becoming part of health care transport. UAVs
Publisher’s Note: MDPI stays neu- initially had military purposes; however, suggested civil applications include industrial
tral with regard to jurisdictional
surveillance, business parcel delivery, and imaging. Applications in the health sector,
claims in published maps and institu-
search and rescue following natural disasters, drug and vaccine delivery in rural districts,
tional affiliations.
the provision of care technology in emergency situations, and the transportation of blood
samples and organs have been topics of study [1–8].
The assessment of whether drone transport may be a sustainable future alternative
Copyright: © 2021 by the authors. for the highly scheduled transport of biological materials requires the study of real
Submitted for possible open access transport services to identify and overcome potential challenges that may arise under the
publication under the terms and con- conditions of strong wind and turbulence across infrastructure (i.e., around buildings and
ditions of the Creative Commons At- varying terrains) and large spans of temperature and precipitation as well as safety issues.
tribution (CC BY) license (http://crea- Many authorities have implemented regulations relating to drone transport in the civil air
tivecommons.org/licenses/by/4.0/). space [9,10], and legislation regulating civilian drone flights with respect to safety, flight
control and public tolerance is in place [11–17].

Int. J. Environ. Res. Public Health 2021, 18, x. https://doi.org/10.3390/xxxxx www.mdpi.com/journal/ijerph

Int. J. Environ. Res. Public Health 2021, 18, x 2 of 20

Multiple studies have adopted a conceptual framework of drone utilization based on

tandem models and the traveling salesman problem to overcome the current limitations
of flight distance and carrier weight in today’s drones [18–23]. However, with an increas-
ing industrial interest in drones and the rapid development of drone technology, we fore-
see that combinations of different propulsive solutions, such as hydrogen fuel cells, elec-
tric batteries and solar energy, will extend the current range, time, and load limitations
[24].
In the current study, we explore a logistic model for a potential full-scale drone solu-
tion to centralize and consolidate a large laboratory within Oslo University Hospital. In
the case of inner-city transport between such large laboratories, short transport distances
are less dependent on the limited drone range and may be handled through the frequent
recharging of batteries. We therefore apply perspectives that are not restricted to the cur-
rent drone range limitations, and we explore the feasibility and challenges of using a
drone system for the transport of biological materials and blood products between the
two largest sites of Oslo University Hospital.
There are several potential benefits for drone applications across larger laboratories.
One potential benefit is that drone transport may enable the merger of large laboratories
with duplicated services and infrastructure. Another is that a drone transport solution can
outcompete existing ground transport. The aims of the current project were to investigate
whether the complete analytic activity, carried out at the second largest laboratory of Oslo
University hospital (located at Ulleval University Hospital), may be replaced by the drone
transport of all laboratory specimens to the laboratory of the National Hospital for analy-
sis, and to evaluate how such a solution may perform compared with the existing car
transport.
We had two research aims:
1. Identify the crucial factors of a drone transport solution that may support a merger
of two large hospital laboratories, and
2. Assess the time performance of such a model against the currently adopted ground
transport system.

2. Background
2.1. Institution
Oslo University Hospital comprises four hospitals located within Oslo: the National
Hospital (providing local, regional, and national services), Ulleval University Hospital
(providing local, regional, and national services), Radiumhospitalet (a specialized cancer
hospital) and Aker University Hospital (a local and central hospital). In 2018, Oslo Uni-
versity Hospital had total patient activity that included 94,000 hospitalizations, 45,000
day-care treatments and 853,000 outpatient consultations. The hospital had 24,000 em-
ployees, and patients were treated at more than 40 locations within a distance of 20 km.
Oslo University Hospital is thus one of the largest hospitals in Europe and provides ser-
vices that span from local hospital treatment to advanced specialized services and trans-
plantations. With its complete range of medical services and large-scale economic and
technical aspects, Oslo University Hospital covers multiple topics relevant to the assess-
ment of UAV solutions as a complete service for the time-critical clinical transport of bio-
logical samples within large and complex institutions.
Our research was motivated by the fact that Oslo University Hospital is planning
new buildings and a new structure to be established within 2030, with drone solutions
being considered a future transport solution.
Although the Euclidean distance between the two laboratories that we focused on is
1.8 km (Figure 1), we anticipate that the drone may have to travel a longer distance owing
to the dense residential area that surrounds the hospitals. On the basis of information pro-
vided by the Civil Aviation Authorities, we assume a flight distance of 3.6 km in our
model.
Int. J. Environ. Res. Public Health 2021, 18, x 3 of 20

Figure 1. Hospital locations and distances. Lower-right corner: location in Oslo of the detailed section. Ground routes are
labeled with distance and driving time, Straight lines show the Euclidean distances. Red lines: Aker Hospital-National
Hospital. Blue lines: Ulleval Hospital-National Hospital. Yellow lines: Radiumhospitalet-National Hospital.

2.2. Laboratory Services during the Study Period (2018)

Oslo University Hospital had laboratory services at all four main hospital locations;
however, because the four laboratories did not conduct all types of analysis, critical trans-
portation among the hospitals was needed. The total annual analytic volume at Oslo Uni-
versity Hospital in 2018 was close to 22.5 million analytic tests of 7.63 million biological
samples (e.g., blood samples, biopsy specimens, and pathologic samples).
Point-of-care analyses (i.e., 3.2 million analyses performed in clinical wards) were not
included in our analyses because such analyses were performed in the patient room/clin-
ical ward and samples were not transported to the laboratories. At Ulleval University
Hospital, laboratories conducted biochemistry, microbiology (i.e., bacteriology, virology,
molecular diagnostics, and serology), and pathology analyses.
The analytic volume at Ulleval University Hospital in 2018 was 6.52 million labora-
tory analyses (2.059 million test samples), made up of analyses in the areas of clinical bio-
chemistry (5.1 million laboratory analyses), microbiology (1.072 million laboratory anal-
yses), and pharmacology (232,000 laboratory analyses) and 43,500 analyses of other labor-
atory services. Of the total analytic volume, 1.465 million (23.5%) of analyses were emer-
gency analyses, and the ratio of hospitalized patient/outpatient analyses was 55.4%/44.5%.

2.3. Laboratory Costs in the Study Period

The current services organized at multiple locations incurred duplicated costs for in-
frastructure and personnel. For some laboratory specialties, this included 24/7 service
with parallel teams of bioengineers and other staff.
The Division of Laboratory Medicine had a net area of infrastructure of 15,305 m 2 at
the National Hospital and approximately 12,708 m2 at Ulleval University hospital. In ad-
dition to the duplicated building structure, there was the servicing and maintenance of
duplicated laboratory equipment. Because these two locations represent infrastructure of
quite differing age (the National Hospital opened in 2000, whereas Ulleval University
Hospital is considerably older), exact comparative costs of infrastructure do not exist.
Some laboratories provided a service at only one location, whereas the Department of
Medical Biochemistry was located at all four sites of Oslo University Hospital. Our study
focuses on the National Hospital and Ulleval University Hospital, which were the largest
units. The total costs and personnel costs suggest that appreciable savings can be made if
Int. J. Environ. Res. Public Health 2021, 18, x 4 of 20

these two laboratories merge (Table 1), and similar perspectives apply to Aker University
Hospital and Radiumhospitalet.

Table 1. Total costs of all laboratory services in the Division of Laboratory Medicine and the costs
related to the Department of Medical Biochemistry for 2018. The Department of Medical Biochem-
istry is organized at four locations. (Annual costs in million Euro. Average exchange rate 2018
NOK/€ = 9.4).

Organizational Unit Total Costs * Personnel Costs *

Division of Laboratory Medicine 256,845 184,854
Department of Medical Biochemistry (MBC) 44,329 27,264
MBC National Hospital 10,101 7402
MBC Ulleval Hospital 9645 7664
MBC Other Locations 24,583 12,198
* average cost in million Euro; average exchange rate NOK/ € 2018 = 9.4.

A merger will not eliminate all duplicative costs at the hospitals, and it requires an
upgrade of the resources at the National Hospital. From our new hospital project, we
know that this is approximately 50%, indicating a cost reduction between EUR 10 and 20
million.

2.4. Ground Transport in the Study Period

The transportation of samples among the hospitals depended on road transport with
three dedicated vehicles used in regular routing between 8 a.m. and 4 p.m. and taxis used
the rest of the time and for urgent samples during the day. A major part of this transport
between Ulleval University Hospital and the National Hospital was for routine analyses,
but there were also emergency services. The transport time was at times unpredictable
owing to traffic congestion and seasonal weather variations. No system was in place for
the detailed control and monitoring of the transport.
The street between Ulleval University Hospital and the National hospital was partly
a residential road, and partly a busy highway with heavy traffic in rush hour. The route
had 15 crosswalks, each potentially delaying drivers for 15 s, and five traffic lights. Four
of the traffic lights had waiting times of 15 s, and the fifth had a tram crossing that could
cause a delay of 2.5 min on the route from the National Hospital to Ulleval University
Hospital. The mean driving times without heavy traffic were 7.5 min from Ulleval Uni-
versity Hospital to the National Hospital and 9.2 min from the National Hospital to
Ulleval University Hospital (via a different route). During rush hour in the morning, the
route from Ulleval University Hospital could be delayed by traffic congestion, and in the
afternoon, the route from the National Hospital could be similarly delayed in the opposite
direction.
The variations in the timelines for regular car transport and taxi transport from
Ulleval University Hospital to the National Hospital were obtained from the hospital an-
nual service registry and are given in Table 2.

Table 2. Calculated minimum driving time from Ulleval University Hospital to the National Hos-
pital with no delays. The minimal and maximum observed times are the actual times registered in
our databases.

Current Ground Transport Times (Minutes)

Transport type Calculated minimum Minimal observed Maximum observed
Routine transport 7.5 minutes 27 minutes 170 minutes
Taxi transport 7.5 minutes 7 minutes 55 minutes

The minimal time of 27 min for routine car transport, as compared with the minimum
possible time, suggests that the logistics of the routine transport are not optimal. The
Int. J. Environ. Res. Public Health 2021, 18, x 5 of 20

transport mode with the shortest transport time was by taxi, which was used only for
emergency deliveries. The distribution of taxi transport times is shown in Figure 2. Alt-
hough 90% of the taxi travel times are below 25 min, improvements might be made in the
current solutions.

(a) (b)
Figure 2. (a) Variation in transport times for 4800 taxi transports in 2018. (b) Distribution of the taxi transport times.

Figure 2 illustrates that a considerable proportion of the service times for emergency
transport was well above the minimal transport time measured with no delays.

3. Clinical Units and Activities at Ulleval University Hospital

We established the demand profile of each clinic relating to planned and emergency
services, the total activity at each of the five specialty laboratories, and the total transport
demand of the complete laboratory activities.
The clinical activity was organized into 19 clinical divisions with 73 medical depart-
ments with a total of 230 (range of 1–24, mean of 4, and median of 4 units per department)
medical subspecialty units (i.e., wards, outpatient clinics, and centers) providing a vary-
ing mix of inpatient treatments, day treatments, outpatient services, and emergency treat-
ment.
A time restriction in our work was that emergency analyses should be completed
within 60 min of the blood being drawn from the patient.

4. Methods
The macroscale perspective adopted in the analyses of our complete system is illus-
trated in Figure 3.
We used data for the pre-drone system in examining the overall time required for
sample transport from the clinical unit hosting a patient to the laboratory receiving center
(defined as the drone loading site in our model). This overall transport time comprised
the clinical time Ct (beginning with the clinical ordering of a blood test and ending with
the sample dispatched by the pneumatic tube system (PTS) or a porter) and the transport
time Tt (beginning with the sample leaving the clinic and ending with the sample reaching
the loading site). We included the whole repertoire of 463 analyses performed in 2018 in
our volume analyses but used the times for tests of C-reactive protein (CRP), the interna-
tional normalized ratio (INR) and troponin, routinely used for the benchmarking of time
at our biochemical laboratory, when assessing transport lead times in our system.
Int. J. Environ. Res. Public Health 2021, 18, x 6 of 20

Figure 3. Structure of the analytical approach: pre-drone system including the clinical activity, drone system for transport
from the clinic to the laboratory and post-drone system including laboratory analysis. (PTS = pneumatic transport system.)

For the post-drone system, we analyzed the laboratory time Lt, beginning when a
sample arrived at the laboratory reception center (assuming that the drone landing site
was located there), ending when the analysis was completed in the laboratory.
The macroscale perspective adopted in the analyses of our complete system is illus-
trated in Figure 4.

Figure 4. Model of the drone flight system and time sequence.

The drone loading time comprised the time needed for the drone to arrive at the
loading station, the time needed to exchange an empty cargo box with a new loaded cargo
box, and the time needed to prepare for takeoff. The flight time comprised the takeoff time
needed to reach the flight altitude, the flight time at the set flight altitude, the descent
time, and the landing time. Although the pre- and post-drone systems were extrinsic to
the drone solution, the above measures defined the time margins for planning drone
transport.

5. Analysis of Total Activity in 2018

The complete laboratory analytic activity in 2018 was analyzed with 1 min time res-
olution for a period of 365 days. Seasonal, monthly, weekly, daily, and diurnal patterns
were mapped to analyze the required transport capacities and identify low-activity peri-
ods. We also targeted current clinical activity models that might have to be modified to
reduce unnecessarily oversized drone capacities in periods of low activity.
The following analyses were performed.

1. Analysis of the total activity profiles across clinical units in characterizing the current
patterns of transport volumes from all clinics to all five laboratories at Ulleval Uni-
versity Hospital.
2. Analysis of the mix of routine/emergency samples in evaluating the need for regular
versus varying routing models.
Int. J. Environ. Res. Public Health 2021, 18, x 7 of 20

3. Analysis of the time from the moment that a test was ordered in the clinical unit to
the moment of the arrival of the sample at the drone loading site.
4. Analysis of the pneumatic tube system (PTS) and porter transport with particular
focus on the transport time and arrival rate at the drone loading site.

5.1. Characterization of Transported Samples

An important aspect was the varying weight and volume of samples arriving from
different clinics. Our analyses quantitatively considered the number, weight, and volume
of the sample specimens. Figure 5 illustrates how the test samples differed considerably
in weight and volume. All test glasses were weighed assuming samples were filled as
recommended by the manufacturer, not correcting for samples with smaller than the rec-
ommended volume. The weight per volume varied from 0.7 to 3.3 g/mL across the test
samples. Other samples, such as those for urine tests, varied depending on the container
used, and average was obtained based through manual weighing. The resulting weights
were allocated to the ordered analyses, adjusting for the fact that multiple analyses may
be made for one sample in a glass container. In some cases, an extra glass container was
used in case of more analyses were needed, however, this was deemed to be of little con-
sequence to the total weight (<1%).

(a) (b)
Figure 5. (a) Bottle weighting 166 g and having a volume of 50 mL; (b) Tube weighing 7 g and
having a volume of 10 mL.

5.2. Analysis of the Mix of Routine/Emergency Services

Our time limits were determined by the needs of emergency services. Certain clinics
conducted more emergency activities than others, and we initially analyzed all data di-
vided by planned and emergency services for the individual clinics and for the five indi-
vidual laboratories.

5.3. The Time from the Moment That the Blood Test Was Taken to the Moment of Arrival at the
Drone Loading Site and Variation in the Time of PTS Transport to the Drone Loading Site
The time from clinical ordering to conducting a test was measured for the emergency
samples because this was the decisive time in our model. We therefore used the current
times relating to emergency analyses in our analyses of the drone system.

5.4. PTS Transport and Arrival Times

Biological samples from different clinical locations were transported manually by
porters or by the PTS to the loading site. We estimated the mean and maximum times of
transport from all 67 PTS stations and the time of porter transport to the drone loading
site for our simulations.
The electronic PTS monitoring system did not provide information on the number of
biological samples in each vacuum tube, and we therefore assessed this number manually
at the loading site on multiple days. The PTS transport times (PTS t) were analyzed for
28,000 transports using automatically recorded data of the electronic monitoring system,
Int. J. Environ. Res. Public Health 2021, 18, x 8 of 20

supplemented by the counting of 2000 samples in the tubes arriving at the drone loading
site.

5.5. Post-Drone Times

The time required for the post-drone phase may vary as some analyses take longer
to process than others (in terms of preparation and the time on instrument). We assessed
the time required to process 50% of the samples and the time required to analyze 95% of
the samples.

6. Simplistic Approach Based on Queue Theory

Our PTS system might be considered a multi-server system because there were 67
PTS sender stations, each located at and dedicated to specific clinics and all sending sam-
ples to the common arrival station in the laboratory. However, as samples from these
sender stations arrived independently of others at the loading site, as seen from the drone
perspective, this uncoordinated current of samples from different clinics added up to an
arrival pattern with a steady state that was within the acceptable limits.
Although this arrival pattern was considered an exogenic factor unrelated to the
drone transport, we included this varying pattern in our evaluations of the drone capacity.
We excluded periods in which the PTS system came to a complete halt for technical rea-
sons and did not consider queuing models with abandonment, as observed for other sys-
tems, because all samples (equivalent to customers in other systems) had to remain in the
system and not leave.
A well-known topic in queue theory is how customers prioritized in terms of wait
times may be ranked according to principles such as first in–first out or first in–last out.
These principles are aimed at reducing the waiting times for priority individuals (samples
in our model) through earlier-arriving customers yielding to later-arriving customers.
This was not relevant to our system because the first sample entering a drone always had
the same departure time as the last sample entering (i.e., batching in a drone).
The PTS and drones in a sequence may also be considered a multi-server and multi-
phase system. However, although multiple drones might represent multiple servers, we
planned a model where just one drone was available for loading at a given time. Assum-
ing that a full transport box may be exchanged with an empty transport box without de-
lay, we used a single queue–single server model because we intended to construct a sim-
ple model.

Flight Time and Frequency in Drone Schedules

On the basis of the time limit of 60 min for emergency analyses, the allowable time
for the drone system is given by
(1) Drone system time Dt = Emergency time restriction − Ct − Tt − Lt.
We therefore assessed guiding numbers for the pre- and post-drone time spans that
were external to the drone system in our simulations. We also calculated the maximum
time for the total system, which was our decisive variable for the planning of drone
transport.
The capacity of drone transport is a product of the number of drone flights per unit
time multiplied by the load on each flight. The latter has a physical limitation in terms of
the maximum drone weight or volume capacity, which must be considered (Figure 2).
The total drone time Dt is defined as the sum of the loading time (Tload), take-off time
(Ttoff), flight time (Tflig), descent time (Tdesc) and offloading time (Toffl):
Dt = Tload + Ttoff + Tflig + Tdesc + Toffl, where Ttoff + Tflig + Tdesc = DFT,
which is the air flight time of the drone (Figure 4).
Int. J. Environ. Res. Public Health 2021, 18, x 9 of 20

Each of the take-off time, flight time, and landing time may be affected by weather
conditions and other air traffic. The flight height and path may depend on wind and tur-
bulence and routing in relation to other traffic, and civil infrastructure may require the
flight course to vary over time.
Although the Euclidian distance was 1.8 km, we based our assumptions on a flight
distance twice as long (i.e., 3.6 km), while the drone speed was set at 60 km/h, which was
taken from a drone we used in preliminary tests (i.e., a Globe UAV Aquila Multicopter).
This gave a value of 3.6 min for Tflig. On the basis of multiple preliminary test flights, we
assumed a period of 1 min for takeoff and a period of 3 min for landing. In our preliminary
tests, the Tflig was shorter with a tailwind and longer with a headwind; however, the total
round-trip times were close to our assumed drone flight time (DFT) of 8 min.
The loading time (Tload) covers the time needed to get the drone in place for loading,
the time needed to exchange a full transport compartment with an empty transport com-
partment and the time needed to prepare the drone for takeoff. The utilization of the drone
capacity is a function of the filling of the drone, which depends on the arrival rate. T load is
thus given by
(2) Tload ≤ Tem − (Pre-drone time) − (Post-drone time) − DFT − Toff.
We assumed an offloading time Toff = 0. Tload is a possible limitation of the utilization
of the drone capacity, as the extent of filling depends on the rate and allowed duration of
filling.

7. Simulations
Across all the weeks in our analysis of laboratory activities, the maximum demand
on any weekday at any time was ≤20% above the corresponding mean maximum for the
same point in time. We therefore used a randomly varying increment of 20% in our sim-
ulations of the total system to assess the effects of such variations relative to the observed
mean values across all variables and days in the period.
We used Excel (Microsoft Corporation, Redmond, WA, USA) and XLSTAT
(Addinsoft Inc., Paris, France) for our simulations and statistical analyses.

8. Results
8.1. Overall Profiles across Clinical Units
Analyses of the activity in 2018 revealed large diurnal variations. The activity was
highest during the morning on weekdays and substantially lower in the afternoons, at
nights and on weekends. There were also large seasonal variations associated with holi-
days and vacations. The results from 8 weeks in March/April and 8 weeks in Septem-
ber/October, during which there were no vacations, were used in the analyses. All other
time periods had lower volumes and were thus covered by the required capacity deter-
mined for the 16 weeks analyzed.
Compared with the biochemical laboratory, the other laboratories had rather small
volumes and there was no need to consider emergency transport to the individual labor-
atories separately.
Figure 6 illustrates the typical routine activity per hour in the medical biochemistry
laboratory on Monday–Thursday, the days having the highest activity. Similar profiles
were observed for the other laboratories, however, with considerably lower peaks and
volumes. Fridays and the weekends had lower activity and were easily covered by the
schedule determined for the earlier days of the week. The figure shows time-varying ac-
tivity with notable peaks throughout the daytime. The results for the schedule with a
flight interval of 1 h suggest that the drone capacity can be downscaled during afternoons
and nights, by either making fewer flights or using smaller drones. It is noted that morn-
ing activities required a drone with a loading capacity close to 8 kg.
Int. J. Environ. Res. Public Health 2021, 18, x 10 of 20

Figure 6. Average, maximum and minimum hourly payload weights on Monday–Thursday for 8
weeks of routine analyses at the medical biochemistry laboratory. Each maximum value was taken
from the day with the highest value.

8.2. Analysis of the Mix of Emergency/Routine Samples

The emergency activities of the medical biochemistry laboratory presented in Figure
7 reveal that schedules with an hourly frequency would not be sufficient. Although the
volume of emergency samples was smaller volumes than the volumes of routine volumes,
they constitute a continuous demand of time-critical services 24 h of the day. Accordingly,
based on the urgency of emergency analyses, hourly drone flights would clearly not sat-
isfy the time restriction of 60 min.
The non-drone times obtained in our analyses (Table 3) reveal that schedules with a
15 min frequency of drone departure are required. Figure 7c,d illustrates variations in the
total weight on Mondays and Tuesdays during an 8 week period for a schedule with a 15
min flight frequency. The maximum deviations from the mean volumes at peak hour are
≤20%.

(a) (b)
Int. J. Environ. Res. Public Health 2021, 18, x 11 of 20

(c) (d)
Figure 7. (a) Number of emergency laboratory samples. (b) Weight of samples corresponding to figure a. (c) Variation in
the load weight on Mondays over 8 weeks for a 15 min frequency. (d) Variation in the load weight on Tuesdays over 8
weeks for a 15 min flight frequency.

8.3. Pre-Drone System: Time from Clinic to Drone Loading Site

8.3.1. Clinical Time
Although emergency analyses were of low volume compared with routine analyses,
they decisively affect our system. The clinical time intervals of both routine and emer-
gency analyses varied considerably; however, we assumed that the emergency analyses
had the potential to have the shortest time intervals in the current operating situation. The
main data of the emergency CRP, INR and troponin analyses are summarized in Table 3.

Table 3. The time elements in the transport model.

Time Measures for Emergency Analyses (minutes)

Mean SD Min Max
Clinical Time 3.5 3.2 1.0 180
PTS transport 3.2 1.4 0.1 28
Laboratory Process Time 28.1 10.5 9.1 125
Total Non-Drone Time 34.7 15.1 9.1 333

Further characteristics of the pre-drone analyses are illustrated in Figure 8. The scat-
ter plot in Figure 8a shows that some emergency samples were taken up to 30 min after
being ordered. While 50% of the clinical orders of emergency samples were performed
within 11 min, it took 75 min for 95% of clinical orders of emergency samples to be per-
formed (Figure 8b). These time variations were not correlated to the typical periods of
high activity but rather occurred during afternoons and at nights.

(a)
Int. J. Environ. Res. Public Health 2021, 18, x 12 of 20

(b)

Figure 8. (a) Single time points. Diurnal measurements of clinical time. (b) Time from ordering to
performing an emergency test.

8.3.2. PTS Transport Times

Figure 9 presents a typical time arrival curve during for the PTS and porter transport
during busy morning hour. It is seen that the arrival rate per minute is determined by a
combination of a random PTS process and the manual transport, which is a partly periodic
and random process. The individual transport times for PTS tubes are depicted in panel
b. Although the maximum transport time was 28 min on the selected days, panel c shows
that 95% of transport times were within 7 min. Panel d compares the maximum transport
time simulated using 20% random increases with the real measured PTS time. Such sim-
ulated maximum transport times were used in the simulation of the complete system.

(a) (b)
Percent of transport times
100 %
100 % 93 % 95 % 97 % 97 % 97 %
87 %
80 % 73 %
Percent

60 % 49 %

40 %

20 % 7%
0%
0%
<1 <2 <3 <4 <5 <6 <7 <8 <9 <10 <30
Less than minutes

(c) (d)
Figure 9. (a) Arrival rate measured at the drone loading site; (b) Measured transport time for an individual PTS; (c) Per-
centage of PTS times within time frames variation; (d) Simulated maximum PTS time allowing 20% random.
Int. J. Environ. Res. Public Health 2021, 18, x 13 of 20

8.4. Drone Filling Rate

Results of the drone filling rate are presented according to the arrival rates between
8 and 12 a.m. These were the busiest hour, which likely had the busiest filling rate, maxi-
mum capacity demand, and the maximum risk of queuing problems. Considering drone
schedules with a flight frequency of 15 min, we assessed the filling of 3.5 kg drones in 15
min periods.
Figure 10a shows the percentage filling for 20 filling periods of 15 min each, starting
5 min apart. The figure shows a variation in filling between 30% and 72% of the drone
capacity. Figure 10b shows the corresponding percentage of accumulated filling of drones
during 15 min periods starting 15 min apart. The figure confirms that the utilization of the
drone varied with time.

Filling rate during 15 minutes

80 %
70 %
60 %
50 %
Percent

40 %
30 %
20 %
10 %
0%
1 5 10 15
Minutes

(a) (b)
Figure 10. (a) Illustrations of the arrival and filling rates over 15 min intervals. Accumulated arrival of sample rates over
15 min intervals; (b) Variation in the percentage utilization of a 3.5 kg drone capacity.

8.5. Post-Drone System: Processing Time in the Laboratory

The laboratory processing times were assessed for CRP, INR and troponin analyses
as depicted in Figure 11. Although 50% of the analyses were processed within 15 min, the
95% percentile was not reached until 116 min.

(a) (b)
Figure 11. (a) Individual times of emergency analyses; (b) Accumulated times of emergency laboratory analyses.

9. Simulation of Predicted Full-Scale Transport Times

We simulated 10,000 events of the complete transport system allowing a random varia-
tion of arrival at the drone loading site and fixing the drone capacity at 3.5 kg. In contrast to
the case for queuing systems using the average time in the service system, we used the maxi-
mum time in the system because no samples were intended to have a response time longer
Int. J. Environ. Res. Public Health 2021, 18, x 14 of 20

than 60 min. The total times for the system varied considerably as depicted in Figure 12 and
Table 4.

Figure 12. Individual times of PTS transport, clinical time, drone time, post-drone time and total time (sum of all) during
simulations.

Table 4. Percent of simulations violating the maximum allowed total time of 60 min.

Time Measure Mean SD Min Max

Total Time in System 32 % 0.9% 30 % 33 %
% PTS > 5 minutes 3% 0.7% 2% 4%
% Clinical times > 15 minutes 53 % 0.7% 52 % 55 %
% Laboratory time > 15 minutes 51 % 0.8% 49 % 53 %
% Drone Times > 15 minutes 0% 0% 0% 0%

Only 3% of the PTS times and none of the drone times were outside our intended
time intervals. On average, 53% of the clinical times and 51% of the laboratory times were
longer than 15 min and, thus, outside the assumed limits for these processes. Likely owing
to the randomness of these measures, only 32% of the total times were outside maximum
interval of 60 min.

10. Discussion
In the current study, we examined how time-varying clinical demands for laboratory
analyses may affect future drone-based transport with the potential to merge a large la-
boratory with another. Our study showed that several factors must be considered in op-
erating a large laboratory to avoid drone-related delays. Our model suggests that several
gains relating to the economics and timeliness of services can be made. All the above are
complex topics that require further study.
While the peak transport volumes per unit time determined the maximum needed
drone load capacity during the peak h, the time restrictions imposed by emergency ser-
vices determined the required frequency of the drone schedules 24 h a day. In our model
with a university laboratory performing 6.5 million analyses per year, schedules with a 15
min flight frequency and drones with a load capacity of 3.5 kg could theoretically satisfied
the demands of both the routine and emergency analyses. Although the time-critical emer-
gency analyses were low in volumes and could easily be absorbed by a drone capacity of
3.5 kg, their urgency was a decisive criterion for the service.
We modelled a solution with a fixed drone capacity, representing a drone service that
was oversized during evenings and holidays; i.e., that is, at times when there is less traffic.
Int. J. Environ. Res. Public Health 2021, 18, x 15 of 20

Further research is needed to assess the proper balance between the drone weight capac-
ity, drone transport frequency, and routings from an economic perspective. This balance
may depend on the local environment, the distance between institutions, other air traffic,
the urban structures, and other factors.
Whereas a higher frequency of drone departures may reduce the required drone size,
which would be favorable in urban regions where drones may be disruptive when flying
through public spaces, a higher frequency of drone flights may also be disruptive and
require more complex management of the air-space traffic. An important topic is whether
solutions should be based on regular drone routings as in our model, on the transport
demand, or on a combination of the two strategies. This may depend on both the mix of
routine and emergency activities and the distances between locations. A topic that re-
quires further research is whether on-demand drones should also be available for urgently
required analyses.
Our analyses of the pre-drone–drone–post-drone system indicated that the drone ser-
vice can be controlled using planned time intervals. This was related to the fact that the
busiest times had rather small variations in volume, which were all covered by the esti-
mated drone capacity, and that this peak capacity absorbed the required capacity of all
other times of the day. Although we may not prevent many samples arriving at the same
time (i.e., the drone load capacity may be exceeded), we consider this a low risk and that
it will at most cause a 15 min delay as a sample waits for the next drone transport. The
PTS system had variations outside the estimated limits in only 3% of the simulations,
which was considered acceptable.
Our model indicates improvements in transport time over the currently used car
transport services. However, optimized drone solutions should be compared with opti-
mized ground transport. The suboptimal organization of ground transport is not an argu-
ment for using drones, and existing solutions should be studied and improved. Our ob-
served car transport times indicate that the current system has potential for improvement,
which should be established before strategic decisions are made. Furthermore, we as-
sumed constant flight times in our model. Seasonal weather conditions may not only af-
fect car transport as we experience today but also affect drone flight times. With current
drone technology, it is not always possible for drones to fly at all. Improvements to the
climatic sustainability of drones must be established before our model can be considered
realistic to implement. Accordingly, conclusions of the benefit of drone services compared
with ground transport must be made with care. Furthermore, not every service in health
care is time critical, and economic evaluations must be made using appropriate standards
to assess which time-related advantages of drone solutions will be sustainable compared
with existing transport solutions.
Our model has a rather short distance between the two chosen laboratories involved.
At larger distances, more time is needed for the drone flight than we used, which may
affect the total response time and require higher drone frequencies and further optimiza-
tion of the service [25]. However, we based our flight times on a drone speed of 60 km/h,
and future drones may be able to fly considerably quicker [26,27], suggesting that poten-
tially longer flight distances may be realistic in the future.

Effect on the Clinical Organization

In contrast to the drone service performance in our model, both the pre-drone clinical
time and analysis time during the post-drone time violated our allowable time intervals
in 50% of simulations. Although the aggregated times exceeded the total time restriction
in only 30% of simulations, such random totals would not be reliable. However, the cor-
ollary of the same fact is that almost 50% of the clinical and laboratory times were satis-
factory, and lead times would be well within the required time limits if clinical routines
were standardized. Accordingly, the lead times illustrate that our time restrictions may
be realistic, given a clinical optimalization of logistics.
Int. J. Environ. Res. Public Health 2021, 18, x 16 of 20

From a simplistic perspective, future drone solutions may be considered merely as a

substitution of the current ground transport solutions with minimal consequences for clin-
ical activities. In our model, however, improvements to the clinical logistics would be nec-
essary to satisfy the defined time restrictions in our modelling. To what extent additional
processing work should accompany the implementation of drone solutions may depend
on local cultures and environments.
Tornatzky et al. [28] developed an interesting concept of the interplay among tech-
nology, the organizational culture and the environment, called the TOE framework. They
categorized the innovation process into ″developing″ and ″using,″ portraying that the pro-
cesses of innovation generation and adoption differ considerably. In some cultures, there
may be an ambition to extend the implementation of new technologies to a broader inno-
vative culture, whereas other cultures appear to mainly implement new technology by
fitting it to existing solutions. Applied in a healthcare logistics setting, the TOE framework
may offer factors affecting the decision to adopt technologies to improve healthcare logis-
tics processes.
In our modelling, we identified necessary logistic improvements related to both the
clinics and laboratory processes. Two well-known specialized methods from industry that
focus on looking for waste, improving workflow and creating more value with less effort
are the LEAN method (originating from the Toyota car manufacturing system) and Six
Sigma (originating from Motorola). The experience of implementing such organizational
processes varies from successful improvements to processes to cases in which implement-
ing LEAN in clinical cultures has sparked further challenges that are more demanding
than with the implementation of the methods in industry [29–37].
How to best engage clinical and laboratory leaders and managers in actively facili-
tating long-term improvement processes for the optimization of drone transport solutions
requires extensive research. Approaches should be tailored to the existing organization
and culture [38]. A new technology will invariably affect the process in which the technol-
ogy is implemented, and processes often need to be aligned with the introduction of new
technologies [39–41].
In our study, the outpatient analyses peaked at the same times of the day as hospi-
talized-patient analyses. Outpatient analyses constituted 44.5% of the total volume anal-
yses, with the major activity occurring between 9 and 12 a.m. If the peak volume of the
outpatient analyses had been 1–2 h later, the maximum transport capacities needed at this
time would have been lower, possibly reducing the maximum needed drone weight ca-
pacity by 15%–20% and allowing the use us smaller drones. Whether such modifications
would need comprehensive adjustments of clinical work schedules or by planning of only
outpatient laboratory visits more flexibly, may be of interest in future studies.
We conclude that comparing drone transport with existing solutions, the logistics
may require substantial refinement if the true potential of drone transport is to be
achieved.

11. Sustainability of Future Drone Solutions

Most health care systems are battling increasing costs, and laboratory services with
increasing complexity are crucial services that have escalating expenses with respect to
infrastructure and operations on a daily 24 h basis. Drone transport may have the poten-
tial to reduce costs if, through its independence from ground traffic congestion and delays,
it allows fast transport solutions that can centralize laboratory services that are tradition-
ally performed at multiple locations with the duplication of infrastructure and 24/7 ser-
vices.
If drones represent a transport system that offers close to 100% uptime with sufficient
quality, they may contribute to the centralization of time-critical laboratory services, re-
ducing both the operational costs and the costs of infrastructure investment. A recent re-
port found that the quality of biological samples following drone turbulence is an im-
portant factor to consider [42]. Drone transport can be applied to other services, such as
Int. J. Environ. Res. Public Health 2021, 18, x 17 of 20

central sterile services providing operating instruments, hospital clothing, and hospital
catering.
Although our drone modelling suggests that the costs of today’s duplicated services
may be reduced by mergers or improved transport, this cost reduction cannot be out-
weighed by the costs relating to purchasing, maintaining, and operating of UAVs and the
required launch infrastructures. The current economy of complex drone transport is not
known in detail sufficient for complete economic evaluation; however, studies have been
published [8,43], and the history of technological development has demonstrated that the
costs of technological innovations decline appreciably over time [44,45]. We did not focus
on solutions that might minimize the total cost of transportation. Economically efficient
solutions may require drone fleets to meet the maximum capacity needs and time con-
straints of the medical demands as well as to adapt to diurnal and seasonal variations in
the required capacity.
We targeted the use of an uncomplicated model in our system. Our goal was to por-
tray a drone service model with adequate but not excessive capacity, where the key trade-
off is between the cost of excess capacity in low-demand periods and the risk of a service
that is insufficient in high-demand periods. We have no knowledge with which to con-
clude what would be the best solution, and more research is required. One option that
should be considered for future time-varying drone solutions, as in our modelling, is
whether the vacant drone capacity in less busy periods may be used for other purposes.
The adoption of point-of-care testing has increased in the past few years because it
reduces the turnaround time [46–48]. Future laboratory activities might include such
point-of-care analyses, centralized laboratories (core laboratories) conducting 24/7 activi-
ties and dedicated laboratories conducting specialized analyses having demands that are
less time critical. This may in turn reduce the needed biological transport volumes for
external inter-institutional transport, contributing to both simpler solutions and lower ca-
pacity demands. When assessing future sustainability, lower transport needs for future
transport than needs observed today should be expected.

12. Limitations
Although our modelling is based on comprehensive data and reflects large laborato-
ries providing a mixture of routine and emergency services, it is related to a structure
having a Euclidean distance of only 1.8 km. Other hospital systems may have longer dis-
tances. We foresee that longer flight distances will apply to urban hospital locations. In-
ner-city transport may be relevant across multiple types of laboratories, for which future
solutions are emerging [49,50].
A stable real-life drone service may depend on several extrinsic factors, such as the
weather, other air traffic and landing sites. A longer flight distance may result in higher
risks of variation in the flight times, variation in regularity of services as well as delays.
Undoubtedly, strong wind conditions may prolong the flight time, and such topics are
part of our current research [51]. Furthermore, the tolerance of biological materials to
flight conditions, such as turbulence and temperature, is an important consideration
[6,42].
We chose to apply a simple drone routing. More sophisticated models may have ad-
vantages from both economic and service perspectives, and research on more complex
solutions is needed. In particular, we believe that flexible flight routings should be ex-
plored.
We assumed a fixed landing site in our modelling, setting the site for landing and
drone loading at the reception center of the current laboratory. More complex institutions
may require multiple service locations and models to operate multiple landing sites. This
may involve more complexity with respect to both the planning of drone routing and eco-
nomics.
Int. J. Environ. Res. Public Health 2021, 18, x 18 of 20

13. Conclusions
We conclude that drone transport models offer transport solutions for large-scale la-
boratory services with the potential to improve service time and laboratory costs, but that
such gains depend on multiple factors that require further investigation.
Drone transport may enable the merger of duplicated services with reduced costs of
service and infrastructure. Increased knowledge of drone service costs, including the costs
of operation, infrastructure, and maintenance are needed, and the effects of local demands
and the framework may be crucial.
Comparisons of the time gains between traditional logistics and drone services re-
quire that the compared solutions be optimized before conclusions are made, and the final
conclusions may depend on the distance, climatic conditions, geographical location, and
type of institution. Importantly, weather conditions which today pose a challenge to
ground transport, are a great threat to the stability of drone traffic.
Care should be taken in considering any health care related service as time critical.
Those services that really are time critical require regular and stable drone services, which
will not be realistic until drones are more robust against physical conditions.

Author Contributions: Conceptualization, K.-A.J.; Data curation, K.-A.J.; Methodology, K.-A.J.;

Writing – original draft, K.-A.J.; Writing – review & editing, K.-A-J.; Data curation, H.C, Review &
editing, H.C, Writing – review & editing, E.F. All authors have read and agreed to the published
version of the manuscript.
Funding: This research was funded by The Research Council of Norway under Grant 282207/2018.
Institutional Review Board Statement: Not applicable.
Informed Consent Statement: Not applicable.
Data Availability Statement: Our data are not available for general distribution. Please consult cor-
responding author for further information if interest.

Acknowledgments: We thank Jens Petter Berg, Faculty of Medicine, Institute of Clinical Medicine,
University of Oslo, for valuable comments on this paper.
Conflicts of Interest: The authors declare no conflict of interest.

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