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Feng T, Ajdari A, Boyle LN, Kannan N, Burd R, Groner JI, Farneth RA, Vavilala MS. Computer Simulation to Assess Emergency Department Length of Stay in Pediatric Traumatic Brain Injury. Pediatr Emerg Care 2024; 40:421-425. [PMID: 38227782 PMCID: PMC11141338 DOI: 10.1097/pec.0000000000003088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
OBJECTIVES Our study aimed to identify how emergency department (ED) arrival rate, process of care, and physical layout can impact ED length of stay (LOS) in pediatric traumatic brain injury care. METHODS Process flows and value stream maps were developed for 3 level I pediatric trauma centers. Computer simulation models were also used to examine "what if" scenarios based on ED arrival rates. RESULTS Differences were observed in prearrival preparation time, ED physical layouts, and time spent on processes. Shorter prearrival preparation time, trauma bed location far from diagnostic or treatment areas, and ED arrival rates that exceed 20 patients/day prolonged ED LOS. This was particularly apparent in 1 center where computer simulation showed that relocation of trauma beds can reduce ED LOS regardless of the number of patients that arrive per day. CONCLUSIONS Exceeding certain threshold ED arrival rates of children with traumatic brain injury can substantially increase pediatric trauma center ED LOS but modifications to ED processes and bed location may mitigate this increase.
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Affiliation(s)
| | - Ali Ajdari
- Harvard Medical School & Massachusetts General Hospital, Boston, MA
| | | | | | - Randall Burd
- Children’s National Medical Center, Washington, DC
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Zhu H, Halwani Y, Rohling R, Fels S, Salcudean S. A unified representation of control logic in human-ultrasound machine interaction. IEEE J Biomed Health Inform 2022; 26:3007-3014. [PMID: 35143407 DOI: 10.1109/jbhi.2022.3150242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Advances in human-computer interaction (HCI) technologies have granted sonographers and radiologists a much improved user experience when operating different ultrasound (US) machines. Continued HCI improvements in US would benefit from a systematic study of the HCI control logic used in this domain. Such a study has not been presented previously and is the subject of this paper. We surveyed sonographers to determine the most frequently used controls in US machines. We standardized the representation of the US machine HCI control logic by using the unified modelling language (UML). We used UML diagrams to analyze the HCI control logic of 10 different cart-based US machines from several major manufacturers, and we discovered that the control logic for the most frequently used functions are identical. While this control logic does not follow an established standard, it has been commonly adopted. Using the UML for the visualization and formulation of control logic, we can target logically optimal interactions (whose operation steps cannot be further reduced), e.g., adjustment of B-mode gain, frequency and depth, and can derive methods to simplify logically sub-optimal interactions, e.g., the pointing and selecting operation, as well as image measurements. Our study provides insights into existing HCI approaches used in US machines and establishes a rigorous UML-based framework for future US machine design to improve interoperability, efficiency and ease-of-use.
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Productivity evaluation of radiologists interpreting computed tomography scans using statistical process control charts. Clin Imaging 2021; 77:135-141. [PMID: 33677406 DOI: 10.1016/j.clinimag.2021.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 01/31/2021] [Accepted: 02/02/2021] [Indexed: 11/24/2022]
Abstract
Radiology service managers search for efficient ways to monitor productivity and improve capacity. One way to assess radiologists' productivity is by measuring their time to complete reports. Radiology reporting times (RRTs) may be monitored using statistical tools, such as process control charts (CCs). This study was carried out in the radiology sector of a University-based general hospital with 850 inward beds. Productivity was monitored using CCs. The selected control variable was RRTs, and process capability was calculated using Cp and Cpk indices. Only chest computed tomography scans were analyzed, totaling 2862 exams over a 6-month period. Our objective was to develop a simple tool to monitor radiologist performance, as given by RRT, over time. For that, we constructed CCs using data from 10 radiologists to monitor the stability of their RRTs. Only 3 radiologists presented mean times below the group average; 6 displayed a trend in RRTs that characterized performance improvement, while 4 displayed the opposite trend. Capability measures for the group indicated a process that is not capable. We demonstrate that CCs may be a useful tool for monitoring radiologists' performances in CT scans interpretation. Results demonstrated that in the individual CT reporting process, common cause variability is the type of variability most frequently observed, being most likely related to natural variations in features of the images analyzed. Lastly, CCs may also assist in decision making in the sector, such as establishing minimum productivity goals based on historical performance.
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Larsen EP, Hailu T, Sheldon L, Ginader A, Bodo N, Dewane D, Degnan AJ, Finley J, Sze RW. Optimizing Radiology Reading Room Design: The Eudaimonia Radiology Machine. J Am Coll Radiol 2021; 18:108-120. [PMID: 33065075 PMCID: PMC7553105 DOI: 10.1016/j.jacr.2020.09.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 11/25/2022]
Abstract
Physical and mental stressors on radiologists can result in burnout. Although current efforts seek to target the issues of burnout and stress for radiologists, the impact of their physical workspace is often overlooked. By combining evidence-based design, human factors, and the architectural concept of the Eudaimonia Machine, we have developed a redesign of the radiology reading room that aims to create an optimal workspace for the radiologist. Informed by classical principles of well-being and contemporary work theory, Eudaimonia integrates concerns for individual wellness and efficiency to create an environment that fosters productivity. This layout arranges a work environment into purposeful spaces, each hosting tasks of varying degrees of intensity. The improved design addresses the radiologist's work requirements while also alleviating cognitive and physical stress, fatigue, and burnout. This new layout organizes the reading room into separate areas, each with a distinct purpose intended to support the range of radiologists' work, from consultation with other health care providers to reading images without interruption. The scientific principles that undergird evidence-based design and human factors considerations ensure that the Eudaimonia Radiology Machine is best suited to support the work of the radiologists and the entire radiology department.
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Affiliation(s)
- Ethan P Larsen
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Center for Healthcare Quality and Analytics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Tigist Hailu
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lydia Sheldon
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Abigail Ginader
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nicole Bodo
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Andrew J Degnan
- Department of Radiology, Abington Hospital-Jefferson Health, Abington, Pennsylvania
| | - John Finley
- Facilities Project Management and Construction, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Raymond W Sze
- Associate Radiologist in Chief, Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Liu H, Liu X, Lin L, Islam SMN, Xu Y. A study of the layout planning of plant facility based on the timed Petri net and systematic layout planning. PLoS One 2020; 15:e0239685. [PMID: 32986749 PMCID: PMC7521678 DOI: 10.1371/journal.pone.0239685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/11/2020] [Indexed: 11/18/2022] Open
Abstract
The purpose of this research is to solve the problems of unreasonable layout of the production plant, disorder of the logistics process, and unbalanced production line in discrete manufacturing plants. By analyzing the production process and characteristics, the timed Petri net model is constructed according to the function and connection of each production unit, which is then used to generate a FlexSim simulation model of the production plant logistics system with a simulation software. Therewith the FlexSim simulation model is used to simulate the original layout of the plant, and to analyse the simulation data synthetically to put forward an improvement strategy. Combined with the use of the systematic layout planning method to analyze the overall layout of the plant and logistics relations, we infer the relevant drawings between the production units and determine the improved layout of the facilities. Finally, by comparing the before and after improvement simulation results, it is verified that the combination of timed Petri nets and systematic layout planning is effective to ameliorate the layout of the plant facilities and the logistics system. This method makes up for the factors that traditional methods have not considered, achieves the goal of reducing the cross circuitous route of the plant and the idle rate of equipment, and improving the efficiency of production.
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Affiliation(s)
- Hanwen Liu
- School of Economics and Management, Dalian University of Technology, Dalian, Liaoning, China
- * E-mail:
| | - Xiaobing Liu
- School of Economics and Management, Dalian University of Technology, Dalian, Liaoning, China
| | - Lin Lin
- CRRC Dalian R&D Co., Ltd., Dalian, Liaoning, China
| | - Sardar M. N. Islam
- Institute for Sustainable Industries & Liveable Cities, Victoria University, Melbourne, Australia
| | - Yuqing Xu
- School of Economics and Management, Dalian University of Technology, Dalian, Liaoning, China
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Advancing evidence-based healthcare facility design: a systematic literature review. Health Care Manag Sci 2020; 23:453-480. [PMID: 32447606 DOI: 10.1007/s10729-020-09506-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 04/15/2020] [Indexed: 12/21/2022]
Abstract
Healthcare facility design is a complex process that brings together diverse stakeholders and ideally aligns operational, environmental, experiential, clinical, and organizational objectives. The challenges inherent in facility design arise from the dynamic and complex nature of healthcare itself, and the growing accountability to the quadruple aims of enhancing patient experience, improving population health, reducing costs, and improving staff work life. Many healthcare systems and design practitioners are adopting an evidence-based approach to facility design, defined broadly as basing decisions about the built environment on credible and rigorous research and linking facility design to quality outcomes. Studies focused on architectural options and concepts in the evidence-based design literature have largely employed observation, surveys, post-occupancy study, space syntax analysis, or have been retrospective in nature. Fewer studies have explored layout optimization frameworks, healthcare layout modeling, applications of artificial intelligence, and layout robustness. These operations research/operations management approaches are highly valuable methods to inform healthcare facility design process in its earliest stages and measure performance in quantitative terms, yet they are currently underutilized. A primary objective of this paper is to begin to bridge this gap. This systematic review summarizes 65 evidence-based research studies related to facility layout and planning concepts published from 2008 through 2018, and categorizes them by methodology, area of focus, typology, and metrics of interest. The review identifies gaps in the existing literature and proposes solutions to advance evidence-based healthcare facility design. This work is the first of its kind to review the facility design literature across the disciplines of evidence-based healthcare design research, healthcare systems engineering, and operations research/operations management. The review suggests areas for future study that will enhance evidence-based healthcare facility designs through the integration of operations research and management science methods.
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Sze RW, Hagerty NM, Sassano C, Kazmi P. The Business Case for Evidence-Based Design in Radiology Departments. J Am Coll Radiol 2020; 17:152-156. [DOI: 10.1016/j.jacr.2019.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 08/06/2019] [Indexed: 11/15/2022]
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Benitez GB, Da Silveira GJC, Fogliatto FS. Layout Planning in Healthcare Facilities: A Systematic Review. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2019; 12:31-44. [PMID: 31179733 DOI: 10.1177/1937586719855336] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This study presents a systematic review of the literature on layout planning in healthcare facilities. The review includes 81 articles from journals, conferences, books, and other documents. Articles were classified in two groups according to their main contents including (i) concepts and guidelines and (ii) techniques and tools to assist in layout planning in healthcare facilities. Results indicate that a great variety of concepts and tools have been used to solve layout problems in healthcare. However, healthcare environments such as hospitals can be complex, limiting the ability to obtain optimal layout solutions. Influential factors may include the flows of patients, staff, materials, and information; layout planning and implementation costs; staff and patients safety and well-being; and environmental contamination, among others. The articles reviewed discussed and often proposed solutions covering one or more factors. Results helped us to propose future research directions on the subject.
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Affiliation(s)
- Guilherme B Benitez
- 1 Industrial Engineering Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Flavio S Fogliatto
- 1 Industrial Engineering Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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