Visualizing the demand for various resources as a function of the master surgery schedule: a case study

Cost-quality tradeoff in nurse staffing: an exploration of USA hospitals facing market competition

Purpose

This research aims to explore the fine-grained relationships between nurse staffing and hospital operational performance with respect to care quality and operating costs. The authors also investigate the moderation effect of competition in local hospital markets on these relationships.

Design/methodology/approach

A six-year panel data is assembled from five separate sources to obtain information of 2,524 USA hospitals. Fixed-effect (FE) models are used to test the proposed hypotheses.

Findings

First, nurse staffing is initially associated with improved care quality until nurse staffing reaches a turning point, beyond which nurse staffing is associated with worse care quality. Second, a similar pattern applies to the relationship between nurse staffing and operating costs, although the turning point is at a much lower nurse staffing level. Third, market competition moderates the relationship between nurse staffing and care quality so that the turning point of nurse staffing will be higher when the degree of competition is higher. This shift of turning point is also observed in the relationship between nurse staffing and operating costs.

Practical implications

The study identifies three ranges of nurse staffing in which hospitals will likely experience simultaneous improvements, a tradeoff or simultaneous decline of care quality and operating costs when investing in more nursing capacity. Hospitals should adjust nurse staffing levels to the right directions to achieve better care or reduce operating costs.

Originality/value

Nurses constitute the largest provider group in hospitals and profoundly impact care quality and operating costs among all health care professionals. Optimizing the level of nurse staffing, therefore, can significantly impact the care quality and operating costs of hospitals.

Increasing efficiency by optimizing table position for elective primary THA and TKA: a prospective monocentric pilot study

Introduction

Hip and knee arthroplasties are very frequently performed surgeries with high quality standards and continuous optimization potential. Intraoperative processes can be standardized and simplified by optimization of table setups in the operating room to improve the quality and to increase efficiency.

Patients and methods

The existing surgical setups for primary hip and knee arthroplasties in a university maximum care hospital with endoprosthesis center were simulated and analysed with a computer program and optimized setup suggestions were worked out, based on handover times, walking distance and ergonomic aspects determined in the program. In a prospective monocentric analysis, primary hip arthroplasties and knee arthroplasties were examined in currently used and in the new optimized setups (standard procedure according to in-house SOP, senior and main surgeons, no assistants). The surgeries were externally and independently supervised and analysed, whereby the time between incision and suture beginning, handovers per minute and handover times were documented, amongst other things. In addition, an evaluation sheet, which showed the satisfaction with the new setup, was filled by the surgical team.

Results

In the period from April 2016 to December 2018, 19 hip arthroplasties in currently used and 15 in the new optimized setup as well as 9 knee arthroplasties in currently used and 13 in the new setup were performed. Attention was paid to constant conditions in the compared groups and disruptive factors (assisted surgeries, complex surgeries, different cementings, etc.) were excluded. In the group of hip arthroplasties, the handover times were significantly different (old 1.82 +/− 1.43 s.; new 1.08 +/− 0.78 s.; p <0.001), as well as the handovers per minute (old 1.62 +/− 0.45 handovers/min.; new 2.10 +/− 0.32 handovers/min.; p = 0,001). The time between incision and suture beginning indicated no significant difference (old 53.89 +/− 18.92 min.; new 49.73 +/− 12.18 min; p = 0.466): During the knee arthroplasties, handovers per minute were significantly different (old 1.83 +/− 0.38 handovers/min.; new 2.40 +/− 0.35 handovers/min.; p = 0.002). The time between incision and suture beginning (old 71.11 +/− 20.72 min.; new 70.69 +/− 17.12 min.; p = 0.959) and the handover times (old 1.06 +/− 0.64 s.; new 0.91 +/− 0.59 s.; p = 0.152) indicated no significant difference. The evaluation of the questionnaires showed a significant difference (p < 0.001) in the group of hip arthroplasties in the category “visibility”. For the knee arthroplasties, all items except “visibility” (p = 0.261) differed significantly. Overall, a high level of staff satisfaction with the new setup was achieved.

Conclusions

In both groups, more handovers per minute could be achieved in the optimized setup and in the group of the hip arthroplasties, the handover times were significantly faster. The evaluation sheet showed a high satisfaction of the surgical staff with the new setup. No reduction of the time between incision and suture beginning could be determined. This can be attributed to a certain training effect, the adjustment to the setup modification and the low number of cases. The new setup offers a practical alternative for hip arthroplasties as well as for knee arthroplasties as it optimizes the events in the operating room in many ways. For example, there were more handovers per minute possible and passing of the surgical instruments free from interferences. Moreover, it increases the efficiency and achieves a high satisfaction of the staff.

Constructing operating theatre schedules using partitioned graph colouring techniques

In hospitals, scheduled operations can often be cancelled in large numbers due to the unavailability of beds for post-operation recovery. Operating theatre scheduling is known to be an N P -hard optimisation problem. Previous studies have shown that the correct scheduling of surgical procedures can have a positive impact on the availability of beds in hospital wards, thereby allowing a reduction in number of elective operation cancellations. This study proposes an exact technique based on the partitioned graph colouring problem for constructing optimal master surgery schedules, with the goal of minimising the number of cancellations. The resultant schedules are then simulated in order to measure how well they cope with the stochastic nature of patient arrivals. Our results show that the utilisation of post-operative beds can be increased, whilst the number of cancellations can be decreased, which may ultimately lead to greater patient throughput and reduced waiting times. A scenario-based model has also been employed to integrate the stochastic-nature associated with the bed requirements into the optimisation process. The results indicate that the proposed model can lead to more robust solutions.

Application of Operational Research Techniques in Operating Room Scheduling Problems: Literature Overview

Increased healthcare costs are pushing hospitals to reduce costs and increase the quality of care. Operating rooms are the most important source of income and expense for hospitals. Therefore, the hospital management focuses on the effectiveness of schedules and plans. This study includes analyses of recent research on operating room scheduling and planning. Most studies in the literature, from 2000 to the present day, were evaluated according to patient characteristics, performance measures, solution techniques used in the research, the uncertainty of the problem, applicability of the research, and the planning strategy to be dealt within the solution. One hundred seventy studies were examined in detail, after scanning the Emerald, Science Direct, JSTOR, Springer, Taylor and Francis, and Google Scholar databases. To facilitate the identification of these studies, they are grouped according to the different criteria of concern and then, a detailed overview is presented.

Making sense of personal health information: challenges for information visualization

This article presents a systematic review of the literature on information visualization for making sense of personal health information. Based on this review, five application themes were identified: treatment planning, examination of patients' medical records, representation of pedigrees and family history, communication and shared decision making, and life management and health monitoring. While there are recognized design challenges associated with each of these themes, such as how best to represent data visually and integrate qualitative and quantitative information, other challenges and opportunities have received little attention to date. In this article, we highlight, in particular, the opportunities for supporting people in better understanding their own illnesses and making sense of their health conditions in order to manage them more effectively.

Capacity of clinical pathways--a strategic multi-level evaluation tool

In this paper we strategically evaluate the efficiency of clinical pathways and their complex interdependencies with respect to joint resource usage and patient throughput. We propose a discrete-event simulation approach that allows for the simultaneous evaluation of multiple clinical pathways and the inherent uncertainty (resource, duration and arrival) that accompanies medical processes. Both the consultation suite and the surgery suite may be modeled and examined in detail by means of sensitivity or scenario analyses. Since each medical facility can somehow be represented as a combination of clinical pathways, i.e. they are conceptually similar, the simulation model is generic in nature. Next to the formulation of the model, we illustrate its applicability by means of a case study that was conducted in a Belgian hospital.