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Tippong D, Petrovic S, Akbari V. A review of applications of operational research in healthcare coordination in disaster management. EUROPEAN JOURNAL OF OPERATIONAL RESEARCH 2022; 301:1-17. [PMID: 34728892 PMCID: PMC8552591 DOI: 10.1016/j.ejor.2021.10.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 10/22/2021] [Indexed: 05/25/2023]
Abstract
Many disasters that have happened in the last decades, including the latest COVID-19 pandemic, have caused a shortage of healthcare resources and change in healthcare operations. Given these impacts, the Operational Research (OR) community has applied various approaches to improve the emergency medical responses. Coordination of healthcare facilities is one of the emergency medical response strategies to ensure the continued provision of medical services during disasters. Although the existing literature reviews of OR approaches have included the perspective of healthcare management, they focused mostly on the application of OR in disaster operations and logistics management. The importance of coordination in healthcare systems during disasters is well recognised in the literature, but to the best of our knowledge there has been no review of the published research in this area. This study provides a focused literature review of the OR contributions in the coordination in healthcare systems during disasters. Definitions of the terms in use in this field are provided. An overall descriptive statistics of the reviewed articles is given, followed by the review of the presented research problems, disaster types, and developed methodologies. The main characteristics of models for the coordination in the healthcare system are described. Measures of coordination effectiveness that denote healthcare resilience are discussed. Based on our findings, we suggest future research directions in the context of existing models extension, and application and development of other methodologies with the aim to provide a solid basis for OR research in the healthcare disaster management.
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Affiliation(s)
| | | | - Vahid Akbari
- Nottingham University Business School, Nottingham, UK
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2
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Mondal PK, Norman BA. Enhancing staffing methods and improving the admission process of a psychiatric hospital using simulation. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2022. [DOI: 10.1080/20479700.2022.2097761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Pritom Kumar Mondal
- Department of Industrial, Manufacturing & Systems Engineering, Texas Tech University, Lubbock, TX, USA
| | - Bryan A. Norman
- Department of Industrial, Manufacturing & Systems Engineering, Texas Tech University, Lubbock, TX, USA
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Dogan O. Process mining based on patient waiting time: an application in health processes. INTERNATIONAL JOURNAL OF WEB INFORMATION SYSTEMS 2022. [DOI: 10.1108/ijwis-02-2022-0027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Similar to many business processes, waiting times are also essential for health care processes, especially in obstetrics and gynecology outpatient department (GOD), because pregnant women may be affected by long waiting times. Since creating process models manually presents subjective and nonrealistic flows, this study aims to meet the need of an objective and realistic method.
Design/methodology/approach
In this study, the authors investigate time-related bottlenecks in both departments for different doctors by process mining. Process mining is a pragmatic analysis to obtain meaningful insights through event logs. It applies data mining techniques to business process management with more comprehensive perspectives. Process mining in this study enables to automatically create patient flows to compare considering each department and doctor.
Findings
The study concludes that average waiting times in the GOD are higher than obstetrics outpatient department. However, waiting times in departments can change inversely for different doctors.
Research limitations/implications
The event log was created by expert opinions because activities in the processes had just starting timestamp. The ending time of activity was computed by considering the average duration of the corresponding activity under a normal distribution.
Originality/value
This study focuses on administrative (nonclinical) health processes in obstetrics and GOD. It uses a parallel activity log inference algorithm (PALIA) to produce process trees by handling duplicate activities. Infrequent information in health processes can have critical information about the patient. PALIA considers infrequent activities in the event log to extract meaningful information, in contrast to many discovery algorithms.
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Daldoul D, Nouaouri I, Bouchriha H, Allaoui H. Simulation-based optimisation approach to improve emergency department resource planning: A case study of Tunisian hospital. Int J Health Plann Manage 2022; 37:2727-2751. [PMID: 35590454 DOI: 10.1002/hpm.3499] [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: 08/28/2020] [Revised: 01/06/2022] [Accepted: 04/25/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The emergency department (ED) is a gateway to hospitals and is in the centre of hospital management efforts. It is often saturated by a continuous flow of patients, which causes excessive patient waiting time. AIMS This study integrates simulations with optimisation to design planning decision support for an ED. We considered all the processes of the ED, from triage to bed assignment. This study's main objective was to determine the optimal number of doctors, nurses, and beds required to schedule patients with different acuity levels to minimise both the total patient waiting time and the patient average length of stay and balance the resource utilisation rates. The problem is also characterised by multiple uncertainties, such as the patient arrival rate and service times in each stage of the process. METHOD We first propose a stochastic mixed-integer programing model that is solved using the sample average approximation approach. The resulting resource sizing is then evaluated using a discrete-event simulation model by comparing different patient scheduling rules. RESULTS Numerical experiments highlight the performance of the proposed approach using data from a Tunisian ED hospital.
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Affiliation(s)
- Dorsaf Daldoul
- University of Tunis El Manar, National Engineering School of Tunis, LR11ES20 LACCS Laboratory, Tunis, Tunisia.,Univ. Artois, UR 3926, Laboratoire de Génie Informatique et d'Automatique de l'Artois (LGI2A), Béthune, France
| | - Issam Nouaouri
- Univ. Artois, UR 3926, Laboratoire de Génie Informatique et d'Automatique de l'Artois (LGI2A), Béthune, France
| | - Hanen Bouchriha
- University of Tunis El Manar, National Engineering School of Tunis, LR11ES20 LACCS Laboratory, Tunis, Tunisia
| | - Hamid Allaoui
- Univ. Artois, UR 3926, Laboratoire de Génie Informatique et d'Automatique de l'Artois (LGI2A), Béthune, France
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Volochtchuk AVL, Leite H. Process improvement approaches in emergency departments: a review of the current knowledge. INTERNATIONAL JOURNAL OF QUALITY & RELIABILITY MANAGEMENT 2021. [DOI: 10.1108/ijqrm-09-2020-0330] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe healthcare system has been under pressure to provide timely and quality healthcare. The influx of patients in the emergency departments (EDs) is testing the capacity of the system to its limit. In order to increase EDs' capacity and performance, healthcare managers and practitioners are adopting process improvement (PI) approaches in their operations. Thus, this study aims to identify the main PI approaches implemented in EDs, as well as the benefits and barriers to implement these approaches.Design/methodology/approachThe study is based on a rigorous systematic literature review of 115 papers. Furthermore, under the lens of thematic analysis, the authors present the descriptive and prescriptive findings.FindingsThe descriptive analysis found copious information related to PI approaches implemented in EDs, such as main PIs used in EDs, type of methodological procedures applied, as well as a set of barriers and benefits. Aiming to provide an in-depth analysis and prescriptive results, the authors carried out a thematic analysis that found underlying barriers (e.g. organisational, technical and behavioural) and benefits (e.g. for patients, the organisation and processes) of PI implementation in EDs.Originality/valueThe authors contribute to knowledge by providing a comprehensive review of the main PI methodologies applied in EDs, underscoring the most prominent ones. This study goes beyond descriptive studies that identify lists of barriers and benefits, and instead the authors categorize prescriptive elements that influence these barriers and benefits. Finally, this study raises discussions about the behavioural influence of patients and medical staff on the implementation of PI approaches.
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Valipoor S, Hatami M, Hakimjavadi H, Akçalı E, Swan WA, De Portu G. Data-Driven Design Strategies to Address Crowding and Boarding in an Emergency Department: A Discrete-Event Simulation Study. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2020; 14:161-177. [PMID: 33176477 DOI: 10.1177/1937586720969933] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To address prolonged lengths of stay (LOS) in a Level 1 trauma center, we examined the impact of implementing two data-driven strategies with a focus on the physical environment. BACKGROUND Crowding in emergency departments (EDs) is a widely reported problem leading to increased service times and patients leaving without being seen. METHODS Using ED historical data and expert estimates, we created a discrete-event simulation model. We analyzed the likely impact of initiating care and boarding patients in the hallway (hallway care) instead of the exam rooms and adding a dedicated triage space for patients who arrive by emergency medical services (EMS triage) to decrease hallway congestion. The scenarios were compared in terms of LOS, time spent in exam rooms and hallway spaces, service time, blocked time, and utilization rate. RESULTS The hallway care scenario resulted in significantly lower LOS and exam room time only for EMS patients but when implemented along with the EMS triage scenario, a significantly lower LOS and exam room time was observed for all patients (EMS and walk-in). The combination of two simulated scenarios resulted in significant improvements in other flow metrics as well. CONCLUSIONS Our findings discourage boarding of admitted patients in ED exam rooms. If space limitations require that admitted patients be placed in ED hallways, designers and planners should consider enabling hallway spaces with features recommended in this article. Alternative locations for boarding should be prioritized in or out of the ED. Our findings also encourage establishing a triage area dedicated to EMS patients in the ED.
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Affiliation(s)
- Shabboo Valipoor
- Department of Interior Design, College of Design, Construction & Planning, 3463University of Florida, Gainesville, FL, USA
| | - Mohsen Hatami
- M. E. Rinker, Sr. School of Construction Management, College of Design, Construction & Planning, 3463University of Florida, Gainesville, FL, USA
| | - Hesamedin Hakimjavadi
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, 3463University of Florida, Gainesville, FL, USA
| | - Elif Akçalı
- Department of Industrial & Systems Engineering, Herbert Wertheim College of Engineering, 3463University of Florida, Gainesville, FL, USA
| | | | - Giuliano De Portu
- Department of Emergency Medicine, College of Medicine, 3463University of Florida, Gainesville, FL, USA
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Ortíz-Barrios MA, Alfaro-Saíz JJ. Methodological Approaches to Support Process Improvement in Emergency Departments: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082664. [PMID: 32294985 PMCID: PMC7216091 DOI: 10.3390/ijerph17082664] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/22/2020] [Accepted: 04/03/2020] [Indexed: 02/07/2023]
Abstract
The most commonly used techniques for addressing each Emergency Department (ED) problem (overcrowding, prolonged waiting time, extended length of stay, excessive patient flow time, and high left-without-being-seen (LWBS) rates) were specified to provide healthcare managers and researchers with a useful framework for effectively solving these operational deficiencies. Finally, we identified the existing research tendencies and highlighted opportunities for future work. We implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology to undertake a review including scholarly articles published between April 1993 and October 2019. The selected papers were categorized considering the leading ED problems and publication year. Two hundred and three (203) papers distributed in 120 journals were found to meet the inclusion criteria. Furthermore, computer simulation and lean manufacturing were concluded to be the most prominent approaches for addressing the leading operational problems in EDs. In future interventions, ED administrators and researchers are widely advised to combine Operations Research (OR) methods, quality-based techniques, and data-driven approaches for upgrading the performance of EDs. On a different tack, more interventions are required for tackling overcrowding and high left-without-being-seen rates.
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Affiliation(s)
- Miguel Angel Ortíz-Barrios
- Department of Industrial Management, Agroindustry and Operations, Universidad de la Costa CUC, Barranquilla 081001, Colombia
- Correspondence: ; Tel.: +57-3007239699
| | - Juan-José Alfaro-Saíz
- Research Centre on Production Management and Engineering, Universitat Politècnica de València, 46022 Valencia, Spain;
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Ibrahim MS. Validating Service Quality (SERVQUAL) in Healthcare: Measuring Patient Satisfaction Using their Perceptions in Jordan. JOURNAL OF INFORMATION & KNOWLEDGE MANAGEMENT 2020. [DOI: 10.1142/s0219649220400213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Patient satisfaction in the developing world has not received sufficient interest in the healthcare literature. More importantly, models predicting patient satisfaction seldom incorporates patient perspectives into their measurement providing ill-suited metrics for healthcare administrators to make decisive decisions concerning service quality improvements. The current analysis utilizes original data collected from 336 patients in Jordan. This paper tests whether service quality (SERVQUAL) is suitable to be used in the new context and concluded that SERVQUAL is reliable and valid in supplying stakeholders with reliable and valid information concerning patient satisfaction. Further, the analysis suggests a large gap between perceived and expected services performed by Jordanian hospitals signalling the need to service quality enhancement. The study calls for the adoption of agile and rapid patient screening models in emergency departments to reduce wait times and decrease the number of patients left without being seen. This study constitutes an emerging attempt at better understanding how service quality influences patient satisfaction, and more importantly, introduce affordable and cost-effective solutions capable of improving satisfaction in the short run.
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Constructing Holistic Patient Flow Simulation Using System Approach. LECTURE NOTES IN COMPUTER SCIENCE 2020. [PMCID: PMC7303693 DOI: 10.1007/978-3-030-50423-6_31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Patient flow often described as a systemic issue requiring a systemic approach because hospital is a collection of highly dynamic, interconnected, complex, ad hoc and multi-disciplinary sub-processes. However, studies on holistic patient flow simulation following system approach are limited and/or poorly understood. Several researchers have been investigating single departments such as ambulatory care unit, Intensive Care Unit (ICU), emergency department, surgery department or patients’ interaction with limited resources such as doctor, endoscopy or bed, independently. Hence, this article demonstrates how to achieve system approach in constructing holistic patient flow simulation, while maintaining the balance between the complexity and the simplicity of the model. To this end, system approach, network analysis and discrete event simulation (DES) were employed. The most important departments in the diagnosis and treatment process are identified by analyzing network of hospital departments. Holistic patient flow simulation is constructed using DES following system approach. Case studies are conducted and the results illustrate that healthcare systems must be modeled and investigated as a complex and interconnected system so that the real impact of changes on the entire system or parts of the system could be observed at strategic as well as operational levels.
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Easter B, Houshiarian N, Pati D, Wiler JL. Designing efficient emergency departments: Discrete event simulation of internal-waiting areas and split flow sorting. Am J Emerg Med 2019; 37:2186-2193. [DOI: 10.1016/j.ajem.2019.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 03/02/2019] [Accepted: 03/10/2019] [Indexed: 11/29/2022] Open
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11
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Barros O, Riffo R, Paredes I. Improving service in an emergency department by designing the health production flow. Health Serv Manage Res 2019; 33:76-85. [PMID: 31274339 DOI: 10.1177/0951484819860325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Most emergency departments have overcapacity with poor service measured by length of stay. We hypothesized that a formal design of the emergency department production flows will improve service. Thus, we propose a methodology that was tested in a large hospital, including new flow implementation. Results We implemented new workflows during June to July 2017. A comparison of the patients’ average length of stay from June to September shows a decrease of 26%. Additionally, a comparison with 2016 shows a decrease of 50%. Direct evaluation of the value generated reveals an emergency department admissions increase of 540 monthly, equivalent of a savings of approximately US$250.000 annually. This savings is a very conservative estimate because the most significant value of this work is fast service that diminishes the patients’ risks. Conclusions Production design is an important problem in health services in terms of potential service improvements, executable with a formal, systemic, replicable method founded on several disciplines. Thus, we are replicating the approach at other hospitals with extensions to other services.
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Affiliation(s)
- Oscar Barros
- Industrial Engineering Department, University of Chile, Santiago, Chile
| | - Rodrigo Riffo
- Emergency Department, Hospital San Juan de Dios, Santiago, Chile
| | - Inti Paredes
- Industrial Engineering Department, University of Chile, Santiago, Chile
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Rojas E, Cifuentes A, Burattin A, Munoz-Gama J, Sepúlveda M, Capurro D. Performance Analysis of Emergency Room Episodes Through Process Mining. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1274. [PMID: 30974731 PMCID: PMC6480699 DOI: 10.3390/ijerph16071274] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 03/29/2019] [Accepted: 04/06/2019] [Indexed: 11/16/2022]
Abstract
The performance analysis of Emergency Room episodes is aimed at providing decision makers with knowledge that allows them to decrease waiting times, reduce patient congestion, and improve the quality of care provided. In this case study, Process Mining is used to determine which activities, sub-processes, interactions, and characteristics of episodes explain why some episodes have a longer duration. The employed method and the results obtained are described in detail to serve as a guide for future performance analysis in this domain. It was discovered that the main cause of the increment in the episode duration is the occurrence of a loop between the Examination and Treatment sub-processes. It was also found out that as the episode severity increases, the number of repetitions of the Examination-Treatment loop increases as well. Moreover, the episodes in which this loop is more common are those that lead to Hospitalization as discharge destination. These findings might help to reduce the occurrence of this loop, in turn lowering the episode duration and, consequently, providing faster attention to more patients.
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Affiliation(s)
- Eric Rojas
- Department of Computer Science, School of Engineering, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile.
- Department of Internal Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile.
| | - Andres Cifuentes
- Department of Computer Science, School of Engineering, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile.
| | - Andrea Burattin
- Software and Process Engineering, Technical University of Denmark, 2800 Kgs. Lyngby, Denmark.
| | - Jorge Munoz-Gama
- Department of Computer Science, School of Engineering, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile.
| | - Marcos Sepúlveda
- Department of Computer Science, School of Engineering, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile.
| | - Daniel Capurro
- Department of Internal Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile.
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Theoretical bounds and approximation of the probability mass function of future hospital bed demand. Health Care Manag Sci 2018; 23:20-33. [PMID: 30397818 PMCID: PMC7223092 DOI: 10.1007/s10729-018-9461-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 10/19/2018] [Indexed: 11/25/2022]
Abstract
Failing to match the supply of resources to the demand for resources in a hospital can cause non-clinical transfers, diversions, safety risks, and expensive under-utilized resource capacity. Forecasting bed demand helps achieve appropriate safety standards and cost management by proactively adjusting staffing levels and patient flow protocols. This paper defines the theoretical bounds on optimal bed demand prediction accuracy and develops a flexible statistical model to approximate the probability mass function of future bed demand. A case study validates the model using blinded data from a mid-sized Massachusetts community hospital. This approach expands upon similar work by forecasting multiple days in advance instead of a single day, providing a probability mass function of demand instead of a point estimate, using the exact surgery schedule instead of assuming a cyclic schedule, and using patient-level duration-varying length-of-stay distributions instead of assuming patient homogeneity and exponential length of stay distributions. The primary results of this work are an accurate and lengthy forecast, which provides managers better information and more time to optimize short-term staffing adaptations to stochastic bed demand, and a derivation of the minimum mean absolute error of an ideal forecast.
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Is the hospital lean? A mathematical model for assessing the implementation of lean thinking in healthcare institutions. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.orhc.2017.05.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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15
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Daldoul D, Nouaouri I, Bouchriha H, Allaoui H. A stochastic model to minimize patient waiting time in an emergency department. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.orhc.2018.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Rodrigues FF, Zaric G, Stanford D. Discrete event simulation model for planning Level 2 “step-down” bed needs using NEMS. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.orhc.2017.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rabbani M, Farshbaf-Geranmayeh A, Yazdanparast R. A simulation optimization approach for integrated resource allocation in an emergency department, pharmacy, and lab. INTELLIGENT DECISION TECHNOLOGIES-NETHERLANDS 2018. [DOI: 10.3233/idt-180327] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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18
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Mitigating overcrowding in emergency departments using Six Sigma and simulation: A case study in Egypt. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.orhc.2017.06.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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19
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Queueing theoretic analysis of labor and delivery : Understanding management styles and C-section rates. Health Care Manag Sci 2017; 22:16-33. [PMID: 28871456 DOI: 10.1007/s10729-017-9418-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 08/25/2017] [Indexed: 10/18/2022]
Abstract
Childbirth is a complex clinical service requiring the coordinated support of highly trained healthcare professionals as well as management of a finite set of critical resources (such as staff and beds) to provide safe care. The mode of delivery (vaginal delivery or cesarean section) has a significant effect on labor and delivery resource needs. Further, resource management decisions may impact the amount of time a physician or nurse is able to spend with any given patient. In this work, we employ queueing theory to model one year of transactional patient information at a tertiary care center in Boston, Massachusetts. First, we observe that the M/G/∞ model effectively predicts patient flow in an obstetrics department. This model captures the dynamics of labor and delivery where patients arrive randomly during the day, the duration of their stay is based on their individual acuity, and their labor progresses at some rate irrespective of whether they are given a bed. Second, using our queueing theoretic model, we show that reducing the rate of cesarean section - a current quality improvement goal in American obstetrics - may have important consequences with regard to the resource needs of a hospital. We also estimate the potential financial impact of these resource needs from the hospital perspective. Third, we report that application of our model to an analysis of potential patient coverage strategies supports the adoption of team-based care, in which attending physicians share responsibilities for patients.
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Almoaber B, Amyot D. A Review on the Contribution of Emergency Department Simulation Studies in Reducing Wait Time. INTERNATIONAL JOURNAL OF E-HEALTH AND MEDICAL COMMUNICATIONS 2017. [DOI: 10.4018/ijehmc.2017070101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background: Because of the important role of hospital emergency departments (EDs) in providing urgent care, EDs face a constantly large demand that often results in long wait times. Objective: To review and analyze the existing literature in ED simulation modeling and its contribution in reducing patient wait time. Methods: A literature review was conducted on simulation modeling in EDs. Results: A total of 41 articles have met the inclusion criteria. The papers were categorized based on their motivations, modeling techniques, data collection processes, patient classification, recommendations, and implementation statuses. Real impact is seldom measured; only four papers (~10%) have reported the implementation of their recommended changes in the real world. Conclusion: The reported implementations contributed significantly to wait time reduction, but the proportion of simulation studies that are implemented is too low to conclude causality. Researchers should budget resources to implement their simulation recommendations in order to measure their impact on patient wait time.
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Affiliation(s)
- Basmah Almoaber
- University of Ottawa, Ottawa, Canada &King Khalid University, Abha, Saudi Arabia
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21
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Modeling and optimization of resources in multi-emergency department settings with patient transfer. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.orhc.2016.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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22
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Managing emergency department crowding through improved triaging and resource allocation. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.orhc.2016.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Azadeh A, Motevali Haghighi S, Gaeini Z, Shabanpour N. Optimization of healthcare supply chain in context of macro-ergonomics factors by a unique mathematical programming approach. APPLIED ERGONOMICS 2016; 55:46-55. [PMID: 26995035 DOI: 10.1016/j.apergo.2016.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 01/08/2016] [Accepted: 01/09/2016] [Indexed: 06/05/2023]
Abstract
This study presents an integrated approach for analyzing the impact of macro-ergonomics factors in healthcare supply chain (HCSC) by data envelopment analysis (DEA). The case of this study is the supply chain (SC) of a real hospital. Thus, healthcare standards and macro-ergonomics factors are considered to be modeled by the mathematical programming approach. Over 28 subsidiary SC divisions with parallel missions and objectives are evaluated by analyzing inputs and outputs through DEA. Each division in this HCSC is considered as decision making unit (DMU). This approach can analyze the impact of macro-ergonomics factors on supply chain management (SCM) in healthcare sector. Also, this method ranks the relevant performance efficiencies of each HCSC. In this study by using proposed method, the most effective macro-ergonomics factor on HCSC is identified as "teamwork" issue. Also, this study would help managers to identify the areas of weaknesses in their SCM system and set improvement target plan for the related SCM system in healthcare industry. To the best of our knowledge, this is the first study for macro-ergonomics optimization of HCSC.
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Affiliation(s)
- A Azadeh
- School of Industrial and Systems Engineering, Center of Excellence for Intelligent-Based Experimental Mechanic, and Department of Engineering Optimization Research, College of Engineering, University of Tehran, Iran.
| | - S Motevali Haghighi
- School of Industrial and Systems Engineering, Center of Excellence for Intelligent-Based Experimental Mechanic, and Department of Engineering Optimization Research, College of Engineering, University of Tehran, Iran; Department of Industrial Engineering, Esfarayen University of Technology, Esfarayen, Iran
| | - Z Gaeini
- School of Industrial and Systems Engineering, Center of Excellence for Intelligent-Based Experimental Mechanic, and Department of Engineering Optimization Research, College of Engineering, University of Tehran, Iran
| | - N Shabanpour
- Department of Mechanical Engineering, Polytechnic University of Milan, Milan, Italy
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Are Split Flow and Provider in Triage Models in the Emergency Department Effective in Reducing Discharge Length of Stay? J Emerg Nurs 2016; 42:487-491. [PMID: 27130191 DOI: 10.1016/j.jen.2016.01.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 12/01/2015] [Accepted: 01/04/2016] [Indexed: 11/21/2022]
Abstract
A quality improvement (QI) project was completed early in 2015 to evaluate the split flow model of care delivery and a provider in triage model within a newly constructed emergency department. The QI project compared 2 emergency departments of similar volumes, one that splits the patient flow and employs a provider in triage model and the other that blends the patient flow and employs a traditional nurse triage model. A total of 68,603 patients were included in this project. The purpose of the split flow model is to create a second flow stream of patients through the emergency department, parallel to the regular acute/critical care flow stream, for patients with problems that are not complex. Specific patient outcomes that were evaluated for the purpose of this QI project were door to discharge or discharge length of stay (DLOS) for all ED patients. The provider in triage model enhances patient triage assessment, as well as patient flow within the emergency department, by allowing patients to be evaluated by an ED provider immediately at the point of triage when the patient first presents to the emergency department. The QI project demonstrated that the split flow model alone reduced DLOS for all ED patients, and when coupled with the provider in triage model, a greater reduction in DLOS, as well as an improvement in front-end throughput metrics, was realized.
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Pines JM, Bernstein SL. Solving the worldwide emergency department crowding problem - what can we learn from an Israeli ED? Isr J Health Policy Res 2015; 4:52. [PMID: 26478811 PMCID: PMC4609084 DOI: 10.1186/s13584-015-0049-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 09/22/2015] [Indexed: 11/15/2022] Open
Abstract
ED crowding is a prevalent and important issue facing hospitals in Israel and around the world, including North and South America, Europe, Australia, Asia and Africa. ED crowding is associated with poorer quality of care and poorer health outcomes, along with extended waits for care. Crowding is caused by a periodic mismatch between the supply of ED and hospital resources and the demand for patient care. In a recent article in the Israel Journal of Health Policy Research, Bashkin et al. present an Ishikawa diagram describing several factors related to longer length of stay (LOS), and higher levels of ED crowding, including management, process, environmental, human factors, and resource issues. Several solutions exist to reduce ED crowding, which involve addressing several of the issues identified by Bashkin et al. This includes reducing the demand for and variation in care, and better matching the supply of resources to demands in care in real time. However, what is needed to reduce crowding is an institutional imperative from senior leadership, implemented by engaged ED and hospital leadership with multi-disciplinary cross-unit collaboration, sufficient resources to implement effective interventions, access to data, and a sustained commitment over time. This may move the culture of a hospital to facilitate improved flow within and across units and ultimately improve quality and safety over the long-term.
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Affiliation(s)
- Jesse M Pines
- Departments of Emergency Medicine and Health Policy & Management, The George Washington University, Washington, DC USA ; Office for Clinical Practice Innovation, George Washington University, 2100 Pennsylvania Ave., N.W. Room 314, Washington, DC 20037 USA
| | - Steven L Bernstein
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT USA
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Saghafian S, Austin G, Traub SJ. Operations research/management contributions to emergency department patient flow optimization: Review and research prospects. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/19488300.2015.1017676] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Jalalpour M, Gel Y, Levin S. Forecasting demand for health services: Development of a publicly available toolbox. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.orhc.2015.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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