Simulation of home-hospital impacts on crowding – FM implications

Creating and Validating a Predictive Model for Suitability of Hospital at Home for Patients With Solid-Tumor Malignancies

PURPOSE

Hospital at home (HaH) is a means of providing inpatient-level care at home. Selection of admissions potentially suitable for HaH in oncology is not well studied. We sought to create a predictive model for identifying admissions of patients with cancer, specifically solid-tumor malignancies, potentially suitable for HaH.

METHODS

In this observational study, we analyzed admissions of patients with solid-tumor malignancies and unplanned admissions (January 1, 2015, to June 12, 2019) at an academic, urban cancer hospital. Potential suitability for HaH was the primary outcome. Admissions were considered potentially suitable if they did not involve escalation of care, rapid response evaluation, in-hospital death, telemetry, surgical procedure, consultation to a procedural service, advanced imaging, transfusion, restraints, and nasogastric tube placement. Admission source, patient demographics, vital signs, laboratory test results, comorbidities, admission and active cancer diagnoses, and recent hospital utilization were included as candidate variables in a multivariable logistic regression model.

RESULTS

Of 3,322 admissions, 905 (27.2%) patients were potentially suitable for HaH. After variable selection in the derivation cohort (n = 1,097), thirteen factors predicted potential suitability: admission source; temperature and respiratory rate at presentation; hemoglobin; breast cancer, GI cancer, or malignancy of secondary or ill-defined origin; admission for genitourinary, musculoskeletal, or neurologic symptoms, intestinal obstruction or ileus, or evaluation of secondary malignancy; and emergency department visit in prior 90 days. Model c-statistics were 0.71 (95% CI, 0.68 to 0.75) and 0.63 (0.59 to 0.67) in the derivation and validation (n = 1,095) cohorts.

CONCLUSION

Hospital admissions of patients potentially suitable for HaH may be identifiable using data available at admission.

Simulating the impact of facility design on operations: a study in an internal medicine ward

Purpose

This study aims to use a narrative-based simulation approach to explore potential implications of including or excluding a dayroom in the design of an internal medicine ward.

Design/methodology/approach

The approach involved: collecting data in facilities using field observations and experts’ interviews; modeling representative behavior patterns in the form of rule-based narratives that direct collaborative behaviors of virtual occupants; simulating the behavior patterns in two alternative design options, one of which includes a dayroom; and analyzing the simulation results with respect to selected key performance indicators of day-to-day operations and spatial occupancy, including occupant density in corridors, number and locations of staff-visitor interactions and duration of a doctors’ round procedure.

Findings

Simulation results suggest that the presence of a dayroom reduces visitors’ density in corridors and diminishes the number of staff–visitor interactions that can delay the performing of scheduled medical procedures.

Research limitations/implications

A high level of uncertainty is intrinsic to the simulation of future human behavior. Additional work is required to systematically collect large volumes of occupancy data in existing facilities, model additional narratives and develop validation protocols to assess the degree of uncertainty of the proposed model.

Originality/value

A limited number of studies explore how simulation can be used to study the impact of building design on operations. This study uses a narrative-based approach to address some of the limitations of existing methods, including discrete-event simulations. Preliminary results suggest that the lack of appropriate spaces for patients and visitors to socialize may cause potential disruptions to hospital operations.

Healthcare facilities maintenance management: a literature review

Purpose

The complexity and criticality of healthcare services highlight the importance of maintenance management function in healthcare facilities. The purpose of this paper is to review the literature on maintenance management of healthcare facilities and hospital buildings to provide an organized literature review and identify gaps from the perspective of research and practice.

Design/methodology/approach

The paper categorizes the literature and adopts a review hierarchy according to maintenance management functions in hospital buildings. It explores the impact of those functions on the performance of maintenance activities in hospitals. Furthermore, it examines the role of information technology and automated decision support systems in facilitating hospital maintenance management functions and performance.

Findings

Literature on maintenance management in healthcare facilities and hospital buildings has so far been very limited. Recently published literature focusing on healthcare facilities management and its maintenance management functions is classified into various areas and sub-areas. The paper highlights gaps in the literature and suggests avenues for future research and improvements.

Originality/value

The paper contains a comprehensive listing of publications and their classifications according to various attributes. It will be useful for researchers, maintenance managers, practitioners and stakeholders concerned with facility management of hospital buildings.