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Cocchi D, Ciagli E, Ancora A, Tortoli P, Carpini C, Cirone D, Rossi E, Frosini F, Vezzosi S. Improving patient waiting time of centralized front office service in a regional hub hospital using the discrete event simulation model. Technol Health Care 2020; 28:487-494. [PMID: 31903999 DOI: 10.3233/thc-191813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Today, hospital rankings are based not only on basic clinical indicators, but even on quality service indicators such as patient waiting times. Improving these indicators is a very important issue for hospital management, so finding a solution to achieve it in a simple and effective way is one of the greatest goals. OBJECTIVES The aim of this article is to evaluate the use of a discrete event simulation model to improve healthcare processes and reduce waiting time of patients and hospital costs. METHODS The case study proposed in this paper is the reorganization of non-clinical front office operation for the patients (i.e. booking of exams, delivering medical reports, etc.) of the Careggi University Hospital of Florence, to optimize the utilization of the human resources and to improve performances of the process. RESULTS The development and validation of the model was made according to an analysis of real processes and data, pre and post implementation of model outcomes. The new organization shows a decrease of waiting times from an average value of 10 minutes and 37 seconds to 5 minutes and 57 seconds (-44%). CONCLUSIONS This paper shows that discrete event simulation could be a precise, cost-limited tool to optimize hospital processes and performance.
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Affiliation(s)
- D Cocchi
- Department of Information Engineering, University of Florence, Florence, Italy
| | - E Ciagli
- Department of Information Engineering, University of Florence, Florence, Italy
| | - A Ancora
- Department of Information Engineering, University of Florence, Florence, Italy
| | - P Tortoli
- Department of Information Engineering, University of Florence, Florence, Italy
| | - C Carpini
- General Management Staff, Careggi University Hospital, Florence, Italy
| | - D Cirone
- General Management Staff, Careggi University Hospital, Florence, Italy
| | - E Rossi
- Innovation Control and Quality Area, Careggi University Hospital, Florence, Italy
| | - F Frosini
- Innovation Control and Quality Area, Careggi University Hospital, Florence, Italy
| | - S Vezzosi
- Innovation Control and Quality Area, Careggi University Hospital, Florence, Italy
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Dimitri M, Staderini F, Brancadoro M, Frosini F, Coratti A, Capineri L, Corvi A, Cianchi F, Biffi Gentili G. A new microwave applicator for laparoscopic and robotic liver resection. Int J Hyperthermia 2018; 36:75-86. [DOI: 10.1080/02656736.2018.1534004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Mattia Dimitri
- Department of Industrial Engineering, University of Florence, Firenze, Italy
| | - Fabio Staderini
- Department of Surgery and Translational Medicine, University of Florence, Firenze, Italy
| | | | - Francesco Frosini
- Department of Information Engineering, University of Florence, Firenze, Italy
| | - Andrea Coratti
- Department of Oncology and Robotic Surgery, University of Florence, Firenze, Italy
| | - Lorenzo Capineri
- Department of Information Engineering, University of Florence, Firenze, Italy
| | - Andrea Corvi
- Department of Industrial Engineering, University of Florence, Firenze, Italy
| | - Fabio Cianchi
- Department of Surgery and Translational Medicine, University of Florence, Firenze, Italy
| | - Guido Biffi Gentili
- Department of Information Engineering, University of Florence, Firenze, Italy
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Frosini F, Miniati R, Grillone S, Dori F, Gentili GB, Belardinelli A. Integrated HTA-FMEA/FMECA methodology for the evaluation of robotic system in urology and general surgery. Technol Health Care 2016; 24:873-887. [DOI: 10.3233/thc-161236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Francesco Frosini
- Department of Information Engineering, School of Engineering, University of Florence, Florence, Italy
| | - Roberto Miniati
- Department of Information Engineering, School of Engineering, University of Florence, Florence, Italy
| | - Saverio Grillone
- Department of Information Engineering, School of Engineering, University of Florence, Florence, Italy
| | - Fabrizio Dori
- Department of Information Engineering, School of Engineering, University of Florence, Florence, Italy
| | - Guido Biffi Gentili
- Department of Information Engineering, School of Engineering, University of Florence, Florence, Italy
| | - Andrea Belardinelli
- Innovation and Planning Area, Head Management, Florence Teaching Hospital AOU-Careggi, Florence, Italy
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Frosini F, Miniati R, Avezzano P, Cecconi G, Dori F, Gentili GB, Belardinelli A. Development of a web based monitoring system for safety and activity analysis in operating theatres. Technol Health Care 2016; 24:99-109. [DOI: 10.3233/thc-151073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Francesco Frosini
- Department of Information Engineering - Biomedical Lab, University of Florence, Italy
| | - Roberto Miniati
- Department of Information Engineering - Biomedical Lab, University of Florence, Italy
| | - Paolo Avezzano
- Department of Information Engineering - Biomedical Lab, University of Florence, Italy
| | - Giulio Cecconi
- Department of Information Engineering - Biomedical Lab, University of Florence, Italy
| | | | - Guido Biffi Gentili
- Department of Information Engineering - Biomedical Lab, University of Florence, Italy
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Miniati R, Cecconi G, Frosini F, Dori F, Regolini J, Iadanza E, Biffi Gentili G. Hospital-based expert model for health technology procurement planning in hospitals. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2014:3504-7. [PMID: 25570746 DOI: 10.1109/embc.2014.6944378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although in the last years technology innovation in healthcare brought big improvements in care level and patient quality of life, hospital complexity and management cost became higher. For this reason, necessity of planning for medical equipment procurement within hospitals is getting more and more important in order to sustainable provide appropriate technology for both routine activity and innovative procedures. In order to support hospital decision makers for technology procurement planning, an expert model was designed as reported in the following paper. It combines the most widely used approaches for technology evaluation by taking into consideration Health Technology Assessment (HTA) and Medical Equipment Replacement Model (MERM). The designing phases include a first definition of prioritization algorithms, then the weighting process through experts' interviews and a final step for the model validation that included both statistical testing and comparison with real decisions. In conclusion, the designed model was able to provide a semi-automated tool that through the use of multidisciplinary information is able to prioritize different requests of technology acquisition in hospitals. Validation outcomes improved the model accuracy and created different "user profiles" according to the specific needs of decision makers.
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Abstract
BACKGROUND This paper reports the development of standard techniques for technology evaluation in hospital carried out at the Florence Teaching Hospital Careggi (AOUC), where, as a complex system, the technological evaluation is a strategic and essential element for the maintenance of high-quality clinical activity and maximization of available resources. OBJECTIVE The aim of this paper has been the development of a system of economically sustainable models for the implementation of HTA and HS analyses in the hospital environment as well as presenting, in addition to a valid scientific resilience, the methodological and temporary flexibility to satisfy needs of hospital decision-makers. METHODS The evaluation models call for 3 main phases: an initial analysis of the in-hospital request, a collection of data, and finally a draft of a specific, easily usable set of reports. RESULTS Three standardized and tested models of evaluation were developed, which, in relation to the objective of the request and schedule of the assignment, provide for the production of a speedy report (1-week), an intermediate report (1-month), or a extensive report typical of classical studies of hospital based HTA (1-year). It is then related to the evaluation model of the IORT (Intra-Operative Radiation Therapy) technology. DISCUSSIONS AND CONCLUSION The developed models have permitted the construction, using personnel and laboratories within the hospital, of an evaluation system reliable and responsive to the HOSPITAL's temporary needs based on the HS and HTA analyses in the hospital environment. Regarding the applicable case of IORT, this has shown how in-hospital requests have been satisfied in the preset time: although it establishes expected improvements on the social effect and weight of the illness and reveals a high territorial strategic relevance, the introduction of IORT in the hospital presents some criticalities on the impact on the healthcare organization and the necessity of specific training of medical technologist personnel.
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Affiliation(s)
- Roberto Miniati
- Department of Information Engineering, Biomedical Laboratory, University of Florence, Florence, Italy
| | - Francesco Frosini
- Department of Information Engineering, Biomedical Laboratory, University of Florence, Florence, Italy
| | - Giulio Cecconi
- Department of Information Engineering, Biomedical Laboratory, University of Florence, Florence, Italy
| | - Fabrizio Dori
- Department of Information Engineering, Biomedical Laboratory, University of Florence, Florence, Italy
| | - G Biffi Gentili
- Department of Information Engineering, Biomedical Laboratory, University of Florence, Florence, Italy
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Miniati R, Cecconi G, Dori F, Frosini F, Iadanza E, Biffi Gentili G, Niccolini F, Gusinu R. A queueing theory based model for business continuity in hospitals. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2013:922-5. [PMID: 24109839 DOI: 10.1109/embc.2013.6609652] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Clinical activities can be seen as results of precise and defined events' succession where every single phase is characterized by a waiting time which includes working duration and possible delay. Technology makes part of this process. For a proper business continuity management, planning the minimum number of devices according to the working load only is not enough. A risk analysis on the whole process should be carried out in order to define which interventions and extra purchase have to be made. Markov models and reliability engineering approaches can be used for evaluating the possible interventions and to protect the whole system from technology failures. The following paper reports a case study on the application of the proposed integrated model, including risk analysis approach and queuing theory model, for defining the proper number of device which are essential to guarantee medical activity and comply the business continuity management requirements in hospitals.
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Bertoni E, Zanazzi M, Rosati A, Carmellini M, Frosini F, Conti P, Dedola G, Tosi P, Moscarelli L, Mosca F, Salvadori M. Causes and effects of delayed graft function in cadaveric renal transplantation: a multivariate analysis. Transplant Proc 1997; 29:2799-800. [PMID: 9365568 DOI: 10.1016/s0041-1345(97)00683-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- E Bertoni
- Renal Unit, Careggiand University Hospital, Florence, Italy
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Carmellini M, Frosini F, Filipponi F, Boggi U, Mosca F. Effect of cilastatin on cyclosporine-induced acute nephrotoxicity in kidney transplant recipients. Transplantation 1997; 64:164-6. [PMID: 9233719 DOI: 10.1097/00007890-199707150-00029] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cyclosporine (CsA)-induced acute nephrotoxicity could be reduced by prevention of parenchymal accumulation of the drug itself. The objective of this prospective study was to evaluate whether cilastatin, an inhibitor of active tubular resorption of CsA, reduces CsA-induced acute nephrotoxicity in kidney graft recipients. METHODS Sixty-nine kidney recipients with immediate graft functional recovery were randomly assigned to either the treatment group (imipenem/cilastatin, n=33) or the control group (ceftazidime, n=36). All patients followed a standard immunosuppressive regimen based on CsA and low-dose prednisone. Graft function and CsA levels were evaluated 3, 5, 10, 15, and 30 days after transplantation. RESULTS Compared with the control group, imipenem/cilastatin administration reduced the serum creatinine level in the first 2 weeks after transplantation, reaching a significant effect on postoperative day 10 (P<0.05). No significant differences were demonstrated between the two groups for CsA levels, patient and graft survival, and all the other examined parameters. CONCLUSIONS Our findings support the hypothesis that cilastatin administration can reduce CsA-induced acute nephrotoxicity after kidney transplantation.
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Affiliation(s)
- M Carmellini
- Instituto di Chirurgia Generale e Sperimentale, Università degli Studidi Pisa, Ospedale di Cisanello, Italy
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Bertoni E, Zanazzi M, Rosati A, Nisticò A, Cirami C, Bandini S, Carmellini M, Frosini F, Mosca F, Rindi P, Rizzo G, Salvadori M. Fate of kidneys retrieved from the same donor and grafted into different recipients: do donor related factors influence the graft outcome? Transplant Proc 1997; 29:125-6. [PMID: 9122924 DOI: 10.1016/s0041-1345(96)00031-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- E Bertoni
- Transplant Department of Florence, Pisa, Italy
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Di Stefano R, Frosini F, Scavuzzo M, Ambrogi M, Fagiolini A, Ferrari M, Pelosi G, Mosca F. C1-Inh and heparan sulfate can prevent discordant rejection. Transplant Proc 1994; 26:1172-3. [PMID: 8029876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- R Di Stefano
- Institute of General and Experimental Surgery, CNR, Pisa, Italy
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12
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Di Stefano R, Fagiolini A, Verunelli F, Ambrogi M, Scavuzzo M, Morgantini A, Oleggini M, Frosini F, Pecori F, Mariotti ML. Perfusion of adult pig heart with human blood: a new automatic apparatus. Transplant Proc 1994; 26:1328-9. [PMID: 8029927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- R Di Stefano
- Transplant Research Laboratory, University of Pisa, Italy
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13
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Di Stefano R, Carobbi A, Frosini F, Scavuzzo M, Rindi P, Rizzo G, Mosca F. Allogeneic and xenogeneic cross-reactions in hyperimmune recipients. Transplant Proc 1993; 25:446. [PMID: 8438372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- R Di Stefano
- Institute of General and Experimental Surgery, University of Pisa, Italy
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Di Stefano R, Carobbi A, Frosini F, Ferrari M, Pelosi W, Rizzo G, Ermini M, Mosca F. Secondary allogeneic challenge of xenotransplant recipients. Transplant Proc 1992; 24:694-5. [PMID: 1566485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- R Di Stefano
- Institute of General and Experimental Surgery, University of Pisa, Italy
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Frosini F, Azzolina G. [Dextrocardia associated with congenital cardiopathies. Our cases]. Minerva Cardioangiol 1985; 33:711-5. [PMID: 4088474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Gagliardi R, Benvenuti L, Frosini F, Ammannati F, Barletta GA, Fantini F. Frequency of echocardiographic abnormalities in patients with ischemia of the carotid territory--a preliminary report. Stroke 1985; 16:118-20. [PMID: 3966255 DOI: 10.1161/01.str.16.1.118] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Eighty-eight consecutive patients referred to a neurosurgical Department (63 men and 25 women) aged from 14 to 68 years, with cerebral ischemia in the carotid territory were subjected to M-mode and two-dimensional echocardiography, carotid angiography and assessment of risk factors. There were 27 patients (average age 54 years) in whom carotid angiography demonstrated a probable source for the ischemia. Carotid angiography was normal in 51 of the remaining 61 (average age 39 years) while 10 revealed distant emboli. Although the incidence of "abnormal echocardiograms" was similar in the two groups (56% and 54% respectively) the spectrum of abnormalities were different. Only 5 (18%) of the 27 patients with abnormal angiograms had a potential cardiac source of emboli while 24 (39%) out of the remaining 61 patients had a potential cardiac source demonstrated at echocardiography. There was a high incidence of mitral valve prolapse (34%) in this latter group of patients. Mitral valve prolapse was not seen in the present series in patients with a probable carotid source on angiography.
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Frosini F. [Asymmetric hypertrophy of the left ventricle]. Minerva Cardioangiol 1982; 30:531-8. [PMID: 6217431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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18
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Malfanti PL, Barletta GA, Bisi G, Frosini F, La Cava G, Pupi A, Fantini F. [Left selective isotopic Tc 99-m angiocardiography. Validity of some indices as compared with echocardiographic indices]. Minerva Cardioangiol 1979; 27:623-8. [PMID: 554969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Fantini F, Malfanti PL, Specchia G, Trevi G, Barletta G, Frosini F. Correlations between the degree of coronary artery stenosis and the segmental motion of the left ventricle. Ann Radiol (Paris) 1979; 22:306-7. [PMID: 496266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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