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Author: Soroush Saghafian
Publisher:
ISBN:
Category :
Languages : en
Pages : 0
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Book Description
Crisis level overcrowding conditions in Emergency Departments (ED's) have led hospitals to seek out new patient flow designs to improve both responsiveness and safety. One approach that has attracted attention and experimentation in the emergency medicine community is a system in which ED beds and care teams are segregated and patients are "streamed" based on predictions of whether they will be discharged or admitted to the hospital. In this paper, we use a combination of analytic and simulation models to determine whether such a streaming policy can improve ED performance, where it is most likely to be effective, and how it should be implemented for maximum performance. Our results suggest that the concept of streaming can indeed improve patient flow, but only in some situations. First, ED resources must be shared across streams rather than physically separated. This leads us to propose a new "virtual-streaming" patient flow design for ED's. Second, this type of streaming is most effective in ED's with (1) a high percentage of admitted patients, (2) longer care times for admitted patients than discharged patients, (3) a high day-to-day variation in the percentage of admitted patients, (4) long patient boarding times (e.g., caused by hospital "bed-block"), and (5) high average physician utilization. Finally, to take full advantage of streaming, physicians assigned to admit patients should prioritize upstream (new) patients, while physicians assigned to discharge patients should prioritize downstream (old) patients.
Author: Soroush Saghafian
Publisher:
ISBN:
Category :
Languages : en
Pages : 0
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Book Description
Crisis level overcrowding conditions in Emergency Departments (ED's) have led hospitals to seek out new patient flow designs to improve both responsiveness and safety. One approach that has attracted attention and experimentation in the emergency medicine community is a system in which ED beds and care teams are segregated and patients are "streamed" based on predictions of whether they will be discharged or admitted to the hospital. In this paper, we use a combination of analytic and simulation models to determine whether such a streaming policy can improve ED performance, where it is most likely to be effective, and how it should be implemented for maximum performance. Our results suggest that the concept of streaming can indeed improve patient flow, but only in some situations. First, ED resources must be shared across streams rather than physically separated. This leads us to propose a new "virtual-streaming" patient flow design for ED's. Second, this type of streaming is most effective in ED's with (1) a high percentage of admitted patients, (2) longer care times for admitted patients than discharged patients, (3) a high day-to-day variation in the percentage of admitted patients, (4) long patient boarding times (e.g., caused by hospital "bed-block"), and (5) high average physician utilization. Finally, to take full advantage of streaming, physicians assigned to admit patients should prioritize upstream (new) patients, while physicians assigned to discharge patients should prioritize downstream (old) patients.
Author: Arshya Feizi
Publisher:
ISBN:
Category :
Languages : en
Pages : 0
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Book Description
Addressing hospital emergency department (ED) overcrowding is a critical challenge for many healthcare systems worldwide. Many hospitals (including our partner hospital) have been experimenting with innovative patient flow designs to address this challenge. A promising new design is to separate patients who can be served vertically (e.g., on a regular chair as opposed to horizontally on an ED bed) and route them to a different area termed the Vertical Processing Pathway (VPP) unit. While this can potentially increase operational efficiency by removing the burden caused by a main ED bottleneck--lack of bed availability--it can degrade performance if patients that are routed to the VPP unit need to be sent back to be served in an ED bed, or if some patients that could have been served in the VPP unit end up occupying an ED bed. Successful implementation of this design, thus, significantly depends on understanding which patients should be routed to the VPP unit and when.To assist our partner hospital and other EDs, we develop a machine learning model trained on large-scale data capable of providing a personalized risk score for each arriving patient on whether or not they will eventually need an ED bed. We then feed these risk scores to an analytical model of patient flow to characterize the optimal protocol for utilizing the VPP unit. We find that the optimal protocol depends not only on the predicted risk scores but also on the machine learning model's accuracy as well as some of the main ED characteristics (e.g., patient arrival intensity and congestion level). To gain deeper insights, we make use of simulation analyses calibrated with hospital data and compare the performance of our recommended VPP-based patient streaming design with more traditional ED flow approaches such as “fast track” or “physician in triage.” Our results suggest that following the VPP design under our recommended protocol can bring several advantages to EDs, allowing them to significantly improve their operations.
Author: Jennifer L. Wiler
Publisher: Cambridge University Press
ISBN: 1108211356
Category : Medical
Languages : en
Pages : 251
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Book Description
Access to acute and emergency care is essential when we are ill or injured, but the costs are significant. How can we make services more efficient and effective? This thought-provoking text provides twenty case studies detailing successful innovations to enhance value, including telehealth, observation medicine, high utilizer programs, and the use of informatics to improve clinical decision support. A detailed history of system developments over the last fifty years in the US and internationally is provided, and subjects including measurement and quality improvement, volume versus value based care, and emergency department crowding are discussed. This book is an ideal way for emergency physicians and healthcare managers to explore new ideas and enhance the quality of care in their area.
Author: Management Association, Information Resources
Publisher: IGI Global
ISBN: 1799824527
Category : Medical
Languages : en
Pages : 627
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Book Description
Improvements in hospital management and emergency medical and critical care services require continual attention and dedication to ensure efficient and proper care for citizens. To support this endeavor, professionals rely more and more on the application of information systems and technologies to promote the overall quality of modern healthcare. Implementing effective technologies and strategies ensures proper quality and instruction for both the patient and medical practitioners. Hospital Management and Emergency Medicine: Breakthroughs in Research and Practice examines the latest scholarly material on emerging strategies and methods for delivering optimal emergency medical care and examines the latest technologies and tools that support the development of efficient emergency departments and hospital staff. While highlighting the challenges medical practitioners and healthcare professionals face when treating patients and striving to optimize their processes, the book shows how revolutionary technologies and methods are vastly improving how healthcare is implemented globally. Highlighting a range of topics such as overcrowding, decision support systems, and patient safety, this publication is an ideal reference source for hospital directors, hospital staff, emergency medical services, paramedics, medical administrators, managers and employees of health units, physicians, medical students, academicians, and researchers seeking current research on providing optimal care in emergency medicine.
Author: Wallace J. Hopp
Publisher: Pearson Education
ISBN: 0132908662
Category : Business & Economics
Languages : en
Pages : 638
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Book Description
"In Hospital Operations, two leading Operations Management experts and five practicing clinicians demonstrate how to apply new OM advances and metrics to substantially improve any hospital's performance. Replete with examples, Hospital Operations shows how to generate principles-driven breakthrough ideas to systematically improve emergency departments, operating rooms, nursing unites, and diagnostic units." -- Back cover
Author: Tinglong Dai
Publisher: John Wiley & Sons
ISBN: 1119300940
Category : Business & Economics
Languages : en
Pages : 482
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Book Description
How can analytics scholars and healthcare professionals access the most exciting and important healthcare topics and tools for the 21st century? Editors Tinglong Dai and Sridhar Tayur, aided by a team of internationally acclaimed experts, have curated this timely volume to help newcomers and seasoned researchers alike to rapidly comprehend a diverse set of thrusts and tools in this rapidly growing cross-disciplinary field. The Handbook covers a wide range of macro-, meso- and micro-level thrusts—such as market design, competing interests, global health, personalized medicine, residential care and concierge medicine, among others—and structures what has been a highly fragmented research area into a coherent scientific discipline. The handbook also provides an easy-to-comprehend introduction to five essential research tools—Markov decision process, game theory and information economics, queueing games, econometric methods, and data science—by illustrating their uses and applicability on examples from diverse healthcare settings, thus connecting tools with thrusts. The primary audience of the Handbook includes analytics scholars interested in healthcare and healthcare practitioners interested in analytics. This Handbook: Instills analytics scholars with a way of thinking that incorporates behavioral, incentive, and policy considerations in various healthcare settings. This change in perspective—a shift in gaze away from narrow, local and one-off operational improvement efforts that do not replicate, scale or remain sustainable—can lead to new knowledge and innovative solutions that healthcare has been seeking so desperately. Facilitates collaboration between healthcare experts and analytics scholar to frame and tackle their pressing concerns through appropriate modern mathematical tools designed for this very purpose. The handbook is designed to be accessible to the independent reader, and it may be used in a variety of settings, from a short lecture series on specific topics to a semester-long course.
Author: Paola Cappanera
Publisher: Springer
ISBN: 3319661469
Category : Medical
Languages : en
Pages : 301
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Book Description
This book presents statistical processes for health care delivery and covers new ideas, methods and technologies used to improve health care organizations. It gathers the proceedings of the Third International Conference on Health Care Systems Engineering (HCSE 2017), which took place in Florence, Italy from May 29 to 31, 2017. The Conference provided a timely opportunity to address operations research and operations management issues in health care delivery systems. Scientists and practitioners discussed new ideas, methods and technologies for improving the operations of health care systems, developed in close collaborations with clinicians. The topics cover a broad spectrum of concrete problems that pose challenges for researchers and practitioners alike: hospital drug logistics, operating theatre management, home care services, modeling, simulation, process mining and data mining in patient care and health care organizations.
Author: Mohammed Rashidul Anwar
Publisher:
ISBN:
Category :
Languages : en
Pages : 0
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Book Description
Background: Several Canadian jurisdictions have launched interventions and strategies to address the complex, multi-dimensional problem of Emergency Department (ED) crowding. Still many of the health systems struggle with long waits. Initiatives that seem to display positive results in one site/system are often unable to show similar results in another. To make sense of such patterns, I drew on a form of theory-based evaluation, Realistic Evaluation (RE). My realist analysis focused on streaming-type interventions such as Fast-track/Minor Treatment Areas, Intake/Rapid Assessment Zones, and diverse types of Short-Stay Units, which separate the whole care process of patients into different streams (based on acuity and service needs) to improve patient flow. Objective- The purpose of this thesis was to identify relevant mechanisms and contextual factors to generate "middle-range theories" for streaming-based flow interventions. Methods- This thesis used the interview data collected for a larger project, "Patient Flow and Health Systems". These interviews were conducted with 300 key stakeholders who were involved in initiatives to improve flow, in one of the ten urban/mostly-urban health regions and zones of Western Canada. I undertook a realist analysis based on participants' explanations for (perceived) success and failure. This work was grounded in the Population-Capacity-Process model, which helped to categorize factors in a meaningful way. Findings- Essential design features of streaming-type interventions that might have led to their success included identification of a designated population (population), allocation of dedicated space and resources (capacity), and establishment of rapid cycle time (process). These supported key mechanisms: patients wait only for services they need, variability among patients is reduced, standardized care is provided, lag time between care steps is prevented and provider attitude change promotes prompt discharge. Critical context factors that might have impacted the interventions were lack of outflow sites and the possibility of demand outstripping capacity. An important finding of this study was that failure of interventions was more commonly attributed to design flaws (in particular, lack of dedicated space) than to context factors. Conclusion- This study helped generate "middle-range theories" which sought to explain the outcomes of diverse interventions that share a basic program theory. In this way, it was able to provide transferable lessons for stakeholders wishing to implement similar interventions elsewhere.
Author: Sandra C. Buttigieg
Publisher: Emerald Group Publishing
ISBN: 1784412783
Category : Medical
Languages : en
Pages : 276
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Book Description
Advances in Health Care Management Volume 17 helps to shape emerging thinking about best practices in international health care management. The volume is divided into two sections: a set of commentaries from US and European scholars, and research articles that compare two or more health systems and focus on specific topics in health care delivery.
Author: J. Mantas
Publisher: IOS Press
ISBN: 1614996644
Category : Medical
Languages : en
Pages : 308
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Book Description
Informatics and technology have become an intrinsic part of healthcare management in recent years; it is almost impossible to imagine a modern healthcare system without them. This book presents the proceedings of the 14th annual International Conference on Informatics, Management and Technology in Healthcare (ICIMTH), held in Athens, Greece, in July 2016. The conference treats the field of biomedical informatics in a very broad framework, and the 68 full papers included here examine the research and applications outcomes of informatics from cell to population, including a number of technologies such as imaging, sensors, mobile communications, biomedical equipment and management, as well as legal and societal issues related to the application of health informatics. The book is divided into sections: Biomedical Technology; Clinical Informatics; E-learning and Education; Formalisation of Knowledge, Ontologies, Clinical Guidelines and Standards of Healthcare; Health Informatics; Healthcare Management and Public Health; mHealth and Telemedicine; and Social Media and Health. Also included are two keynote speeches. Covering a wide spectrum of applications, the book will be of interest to all those working in the design, management and delivery of healthcare services whose work involves the development or use of biomedical informatics.
