Stochastic surgery selection and sequencing under dynamic emergency break-ins

Anticipating the impact of urgent emergency arrivals on operating room schedules remains methodologically and computationally challenging. This paper investigates a model for surgery scheduling, in which both surgery durations and emergency patient arrivals are stochastic. When an emergency patient arrives he enters the first available room. Given the sets of surgeries available to each operating room for that day, as well as the distributions of the main stochastic variables, we aim to find the per-room surgery sequences that minimise a joint objective, which includes over- and under-utilisation, the amount of cancelled patients, as well as the risk that emergencies suffer an excessively long waiting time. We show that a detailed analysis of emergency break-ins and their disruption of the schedule leads to a lower total cost compared to less sophisticated models. We also map the trade-off between the threshold for excessive waiting time, and the set of other objectives. Finally, an efficient heuristic is proposed to accurately estimate the value of a solution with significantly less computational effort.Anticipating the impact of urgent emergency arrivals on operating room schedules remains methodologically and computationally challenging. This paper investigates a model for surgery scheduling, in which both surgery durations and emergency patient arrivals are stochastic. When an emergency patient arrives he enters the first available room. Given the sets of surgeries available to each operating room for that day, as well as the distributions of the main stochastic variables, we aim to find the per-room surgery sequences that minimise a joint objective, which includes over- and under-utilisation, the amount of cancelled patients, as well as the risk that emergencies suffer an excessively long waiting time. We show that a detailed analysis of emergency break-ins and their disruption of the schedule leads to a lower total cost compared to less sophisticated models. We also map the trade-off between the threshold for excessive waiting time, and the set of other objectives. Finally, an efficient heuristic is proposed to accurately estimate the value of a solution with significantly less computational effort.A

Integrated Approaches to Digital-enabled Design for Manufacture and Assembly: A Modularity Perspective and Case Study of Huoshenshan Hospital in Wuhan, China

Countries are trying to expand their healthcare capacity through advanced construction, modular innovation, digital technologies and integrated design approaches such as Design for Manufacture and Assembly (DfMA). Within the context of China, there is a need for stronger implementation of digital technologies and DfMA, as well as a knowledge gap regarding how digital-enabled DfMA is implemented. More critically, an integrated approach is needed in addition to DfMA guidelines and digital-enabled approaches. For this research, a mixed method was used. Questionnaires defined the context of Huoshenshan Hospital, namely the healthcare construction in China. Then, Huoshenshan Hospital provided a case study of the first emergency hospital which addressed the uncertainty of COVID-19. This extreme project, a 1,000-bed hospital built in 10 days, implemented DfMA in healthcare construction and provides an opportunity to examine the use of modularity. A workshop with a design institution provided basic facts and insight into past practice and was followed by interviews with 18 designers, from various design disciplines, who were involved in the project. Finally, multiple archival materials were used as secondary data sources. It was found that complexity hinders building systems integration, while reinforcement relationships between multiple dimensions of modularity (across organisation-process-product-supply chain dimensions) are the underlying mechanism that allows for the reduction of complexity and the integration of building systems. Promoting integrated approaches to DfMA relies on adjusting and coupling multi-dimensional modular reinforcement relationships (namely, relationships of modular alignment, modular complement, and modular incentive). Thus, the building systems integrator can use these three approaches to increase the success of digital-enabled DfMA

Sistemi integrati BIM-GIS nella progettazione di edilizia ospedaliera ad alta efficienza energetica

The interoperability of the tools for managing and controlling the design process is one of the themes on which research and innovations are focussed in the field of BIM (Building Information Modelling) systems. A strategic objective of the STREAMER research, co-funded by the European Union within the context of the Seventh Framework Programme, is that of defining the tools and methods of designing hospital buildings that allow for a 50% reduction in energy consumption and emissions in large healthcare districts. Contributing to the achievement of this result is the creation of integrated tools, based on BIM and GIS systems, capable of providing an effective backup to the decisions of the various subjects involved in the project and the management of hospital complexes

Lean Management Framework for Healthcare Facilities Integrating BIM, BEPS and Big Data Analytics

An increase in the usage of information and communication technologies (ICT) and the Internet of Things (IoT) in Facility Management (FM) induces a huge data stack. Even though these data bring opportunities such as cost savings, time savings, increase in user comfort, space optimization, energy savings, inventory management, etc., these data sources cannot be managed and manipulated effectively to increase efficiency at the FM stage. In addition to data management issues, FM practices, or developed solutions, need to be supported with the implementation of lean management philosophy to reveal organizational and managerial wastes. In the literature, some researchers performed studies about awareness about building information modeling (BIM)-FM, and FM-related data management problems in terms of lean philosophy. However, the comprehensive solution for effective FM has not been investigated with the application of lean management philosophy yet. Therefore, this study aims to develop an FM framework for healthcare facilities by considering lean management philosophy since more stable workflow, continuous improvement, and creating more value to customers will help to deliver a more acceptable solution for the FM industry. Within this context, the integration of BIM, Building Energy Performance Simulations, and Big Data Analytics are proposed as a solution. In the study, the Design Science Research (DSR) methodology was followed to develop the FM framework. Depending on the DSR methodology, two scenarios were used to investigate the issue in a real healthcare facility and develop the FM framework. The developed framework was evaluated by four experts, and the revisions of the proposed framework were realized

Health Building Information Modeling (HBIM)-based Facility Management: A Conceptual Framework

The outbreak of the COVID-19 epidemic has brought significant challenges to building operation and occupant health. In practice, building operators have begun to use various Internet of Things (IoT) technologies, intelligent sensing devices, and manual registration methods to update occupant information and behaviour in different building areas. Building spaces are classified according to their health, such as the distinction between safe areas and infected areas. Using the health data of occupants and spaces to help buildings operate efficiently and safely is a problem that needs to be solved urgently. This research proposed a conceptual framework for facility management driven by a Health Building Information Model (HBIM). The framework aims to incorporate the emerging data types to enrich the health information of the BIM model and provide decision support for facility operation and maintenance

Health and Care Infrastructure Research and Innovation Centre final report 2014

Improving healthcare, while containing costs, demands sophisticated understanding of three core elements in healthcare systems: infrastructure, technology and services. Their tripartite relationship is extremely complex, not least because the pace of change for each is different. That creates considerable challenges in planning for future needs and makes the management of innovation and change difficult. [Continues.

The effects of short-term omission of daily medication on the pathophysiology of heart failure

Aims Pharmacological therapies for heart failure (HF) aim to improve congestion, symptoms, and prognosis. Failing to take medication is a potential cause of worsening HF. Characterizing the effects of short-term medication omission could inform the development of better technologies and strategies to detect and interpret the reasons for worsening HF. We examined the effect of planned HF medication omission for 48 h on weight, echocardiograms, transthoracic bio-impedance, and plasma concentrations of NT-proBNP. Methods and results Outpatients with stable HF and an LVEF <45% were assigned to take or omit their HF medication for 48 h in a randomized, crossover trial. Twenty patients (16 men, LVEF 32 ± 9%, median NT-proBNP 962 ng/L) were included. Compared with regular medication, omission led to an increase in NT-proBNP by 99% (from 962 to 1883 ng/L, P < 0.001), systolic blood pressure by 16% (from 131 to 152 mmHg, P < 0.001), and left atrial volume by 21% (from 69 to 80 mL, P = 0.001), and reductions in transthoracic bio-impedance by 10% (from 33 to 30 Σ, P = 0.001) and serum creatinine by 8% (from 135 to 118 µmol/L, P = 0.012). No significant changes in body weight, heart rate, or LVEF were observed. Conclusions The characteristic pattern of response to short-term medication omission is of increasing congestion but, in contrast to the pattern reported for disease progression, with a rise in blood pressure and improved renal function. In stable HF, weight is not a sensitive marker of short-term diuretic omission