Implementation and validation of a new method to model voluntary departures from emergency departments

In the literature, several organizational solutions have been proposed for determining the probability of voluntary patient discharge from the emergency department. Here, the issue of self-discharge is analyzed by Markov theory-based modeling, an innovative approach diffusely applied in the healthcare field in recent years. The aim of this work is to propose a new method for calculating the rate of voluntary discharge by defining a generic model to describe the process of first aid using a “behavioral” Markov chain model, a new approach that takes into account the satisfaction of the patient. The proposed model is then implemented in MATLAB and validated with a real case study from the hospital “A. Cardarelli” of Naples. It is found that most of the risk of self-discharge occurs during the wait time before the patient is seen and during the wait time for the final report; usually, once the analysis is requested, the patient, although not very satisfied, is willing to wait longer for the results. The model allows the description of the first aid process from the perspective of the patient. The presented model is generic and can be adapted to each hospital facility by changing only the transition probabilities between states

Discrete Event Simulations

Considered by many authors as a technique for modelling stochastic, dynamic and discretely evolving systems, this technique has gained widespread acceptance among the practitioners who want to represent and improve complex systems. Since DES is a technique applied in incredibly different areas, this book reflects many different points of view about DES, thus, all authors describe how it is understood and applied within their context of work, providing an extensive understanding of what DES is. It can be said that the name of the book itself reflects the plurality that these points of view represent. The book embraces a number of topics covering theory, methods and applications to a wide range of sectors and problem areas that have been categorised into five groups. As well as the previously explained variety of points of view concerning DES, there is one additional thing to remark about this book: its richness when talking about actual data or actual data based analysis. When most academic areas are lacking application cases, roughly the half part of the chapters included in this book deal with actual problems or at least are based on actual data. Thus, the editor firmly believes that this book will be interesting for both beginners and practitioners in the area of DES

Early Information Access to Alleviate Emergency Department Congestion

Alleviating Emergency Department (ED) congestion results in shorter hospital stay which not only reduces the cost of medical procedure but also increase the hospital performance. Length of patient stay is used to determine the hospital performance. Organization Information Processing (OIPT) Theory is used to explain the impact of information access and availability on the information processing need and ability of a hospital. Technical devices such as RFID that works as “Auto Identification tags” is suggested to increase the information availability as well as the information processing capability of the hospitals. This study suggests that the OIPT needs to be further broken down into its entity form and then the impact of these entities is measured separately. On the other hand, institutional factors such as employee behavior towards the new technology is studied to analyze the impact of human factors in the implementation of these technical devices in the ED procedures. It can be implied from this study that early information access does increase the use of supporting EMR implementation. However, the importance of the use of EMR decreases with time on hospital performance. Moreover, other factors such as management policies related to IT positively moderates the relationship between information availability and the processing capability of a hospital ED

Telecommunications Networks

This book guides readers through the basics of rapidly emerging networks to more advanced concepts and future expectations of Telecommunications Networks. It identifies and examines the most pressing research issues in Telecommunications and it contains chapters written by leading researchers, academics and industry professionals. Telecommunications Networks - Current Status and Future Trends covers surveys of recent publications that investigate key areas of interest such as: IMS, eTOM, 3G/4G, optimization problems, modeling, simulation, quality of service, etc. This book, that is suitable for both PhD and master students, is organized into six sections: New Generation Networks, Quality of Services, Sensor Networks, Telecommunications, Traffic Engineering and Routing

Patient Safety and Quality: An Evidence-Based Handbook for Nurses

Compiles peer-reviewed research and literature reviews on issues regarding patient safety and quality of care, ranging from evidence-based practice, patient-centered care, and nurses' working conditions to critical opportunities and tools for improvement

An Optimisation-based Framework for Complex Business Process: Healthcare Application

The Irish healthcare system is currently facing major pressures due to rising demand, caused by population growth, ageing and high expectations of service quality. This pressure on the Irish healthcare system creates a need for support from research institutions in dealing with decision areas such as resource allocation and performance measurement. While approaches such as modelling, simulation, multi-criteria decision analysis, performance management, and optimisation can – when applied skilfully – improve healthcare performance, they represent just one part of the solution. Accordingly, to achieve significant and sustainable performance, this research aims to develop a practical, yet effective, optimisation-based framework for managing complex processes in the healthcare domain. Through an extensive review of the literature on the aforementioned solution techniques, limitations of using each technique on its own are identified in order to define a practical integrated approach toward developing the proposed framework. During the framework validation phase, real-time strategies have to be optimised to solve Emergency Department performance issues in a major hospital. Results show a potential of significant reduction in patients average length of stay (i.e. 48% of average patient throughput time) whilst reducing the over-reliance on overstretched nursing resources, that resulted in an increase of staff utilisation between 7% and 10%. Given the high uncertainty in healthcare service demand, using the integrated framework allows decision makers to find optimal staff schedules that improve emergency department performance. The proposed optimum staff schedule reduces the average waiting time of patients by 57% and also contributes to reduce number of patients left without treatment to 8% instead of 17%. The developed framework has been implemented by the hospital partner with a high level of success

Self-Evaluation Applied Mathematics 2003-2008 University of Twente

This report contains the self-study for the research assessment of the Department of Applied Mathematics (AM) of the Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS) at the University of Twente (UT). The report provides the information for the Research Assessment Committee for Applied Mathematics, dealing with mathematical sciences at the three universities of technology in the Netherlands. It describes the state of affairs pertaining to the period 1 January 2003 to 31 December 2008

Analysis and Implementation of Reinforcement Learning on a GNU Radio Cognitive Radio Platform

Spectrum today is regulated based on fixed licensees. In the past radio operators have been allocated a frequency band for exclusive use. This has become problem for new users and the modern explosion in wireless services that, having arrived late find there is a scarcity in the remaining available spectrum. Cognitive radio (CR) presents a solution. CRs combine intelligence, spectrum sensing and software reconfigurable radio capabilities. This allows them to opportunistically transmit among several licensed bands for seamless communications, switching to another channel when a licensee is sensed in the original band without causing interference. Enabling this is an intelligent dynamic channel selection strategy capable of finding the best quality channel to transmit on that suffers from the least licensee interruption. This thesis evaluates a Q-learning channel selection scheme using an experimental approach. A cognitive radio deploying the scheme is implemented on GNU Radio and its performance is measured among channels with different utilizations in terms of its packet transmission success rate, goodput and interference caused. We derive similar analytical expressions in the general case of large-scale networks. Our results show that using the Q-learning scheme for channel selection significantly improves the goodput and packet transmission success rate of the system

Algoritmos de optimización para el servicio de urgencias: Caso de estudio en el Hospital Universitario Virgen del Rocío

La búsqueda de la eficiencia está cada vez más presente en los diferentes sectores y entre ellos, el sector sanitario. La gestión sanitaria, se encuentra en una situación compleja donde, con recursos limitados y costes de personal, maquinarias y tratamientos muy elevados han de hacer frente a una demanda creciente de pacientes. Es por ello que cada vez más, se destinen recursos y esfuerzos para aumentar y optimizar los recursos hospitalarios a través de decisiones tácticas y organización de los recursos. Esta situación se extiende al servicio de urgencias (SU), el más frecuentado de un hospital. El objetivo principal del SU es poder responder a la necesidad de una atención de emergencia a los pacientes que llegan durante los 365 días del año, 24 horas al día y por ello, se le denomina en muchas ocasiones como la red de seguridad del sistema de atención médica. Este servicio es uno de los componentes clave de la sanidad y más aún cuando se considera uno de los factores por los que se juzga a un hospital. (Extraído de la Introducción)Universidad de Sevilla. Máster en Organización Industrial y Gestión de Empresa