A COVID-19 Recovery Strategy Based on the Health System Capacity Modeling. Implications on Citizen Self-management

Versión preprint depositada sin articulo publicado dada la actualidad del tema. *Solicitud de los autoresConfinement ends, and recovery phase should be accurate planned. Health System (HS) capacity, specially ICUs and plants capacity and availability, will remain the key stone in this new Covid-19 pandemic life cycle phase. Until massive vaccination programs will be a real option (vaccine developed, world wield production capacity and effective and efficient administration process), date that will mark recovery phase end, important decisions should be taken. Not only by authorities. Citizen self-management and organizations self-management will be crucial. This means: citizen and organizations day a day decision in order to control their own risks (infecting others and being infected). This paper proposes a management tool that is based on a ICUs and plants capacity model. Principal outputs of this tool are, by sequential order and by last best data available: (i) ICUs and plants saturation estimation data (according to incoming rate of patients), (ii) with this results new local and temporal confinement measure can be planned and also a dynamic analysis can be done to estimate maximum Ro saturation scenarios, and finally (iii) provide citizen with clear and accurate data allow them adapting their behavior to authorities’ previous recommendations. One common objective: to accelerate as much as possible socioeconomic normalization with a strict control over HS relapses risk

A survey of health care models that encompass multiple departments

In this survey we review quantitative health care models to illustrate the extent to which they encompass multiple hospital departments. The paper provides general overviews of the relationships that exists between major hospital departments and describes how these relationships are accounted for by researchers. We find the atomistic view of hospitals often taken by researchers is partially due to the ambiguity of patient care trajectories. To this end clinical pathways literature is reviewed to illustrate its potential for clarifying patient flows and for providing a holistic hospital perspective

The impact of central government steering and local network dynamics on the performance of mandated service delivery networks: the case of the Primary Health Care networks in Flanders

This paper focuses on the impact of central – local relations on the performance of local service delivery networks set up by central government. Analyzing network literature leaves us with some questions about the impact of coordination strategies of central government as a possible determinant of network-level effectiveness for this type of network and the possible interaction between central government coordination (as part of the network context) and internal network dynamics and the combined effects hereof on the effectiveness of mandated service delivery networks in particular. Our analysis shows that both levels are important to explain the outcomes of the Primary Health Care networks in Flanders. Our study also leads to some important observations about the meaning of ‘central government coordination’ in this context

Taxonomic classification of planning decisions in health care: a review of the state of the art in OR/MS

We provide a structured overview of the typical decisions to be made in resource capacity planning and control in health care, and a review of relevant OR/MS articles for each planning decision. The contribution of this paper is twofold. First, to position the planning decisions, a taxonomy is presented. This taxonomy provides health care managers and OR/MS researchers with a method to identify, break down and classify planning and control decisions. Second, following the taxonomy, for six health care services, we provide an exhaustive specification of planning and control decisions in resource capacity planning and control. For each planning and control decision, we structurally review the key OR/MS articles and the OR/MS methods and techniques that are applied in the literature to support decision making

Flexible nurse staffing based on hourly bed census predictions

Workload on nursing wards depends highly on patient arrivals and patient lengths of stay, which are both inherently variable. Predicting this workload and staffing nurses accordingly is essential for guaranteeing quality of care in a cost effective manner. This paper introduces a stochastic method that uses hourly census predictions to derive efficient nurse staffing policies. The generic analytic approach minimizes staffing levels while satisfying so-called nurse-to-patient ratios. In particular, we explore the potential of flexible staffing policies which allow hospitals to dynamically respond to their fluctuating patient population by employing float nurses. The method is applied to a case study of the surgical inpatient clinic of the Academic Medical Center (AMC) Amsterdam. This case study demonstrates the method's potential to study the complex interaction between staffing requirements and several interrelated planning issues such as case mix, care unit partitioning and size, and surgical block planning. Inspired by the numerical results, the AMC decided that this flexible nurse staffing methodology will be incorporated in the redesign of the inpatient care operations during the upcoming years

Reallocating resources to focused factories: a case study in chemotherapy

This study investigates the expected service performance associated with a proposal to reallocate resources from a centralized chemotherapy department to a breast cancer focused factory. Using a slotted queueing model we show that a decrease in performance is expected and calculate the amount of additional resources required to offset these losses. The model relies solely on typical outpatient scheduling system data, making the methodology easy to replicate in other outpatient clinic settings. Finally, the paper highlights important factors to consider when assigning capacity to focused factories. These considerations are generally relevant to other resource allocation decisions

Reallocating resources to focused factories: a case study in chemotherapy

This study investigates the expected service performance associated with a proposal to reallocate resources from a centralized chemotherapy department to a breast cancer focused factory. Using a slotted queueing model we show that a decrease in performance is expected and calculate the amount of additional resources required to offset these losses. The model relies solely on typical outpatient scheduling system data, making the methodology easy to replicate in other outpatient clinic settings. Finally, the paper highlights important factors to consider when assigning capacity to focused factories. These considerations are generally relevant to other resource allocation decisions

The transmission of nosocomial pathogens in an intensive care unit: a space–time clustering and structural equation modelling approach

We investigated the incidence of cases of nosocomial pathogens and risk factors in an intensive treatment unit ward to determine if the number of cases is dependent on location of patients and the colonization/infection history of the ward. A clustering approach method was developed to investigate the patterns of spread of cases through time for five microorganisms [methicillin-resistant Staphylococcus aureus (MRSA), Acinetobacter spp., Klebsiella spp., Candida spp., and Pseudomonas aeruginosa] using hospital microbiological monitoring data and ward records of patient-bed use. Cases of colonization/infection by MRSA, Candida and Pseudomonas were clustered in beds and through time while cases of Klebsiella and Acinetobacter were not. We used structural equation modelling to analyse interacting risk factors and the potential pathways of transmission in the ward. Prior nurse contact with colonized/infected patients, mediated by the number of patient-bed movements, were important predictors for all cases, except for those of Pseudomonas. General health and invasive surgery were significant predictors of cases of Candida and Klebsiella. We suggest that isolation and bed movement as a strategy to manage MRSA infections is likely to impact upon the incidence of cases of other opportunist pathogen

Nurses’ Experiences Empowering Hospitalized Patients

Four focus groups were conducted to explore acute care nurses’ experiences empowering patients and the facilitators and barriers they encountered during the process. Thirty-four nurses employed at four hospitals in the Midwestern United States participated in the study between February and April 2015. Facilitators of empowerment included establishing a therapeutic relationship, fostering communication, providing education, respecting patient autonomy, engaging support systems, and lifting spirit/giving hope. Barriers included conflicting information about plans of care, lack of time, fear and anxiety over unfamiliar environments and routines, ineffective or inadequate support systems, lack of/low accountability, and killing the soul. Nurses also described innovative strategies they used to overcome the barriers. The development of future inpatient empowerment interventions needs to focus on the innovative strategies nurses used to overcome barriers in addition to considering the facilitators and barriers to empowerment that nurses identified