Stop the Bleed and Seize Control: The use of Simulation and Video Modules in Educating Emergency Department Staff Regarding Maternal Hypertension and Hemorrhage

In order to address shortcomings of the health care system within the United States surrounding the early recognition and response to preeclampsia (PreE) and postpartum hemorrhage (PPH) emergencies The Joint Commission (TJC) revised the accreditation requirements regarding implementing yearly maternal hypertension and hemorrhage simulation scenarios in emergency departments. A Quality improvement team of Clinical Nurse Leader (CNL) students at University of San Francisco, working alongside the emergency department and labor and delivery department nurse educators assisted a dual hospital system in the Bay Area of California to develop and implement training materials and simulations for the hospital system’s Emergency Department (ED) staff. Pre and post simulation data were collected, and simulation debriefs were conducted to determine staffs level of awareness of hospital policies and procedures as well as comfort levels in recognizing and treating PreE and PPH prior to and after implementation of the simulation scenarios. The CNL students were also tasked with developing a staged and recorded example of two simulations, PreE and PPH, to be uploaded to the hospital system’s knowledge center (online learning platform) in early 2023. Low survey response rates made results analysis difficult but the debriefs provided valuable insight into the usefulness of simulation and debrief to increase awareness of policies and procedures. The QI team and will not be able to obtain post-intervention data on the effectiveness of the video training materials until implementation in early 2023

Applying Mathematical Models to Surgical Patient Planning

On a daily basis surgeons, nurses, and managers face cancellation of surgery, peak demands on wards, and overtime in operating rooms. Moreover, the lack of an integral planning approach for operating rooms, wards, and intensive care units causes low resource utilization and makes patient flows unpredictable. An ageing population and advances in medicine are putting the available healthcare budget under great pressure. Under these circumstances, hospitals are seeking innovative ways of providing optimal quality at the lowest costs. This thesis provides hospitals with instruments for optimizing surgical patient planning. We describe a cyclic and integrated operating room planning approach, called master surgical scheduling, and models for efficient planning of emergency operations. Application of these instruments enables the simultaneous optimization of the utilization of operating rooms, ward and intensive care units. Moreover, iteratively executing a master schedule of surgical case types provides steady and thus more predictable patient flows in hospitals. The approach is generic and so can be implemented taking account of specific characteristics of individual hospitals. Prerequisites for successful implementation of logistical models in hospitals comprise sufficient room for last-minute changes as well as keeping the ultimate responsibility for individual patient scheduling with medical specialists. Both are satisfied in the master surgical scheduling approach which has already been successfully implemented in hospitals

Modelling based framework for the management of emergency departments.

In the twenty-first century, the healthcare industry faces ever-changing economic, social, political and technology challenges. Costs are rising, funding is diminishing, human and fiscal resources are becoming scarcer, customer-expectations are rising, the complexity of disease is increasing and technology is becoming more complex. These trends have a massive impact on every aspect of hospital operations and the Emergency Department is no exception. Overcrowding in the Emergency Department (ED) in hospitals has become a growing problem in many developed countries around the world. ED overcrowding has a direct effect on patient-care, including compromised patient-safety, increased length-of-stay, increased mortality and morbidity-rates and increased costs. Healthcare policy-makers and hospital and ED administrators are being forced to search for ways to improve the capacity of EDs by better utilisation of existing resources and creating more efficient systems to overcome this problem.Throughout the past few decades, there has been an increasing trend of using numerous systems-analysis tools and techniques which have come from manufacturing and other service industries to address the various issues in healthcare and EDs. Among those tools Discrete-Event Simulation (DES) is a powerful tool to improve the efficiency and capacity in dynamic and complex systems. Use of these tools to address the overcrowding problem in EDs has been patchy; specific aspects of issues have been studied but no attempt has been made to deploy DES or any other systems-analysis tool in a strategic and holistic manner.The aim of this research is to develop a modelling-based framework to manage the overcrowding problem in EDs. The research identified the causes of overcrowding in EDs and developed a decisions-framework with the long-term, medium-term and short-tem decisions in EDs that related to the overcrowding problem. Finally, it identified the best possible systems-analysis tools to support those decisions to overcome the overcrowding problem in EDs. This research could help the healthcare policy-makers, managers, systems-engineers as well as the researchers and consultants who are interesting in the Emergency Department operational management

Modeling and Management of Variation in the Operating Theatre

After having worked in the profit industry, I continued my career in 2004 as a manager of operating rooms (ORs) in a large general teaching hospital in Rotterdam. My experiences in industry management taught me to work efficiently, effectively and to excel in service to every customer and prospect. With this experience in mind I started my new job on the first of January 2004. A job in an environment filled with costly equipment and a range of highly skilled professionals such as surgeons, residents, anesthesiologists and OR staff: a multi-million euro business within a hospital. Last but not least, a business with customers: patients who needed care. Prior to starting the job, I had assumed that processes were already efficient and effective, as a result of the relatively high labor and investment costs. Being a pilot, I fully realize what a valuable resource airspace is, particularly when subject to high traffic demand. Since airspace is a fixed volume, as is the case with OR capacity, managing it is a vital activity for satisfying the needs of the aircraft operators in the most efficient and equitable manner using a sophisticated decision support system. As none of this appeared to be the case in the OR environment, I conjectured that it must be possible to run the OR more efficiently, effectively and in a more patient-centered way

Healthcare Logistics: the art of balance

Healthcare management is a very complex and demanding business. The pro - cesses involved – operational, tactical and strategic – are extremely divers, sophisticated, and we see medical-technological advancements following on each other’s heels at breathtaking speed. And then there is the constant great pressure exerted from many sides: ever-increasing needs and demands from patients and society, thinking about organizations, growing competition, necessity to incorporate these rapidly succeeding medical-technological advancements into the organization, strict cost containment, growing demand for healthcare, and a constant tightening of budgets. These developments force healthcare managers in the individual organizations to find a balance between said developments, the feasibilities of organization in question, and the desired healthcare outcomes in an ever-changing world. The search for individual organizational balances requires that the world of professional competencies, i.e. the clinicians, and the world of healthcare managers should speak the same language when weighing the various developments and translating the outcomes into organizational choices. For the clinicians to make the right choices they must be facilitated to appraise the effects of their choices on organizational outcomes. Likewise, the healthcare managers’ decision- making process should include the effects on the medical policies pursued by the individual clinicians in the own organization. This thesis places a focus on developing methods for allocation of hospital resources within a framework that enables clinicians and healthcare managers to balance the developments on the various levels, thus providing a basis for policymaking

How Can we Use Simulation to Improve Competencies in Nursing?

This open access book offers an overview of theories related to simulation and describes different simulation areas within nursing. It illustrates how simulation may be used in different levels in professional education. The book deals with the role of the Simulation Facilitator, peer learning and the use of Virtual Reality in simulation. It provides new insights and paths to the development of the use of simulation within nursing and healthcare and contributes with new knowledge from research and experiences of implementation of different simulating scenarios within nursing and midwifery. It is intended to teachers in nursing and other healthcare professionals with an interest in the use of active learning methods