Simulation Modelling in Healthcare: Challenges and Trends

AbstractIn this paper, we describe simulation models in healthcare that have been developed in the past two decades. Simulation systems, ranging from simulation of patient flow in emergency rooms to simulation of populations with a specific chronic diseases, are reviewed. Simulation types included discrete event simulation (DES) and agent based simulation (ABS). A trend of variability and scalability were identified, and discussed in terms of platform used to develop the model, data sources, and computational power needed to run the simulation. In the synthesis of simulation models, programming languages and products emerged as clusters. Design models and systems engineering development processes are examined with a focus on requirements discovery, models and scenarios of simulation. Graphic user interfaces in the simulation tools in healthcare are reviewed in terms of visual design and human factors. Furthermore, interaction modes and trends of information visualization techniques used for the simulations are reported. Agent-based simulation models in particular were reviewed, and findings suggest agent characteristics varied across literature researched in aspects such as socio-demographic design considerations

How Labor-Management Partnerships Improve Patient Care, Cost Control, and Labor Relations: Case Studies of Fletcher Allen Health Care, Kaiser Permanente, and Montefiore Medical Center’s Care Management Corporation

[Excerpt] This paper explores the ways in which healthcare unions and their members are strategically engaging with management through partnership to control costs and improve the patient experience, clinical outcomes, workplace environment, and labor relations. These initiatives depend on making use of the knowledge of front-line healthcare workers, improving communication between all staff members, and increasing transparency. In turn, these initiatives can also lead to more robust and dynamic local unions. Through participating in joint work activities, many union members note feeling more respected in their workplace and more connected to their union. Unions can benefit from these activities by offering their members the ability to inform decisions about how work gets done

Decreasing Operating Room Delays for Surgical Orthopedic Patients

The operating room (OR) at the project site was experiencing surgical delays for orthopedic surgical patients due to unavailable instruments, which led to a decrease in the efficiency of OR utilization. The purpose of this project was to decrease operating room delays for the orthopedic surgical patients. The practice-focused question explored whether a multidisciplinary approach to the procurement of instruments and supplies for the orthopedic surgical patient would help to ensure an on-time surgery start, resulting in increased efficiency in the utilization of the OR from 42% to 65% within a 9-month period. Lewin\u27s change model was used to guide the project. Data analysis was conducted using a t test to compare the changes in the mean scores of the OR utilization rate before and after the involvement of a multidisciplinary team. An independent samples t test found no significant effect of the intervention, t (13) = 0.74, p \u3e .05. Because the t test results were not significant at the α = .05 level, results showed no evidence that the multidisciplinary team affected the OR utilization rate. Decreasing surgical delays can have the potential implication for positive social change at the organization level, because delays hinder optimal patient flow, increase anxiety for patient and families, and have a significant negative economic impact on hospitals

Specialization in health care delivery: assessing quality and factors affecting location

Thesis (Ph.D.)--Boston UniversitySeveral new organizational health care delivery forms have developed in recent decades. For hospital services, the number of single specialty hospitals (SSHs) providing cardiac and orthopedic/surgical services has grown significantly. Physician-owners claim that these SSHs use limited-scope and economies of scale to provide higher quality of care and reduce costs. While SSH costs have been studied, a comprehensive assessment of SSH quality of care and an evaluation of factors affecting SSH location is useful. For primary care services, significant growth in the number of retail health clinics (RHCs) has employed nurse practitioners (NPs) to provide care for a limited set of low-acuity conditions. Whether state regulations limiting the ability of NPs to practice independently affect RHC location is not known. To assess whether SSHs provide higher quality of care than competing general hospitals, we compared process of care and outcome measures for SSHs and general hospitals in the same health care market for 2008 through 2011. Cardiac SSHs had better scores for some outcomes. All SSHs had some better and some worse process of care scores, although scores for all hospitals increased over time and differences between SSHs and general hospitals diminished. Any improvements in quality of care were not robust to other factors. To evaluate the economic factors affecting hospital service specialization, we used ordered logistic regression to model presence of an SSH or ambulatory surgery center (ASC) on supply, demand, and regulatory factors. A higher degree of hospital specialization is associated with higher population levels and growth, more specialists and operating rooms per capita, and the absence of certificate of need laws. To assess economic factors affecting RHC location and test whether regulations limiting NP practice autonomy affect RHC location, we used logistic regression to model presence of an RHC on relevant economic factors and state regulations limiting NP practice autonomy. RHC location is associated with higher private insurance levels and certain factors affecting primary care supply, but is unhindered by regulations limiting NP practice autonomy. Each new form of in health care delivery examined appears uniquely affected by geographic differences in supply, demand, and regulatory factors

Improving Provider Knowledge on Surgical Site Infection Prevention Using a Surgical Surveillance Education Program

Background: Surgical site infections are a serious adverse outcome following any surgery. Despite the presence of international and standardized hospital guidelines, the prevention of surgical site infections remains a challenge for private practices and ambulatory centers. Currently, most ambulatory centers rely solely on provider reporting for their infection control reports and the education on prevention in these practices is minimal. It is critical that healthcare professionals have appropriate knowledge on surgical site infections, prevention methods and on their role in implementing evidence-based prevention strategies such as a surgical surveillance program. Purpose: The purpose of this quality improvement project (QIP) was to improve healthcare professionals’ knowledge on surgical surveillance and its potential impact on infection prevention in private and ambulatory settings. Methods/practice: The findings from the literature helped guide this QIP. A test was created to be used in the pre- and post-intervention phases. The test consisted of 4 demographic questions and 10 knowledge questions on current surgical infection prevention practices, surgical surveillance guidelines including telehealth follow ups, and 4 ungraded self-knowledge level questions. Ten participants completed the pre-test, and ten participants completed the educational session and post-test. A 30-minute evidenced-based educational session was conducted at a primary care clinic on indirect surgical surveillance and how it can be utilized in private practice to improve patient outcomes. Conclusion: The findings indicated that the participants lacked the appropriate education and information on what surgical surveillance entails and how it can be utilized in private settings. Findings from the post-test indicated that the educational session did increase the knowledge of the participants on surgical surveilling and how it can directly impact patient outcomes. Post-test scores improved 29% over pre-testing scores following the educational session. Implications for Practice: There is a lack of education and implementation of surgical surveillance guidelines in private practices across the country. Both educational leadership and management should implement the continuous and important education on how to properly utilize surgical surveillance to ensure the best and safest care is being provided to patients

Enhancing Occupational Performance Outcomes For Individuals With Orthopedic Injuries That Includes Psychosocial Well-Being Considerations In Occupational Therapy

Approximately one-third of people who sustain any type of acute orthopedic injury experience depression, one-quarter experience post-traumatic stress disorder (PTSD) and up to one-half have anxiety up to 10 years after the initial injury (Breazeale et al., 2021; Muscatelli et al., 2017). These psychosocial factors can have negative impacts on clients’ everyday life and occupations such as participation in social activities, return to work, and limit independence in daily activities (Vincent et al., 2018). Occupational therapists are often responsible for evaluating and providing intervention for individuals with upper extremity orthopedic injuries; more than 85% of certified hand therapists are occupational therapists (Hand Therapy Certification Commission, n.d.). Providing holistic care to clients through interventions for both mental and physical health demonstrates the unique view occupational therapy brings to the orthopedic setting and how occupational therapists can aid in increasing individual’s performance range (Dunn, 2017; Ikuigu, 2017). While occupational therapists are able to address psychosocial needs of clients, they are not always the main priority with orthopedic injuries. The benefit of addressing both physical and mental health following orthopedic injuries is continuously being studied to gain further information on best-practice in the area (Archer et al., 2022). With the practice gap between physical health and mental health rehabilitation in the field of orthopedic OT, a need to bridge that gap has emerged with a focus on implementation of both mental and physical interventions (Archer et al., 2022). The purpose of this project was to build a product to facilitate enhancing occupational performance outcomes for individuals experiencing upper extremity orthopedic injuries through the implementation of interventions targeting psychosocial factors in conjunction with orthopedic interventions in an outpatient occupational therapy setting, specialized in hand therapy. I partnered with occupational therapists, certified in hand therapy, at an outpatient orthopedic clinic in an urban town that serves both urban and rural populations. This aided in completion of a needs assessment to learn about the client population, client needs, current clinic needs, and educational experience to further inform the creation of the product. A literature review and an on-site needs assessment were conducted to guide the project’s development and build a useful product based on existing literature paired with community need. A literature review was conducted using journal articles from the Cumulated Index to Nursing and Allied Health Literature (CINAHL), PubMed, Google Scholar, OT Seeker, Substance Abuse and Mental Health Services Administration (SAHMSA), Center for Disease Control and Prevention (CDC), American Occupational Therapy Association (AOTA), UND Scholarly Commons, and American Society of Hand Therapists (ASHT). Key terms included Occupational therapy, upper extremity, lifestyle redesign, Complex regional pain syndrome, mental health, orthopedic injuries, hand therapy, model of human occupation, ecology of human performance, and orthopedics. The information gathered from the literature review aided in the identification of the problem statement, demonstrating an increased need for addressing psychosocial factors in the orthopedic setting. The theory used to guide the creation of the product was the Ecology of Human Performance (Dunn, 2017). The Ecology of Human Performance is an ecological model within the occupational therapy profession that focuses on the interaction between the person, their contexts, the tasks available within their contexts, and how those interactions influence the person’s performance range (Dunn, 2017). The theory was used with the facets of the model in mind, working to address and enhance client performance range through increased task availability, the client’s contexts in which they participate in, and looking at all aspects of the person highlighted by the Ecology of Human Performance (Dunn, 2017). The completed product consists of a compilation and education on various mental health screening tools, a constructed tip sheet consisting of evidence-based occupational therapy interventions for psychosocial well-being to implement into the orthopedic setting, and a referral resource for continued mental health care specifically for the surrounding community. The product is intended to positively impact clients working with outpatient occupational therapists treating upper extremity orthopedic injures as to guide occupational therapy intervention planning for holistic care of clients. This addresses the stated problem as implementation of physical and mental health interventions are suggested with the use of the created product

Focal Spot, Summer/Fall 2007

https://digitalcommons.wustl.edu/focal_spot_archives/1106/thumbnail.jp

Faculty Perceptions of Using Interprofessional Education to Prepare Doctor of Physical Therapy Students for the Workforce

Interprofessional collaboration (IPC) between health professionals of various disciplines aims to improve patient care by optimizing patient outcomes and employee enthusiasm for their jobs. Interprofessional education (IPE) is the pedagogical approach to teaching IPC. There is an expectation that physical therapy (PT) instructors will adopt and teach this approach, but research on faculty attitudes in Doctor of Physical Therapy (DPT) programs is limited. The purpose of this basic qualitative study was to explore how PT faculty perceive IPE as a pedagogical approach for preparing DPT students for the workforce. In this study, the constructs of Rogers’s diffusion of innovations theory were used to guide the exploration of faculty attitudes toward IPE. Purposeful sampling was used to collect qualitative data from interviews of 13 PTs who taught for a single university in DPT programs on four different campuses across the United States. Data were analyzed using emergent coding and thematic analysis. The key findings were that DPT faculty identified IPE as a valuable pedagogical approach for preparing DPT students for the workforce, but it was challenging to develop, implement, and assess. PT faculty perceived the adoption and sustainability of IPE as dependent on incorporating key facilitators. This study may impact positive social change by informing policymakers, administrators, and DPT program curriculum developers on supporting faculty and curricula development in IPE. Advancement of IPE in these institutions may help students learn skills such as communication and teamwork during their graduate education so they enter the workforce ready to work collaboratively and facilitate positive changes to the current health care systems

The Rationale and Design of the Taper Wheel for Use in Tapering Opiod and Benzodiazepine Medications in Post-Operative Patients at Home

The management of post-operative pain in children is an art and a science that has yet to be perfected. While research findings differ widely on medications, methods, and timing of interventions to manage post-operative pain, one finding is consistently reported: the treatment of pediatric post-operative pain is suboptimal (Corizzo, Baker, & Henkelmann, 2000; Dowden, McCarthy, & Chalkiadis, 2008; Kavanagh, Watt-Watson, & Stevens, 2007; Vadivelu, Mitra, & Narayan, 2010; Zhang, Hsu, Zou, Li, Wang, & Huang, 2008). Reasons for this deficiency originate in biases of clinicians and parents, difficulties in assessing pain due to variances in physical and developmental levels of children, and lack of research in best practices for pediatric pain management. Because hospital stays are reduced, parents or caregivers must often manage this pain at home. Therefore, educating these primary caregivers in the safe, effective use of pain medications, the reduction of side effects, and the appropriate tapering of the medications is paramount. It is also complex and multifaceted. Preferred methods of patient education are under much scrutiny and the needs of this group of learners are extensive. It is not enough to teach on just the cognitive level. Psychosocial, cultural, and environmental factors impact both the learning and the perceived need for managing children’s post-operative pain management at home. Therefore, when educating caregivers on this important task, a learning device that addresses these barriers and provides a simple guide for medication management appears to be a promising solution. This paper presents such a learning device, designed for the purpose of assisting parents in the timing, the dosing, and, ultimately, the elimination of opioid and antispasmodic medications for their children at home. This tool is called the Taper Wheel