1,554 research outputs found

    A survey of health care models that encompass multiple departments

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    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

    Early Information Access to Alleviate Emergency Department Congestion

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    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 ā€œAuto Identification tagsā€ 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

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

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    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

    Effect of Creatinine Point-of-Care Testing on Turnaround Time for Computed Tomography Exams with Intravenous Contrast

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    Abstract Emergency departments often have a stigma of long wait times. They face multiple challenges related to the flow of patient care due to the variety of factors that affect care and treatment. In order to support patient-centered care, the purpose of this project was to determine if point-of-care testing of creatinine decreases turnaround time for computed tomography exams with intravenous contrast in the emergency department. A mixed methodology of consecutive sampling and retrospective data collection was used. In all, 128 ratio data elements were reviewed, including a retrospective review of 64 charts from September 2018 and a consecutive sample of 64 charts from September 2019 for ED patients aged 18 or older who had a CT with IV contrast exam ordered and completed. Results showed a decrease in turnaround time of 66 minutes. Further research and data collection are recommended to ensure sustainability and a hardwired process change and to determine other benefits of implementation of point-of-care testing in the emergency department. Keywords: point-of-care testing (POCT), intravenous (IV) contrast, turnaround tim

    Impact of Queueing Theory on Capacity Management in the Emergency Department

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    Hospital systems in the United States are facing a dilemma regarding capacity management in the emergency department (ED) and the inpatient care setting. The average wait time in EDs across the United States exceeds 98 minutes, which is also the point at which patients begin to abandon healthcare treatment. The purpose of this quantitative study was to examine the use of queueing theory in capacity management on length-of-stay (LOS) rates, left-without-being-seen (LWBS) rates, and boarding rates in the ED and inpatient setting. The boarding rates represent the rate in which patients were roomed in the ED but required inpatient care. This study assessed the relationships between capacity management using queueing theory and a reduction in the aforementioned rates compared to traditional processes across systems within the continental United States. A linear regression analysis with a confidence interval 95% paired with an independent sample t test was used to analyze the secondary datasets. A sample size of approximately 33,000 patients was tested in the areas of LOS, LWBS, and boarding. The results of the analysis determined that access was improved in the ED and inpatient setting when queueing theory was deployed within the hospital system compared to traditional processes for managing capacity within the system. Queuing theory used for capacity management resulted in lower LOS, LWBS, and boarding rates. The implications of this study for positive social change include the opportunity to provide greater access to care for the population as a whole, and better health outcomes for the promotion of population health

    Dynamic Queue Management for Hospital Emergency Room Services

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    Designing of elements for Digitized Referral Appointment System (DRAS) towards enhancing booking appointments in Tanzania

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    The issue of making an appointment with accessing referral services, you need to have individual relationships to the medical staffs like friendship or relatively. In Tanzania, many years ago, the tradition referral systems did not offer assurance to access specialty hospital services. Numbers of ICT projects have been adopted and put into application but referral area remains forgotten. The challenges to referral services include shortage of human resources, facilities and equipment. Tanzania has several regional hospitals with a few medical doctors who are not specialized in referral services. No way, patient has to travel from one hospital to another seeking for quality healthcare delivery by faith without assurance of being served. Thus, create long waiting time for patients, doctorsā€™ idle time, unnecessary cost to patients and disturbances. The major purpose of this paper is to design detailed elements of Digitized Referral Appointment System (DRAS) through application of ICT to solve referral challenges by allowing patients to book an appointment to access referral services before travelling. This solution will provide efficient use of few available health resources like medical specialty doctors, time and equipments. Keywords: Referral services, Patient appointment system/Technology (PAS/T), Information and Communication Technology (ICT), Digitized Referral Appointment System (DRAS) and E-healthcare.

    Empirical Studies in Hospital Emergency Departments

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    This dissertation focuses on the operational impacts of crowding in hospital emergency departments. The body of this work is comprised of three essays. In the first essay, Waiting Patiently: An Empirical Study of Queue Abandonment in an Emergency Department, we study queue abandonment, or left without being seen. We show that abandonment is not only influenced by wait time, but also by the queue length and the observable queue flows during the waiting exposure. We show that patients are sensitive to being jumped in the line and that patients respond differently to people more sick and less sick moving through the system. This study shows that managers have an opportunity to impact abandonment behavior by altering what information is available to waiting customers. In the second essay, Doctors Under Load: An Empirical Study of State-Dependent Service Times in Emergency Care, we show that when crowded, multiple mechanisms in the emergency department act to retard patient treatment, but care providers adjust their clinical behavior to accelerate the service. We identify two mechanisms that providers use to accelerate the system: early task initiation and task reduction. In contrast to other recent works, we find the net effect of these countervailing forces to be an increase in service time when the system is crowded. Further, we use simulation to show that ignoring state-dependent service times leads to modeling errors that could cause hospitals to overinvest in human and physical resources. In the final essay, The Financial Consequences of Lost Demand and Reducing Boarding in Hospital Emergency Departments, we use discrete event simulation to estimate the number of patients lost to Left Without Being Seen and ambulance diversion as a result of patients waiting in the emergency department for an inpatient bed (known as boarding). These lost patients represent both a failure of the emergency department to meet the needs of those seeking care and lost revenue for the hospital. We show that dynamic bed management policies that proactively cancel some non-emergency patients when the hospital is near capacity can lead to reduced boarding, increased number of patients served, and increased hospital revenue
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