Gambaran Beberapa Faktor Terkait Pemanfaatan Bed Occupancy Rate (Bor) di Rumah Sakit Umum Daerah Dr. R. Koesma Kabupaten Tuban

BOR indicators is an important indicator to determine the level of hospital services that are used by hospital management. The purpose of this study is to describe the factors related to the utilization of bed occupancy rate (BOR) in RPH of sr. R. Koesma Tuban. This research is explanatory research with quantitative-qualitative method. The population of this research are all heads of the wards in dr. R. Koesma Tuban. The sample of this research is total population of 12 persons chief of inpatient room, 1 person chief of nursing hospitalization, and 1 deputy director of field services. The results of the univariate study shows the percentage of knowledge (78.6%), the percentage of completeness data collection (70.93%), the percentage of utilization of the data (37.5%). Planning for energy needs, infrastructure, mapping hospitalization, and finance are obtained from Regional Revenue and Expenditure Budget, State Revenue and Expenditure Budget, fund hospital. Human resources are still lacking for some of the wards and no reward in the utilization BOR. Suggestion from the researcher to chief the nursing hospitalization are to provide education and training related to the daily inpatient room census filling, prepare standard operating procedures on the utilization of BOR for chief of the ward, and give rewards to the ward

A Retrospective Study of Operating Room Utilization and Efficiency in a Pediatric Dental Residency Program

Purpose: The purpose was to assess and understand operating room (OR) utilization and efficiency in a pediatric dental residency program. Methods: A retrospective study was performed using chart extraction from 778 patients completed by both pediatric dentistry faculty (n=7) and residents (n=17) in an ambulatory care setting over a 32 month period (between July 2010 and March 2013). Patterns in OR usage time were determined by documenting various timing metrics (start and stop times for anesthesia, start and stop times for the dental procedure, times for throat pack in and out), noting patient information (age and ASA patient classification status), and creating variables by grouping data by clinical provider type and dental procedure. OR usage time was analyzed using multiple regression to estimate the per-tooth or per-mouth time for each type of procedure. Results: The median procedure time was 75 minutes (range= 1 to 517 minutes). Multiple regression indicated that for the average patient, a faculty member took 63.8 minutes (95% CI = 60.8 to 66.7 minutes) and a resident took 81.9 minutes (95% CI = 78.7 to 85.0 minutes, P\u3c.0001).These results demonstrate that the appropriate scheduling of operating room should be based on the proficiency level of provider as well as the complexity of the dental procedure. Conclusion: This study concludes that pediatric dental operating room planning and scheduling in teaching hospitals should take into account real constraints such as residents’ level of training and skill

Levelled bed occupancy and controlled waiting lists using Master surgical schedules

Scheduling surgical patients is one of the complex organizational tasks hospitals face daily. Master surgical scheduling is one way to optimize utilization of scarce resources and to create a more predictable outflow from the operating room towards subsequent hospital departments. The paper addresses two aims. First, we investigate the effect of the length of the planning horizon and other planning parameters in a master surgical scheduling approach on patients ́ waiting time, schedule stability and hospital efficiency. Second, the master surgical scheduling approach is compared with a standard operating room planning approach on levelled bed occupancy. The assignment of patients to a master surgical schedule is carefully described. Using real case data from a regional hospital i

What is the best practice in domestic inquiry?

Before we go through what is the best practice of domestic inquiry in Malaysia, we have to get ourselves more familiar with the meaning of best practice and domestic inquiry. A best practice is a type of method or strategy universally accepted as preferable to any alternative since it produces results superior for those attained through other means or because it is becoming a typical way of acting. Such as a standard way of implementing and practice domestic inquiry in the work environment. Best practices are an easy solution to obligatory federal norms to retain quality and based on personal-assessment or performance analysis. Some counselling firms spend significant time in the region of best practice and offer pre-made formats to institutionalize business process documentation. Now and again, a best practice is not pertinent or is improper for a specific association’s needs. This assignment will define what particle was required to enhance and maintain the best practice of domestic inquiry to protect the rights at work

Integral resource capacity planning for inpatient care services based on hourly bed census predictions

The design and operations of inpatient care facilities are typically largely historically shaped. A better match with the changing environment is often possible, and even inevitable due to the pressure on hospital budgets. Effectively organizing inpatient care requires simultaneous consideration of several interrelated planning issues. Also, coordination with upstream departments like the operating theater and the emergency department is much-needed. We present a generic analytical approach to predict bed census on nursing wards by hour, as a function of the Master Surgical Schedule (MSS) and arrival patterns of emergency patients. Along these predictions, insight is gained on the impact of strategic (i.e., case mix, care unit size, care unit partitioning), tactical (i.e., allocation of operating room time, misplacement rules), and operational decisions (i.e., time of admission/discharge). The method is used in the Academic Medical Center Amsterdam as a decision support tool in a complete redesign of the inpatient care operations

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 passive operating mode of the linear optical gesture sensor

The study evaluates the influence of natural light conditions on the effectiveness of the linear optical gesture sensor, working in the presence of ambient light only (passive mode). The orientations of the device in reference to the light source were modified in order to verify the sensitivity of the sensor. A criterion for the differentiation between two states: "possible gesture" and "no gesture" was proposed. Additionally, different light conditions and possible features were investigated, relevant for the decision of switching between the passive and active modes of the device. The criterion was evaluated based on the specificity and sensitivity analysis of the binary ambient light condition classifier. The elaborated classifier predicts ambient light conditions with the accuracy of 85.15%. Understanding the light conditions, the hand pose can be detected. The achieved accuracy of the hand poses classifier trained on the data obtained in the passive mode in favorable light conditions was 98.76%. It was also shown that the passive operating mode of the linear gesture sensor reduces the total energy consumption by 93.34%, resulting in 0.132 mA. It was concluded that optical linear sensor could be efficiently used in various lighting conditions.Comment: 10 pages, 14 figure

Improving Patient Satisfaction with the Virtual Handoff Process through the Utilization of Educational Pamphlets in the Emergency Department

Boarding patients in the emergency room while waiting to transfer the patient to the proper unit can be harmful to clinical care and have significant financial opportunity costs. At one local hospital it was found that on average patients were being boarded in the emergency room (ED) for approximately 85 minutes waiting to be transferred. Several barriers that caused this delay were found including, delay in room cleaning, nurse staff shortage, and inability to give report to the nurse receiving the patient. In an attempt to combat this delay which may be caused by a difficulty in giving patient report, this organization is rolling out a virtual bedside handoff process. While virtual technology is not a new concept, there are many patients that may not be comfortable with the technology. The purpose of the evidence-based project was to provide a written educational pamphlet that details the how’s and why’s of the virtual handoff process to the patient to be given upon admission. The goal of the educational pamphlet was to increase the patients’ satisfaction with the process. A pre-survey was given to a group of patients after they experienced the virtual handoff process to assess their comfort level. These results were compared to the post-survey results of patients that received the educational pamphlet prior to experiencing the virtual handoff process. Ten pre-surveys and seven post-surveys were analyzed utilizing SPSS and descriptive statistics. The analysis concluded that the participants who received the educational pamphlet felt more prepared for the virtual handoff process

Improved costs and outcomes with conscious sedation vs general anesthesia in TAVR patients: Time to wake up?

BackgroundTranscatheter aortic valve replacement (TAVR) has become a commonplace procedure for the treatment of aortic stenosis in higher risk surgical patients. With the high cost and steadily increasing number of patients receiving TAVR, emphasis has been placed on optimizing outcomes as well as resource utilization. Recently, studies have demonstrated the feasibility of conscious sedation in lieu of general anesthesia for TAVR. This study aimed to investigate the clinical as well as cost outcomes associated with conscious sedation in comparison to general anesthesia in TAVR.MethodsRecords for all adult patients undergoing TAVR at our institution between August 2012 and June 2016 were included using our institutional Society of Thoracic Surgeons (STS) and American College of Cardiology (ACC) registries. Cost data was gathered using the BIOME database. Patients were stratified into two groups according to whether they received general anesthesia (GA) or conscious sedation (CS) during the procedure. No-replacement propensity score matching was done using the validated STS predicted risk of mortality (PROM) as a propensity score. Primary outcome measure with survival to discharge and several secondary outcome measures were also included in analysis. According to our institution's data reporting guidelines, all cost data is presented as a percentage of the general anesthesia control group cost.ResultsOf the 231 patients initially identified, 225 (157 GA, 68 CS) were included for analysis. After no-replacement propensity score matching, 196 patients (147 GA, 49 CS) remained. Overall mortality was 1.5% in the matched population with a trend towards lower mortality in the CS group. Conscious sedation was associated with significantly fewer ICU hours (30 vs 96 hours, p = <0.001) and total hospital days (4.9 vs 10.4, p<0.001). Additionally, there was a 28% decrease in direct cost (p<0.001) as well as significant decreases in all individual all cost categories associated with the use of conscious sedation. There was no difference in composite major adverse events between groups. These trends remained on all subsequent subgroup analyses.ConclusionConscious sedation is emerging as a safe and viable option for anesthesia in patients undergoing transcatheter aortic valve replacement. The use of conscious sedation was not only associated with similar rates of adverse events, but also shortened ICU and overall hospital stays. Finally, there were significant decreases in all cost categories when compared to a propensity matched cohort receiving general anesthesia