An Exploratory Study of Patient Falls

Debate continues between the contribution of education level and clinical expertise in the nursing practice environment. Research suggests a link between Baccalaureate of Science in Nursing (BSN) nurses and positive patient outcomes such as lower mortality, decreased falls, and fewer medication errors. Purpose: To examine if there a negative correlation between patient falls and the level of nurse education at an urban hospital located in Midwest Illinois during the years 2010-2014? Methods: A retrospective crosssectional cohort analysis was conducted using data from the National Database of Nursing Quality Indicators (NDNQI) from the years 2010-2014. Sample: Inpatients aged ≥ 18 years who experienced a unintentional sudden descent, with or without injury that resulted in the patient striking the floor or object and occurred on inpatient nursing units. Results: The regression model was constructed with annual patient falls as the dependent variable and formal education and a log transformed variable for percentage of certified nurses as the independent variables. The model overall is a good fit, F (2,22) = 9.014, p = .001, adj. R2 = .40. Conclusion: Annual patient falls will decrease by increasing the number of nurses with baccalaureate degrees and/or certifications from a professional nursing board-governing body

Strategies for dynamic appointment making by container terminals

We consider a container terminal that has to make appointments with barges dynamically, in real-time, and partly automatic. The challenge for the terminal is to make appointments with only limited knowledge about future arriving barges, and in the view of uncertainty and disturbances, such as uncertain arrival and handling times, as well as cancellations and no-shows. We illustrate this problem using an innovative implementation project which is currently running in the Port of Rotterdam. This project aims to align barge rotations and terminal quay schedules by means of a multi-agent system. In this\ud paper, we take the perspective of a single terminal that will participate in this planning system, and focus on the decision making capabilities of its intelligent agent. We focus on the question how the terminal operator can optimize, on an operational level, the utilization of its quay resources, while making reliable appointments with barges, i.e., with a guaranteed departure time. We explore two approaches: (i) an analytical approach based on the value of having certain intervals within the schedule and (ii) an approach based on sources of exibility that are naturally available to the terminal. We use simulation to get insight in the benefits of these approaches. We conclude that a major increase in utilization degree could be achieved only by deploying the sources of exibility, without harming the waiting time of barges too much

Operations Management

Global competition has caused fundamental changes in the competitive environment of the manufacturing and service industries. Firms should develop strategic objectives that, upon achievement, result in a competitive advantage in the market place. The forces of globalization on one hand and rapidly growing marketing opportunities overseas, especially in emerging economies on the other, have led to the expansion of operations on a global scale. The book aims to cover the main topics characterizing operations management including both strategic issues and practical applications. A global environmental business including both manufacturing and services is analyzed. The book contains original research and application chapters from different perspectives. It is enriched through the analyses of case studies

Planning and Scheduling Optimization

Although planning and scheduling optimization have been explored in the literature for many years now, it still remains a hot topic in the current scientific research. The changing market trends, globalization, technical and technological progress, and sustainability considerations make it necessary to deal with new optimization challenges in modern manufacturing, engineering, and healthcare systems. This book provides an overview of the recent advances in different areas connected with operations research models and other applications of intelligent computing techniques used for planning and scheduling optimization. The wide range of theoretical and practical research findings reported in this book confirms that the planning and scheduling problem is a complex issue that is present in different industrial sectors and organizations and opens promising and dynamic perspectives of research and development

Inventory routing for dynamic waste collection

We consider the problem of collecting waste from sensor equipped underground containers. These sensors enable the use of a dynamic collection policy. The problem, which is known as a reverse inventory routing problem, involves decisions regarding routing and container selection. In more dense networks, the latter becomes more important. To cope with uncertainty in deposit volumes and with fluctuations due to daily and seasonal e ects, we need an anticipatory policy that balances the workload over time. We propose a relatively simple heuristic consisting of several tunable parameters depending on the day of the week. We tune the parameters of this policy using optimal learning techniques combined with simulation. We illustrate our approach using a real life problem instance of a waste collection company, located in The Netherlands, and perform experiments on several other instances. For our case study, we show that costs savings up to 40% are possible by optimizing the parameters

Improving healthcare supply chains and decision making in the management of pharmaceuticals

The rising cost of quality healthcare is becoming an increasing concern. A significant part of healthcare cost is the pharmaceutical supply component. Improving healthcare supply chains is critical not only because of the financial magnitude but also because it impacts so many people. Efforts such as this project are essential in understanding the current operations of healthcare pharmacy systems and in offering decision support tools to managers struggling to make the best use of organizational resources. The purpose of this study is to address the objectives of a local hospital that exhibits typical problems in pharmacy supply chain management. We analyze the pharmacy supply network structure and the different, often conflicting goals in the decisions of the various stakeholders. We develop quantitative models useful in optimizing supply chain management and inventory management practices. We provide decision support tools that improve operational, tactical, and strategic decision making in the pharmacy supply chain and inventory management of pharmaceuticals. On one hand, advanced computerized technology that manages pharmaceutical dispensation and automates the ordering process offers considerable progress to support pharmacy product distribution. On the other hand, the available information is not utilized to help the managers in making the appropriate decisions and control the supply chain management. Quantitative methods are presented that provide simplified, practical solutions to pharmacy objectives and serve as decision support tools. For operational inventory decisions we provide the min and max par levels (reorder point and order up to level) that control the automated ordering system for pharmaceuticals. These parameters are based on two near-optimal allocation policies of cycle stock and safety stock under storage space constraint. For the tactical decision we demonstrate the influence of varying inventory holding cost rates on setting the optimal reorder point and order quantity for items. We present a strategic decision support tool to analyze the tradeoffs among the refill workload, the emergency workload, and the variety of drugs offered. We reveal the relationship of these tradeoffs to the three key performance indicators at a local care unit: the expected number of daily refills, the service level, and the storage space utilization

Analyst-driven development of an open-source simulation tool to address poor uptake of O.R. in healthcare

Computer simulation studies of health and care problems have been reported extensively in the academic literature, but the one-off research projects typically undertaken have failed to create an enduring legacy of widespread use by healthcare practitioners. Simulation and other modelling tools designed and developed to be used routinely have not fared much better either. Following a review of the literature and a survey of frontline analysts in the UK NHS, we found that one reason for this is because simulation tools have, to date, not been developed with the requirements of the end-user in the heart of the development process. Starting with a thorough needs assessment of NHS based healthcare analysts, this study outlines a set of practical design principles to guide development of simulation software tool for conducting patient flow simulation studies. The overall requirement is that patient flow be modelled over a number of inter-connected points of delivery while capturing the stochastic nature of patient arrivals and hospital length of stay, as well as the dynamic delays to patient discharge and transfer of care between different points of care delivery. In ensuring a cost-free solution that is both versatile and user-friendly, and coded in an increasingly popular language among the envisaged end users, the tool was implemented is the R programming language and software environment, with the user interface implemented in the interactive R-Shiny application. The talk will provide an overview of the project lifecycle including an illustrative example of an empirical simulation study concerning the centralisation of an acute stroke pathway

Platelet inventory management in blood supply chain under demand and supply uncertainty

Supply chain management of blood and its products are of paramount importance in medical treatment due to its perishable nature, uncertain demand, and lack of auxiliary substitutes. For example, the Red Blood Cells (RBC's) have a life span of approximately 40 days, whereas platelets have a shelf life of up to five days after extraction from the human body. According to the World Health Organization, approximately 112 million blood units are collected worldwide annually. However, nearly 20 percent of units are discarded in developed nations due to being expired before the final use. A similar trend is noticed in developing countries as well. On the other hand, blood shortage could lead to elective surgeries cancellations. Therefore, managing blood distribution and developing an efficient blood inventory management is considered a critical issue in the supply chain domain. A standard blood supply chain (BSC) achieves the movement of blood products (red blood cells, white blood cells, and platelets) from initial collection to final patients in several echelons. The first step comprises of donation of blood by donors at the donation or mobile centers. The donation sites transport the blood units to blood centers where several tests for infections are carried out. The blood centers then store either the whole blood units or segregate them into their individual products. Finally, they are distributed to the healthcare facilities when required. In this dissertation, an efficient forecasting model is developed to forecast the supply of blood. We leverage five years' worth of historical blood supply data from the Taiwan Blood Services Foundation (TBSF) to conduct our forecasting study. With the generated supply and demand distributioins from historial supply and demand data as inputs, a single objective stochastic model is developed to determine the number of platelet units to order and the time between orders at the hospitals. To reduce platelet shortage and outdating, a collaborative network between the blood centers and hospitals is proposed; the model is extended to determine the optimal ordering policy for a divergent network consisting of multiple blood centers and hospitals. It has been shown that a collaborative system of blood centers and hospitals is better than a decentralized system in which each hospital is supplied with blood only by its corresponding blood center. Furthermore, a mathematical model is proposed based on multi-criteria decision-making (MCDM) techniques, in which different conflicting objective functions are satisfied to generate an efficient and satisfactory solution for a blood supply chain comprising of two hospitals and one blood center. This study also conducted a sensitivity analysis to examine the impacts of the coefficient of demand and supply variation and the settings of cost parameters on the average total cost and the performance measures (units of shortage, outdated units, inventory holding units, and purchased units) for both the blood center and hospitals. The proposed models can also be applied to determine ordering policies for other supply chain of perishable products, such as perishable food or drug supply chains.Includes bibliographical references