Optimización en la utilización de los recursos dentro de la unidad de pabellones quirúrgicos del hospital del Salvador

Tesis (Ingeniero Civil Industrial)El Hospital del Salvador (HDS) fue fundado el 7 de diciembre de 1871 con el fin enfrentar la alta tasa de mortalidad infantil y las epidemias de viruela y cólera que afectaban periódicamente al país, el dinero empleado en su construcción provino principalmente de las familias más adineradas de Santiago. Desde el año 1990 el HDS ha recibido constantes aportes que le han permitido mejorar su servicio gracias a la incorporación de nuevos equipamientos tecnológicos, que le ha permitido cumplir con importantes metas de producción por servicio clínico, junto a importantes innovaciones en la gestión del hospital, le ha permitido aumentar los recursos propios, optimizando el gasto en bienes y servicios de consumo. Hay mucha frecuencia de pacientes operados, por distintas patologías o enfermedades. El 58,7% son actividades de tipo quirúrgicas. Estas actividades se realizan en el Pabellón Quirúrgico, que es un recinto especialmente diseñado y equipado para garantizar la seguridad en la atención del paciente que va a ser sometido a una actividad anestésica o quirúrgica. En un pabellón se atiende diferentes tipos de intervenciones, una de las intervenciones que se realizan, son a los pacientes que llegan de forma espontánea y deben ser intervenidos quirúrgicamente de inmediato, el otro tipo de intervención es la cirugía electiva, en el cual los pacientes luego del diagnóstico pueden irse a su casa y esperar el tiempo que sea necesario, esta última genera un 40% o más de los ingresos de un hospital. El área de Pabellón quirúrgico, es una de las unidades más importantes de la organización del hospital, los cuales están considerados entre los recursos más costosos dentro de las instalaciones de salud. Por lo tanto, las intervenciones quirúrgicas juegan un papel relevante en las utilidades que percibe la institución. Esta unidad posee distintos pabellones quirúrgicos en los cuales cada uno es especializado o adaptado para determinadas cirugías correspondientes a cada pabellón, lo que permite dar solución a todos los problemas de salud de manera oportuna, eficiente y cercana al paciente

Using Prediction to Improve Elective Surgery Scheduling

BackgroundTimely diagnosis and reporting of patient symptoms in hospital emergency departments (ED) is a critical component of health services delivery. However, due to dispersed information resources and a vast amount of manual processing of unstructured information, accurate point-of-care diagnosis is often difficult. AimsThe aim of this research is to report initial experimental evaluation of a clinician-informed automated method for the issue of initial misdiagnoses associated with delayed receipt of unstructured radiology reports. Method A method was developed that resembles clinical reasoning for identifying limb abnormalities. The method consists of a gazetteer of keywords related to radiological findings; the method classifies an X-ray report as abnormal if it contains evidence contained in the gazetteer. A set of 99 narrative reports of radiological findings was sourced from a tertiary hospital. Reports were manually assessed by two clinicians and discrepancies were validated by a third expert ED clinician; the final manual classification generated by the expert ED clinician was used as ground truth to empirically evaluate the approach.ResultsThe automated method that attempts to individuate limb abnormalities by searching for keywords expressed by clinicians achieved an F-measure of 0.80 and an accuracy of 0.80.ConclusionWhile the automated clinician-driven method achieved promising performances, a number of avenues for improvement were identified using advanced natural language processing (NLP) and machine learning techniques

Modeling and simulating hospital operations in a 3D environment

The use of dashboards to aid hospital decision makers in managerial and clinical decisions is well documented in the literature, though few broach the challenging subject of combining cost measurement with user satisfaction and building layout optimization. This paper presents an innovative dashboard in a 3D environment, providing decision makers with simulation capabilities using agent based simulation, allowing examination of their facility and the impact of policy, process and layout changes on patients and finances. An example is presented for an Emergency Department, wherein the presented dashboard revealed that the costs of constructing additional triage rooms would produce no benefit to patients; rather, a change in the process would be more beneficial compared with the existing situation. It is concluded that the developed dashboard allows users to make comparisons between multiple scenarios and visualize data in an intuitive format, allowing for decision makers to optimize their facility and operations

Maximising patient throughput using discrete-event simulation

As the National Health Service (NHS) of England continues to face tighter cost saving and utilisation government set targets, finding the optimum between costs, patient waiting times, utilisation of resources, and user satisfaction is increasingly challenging. Patient scheduling is a subject which has been extensively covered in the literature, with many previous studies offering solutions to optimise the patient schedule for a given metric. However, few analyse a large range of metrics pertinent to the NHS. The tool presented in this paper provides a discrete-event simulation tool for analysing a range of patient schedules across nine metrics, including: patient waiting, clinic room utilisation, waiting room utilisation, staff hub utilisation, clinician utilisation, patient facing time, clinic over-run, post-clinic waiting, and post-clinic patients still being examined. This allows clinic managers to analyse a number of scheduling solutions to find the optimum schedule for their department by comparing the metrics and selecting their preferred schedule. Also provided is an analysis of the impact of variations in appointment durations and their impact on how a simulation tool provides results. This analysis highlights the need for multiple simulation runs to reduce the impact of non-representative results from the final schedule analysis

Maximising patient throughput using discrete-event simulation

As the National Health Service (NHS) of England continues to face tighter cost saving and utilisation government set targets, finding the optimum between costs, patient waiting times, utilisation of resources, and user satisfaction is increasingly challenging. Patient scheduling is a subject which has been extensively covered in the literature, with many previous studies offering solutions to optimise the patient schedule for a given metric. However, few analyse a large range of metrics pertinent to the NHS. The tool presented in this paper provides a discrete-event simulation tool for analysing a range of patient schedules across nine metrics, including: patient waiting, clinic room utilisation, waiting room utilisation, staff hub utilisation, clinician utilisation, patient facing time, clinic over-run, post-clinic waiting, and post-clinic patients still being examined. This allows clinic managers to analyse a number of scheduling solutions to find the optimum schedule for their department by comparing the metrics and selecting their preferred schedule. Also provided is an analysis of the impact of variations in appointment durations and their impact on how a simulation tool provides results. This analysis highlights the need for multiple simulation runs to reduce the impact of non-representative results from the final schedule analysis

Operating room planning and scheduling: A literature review.

This paper provides a review of recent research on operating room planning and scheduling. We evaluate the literature on multiple fields that are related to either the problem setting (e.g. performance measures or patient classes) or the technical features (e.g. solution technique or uncertainty incorporation). Since papers are pooled and evaluated in various ways, a diversified and detailed overview is obtained that facilitates the identification of manuscripts related to the reader's specific interests. Throughout the literature review, we summarize the significant trends in research on operating room planning and scheduling and we identify areas that need to be addressed in the future.Health care; Operating room; Scheduling; Planning; Literature review;

A system thinking approach to staff sizing in health care institutions

El talento humano es la piedra angular en cualquier sistema de salud. Sin personal idóneo no es posible prestar un servicio de calidad a la población necesitada, por lo tanto, se hace indispensable contar con metodologías de trabajo que faciliten y fortalezcan la planeación y la gestión del personal de apoyo de los servicios de salud. Este artículo pretende presentar un modelo de planeación de recursos utilizando la simulación, bajo el paradigma de dinámica de sistemas como herramienta de trabajo, con el objeto de brindar apoyo a aquellas personas encargadas de la elaboración de políticas y planes en instituciones de salud para tomar mejores decisiones, en lo referente a la cantidad de talento humano que deben contratar, para satisfacer la oportunidad, calidad y servicio en la atención.Human talent is the cornerstone of any health system. Without suitable staff, a quality service cannot be provided to the needy. Therefore, methods that facilitate and improve the planning and management of the support staff in health services should be available. Using simulations, this article presents a resource planning model that adopts the paradigm of system dynamics as a tool. The objective is to support the decision making process of those in charge of developing policies and plans at health care institutions regarding the human talent to hire in order to provide a timely, quality service

Alimentación de un modelo de simulación mediante una conexión entre un sistema de información, R y SDLPS

Redacción del paper: alimentación de un modelo de simulación mediante una conexión entre un sistema de información, R y SDLPSEste trabajo desarrolla una metodología para alimentar de forma más automatizada un modelo de simulación. Para ello se generó un código de programación hecho con el lenguaje R que: 1) se conecta con base de datos; 2) valida los datos y 3) alimenta un modelo de simulación descrito en SDL e implementado en el software de simulación SDLPS, el cual lee la información generada en R. Este desarrollo se aplicó a un proceso de un hospital chileno. Los principales beneficios son: Es aplicable a distintas áreas y procesos; aumenta la oportunidad de la verificación y validación operacional del modelo; facilita el monitoreo del sistema en periodos más cortos y permite la experimentación más temprana de distintos escenarios para evaluar y planificar soluciones ante eventuales problemas.Preprin

The Impact of Block Scheduling and Release Time on Operating Room Efficiency

Planning for sufficient surgical capacity at a hospital requires that many tactical and operational decisions be made before the day of surgery. Typically, blocks of time in operating rooms (ORs) are assigned and specific surgical cases are placed in rooms. The hospital monitors utilization to determine the schedule\u27s effectiveness in balancing the risk of overtime with idle time. In this thesis, we will examine how adjusting schedule risk ratios and penalty values, and providing shared, open posting time affected the hospital\u27s ability to identify an efficient but high quality and low cost block schedule. The proposed schedules were tested by assigning surgical cases to ORs and simulating the schedule\u27s performance using recent data from a local hospital. We also show how scheduling accuracy can impact the performance level of the schedules proposed. Once the schedule has been set, the use of block release time is investigated in order to provide insight on how to better fill these ORs and increase utilization levels. Release policies are simulated based on various surgery arrival distributions, capacity levels, and case durations. We will show how different policies involving assigned and open posting rooms impact utilization levels, number of cases not fit into the schedule, and number of cases posted after the block release time

Optimising hospital designs and processes to improve efficiency and enhance the user experience

The health sector is facing increasing pressure to provide effective, efficient, and affordable care to the population it serves. The National Health Service (NHS) of the United Kingdom (UK) has regularly faced scrutiny with NHS England being issued a number of challenges in recent years to improve operational efficiency, reduce wasted space, and cut expenditure. The most recent challenge issued to NHS England has seen a requirement to save £5bn per annum by 2020, while reducing wasted space from 4.4% to 2.5% across the NHS estate. Similarly, satisfaction in the health service is also under scrutiny as staff retention and patient experiences are used in determining the performance of facilities. [Continues.