Abdominal surgery process modeling frameworkfor simulation using spreadsheets

We provide a continuation of the existing Activity Table Modeling methodology with a modu-lar spreadsheets simulation. The simulation model developed is comprised of 28 modelingelements for the abdominal surgery cycle process. The simulation of a two-week patientflow in an abdominal clinic with 75 beds demonstrates the applicability of the methodol-ogy. The simulation does not include macros, thus programming experience is not essentialfor replication or upgrading the model. Unlike the existing methods, the proposed solu-tion employs a modular approach for modeling the activities that ensures better readability,the possibility of easily upgrading the model with other activities, and its easy extensionand connectives with other similar models. We propose a first-in-first-served approach forsimulation of servicing multiple patients. The uncertain time duration of the activities ismodeled using the function “rand()”. The patients movements from one activity to the nextone is tracked with nested “if()” functions, thus allowing easy re-creation of the processwithout the need of complex programming

Healthcare process analysis and improvement at Department of abdominal surgery-University Medical Centre Ljubljana

Background: Healthcare processes in hospitals, likewise processes in companies or governmental organizations, may accumulate problems and obstacles over time, which consequently cause the processes to become ineffective. BPM (Business Process Management) is an approach to process modeling, improvement and automating, which has been used with great success for process improvement. Methods: This work was to examine the possibility of improving healthcare process by using BPM. To implement BPM ideas, a revised TAD (Tabular Application Development) methodology was developed, representing an important contribution to BPM. The first three phases of the TAD methodology were introduced in a step-bystep approach. The first phase deals with process identification, the second develops the “as-is” model, and the third phase discusses process improvement by developing a “to-be” model. Results: We found that (a) the Surgery process is efficient and well organized; (b) patient stay in the Department could be shortened; however for humane and social reasons the leadership prefers to leave the residence time as it is; (c) the process is associated with some time-consuming activities that are performed by other departments and represent the bottleneck of the process. Conclusions: The following were concluded (a) BPM proved to be a suitable approach for carrying out healthcare process improvement; (b) the revised TAD methodology showed to be consistent and efficient in performing BPM approach; (c) The Surgery process discussed was found to be an effective one and no changes or improvements are needed; (d) Concerning time-consuming activities, the leadership decided to discuss this problem with the management of the departments where the activities are executed

Guidelines for the management of patients with squamous cell carcinoma of the anal canal and perianal skin (anal margin)

Cancer of the anal canal and anal margin is a rare disease. In Slovenia, on average 20 patients are diagnosed with this disease each year, more women than men. However, the incidence has increased in the last year, mainly in young, homosexual men, most probably due to infections with the sexually-transmitted human papillomavirus (HPV) and human immunodeficiency virus (HIV), which are known causal agents of this disease. Cancer of the anal canal and anal margin is primarily a locoregional disease, as distant metastases are found in less than 10% of the patients. Radical radiochemotherapy plays the central role in the treatment of anal canal and anal margin carcinomas with no distant metastases, except in well-differentiated anal margin carcinomas smaller than 2 cm, where local excision is advised. Radical radiochemotherapy provides a complete response in as many as 80-90%, which is reflected also in an excellent treatment outcome with 5-year survival of 80%. Patients clinically staged as cT1-2 stand a 6.5% chance of developing inguinal lymph node metastases, while the likelihood in patients staged as cT3-4 is 16%. Surgery, namely abdominoperineal excision, has a role in the treatment of residual disease after radical radiochemotherapy. In the future, HPV vaccines hold great promise for the prevention of this virus-induced disease