Healthcare Engineering Defined: A White Paper

Engineering has been playing an important role in serving and advancing healthcare. The term "Healthcare Engineering" has been used by professional societies, universities, scientific authors, and the healthcare industry for decades. However, the definition of "Healthcare Engineering" remains ambiguous. The purpose of this position paper is to present a definition of Healthcare Engineering as an academic discipline, an area of research, a field of specialty, and a profession. Healthcare Engineering is defined in terms of what it is, who performs it, where it is performed, and how it is performed, including its purpose, scope, topics, synergy, education/training, contributions, and prospects

Dynamic Optimization Addressing Chemotherapy Outpatient Scheduling

Chemotherapy outpatient scheduling is a complex problem containing uncertainty. Chemotherapy centres are facing increasing demands and they need to increase their efficiency. However, there are very few studies looking at using optimization methods on the chemotherapy scheduling problem.In this dissertation, the chemotherapy outpatient scheduling problem is defined within the scheduling literature. Next, we propose a methodology for choosing what information to include from the problem domain when creating a mathematical model of a real world problem. Several constraint programming models, representing different problem definitions of the deterministic chemotherapy scheduling problem, are created and evaluated for their solvability and the quality of their solutions. The chosen optimization model was tested within a dynamic framework in order to accommodate the dynamism and uncertainty inherent in chemotherapy outpatient scheduling. Termed dynamic template scheduling, this novel algorithm uses the chemotherapy centre's past records and the chosen model to create a template of open slots. As requests for appointments arrive, we use the template to schedule them. When a request arrives that does not fit the template, we update the template. To accommodate last minute additions and cancellations to the schedule, we test a shifting algorithm that moves patient start times within a predefined time limit. We demonstrate that chemotherapy centres can use records of past appointments to inform future schedules and that integrating optimization methods into the scheduling procedures can improve efficiency and increase throughput. This research makes a contribution to scheduling research by developing a novel technique that combines proactive and reactive scheduling to address dynamic problems with real-time uncertainty. This research also makes a contribution to health care scheduling applications by solving a case of chemotherapy outpatient scheduling, a practically important problem that has had very little treatment in the literature.Ph.D

"We are doing it together"; The integral role of caregivers in a patients' transition home from the medicine unit.

BACKGROUND:An admission to hospital for acute illness can be difficult for patients and lead to high levels of anxiety. Patients are given a lot of information throughout their hospital stay and instructions at discharge to follow when they get home. For complex medical patients, the ability to retain, understand, and adhere to these instructions is a critical marker of a successful transition. This study was undertaken to explore factors impacting the ability of patients to understand and adhere to instructions. METHODS:A qualitative design of interviews with patients and caregivers was used. Participants were adult patients and caregivers with congestive heart failure, chronic obstructive pulmonary disease, or community-acquired pneumonia being discharged home from three academic acute care hospitals in Ontario, Canada. Semi structured interviews were conducted with participants within one week following their discharge from hospital. Interviews were audiotaped and transcribed. Five independent researchers participated in an iterative process of coding, reviewing, and analyzing the interviews using direct content analysis. RESULTS:In total, 27 participants completed qualitative interviews. Analysis revealed the role of the caregiver to be critical in its relation to the ability of patients to understand and adhere to discharge instructions. Within the topic of caregiving, we draw on three areas of insight: The first clarified how caregivers support patients after they are discharged home from the hospital. The second highlighted how caregiver involvement impacts patient understanding and adherence to discharge instructions. The third revealed system factors that influence a caregiver's involvement when receiving discharge instructions. CONCLUSION:Caregivers play an important role in the transition of a complex medical patient by impacting a patient's ability to understand and adhere to their discharge instructions. The themes identified in this paper highlight opportunities for healthcare providers and institutions to effectively involve caregivers during transitions from acute care hospitals to home

Planning Capacity for Mental Health and Addiction Services in the Emergency Department: A Discrete-Event Simulation Approach

Ontario has shown an increasing number of emergency department (ED) visits, particularly for mental health and addiction (MHA) complaints. Given the current opioid crises Canada is facing and the legalization of recreational cannabis in October 2018, the number of MHA visits to the ED is expected to grow even further. In face of these events, we examine capacity planning alternatives for the ED of an academic hospital in Toronto. We first quantify the volume of ED visits the hospital has received in recent years (from 2012 to 2016) and use forecasting techniques to predict future ED demand for the hospital. We then employ a discrete-event simulation model to analyze the impacts of the following scenarios: (a) increasing overall demand to the ED, (b) increasing or decreasing number of ED visits due to substance abuse, and (c) adjusting resource capacity to address the forecasted demand. Key performance indicators used in this analysis are the overall ED length of stay (LOS) and the total number of patients treated in the Psychiatric Emergency Services Unit (PESU) as a percentage of the total number of MHA visits. Our results showed that if resource capacity is not adjusted, ED LOS will deteriorate considerably given the expected growth in demand; programs that aim to reduce the number of alcohol and/or opioid visits can greatly aid in reducing ED wait times; the legalization of recreational use of cannabis will have minimal impact, and increasing the number of PESU beds can provide great aid in reducing ED pressure.Peer Reviewe

Baseline characteristics of the interview population (n = 27).

<p>Baseline characteristics of the interview population (n = 27).</p

Caregiving roles and descriptions.

<p>Caregiving roles and descriptions.</p

Patient and caregiver interview topics and questions.

<p>Patient and caregiver interview topics and questions.</p

Themes related to caregiver involvement at and after the transition from hospital to home.

<p>Themes related to caregiver involvement at and after the transition from hospital to home.</p

A scoping review of medication self-management intervention tools to support persons with traumatic spinal cord injury.

BackgroundPersons with traumatic spinal cord injury (SCI) use multiple medications (polypharmacy) to manage the high number of secondary complications and concurrent conditions. Despite the prevalence of polypharmacy and challenges associated with managing medications, there are few tools to support medication self-management for persons with SCI.ObjectiveThe purpose of this scoping review was to identify and summarize what is reported in the literature on medication self-management interventions for adults with traumatic SCI.MethodsElectronic databases and grey literature were searched for articles that included an adult population with a traumatic SCI and an intervention targeting medication management. The intervention was required to incorporate a component of self-management. Articles were double screened and data were extracted and synthesized using descriptive approaches.ResultsThree studies were included in this review, all of which were quantitative. A mobile app and two education-based interventions to address self-management of SCI, medication management, and pain management, respectively, were included. Only one of the interventions was co-developed with patients, caregivers, and clinicians. There was minimal overlap in the outcomes measured across the studies, but learning outcomes (e.g., perceived knowledge and confidence), behavioural outcomes (e.g., management strategies, data entry), and clinical outcomes (e.g., number of medications, pain scores, functional outcomes) were evaluated. Results of the interventions varied, but some positive outcomes were noted.ConclusionsThere is an opportunity to better support medication self-management for persons with SCI by co-designing an intervention with end-users that comprehensively addresses self-management. This will aid in understanding why interventions work, for whom, in what setting, and under what circumstances

Medication self-management toolkits for adults with multiple sclerosis : A scoping review

Background: Multiple sclerosis (MS) is an autoimmune disease that is often treated with multiple medications. Managing multiple medications, also known as polypharmacy, can be challenging for persons with MS. Toolkits are instructional resources designed to promote behaviour change. Toolkits may support medication self-management for adults with MS, as they have been useful in other populations with chronic conditions. Objective: The main purpose of this review was to identify and summarize medication self-management toolkits for MS, as related to the design, delivery, components, and measures used to evaluate implementation and/or outcomes. Methods: A scoping review was conducted following guidelines by JBI. Articles were included if they focused on adults (18 years or older) with MS. Results: Six articles reporting on four unique toolkits were included. Most toolkits were technology-based, including mobile or online applications, with only one toolkit being paper-based. The toolkits varied in type, frequency, and duration of medication management support. Varying outcomes were also identified, but there were improvements reported in symptom management, medication adherence, decision-making, and quality of life. The six studies were quantitative in design, with no studies exploring the user experience from a qualitative or mixed-methods design. Conclusions: There is limited research on medication self-management toolkits among adults with MS. Future development, implementation, and evaluation mixed-methods research are needed to explore user experiences and overall design of toolkits