Applying multi-phase DES approach for modelling the patient journey through accident and emergency departments

Accident and Emergency departments (A&ED) are in charge of providing access to patients requiring urgent acute care. A&ED are difficult to model due to the presence of interactions, different pathways and the multiple outcomes that patients may undertake depending on their health status. In addition, public concern has focused on the presence of overcrowding, long waiting times, patient dissatisfaction and cost overruns associated with A&ED. There is then a need for tackling these problems through developing integrated and explicit models supporting healthcare planning. However, the studies directly concentrating on modelling the A&EDs are largely limited. Therefore, this paper presents the use of a multi-phase DES framework for modelling the A&ED and facilitating the assessment of potential improvement strategies. Initially, the main components, critical variables and different states of the A&ED are identified to correctly model the entire patient journey. In this step, it is also necessary to characterize the demand in order to categorize the patients into pipelines. After this, a discrete-event simulation (DES) model is developed. Then, validation is conducted through the 2-sample t test to demonstrate whether the model is statistically comparable with the real-world A&ED department. This is followed by the use of Markov phase-type models for calculating the total costs of the whole system. Finally, various scenarios are explored to assess their potential impact on multiple outcomes of interest. A case study of a mixed-patient environment in a private A&E department is provided to validate the effectiveness of the multi-phase DES approach

Annotated BPMN models for optimised healthcare resource planning

There is an unquestionable need to improve healthcare processes across all levels of care in order to optimise the use of resources whilst guaranteeing high quality care to patients. However, healthcare processes are generally very complex and have to be fully understood before enhancement suggestions can be made. Modelling with widely used notation such as BPMN (Business Process Modelling and Notation) can help gain a shared understanding of a process, but is not sufficient to understand the needs and demands of resources. We propose an approach to enrich BPMN models with structured annotations which enables us to attach further information to individual elements within the process model. We then use performance analysis (e.g., throughput and utilisation) to reason about resources across a model and propose optimisations. We show the usefulness of our approach for an A&E department of a sizeable hospital in the south of Brazil and how different stakeholders may profit from a richer annotated BPMN-based model.Postprin

Hand Anthropometry in Bangladeshis Living in America and Comparisons With Other Populations

An anthropometric study of a convenience sample of 51 female and 50 male adults of Bangladeshi origin (mean age 41.3 years), living in the United States, but who spent most of their lives in Bangladesh, was conducted. Standard measurements were taken on 24 dimensions of the right hand that were relevant to the design of hand tools, gloves and access spaces using a standard sliding calliper. Analysis of the results showed significant differences in palm and finger segment lengths, breadths and depths between genders in Bangladeshis and also within each gender between Bangladeshis and other populations. The differences between Bangladeshis and other populations were of about the same magnitude as the differences between genders in Bangladeshis. The data gathered may be used for the design of hand tools, gloves, machine access spaces and hand-held devices and for selection of hand tools for use by Bangladeshis. The study also allows inter-population comparisons that can enhance the understanding of hand anthropometry