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Baum KD, Vlaanderen L, James W, Huppert MJ, Kettler P, Chell C, Shadiow A, Strike H, Greenlee K, Brown D, Hick JL, Wolf JM, Fiecas MB, McLachlan E, Seaberg J, MacDonnell S, Kesler S, Dichter JR. The Minnesota Medical Operations Coordination Center: A COVID-19 Statewide Response to Ensure Access to Critical Care and Medical-Surgical Beds. Chest 2024; 165:95-109. [PMID: 37597611 DOI: 10.1016/j.chest.2023.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 08/03/2023] [Accepted: 08/05/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND COVID-19 led to unprecedented inpatient capacity challenges, particularly in ICUs, which spurred development of statewide or regional placement centers for coordinating transfer (load-balancing) of adult patients needing intensive care to hospitals with remaining capacity. RESEARCH QUESTION Do Medical Operations Coordination Centers (MOCC) augment patient placement during times of severe capacity challenges? STUDY DESIGN AND METHODS The Minnesota MOCC was established with a focus on transfer of adult ICU and medical-surgical patients; trauma, cardiac, stroke, burn, and extracorporeal membrane oxygenation cases were excluded. The center operated within one health care system's bed management center, using a dedicated 24/7 telephone number. Major health care systems statewide and two tertiary centers in a neighboring state participated, sharing information on system status, challenges, and strategies. Patient volumes and transfer data were tracked; client satisfaction was evaluated through an anonymous survey. RESULTS From August 1, 2020, through March 31, 2022, a total of 5,307 requests were made, 2,008 beds identified, 1,316 requests canceled, and 1,981 requests were unable to be fulfilled. A total of 1,715 patients had COVID-19 (32.3%), and 2,473 were negative or low risk for COVID-19 (46.6%). COVID-19 status was unknown in 1,119 (21.1%). Overall, 760 were patients on ventilators (49.1% COVID-19 positive). The Minnesota Critical Care Coordination Center placed most patients during the fall 2020 surge with the Minnesota Governor's stay-at-home order during the peak. However, during the fall 2021 surge, only 30% of ICU patients and 39% of medical-surgical patients were placed. Indicators characterizing severe surge include the number of Critical Care Coordination Center requests, decreasing placements, longer placement times, and time series analysis showing significant request-acceptance differences. INTERPRETATION Implementation of a large-scale Minnesota MOCC program was effective at placing patients during the first COVID-19 pandemic fall 2020 surge and was well regarded by hospitals and health systems. However, under worsening duress of limited resources during the fall 2021 surge, placement of ICU and medical-surgical patients was greatly decreased.
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Affiliation(s)
- Karyn D Baum
- Essentia Health, Duluth, MN; University of Minnesota, Minneapolis, MN
| | - Lauren Vlaanderen
- M Health Fairview, Minneapolis, MN; Scope Anesthesia of North Carolina PLLC, Charlotte, NC
| | | | | | | | - Christine Chell
- Metro Health & Medical Preparedness Coalition, Minneapolis, MN
| | | | | | | | | | - John L Hick
- University of Minnesota, Minneapolis, MN; Hennepin Healthcare, Minneapolis, MN
| | | | | | - Erin McLachlan
- Minnesota Department of Health, St. Paul, MN; Hennepin Healthcare, Minneapolis, MN
| | - Judy Seaberg
- Minnesota Department of Health, St. Paul, MN; Hennepin Healthcare, Minneapolis, MN
| | - Sean MacDonnell
- Minnesota Department of Health, St. Paul, MN; Hennepin Healthcare, Minneapolis, MN
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Jones RP. Addressing the Knowledge Deficit in Hospital Bed Planning and Defining an Optimum Region for the Number of Different Types of Hospital Beds in an Effective Health Care System. Int J Environ Res Public Health 2023; 20:7171. [PMID: 38131722 DOI: 10.3390/ijerph20247171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
Based upon 30-years of research by the author, a new approach to hospital bed planning and international benchmarking is proposed. The number of hospital beds per 1000 people is commonly used to compare international bed numbers. This method is flawed because it does not consider population age structure or the effect of nearness-to-death on hospital utilization. Deaths are also serving as a proxy for wider bed demand arising from undetected outbreaks of 3000 species of human pathogens. To remedy this problem, a new approach to bed modeling has been developed that plots beds per 1000 deaths against deaths per 1000 population. Lines of equivalence can be drawn on the plot to delineate countries with a higher or lower bed supply. This method is extended to attempt to define the optimum region for bed supply in an effective health care system. England is used as an example of a health system descending into operational chaos due to too few beds and manpower. The former Soviet bloc countries represent a health system overly dependent on hospital beds. Several countries also show evidence of overutilization of hospital beds. The new method is used to define a potential range for bed supply and manpower where the most effective health systems currently reside. The method is applied to total curative beds, medical beds, psychiatric beds, critical care, geriatric care, etc., and can also be used to compare different types of healthcare staff, i.e., nurses, physicians, and surgeons. Issues surrounding the optimum hospital size and the optimum average occupancy will also be discussed. The role of poor policy in the English NHS is used to show how the NHS has been led into a bed crisis. The method is also extended beyond international benchmarking to illustrate how it can be applied at a local or regional level in the process of long-term bed planning. Issues regarding the volatility in hospital admissions are also addressed to explain the need for surge capacity and why an adequate average bed occupancy margin is required for an optimally functioning hospital.
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Saddington E, Rahman F, Stuart J, Hocking J, Talarico C, Smit DV, Cameron PA, Mitra B. Initial experience of a Priority Primary Care Centre in metropolitan Melbourne. Emerg Med Australas 2023; 35:1044-1046. [PMID: 37783472 DOI: 10.1111/1742-6723.14326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/05/2023] [Accepted: 09/19/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVE To report the initial experience of a newly built Priority Primary Care Centre (PPCC) from the ED perspective. METHODS A single-centre prospective cohort study, assessing referrals to the PPCC from 1 February to 30 June 2023. RESULTS There were 1240 patients referred to the PPCC from the ED, of which 87 (7.0%) were referred back to the ED. The incidence rate of PPCC referrals was 4.2% (95% confidence interval 4.0-4.5). CONCLUSIONS The PPCC enabled re-direction of a small proportion of ED presentations. Early results suggest that such patients can be adequately selected and managed at PPCCs.
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Affiliation(s)
- Emma Saddington
- Emergency and Trauma Centre, Alfred Health Emergency Service, Melbourne, Victoria, Australia
| | - Fatima Rahman
- Emergency and Trauma Centre, Alfred Health Emergency Service, Melbourne, Victoria, Australia
| | - Josh Stuart
- Emergency and Trauma Centre, Alfred Health Emergency Service, Melbourne, Victoria, Australia
| | - Jessica Hocking
- Emergency and Trauma Centre, Alfred Health Emergency Service, Melbourne, Victoria, Australia
| | - Carly Talarico
- Emergency and Trauma Centre, Alfred Health Emergency Service, Melbourne, Victoria, Australia
| | - De Villiers Smit
- Emergency and Trauma Centre, Alfred Health Emergency Service, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter A Cameron
- Emergency and Trauma Centre, Alfred Health Emergency Service, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Biswadev Mitra
- Emergency and Trauma Centre, Alfred Health Emergency Service, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Mebrahtu TF, McInerney CD, Benn J, McCrorie C, Granger J, Lawton T, Sheikh N, Habli I, Randell R, Johnson O. The impact of hospital command centre on patient flow and data quality: findings from the UK National Health Service. Int J Qual Health Care 2023; 35:mzad072. [PMID: 37750687 PMCID: PMC10566538 DOI: 10.1093/intqhc/mzad072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 05/25/2023] [Accepted: 09/15/2023] [Indexed: 09/27/2023] Open
Abstract
In the last 6 years, hospitals in developed countries have been trialling the use of command centres for improving organizational efficiency and patient care. However, the impact of these command centres has not been systematically studied in the past. It is a retrospective population-based study. Participants were patients who visited the Bradford Royal Infirmary hospital, Accident and Emergency (A&E) Department, between 1 January 2018 and 31 August 2021. Outcomes were patient flow (measured as A&E waiting time, length of stay, and clinician seen time) and data quality (measured by the proportion of missing treatment and assessment dates and valid transition between A&E care stages). Interrupted time-series segmented regression and process mining were used for analysis. A&E transition time from patient arrival to assessment by a clinician marginally improved during the intervention period; there was a decrease of 0.9 min [95% confidence interval (CI): 0.35-1.4], 3 min (95% CI: 2.4-3.5), 9.7 min (95% CI: 8.4-11.0), and 3.1 min (95% CI: 2.7-3.5) during 'patient flow program', 'command centre display roll-in', 'command centre activation', and 'hospital wide training program', respectively. However, the transition time from patient treatment until the conclusion of consultation showed an increase of 11.5 min (95% CI: 9.2-13.9), 12.3 min (95% CI: 8.7-15.9), 53.4 min (95% CI: 48.1-58.7), and 50.2 min (95% CI: 47.5-52.9) for the respective four post-intervention periods. Furthermore, the length of stay was not significantly impacted; the change was -8.8 h (95% CI: -17.6 to 0.08), -8.9 h (95% CI: -18.6 to 0.65), -1.67 h (95% CI: -10.3 to 6.9), and -0.54 h (95% CI: -13.9 to 12.8) during the four respective post-intervention periods. It was a similar pattern for the waiting and clinician seen times. Data quality as measured by the proportion of missing dates of records was generally poor (treatment date = 42.7% and clinician seen date = 23.4%) and did not significantly improve during the intervention periods. The findings of the study suggest that a command centre package that includes process change and software technology does not appear to have a consistent positive impact on patient safety and data quality based on the indicators and data we used. Therefore, hospitals considering introducing a command centre should not assume there will be benefits in patient flow and data quality.
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Affiliation(s)
- Teumzghi F Mebrahtu
- School of Computing, University of Leeds, Leeds LS2 9JT, UK
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford Royal Infirmary, Duckworth Ln, Bradford BD9 6RJ, UK
| | - Ciaran D McInerney
- School of Computing, University of Leeds, Leeds LS2 9JT, UK
- Yorkshire and Humber Patient Safety Translational Research Centre, Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Duckworth Ln, Bradford BD9 6RJ, UK
| | - Jonathan Benn
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford Royal Infirmary, Duckworth Ln, Bradford BD9 6RJ, UK
- School of Psychology, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK
| | - Carolyn McCrorie
- Yorkshire and Humber Patient Safety Translational Research Centre, Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Duckworth Ln, Bradford BD9 6RJ, UK
- School of Psychology, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK
| | - Josh Granger
- School of Psychology, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK
| | - Tom Lawton
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford Royal Infirmary, Duckworth Ln, Bradford BD9 6RJ, UK
| | - Naeem Sheikh
- Yorkshire and Humber Patient Safety Translational Research Centre, Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Duckworth Ln, Bradford BD9 6RJ, UK
| | - Ibrahim Habli
- Department of Computer Science, University of York, Heslington, York YO10 5DD, UK
| | - Rebecca Randell
- Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Duckworth Ln, Bradford BD9 6RJ, UK
- Faculty of Health Studies, University of Bradford, Richmond Rd, Bradford BD7 1DP, UK
| | - Owen Johnson
- School of Computing, University of Leeds, Leeds LS2 9JT, UK
- Yorkshire and Humber Patient Safety Translational Research Centre, Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Duckworth Ln, Bradford BD9 6RJ, UK
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Habib H, Sudaryo MK. Association Between the Emergency Department Length of Stay and in-Hospital Mortality: A Retrospective Cohort Study. Open Access Emerg Med 2023; 15:313-323. [PMID: 37724246 PMCID: PMC10505382 DOI: 10.2147/oaem.s415971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/30/2023] [Indexed: 09/20/2023] Open
Abstract
Purpose The number of emergency department (ED) visits and prolonged ED length of stay (LOS) are increasing worldwide. Prolonged ED LOS may be associated with a higher risk of in-hospital mortality. Here, we analysed the association between of ED LOS and the risk of in-hospital mortality in a hospital in Jakarta, Indonesia. Patients and methods This was a single-centre retrospective cohort study performed in a referral academic hospital in Jakarta, Indonesia. Data on ED visits in 2019 were obtained from the electronic medical records. ED patient was used as the unit of the analysis. The dependent variable was all-cause in-hospital mortality during one's visit. The main independent variable was ED LOS with respect to approval (<8 h) and prolonged (≥8 h). Potential confounders were sex, age, triage categories, trauma-related case, malignancy-related case, labour-related case, and referral patients from other healthcare facilities. Multivariate logistic regression analysis was performed to evaluate the association of ED LOS and in-hospital mortality after adjusting for other confounders. Results There were 18,553 participants included in the analysis. The in-hospital mortality was 13.5% among all participants, and 63.5% participants had an ED LOS ≥8 h. Multivariate analysis showed that a prolonged ED LOS was associated with an increased risk of in-hospital mortality (adjusted relative risk, 2.69; 95% confidence interval, 2.40-3.03; P<0.001). Conclusion Prolonged ED LOS was associated with risk an increased of in-hospital mortality after adjusting for several confounders. In future, hospital service plans should aim to reduce ED LOS and increase patient flow from the ED to in-patient wards.
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Affiliation(s)
- Hadiki Habib
- Doctoral Program of Epidemiology, Epidemiology Department, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
- Emergency Unit, Dr. Cipto Mangunkusumo Hospital/Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Division of Respirology and Critical Illness, Department of Internal Medicine, Dr. Cipto Mangunkusumo Hospital/Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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Carfagnini QA, Ayanso A, Law MP, Orlando E, Faught BE. What Factors Increase Odds of Long-Stay Delayed Discharge in Alternate Level of Care Patients? J Am Med Dir Assoc 2023; 24:1327-1333. [PMID: 36996875 DOI: 10.1016/j.jamda.2023.02.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE The objective of this study was to determine the factors that increase the odds of long-stay delayed discharge in alternate level of care (ALC) patients using data collected from the Ontario Wait Time Information System (WTIS) database. DESIGN Retrospective cohort study utilizing data from Niagara Health's WTIS database. WTIS includes individuals admitted to any of the Niagara Health sites that have been designated as ALC. SETTING AND PARTICIPANTS Sample consisted of 16,429 ALC patients who received care in Niagara Health hospitals from September 2014 to September 2019 and were recorded in the WTIS database. METHODS ALC designation of 30 or more days was used as the threshold for a long-stay delayed discharge. This study used binary logistic regression modeling to analyze sex, age, admission source, and discharge destination as well needs/barriers requirements to assess the likelihood of a long-stay delayed discharge among acute care (AC) and post-acute care (PAC) patients given the presence of each variable. Sample sizes calculations and receiver operating characteristic curves were used to verify the validity of the regression model. RESULTS Overall, 10.2% of the sample were considered long-stay ALC patients. Both AC and PAC long-stay ALC patients were more likely to be male [OR = 1.23, (1.06-1.43); OR = 1.28, (1.03-1.60)] and have a discharge destination of a long-term care bed [OR = 28.68, (22.83-36.04); OR = 6.22, (4.75-8.15)]. AC patients had bariatric [OR = 7.16, (3.45-14.83)], behavioral [OR = 1.89, (1.22-2.91)], infection (isolation) [OR = 2.31, (1.63-3.28)], and feeding [OR = 6.38, (1.82-22.30)] barriers hindering discharge. PAC patients had no significant barriers hindering patient discharge. CONCLUSIONS AND IMPLICATIONS Shifting the focus from ALC patient designation to short- vs long-stay ALC patients allowed this study to focus on the subset of patients that are disproportionately affecting delayed discharges. Understanding the importance of specialized patient requirements in addition to clinical factors can help hospitals become more prepared in preventing delayed discharges.
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Affiliation(s)
- Quinten A Carfagnini
- Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada.
| | - Anteneh Ayanso
- Goodman School of Business, Brock University, St. Catharines, Ontario, Canada
| | - Madelyn P Law
- Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Elaina Orlando
- Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada; Niagara Health, St. Catharines, Ontario, Canada
| | - Brent E Faught
- Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
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Harding KE, Lewis AK, Taylor NF. 'I just need a plan': Consumer perceptions of waiting for healthcare. J Eval Clin Pract 2023; 29:976-983. [PMID: 36861145 DOI: 10.1111/jep.13821] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 03/03/2023]
Abstract
RATIONALE Wait lists are common in the provision of publicly funded services in outpatient and community settings. AIMS AND OBJECTIVES We aimed to explore the experiences of consumers on wait lists across a broad range of services and to understand the impact of delays in access to services on people's lives. METHODS Consumers with experience of being on a wait list for an outpatient or community-based health service participated in one of three focus groups. Data were transcribed and analysed inductively using a thematic approach. RESULTS Waiting for healthcare has detrimental impacts on health and well-being. Consumers on wait lists want their health needs addressed, but they also want the ability to plan, clear communication and to feel like someone cares. Instead, they feel forgotten by impersonal and inflexible systems with very little communication, with emergency departments and general practitioners often left to fill in the gaps. CONCLUSIONS More consumer-centred approaches are needed for access systems for outpatient and community services, featuring honesty about what services can realistically be provided, early access to initial assessment and information and clear lines of communication.
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Affiliation(s)
- Katherine E Harding
- Eastern Health, Allied Health Clinical Research Office, Box Hill, Victoria, Australia
- School of Allied Health, Health Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Annie K Lewis
- Eastern Health, Allied Health Clinical Research Office, Box Hill, Victoria, Australia
- School of Allied Health, Health Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Nicholas F Taylor
- Eastern Health, Allied Health Clinical Research Office, Box Hill, Victoria, Australia
- School of Allied Health, Health Services and Sport, La Trobe University, Bundoora, Victoria, Australia
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Terning G, El-Thalji I, Brun EC. The Impact of Patient Infection Rate on Emergency Department Patient Flow: Hybrid Simulation Study in a Norwegian Case. Healthcare (Basel) 2023; 11:1904. [PMID: 37444740 DOI: 10.3390/healthcare11131904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
The COVID-19 pandemic put emergency departments all over the world under severe and unprecedented distress. Previous methods of evaluating patient flow impact, such as in-situ simulation, tabletop studies, etc., in a rapidly evolving pandemic are prohibitively impractical, time-consuming, costly, and inflexible. For instance, it is challenging to study the patient flow in the emergency department under different infection rates and get insights using in-situ simulation and tabletop studies. Despite circumventing many of these challenges, the simulation modeling approach and hybrid agent-based modeling stand underutilized. This study investigates the impact of increased patient infection rate on the emergency department patient flow by using a developed hybrid agent-based simulation model. This study reports findings on the patient infection rate in different emergency department patient flow configurations. This study's results quantify and demonstrate that an increase in patient infection rate will lead to an incremental deterioration of the patient flow metrics average length of stay and crowding within the emergency department, especially if the waiting functions are introduced. Along with other findings, it is concluded that waiting functions, including the waiting zone, make the single average length of stay an ineffective measure as it creates a multinomial distribution of several tendencies.
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Affiliation(s)
- Gaute Terning
- Department of Safety, Economics, and Planning, University of Stavanger, 4036 Stavanger, Norway
| | - Idriss El-Thalji
- Department of Mechanical and Structural Engineering and Materials Science, University of Stavanger, 4036 Stavanger, Norway
| | - Eric Christian Brun
- Department of Safety, Economics, and Planning, University of Stavanger, 4036 Stavanger, Norway
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McKay S, Mohammed E, Roy M, Hung V, Wong M, Lum B, King EC. Is 911 The Answer? A Retrospective Review of Emergency Medical Services Use by Home Care Providers. Health Serv Insights 2023; 16:11786329231178767. [PMID: 37275948 PMCID: PMC10233601 DOI: 10.1177/11786329231178767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/11/2023] [Indexed: 06/07/2023] Open
Abstract
With the Ontario healthcare system under strain the use of resources-particularly emergency medical services (EMS) is an increasing focus. Recent work has identified long-term care facilities as high users of EMS despite access to health-related support outside of the hospital. However, such insights are not available for home care. A retrospective review of administrative records of EMS calls drawn from over 6 million visits by home care providers found relatively low call rates: 8.4 calls per 100 000 personal support visits, 4.1 calls per 100 000 for rehabilitation providers, and 0.9 calls per 100 000 for nurses. The majority (85%) of calls resulted in transport to the hospital; the notable exception was fall-related events, and of these falls, a third (32%) were treated at home. Classification of reported physical symptoms suggests opportunities for leveraging in-home clinical specialists to avoid hospital transport where possible and preserve EMS capacity to respond to the most urgent and severe events.
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Affiliation(s)
- Sandra McKay
- Institute of Health Policy Management &
Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Physical Therapy, University of
Toronto, Toronto, ON, Canada
- Ted Rogers School of Management, Toronto
Metropolitan University, Toronto, ON, Canada
- VHA Home HealthCare, Toronto, ON,
Canada
| | | | - Meghla Roy
- VHA Home HealthCare, Toronto, ON,
Canada
| | | | | | - Bonnie Lum
- VHA Home HealthCare, Toronto, ON,
Canada
| | - Emily C King
- VHA Home HealthCare, Toronto, ON,
Canada
- Dalla Lana School of Public Health,
University of Toronto, Toronto, ON, Canada
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Tsao H, Macdonald R, Dwyer D, Harper T, Rutz D, Sutherland J. Prolonged length of stay is associated with reduced hand hygiene compliance in the emergency department: A single centre retrospective study. Emerg Med Australas 2023; 35:213-217. [PMID: 36184077 DOI: 10.1111/1742-6723.14097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine whether patient flow factors in the ED such as prolonged length of stay are associated with hand hygiene (HH) compliance. METHODS We conducted a retrospective study at an urban district hospital utilising available data from January 2018 to December 2021. Compliance to the World Health Organization five moments of HH expressed as percentage of total moments observed were collated every 2 months. Patient flow measures including proportion of patients referred or discharged within 4 h (LOS4), proportion of patients with ED length of stay >24 h (LOS24) and total number of patient presentations, were obtained for each 2-month periods. The association between these patient flow measures and HH compliance was examined using Pearson's correlation (P < 0.05). RESULTS The results showed a moderate and significant association between rates of HH compliance and LOS24 (r = -0.48, P = 0.025). That is, lower proportion of patients with ED length of stay >24 h was associated with improved HH compliance. There was no significant correlation between HH compliance and LOS4 (r = 0.38, P = 0.085) or total number of ED presentations (r = -0.30, P = 0.17). CONCLUSIONS The findings show that prolonged ED length of stay may explain, at least partly, lower rates of HH compliance. Improvements in ED HH compliance should also include strategies that enhance patient flow.
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Affiliation(s)
- Henry Tsao
- Emergency Department, Redland Hospital, Brisbane, Queensland, Australia
| | - Rachel Macdonald
- Emergency Department, Redland Hospital, Brisbane, Queensland, Australia
| | - Damien Dwyer
- Emergency Department, Redland Hospital, Brisbane, Queensland, Australia
| | - Tracey Harper
- Infection Control, Redland Hospital, Brisbane, Queensland, Australia
| | - Dominik Rutz
- Emergency Department, Redland Hospital, Brisbane, Queensland, Australia
| | - John Sutherland
- Emergency Department, Redland Hospital, Brisbane, Queensland, Australia
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Cildoz M, Ibarra A, Mallor F. Acuity-based rotational patient-to-physician assignment in an emergency department using electronic health records in triage. Health Informatics J 2023; 29:14604582231167430. [PMID: 37068379 DOI: 10.1177/14604582231167430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Emergency department (ED) operational metrics generated by a new acuity-based rotational patient-to-physician assignment (ARPA) algorithm are compared with those obtained with a simple rotational patient assignment (SRPA) system aimed only at an equitable patient distribution. The new ARPA method theoretically guarantees that no two physicians' assigned patient loads can differ by more than one, either partially (by acuity levels) or in total; whereas SRPA guarantees only the latter. The performance of the ARPA method was assessed in practice in the ED of the main public hospital (Hospital Compound of Navarra) in the region of Navarre in Spain. This ED attends over 140 000 patients every year. Data analysis was conducted on 9,063 ED patients in the SRPA cohort, and 8,892 ED patients in the ARPA cohort. The metrics of interest are related both to patient access to healthcare and physician workload distribution: patient length of stay; arrival-to-provider time; ratio of patients exceeding the APT target threshold; and range of assigned patients across physicians by priority levels. The transition from SRPA to ARPA is associated with improvements in all ED operational metrics. This research demonstrates that ARPA is a simple and useful strategy for redesigning front-end ED processes.
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Affiliation(s)
- Marta Cildoz
- Institute of Smart Cities, Public University of Navarre, Pamplona, Spain
| | | | - Fermin Mallor
- Institute of Smart Cities, Public University of Navarre, Pamplona, Spain
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12
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Øzhayat EB, Bahrami G, Rosing K. Impact of the Covid-19 pandemic on dental practices in Denmark. Acta Odontol Scand 2023; 81:131-136. [PMID: 35802695 DOI: 10.1080/00016357.2022.2096923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To investigate the impact of the Covid-19 pandemic on the patient flow and economy as experienced by dental practices in Denmark. MATERIAL AND METHODS A survey regarding experience of patient flow, economical turnover, financial strain and willingness to pay for large treatments during the first year of the Covid-19 pandemic (March 2020 to March 2021), along with information on the characteristics of the practice (specialist practice, ownership, practice operation and size) was distributed to all dental practices in Denmark in March 2021. RESULTS Of the 1728 practices, 581 (33.6%) answered the survey. A decline in patient flow and a decline in economical turnover were reported by 79% and 84.4% of the practices, respectively. Financial strain was reported by 15.8% and an increased willingness to pay for large treatments was reported by 32.1%. A large decline in turnover and financial strain were associated with non-specialized practices, practices with a single owner and small practices. Logistic regressions showed that practices not receiving referrals had an odds ratio of 2.34 (CI: 1.32-4.14) for having a large decline in economic turnover compared with practices receiving referrals and that small practices had an odds ratio of 1.92 (CI: 1.16-3.19) for reporting financial strain compared with large practices. CONCLUSIONS Reportedly, the Covid-19 pandemic resulted in a decline in both patient flow and economical turnover in Danish dental practices. Large and more specialized practices seem to have managed the economic crisis better.
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Affiliation(s)
- Esben Boeskov Øzhayat
- Section of Community Dentistry, Department of Odontology, University of Copenhagen, Copenhagen Denmark
| | - Golnosh Bahrami
- Section for Prosthetic Dentistry, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Kasper Rosing
- Section of Community Dentistry, Department of Odontology, University of Copenhagen, Copenhagen Denmark
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13
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Rovira-Simon J, Sales-i-Coll M, Pozo-Rosich P, Hueto-Madrid JA, Paradell RC, Aguilar AODE, Carbonell-Cobo M, de Castro R, Shaw G. The Green Surgical Block 4.0: Automation of the operating theatre's climate conditions through a real-time patient-flow solution. Future Healthc J 2023; 10:46-49. [PMID: 37786502 PMCID: PMC10538689 DOI: 10.7861/fhj.2022-0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
The energy consumed by surgery units constitutes a staggering part of the overall healthcare carbon footprint. Partly due to the demanding climate conditions necessitated by operating theatres (OTs), energy is also wasted because of poorly managed heating, ventilation and air-conditioning systems (HVACs) that consume up to 57% of the total energy used in a hospital. With their goal of optimising OTs' performance and reducing patient waiting lists, heads of surgery units worldwide do not dare to risk cancelling scheduled surgery because of problems with the OT environment conditions (ie temperature, humidity, pressure). Current solutions are monolithic, complex and completely disconnected from healthcare logic, failing to take into account the idiosyncrasy of hospitals. This article presents an innovation that uses real-time patient flow data to automate and optimise the OT's climate conditions.
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Affiliation(s)
| | | | | | - Juan Antonio Hueto-Madrid
- Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain, and professor of surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
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14
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Manning L, Islam MS. A systematic review to identify the challenges to achieving effective patient flow in public hospitals. Int J Health Plann Manage 2023; 38:805-828. [PMID: 36855322 DOI: 10.1002/hpm.3626] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/14/2022] [Accepted: 02/10/2023] [Indexed: 03/02/2023] Open
Abstract
This systematic review aims to uncover the challenges related to patient flow from a whole public hospital perspective and identify strategies to overcome these challenges. A search in Medline, Emcare and PubMed was conducted and 24 articles published in English, from 2015 to 2020, were selected in relation to patient flow challenges and strategies. Analysis of the articles was completed using a thematic approach to identify common themes in relation to the area of focus. Strategies from the literature were then aligned with the challenges to inform areas of potential improvement in relation to patient flow. The themes generated included Teamwork, Collaboration and Communication; Public Hospitals as complex systems; Timely discharge; Policy, Process and Decision-making; and Resources-capacity and demand. The key finding is that a whole system approach is required to improve patient flow in public hospitals. When effective patient flow is achieved, demand and capacity are matched, increasing patient access to the health service and enabling the resources required to provide high quality patient care. The findings will create a better understanding of improving patient flow in public hospitals.
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Affiliation(s)
- Larissa Manning
- Southern NSW Local Health District, NSW Health, Queanbeyan, New South Wales, Australia
| | - Md Shahidul Islam
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, New South Wales, Australia
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15
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Hardway J, Lucente FC, T Crawford A, Jarrouj A, Samanta D. Impact of the 24/7 nurse practitioner model on emergency department stay at a level 1 trauma center: A retrospective study. J Clin Nurs 2023; 32:517-522. [PMID: 35307879 DOI: 10.1111/jocn.16300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/22/2022] [Accepted: 03/09/2022] [Indexed: 01/17/2023]
Abstract
AIMS The aim of the study was to assess the impact of 24/7 trauma nurse practitioner service model on the emergency department patient flow. BACKGROUND Seamless transition of trauma patients through the emergency department to inpatient hospital care is crucial for coordination of care, clinical safety and positive health outcomes. A level 1 trauma centre located in Southern West Virginia, USA expanded their trauma nurse practitioner service covering the emergency department 24/7. DESIGN Retrospective cohort study conducted in accordance with the Strengthening the Reporting of Observational studies in Epidemiology guidelines. METHODS Patients admitted to the trauma centre between March 2019 and February 2020 were divided into two groups: trauma patients managed by trauma nurse practitioners versus the hospitalist service. The hospital service group was chosen as the comparator group because any admission prior to night coverage by the trauma nurse practitioners were managed by the hospitalist service. RESULTS The emergency department length of stay was significantly lower in trauma nurse practitioners' patients by an average of 300 min (772.25 ± 831.91 vs. 471.44 ± 336.65, p = <.001). Similarly, time to place emergency department discharge order was shorter by 49 min (277.76 ± 159.69 vs. 228.27 ± 116.04, p = .001) for this group. Moreover, trauma nurse practitioners on an average placed one less consultation (1.06 ± 0.23 vs. 1.46 ± 0.74, p < .001). CONCLUSION The patient care provided by trauma nurse practitioners aided in the reduction of strain felt by their emergency department. They were able to help facilitate patient flow thus lessening the pressure of boarding in an overcrowded emergency department. The study institution hopes to sustain the current service model and continue to review outcomes and processes managed by trauma nurse practitioners to ensure consistency and quality. RELEVANCE TO CLINICAL PRACTICE Similar trauma centres should evaluate the structure of their trauma service that includes the role of trauma nurse practitioner service and work towards allowing them to manage patient care from the emergency department 24/7.
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Affiliation(s)
- Jessica Hardway
- Charleston Area Medical Center, Charleston, West Virginia, USA
| | - Frank C Lucente
- Charleston Area Medical Center, West Virginia University Physicians of Charleston, Charleston, West Virginia, USA
| | - Adam T Crawford
- Charleston Area Medical Center, Charleston, West Virginia, USA
| | - Aous Jarrouj
- Center for Health Services and Outcomes Research, Charleston Area Medical Center Institute for Academic Medicine, Charleston, West Virginia, USA
| | - Damayanti Samanta
- Center for Health Services and Outcomes Research, Charleston Area Medical Center Institute for Academic Medicine, Charleston, West Virginia, USA
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16
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Park AI, Lansigan F, Kong L, O'Brien JF, Lastrilla PC, Nagle J. Nurse-Driven Interprofessional Rounds: Improving Care Coordination and Length of Stay. Clin J Oncol Nurs 2023; 27:40-46. [PMID: 37677813 DOI: 10.1188/23.cjon.40-46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND Inpatient oncology units care for patients with some of the most complex medical conditions outside of the intensive care unit. These patients benefit from structured care coordination. Reduced ability to admit patients to oncology beds contributes to delays in specialty care. OBJECTIVES This quality improvement initiative established nurse-driven interprofessional rounds (IPRs) to reduce length of stay (LOS), improve discharge time of day, and enhance care coordination, patient flow, and access to care in the community. METHODS Care coordination during enhanced IPRs (eIPRs) included estimation of discharge dates, comparison of LOS to a standard geometric mean LOS, and discussion of clinical milestones and barriers to progression and discharge. Data analysis evaluated the effect of eIPRs on key outcomes. FINDINGS Although LOS variance was reduced by 15.8% and 44.1% in all-unit and hematology-oncology discharges, respectively, the results were not significant. Discharges by 2 pm improved significantly for all-unit and hematology-oncology populations, respectively. Patient flow measured by accepted patient transfers requesting hematology-oncology services improved significantly.
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17
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Terning G, Brun EC, El-Thalji I. The Patient Flow Effect of Pandemic Policies: A Hybrid Simulation Study in a Norwegian Emergency Department. Healthcare (Basel) 2022; 11:healthcare11010001. [PMID: 36611461 PMCID: PMC9818521 DOI: 10.3390/healthcare11010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
The COVID-19 pandemic required several interventions within emergency departments, complicating the patient flow. This study explores the effect of intervention policies on patient flow in emergency departments under pandemic conditions. The patient flow interventions under evaluation here are the addition of extra treatment rooms and the addition of a waiting zone. A predeveloped hybrid simulation model was used to conduct five scenarios: (1) pre-pandemic patient flow, (2) patient flow with a 20% contamination rate, (3) adding extra treatment rooms to patient flow, (4) adding a waiting zone to the patient flow, (5) adding extra treatment rooms and a waiting zone to the patient flow. Experiments were examined based on multiple patient flow metrics incorporated into the model. Running the scenarios showed that introducing the extra treatment rooms improved all the patient flow parameters. Adding the waiting zone further improved only the contaminated patient flow parameters. Still, the benefit of achieving this must be weighed against the disadvantage for ordinary patients. Introducing the waiting zone in addition to the extra treatment room has one positive effect, decreasing time that the treatment rooms are blocked for contaminated patients entering the treatment room.
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Affiliation(s)
- Gaute Terning
- Department of Safety, Economics, and Planning, University of Stavanger, 4036 Stavanger, Norway
- Correspondence:
| | - Eric Christian Brun
- Department of Safety, Economics, and Planning, University of Stavanger, 4036 Stavanger, Norway
| | - Idriss El-Thalji
- Department of Mechanical and Structural Engineering and Materials Science, University of Stavanger, 4036 Stavanger, Norway
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18
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Benjamin E, Wolf LA. "Nurses are every bit of the flow:" Emergency department nurses' conceptualization of patient flow management. Nurs Forum 2022; 57:1407-1414. [PMID: 36398596 DOI: 10.1111/nuf.12834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
AIM To validate and refine Benjamin and Jacelon's 2021 definition of patient flow management using the experience and knowledge of practicing emergency department nurses. BACKGROUND Patient flow requires complex, real-time decision-making to match patients to limited resources and facilitate their movement through care processes. A literature-based concept analysis of patient flow management was first performed in 2021, but the voice of nurses is largely absent from existing patient flow research. DESIGN This study employed an expanded concept analysis methodology, as articulated by Kathleen Cowles. DATA SOURCE Focus groups of nine emergency nurses were conducted. RESULTS Emergency nurses' conceptualization of patient flow management differs from the definition as it has emerged through patient flow literature. Patient flow management is a nurse-driven process that relies on nursing knowledge and the work of all emergency nurses, including bedside nurses. Emergency nurses perceive the ultimate goal of patient flow management to be the collective safety of patients, and they work to promote patient safety within their own scope of responsibility. CONCLUSION Understanding patient flow management as a nurse-driven process emphasizes the importance of nurse training and capacity to effective patient flow. Future research should explore the role of emergency nurses as active directors, rather than passive components, of patient flow. More work is needed to investigate this complex nursing task.
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Affiliation(s)
- Ellen Benjamin
- Elaine Marieb College of Nursing, University of Massachusetts, Amherst, Massachusetts, USA
| | - Lisa A Wolf
- Elaine Marieb College of Nursing, University of Massachusetts, Amherst, Massachusetts, USA
- Emergency Nursing Research, Emergency Nurses Association, Schaumburg, Illinois, USA
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19
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Bacelar-Silva GM, Cox JF, Rodrigues P. Achieving rapid and significant results in healthcare services by using the theory of constraints. Health Syst (Basingstoke) 2022; 13:48-61. [PMID: 38370321 PMCID: PMC10868449 DOI: 10.1080/20476965.2022.2115408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/12/2022] [Indexed: 10/15/2022] Open
Abstract
Lack of timeliness and capacity are seen as fundamental problems that jeopardise healthcare delivery systems everywhere. Many believe the shortage of medical providers is causing this timeliness problem. This action research presents how one doctor implemented the theory of constraints (TOC) to improve the throughput (quantity of patients treated) of his ophthalmology imaging practice by 64% in a few weeks with little to no expense. The five focusing steps (5FS) guided the TOC implementation - which included the drum-buffer-rope scheduling and buffer management - and occurred in a matter of days. The implementation provided significant bottom-line results almost immediately. This article explains each step of the 5FS in general terms followed by specific applications to healthcare services, as well as the detailed use in this action research. Although TOC successfully addressed the practice problems, this implementation was not sustained after the TOC champion left the organisation. However, this drawback provided valuable knowledge. The article provides insightful knowledge to help readers implement TOC in their environments to provide immediate and significant results at little to no expense.
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Affiliation(s)
- Gustavo M. Bacelar-Silva
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine (MEDCIDS-FMUP), University of Porto, Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Department of Distance Learning, Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - James F. Cox
- Management Department, Terry College of Business,University of Georgia, Athens, Georgia, USA
| | - Pedro Rodrigues
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine (MEDCIDS-FMUP), University of Porto, Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
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20
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Shima M, Piovacari SMF, Steinman M, Pereira AZ, dos Santos OFP. Telehealth for Nutritional Care: A Tool for Improving Patient Flow in Hospitals. Telemed Rep 2022; 3:117-124. [PMID: 35860304 PMCID: PMC9282778 DOI: 10.1089/tmr.2021.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Hospitals are constantly searching for opportunities to improve efficiency, and telehealth (TH) has recently emerged as a strategy to assist in patient flow. We evaluated two methods of dietary counseling offered to patients in the time period between the medical and final hospital discharge. Counseling was given either via the TH group or the face to face (FTF) group to the patients and their respective impact was evaluated on the patients' satisfaction and on the hospital patient flow. METHODS This study was a prospective, randomized clinical trial where patients were randomized to receive dietary counseling via TH (use of tablet) or FTF at the time of hospital discharge. We evaluate the duration of time between medical discharge and hospital discharge; between requesting dietary counseling and dietitian's arrival; and duration of dietary counseling. At the end of dietary counseling, both groups received a patient satisfaction questionnaire to answer. RESULTS A total of 159 patients were randomized to receive dietary counseling via TH (TH, n = 78) or FTF (FTF, n = 81). The two groups TH and FTF did not differ in terms of the median time between (1) medical and hospital discharge; (2) requesting counseling and the dietitian's arrival; and (3) duration of dietary counseling. Both groups mostly reported being "satisfied" or "above expectations," and the FTF group scored "highest satisfaction" more often relative to the dietitian's work and interaction and on confidence in the dietitian's orientations. Finally, in the TH group, 90.7% graded likely-4 or very likely-5 when asked whether dietary counseling can be conducted entirely via TH, and 92% answered "4" or "5" when asked whether they would recommend dietary counseling via TH. CONCLUSIONS Although the FTF group had a greater overall satisfaction relative to the TH group, TH proved to be a useful tool for dietary counseling.The trial has only Institutional Review Board approval (protocol 2685-16).
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Affiliation(s)
- Mayumi Shima
- Clinical Nutrition Service, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Milton Steinman
- Supervisor of the General Surgery Residency and Professor of Medicine, Emergency Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Andrea Z. Pereira
- Oncology and Hematology Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
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21
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Abstract
OBJECTIVE The objective of this study is present how a patient movement-based patient-flow analysis is performed for planning the new Heart Hospital of Tampere University Hospital and how patient transfer distances can be shortened by this method. BACKGROUND The Heart Hospital had served patients as a service line organization for years. However, the Heart Hospital layout rather looked like functional layout instead of service line layout because the units of the Heart Hospital have been spread out around the large university hospital campus. METHOD The flow routes of patients treated over the course of 1 year were analyzed by information technology systems in the hospital planning phase. Then, the proximity ranking of the main functions of the Heart Hospital was made. Layout planning was performed based on the proximity ranking. Nine months after the opening of the new Heart Hospital, the distances between the various hospital functions were calculated for the old Heart Hospital and the new one. RESULTS In the old Heart Hospital, patients' transfer distance was 5,654 km (3,513 miles), while the corresponding figure for the new Heart Hospital was 3,797 km (2,359 miles), which means the distance was reduced by 33%. CONCLUSION The patient-flow analysis works as it generated substantially shorter patient transfer distances in the new Heart Hospital. Shorter distances have supported more fluent patient flows that, in turn, has contributed higher productivity and quality of care.
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Affiliation(s)
| | - Markku Eskola
- Heart Hospital, Tampere University Hospital, Finland.,Faculty of Medicine and Health Technology, Tampere University, Finland
| | | | - Timo Porkkala
- Heart Hospital, Tampere University Hospital, Finland
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22
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Maass KL, Halter E, Huschka TR, Sir MY, Nordland MR, Pasupathy KS. A discrete event simulation to evaluate impact of radiology process changes on emergency department computed tomography access. J Eval Clin Pract 2022; 28:120-128. [PMID: 34309137 DOI: 10.1111/jep.13606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/31/2021] [Accepted: 07/07/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Hospitals face the challenge of managing demand for limited computed tomography (CT) resources from multiple patient types while ensuring timely access. METHODS A discrete event simulation model was created to evaluate CT access time for emergency department (ED) patients at a large academic medical center with six unique CT machines that serve unscheduled emergency, semi-scheduled inpatient, and scheduled outpatient demand. Three operational interventions were tested: adding additional patient transporters, using an alternative creatinine lab, and adding a registered nurse dedicated to monitoring CT patients in the ED. RESULTS All interventions improved access times. Adding one or two transporters improved ED access times by up to 9.8 minutes (Mann-Whitney (MW) CI: [-11.0,-8.7]) and 10.3 minutes (MW CI [-11.5, -9.2]). The alternative creatinine and RN interventions provided 3-minute (MW CI: [-4.0, -2.0]) and 8.5-minute (MW CI: [-9.7, -8.3]) improvements. CONCLUSIONS Adding one transporter provided the greatest combination of reduced delay and ability to implement. The projected simulation improvements have been realized in practice.
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Affiliation(s)
- Kayse Lee Maass
- Mechanical and Industrial Engineering Department, Northeastern University, Boston, Massachusetts, USA.,Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Elizabeth Halter
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.,Industrial and Systems Engineering Department, Washington University, St. Louis, Missouri, USA
| | - Todd R Huschka
- Mayo Clinic Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mustafa Y Sir
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Kalyan S Pasupathy
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
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23
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Adeoti AO, Demir E, Adeyemi S, Yakutcan U, Kengne AP, Kayode G, Aliyu A, Idika N, Isichei C. Impact of pre-exposure and post-exposure prophylaxes prevention programme on HIV burden and services in a low-resource setting: a simulation modelling approach. Pan Afr Med J 2022; 40:163. [PMID: 34970405 PMCID: PMC8683480 DOI: 10.11604/pamj.2021.40.163.26486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/21/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction sub-Saharan African countries contribute substantially to the global HIV disease burden. Despite this burden, and the promises that prevention could deliver, the implementation and uptake of HIV prevention programmes are still low. The study used the decision support system model to explore the potential impacts of prevention implementation on HIV burden (incidence) and service delivery. Methods an operational research technique known as discrete event simulation model was used to capture an individual patient´s pathways through the HIV care process from diagnosis to treatment and monitoring. The regular monitoring, over a 5-year period, including all the activities and resources utilized at each stage of the pathway were analysed, and the impact of increasing prevention measures for an HIV treatment service in a treatment centre in Nigeria was tested using the simulation model. Results forty-three patients currently access the Pre-Exposure Prophylaxis (PrEP) and Post Exposure Prophylaxis (PEP) annually, with a 20% and 80% split in the number of patients offered PrEP and PEP, respectively. Scenarios-based on increasing the number of people offered PrEP and PEP from 43 to 250 with a 50/50 split were tested. The outputs revealed improved preventive care by averting new HIV cases, reduction in service demand and utilization, but an increase in the required human resource as well as financial burden. In the next 5 years, the cumulative averted HIV cases are expected to increase from 2 and 5 people (baseline) to 24 and 20 people for PrEP and PEP, respectively. The potentially averted 2 cases per infected persons based on the basic reproductive number of HIV. Conclusion the effective implementation of PrEP/PEP programme offers an additional safety measure to prevent HIV transmission in at-risk individuals and possibility of ending HIV epidemic.
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Affiliation(s)
- Adekunle Olatayo Adeoti
- Department of Medicine, Ekiti State University/Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Eren Demir
- University of Hertfordshire, Hertfordshire Business School, AL10 9AB, Hatfield, United Kingdom
| | - Shola Adeyemi
- Statsxperts Consulting Ltd and Bohemian Smartlytics Ltd, Haverhill, CB9 8PP, United Kingdom
| | - Usame Yakutcan
- University of Hertfordshire, Hertfordshire Business School, AL10 9AB, Hatfield, United Kingdom
| | - Andre Pascal Kengne
- South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, Western Cape, South Africa
| | - Gbenga Kayode
- Institute of Human Virology, Nigeria, Maina Court, Herbert Macaulay Way, Central Business District, Abuja, Nigeria
| | - Ahmad Aliyu
- Institute of Human Virology, Nigeria, Maina Court, Herbert Macaulay Way, Central Business District, Abuja, Nigeria.,Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Nneoma Idika
- Statsxperts Consulting Ltd and Bohemian Smartlytics Ltd, Haverhill, CB9 8PP, United Kingdom
| | - Christian Isichei
- Faith Alive Foundation-Nigeria, Jos, Nigeria.,University of Jos, Jos University Teaching Hospital, Department of Chemical Pathology, Jos, Nigeria
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Daly A, Teeling SP, Ward M, McNamara M, Robinson C. The Use of Lean Six Sigma for Improving Availability of and Access to Emergency Department Data to Facilitate Patient Flow. Int J Environ Res Public Health 2021; 18:11030. [PMID: 34769548 DOI: 10.3390/ijerph182111030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/14/2021] [Accepted: 10/16/2021] [Indexed: 11/17/2022]
Abstract
The aim of this study was to redesign an emergency department [ED] data management system to improve the availability of, and access to, data to facilitate patient flow. A pre-/post-intervention design was employed using Lean Six Sigma methodology with a focus on the voice of the customer, Gemba, and 5S to identify areas for improvement in ED data management processes and to inform solutions for improved ED patient flow processes. A multidisciplinary ED team includes medical consultants and registrars, nurses, patient service staff, radiology staff, as well as information technology and hospital management staff. Lean Six Sigma [LSS] diagnostic tools identified areas for improvement in the current process for data availability and access. A set of improvements were implemented to redesign the pathway for data collection in the ED to improve data availability and access. We achieved a reduction in the time taken to access ED patient flow data from a mean of 9 min per patient pre-intervention to immediate post-intervention. This enabled faster decision-making by the ED team related to patient assessment and treatment and informed improvements in patient flow. Optimizing patient flow through a hospital’s ED is a complex task involving collaboration and participation from multiple disciplines. Through the use of LSS methodology, we improved the availability of, and fast access to, accurate, current information regarding ED patient flow. This allows ED and hospital management teams to identify and rapidly respond to actions impacting patient flow.
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25
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Abstract
Emergency departments (EDs) are the point of entry for infectious diseases, making it necessary to reevaluate current practices and make adjustments to decrease transmission when presented with a novel viral infection. This article discusses strategies implemented in the ED to prevent transmission of coronavirus disease-2019 (COVID-19) while identifying areas of needed change in creating a safe environment for patients, health care workers, and ancillary staff. A team approach is ultimately necessary for success; therefore, development of interprofessional teams was formed to mitigate any obstacles. Dissemination of the most current information regarding proper personal protective equipment use, triaging, patient flow, and treatment areas were implemented with weekly emails, videoconferencing, and daily huddles. Developing an efficient triage screening process, redesigning patient flow, and cohorting of patients and staff to a geographical location are essential to minimize transmission. Constant reevaluation of processes is necessary to meet all the needs of patients and health care staff to prevent the spread of COVID-19.
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Affiliation(s)
- Lisa R. Ponsford
- College of Graduate Nursing, Western University of Health Sciences, Pomona, California (Dr Ponsford and Ms Weaver); and Emergency Department, Loma Linda University Medical Center, Loma Linda, California (Dr Ponsford and Mss Weaver and Potter)
| | - Michelle A. Weaver
- College of Graduate Nursing, Western University of Health Sciences, Pomona, California (Dr Ponsford and Ms Weaver); and Emergency Department, Loma Linda University Medical Center, Loma Linda, California (Dr Ponsford and Mss Weaver and Potter)
| | - Mindy Potter
- College of Graduate Nursing, Western University of Health Sciences, Pomona, California (Dr Ponsford and Ms Weaver); and Emergency Department, Loma Linda University Medical Center, Loma Linda, California (Dr Ponsford and Mss Weaver and Potter)
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Harrou F, Kadri F, Sun Y, Khadraoui S. Monitoring patient flow in a hospital emergency department: ARMA-based nonparametric GLRT scheme. Health Informatics J 2021; 27:14604582211021649. [PMID: 34096378 DOI: 10.1177/14604582211021649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Overcrowding in emergency departments (EDs) is a primary concern for hospital administration. They aim to efficiently manage patient demands and reducing stress in the ED. Detection of abnormal ED demands (patient flows) in hospital systems aids ED managers to obtain appropriate decisions by optimally allocating the available resources following patient attendance. This paper presents a monitoring strategy that provides an early alert in an ED when an abnormally high patient influx occurs. Anomaly detection using this strategy involves the amalgamation of autoregressive-moving-average (ARMA) time series models with the generalized likelihood ratio (GLR) chart. A nonparametric procedure based on kernel density estimation is employed to determine the detection threshold of the ARMA-GLR chart. The developed ARMA-based GLR has been validated through practical data from the ED at Lille Hospital, France. Then, the ARMA-based GLR method's performance was compared to that of other commonly used charts, including a Shewhart chart and an exponentially weighted moving average chart; it proved more accurate.
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Affiliation(s)
- Fouzi Harrou
- Computer, Electrical and Mathematical Sciences and Engineering (CEMSE) Division, King Abdullah University of Science and Technology, Saudi Arabia
| | - Farid Kadri
- Aeroline and Customer Services, Agence, Sopra Steria Group, France
| | - Ying Sun
- Computer, Electrical and Mathematical Sciences and Engineering (CEMSE) Division, King Abdullah University of Science and Technology, Saudi Arabia
| | - Sofiane Khadraoui
- Department of Electrical Engineering, University of Sharjah, United Arab Emirates
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Yagudina R, Kulikov A, Serpik V, Borodin A, Vygodchikova I. Patient Flows, Patient Distribution Computations and Medicines Accounting in the Pharmacoeconomic Models Through Procurement Perspective. Clinicoecon Outcomes Res 2021; 13:673-680. [PMID: 34326653 PMCID: PMC8315840 DOI: 10.2147/ceor.s312986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/12/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Stimulating cost reduction of pharmaceutical companies to optimize the structure of distribution of patients by the level of treatment costs in various programs. Patients and Methods In this article, we rise up the issues of pharmacoeconomic modeling related to the description of the patient flows in the pharmacoeconomic model and methods to determining the course dose of drugs under the restriction of integer computations. We established two possible ways of distributing patients through treatment regimens in pharmacoeconomic models, also analyzed the effects of simultaneous and uniform entry of patients into the model. Also, we considered the limitations and possibilities of calculations based on the active substance and packaging, as well as the transition factor of the remainder of the drug in the next time period. Results A mathematical model of the analysis of the system assessment of patients by the level of risk of abandoning a healthy lifestyle in connection with the growing problems of the difficult-to-control process is developed. The use of a rational data convolution mode allowed us to obtain a criterion for the optimality of the process and a logical point of stability of the pharmaceutical company by rationally applying treatment methods according to established standards (percentage base). This approach makes it possible to influence the management of private clinics through clear ideas on the algorithms for prescribing drugs in each group of patients and their zoning in the vector recovery mode. Conclusion Initial data and sample size: 552 measurements of the intervals of changes in the subject's indicators in seconds (smoothing and scaling the data to the level of the base (analytical) period or the final (barrier) period). Regular use of this approach makes it possible to reserve the resources of the body of a healthy and physically active person in a timely manner for a very reliable functioning of all body systems, taking into account the dosed intake of prescribed drugs and the conditions of comfortable (decent) maintenance of patients during the course of treatment according to the method chosen by the doctor.
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Affiliation(s)
- Roza Yagudina
- Department of Organization of Medical Provision and Pharmacoeconomics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Andrey Kulikov
- Department of Organization of Medical Provision and Pharmacoeconomics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Vyacheslav Serpik
- Department of Organization of Medical Provision and Pharmacoeconomics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Alex Borodin
- Plekhanov Russian University of Economics, Moscow, Russia
| | - Irina Vygodchikova
- Department of Differential Equations and Mathematical Economics, Saratov State University, Saratov, Russia
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Sai Prashanthi G, Molugu N, Kammari P, Vadapalli R, Das AV. Forecast of Outpatient Visits to a Tertiary Eyecare Network in India Using the EyeSmart Electronic Medical Record System. Healthcare (Basel) 2021; 9:healthcare9060749. [PMID: 34207070 PMCID: PMC8233739 DOI: 10.3390/healthcare9060749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 01/10/2023] Open
Abstract
India is home to 1.3 billion people. The geography and the magnitude of the population present unique challenges in the delivery of healthcare services. The implementation of electronic health records and tools for conducting predictive modeling enables opportunities to explore time series data like patient inflow to the hospital. This study aims to analyze expected outpatient visits to the tertiary eyecare network in India using datasets from a domestically developed electronic medical record system (eyeSmart™) implemented across a large multitier ophthalmology network in India. Demographic information of 3,384,157 patient visits was obtained from eyeSmart EMR from August 2010 to December 2017 across the L.V. Prasad Eye Institute network. Age, gender, date of visit and time status of the patients were selected for analysis. The datapoints for each parameter from the patient visits were modeled using the seasonal autoregressive integrated moving average (SARIMA) modeling. SARIMA (0,0,1)(0,1,7)7 provided the best fit for predicting total outpatient visits. This study describes the prediction method of forecasting outpatient visits to a large eyecare network in India. The results of our model hold the potential to be used to support the decisions of resource planning in the delivery of eyecare services to patients.
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Affiliation(s)
- Gumpili Sai Prashanthi
- Department of EyeSmart EMR & AEye, L. V. Prasad Eye Institute, Hyderabad 500034, India; (G.S.P.); (P.K.); (R.V.)
- Indian Health Outcomes, Public Health and Economics Research Center, L. V. Prasad Eye Institute, Hyderabad 500034, India
| | - Nareen Molugu
- LVPEI Center for Innovation, L.V. Prasad Eye Institute, Banjara Hills, Hyderabad 500034, India;
| | - Priyanka Kammari
- Department of EyeSmart EMR & AEye, L. V. Prasad Eye Institute, Hyderabad 500034, India; (G.S.P.); (P.K.); (R.V.)
| | - Ranganath Vadapalli
- Department of EyeSmart EMR & AEye, L. V. Prasad Eye Institute, Hyderabad 500034, India; (G.S.P.); (P.K.); (R.V.)
| | - Anthony Vipin Das
- Department of EyeSmart EMR & AEye, L. V. Prasad Eye Institute, Hyderabad 500034, India; (G.S.P.); (P.K.); (R.V.)
- Indian Health Outcomes, Public Health and Economics Research Center, L. V. Prasad Eye Institute, Hyderabad 500034, India
- Correspondence: ; Tel.: +040-68102367
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Franklin BJ, Li KY, Somand DM, Kocher KE, Kronick SL, Parekh VI, Goralnick E, Nix AT, Haas NL. Emergency department provider in triage: assessing site-specific rationale, operational feasibility, and financial impact. J Am Coll Emerg Physicians Open 2021; 2:e12450. [PMID: 34085053 PMCID: PMC8144283 DOI: 10.1002/emp2.12450] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 04/09/2021] [Accepted: 04/22/2021] [Indexed: 11/18/2022] Open
Abstract
Emergency department (ED) crowding is recognized as a critical threat to patient safety, while sub-optimal ED patient flow also contributes to reduced patient satisfaction and efficiency of care. Provider in triage (PIT) programs-which typically involve, at a minimum, a physician or advanced practice provider conducting an initial screening exam and potentially initiating treatment and diagnostic testing at the time of triage-are frequently endorsed as a mechanism to reduce ED length of stay (LOS) and therefore mitigate crowding, improve patient satisfaction, and improve ED operational and financial performance. However, the peer-reviewed evidence regarding the impact of PIT programs on measures including ED LOS, wait times, and costs (as variously defined) is mixed. Mechanistically, PIT programs exert their effects by initiating diagnostic work-ups earlier and, sometimes, by equipping triage providers to directly disposition patients. However, depending on local contextual factors-including the co-existence of other front-end interventions and delays in ED throughput not addressed by PIT-we demonstrate how these features may or may not ultimately translate into reduced ED LOS in different settings. Consequently, site-specific analysis of the root causes of excessive ED LOS, along with mechanistic assessment of potential countermeasures, is essential for appropriate deployment and successful design of PIT programs at individual EDs. Additional motivations for implementing PIT programs may include their potential to enhance patient safety, patient satisfaction, and team dynamics. In this conceptual article, we address a gap in the literature by demonstrating the mechanisms underlying PIT program results and providing a framework for ED decision-makers to assess the local rationale for, operational feasibility of, and financial impact of PIT programs.
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Affiliation(s)
| | - Kathleen Y. Li
- Institute for Healthcare Policy and InnovationUniversity of MichiganAnn ArborMichiganUSA
- Department of Emergency MedicineMichigan MedicineAnn ArborMichiganUSA
- Department of Emergency MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - David M. Somand
- Department of Emergency MedicineMichigan MedicineAnn ArborMichiganUSA
- Division of Emergency Critical CareMichigan MedicineAnn ArborMichiganUSA
| | - Keith E. Kocher
- Institute for Healthcare Policy and InnovationUniversity of MichiganAnn ArborMichiganUSA
- Department of Emergency MedicineMichigan MedicineAnn ArborMichiganUSA
| | - Steven L. Kronick
- Department of Emergency MedicineMichigan MedicineAnn ArborMichiganUSA
| | - Vikas I. Parekh
- Department of Internal MedicineMichigan MedicineAnn ArborMichiganUSA
| | - Eric Goralnick
- Department of Emergency MedicineBrigham and Women's HospitalBostonMassachusettsUSA
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - A. Tyler Nix
- Taubman Health Sciences LibraryUniversity of MichiganAnn ArborMichiganUSA
| | - Nathan L. Haas
- Department of Emergency MedicineMichigan MedicineAnn ArborMichiganUSA
- Division of Emergency Critical CareMichigan MedicineAnn ArborMichiganUSA
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Feretzakis G, Karlis G, Tsekouras K, Orfanos S, Loupelis E, Petropoulou S, Mantzouranis K, Tsafaridou M, Chatzikyriakou R, Sofianou A, Zafeiriadou P, Tika A, Dalainas I, Kaldis V. Analyzing Acute Care Surgery Patient Flow in the Emergency Department During COVID-19 Pandemic. Stud Health Technol Inform 2021; 281:540-544. [PMID: 34042634 DOI: 10.3233/shti210229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
During the COVID-19 pandemic, the number of visits in emergency departments (ED) worldwide decreased significantly based on several studies. This study aims to compare the patient flow in the emergency surgery department during the COVID-19 pandemic and a control period in the emergency department of a public tertiary care hospital in Greece. The overall patient flow reduction regarding the ED visits between the two examined periods was 49.07%. The emergency surgery department's corresponding visits were 235 and 552, respectively, which indicated an overall patient flow decrease of 57.43%. Chi-square analysis showed that age groups and ambulance use had statistically significant associations with the periods examined. An independent samples t-test was applied and deduced that the average patient's age was statistically significantly higher in the COVID-19 pandemic than in the non-pandemic period. By analyzing hospital information system data, useful conclusions can be drawn to prepare a surgical emergency unit better and optimize resource allocation in a healthcare facility in similar critical situations.
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Affiliation(s)
- Georgios Feretzakis
- School of Science and Technology, Hellenic Open University, Patras, Greece.,Sismanogleio General Hospital, IT department, Marousi, Greece.,Sismanogleio General Hospital, Department of Quality Control, Research and Continuing Education, Marousi, Greece
| | - Georgios Karlis
- Sismanogleio General Hospital, Emergency Department, Marousi, Greece
| | | | - Stamatios Orfanos
- Sismanogleio General Hospital, Emergency Department, Marousi, Greece
| | | | | | | | | | | | | | | | - Aikaterini Tika
- Sismanogleio General Hospital, Administration, Marousi, Greece
| | - Ilias Dalainas
- Sismanogleio General Hospital, Administration, Marousi, Greece
| | - Vasileios Kaldis
- Sismanogleio General Hospital, Emergency Department, Marousi, Greece
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Lin HJ, Tsai YP, Lo YC, Lin YC, Lu HJ, Hsiao CC. [Care Process Improvement in Total Knee Arthroplasty Using the Concept of Patient Flow]. Hu Li Za Zhi 2021; 68:64-72. [PMID: 34013507 DOI: 10.6224/jn.202106_68(3).09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND & PROBLEM Improving the process of care may effectively improve the quality of medical care and increase patient satisfaction. An investigation found that the process of care used in our unit was imperfect, resulting in a low preoperative enrollment rate of case managers, overly long patient waiting times for ward assignment, insufficient pre-operative knowledge, and high cancellation rates for routine operations. PURPOSE The aim of this project was to review the overall process of care using the concept of patient flow to improve and formulate countermeasures to improve quality of care. RESOLUTION To improve the process of care, the corresponding countermeasures were formulated. 1. Set criteria for enrollment for orthopedic case managers to increase the preoperative enrollment rate; 2. Set up a specialized arthroplasty care area for central case management to reduce the time patients need to wait for the ward; and 3. Improve patient compliance with preoperative education and reduce the operation cancellation rate by distributing patient education pamphlets, filming videos of pre-operative instructions, facilitating home environment preparation, and providing education on sterilization baths. RESULTS After implementation of the countermeasures, the preoperative case manager enrollment rate increased from 27.8% to 84.6%; the average ward wait time for patients reduced from 73 to 41 minutes; compliance with patient education increased from 83.0% to 100%; and the operation cancellation rate reduced from 11.1% to 0%. CONCLUSIONS This project used the concept of patient flow to review the care process used for total knee arthroplasty. This improvement strategy may be used to standardize care processes and improve the quality of medical care provided.
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Affiliation(s)
- Hsiu-Jung Lin
- BSN, RN, Assistant Head Nurse, Orthopedics Ward, Chang Gung Memorial Hospital at Chia-Yi, Taiwan, ROC
| | - Yu-Ping Tsai
- BSN, RN, Assistant Head Nurse, Operating Room, Chang Gung Memorial Hospital at Chia-Yi, Taiwan, ROC
| | - Yu-Ching Lo
- BSN, RN, Surgical Ward, Chang Gung Memorial Hospital at Chia-Yi, Taiwan, ROC
| | - Yi-Chun Lin
- BSN, RN, Emergency Room, Chang Gung Memorial Hospital at Chia-Yi, Taiwan, ROC
| | - Hsing-Ju Lu
- MSN, RN, Supervisor, Department of Nursing, Chang Gung Memorial Hospital at Chia-Yi, Taiwan, ROC.
| | - Chia-Chi Hsiao
- MSN, RN, Supervisor, Department of Nursing, Chang Gung Memorial Hospital at Chia-Yi, Taiwan, ROC
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Montazeri M, Multmeier J, Novorol C, Upadhyay S, Wicks P, Gilbert S. Optimization of Patient Flow in Urgent Care Centers Using a Digital Tool for Recording Patient Symptoms and History: Simulation Study. JMIR Form Res 2021; 5:e26402. [PMID: 34018963 PMCID: PMC8178735 DOI: 10.2196/26402] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/19/2021] [Accepted: 04/14/2021] [Indexed: 12/17/2022] Open
Abstract
Background Crowding can negatively affect patient and staff experience, and consequently the performance of health care facilities. Crowding can potentially be eased through streamlining and the reduction of duplication in patient history-taking through the use of a digital symptom-taking app. Objective We simulated the introduction of a digital symptom-taking app on patient flow. We hypothesized that waiting times and crowding in an urgent care center (UCC) could be reduced, and that this would be more efficient than simply adding more staff. Methods A discrete-event approach was used to simulate patient flow in a UCC during a 4-hour time frame. The baseline scenario was a small UCC with 2 triage nurses, 2 doctors, 1 treatment/examination nurse, and 1 discharge administrator in service. We simulated 33 scenarios with different staff numbers or different potential time savings through the app. We explored average queue length, waiting time, idle time, and staff utilization for each scenario. Results Discrete-event simulation showed that even a few minutes saved through patient app-based self-history recording during triage could result in significantly increased efficiency. A modest estimated time saving per patient of 2.5 minutes decreased the average patient wait time for triage by 26.17%, whereas a time saving of 5 minutes led to a 54.88% reduction in patient wait times. Alternatively, adding an additional triage nurse was less efficient, as the additional staff were only required at the busiest times. Conclusions Small time savings in the history-taking process have potential to result in substantial reductions in total patient waiting time for triage nurses, with likely effects of reduced patient anxiety, staff anxiety, and improved patient care. Patient self-history recording could be carried out at home or in the waiting room via a check-in kiosk or a portable tablet computer. This formative simulation study has potential to impact service provision and approaches to digitalization at scale.
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Khan N, Hafeez H, Khawaja SN. Improving the efficiency and reducing variability in patient flow in an outpatient parenteral antibiotic therapy unit of a tertiary care hospital. Future Healthc J 2021; 8:e263-e266. [PMID: 34286195 DOI: 10.7861/fhj.2020-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Outpatient parenteral administration of medications and blood transfusions using an outpatient parenteral antibiotic therapy (OPAT) unit has gradually become a standard of care. We report a continuous quality improvement project that was conducted on an OPAT unit of a tertiary care cancer hospital in Lahore, Pakistan. Prior to the initiation of the project, it was identified that 52% of the patient encounters in the OPAT unit were being delayed by a median of 63.5 minutes. A cause-and-effect analysis was performed, using a fishbone diagram, to identify the reasons for the delay in appointments. Based on the findings, several modifications were made to the processes of the OPAT unit including, but not limited to, a computerised physician order entry (CPOE) system module for prescribing, dispensing, reviewing and dispensing medications, changes in the nursing and staffing roster, and assignment of additional duties to the ward clerks. These changes resulted in improvement of waiting time to a median of 24.5 minutes and percentage delay in patient meetings decreased to 18%. Likewise, in 2019, 5,399 (27%) more patient meetings took place compared with 2018, which would have otherwise costed the hospital between 21.28 to 45.85 million Pakistani rupees. The use of continuous quality improvement techniques in the OPAT unit can result in substantial and appropriate changes in the process of patient flow, leading to measurable and significant reductions in the variability of care, and optimisation of service.
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Affiliation(s)
- Nasir Khan
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Haroon Hafeez
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Shehryar N Khawaja
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
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Mbarek HB, Aissaoui N, Bhar Layeb S, Hadj-Alouane AB. A Value Stream Mapping Analysis to improve patient flow in a Tunisian outpatient department. Tunis Med 2021; 99:531-537. [PMID: 35244902 PMCID: PMC8759318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Waiting time is often viewed as the main source of dissatisfaction in public healthcare organizations in general and outpatient departments in particular. To address this issue, one alternative is to accelerate the patient flow by identifying and reducing bottlenecks. METHODS The Value Stream Mapping (VSM) of the patient care process in a pneumology outpatient department in Tunisia allows to (i) model the process by representing its activities and the corresponding flows, (ii) identify and quantify non-value-added activities and (iii) measure the global performance by calculating the patients length of stay as well as the total percentage of added value of the process. RESULTS The current Value Stream Mapping (VSM) identified and quantified waiting times and patient movements leading to a total added value rate below 11%. The analysis revealed three root causes: an ineffective directional signage, an inappropriate appointment scheduling and an inefficient management of medical records. CONCLUSIONS The results of this study help managers to identify improvement opportunities that can accelerate patient flow. By including this study as part of a continuous improvement approach, it would be possible to periodically evaluate the performance of the process in order to monitor the outpatient pneumology department in a more efficient manner.
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Affiliation(s)
- Hana Ben Mbarek
- 1- Université de Tunis El Manar, Ecole Nationale d'Ingénieurs de Tunis -Laboratoire de Recherche OASIS-TunisTunisie
| | - Najla Aissaoui
- 1- Université de Tunis El Manar, Ecole Nationale d'Ingénieurs de Tunis -Laboratoire de Recherche OASIS-TunisTunisie
| | - Safa Bhar Layeb
- 1- Université de Tunis El Manar, Ecole Nationale d'Ingénieurs de Tunis -Laboratoire de Recherche OASIS-TunisTunisie
| | - Atidel B Hadj-Alouane
- 1- Université de Tunis El Manar, Ecole Nationale d'Ingénieurs de Tunis -Laboratoire de Recherche OASIS-TunisTunisie
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El-Bouri R, Taylor T, Youssef A, Zhu T, Clifton DA. Machine learning in patient flow: a review. Prog Biomed Eng (Bristol) 2021; 3:022002. [PMID: 34738074 PMCID: PMC8559147 DOI: 10.1088/2516-1091/abddc5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 12/13/2022]
Abstract
This work is a review of the ways in which machine learning has been used in order to plan, improve or aid the problem of moving patients through healthcare services. We decompose the patient flow problem into four subcategories: prediction of demand on a healthcare institution, prediction of the demand and resource required to transfer patients from the emergency department to the hospital, prediction of potential resource required for the treatment and movement of inpatients and prediction of length-of-stay and discharge timing. We argue that there are benefits to both approaches of considering the healthcare institution as a whole as well as the patient by patient case and that ideally a combination of these would be best for improving patient flow through hospitals. We also argue that it is essential for there to be a shared dataset that will allow researchers to benchmark their algorithms on and thereby allow future researchers to build on that which has already been done. We conclude that machine learning for the improvement of patient flow is still a young field with very few papers tailor-making machine learning methods for the problem being considered. Future works should consider the need to transfer algorithms trained on a dataset to multiple hospitals and allowing for dynamic algorithms which will allow real-time decision-making to help clinical staff on the shop floor.
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Affiliation(s)
- Rasheed El-Bouri
- Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - Thomas Taylor
- Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - Alexey Youssef
- Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - Tingting Zhu
- Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - David A Clifton
- Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
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Abstract
The CDC regularly updates guidance on COVID-19 testing for inpatients and hospital discharges to nursing homes and long-term care facilities. However, most long-term care facilities require a negative COVID-19 test result before accepting patients discharged from the hospital which directly contravenes the CDC guidelines. Due to delays in COVID-19 testing and obtaining test results, patients end up staying additional 2–3 days in the hospital before they can be discharged to nursing care facilities. Furthermore, hospitals have reported facing resistance from health insurance plans to paying for patients’ additional days in the hospital while awaiting COVID-19 test results. Hospitals across the country continue to experience an increase in hospitalizations for COVID-19 infection. Complying with the CDC guidance on testing and disposition of patients may prevent delays in transferring patients to long-term lower acuity level nursing facilities, reduce the length of hospital stay, improve patient flow and ultimately free up hospital beds for incoming COVID-19 patients.
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Affiliation(s)
- Titilope Olanipekun
- Department of Internal Medicine, Covenant Health System, Knoxville, Tennessee, USA
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Dos Santos Andrade LS, De Melo Santos TT, Case de Oliveira ME, Lima Gomes KA, Araújo Pereira Soares AR, Almeida de Oliveira T, Weller M. Shorter delay to treatment by integrated diagnostic services and NGO-provided support among breast cancer patients in two Brazilian referral centres. J Public Health Res 2021; 10:1880. [PMID: 33709643 PMCID: PMC8314677 DOI: 10.4081/jphr.2021.1880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 03/06/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The diagnosis of breast cancer requires a complicated series of diagnostic exams. The present study addressed the delay of patients who used publicly and privately financed diagnostic services. Non-governmental organizations (NGOs) donated diagnostic mammograms and biopsies. DESIGN AND METHODS Data from 304 patients were obtained from two Brazilian referral centres. In one referral centre (FAP), diagnostic mammography, clinic-histopathological exam and immunohistochemistry were outsourced, whereas in the other centre (HNL), these services were integrated. Cox regression, Kaplan-Meier analysis and non-parametric tests were used to compare variables and time intervals. RESULTS If diagnostic mammography was financed privately and covered by private health insurance, the likelihood of a delay of >90 days between the first medical visit and the initiation of treatment decreased 2.15-fold (95%CI: 1.06- 4.36; p=0.033) and 4.44-fold (95%CI: 1.58-12.46; p=0.004), respectively. If the clinic-histopathological exam was outsourced (FAP) and publicly or privately financed, the median time between diagnostic mammography and the diagnostic result was 53 and 65 days in the integrated (HNL) and outsourced public system, compared to 29 days in the outsourced private system (p<0.050). The median time between the first medical visit and the diagnostic results of patients who were supported by NGOs, who financed their diagnostic services privately, and who used exclusively public diagnostic services was, respectively, 28.0, 48.5 and 77.5 days (p<0.050). CONCLUSION Patients who used privately financed health services had shorter delays. Compared to outsourcing, the integration of the publicly financed clinic- histopathological exam diminished the delay. The support of patients by NGOs accelerated patient flow.
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Affiliation(s)
| | | | | | - Kedma Anne Lima Gomes
- Post Graduate Program in Public Health, State University of Paraíba (UEPB), Campina Grande-Paraíba.
| | | | | | - Mathias Weller
- Post Graduate Program in Public Health, State University of Paraíba (UEPB), Campina Grande-Paraíba.
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Abstract
OBJECTIVE To review the literature on common issues impacting psychiatric patient flow in emergency departments (EDs) and to explore evidence-based solutions proposed to improve patient flow. METHODS The review was divided into three parts and a broad array of keywords were chosen to achieve greater depth in the review. Administrative data and organisational publications were included along with peer-reviewed articles in various databases. RESULTS Psychiatric patients have increased ED length of stay (EDLOS) and the proportion of psychiatric presentations in ED has increased significantly.1 Several factors contributed to increased EDLOS. Introduction of psychiatric short stay units,2 improving patient flow3 and appropriate increase in beds were identified as some of the possible solutions to improve patient flow. CONCLUSION Psychiatric patient flow in ED is a complex issue and needs a coordinated approach to improve access. Future studies should focus on understanding the effectiveness of some of the proposed strategies.
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Daniel C, Mukaro V, Yap CYL, C Knott J, Kelly P, Innes A, Braitberg G, Gerdtz M. Characteristics and clinical outcomes for mental health patients admitted to a behavioural assessment unit: Implications for model of care and practice. Int J Ment Health Nurs 2021; 30:249-260. [PMID: 32929864 DOI: 10.1111/inm.12779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/15/2020] [Accepted: 08/04/2020] [Indexed: 11/30/2022]
Abstract
Behavioural assessment units (BAU) have been established in emergency departments (EDs) to provide short-term observation, treatment, and care to people experiencing acute behavioural disturbance. A prospective observational study was conducted in a cohort of adult patients admitted to one BAU located within an ED (July-December 2017) to compare clinical characteristics, treatment outcomes, and use of restrictive interventions for those who received a specialist mental health (MH) assessment with those who did not. Of the 457 patients, 61.5% received a specialist MH assessment. This group had a lower acuity (Australasian Triage Score 10.4%; CI 0.2-2.0% vs 13.6%; CI 9.3-19.5%); more arrived with police (28.8%; CI 23.8-34.3 vs 5.1%; CI 2.7-9.4%); and were subjected to restrictive interventions while in the BAU. Security responses for unarmed threat (code grey) were higher (10.9%; CI 7.8-15.0% vs 4.4%; CI 2.3-8.5%), as was the use of chemical restraint (4.2%; CI 2.4-7.2 vs 0.0% CI 0.0 - 2.1%). Those requiring specialist MH assessment had a longer length of stay (12.7 vs 5.2 hours). Further development of the BAU model of care must include targeted, evidence-based strategies to minimize the use of restrictive interventions and ensure timely access to acute mental health services.
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Affiliation(s)
- Catherine Daniel
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Melbourne Health, Parkville, Victoria, Australia.,Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Violet Mukaro
- Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Celene Y L Yap
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jonathan C Knott
- Emergency Department, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Melbourne Health, Parkville, Victoria, Australia.,Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter Kelly
- Melbourne Health, Parkville, Victoria, Australia
| | - Andrew Innes
- Emergency Department, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - George Braitberg
- Melbourne Health, Parkville, Victoria, Australia.,Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marie Gerdtz
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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Marin-Garcia JA, Vidal-Carreras PI, Garcia-Sabater JJ. The Role of Value Stream Mapping in Healthcare Services: A Scoping Review. Int J Environ Res Public Health 2021; 18:ijerph18030951. [PMID: 33499116 PMCID: PMC7908358 DOI: 10.3390/ijerph18030951] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/04/2021] [Accepted: 01/15/2021] [Indexed: 12/16/2022]
Abstract
Lean healthcare aims to manage and improve the processes in the healthcare sector by eliminating everything that adds no value by improving quality of services, ensuring patient safety and facilitating health professionals’ work to achieve a flexible and reliable organization. Value Stream Mapping (VSM) is considered the starting point of any lean implementation. Some papers report applications of VSM in healthcare services, but there has been less attention paid to their contribution on sustainability indicators. The purpose of this work is to analyze the role of VSM in this context. To do so, a scoping review of works from recent years (2015 to 2019) was done. The results show that most applications of VSM reported are in the tertiary level of care, and the United States of America (USA) is the country which leads most of the applications published. In relation with the development of VSM, a heterogeneity in the maps and the sustainability indicators is remarkable. Moreover, only operational and social sustainability indicators are commonly included. We can conclude that more standardization is required in the development of the VSM in the healthcare sector, also including the environmental indicators.
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Elgen I, Lygre R, Greve G, Griffiths S, Heggestad T. Interdisciplinary Approaches Suggested for Children With Multiple Hospital Referrals Presenting With Non-specific Conditions. Front Pediatr 2021; 9:656939. [PMID: 33898364 PMCID: PMC8058187 DOI: 10.3389/fped.2021.656939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/11/2021] [Indexed: 11/13/2022] Open
Abstract
Aims: To describe the care patterns of patients with repeated referrals to both mental and somatic specialist healthcare, and to study their diagnostic processes. Methods: In a previous register study patients aged 6-12 years referred to Haukeland University Hospital from 2013 to 2015, we found 922 children with at least three referrals including both somatic and mental health services. Of these, more than one in four (250) were randomly selected and observed from their first hospital episode ever and further after inclusion followed during their next three referrals or until July 2017. Data on referral patterns and diagnostics were collected from patient hospital records. Results: Mean number of referrals was 6.5 prior to inclusion and 4.2 in the follow-up period. At the end of the study period 15% of patients still had a non-specific diagnosis. During the follow-up period, more than half of the children were again referred across the border between somatic and mental healthcare. Conclusion: Very complex care patterns were found for these patients, who were repeatedly being referred and "crossing over" between mental and somatic healthcare. This indicates a need for more interdisciplinary-based approaches both within specialist care and between different care levels to broaden the perspective and achieve shorter time lag before reaching a diagnostic conclusion. Trial Registration: Data was obtained from Haukeland university hospital the patient registry system No. 2017/12470. Start of registration was April 1th 2017 and patients included was from 2013 to 15.
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Affiliation(s)
- Irene Elgen
- Division of Psychiatry, Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ragnhild Lygre
- Division of Psychiatry, Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Gottfried Greve
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Silja Griffiths
- Department of Child and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Torhild Heggestad
- Department of Research & Development, Haukeland University Hospital, Bergen, Norway
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Heggestad T, Greve G, Skilbrei B, Elgen I. Complex care pathways for children with multiple referrals demonstrated in a retrospective population-based study. Acta Paediatr 2020; 109:2641-2647. [PMID: 32159873 DOI: 10.1111/apa.15250] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/05/2020] [Accepted: 03/09/2020] [Indexed: 11/29/2022]
Abstract
AIM To identify children with complex medical needs by examining their patterns of hospital care. METHODS We conducted a retrospective population-based study on 18 577 patients aged 6-12 years from the Haukeland University Hospital register over a 3-year period (from 2013 to 2015). Data were structured to examine the temporal patterns and sequences of referrals, care episodes and diagnoses, including flow across medical specialties. RESULTS Over a third of patients had repeated referrals, and 14.9% of all had three or more. Furthermore, 9.3% of patients were referred to both somatic and mental healthcare services. Patients with such combined referrals had a higher number of referrals as well as a higher number of different diagnoses. Overall, there was a high frequency of non-specific diagnoses, and 34.8% of patients still had a non-specific main diagnosis at the end of their hospital contact. CONCLUSION This study demonstrates an increased risk for complex care pathways in children with multiple referrals. Interdisciplinary patterns of referrals were relatively common, particularly for patients in mental health care. These findings highlight the importance of developing interdisciplinary-based approaches for patients with complex complaints.
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Affiliation(s)
- Torhild Heggestad
- Department of Research and Development Haukeland University Hospital Bergen Norway
| | - Gottfried Greve
- Department of Heart Disease Haukeland University Hospital Bergen Norway
- Department of Clinical Science University of Bergen Bergen Norway
| | - Birger Skilbrei
- Department of Research and Development Haukeland University Hospital Bergen Norway
| | - Irene Elgen
- Department of Clinical Medicine University of Bergen Bergen Norway
- Department of Child and Adolescent Psychiatry Division of Mental Health Haukeland University Hospital Bergen Norway
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Fujimoto A, Sato K, Enoki H. Change in Patient Flow in the Epilepsy Care Network Due to Novel Coronavirus Infection: An Opportunity to Strengthen Local Interdisciplinary Epilepsy Care With General Physicians. Front Neurol 2020; 11:591423. [PMID: 33304311 PMCID: PMC7701112 DOI: 10.3389/fneur.2020.591423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/16/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction: Novel coronavirus disease 2019 (COVID-19) infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is spreading worldwide. We hypothesized that patient flow in epilepsy care would change as a result of the COVID-19 pandemic. The purpose of this study was to compare the number of patients who visited our epilepsy center before and during the first peak of the pandemic. Methods: We recorded the number of patients with epilepsy referred from general physicians (GPs) to our hospital (GP-H group), the number of patients who visited our hospital on a regular basis (R group), and the number of patients referred from our hospital to GPs (H-GP group) between July 2019 and June 2020. Results: A total of 1,839 epilepsy patients made 4,197 visits to our hospital: 979 males and 860 females (age range, 0-94 years; mean age, 37.6 years; median age, 34 years). There were 433 patients in the GP-H group (247 before the pandemic, 186 during the first peak of the pandemic; p = 0.008). In the R group, 1,406 patients made 3,764 visits (1,992 visits before the pandemic, 1,772 during the first peak of the pandemic). In the H-GP group, 135 patients were referred to GPs (47 patients before the pandemic, 88 patients during the first peak of the pandemic; p = 0.023). Conclusion: Patient flow in the epilepsy care network changed as a result of the COVID-19 pandemic. These changes might present an opportunity to strengthen local interdisciplinary epilepsy care.
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Affiliation(s)
- Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
- Departments of Neurosurgery, Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Keishiro Sato
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
- Departments of Neurology, Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Hideo Enoki
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
- Departments of Pediatric Neurology, Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
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Bacelar-Silva GM, Cox JF, Rodrigues PP. Outcomes of managing healthcare services using the Theory of Constraints: A systematic review. Health Syst (Basingstoke) 2020; 11:1-16. [PMID: 35127055 PMCID: PMC8812771 DOI: 10.1080/20476965.2020.1813056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022] Open
Abstract
Despite ever-increasing resources devoted to healthcare, lack of capacity and timeliness are still chronic problems worldwide. This systematic review aims to present an overview of the Theory of Constraints (TOC) implementations in healthcare services and their outcomes. We analysed 42 TOC implementations (15 full-text articles, 12 video proceedings, and 2 theses/disserations) from major scientific electronic databases and TOC International Certification Organization Conferences. All implementations reported positive outcomes, both tangible and intangible. The two main improvements reported by authors were in productivity (98%; n = 41) - more patients treated - and in the timeliness of care (83%; n = 35). Furthermore, the selected studies reported dramatic improvements: 50% mean reductions in patient waiting time; 38% reduction in patient length of stay; 43% mean increase in operating room productivity and 34% mean increase in throughput. TOC implementations attained positive results in all levels of the health and social care chain. Most TOC recommendations and changes showed almost immediate results and required little or no additional cost to implement. Evidence supports TOC as a promising solution for the chronic healthcare problem, improving quality and timeliness, both necessary conditions for providing effective healthcare.
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Affiliation(s)
- Gustavo M Bacelar-Silva
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine (MEDCIDS-FMUP), University of Porto, Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Department of Distance Learning, Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - James F Cox
- Management Department, Terry College of Business, University of Georgia, Athens, GA, USA
| | - Pedro Pereira Rodrigues
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine (MEDCIDS-FMUP), University of Porto, Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
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45
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Petrie DA, Comber S. Emergency Department access and flow: Complex systems need complex approaches. J Eval Clin Pract 2020; 26:1552-1558. [PMID: 32496003 DOI: 10.1111/jep.13418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 05/10/2020] [Indexed: 12/01/2022]
Affiliation(s)
- David A Petrie
- Faculty of Medicine, Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Scott Comber
- School of Business, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Kim KP, Park YR, Lee JB, Kim HR, Lyu Y, Kim JE, Hong YS, Lee JL, Kim TW. Evaluating waiting time with real-world health information in a high-volume cancer center. Medicine (Baltimore) 2020; 99:e21796. [PMID: 32991401 PMCID: PMC7523863 DOI: 10.1097/md.0000000000021796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Wait time and scheduling for outpatient chemotherapy administration depends on various factors including infusion room hours of operation, availability of oncologists, nursing and pharmacy staffing, and physical space limitations. The aim of this study was to use the electronic event log of patients on health information system (HIS) to map and analyze patient flow in advanced metastatic colorectal patients at an academic cancer center. From January 2009 to December 2014, patients who were diagnosed with metastatic colorectal cancer and received outpatient chemotherapy confined to FOLFIRI (fluorouracil, leucovorin, and irinotecan) or FOLFOX (folinic acid, fluorouracil, and oxaliplatin) were identified. From the HIS, patient flow was mapped by collection of event records including blood collection and pretreatment laboratory test, arrival to outpatient clinics, outpatient session (interview, drug accountability and appointment scheduling), and initiation of chemotherapy. A total of 10,638 patients were analyzed for 136,281 outpatient visits. The total office stay time from outpatient registration to initiation of chemotherapy was 92.58 ± 87.96 (mean ± standard deviation) minutes. Each outpatient session lasted 23.75 ± 51.55 minutes. After completing the outpatient session, patients waited 1,657.23 ± 3,027.65 minutes before chemotherapy and 46.66 ± 75.94 minutes within infusion room. Compared to the prior first come first serve rule, the new reservation system showed an improvement in overall waiting time from 2,432.3 ± 4,822.9 to 2,386.7 ± 143.4 minutes; however, waiting time within infusion room slightly increased from 36.68 ± 49.33 to 48.13 ± 46.32 minutes. Our findings indicate that transaction data analytics from HIS can be used to evaluate patient flow within oncology outpatient practice based on real-world hospital data.
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Affiliation(s)
- Kyu-pyo Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine
| | - Yu Rang Park
- Department of Biomedical Systems Informatics Yonsei University College of Medicine
| | | | - Hae Reong Kim
- Department of Biomedical Systems Informatics Yonsei University College of Medicine
| | - Yongman Lyu
- Clinical Research Center, Asan Medical Center, Seoul, Korea
| | - Jeong-Eun Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine
| | - Yong Sang Hong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine
| | - Jae-Lyun Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine
| | - Tae Won Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine
- Clinical Research Center, Asan Medical Center, Seoul, Korea
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Saleh R, Makki M, Tamim H, Hitti E. The Impact of Ramadan on Patient Attendance Patterns in an Emergency Department at a Tertiary Care Center in Beirut, Lebanon. J Emerg Med 2020; 59:720-725. [PMID: 32921541 DOI: 10.1016/j.jemermed.2020.06.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/03/2020] [Accepted: 06/06/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Emergency departments (EDs) worldwide experience substantial variability in hourly patient arrivals. The month of Ramadan represents a repetitive annual occurrence, which could be associated with distinct patient arrival patterns compared with other months of the year. OBJECTIVE This study examined hourly patient arrival patterns and patient characteristics in an ED in a tertiary care center in Beirut, Lebanon to determine whether there are significant changes in patient attendance patterns during the month of Ramadan. METHODS Data on patients presenting to the ED during the month of Ramadan with those presenting 1 month prior to and 1 month after, between 2012 and 2018, were accounted for in the study. Pearson chi-squared test was used in the bivariate analysis, whereas Student's t-test was used to compare continuous variables. RESULTS Patient attendance patterns significantly varied between Ramadan and non-Ramadan periods (p < 0.0001). Patient flow dropped starting at 8:00 am, with the greatest drop between 6:00 pm and 9:00 pm, and increased in the early morning hours between 2:00 am and 4:00 am (p < 0.0001). The total number of visits per day significantly decreased in Ramadan compared with non-Ramadan periods (135.6 ± 14.74 vs. 145.5 ± 18.90, p-value < 0.0001), whereas length of stay decreased slightly. CONCLUSION We found a drop in daily ED visits during Ramadan, in addition to a distinct pattern of patient arrivals. ED administrators should consider different scheduling arrangements for nurses and physicians during this period in EDs that serve communities where Ramadan is commonly observed.
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Affiliation(s)
- Rana Saleh
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maha Makki
- Clinical Research Institute, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- Clinical Research Institute, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Eveline Hitti
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Zepeda-Lugo C, Tlapa D, Baez-Lopez Y, Limon-Romero J, Ontiveros S, Perez-Sanchez A, Tortorella G. Assessing the Impact of Lean Healthcare on Inpatient Care: A Systematic Review. Int J Environ Res Public Health 2020; 17:ijerph17155609. [PMID: 32759705 PMCID: PMC7432925 DOI: 10.3390/ijerph17155609] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/23/2020] [Accepted: 07/29/2020] [Indexed: 12/16/2022]
Abstract
Healthcare services are facing challenges in increasing their efficiency, quality of care, and coping with surges in demand. To this end, some hospitals have implemented lean healthcare. The aim of this systematic review is to evaluate the effects of lean healthcare (LH) interventions on inpatient care and determine whether patient flow and efficiency outcomes improve. The review was performed according to PRISMA. We used six databases to search for studies published from 2002 to 2019. Out of 5732 studies, 39 measuring one or more defined outcomes were included. Hospital length of stay (LOS) was measured in 23 studies, 16 of which reported a reduction, turnover time (TOT) decreased in six out of eight studies, while the turnaround time (TAT) and on-time starts (OTS) improved in all five and seven studies, respectively. Moreover, eight out of nine studies reported an earlier discharge time, and the boarding time decreased in all four cases. Meanwhile, the readmission rate did not increase in all nine studies. Lastly, staff and patient satisfaction improved in all eight studies. Our findings show that by focusing on reducing non-value-added activities, LH contributed to improving patient flow and efficiency within inpatient care.
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Affiliation(s)
- Carlos Zepeda-Lugo
- Facultad de Ingeniería, Arquitectura y Diseño, Universidad Autónoma de Baja California, Ensenada 22860, Mexico; (C.Z.-L.); (J.L.-R.)
| | - Diego Tlapa
- Facultad de Ingeniería, Arquitectura y Diseño, Universidad Autónoma de Baja California, Ensenada 22860, Mexico; (C.Z.-L.); (J.L.-R.)
- Correspondence: (D.T.); (Y.B.-L.); Tel.: +52-6461750744 (D.T.)
| | - Yolanda Baez-Lopez
- Facultad de Ingeniería, Arquitectura y Diseño, Universidad Autónoma de Baja California, Ensenada 22860, Mexico; (C.Z.-L.); (J.L.-R.)
- Correspondence: (D.T.); (Y.B.-L.); Tel.: +52-6461750744 (D.T.)
| | - Jorge Limon-Romero
- Facultad de Ingeniería, Arquitectura y Diseño, Universidad Autónoma de Baja California, Ensenada 22860, Mexico; (C.Z.-L.); (J.L.-R.)
| | - Sinue Ontiveros
- Facultad de Ciencias de la Ingeniería, Administrativas y Sociales, Universidad Autónoma de Baja California, Tecate 21460, Mexico;
| | - Armando Perez-Sanchez
- Facultad de Ciencias de la Ingeniería y Tecnología, Universidad Autónoma de Baja California, Tijuana 22260, Mexico;
| | - Guilherme Tortorella
- Department of Systems and Production Engineering, Universidade Federal de Santa Catarina, Florianópolis 88040, Brazil;
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Papp C, Harsanyi S, Gesztelyi R, Emri M, Zsuga J. Assessment of patient flow and optimized use of lean thinking transformation from the perspective of graph theory and spectral graph theory: A case study. Technol Health Care 2020; 29:199-211. [PMID: 32568129 DOI: 10.3233/thc-191782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hospital re-engineering initiatives aiming to meet the requirement for patient-centered care often face significant barriers. Opportunities from the optimization of patient flow logistics are often overlooked due to the perception that patient transport related services are ancillary. OBJECTIVES To reorganize patient pathways by optimizing inpatient assignment and outpatient unit relocation. METHODS Our analysis was conducted in a campus-based hospital hosting 1694 inpatient beds. Patient flow data was used for algorithm-based optimization to minimize the sum of the distances due to visits to outpatient units and visits by consulting physicians. Inpatients were reordered and outpatient units were relocated to minimize transport need. Optimized schemes were analyzed using graph- and spectral graph theory. RESULTS Both optimizations yielded an altered hospital layout in which the need for patient transfers decreased (over 30% and 23% in terms of total distance and transfer episodes, respectively). The optimized systems gave rise to buildings with greater specialization, higher importance in terms of contributing to the network architecture, greater synchronization and robustness. CONCLUSIONS The top-down algorithm-based optimization scheme yielded a system in which the need for cross-building patient transfer decreased. We suggest that network analysis may be a useful tool for capacity planning.
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Affiliation(s)
- Csaba Papp
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Szilvia Harsanyi
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Rudolf Gesztelyi
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Miklos Emri
- Department of Medical Imaging, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Judit Zsuga
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
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Kreindler SA, Star N, Hastings S, Winters S, Johnson K, Mallinson S, Brierley M, Goertzen LN, Anwar MR, Aboud Z. "Working Against Gravity": The Uphill Task of Overcapacity Management. Health Serv Insights 2020; 13:1178632920929986. [PMID: 32587459 PMCID: PMC7294368 DOI: 10.1177/1178632920929986] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/04/2020] [Indexed: 11/17/2022] Open
Abstract
While most health systems have implemented interventions to manage situations in which patient demand exceeds capacity, little is known about the long-term sustainability or effectiveness of such interventions. A large multi-jurisdictional study on patient flow in Western Canada provided the opportunity to explore experiences with overcapacity management strategies across 10 diverse health regions. Four categories of interventions were employed by all or most regions: overcapacity protocols, alternative locations for emergency patients, locations for discharge-ready inpatients, and meetings to guide redistribution of patients. Two mechanisms undergirded successful interventions: providing a capacity buffer and promoting action by inpatient units by increasing staff accountability and/or solidarity. Participants reported that interventions demanded significant time and resources and the ongoing active involvement of middle and senior management. Furthermore, although most participants characterized overcapacity management practices as effective, this effectiveness was almost universally experienced as temporary. Many regions described a context of chronic overcapacity, which persisted despite continued intervention. Processes designed to manage short-term surges in demand cannot rectify a long-term mismatch between capacity and demand; solutions at the level of system redesign are needed.
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Affiliation(s)
- Sara A Kreindler
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg Regional Health Authority/University of Manitoba, Winnipeg, MB, Canada
| | - Noah Star
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Stephanie Hastings
- Health Systems Evaluation & Evidence, Alberta Health Services, Calgary, AB, Canada
| | - Shannon Winters
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg Regional Health Authority/University of Manitoba, Winnipeg, MB, Canada
| | - Keir Johnson
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg Regional Health Authority/University of Manitoba, Winnipeg, MB, Canada
| | - Sara Mallinson
- Health Systems Evaluation & Evidence, Alberta Health Services, Calgary, AB, Canada
| | - Meaghan Brierley
- Health Systems Evaluation & Evidence, Alberta Health Services, Calgary, AB, Canada
| | | | | | - Zaid Aboud
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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