Health care management science
-
Health Care Manag Sci · Mar 2014
An IP-based healthcare provider shift design approach to minimize patient handoffs.
The new Accreditation Council for Graduate Medical Education (ACGME) duty-hour standards for residents and fellows went into effect in 2011. These regulations were designed to reduce fatigue-related medical errors and improve patient safety. The new shift restrictions, however, have led to more frequent transitions in patient care (handoffs), resulting in greater opportunity for communication breakdowns between caregivers, which correlate with medical errors and adverse events. ⋯ This research leverages integer programming methods to design a work shift schedule for trainees that minimizes patient handoffs while complying with all ACGME duty-hour standards, providing required coverage, and maintaining physician quality of life. In a case study of redesigning the trainees' schedule for a Mayo Clinic Medical Intensive Care Unit (MICU), we show that the number of patient handoffs can be reduced by 23 % and still meet all required and most desired scheduling constraints. Furthermore, a 48 % reduction in handoffs could be achieved if only the minimum required rules are satisfied.
-
Health Care Manag Sci · Mar 2014
Estimating the waiting time of multi-priority emergency patients with downstream blocking.
To characterize the coupling effect between patient flow to access the emergency department (ED) and that to access the inpatient unit (IU), we develop a model with two connected queues: one upstream queue for the patient flow to access the ED and one downstream queue for the patient flow to access the IU. Building on this patient flow model, we employ queueing theory to estimate the average waiting time across patients. ⋯ Finally, we investigate how an alternative way of accessing ED (Fast Track) impacts the average waiting time of patients as well as the necessary number of ED/IU resources. This model as well as the analysis on patient flow can help the designer or manager of a hospital make decisions on the allocation of ED/IU resources in a hospital.