Health care management science
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Ambulatory Care facilities (often referred to as diagnosis and treatment centres) separate the routine elective activity from the uncertainty of complex inpatient and emergency treatment. Only routine patients with predictable outcomes should be treated in Ambulatory Care. Hence the centre should be able to plan its activities effectively. ⋯ The adoption of Ambulatory Care will increase the proportion of day case treatment but the reduction in the overall bed requirement will be relatively small (at most 10%). Separating the elective theatre activity into day case and inpatient sessions will tend to produce inpatient theatre sessions with a disproportionate number of longer procedures. This can reduce overall theatre utilisation by up to 15%, which implies the need for an increase of up to 18% in the number of theatre sessions if waiting times are to be maintained.
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This paper presents a model for optimizing admissions to an intensive care unit (ICU) where the objective is to maximize the expected incremental number of lives saved from operating the ICU. The probability distribution of the number of occupied ICU beds is modeled using queueing theory. ⋯ After statistically estimating the distribution of expected incremental survival benefits among those referred to the ICU, we show that if only those referrals where ICU admission would improve the probability of survival by at least 19.4 percentage points were admitted, an additional 18 statistical lives would be saved annually compared to the FCFS policy, a relative life saving improvement of 17.9%. Implementing the more complex optimal bed specific hurdle policy would save an additional 1.4 statistical lives annually beyond what can be achieved with FCFS-H, a marginal improvement of only 1.2%.
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Health Care Manag Sci · May 2003
Analytical methods for calculating the capacity required to operate an effective booked admissions policy for elective inpatient services.
In the UK, hospitals are being encouraged to introduce booked admissions policies for elective inpatient services whereby patients are given a date for hospital admission months in advance rather than being put on a waiting list and then informed of their admission date at short notice. We address the question of what level of capacity is required to operate such a system if cancellations of booked elective patients are to be kept to a low level. Methods are presented for quantifying the day to day variation in bed demand due to emergency admissions, patient initiated cancellations and variable lengths of stay amongst patients.
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This paper describes a model that can forecast the daily number of occupied beds due to emergency admissions in an acute hospital. Out of sample forecasts 32 day days in advance. have an RMS error of 3% of the mean number of beds used for emergency admissions. ⋯ We find that a period of high volatility, indicated by GARCH errors, will result in an increase in waiting times in the A&E Department. Furthermore. volatility gives more warning of waiting times in A&E than total bed occupancy.
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This paper introduces the problem of scheduling emergency room physicians. We interviewed physicians from six hospitals in the greater Montreal, Canada area, in order to understand the emergency room scheduling problem. ⋯ We present the characteristics of the scheduling problem and the scheduling techniques currently used in the six emergency rooms we analyzed. Using the scheduling problems of Charles-Lemoyne Hospital and the Jewish General Hospital, we show how to modify a hospital's existing scheduling rules to develop techniques which produce better schedules and reduce the time needed to build them.