Health care management science
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Health Care Manag Sci · Jun 2007
Modeling the emergency cardiac in-patient flow: an application of queuing theory.
This study investigates the bottlenecks in the emergency care chain of cardiac in-patient flow. The primary goal is to determine the optimal bed allocation over the care chain given a maximum number of refused admissions. Another objective is to provide deeper insight in the relation between natural variation in arrivals and length of stay and occupancy rates. ⋯ An important result is that refused admissions at the First Cardiac Aid (FCA) are primarily caused by unavailability of beds downstream the care chain. Both variability in LOS and fluctuations in arrivals result in large workload variations. Techniques from operations research were successfully used to describe the complexity and dynamics of emergency in-patient flow.
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In this paper we develop a three-phase, hierarchical approach for the weekly scheduling of operating rooms. This approach has been implemented in one of the surgical departments of a public hospital located in Genova (Genoa), Italy. Our aim is to suggest an integrated way of facing surgical activity planning in order to improve overall operating theatre efficiency in terms of overtime and throughput as well as waiting list reduction, while improving department organization. ⋯ Lastly, once the MSS has been determined we use the simulation software environment Witness 2004 in order to analyze different sequencings of surgical activities that arise when priority is given on the basis of a) the longest waiting time (LWT), b) the longest processing time (LPT) and c) the shortest processing time (SPT). The resulting simulation models also allow us to outline possible organizational improvements in surgical activity. The results of an extensive computational experimentation pertaining to the studied surgical department are here given and analyzed.
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Health Care Manag Sci · Feb 2007
Optimization of surgery sequencing and scheduling decisions under uncertainty.
Operating rooms (ORs) are simultaneously the largest cost center and greatest source of revenues for most hospitals. Due to significant uncertainty in surgery durations, scheduling of ORs can be very challenging. Longer than average surgery durations result in late starts not only for the next surgery in the schedule, but potentially for the rest of the surgeries in the day as well. ⋯ We focus on the simultaneous effects of sequencing surgeries and scheduling start times. We show that a simple sequencing rule based on surgery duration variance can be used to generate substantial reductions in total surgeon and OR team waiting, OR idling, and overtime costs. We illustrate this with results of a case study that uses real data to compare actual schedules at a particular hospital to those recommended by our model.
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Health Care Manag Sci · Nov 2006
Observational study of operating room times for knee and hip replacement surgery at nine U.S. community hospitals.
Knee (N = 185) and hip (N = 140) replacement cases were studied at nine community hospitals in the midwestern United States to determine whether certain management interventions could decrease case durations and reduce labor costs. Substantive (10 min) reductions in operating room (OR) time per case were not associated with: 1) increases in OR staffing, such as the addition of a surgical assistant; 2) complete elimination of all delays; or 3) increases in anesthesiologists' presence in the ORs. ⋯ Even if these factors had been associated with differences in OR time per case, any changes resulting from management interventions would still not have reduced labor costs. At these hospitals, OR nursing and anesthesia labor costs were fixed costs, because the OR workload averaged only 5.6 hr of cases per day.
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Health Care Manag Sci · Feb 2006
Impact of surgical sequencing on post anesthesia care unit staffing.
This paper analyzes the impact of sequencing rules on the phase I post anesthesia care unit (PACU) staffing and over-utilized operating room (OR) time resulting from delays in PACU admission. The sequencing rules are applied to each surgeon's list of cases independently. Discrete event simulation shows the importance of having a sufficient number of PACU nurses. ⋯ The best rules are those that smooth the flow of patients entering in the PACU (HIHD (Half Increase in OR time and Half Decrease in OR time) and MIX (MIX OR time)). We advise against using the LCF (Longest Cases First) and equivalent sequencing methods. They generate more over-utilized OR time, require more PACU nurses during the workday, and result in more days with at least one delay in PACU admission.