Simulation and Queuing
In this presentation, Lou Keller calls on 45 years of experience dealing with every manner of healthcare planning, management, design, control and implementation problem to paint a compelling and entertaining picture, not just of the critical differences between healthcare and all other management systems, but how to use an in-depth understanding and appreciation of those differences to achieve continual and lasting healthcare process improvement.
Dr. Crane addresses a host of issues in this article for improving ED performance including the application of queuing theory, demand matching, and more frequent budgeting.
Have you lost that disk from your college days that had a queuing theory calculator on it? There is at least one online queuing theory calculator that may meet your needs in your next queuing analysis.
As healthcare costs continue to rise and providers move towards patient-center care and measurable outcomes, healthcare organizations have sought out new tools to contain costs and attain these goals. Consequently, the demand for simulation has been rising rapidly based on prior success in other industries. This presentation will cover the statistical methodology used in discrete event simulation, model development, and common applications review of conceptual and algorithmic logic behind simulation.
The authors of this presentation describe how industrial engineering research improved patient access and reduced cost by applying a machine learning simulation approach at Grady Health System in Atlanta.
This article in the Perkins+Will Research Journal shows a process modeling approach to defining the size of waiting spaces in a medical office building in the Southeast.
This article discusses about systems engineering's concepts and some applications including therapeutic optimization and hospital operations modeling with an objective to bridge the gap between systems engineering and healthcare. This is an excellent resource for those interested to learn about applications of Systems Engineering in healthcare.
This article describes the application of discrete-event simulation skills to enhance the efficiency of healthcare system, reduce costs and increase patient satisfaction at Mayo Clinic. According to Dr. Sarah Lam, associate professor of systems science and industrial engineering at Binghampton University, "Discrete-event simulation is a technique that enables the user to evaluate the efficiency of existing healthcare delivery systems, to ask "what if" questions and to design new systems."
This presentation was originally delivered at the Society for Health System's Healthcare Systems Process Improvement Conference 2013 in New Orleans. Shands Healthcare's Management Engineering was asked to model the impact to resource utilization of the Pre-Op/PACU/OR area resulting from relocating the current GI/ENDO procedure suites from North to South Tower. A dynamic simulation model was developed as the most effective and timely method to model the current operational state plus three future growth scenarios.
Allocating limited inpatient bed capacity
Many academic hospitals struggle to maintain a mix of patients that satisfies their teaching, research, and financial needs. One such hospital received dispensation from the government to partition its inpatient beds into wings. Each wing is allocated a fixed number of beds and can admit only a fixed set of clinical specialties. This presentation delivered at the 2012 Healthcare Systems Improvement Conference describes how a model was developed to investigate how best to form wings so as to optimize patient mix.
Real-time forecasting of pediatric intensive care unit length of stay using computerized provider orders
The authors conducted a retrospective cohort study to describe a model to provide real-time, updated forecasts of patients' intensive care unit length of stay using naturally generated provider orders. The study was based on more than 2,000 admissions to a pediatric intensive care unit. The model was designed to be integrated within a computerized decision support system to improve patient flow management.
This article examines the journey from a reactive to a proactive culture by a team of frontline clinical leaders managing capacity and staffing in a 600-bed New Zealand Hospital.
Over the last several years, opportunities for use of simulation in our healthcare industry is steadily increasing. Simulation packages are used commonly for insights to improve patient flow, medical supply distribution and overall staff/resource utilization. They enable a Lean/PI to team to view current states and modify future states of these processes in a dynamic and “safe” environment. Here, Daniel J Barata, P.E. shares some general tips/guidelines for setting-up and executing simulation projects within Healthcare. Daniel J. Barata, P.E., MBA, is a professionally licensed industrial engineer with more than 18 years of experience applied in process and system improvement. He currently serves as director of healthcare systems for Efficiency Engineers where he manages, develops and implements improvement programs within the healthcare industry. You can contact Daniel at firstname.lastname@example.org.
North Carolina State University technicianonline.com describes how N.C. State students and faculty from the Edward P. Fitts Department of Industrial and Systems Engineering are working on research to improve inventory management in hospitals. The article also describes the complexity of managing hospital supply and medication inventory.
A recent feature in Binghamton's Watson Review describes ongoing healthcare improvement research at the Watson Institute for Systems Excellence (WISE). Ongoing healthcare research at WISE includes research in ED throughput and supply chain. WISE researchers collaborate with a number of hospital systems including Vitua, Mayo, and Wilson and Binghamton General Hospitals. Thirteen research assistants in the WISE program have recently been placed in healthcare organizations.
In this paper recognized at the SHS 2011 Conference, the authors from the École Polytechnique de Montréal address the difficulty and complexity of nurse scheduling. The authors developed an algorithm to optimize nurse scheduling and also a heuristic model that can be applied without complex computer analysis that results in considerable improvement over the current methodologies. The authors applied the optimization and heuristic models to two different hospitals in Montreal.
A multidisciplinary team working at the Rady Children's Hospital in San Diego, Calif., was formed to improve ED throughput. Based on comprehensive variability analysis the team implemented a number of changes including daily performance reporting, a fast track for lower acuity patients, and standardized nurse and physician rounding. The changes resulted in a 10 percent lower length of stay and a 50 percent reduction in left without being seen. These changes are planned to improve revenue by $782,000 to be budgeted in the next fiscal year.
The Fourth Annual Conference on Systems Engineering & Operations Research in Healthcare will take place Aug. 10-12 on the Mayo Clinic campus in Rochester, Minn. Conference attendees will have the opportunity to join colleagues in discussion on how clinicians and SE/OR/OM practitioners and academics can collaborate to address the challenges faced by the health care industry to deliver patient care that is high quality, safe, effective and efficient, and affordable through the application of advanced analytical methods and tools.
Many U.S. healthcare organizations are already being exposed to Recovery Audit Contractor (RAC) reviews of Medicare and Medicaid billing as well as other third-party payor audits to assure accurate and non-fraudulent billing. In response, the authors propose an analytical approach to efficiently evaluate the accuracy of billing.
Industrial engineering principles in improving patient flow at Odessa's Medical Center Hospital in Texas.
Emergency department operations: The basis for developing a simulation tool
In this paper originally published in IIE Transactions, the authors describe a foundational approach for simulation modeling of emergency departments that is general, simple, intuitive and easy to use.
Management Engineering: What is it?
A traditional process improvement methodology leads to changes within a hospital's HR department. Results from time studies, swim lanes, and simulation are used to support the proposed solutions.
Lean tools and simulation are used to recommend improvements to HIM operational processes.
Several examples use both discrete-event simulation and queuing theory to generate a solution. Contrary to conventional wisdom, discrete-event simulation is shown to be more applicable to real-world scenarios.
Queuing simulation results are applied to healthcare problems.
A CT scan department has its demand smoothed.
Future advances in medical devices and informatics within health care IT are described in this article.
An ED is redesigned after patient flows were modelled using queuing theory.
The process of creating and achieving approval of an ED simulation is discussed.
Improvements to a pediatric OR are proposed and tested with simulation.
Successful supply chain management is discussed. Examples show potential savings and describe the buy-in needed to achieve those dollars.
A methodology for standardized evaluation of the financial impact of operational and patient care improvements is discussed.
In a for-profit ambulatory surgical center, the current scheduling method often results in cases starting later than the initial plan. The presentation describes an implementation of clustering as well as multiple simulations of different possibilities.
A pharmacy is simulated and the results are discussed.
Parts of a hospital are modelled using queuing theory. Results of the model are discussed.
All processes in an ED are redesigned, with multiple outcomes showing improvement.
A 100,000 annual visit hospital ED is redesigned using lean principles. Wait times decrease and pt satisfaction and revenue increases. Simulation shows further viability of new processes. This presentation is made by a MD who became a lean coach.
ED throughput process improvement projects are discussed. The presenter is a MD. Several changes are shown with great results.
A program is proposed that effectively confronts a majority of the issues with scheduling patient surgeries.
A model is proposed for disaster preparedness regarding pandemics.
A Premier consultant discusses lessons learned from performing many Lean ED projects during her career.
Emergent Care was redesigned to decrease wait time significantly.
Improvements within an HR department are proposed and implemented. Results are examined, as well as a simulation of the process.
Lean principles are utilized during analysis and transformation of a HIM department. Results and lessons learned are discussed.
Hospital IT implementations must make assumptions to generate and defend the ROI. Several assumptions relevant to initial facilities planning are considered within this presentation.