Patient Flow: Reducing Delay in Healthcare Delivery (eBook)

Contents 6
Contributing Authors 8
Preface 11
Acknowledgments 13
Chapter 1 MODELING PATIENT FLOWS THROUGH THE HEALTHCARE SYSTEM 14
1. INTRODUCTION 14
2. CASE STUDY: LOS ANGELES COUNTY HOSPITAL 26
3. EVALUATION AND IMPROVEMENT STRATEGIES 43
4. CONCLUSIONS AND EXTENSIONS 56
5. ACKNOWLEDGMENT 56
6. REFERENCES 56
Chapter 2 HOSPITALS AND CLINICAL FACILITIES, PROCESSES AND DESIGN FOR PATIENT FLOW 58
1. THE CHALLENGE 58
2. KEY DRIVERS 61
3. KEY MYTHS OF HEALTHCARE DELIVERY 62
4. PHYSICAL PLANT CONSIDERATIONS 65
5. KEY CONTEMPORARY SOLUTIONS FOR CAPACITY AND FLOW MANAGMENT 69
6. RESOLVING CAPACITY AND FLOW PROBLEMS DRIVERS 79
7. CONCLUSIONS AND EXTENSIONS 89
8. REFERENCES 89
Chapter 3 ACCESS TO SURGERY AND MEDICAL CONSEQUENCES OF DELAYS 91
1. The Canadian health care system 92
2. Access to elective surgery 93
3. Access to coronary artery surgery 95
4. Two studies on adverse events while waiting for surgery 96
5. Discussion 104
6. References 110
Chapter 4 BREAKTHROUGH DEMAND-CAPACITY MANAGEMENT STRATEGIES TO IMPROVE HOSPITAL FLOW, SAFETY, AND SATISFACTION 113
1. INTRODUCTION 113
2. BACKGROUND 114
3. DEMAND TO CAPACITY MANAGEMENT SYSTEM ( DCMS) 123
4. WHAT YOU DON'T MEASURE IS HARD TO IMPROVE! 128
5. DISCUSSION 132
6. CONCLUSIONS 132
7. REFERENCES 133
Chapter 5 MANAGING PATIENT APPOINTMENTS IN PRIMARY CARE 135
1. INTRODUCTION: DELAYS IN ACCESS TO PRIMARY CARE 136
2. APPOINTMENT BACKLOGS IN PRIMARY CARE: HOW ARE THEY CREATED 138
3. ELIMINIATING APPOINTMENT DELAYS THROUGH ADVANCED ACCESS 144
4. CONCLUSIONS 160
5. REFERENCES 161
Chapter 6 WAITING LISTS FOR SURGERY 163
1. INTRODUCTION 163
2. NATIONAL HEALTH SYSTEMS AND SURGERY WAITING LISTS IN EUROPEAN COUNTRIES 164
3. THE MAJOR POLICIES USED TO REDUCE WAITING TIME 170
4. WAITING TIME AND THE PUBLIC AND PRIVATE SECTOR 173
5. SETTING PRIORITIES FOR WAITING LISTS 175
6. A MODEL OF OPTIMAL MANAGEMENT 177
7. CONCLUSIONS AND FUTURE DIRECTIONS 192
8. REFERENCES 194
APPENDIX: ADDITIONAL DATA 196
Chapter 7 PERSONNEL STAFFING AND SCHEDULING 200
1. INTRODUCTION 201
2. DEFINITIONS 201
3. THE STAGES LEADING TO STAFF SCHEDULING 202
4. MODELLING THE SCHEDULING AND STAFFING DECISIONS 204
5. HISTORY OF AUTOMATED SCHEDULING AND STAFFING 207
6. MOVING SHIFT STAFFING INTO THE NEAR FUTURE 208
7. FORECASTING DEMAND: PROJECTION AND PREDICTION 208
8. PREDICTING NO- SHOWS 215
9. PROACTIVE PROTOCOLS 215
10. THE STAFFING SYSTEM 216
11. CONCLUSIONS AND FUTURE EXTENSIONS 218
12. REFERENCES 220
Chapter 8 DISCRETE- EVENT SIMULATION OF HEALTH CARE SYSTEMS 221
1. INTRODUCTION 222
2. FUNDAMENTALS OF DISCRETE-EVENT SIMULATION IN HEALTH CARE 223
3. RECENT INNOVATIONS AND FUTURE DIRECTIONS 244
4. SUMMARY AND CONCLUSIONS 250
5. REFERENCES 251
Chapter 9 FORECASTING DEMAND FOR REGIONAL HEALTHCARE 263
1. INTRODUCTION 263
2. MODELLING ISSUES 265
3. PROJECTING REFERRAL PATTERNS BY AGE AND SPECIALTY 268
4. PROJECTING NATIONAL SPECIALTY REFERRAL RATES 270
5. COMPARISON WITH THE UK NATIONAL BEDS INQUIRY 275
6. PROJECTIONS OF TOTAL REGION WIDE ACUTE ACTIVITY 277
7. MODELLING THE DISTRIBUTION OF TOTAL ACTIVITY TO ALTERNATIVE SITES EXTENDED GRAVITY MODEL FOR PATIENT FLOWS
8. INCORPORATING SUPPLY CHANGE 280
9. FORECASTS AND THEIR SENSITIVITY 284
10. IMPLICATIONS FOR CAPACITY PLANNING 286
11. AVENUES FOR FURTHER RESEARCH 287
12. REFERENCES 289
Chapter 10 QUEUEING ANALYSIS IN HEALTHCARE 291
1. INTRODUCTION 291
2. BASIC QUEUEING PRINCIPLES AND MODELS 294
3. ANALYSES OF FIXED CAPACITY: HOW MANY HOSPITAL BEDS? 302
4. ANALYSES OF FLEXIBLE CAPACITY: DETERMINING STAFFING LEVELS TO MEET TIME- VARYING DEMANDS 311
5. USING QUEUEING MODELS TO IMPROVE HEALTHCARE DELIVERY: OPPORTUNITIES AND CHALLENGES 314
6. REFERENCES 316
Chapter 11 RAPID DISTRIBUTION OF MEDICAL SUPPLIES 318
1. INTRODUCTION 318
2. LITERATURE REVIEW 321
3. A LARGE-SCALE EMERNGECY -- AN ANTHRAX ATTACK 328
4. MATHEMATICAL MODEL FORMULATIONS 333
5. PROBLEM SOLUTION AND ANALYSES 339
6. CONCLUSIONS AND FUTURE DIRECTIONS 343
7. ACKNOWLEDGEMENT: 344
8. REFERENCES 344
Chapter 12 USING A DIAGNOSTIC TO FOCUS HOSPITAL FLOW IMPROVEMENT STRATEGIES 348
Chapter 13 CONTINUUM OF CARE PROGRAM 365
1. INTRODUCTION 365
2. CONTINUUM OF CARE PROGRAM 368
3. THE VIRTUAL BED TOWER WITHOUT BRICKS AND MORTAR 369
4. HOSPITAL PUSH 369
5. INTENSIVE CARE UNIT REDESIGN 371
6. ACUTE CARE REDESIGN 374
7. PATIENT CARE TEAM REDESIGN 376
8. OUT OF HOSPITAL PULL 377
9. NURSING HOME REDESIGN 383
10. HOME SETTING 384
11. CASES TO DEMONSTRATE TO DEMONSTRATE THE STRENGTH OF THE CONTINUUM OF CARE PROGRAM. 392
12. CONCLUSIONS 396
13. REFERENCES 397
Chapter 14 A LOGISTICS APPROACH FOR HOSPITAL PROCESS IMPROVEMENTS 400
1. INTRODUCTION 401
2. AN OPERATIONS MANAGEMENT CONTEXT FOR HOSPITAL PROCESS IMPROVEMENT 402
3. STEPS IN AN OM APPROACH TO HOSPITAL PROCESS IMPROVEMENT 412
4. CONCLUSIONS AND FUTURE WORK 431
Chapter 15 MANAGING A PATIENT FLOW IMPROVEMENT PROJECT 435
1. INTRODUCTION 435
2. PROJECT MANAGEMENT METHODS IN HEALTH CARE 436
3. PATIENT FLOW PROJECTS 447
4. CASE STUDY: IDENTIFYING PATIENT FLOW BOTTLENECKS 448
5. SUMMARY AND CONCLUSIONS 456
6. REFERENCES 457
Biographies 459
Index 463