Application Of Systems Engineering Tools And Methods To Improve Healthcare Delivery Inside The Emergency Department Of A Mid-Size Hospital (original) (raw)
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Use of Systems Engineering to Design a Hospital Command Center
Joint Commission journal on quality and patient safety, 2019
Background: In hospitals and health systems across the country, patient flow bottlenecks delay care delivery-emergency department boarding and operating room exit holds are familiar examples. In other industries, such as oil, gas, and air traffic control, command centers proactively manage flow through complex systems. Methods: A systems engineering approach was used to analyze and maximize existing capacity in one health system, which led to the creation of the Judy Reitz Capacity Command Center. This article describes the key elements of this novel health system command center, which include strategic colocation of teams, automated visual displays of real-time data providing a global view, predictive analytics, standard work and rules-based protocols, and a clear chain of command and guiding tenets. Preliminary data are also shared. Results: With proactive capacity management, subcycle times decreased and allowed the health system's flagship hospital to increase occupancy from 85% to 92% while decreasing patient delays. Conclusion: The command center was built with three primary goals-reducing emergency department boarding, eliminating operating room holds, and facilitating transfers in from outside facilities-but the command center infrastructure has the potential to improve hospital operations in many other areas. PROBLEM DEFINITION AND CONTEXT I n the inpatient setting, hospital gridlock often delays patient movement to the optimal location for care. Emergency department (ED) crowding and boarding, which stem from systemwide inefficiencies, 1-3 have been directly linked to higher inpatient morbidity, preventable harm, and overall mortality, as well as increased total inpatient length of stay and decreased patient satisfaction. 4-16 Operating room (OR) exit holds, in which patients are unable to move from the OR to the postanesthesia care unit (PACU) or the ICU due to capacity constraints, are associated with worse patient outcomes and avoidable expense. 17,18 Delays in moving patients to critical care units are associated with increased mortality. 19-21 At tertiary care centers, inefficiencies often limit the number of patients eligible for transfer in from surrounding community hospitals, thereby delaying or preventing access to care. Many approaches have been tried to address boarding and crowding, such as monitoring of bed turnaround time, OR schedule smoothing, telemedicine consults, Lean and Plan-Do-Study-Act (PDSA) rapid cycle improvement, and many more. 2,5,22,23 Despite this, crowding continues to increase, leading The Joint Commission to require hospitals to measure and address ED boarding and the Centers for Medicare & Medicaid Services to include related metrics
Improving Patients Experience in an Emergency Department Using Systems Engineering Approach
2019
Healthcare industry in United States of America is facing a big paradox. Although US is a leader in the industry of medical devices, medical practices and medical researches, however there isnt enough satisfaction and quality in performance of US healthcare operations. Despite the big investments and budgets associated with US healthcare, there are big threats to US healthcare operational side, that reduces the quality of care. In this research study, a step by step Systems Engineering approach is applied to improve healthcare delivery process in an Emergency Department of a hospital located in Indianapolis, Indiana. In this study, different type of systems engineering tools and techniques are used to improve the quality of care and patients satisfaction in ED of Eskenazi hospital. Having a simulation model will help to have a better understanding of the ED process and learn more about the bottlenecks of the process. Simulation model is verified and validated using different techniq...
Modelling and Optimizing Hospital Emergency Department Workflow
2020
Emergency department (ED) is a complex system that falls under the category of acute healthcare institutions where health services are provided intensively regardless of the unknowingness of the severity of the medical cases and their spontaneous arrivals. Accordingly, developing a simulation model that exhibits the incurred interactions in ED will lend a hand in supporting the management of the ED in dealing with all those uncertainties. The model performs as a decision-making tool addressing the randomness nature of such an environment. Agent-based modeling simulation was preferred to model the interaction of ED elements using a computer language called Netlogo. And this selection was agreed upon after considering several literature reviews. The ED of Sultan Qaboos University Hospital was monitored, and the medical staff was also interviewed too to gain the required information to build up the model. A conceptual model of the ED was formulated Then, a simulation model was developed.
BMC Medical Informatics and Decision Making
Background One of the important components of the health system is the emergency medical services (EMS) system. The EMS system was implemented at Kerman University of Medical Sciences teaching hospitals to communicate the situation of patients being transferred to the hospital by EMS and to provide facilities tailored to the patient's condition. The objective of this study was to investigate the impact of the EMS system on the patient care process and the workflow of users. Methods The hospital information system (HIS) report was used to investigate the impact of the EMS system on the patient care process and a questionnaire was distributed among 244 participants to determine its impact on the workflow of the users. Mann–Whitney U was used to analyze HIS reports, and Chi-square was used to analyze the data collected by questionnaires. Results The EMS system reduced the patient's stay in hospital by an average of 3 h and 45 min. It also increased the number of patients' d...
Patient Pathway Workflow Model Identifying Overcrowding Indicators in Emergency Department
2018
The overcrowding situation in emergency department is serious problem worldwide. In fact, the majority of developing countries are interested in developing their hospital system in order to anticipate the overcrowding situations and ameliorate the quality of patient care. In this paper, we focus on patient pathway in an Adult Emergency Departments (AED). This process presents the main burden for overall system operation due to its growing dynamics and the distributed organizational structure of hospitals. In order to determine the key performance indicators for the internal functioning of AED, we are building a workflow model based on the real patient pathway to direct the patients into the dedicated service while respecting the quality of care according to the expectations and requirements of the patient. Our approach is tested on a set of real database from AED of CHRU in Lille (France). Simulation results show that the proposed model can determine 3 keys performances indicators t...
Optimized Workflow for the Healthcare Logistic: Case of the Pediatric Emergency Department
Advances in Intelligent Systems and Computing, 2013
The Emergency Department (ED) in a hospital, as its name implies, is a facility to be utilized by those who require emergency medical care. This paper introduces the longitudinal organization of the patient handling" in the Pediatric Emergency called the "Pediatric Emergency Path". This work discusses the usability of the workflow approach in order to design the patient path in the Pediatric Emergency Department (PED) in order to thwart the care complexity scheme. The goal is to optimize these paths to improve the quality of the patient handling while mastering the wait time. The development of this model was based on accurate visits made in the PED of the Regional University Hospital Center (CHRU) of Lille (France). This modeling, which has to represent most faithfully possible the reality of the PED of CHRU of Lille, is necessary. It must be enough retailed to produce an analysis allowing to identify the dysfunctions of the PED and also to propose and to estimate prevention indicators of tensions. Our survey is integrated into the French National Research Agency project, titled: "Hospital: optimization, simulation and avoidance of strain" (ANR HOST) 1 .
Mapping patient path in the Pediatric Emergency Department: A workflow model driven approach
Journal of Biomedical Informatics, 2015
The Workflow models of the patient journey in a Pediatric Emergency Department (PED) seems to be an effective approach to develop an accurate and complete representation of the PED processes. This model can drive the collection of comprehensive quantitative and qualitative service delivery and patient treatment data as an evidence base for the PED service planning. Our objective in this study is to identify tension indicators and bottlenecks that contribute to overcrowding. The greatest source of delay in patient flow is the waiting time from the health care request, and especially the bed request to exit from the PED for hospital admission. It represented 70% of the time that these patients occupied in the PED waiting rooms. The use of real data to construct the Workflow model of the patient path is effective in identifying sources of delay in patient flow, and aspects of the PED activity that could be improved. The development of this model was based on accurate visits made in the PED of the Regional University Hospital Center (CHRU) of Lille (France). This modeling, which has to represent most faithfully possible the reality of the PED of CHRU of Lille, is necessary. It must be enough retailed to produce an analysis allowing to identify the dysfunctions of the PED and also to propose and to estimate prevention indicators of tensions. Our survey is integrated into the French National Research Agency project, titled: "Hospital: optimization, simulation and avoidance of strain" (ANR HOST) 1 .
Tools for Process Optimizing in Emergency Departments
Conference Papers in Medicine, 2013
Overcrowding is a universal challenge in emergency departments (ED). In (re)organizing an ED, experience from other "industries" could be taken into consideration. The recommendations are to ensure standardization and focus on flow and logistics. Examples that can be taken into consideration are described. One of the most important things to focus on is to keep the patients, who are not seriously ill, in flow at all times. They are a great challenge to overcrowding, and one has to use skilled staff to deal with this particular group.
Healthcare engineering for an efficient medical care system
International Journal of Healthcare Technology and Management, 2006
Rising costs and increasing expectations from patients (consumers) have caused healthcare planners to seek ways to improve efficiency, while striking a balance with the quality of services offered. This study explores how the integrated emerging technologies can play a valuable role in cost-effective medical and healthcare delivery by means of e-data computer simulation of clinical units, borderless data (such as intelligent patient medical records), engineering e-processes and systems analysis of primary-to-tertiary care systems. Incorporation of costly medical technologies into healthcare delivery is supposed to make: • medical diagnosis more timely and reliable • treatment more efficacious • the delivery system more cost-effective. However, this can only happen if: • all the components of the healthcare delivery system are analysed as a chain system without duplication of services • the submits of each of these components are also operating as a multi-compartmental system with feedback loops tying them into one integrated regulatory system, having the objectives of optimal patient care with streamlined operations. Finally, a virtual diagnostic clinic is constructed by means of a system dynamics approach to illustrate these concepts.
DEVS Modelling and Simulation for Healthcare Process Application for Hospital Emergency Department
50th Annual Simulation Symposium (ANSS 2017), 2017
Healthcare organizations are facing huge daily challenges which led them trying to give the best solutions in order to manage their resources and deliver a best quality of services. The recent adoption of Business Process Management (BPM) in healthcare organizations is dealing with the development of performance indicators in this domain to help healthcare providers structuring the interaction of information between systems and people. Moreover, there are a lot of available methods and tools for BPM that afford different manners to simulate models. Nevertheless in these process models, the resource handling is frequently missing or it is defined in a simplistic way. In this paper, we present the application of BPM in healthcare sector, using the Business Process Model and Notation (BPMN), coupled with a multidimensional Agent Based Model (ABM) of multidimensional organizational network of resources and geographical positioned population on a territory.