| SIMULATION MODELING AS
AN AID TO DECISION-MAKING IN HEALTHCARE MANAGEMENT: THE ADJUVANT BREAST
CANCER (ABC) TRIAL |
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|---|---|---|
| Lynne P.
Baldwin Tillal. Eldabi Ray J. Paul Centre for Applied Simulation Modelling, Department of Information Systems and Computing, Brunel University Uxbridge, Middlesex UB8 3PH, UK |
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| ABSTRACT | ||
| This paper presents simulation modeling as a decision support technique and suggests that it can be a useful for understanding problems related to health care, Randomized Clinical Trials in this case. The paper shows that simulation may not be regarded as tool for deriving solutions to certain problems. In fact simulation is better suited for understanding the problem and enhancing systematic debate between the problem owners. The paper also demonstrates the usefulness of combining different software to provide a comprehensive tailor-made package (ABCSim). The example used is based on modeling a randomized clinical trial for Adjuvant Breast Cancer. | ||
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| EMERGENCY DEPARTMENT
SIMULATION AND DETERMINATION OF OPTIMAL ATTENDING PHYSICIAN STAFFING
SCHEDULES |
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|---|---|---|
| Manuel D. Rossetti,
Ph.D. Department of Industrial Engineering Room 4207 Bell Engineering Center University of Arkansas Fayetteville, AR 72701 U.S.A. |
Gregory F.
Trzcinski Department of Systems Engineering University of Virginia Thornton Hall Charlottesville, Virginia 22903, U.S.A. |
Scott A. Syverud,
M.D. Vice-Chair of Emergency Medicine Associate Professor Department of Emergency Medicine UVA Health Sciences Center # 523 - 21 Charlottesville, VA 22908 |
| ABSTRACT | ||
| Efficient allocation and utilization of staff resources is an important issue facing emergency department (ED) administrators. Increased pressure from competition, heath care reform, reimbursement difficulties, and rising heath care costs are primarily responsible for the high level of interest in this, and other ED operating efficiency issues. This paper discusses the use of computer simulation to test alternative ED attending physician-staffing schedules and to analyze the corresponding impacts on patient throughput and resource utilization. The simulation model can also be used to help identify process inefficiencies and to evaluate the effects of staffing, layout, resource, and patient flow changes on system performance without disturbing the actual system. The development of this model was based on the Emergency Department at the University of Virginia Medical Center in Charlottesville, Virginia. | ||
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| THE USE OF SIMULATION
FOR PROCESS IMPROVEMENT IN A CANCER TREATMENT CENTER
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|---|---|---|
| José A.
Sepûlveda William J. Thompson Felipe F. Baesler María I. Alvarez Industrial Engineering and Management Systems University of Central Florida P.O. Box 162450 Orlando, FL 32816-2450, U.S.A. |
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Lonnie E. Cahoon,
III M.D. Anderson Cancer Center Orlando 85 W. Miller Street Orlando, FL 32806, U.S.A. |
| ABSTRACT | ||
| This work addresses experience with a simulation model of a full service cancer treatment center. The objective was to analyze patient flow throughout the unit, evaluate the impact of alternative floor layouts, using different scheduling options and to analyze resources and patient flow requirements of a new building. The simulation model provided strong justification to relocate the center's laboratory and pharmacy as well as identifying changes in scheduling procedures that would allow a 30% increase in patient throughput with the same resources. The new building analysis identified a waiting room area that was too small for the increased patient flow. | ||
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| GERMS: AN EPIDEMIOLOGIC
SIMULATION TOOL FOR STUDYING GEOGRAPHIC AND SOCIAL EFFECTS ON INFECTION
TRANSMISSION |
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|---|---|---|
| Andrew L.
Adams James S. Koopman Department of Epidemiology, SPH-1 The University of Michigan 109 Observatory St. Ann Arbor, MI 48109 |
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Stephen E.
Chick Peter J. Yu Department of Industrial and Operations Engineering The University of Michigan 1205 Beal Avenue Ann Arbor, MI 48109 |
| ABSTRACT | ||
| The analysis, surveillance, and control of infectious diseases are important functions of public health organiza-tions around the world. This article describes the design and implementation of simulation tools that include several innovations for modeling infectious disease transmission. These tools address several important issues for understanding the epidemiology of sexually transmitted infections. The model accounts for realistic in-fection transmission systems by explicitly modeling (i) heterogeneous populations of individuals with varying social and geographic characteristics, (ii) complex interaction between individuals to characterize opportunities for transmission, (iii) infection characteristics such as transmission probabilities and infection duration, and (iv) contact and infection histories. Since public health organizations collect and use information regarding infected individuals, including geographic location and partnership data, the tool is well equipped to help evaluate the effectiveness of interventions based on that data. We outline design decisions and present results of initial simulation analysis. We also discuss short-term goals for extending the simulation toolkit to address specific needs of the Centers for Disease Control. | ||
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| Simulating Outpatient
Obstetrical Clinics |
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|---|---|---|
| Mark W.
Isken Decision and Information Sciences Oakland University Rochester, MI 48309, U.S.A. |
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Timothy J. Ward
Timothy C. McKee Health Services Engineering, Inc. Cabin John, MD 20818, U.S.A |
| ABSTRACT | ||
| Computer simulation is a useful tool for addressing resource allocation problems in outpatient obstetrical clinics. We present a general framework for modeling such clinics for the purpose of exploring questions related to demand, appointment scheduling, exam room allocation, patient flow patterns and staffing. Modeling challenges are identified and solutions suggested. Examples from a project completed by the authors at a large obstetrical clinic are used to illustrate the concepts. | ||
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| THE BENEFITS OF
SIMULATION MODELING IN MEDICAL PLANNING AND MEDICAL DESIGN
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|---|---|---|
| Victor E. Lange, RN,
AIA PROMODEL Corporation 1875 South State, Suite 3400 Orem, Utah 84097, U.S.A. |
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| ABSTRACT | ||
| Architecture, medical planning and the actual physical implementation of the facilities where care is rendered is often a source of great trepidation on the part of those who actually render care. Mistakes in this arena are very expensive and can hamper operations for years to come. Simulation is a tool that, though rarely used, can be very valuable in helping generate correct architectural decisions. | ||
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| DETERMINATION OF
OPERATING ROOM REQUIREMENTS USING SIMULATION
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|---|---|---|
| Julie C.
Lowery Jennifer A. Davis VA Center for Practice Management and Outcomes Research P.O. Box 130170 Ann Arbor, MI 48113-0170, U.S.A. |
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| ABSTRACT | ||
| In 1997 Brigham and Women's Hospital (BWH) in Boston initiated a construction project to renovate its existing surgical suite to include 32 operating rooms--two less than the current number. The new suite would be used for performing primarily inpatient cases; 95% of all outpatient cases would be moved to another facility. BWH administrators, planners, and clinicians wanted to be sure that the 32 rooms would be sufficient for accommodating projected increases in the inpatient surgical volume. In addition, they wanted to examine the possible effects of changes in the surgical schedule and in case times on the number of rooms required. A simulation model using MedModel simulation software was developed for examining these issues. The resultant model includes a number of assumptions that simplified model construction, yet still resulted in a valid model that met project objectives. The model showed that the projected changes in surgical workload could be accommodated in 30 operating rooms (or fewer) if scheduled block time were extended during the weekdays and Saturday blocks were added. | ||
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| DYNAMIC SIMULATION
MODELING OF ICU BED AVAILABILITY |
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|---|---|---|
| William Cahill,
MD Marta Render, MD Cincinnati VA Medical Center University of Cincinnati Medical Center Departments of Neurology and Internal Medicine 3200 Vine Street Cincinnati, Ohio 45220, U.S.A. |
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| ABSTRACT | ||
| The intensive care unit accounts for
nearly 30% of all inpatient expenditures while representing only 8% of the
patient population. All healthcare systems must balance the need for
access and availability of intensive care unit beds (ICU) versus excess
capacity that wastes increasingly limited healthcare resources including
bed space and personnel. The Cincinnati VA Medical Center is an acute
care, university affiliated 220-bed facility serving eligible veterans
with medical, surgical, neurological and psychiatric care needs. ICU beds
are unavailable nearly one third of the time, eliminating new ICU
admissions, and requiring diversion of ambulance traffic. Diverting
ambulance traffic adversely impacts patient satisfaction and community
perception of quality of care delivered at this center. Phased
construction to relieve the problem was planned, including additional
telemetry beds, move of ventilator dependent patients out of the ICU to a
Respiratory Care Unit (Tele/RCU), and development of ICU swing beds in the
emergency room area (Heart ER). We assessed the likelihood that the
planned changes would result in the desired outcomes. A computer model representing medical bed utilization at this facility was developed using dynamic simulation software (Arenaâ). This model analyzed the flow of patients through the ICU, telemetry and medical floor beds under current bed allocation. The model was then used to evaluate the effects of the planned phased construction. The model demonstrated improved availability of ICU beds with the addition of the telemetry and respiratory care unit beds. Resolving ICU access problems required addition of Heart ER beds. Unexpectedly, increased ICU bed availability resulted in increased telemetry and medical floor bed utilization downstream and increased length of stay on the medical service as the proportion of post-ICU patients increased on the floors. | ||
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| HEALTHCARE SIMULATION: A
CASE STUDY AT A LOCAL CLINIC |
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|---|---|---|
| Mark L.
Weng Ali A. Houshmand Department of Industrial Engineering University of Cincinnati Cincinnati, Ohio 45221-0072, USA |
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| ABSTRACT | ||
| Today, researchers and analysts are beginning to uncover the potential for using simulation in the health care field; with a multitude of interactions between patients, physicians, nurses, and technical and support staff, simulation can be an invaluable tool. Inefficiencies can be eliminated or resource allocation changed to determine an optimal setup. Primarily, simulation has been used in the health care field in comparison studies of alternative systems for resource or scheduling requirements (Lowery, 1998). When analyzing such alternatives, the standard performance measures are typically reported: throughput, time in system, and queue times and lengths. This paper is a systems analysis of a clinic using the above mentioned performance measures along with another proposed performance measure, total cash flow. | ||
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