High-fidelity whole-system patient flow modeling to assess health care transformation policies

2018 ◽  
Vol 266 (1) ◽  
pp. 221-237 ◽  
Author(s):  
Ali Vahit Esensoy ◽  
Michael W. Carter
Keyword(s):  
Health Care ◽  
Patient Flow ◽  
High Fidelity ◽  
Flow Modeling ◽  
Health Care Transformation

Patient Flow or the Patient’s Journey? Exploring Health Care Providers’ Experiences and Understandings of Implementing a Care Pathway to Improve the Quality of Transitional Care for Older People

2021 ◽  
pp. 104973232110038
Author(s):  
Cecilie Fromholt Olsen ◽  
Astrid Bergland ◽  
Jonas Debesay ◽  
Asta Bye ◽  
Anne Gudrun Langaas
Keyword(s):  
Health Care ◽  
Older People ◽  
Health Care Providers ◽  
Transitional Care ◽  
Care Pathway ◽  
Patient Flow ◽  
Care Pathways ◽  
Care Providers ◽  
Patient Centered ◽  
Care For Older People

Internationally, the implementation of care pathways is a common strategy for making transitional care for older people more effective and patient-centered. Previous research highlights inherent tensions in care pathways, particularly in relation to their patient-centered aspects, which may cause dilemmas for health care providers. Health care providers’ understandings and experiences of this, however, remain unclear. Our aim was to explore health care providers’ experiences and understandings of implementing a care pathway to improve transitional care for older people. We conducted semistructured interviews with 20 health care providers and three key persons, along with participant observations of 22 meetings, in a Norwegian quality improvement collaborative. Through a thematic analysis, we identified an understanding of the care pathway as both patient flow and the patient’s journey and a dilemma between the two, and we discuss how the negotiation of conflicting institutional logics is a central part of care pathway implementation.

Mass-Casualty Training Exercise Using High-Fidelity Computerized Simulators and Involving Time and Resource Limitation

2021 ◽  
Vol 36 (3) ◽  
pp. 313-320
Author(s):  
Phillip A. Jacobson ◽  
Paul N. Severin ◽  
Dino P. Rumoro ◽  
Shital Shah
Keyword(s):  
Health Care ◽  
Resource Limitation ◽  
Mass Casualty ◽  
Health Care Personnel ◽  
High Fidelity ◽  
Medical Team ◽  
Training Exercise ◽  
The Mean ◽  
Medical Teams

AbstractPurpose:Training emergency department (ED) personnel in the care of victims of mass-casualty incidents (MCIs) is a highly challenging task requiring unique and innovative approaches. The purpose of this study was to retrospectively explore the value of high-fidelity simulators in an exercise that incorporates time and resource limitation as an optimal method of training health care personnel in mass-casualty care.Methods:Mass-casualty injury patterns from an explosive blast event were simulated for 12 victims using high-fidelity computerized simulators (HFCS). Programmed outcomes, based on the nature of injuries and conduct of participants, ranged from successful resuscitation and survival to death. The training exercise was conducted five times with different teams of health care personnel (n = 42). The exercise involved limited time and resources such as blood, ventilators, and imaging capability. Medical team performance was observed and recorded. Following the exercise, participants completed a survey regarding their training satisfaction, quality of the exercise, and their prior experiences with MCI simulations. The Likert scale responses from the survey were evaluated using mean with 95% confidence interval, as well as median and inter-quartile range. For the categorical responses, the frequency, proportions, and associated 95% confidence interval were calculated.Results:The mean rating on the quality of experiences related trainee survey questions (n = 42) was between 4.1 and 4.6 on a scale of 5.0. The mean ratings on a scale of 10.0 for quality, usefulness, and pertinence of the program were 9.2, 9.5, and 9.5, respectfully. One hundred percent of respondents believed that this type of exercise should be required for MCI training and would recommend this exercise to colleagues. The five medical team (n = 5) performances resulted in the number of deaths ranging from two (including the expectant victims) to six. Eighty percent of medical teams attempted to resuscitate the “expectant” infant and exhausted the O- blood supply. Sixty percent of medical teams depleted the supply of ventilators. Forty percent of medical teams treated “delayed” victims too early.Conclusion:A training exercise using HFCS for mass casualties and employing limited time and resources is described. This exercise is a preferred method of training among participating health care personnel.

scholarly journals Health Care Transformation Initiatives in Type 2 Diabetes Care: A Qualitative Study in the Cincinnati Beacon Community

2015 ◽  
Vol 28 (2) ◽  
pp. 132-140
Author(s):  
Ronda Christopher ◽  
Tara Trudnak ◽  
Regina Hemenway ◽  
Sara Bolton ◽  
Barbara Tobias ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Health Care ◽  
Qualitative Study ◽  
Diabetes Care ◽  
Health Care Transformation

scholarly journals The impact on patient flow after the integration of nurse practitioners and physician assistants in 6 Ontario emergency departments

CJEM ◽  
2009 ◽  
Vol 11 (05) ◽  
pp. 455-461 ◽  
Author(s):  
James Ducharme ◽  
Robert J. Alder ◽  
Cindy Pelletier ◽  
Don Murray ◽  
Joshua Tepper
Keyword(s):  
Health Care ◽  
Nurse Practitioners ◽  
Emergency Departments ◽  
Patient Flow ◽  
Physician Assistants ◽  
Wait Times ◽  
Care Providers ◽  
Lengths Of Stay ◽  
Left Without Being Seen ◽  
The Impact

ABSTRACT Objective: We sought to assess the impact of the integration of the new roles of primary health care nurse practitioners (NPs) and physician assistants (PAs) on patient flow, wait times and proportions of patients who left without being seen in 6 Ontario emergency departments (EDs). Methods: We performed a retrospective review of health records data on patient arrival time, time of initial assessment by a physician, time of discharge from the ED and discharge status. Results: Whether a PA or NP was directly involved in the care of patients or indirectly involved by being on duty, the wait times, lengths of stay and proportion of patients who left without being seen were significantly reduced. When a PA or NP were directly involved in patients' care, patients were 1.6 (95% confidence interval [CI] 1.3–2.1, p < 0.05) and 2.1 (95% CI 1.6–2.8, p < 0.05) times more likely to be seen within the wait time benchmarks, respectively. Lengths of stay were 30.3% (95% CI 21.6%–39.0%, p < 0.01) and 48.8% (95% CI 35.0%–62.7%, p < 0.01) lower when PAs and NPs, respectively, were involved. When PAs and NPs were not on duty, the proportion of patients who left without being seen were 44% (95% CI 31%–63%, p < 0.01) and 71% (95% CI 53%–96%, p < 0.05), respectively. Conclusion: The addition of PAs or NPs to the ED team can improve patient flow in medium-sized community hospital EDs. Given the ongoing shortage of physicians, use of alternative health care providers should be considered. These results require validation, as their generalizability to other locations or types of EDs is not known.

Rapid Modelling of Patient Flow in a Health Care Setting: Integrating Simulation with Lean

2010 ◽  
pp. 131-142 ◽  
Author(s):  
Claire Worthington ◽  
Stewart Robinson ◽  
Nicola Burgess ◽  
Zoe Radnor
Keyword(s):  
Health Care ◽  
Care Setting ◽  
Patient Flow ◽  
Health Care Setting

Costs and Resource Utilization in Prolonged Critical Illness

2014 ◽  
Author(s):  
Christopher E Cox
Keyword(s):  
Health Care ◽  
Critical Illness ◽  
Acute Care ◽  
Patient Population ◽  
Health Care Policy ◽  
Patient Flow ◽  
Prolonged Mechanical Ventilation ◽  
Post Discharge ◽  
Chronic Critical Illness ◽  
Post Acute Care

Patients who have chronic critical illness, operationally defined as those requiring prolonged mechanical ventilation, are markedly increasing in number and commonly experience profound, persistent physical and psychological debilitation. This patient population consumes an extraordinary amount of health care resources attributed to both the acute hospitalization as well as complex post-discharge treatments provided across multiple post-acute care facilities. Currently, the US health care system incentivizes these patient flow dynamics. Health care policy changes addressing post-acute care payment are inevitable. This chapter highlights potential patient, family, physician, and systems targets for current and future interventions, designed to improve quality and reduce costs for this patient population.

Fifteen Years After Katrina: Paving the Way for Health Care Transformation

2020 ◽  
Vol 110 (10) ◽  
pp. 1472-1475 ◽  
Author(s):  
Shelina Davis ◽  
Alexander Billioux ◽  
Jennifer L. Avegno ◽  
Tiffany Netters ◽  
Gerrelda Davis ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Hurricane Katrina ◽  
New Orleans ◽  
Public And Private ◽  
Primary Care Access ◽  
Care Access ◽  
Public And Private Stakeholders ◽  
Health Care Transformation ◽  
The Way

Following the devastation of the Greater New Orleans, Louisiana, region by Hurricane Katrina, 25 nonprofit health care organizations in partnership with public and private stakeholders worked to build a community-based primary care and behavioral health network. The work was made possible in large part by a $100 million federal award, the Primary Care Access Stabilization Grant, which paved the way for innovative and sustained public health and health care transformation across the Greater New Orleans area and the state of Louisiana.

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