The Elimination of Transfer Distances Is an Important Part of Hospital Design

2016 ◽  
Vol 10 (3) ◽  
pp. 142-151 ◽  
Author(s):  
Sauli Karvonen ◽  
Isto Nordback ◽  
Jussi Elo ◽  
Jouni Havulinna ◽  
Heikki-Jussi Laine
Keyword(s):  
Architectural Design ◽  
Patient Flow ◽  
Flow Analysis ◽  
Hand Surgery ◽  
University Hospital ◽  
Productivity Improvement ◽  
Specific Patient ◽  
Patient Transfers ◽  
Additional Tool ◽  
Hospital Design

Objective: The objective of the present study was to describe how a specific patient flow analysis with from-to charts can be used in hospital design and layout planning. Background: As part of a large renewal project at a university hospital, a detailed patient flow analysis was applied to planning the musculoskeletal surgery unit (orthopedics and traumatology, hand surgery, and plastic surgery). Method: First, the main activities of the unit were determined. Next, the routes of all patients treated over the course of 1 year were studied, and their physical movements in the current hospital were calculated. An ideal layout of the new hospital was then generated to minimize transfer distances by placing the main activities with close to each other, according to the patient flow analysis. The actual architectural design was based on the ideal layout plan. Finally, we compared the current transfer distances to the distances patients will move in the new hospital. Results: The methods enabled us to estimate an approximate 50% reduction in transfer distances for inpatients (from 3,100 km/year to 1,600 km/year) and 30% reduction for outpatients (from 2,100 km/year to 1,400 km/year). Conclusions: Patient transfers are nonvalue-added activities. This study demonstrates that a detailed patient flow analysis with from-to charts can substantially shorten transfer distances, thereby minimizing extraneous patient and personnel movements. This reduction supports productivity improvement, cross-professional teamwork, and patient safety by placing all patient flow activities close to each other. Thus, this method is a valuable additional tool in hospital design.

Evaluation and cost estimation of laboratory tests overuse through a CCDSS in a university hospital

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
D Vallone ◽  
A Tamburrano ◽  
C Carrozza ◽  
A Urbani ◽  
A Cambieri ◽  
...  
Keyword(s):  
Cost Estimation ◽  
Laboratory Tests ◽  
Quality Care ◽  
Clinical Decision Support Systems ◽  
Patient Characteristics ◽  
Clinical Decision ◽  
University Hospital ◽  
Specific Patient ◽  
Global Rate ◽  
Common Laboratory

Abstract Computerized Clinical Decision Support Systems (CCDSS) are information technology-based systems that use specific patient characteristics and combine them with rule-based algorithms. The aim of this study is to conduct a survey to measure and assess the over-utilization rates of laboratory requests and to estimate the monthly cost of inappropriate requests in inpatients of the “Fondazione Policlinico Universitario A. Gemelli IRCCS” Care Units. This observational study is based on the count of rules violations for 43 different types of laboratory tests requested by the Hospital physicians, for a total of 5,716,370 requests, over a continuous period of 20 months (from 1 July 2016 to 28 February 2018). Requests from all the hospital internal departments (except for Emergency, Intensive Care Units and Urgent requests) were monitored. The software intercepted and counted, in silent mode for the operator, all requests and violations for each laboratory test among those identified. During the observation period a mean of 285,819 requests per month were analyzed and 40,462 violations were counted. The global rate of overuse was 15.2% ± 3.0%. The overall difference among sub-groups was significant (p < 0.001). The most inappropriate exams were Alpha Fetoprotein (85.8% ± 30.5%), Chlamydia trachomatis PCR (48.7% ± 8.8%) and Alkaline Phosphatase (20.3% ± 6.5%). All the exams, globally considered, generated an estimated avoidable cost of 1,719,337€ (85,967€ per month) for the hospital. This study reports rates (15.2%) similar to other works. The real impact of inappropriateness is difficult to assess, but the generated costs for patients, hospitals and health systems are certainly high and not negligible. Key messages It would be desirable for international medical communities to produce a complete panel of prescriptive rules for all the most common laboratory exam. That is useful not only to reduce costs, but also to ensure standardization and high-quality care.

scholarly journals An assessment of the quality indicators of operative and non-operative times in a public university hospital

2015 ◽  
Vol 13 (4) ◽  
pp. 594-599 ◽  
Author(s):  
Altair da Silva Costa Jr ◽  
Luiz Eduardo Villaça Leão ◽  
Maykon Anderson Pires de Novais ◽  
Paola Zucchi
Keyword(s):  
Standard Deviation ◽  
Operating Room ◽  
Operative Time ◽  
Patient Flow ◽  
Cross Sectional Study ◽  
Public University ◽  
Major Effect ◽  
University Hospital ◽  
Cross Sectional ◽  
Using Data

ABSTRACT Objective To assess the operative time indicators in a public university hospital. Methods A descriptive cross-sectional study was conducted using data from operating room database. The sample was obtained from January 2011 to January 2012. The operations performed in sequence in the same operating room, between 7:00 am and 5:00 pm, elective or emergency, were included. The procedures with incomplete data in the system were excluded, as well as the operations performed after 5:00 pm or on weekends or holidays. Results We measured the operative and non-operative time of 8,420 operations. The operative time (mean and standard deviation) of anesthesias and operations were 177.6±110 and 129.8±97.1 minutes, respectively. The total time of the patient in operative room (mean and standard deviation) was 196.8±113.2. The non-operative time, e.g., between the arrival of the patient and the onset of anesthesia was 14.3±17.3 minutes. The time to set the next patient in operating room was 119.8±79.6 minutes. Our total non-operative time was 155 minutes. Conclusion Delays frequently occurred in our operating room and had a major effect on patient flow and resource utilization. The non-operative time was longer than the operative time. It is possible to increase the operating room capacity by management and training of the professionals involved. The indicators provided a tool to improve operating room efficiency.

scholarly journals Dietitian first gastroenterology clinic: an initiative to reduce wait lists and wait times for gastroenterology outpatients in a tertiary hospital service

2018 ◽  
Vol 10 (3) ◽  
pp. 229-235 ◽  
Author(s):  
Rumbidzai N Mutsekwa ◽  
Russell Canavan ◽  
Anthony Whitfield ◽  
Alan Spencer ◽  
Rebecca L Angus
Keyword(s):  
Patient Flow ◽  
Wait Time ◽  
Tertiary Hospital ◽  
University Hospital ◽  
Wait Times ◽  
Activity Data ◽  
Patient Journey ◽  
Service Activity ◽  
High Level ◽  
The Impact

ObjectiveThe demand for outpatient gastroenterology medical specialist consultations is above what can be met within budgetary and staffing constraints. This study describes the establishment of a dietitian first gastroenterology clinic to address this issue, the patient journey and its impact on wait lists and wait times in a tertiary gastroenterology service.DesignA dietitian first gastroenterology clinic model was developed and a mixed-methods approach used to evaluate the impact of the service over a 21-month period.SettingGold Coast University Hospital, Queensland, Australia (a public tertiary hospital).Patients658 patients were triaged to the clinic between June 2016 and March 2018.InterventionA dietitian first gastroenterology clinic for low-risk gastroenterology patients.Main outcome measuresWe examined demographic, referral, wait list, wait time and service activity data, patient satisfaction and patient journey.ResultsAt the time of audit, 399 new (67.9% female) and 307 review patients had been seen. Wait times for eligible patients reduced from 280 to 66 days and the percentage of those in breach of their recommended wait times reduced from 95% to zero. The average time from referral to discharge was 117.8 days with an average of 2.4 occasions of service. 277 patients (69.4%) had been discharged to the care of their general practitioner and 43 patients (10.7%) had an expedited specialist medical review. Patient surveys indicated a high level of satisfaction.ConclusionA dietitian first gastroenterology model of care helps improve patient flow, reduces wait times and may be useful elsewhere to address outpatient gastroenterology service pressures.

The Impact of Post-thyroidectomy Paresis on Quality of Life in Patients with Nodular Thyroid Disease

2019 ◽  
Vol 161 (4) ◽  
pp. 589-597 ◽  
Author(s):  
Jesper Roed Sorensen ◽  
Trine Printz ◽  
Jenny Iwarsson ◽  
Ågot Møller Grøntved ◽  
Helle Døssing ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Thyroid Disease ◽  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
University Hospital ◽  
Specific Patient ◽  
Perceptual Evaluation ◽  
Patient Reported ◽  
The Impact

Objective To investigate the impact of postoperative paresis on disease-specific quality of life (DSQoL) after thyroidectomy in patients with benign nodular thyroid disease. Study Design Observational study. Setting University hospital. Subjects and Methods Patients were evaluated before and 3 weeks and 6 months after surgery in an individual prospective cohort study using videolaryngostroboscopy (VLS), voice range profile, voice handicap index (VHI), multidimensional voice program, maximum phonation time (MPT), and auditory perceptual evaluation. Changes in DSQoL were assessed by the Thyroid-specific Patient-Reported Outcome measure. Cohen’s effect size was used to evaluate changes. Results Sixty-two patients were included, 55 of whom completed all examinations. Three weeks after surgery, a blinded VLS examination showed signs of paresis of either the recurrent laryngeal nerve or the external branch of the superior laryngeal nerve (RLN/EBSLN) in 13 patients (24%). A paresis corresponded to a 12 ± 28 point increase in VHI ( P = .002) and was associated with a significant 4.3 ± 7.5 semitone decrease in the maximum fundamental frequency ( P < .001) and a 5.3 ± 8.2 dB reduction in maximum intensity. Further, it was associated with a 4.5 ± 11.2 second reduction in MPT ( P = .001) and an increase of 0.40 ± 1.19 in grade, 0.42 ± 1.41 in roughness, and 0.36 ± 1.11 in breathiness. Signs of postoperative RLN/EBSLN paresis correlated with an 11.0-point ( P = .02) poorer improvement in goiter symptoms at both 3 weeks and 6 months after surgery. Conclusion Signs of RLN/EBSLN paresis after thyroidectomy were associated with less pronounced improvement in goiter symptoms in patients with thyroid nodular disease. However, thyroidectomy was associated with an overall improved DSQoL by 6 months after surgery.

scholarly journals The Black Cloud Phenomenon in Hand Surgery

Hand ◽  
2018 ◽  
Vol 14 (6) ◽  
pp. 819-822
Author(s):  
Emily Zhao ◽  
Nathan Tiedeken ◽  
William Wang ◽  
John Fowler
Keyword(s):  
Trauma Center ◽  
Hand Surgery ◽  
Patient Transfers ◽  
Level I ◽  
Call Volume

Background: The term black cloud for a surgeon is generally used to describe someone who is unusually busy compared with his or her counterparts, and it is a superstition that tends to pervade the medical world. The purpose of this study is to investigate whether black clouds exist in hand surgery. Methods: We examined one academic year’s worth of hand surgery–specific call at a level I trauma center and tabulated the number of hand-related patient transfers and add-on cases per surgeon. Each surgeon was given a black cloud rating by the fellows who were in training that year. Correlations were made between the black cloud rating and the surgeons’ call volume. Results: There were 12 surgeons who shared 365 days of hand call, and 5 of them are hand surgery fellowship trained. Those 5 surgeons tended to be busier on their call days, with more cases added on overnight and the next day, and also had worse black cloud ratings than the 7 non–hand fellowship trained surgeons. Conclusions: In regard to hand surgery, while true emergencies occur and require emergent intervention, how busy hand surgeons may be during call may be influenced by a variety of factors not related to their patients’ problems but rather their daily schedules, their hospitals’ ability to facilitate add-on cases, and their rapport with their fellow surgeons to share case loads.

scholarly journals A Patient Flow Analysis: Identification of Process Inefficiencies and Workflow Metrics at an Ambulatory Endoscopy Unit

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Rowena Almeida ◽  
William G. Paterson ◽  
Nancy Craig ◽  
Lawrence Hookey
Keyword(s):  
Care Delivery ◽  
Patient Flow ◽  
Qualitative Interviews ◽  
Flow Analysis ◽  
Related Factors ◽  
Endoscopy Unit ◽  
Time And Motion ◽  
Operational Characteristics ◽  
Increasing Demand ◽  
The Impact

Background. The increasing demand for endoscopic procedures coincides with the paradigm shift in health care delivery that emphasizes efficient use of existing resources. However, there is limited literature on the range of endoscopy unit efficiencies.Methods. A time and motion analysis of patient flow through the Hotel-Dieu Hospital (Kingston, Ontario) endoscopy unit was followed by qualitative interviews. Procedures were directly observed in three segments: individual endoscopy room use, preprocedure/recovery room, and overall endoscopy unit utilization.Results. Data were collected for 137 procedures in the endoscopy room, 139 procedures in the preprocedure room, and 143 procedures for overall room utilization. The mean duration spent in the endoscopy room was 31.47 min for an esophagogastroduodenoscopy, 52.93 min for a colonoscopy, 30.47 min for a flexible sigmoidoscopy, and 66.88 min for a double procedure. The procedure itself accounted for 8.11 min, 34.24 min, 9.02 min, and 39.13 min for the above procedures, respectively. The focused interviews identified the scheduling template as a major area of operational inefficiency.Conclusions. Despite reasonable procedure times for all except colonoscopies, the endoscopy room durations exceed the allocated times, reflecting the impact of non-procedure-related factors and the need for a revised scheduling template. Endoscopy units have unique operational characteristics and identification of process inefficiencies can lead to targeted quality improvement initiatives.

Patient flow analysis: planning a new surgery unit

2012 ◽  
Vol 18 (2) ◽  
pp. 96-102 ◽  
Author(s):  
Sauli Karvonen ◽  
Matti Lehto ◽  
Jussi Elo
Keyword(s):  
Patient Flow ◽  
Flow Analysis ◽  
New Surgery

scholarly journals LO007: A pragmatic randomized and controlled evaluation of nurse-initiated protocols

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S32-S32
Author(s):  
M.J. Douma ◽  
D. O Dochartiagh ◽  
C.A. Drake ◽  
K.E. Smith
Keyword(s):  
Length Of Stay ◽  
Average Length ◽  
Patient Flow ◽  
Intervention Group ◽  
Control Group ◽  
Emergency Nurses ◽  
Specific Patient ◽  
Patient Allocation ◽  
Ed Overcrowding ◽  
Controlled Evaluation

Introduction: Emergency department (ED) overcrowding is a common and complicated challenge for EDs worldwide. Nurse-initiated protocols, diagnostics and/or treatments implemented by nurses prior to patients being seen by a physician or nurse practitioner, have been suggested as a potential strategy to improve patient flow. Methods: This randomized, pragmatic, controlled evaluation of 5 nurse-initiated protocols occured in a crowded inner-city ED. Six physicians and 44 registered nurses, 3 clinical nurse educators and 3 unit managers were involved in revising 5 patient-complaint focused protocols prior to evaluation. Thirty (30/180) emergency nurses were provided 1 hour of training on inclusion and exclusion criteria, procedure and evaluation methods. Data was abstracted in a manner concealing patient allocation. Primary outcomes evaluated included time to diagnostic test, treatment, consultation or ED length of stay. This evaluation was completed following both the CONSORT and SQUIRE guidelines. Results: Time to acetaminophen for the intervention group (n=11) was 1h:04 min on average (95%CI 30min to 1h:37min) whereas the control group (n=9) was 3h:35min (95%CI 2h:21min to 4h:48min). The average length of stay of a suspected fractured-hip in the intervention group (n=5) was 3h:34min (95%CI 1h:49min to 5h:19min) and 7h:34min for the control group (n=4) was (95%CI 5h:26min to 9h:42min). Time to troponin in the intervention group (n=29) was one quarter (average 48min, 95% CI 32min to 64min) of the time it was in the control group (n=14) (average 3h:16min, 95%CI 1h:53min to 4h:39min; p < 0.001). The vaginal bleeding in pregnancy protocol reduced length of stay by roughly fifty-percent; the intervention group (n=11) had a length of stay of 4h:57min (95%CI 3h:46min to 6h:08min) compared to 8h:33min (95% CI 6h:23min to 10h:44min) for the control (n=7) (p < 0.001). There was no statistical difference in the length of stay for patients who received protocolized diagnostics for abdominal pain. Conclusion: Targeting specific patient groups with carefully written protocols can improve the timeliness of care. A cooperative and collaborative interdisciplinary group are essential to success. Having a system in place to ensure ongoing quality in protocol application and interdisciplinary support has proven more difficult than improving the primary outcomes in this evaluation.

Assembly line productivity improvement as re-engineered by MOST

2016 ◽  
Vol 65 (7) ◽  
pp. 977-994 ◽  
Author(s):  
A.N. Mustafizul Karim ◽  
Saravanan Tanjong Tuan ◽  
H.M. Emrul Kays
Keyword(s):  
Assembly Line ◽  
Flow Analysis ◽  
Value Added ◽  
Poor Performance ◽  
Hand Tools ◽  
Rear Window ◽  
Productivity Improvement ◽  
Content Type ◽  
Time Standards ◽  
Work Method

Purpose The purpose of this paper is to address and solve operational problems of an automotive industry in reaching production target by adopting Maynard Operation Sequence Technique (MOST) as lean and productivity improvement strategies. Design/methodology/approach In the undertaken case of auto-car rear window assembly line, a recurring production shortfall in fulfilling the daily demand is seemingly due to inappropriate work method. Initial observation of the operations led to suspect certain lapses in initiatives to adopt the time standards, to reduce or eliminate non-value added motions, to design suitable aisle and to assign tasks among workstations in a balanced manner. Subsequently an attempt is made to pinpoint the causes of poor performance and the bottlenecks through process flow analysis and time study by applying MOST. The elemental tasks are closely examined for possible reduction of workstation times by choosing efficient work methods with ergonomic features. Thus appropriate hand tools, jigs and fixture with nominal investment are prescribed to incorporate in the assembly works. The operational changes as steered by the MOST application have enhanced the workflow with a shorter cycle time which led to a substantial increase in productivity. Findings The productivity of the assembly line is increased by more than 29 percent from the earlier capacity through the MOST application which is deemed to meet the current level of demand. Originality/value The adopted framework for recognizing the effectiveness of MOST to expose and rectify the flaws in work methods without much investment is expected to be beneficial for a manufacturer in securing the competitiveness.

Sign in / Sign up

Export Citation Format

Share Document