Using Simulation Optimization to Solve Patient Appointment Scheduling and Examination Room Assignment Problems for Patients Undergoing Ultrasound Examination

This study investigates patient appointment scheduling and examination room assignment problems involving patients who undergo ultrasound examination with considerations of multiple examination rooms, multiple types of patients, multiple body parts to be examined, and special restrictions. Following are the recommended time intervals based on the findings of three scenarios in this study: In Scenario 1, the time interval recommended for patients’ arrival at the radiology department on the day of the examination is 18 min. In Scenario 2, it is best to assign patients to examination rooms based on weighted cumulative examination points. In Scenario 3, we recommend that three outpatients come to the radiology department every 18 min to undergo ultrasound examinations; the number of inpatients and emergency patients arriving for ultrasound examination is consistent with the original time interval distribution. Simulation optimization may provide solutions to the problems of appointment scheduling and examination room assignment problems to balance the workload of radiological technologists, maintain high equipment utilization rates, and reduce waiting times for patients undergoing ultrasound examination.

Simulation of aerosol dispersion during medical examinations

The main route of transmission of the SARS-CoV2 virus has been shown to be airborne. The objective of this study is to analyze the aerosol dispersion and potential exposure to medical staff within a typical medical examination room during classical airway procedures. The multiphase simulation of the aerosol particles in the airflow is based on a Lagrangian-Eulerian approach. All simulation cases with surgical mask show partially but significantly reduced maximum dispersion distances of the aerosol particles compared to the cases without surgical mask. The simulations have shown that medical examiner are exposed to large amount of aerosol particles, especially during procedures such as laryngoscopy where the examiner's head is directly in front of the patient's face. However, exposure can be drastically reduced if the patient wears a mask which is possible for the most of the procedures studied, such as otoscopy, sonography, or anamnesis.

THE QUALITY OF ANTENATAL CARE BASED ON INDEX SATISFACTION OF PREGNANT WOMEN

Background: Quality antenatal care in the MCH program is considered to be one of the effective efforts to reduce maternal and child morbidity and mortality. An indicator of the success of ANC services can be seen from the output produced, namely in the form of K4 coverage. According to Kotler there are 5 (five) determinants of service quality that can be used as a basis for assessing the level of customer satisfaction with the quality of service received including Tangibles, Reliability, Responsiveness, Assurance and Empathy. Method: This research method is quantitative descriptive with survey approach. The total sample of 149 pregnant women with total sampling techniques. The instrument used was a questionnaire. Data analysis uses univariate analysis. Results: The most valued statements both from each dimension namely; tangible: Midwife performance reliability: recording in the MCH handbook, responsiveness: responses to complaints, assurance: the nature of the Midwife, empathy of communication between midwives and patients. The most valued statements are enough from each dimension namely; tangible: examination room, reliability: service procedures, responsieness: midwife response to patients waiting for long queues, assurance: guarantee to service, empathy: suitability of waiting time and duration of service. Conclusion: The data shows that the majority of respondents considered the quality of antenatal services at the Tambakrejo Public Health Center to be good but still needed to be improved so that the assessment was sufficiently good.

Cutting Staff Radiation Exposure and Improving Freedom of Motion during CT Interventions: Comparison of a Novel Workflow Utilizing a Radiation Protection Cabin versus Two Conventional Workflows

This study aimed to evaluate the radiation exposure to the radiologist and the procedure time of prospectively matched CT interventions implementing three different workflows—the radiologist—(I) leaving the CT room during scanning; (II) wearing a lead apron and staying in the CT room; (III) staying in the CT room in a prototype radiation protection cabin without lead apron while utilizing a wireless remote control and a tablet. We prospectively evaluated the radiologist’s radiation exposure utilizing an electronic personal dosimeter, the intervention time, and success in CT interventions matched to the three different workflows. We compared the interventional success, the patient’s dose of the interventional scans in each workflow (total mAs and total DLP), the radiologist’s personal dose (in µSV), and interventional time. To perform workflow III, a prototype of a radiation protection cabin, with 3 mm lead equivalent walls and a foot switch to operate the doors, was built in the CT examination room. Radiation exposure during the maximum tube output at 120 kV was measured by the local admission officials inside the cabin at the same level as in the technician’s control room (below 0.5 μSv/h and 1 mSv/y). Further, to utilize the full potential of this novel workflow, a sterile packed remote control (to move the CT table and to trigger the radiation) and a sterile packed tablet anchored on the CT table (to plan and navigate during the CT intervention) were operated by the radiologist. There were 18 interventions performed in workflow I, 16 in workflow II, and 27 in workflow III. There were no significant differences in the intervention time (workflow I: 23 min ± 12, workflow II: 20 min ± 8, and workflow III: 21 min ± 10, p = 0.71) and the patient’s dose (total DLP, p = 0.14). However, the personal dosimeter registered 0.17 ± 0.22 µSv for workflow II, while I and III both documented 0 µSv, displaying significant difference (p < 0.001). All workflows were performed completely and successfully in all cases. The new workflow has the potential to reduce interventional CT radiologists’ radiation dose to zero while relieving them from working in a lead apron all day.

The Effect of Mobile Indoor Air Cleaners on the Risk of Infection with SARS-CoV-2 in Surgical Examination and Treatment Rooms with Limited Ventilation Options

Objective: Due to the airborne transmission of the Coronavirus Disease (Covid-19) via aerosols, we investigated the effect of a mobile air filter system in a surgical examination room. Methods: A mobile indoor air cleaner (AP 90, DEMA-airtech, Germany) was run during regular surgical consulting hour in our outpatient’s clinic. Aerosol concentration was measured by Fidas Frog fine dust monitoring system (Palas, Germany) by constantly recording PM1.0, PM2.5, PM4, PM10 and the total particle load PMtot. Results: The use of the air filter system led to a significant reduction of aerosols in the room despite the fact that there were various numbers of persons in the room constantly. Conclusion: The use of a high efficiency air filtration device, especially in examination rooms with poor ventilation, e.g., lack of windows or local exhaust is recommendable.

Review of High Relative Humidity in Catheter Laboratory of a Private Hospital and a Low Energy Consuming Solution

The Relative Humidity in a Catheter Laboratory is desirous to be controlled within a range of 30 to 65% RH. A maximum Relative Humidity (RH) fluctuation of up to 70% is tolerated. A case study is presented whereby a high RH of up to 80% RH has been recorded in the examination room of a Catheter Laboratory (CathLab) in a local Hospital. The conditioned air to the CathLab is supplied through an existing dedicated Chilled Water Air Handling Unit. Two (2) solutions were considered and the technical and commercial comparisons carried out. The first option is an inline dehumidifier system and the second option is to install a portable standalone dehumidifier inside the CathLab examination room. Solutions to address the high Relative Humidity have to be carefully considered as the introduction of in-line dehumidifiers contribute to higher energy consumption. The latter was selected based on commercial reasons. Three (3) weeks of RH monitoring via the building’s Integrated Building Management System (IBMS) was carried out. The readings measured show a drastic reduction in RH to a mean of about 60% RH which meets the end user’s requirement. The cost for the second option was also found to be much lower at about 10% of the first option.