Lu, Lingbo; Li, Jingshan; Gisler, Paula
Radiology tests, such as MRI, CT-scan, X-ray and ultrasound, are cost intensive and insurance pre-approvals are necessary to get reimbursement. In some cases, tests may be denied for payments by insurance companies due to lack of pre-approvals, inaccurate or missing necessary information. This can lead to substantial revenue losses for the hospital. In this paper, we present a simulation study of a centralized scheduling process for outpatient radiology tests at a large community hospital (Central Baptist Hospital in Lexington, Kentucky). Based on analysis of the central scheduling process, a simulation model of information flow in the process has been developed. Using such a model, the root causes of financial losses associated with errors and omissions in this process were identified and analyzed, and their impacts were quantified. In addition, "what-if" analysis was conducted to identify potential process improvement strategies in the form of recommendations to the hospital leadership. Such a model provides a quantitative tool for continuous improvement and process control in radiology outpatient test scheduling process to reduce financial losses associated with process error. This method of analysis is also applicable to other departments in the hospital.
I.B. Vermeulen (Ivan); S.M. Bohte (Sander); D.J.A. Somefun (Koye); J.A. La Poutré (Han)
htmlabstractWe present a dynamic and distributed approach to the hospital patient scheduling problem, in which patients can have multiple appointments that have to be scheduled to different resources. To efficiently solve this problem we develop a multi-agent Pareto-improvement appointment
Vermeulen, I.B.; Bohté, S.M.; Somefun, D.J.A.; Poutré, La J.A.
We present a dynamic and distributed approach to the hospital patient scheduling problem, in which patients can have multiple appointments that have to be scheduled to different resources. To efficiently solve this problem we develop a multi-agent Pareto-improvement appointment exchanging algorithm:
Nainggolan, J. C. T.; Kusumastuti, R. D.
Hospitals play an essential role in the community by providing medical services to the public. In order to provide high quality medical services, hospitals must manage their resources (including nurses) effectively and efficiently. Scheduling of nurses’ work shifts, in particular, is crucial, and must be conducted carefully to ensure availability and fairness. This research discusses the job scheduling system for nurses in PGI Cikini Hospital, Jakarta with Goal Programming approach. The research objectives are to identify nurse scheduling criteria and find the best schedule that can meet the criteria. The model has hospital regulations (including government regulations) as hard constraints, and nurses’ preferences as soft constraints. We gather primary data (hospital regulations and nurses’ preferences) through interviews with three Head Nurses and distributing questionnaires to fifty nurses. The results show that on the best schedule, all hard constraints can be satisfied. However, only two out of four soft constraints are satisfied. Compared to current scheduling practice, the resulting schedule ensures the availability of nurses as it satisfies all hospital’s regulations and it has a higher level of fairness as it can accommodate some of the nurses’ preferences.
Full Text Available Hospital outpatient departments operate by selling fixed period appointments for different treatments. The challenge being faced is to improve profit by determining the mix of full time and part time doctors and allocating appointments (which involves scheduling a combination of doctors, patients, and treatments to a time period in a department optimally. In this paper, a bilevel fuzzy chance constrained model is developed to solve the hospital outpatient appointment scheduling problem based on revenue management. In the model, the hospital, the leader in the hierarchy, decides the mix of the hired full time and part time doctors to maximize the total profit; each department, the follower in the hierarchy, makes the decision of the appointment scheduling to maximize its own profit while simultaneously minimizing surplus capacity. Doctor wage and demand are considered as fuzzy variables to better describe the real-life situation. Then we use chance operator to handle the model with fuzzy parameters and equivalently transform the appointment scheduling model into a crisp model. Moreover, interactive algorithm based on satisfaction is employed to convert the bilevel programming into a single level programming, in order to make it solvable. Finally, the numerical experiments were executed to demonstrate the efficiency and effectiveness of the proposed approaches.
Lin, C K
This paper focuses on labour scheduling for hospital porters who are the major workforce providing routine cleansing of wards, transportation and messenger services. Generating an equitable monthly roster for porters while meeting the daily minimum demand is a tedious task scheduled manually by a supervisor. In considering a variety of constraints and goals, a manual schedule was usually produced in seven to ten days. To be in line with the strategic goal of scientific management of an acute care regional hospital in Hong Kong, a microcomputer-based algorithm was developed to schedule the monthly roster. The algorithm, coded in Digital Visual Fortran 5.0 Professional, could generate a monthly roster in seconds. Implementation has been carried out since September 1998 and the results proved to be useful to hospital administrators and porters. This paper discusses both the technical and human issues involved during the computerization process.
Wallace, Laurel-Anne; Pierson, Sharon
In 2003, Hamilton Health Sciences embarked on an initiative to improve and standardize nursing schedules and scheduling practices. The scheduling project was one of several initiatives undertaken by a corporate-wide Nursing Resource Group established to enhance the work environment and patient care and to ensure appropriate utilization of nursing resources across the organization's five hospitals. This article focuses on major activities undertaken in the scheduling initiative. The step-by-step approach described, plus examples of the scheduling resources developed and samples of extended-tour schedules, will all provide insight, potential strategies and practical help for nursing administrators, human resources (HR) personnel and others interested in improving nurse scheduling.
Simon, Ross William; Canacari, Elena G
A large teaching hospital in the northeast United States had an inefficient, paper-based process for scheduling orthopedic surgery that caused delays and contributed to site/side discrepancies. The hospital's leaders formed a team with the goals of developing a safe, effective, patient-centered, timely, efficient, and accurate orthopedic scheduling process; smoothing the schedule so that block time was allocated more evenly; and ensuring correct site/side. Under the resulting process, real-time patient information is entered into a database during the patient's preoperative visit in the surgeon's office. The team found the new process reduced the occurrence of site/side discrepancies to zero, reduced instances of changing the sequence of orthopedic procedures by 70%, and increased patient satisfaction. Copyright © 2014 AORN, Inc. Published by Elsevier Inc. All rights reserved.
Dhaini, Suzanne R; Denhaerynck, Kris; Bachnick, Stefanie; Schwendimann, René; Schubert, Maria; De Geest, Sabina; Simon, Michael
Emotional exhaustion among healthcare workers is a widely investigated, well-recognized problem, the incidence of which has recently been linked to work environment factors, particularly work/family conflict. However, another environmental feature that may be equally influential, but that is more amenable to nurse manager action, remains less recognized: shift schedule flexibility. This study's main purposes were to assess variations in work schedule flexibility between Swiss acute care hospital units, and to investigate associations between psychosocial work environment (e.g. work schedule flexibility) and self-reported emotional exhaustion among registered nurses. This is a secondary analysis of data collected for the multi-center observational cross-sectional Match RN study, which included a national sample of 23 hospitals and 1833 registered nurses across Switzerland. Overall, self-reported work schedule flexibility among registered nurses was limited: 32% of participants reported little or no influence in planning their own shifts. Work schedule flexibility (β -0.11; CI -0.16; -0.06) and perceived nurse manager ability (β -0.30; CI -0.49; -0.10) were negatively related to self-reported emotional exhaustion. Work-family conflict (β 0.39; CI 0.33; 0.45) was positively correlated to emotional exhaustion. The study results indicate that managerial efforts to improve working environments, including special efforts to improve work schedule flexibility, might play an important role in promoting nurses' emotional health. Copyright © 2018 Elsevier Ltd. All rights reserved.
Full Text Available Common problems of Thai nurses are low quality of life, working long hours, and a high turnover rate. The workload imbalance among nurses also worsens the turnover rate. With careful schedule planning, nurses do not have to work in consecutive shifts and can rest more. We interviewed and collected data from an emergency department at a hospital administered by a Thai university, related to objectives and constraints of monthly nurse scheduling, and actual monthly schedules. A multi-objective mathematical model was developed using the open source “OpenSolver” software in MS-Excel for nurse schedulers to freely use. We tested the model using actual data collected from the department and found that the schedules created by the model tended to provide more balanced workloads and more days off compared to the schedules created manually by a real scheduler. The model also suggested an easy policy to increase the number of nurses for future expansion.
Liao, C J; Kao, C Y
Suggests that with the shortage of nursing personnel, hospital administrators have to pay more attention to the needs of nurses to retain and recruit them. Also asserts that improving nurses' schedules is one of the most economic ways for the hospital administration to create a better working environment for nurses. Develops an algorithm for scheduling nursing personnel. Contrary to the current hospital approach, which schedules nurses on a person-by-person basis, the proposed algorithm constructs schedules on a day-by-day basis. The algorithm has inherent flexibility in handling a variety of possible constraints and goals, similar to other non-cyclical approaches. But, unlike most other non-cyclical approaches, it can also generate a quality schedule in a short time on a microcomputer. The algorithm was coded in C language and run on a microcomputer. The developed software is currently implemented at a leading hospital in Taiwan. The response to the initial implementation is quite promising.
Bader, Ahmed; Alouini, Mohamed-Slim; Ayadi, Yassin
In accordance with the present disclosure, embodiments of an exemplary scheduling controller module or device implement an improved scheduling process such that the targeted reduction in schedule length can be achieve while incurring minimal energy penalty by allowing for a large rate (or duration) selection alphabet.
In accordance with the present disclosure, embodiments of an exemplary scheduling controller module or device implement an improved scheduling process such that the targeted reduction in schedule length can be achieve while incurring minimal energy penalty by allowing for a large rate (or duration) selection alphabet.
Qin, Danyang; Yang, Songxiang; Zhang, Yan; Ma, Jingya; Ding, Qun
Wireless energy collecting technology can effectively reduce the network time overhead and prolong the wireless sensor network (WSN) lifetime. However, the traditional energy collecting technology cannot achieve the balance between ergodic channel capacity and average collected energy. In order to solve the problem of the network transmission efficiency and the limited energy of wireless devices, three improved scheduling mechanisms are proposed: improved signal noise ratio (SNR) scheduling mechanism (IS2M), improved N-SNR scheduling mechanism (INS2M) and an improved Equal Throughput scheduling mechanism (IETSM) for different channel conditions to improve the whole network performance. Meanwhile, the average collected energy of single users and the ergodic channel capacity of three scheduling mechanisms can be obtained through the order statistical theory in Rayleig, Ricean, Nakagami- m and Weibull fading channels. It is concluded that the proposed scheduling mechanisms can achieve better balance between energy collection and data transmission, so as to provide a new solution to realize synchronous information and energy transmission for WSNs.
Full Text Available Abstract The problem of scheduling nurses at the Out-Patient Department OPD at Tafo Government Hospital Kumasi Ghana is presented. Currently the schedules are prepared by head nurse who performs this difficult and time consuming task by hand. Due to the existence of many constraints the resulting schedule usually does not guarantee the fairness of distribution of work. The problem was formulated as 0-1goal programming model with the of objective of evenly balancing the workload among nurses and satisfying their preferences as much as possible while complying with the legal and working regulations.. The developed model was then solved using LINGO14.0 software. The resulting schedules based on 0-1goal programming model balanced the workload in terms of the distribution of shift duties fairness in terms of the number of consecutive night duties and satisfied the preferences of the nurses. This is an improvement over the schedules done manually.
da Silva, Amanda Tabosa Pereira; Lima, Eduardo Jorge da Fonseca; Caminha, Maria de Fátima Costa; da Silva, Andresa Tabosa Pereira; Rodrigues, Edil de Albuquerque; dos Santos, Carmina Silva
ABSTRACT OBJECTIVE: To verify the adequacy and factors associated with compliance with the immunization schedule (BCG, DTP-Hib, MMR, PCV-10) in children hospitalized with pneumonia at a pediatric referral hospital in Northeast Brazil. METHODS: This is a cross-sectional, descriptive study with an analytical component, with a sample of 452 children hospitalized with pneumonia at the Instituto de Medicina Integral Prof. Fernando Figueira, between 2010 and 2013. The inclusion criterion was children aged from one month to less than five years of age with proof in the immunization record. The exclusion criterion was the presence of hospital-acquired pneumonia or concomitant disease. We have evaluated the adequacy of the immunization schedule for the BCG, tetravalent, MMR, and 10-valent pneumococcal conjugate (PCV-10) vaccines. We used the chi-square test and Fisher's exact test followed by multivariate Poisson regression, estimating the crude and adjusted prevalence ratios and respective 95% confidence intervals. The variables with p < 0.20 in the univariate analysis were included in the multivariate analysis. RESULTS: There was good adequacy in the immunization schedule, except for PCV-10, which presented a percentage lower than 85%. We have observed an association between adequate compliance with the immunization schedule and education level of the mother (89.9% complete high school), sex of the child (87.2% female), age of the child (94.2% younger than six months), and breastfeeding (84.3% breastfed). CONCLUSIONS: Given the high rate of education level of the mother and the high percentage of breastfeeding, we can understand that there is a better understanding of the health of the child by the mothers studied in this study, showing the effectiveness of public policies for infant feeding. However, children did not have good adequacy of the immunization schedule of PCV-10, one of the main vaccines against pneumonia, which can be one of the main factors in the causes of
Phunchongharn, Phond; Hossain, Ekram; Camorlinga, Sergio
We study the multiple access problem for e-Health applications (referred to as secondary users) coexisting with medical devices (referred to as primary or protected users) in a hospital environment. In particular, we focus on transmission scheduling and power control of secondary users in multiple spatial reuse time-division multiple access (STDMA) networks. The objective is to maximize the spectrum utilization of secondary users and minimize their power consumption subject to the electromagnetic interference (EMI) constraints for active and passive medical devices and minimum throughput guarantee for secondary users. The multiple access problem is formulated as a dual objective optimization problem which is shown to be NP-complete. We propose a joint scheduling and power control algorithm based on a greedy approach to solve the problem with much lower computational complexity. To this end, an enhanced greedy algorithm is proposed to improve the performance of the greedy algorithm by finding the optimal sequence of secondary users for scheduling. Using extensive simulations, the tradeoff in performance in terms of spectrum utilization, energy consumption, and computational complexity is evaluated for both the algorithms.
Full Text Available The goal of the scheduling is to arrange operations on suitable machines with optimal sequence for corresponding objectives. In order to meet market requirements, scheduling systems must own enough flexibility against uncertain events. These events can change production status or processing parameters, even causing the original schedule to no longer be optimal or even to be infeasible. Traditional scheduling strategies, however, cannot cope with these cases. Therefore, a new idea of scheduling called inverse scheduling has been proposed. In this paper, the inverse scheduling with weighted completion time (SMISP is considered in a single-machine shop environment. In this paper, an improved genetic algorithm (IGA with a local searching strategy is proposed. To improve the performance of IGA, efficient encoding scheme, fitness evaluation mechanism, feasible initialization methods, and a local search procedure have been employed in the paper. Because of the local improving method, the proposed IGA can balance its exploration ability and exploitation ability. We adopt 27 instances to verify the effectiveness of the proposed algorithm. The experimental results illustrated that the proposed algorithm can generate satisfactory solutions. This approach also has been applied to solve the scheduling problem in the real Chinese shipyard and can bring some benefits.
Lindhard, Søren; Wandahl, Søren
-down the contractors, and force them to rigorously adhere to the initial schedule. If delayed the work-pace or manpower has to be increased to observe the schedule. In attempt to improve productivity three independent site-mangers have been interviewed about time-scheduling. Their experiences and opinions have been...... analyzed and weaknesses in existing time scheduling have been found. The findings showed a negative side effect of keeping the schedule to tight. A too tight schedule is inflexible and cannot absorb variability in production. Flexibility is necessary because of the contractors interacting and dependable....... The result is a chaotic, complex and uncontrolled construction site. Furthermore, strict time limits entail the workflow to be optimized under non-optimal conditions. Even though productivity seems to be increasing, productivity per man-hour is decreasing resulting in increased cost. To increase productivity...
Full Text Available Job Shop Scheduling Problem (JSSP and Flow Shop Scheduling Problem (FSSP are strong NP-complete combinatorial optimization problems among class of typical production scheduling problems. An improved Sheep Flock Heredity Algorithm (ISFHA is proposed in this paper to find a schedule of operations that can minimize makespan. In ISFHA, the pairwise mutation operation is replaced by a single point mutation process with a probabilistic property which guarantees the feasibility of the solutions in the local search domain. A Robust-Replace (R-R heuristic is introduced in place of chromosomal crossover to enhance the global search and to improve the convergence. The R-R heuristic is found to enhance the exploring potential of the algorithm and enrich the diversity of neighborhoods. Experimental results reveal the effectiveness of the proposed algorithm, whose optimization performance is markedly superior to that of genetic algorithms and is comparable to the best results reported in the literature.
Ge, Junwei; He, Qian; Fang, Yiqiu
In order to optimize the cloud computing task scheduling scheme, an improved differential evolution algorithm for cloud computing task scheduling is proposed. Firstly, the cloud computing task scheduling model, according to the model of the fitness function, and then used improved optimization calculation of the fitness function of the evolutionary algorithm, according to the evolution of generation of dynamic selection strategy through dynamic mutation strategy to ensure the global and local search ability. The performance test experiment was carried out in the CloudSim simulation platform, the experimental results show that the improved differential evolution algorithm can reduce the cloud computing task execution time and user cost saving, good implementation of the optimal scheduling of cloud computing tasks.
Thompson, Debbie Gearner; Tielsch-Goddard, Anna
Surgical preparation for children with autism spectrum disorders can be a challenge to perioperative staff because of the unique individual needs and behaviors in this population. Most children with autism function best in predictable, routine environments, and being in the hospital and other health care settings can create a stressful situation. This prospective, descriptive, quality improvement project was conducted to optimize best practices for perioperative staff and better individualize the plan of care for the autistic child and his or her family. Forty-three patients with a diagnosis of autism or autistic spectrum disorder were seen over 6 months at a suburban pediatric hospital affiliated with a major urban pediatric hospital and had an upcoming scheduled surgery or procedure requiring anesthesia. Caregivers were interviewed before and after surgery to collect information to better help their child cope with their hospital visit. In an evaluation of project outcomes, data were tabulated and summarized and interview data were qualitatively coded for emerging themes to improve the perioperative process for the child. Findings showed that staff members were able to recognize potential and actual stressors and help identify individual needs of surgical patients with autism. The families were pleased and appreciative of the individual attention and focus on their child's special needs. Investigators also found increased staff interest in optimizing the surgical experience for autistic children. Copyright © 2014 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.
van Oostrum, Jeroen M.; van Houdenhoven, M.; Hurink, Johann L.; Hans, Elias W.; Wullink, Gerhard; Kazemier, G.
This paper addresses the problem of operating room (OR) scheduling at the tactical level of hospital planning and control. Hospitals repetitively construct operating room schedules, which is a time-consuming, tedious, and complex task. The stochasticity of the durations of surgical procedures
Pop, Paul; Eles, Petru; Peng, Zebo
clock synchronization and mode changes. We have improved the quality of the schedules by introducing a new priority function that takes into consideration the communication protocol. Communication has been optimized through packaging messages into slots with a properly selected order and lengths......In this paper we present an improved scheduling technique for the synthesis of time-triggered embedded systems. Our system model captures both the flow of data and that of control. We have considered communication of data and conditions for a time-triggered protocol implementation that supports...
Tagge, Edward P; Thirumoorthi, Arul S; Lenart, John; Garberoglio, Carlos; Mitchell, Kenneth W
Lean Six Sigma (LSS) is a process improvement methodology that utilizes a collaborative team effort to improve performance by systematically identifying root causes of problems. Our objective was to determine whether application of LSS could improve efficiency when applied simultaneously to all services of an academic children's hospital. In our tertiary academic medical center, a multidisciplinary committee was formed, and the entire perioperative process was mapped, using fishbone diagrams, Pareto analysis, and other process improvement tools. Results for Children's Hospital scheduled main operating room (OR) cases were analyzed, where the surgical attending followed themselves. Six hundred twelve cases were included in the seven Children's Hospital operating rooms (OR) over a 6-month period. Turnover Time (interval between patient OR departure and arrival of the subsequent patient) decreased from a median 41min in the baseline period to 32min in the intervention period (p<0.0001). Turnaround Time (interval between surgical dressing application and subsequent surgical incision) decreased from a median 81.5min in the baseline period to 71min in the intervention period (p<0.0001). These results demonstrate that a coordinated multidisciplinary process improvement redesign can significantly improve efficiency in an academic Children's Hospital without preselecting specific services, removing surgical residents, or incorporating new personnel or technology. Prospective comparative study, Level II. Copyright © 2017 Elsevier Inc. All rights reserved.
van Houdenhoven, Mark; van Oostrum, Jeroen M.; Wullink, Gerhard; Hans, Elias W.; Hurink, Johann L.; Bakker, Jan; Kazemier, Geert
Purpose: Mounting health care costs force hospital managers to maximize utilization of scarce resources and simultaneously improve access to hospital services. This article assesses the benefits of a cyclic case scheduling approach that exploits a master surgical schedule (MSS). An MSS maximizes
Harchol-Balter, M.; Schroeder, B.; Bansal, N.; Agrawal, M.
Is it possible to reduce the expected response time of every request at a web server, simply by changing the order in which we schedule the requests? That is the question we ask in this paper.This paper proposes a method for improving the performance of web servers servicing static HTTP requests.
Woltering, R; Hoffmann, G; Isermann, J; Heudorf, U
Background and Objective: An assessment of cleaning and disinfection in hospitals by the use of objective surveillance and review of mandatory corrective measures was undertaken. Methods: A prospective examination of the cleaning and disinfection of surfaces scheduled for daily cleaning in 5 general care hospitals by use of an ultraviolet fluorescence targeting method (UVM) was performed, followed by structured educational and procedural interventions. The survey was conducted in hospital wards, operating theatres and intensive care units. Cleaning performance was measured by complete removal of UVM. Training courses and reinforced self-monitoring were implemented after the first evaluation. 6 months later, we repeated the assessment for confirmation of success. Results: The average cleaning performance was 34% (31/90) at base-line with significant differences between the 5 hospitals (11-67%). The best results were achieved in intensive care units (61%) and operating theatres (58%), the worst results in hospital wards (22%). The intervention significantly improved cleaning performance up to an average of 69% (65/94; +34.7%; 95% confidence interval (CI): 21.2-48.3; pcleaning and disinfection of surfaces by fluorescence targeting is appropriate for evaluating hygiene regulations. An intervention can lead to a significant improvement of cleaning performance. As part of a strategy to improve infection control in hospitals, fluorescence targeting enables a simple inexpensive and effective surveillance of the cleaning performance and corrective measures. © Georg Thieme Verlag KG Stuttgart · New York.
van Oostrum, J.M.; van Houdenhoven, M.; Hurink, Johann L.; Hans, Elias W.; Wullink, Gerhard; Kazemier, G.
This paper addresses the problem of operating room scheduling at the tactical level of hospital planning and control. Hospitals repetitively construct operating room schedules, which is a time consuming tedious and complex task. The stochasticity of the durations of surgical procedures complicates
Carlton, Erik L; Singh, Simone Rauscher
To examine the association between hospital-local health department (LHD) collaboration around community health needs assessments (CHNAs) and hospital investment in community health. We combined 2015 National Association of County and City Health Officials (NACCHO) Forces of Change, 2013 NACCHO Profile, and 2014-2015 Area Health Resource File data to identify a sample of LHDs (n = 439) across the United States. We included data on hospitals' community benefit from their 2014 tax filings (Internal Revenue Service Form 990, Schedule H). We used bivariate and multivariate regression analyses to examine LHDs' involvement in hospitals' CHNAs and implementation strategies and the relationship with hospital investment in community health. The LHDs that collaborated with hospitals around CHNAs were significantly more likely to be involved in joint implementation planning activities than were those that did not. Importantly, LHD involvement in hospitals' implementation strategies was associated with greater hospital investment in community health improvement initiatives. Joint CHNAs may improve coordination of community-wide health improvement efforts between hospitals and LHDs and encourage hospital investment in community health improvement activities. Public Health Implications. Policies that strengthen LHD-hospital collaboration around the CHNA may enhance hospital investments in community health.
Shinn, Stephen A.; Bryson, Jonathan; Klein, Gerald; Lunz-Ruark, Val; Majerowicz, Walt; McKeever, J.; Nair, Param
Goddard Space Flight Center's Flight Projects Directorate employed a Business Change Initiative (BCI) to infuse a series of activities coordinated to drive improved cost and schedule performance across Goddard's missions. This sustaining change framework provides a platform to manage and implement cost and schedule control techniques throughout the project portfolio. The BCI concluded in December 2014, deploying over 100 cost and schedule management changes including best practices, tools, methods, training, and knowledge sharing. The new business approach has driven the portfolio to improved programmatic performance. The last eight launched GSFC missions have optimized cost, schedule, and technical performance on a sustained basis to deliver on time and within budget, returning funds in many cases. While not every future mission will boast such strong performance, improved cost and schedule tools, management practices, and ongoing comprehensive evaluations of program planning and control methods to refine and implement best practices will continue to provide a framework for sustained performance. This paper will describe the tools, techniques, and processes developed during the BCI and the utilization of collaborative content management tools to disseminate project planning and control techniques to ensure continuous collaboration and optimization of cost and schedule management in the future.
de Blanche, Andreas; Lundqvist, Thomas
Programs running on different cores in a multicore server are often forced to share resources like off-chip memory, caches, I/O devices, etc. This resource sharing often leads to degraded performance, a slowdown, for the programs that share the resources. A job scheduler can improve performance by co-scheduling programs that use different resources on the same server. The most common approach to solve this co-scheduling problem has been to make job-schedulers resource aware, finding ways to c...
disrupted schedules are rescheduled , minimizing the total number of changes with respect to the previous schedule’s objective function. Output...producing rosters for a nursing staff in a large general hospital (Dowsland, 1998) and afterwards Aickelin and Dowsland use an Indirect Genetic...algorithm to improve the solutions of the nurse scheduling problem which is similar to the fighter squadron pilot scheduling problem (Aickelin and
Shahidin, Ainon Mardhiyah; Said, Mohd Syazwan Md; Said, Noor Hizwan Mohamad; Sazali, Noor Izatie Amaliena
Time management is the art of arranging, organizing and scheduling one's time for the purpose of generating more effective work and productivity. Scheduling is the process of deciding how to commit resources between varieties of possible tasks. Thus, it is crucial for every organization to have a good work schedule for their staffs. The job of Ward nurses at hospitals runs for 24 hours every day. Therefore, nurses will be working using shift scheduling. This study is aimed to solve the nurse scheduling problem at an emergency ward of a private hospital. A 7-day work schedule for 7 consecutive weeks satisfying all the constraints set by the hospital will be developed using Integer Programming. The work schedule for the nurses obtained gives an optimal solution where all the constraints are being satisfied successfully.
There are close to 20,000 cataloged manmade objects in space, the large majority of which are not active, functioning satellites. These are tracked by phased array and mechanical radars and ground and space-based optical telescopes, collectively known as the Space Surveillance Network (SSN). A better SSN schedule of observations could, using exactly the same legacy sensor resources, improve space catalog accuracy through more complementary tracking, provide better responsiveness to real-time changes, better track small debris in low earth orbit (LEO) through efficient use of applicable sensors, efficiently track deep space (DS) frequent revisit objects, handle increased numbers of objects and new types of sensors, and take advantage of future improved communication and control to globally optimize the SSN schedule. We have developed a scheduling algorithm that takes as input the space catalog and the associated covariance matrices and produces a globally optimized schedule for each sensor site as to what objects to observe and when. This algorithm is able to schedule more observations with the same sensor resources and have those observations be more complementary, in terms of the precision with which each orbit metric is known, to produce a satellite observation schedule that, when executed, minimizes the covariances across the entire space object catalog. If used operationally, the results would be significantly increased accuracy of the space catalog with fewer lost objects with the same set of sensor resources. This approach inherently can also trade-off fewer high priority tasks against more lower-priority tasks, when there is benefit in doing so. Currently the project has completed a prototyping and feasibility study, using open source data on the SSN's sensors, that showed significant reduction in orbit metric covariances. The algorithm techniques and results will be discussed along with future directions for the research.
Full Text Available Uncertainty is common in ship construction. However, few studies have focused on scheduling problems under uncertainty in shipbuilding. This paper formulates the scheduling problem of panel block construction as a multiobjective fuzzy flow shop scheduling problem (FSSP with a fuzzy processing time, a fuzzy due date, and the just-in-time (JIT concept. An improved multiobjective particle swarm optimization called MOPSO-M is developed to solve the scheduling problem. MOPSO-M utilizes a ranked-order-value rule to convert the continuous position of particles into the discrete permutations of jobs, and an available mapping is employed to obtain the precedence-based permutation of the jobs. In addition, to improve the performance of MOPSO-M, archive maintenance is combined with global best position selection, and mutation and a velocity constriction mechanism are introduced into the algorithm. The feasibility and effectiveness of MOPSO-M are assessed in comparison with general MOPSO and nondominated sorting genetic algorithm-II (NSGA-II.
Mahaney, Lynnae; Sanborn, Michael; Alexander, Emily
Nontraditional work schedules for pharmacists at three institutions are described. The demand for pharmacists and health care in general continues to increase, yet significant material changes are occurring in the pharmacy work force. These changing demographics, coupled with historical vacancy rates and turnover trends for pharmacy staff, require an increased emphasis on workplace changes that can improve staff recruitment and retention. At William S. Middleton Memorial Veterans Affairs Hospital in Madison, Wisconsin, creative pharmacist work schedules and roles are now mainstays to the recruitment and retention of staff. The major challenge that such scheduling presents is the 8 hours needed to prepare a six-week schedule. Baylor Medical Center at Grapevine in Dallas, Texas, has a total of 45 pharmacy employees, and slightly less than half of the 24.5 full-time-equivalent staff work full-time, with most preferring to work one, two, or three days per week. As long as the coverage needs of the facility are met, Envision Telepharmacy in Alpine, Texas, allows almost any scheduling arrangement preferred by individual pharmacists or the pharmacist group covering the facility. Staffing involves a great variety of shift lengths and intervals, with shifts ranging from 2 to 10 hours. Pharmacy leaders must be increasingly aware of opportunities to provide staff with unique scheduling and operational enhancements that can provide for a better work-life balance. Compressed workweeks, job-sharing, and team scheduling were the most common types of alternative work schedules implemented at three different institutions.
Sayyida, Ghany; Fahma, Fakhrina; Iftadi, Irwan
RSUD dr. Soediran Mangun Sumarso is a public hospital in Wonogiri district which has an outpatient installation service. However, the waiting time of some services in outpatient installations exceeds the standard time set by the health minister of the Republic of Indonesia. It is known from the data waiting time in the outpatient installation. The purpose of this study is to provide improvements using lean hospital approach. Proposed improvement is done by eliminating waste that occurs in outpatient installation service. The methodology used in this study consists of four stages. The first stage is describing the service system using a cross-functional flowchart. The second stage is identifying waste using value stream mapping, observation and interview. The third stage is to determine critical waste by borda method and pareto diagram. The last stage is to provide recommendation improvement using fishbone diagram and FMEA. The result of this research is proposed improvements. The proposed improvements are adding special register counters, implementing an online reservation system, doctors schedule synchronization, adding doctors in polyclinics, fixing queue numbers, applying visual management concepts, making connecting glass in pharmacies and adding multifunction shelves in polyclinics.
Sondes CHAABANE; Nadine MESKENS; Alain GUINET; Marius LAURENT
Operating Theatre is the centre of the hospital management's efforts. It constitutes the most expensive sector with more than 10% of the intended operating budget of the hospital. To reduce the costs while maintaining a good quality of care, one of the solutions is to improve the existent planning and scheduling methods by improving the services and surgical specialty coordination or finding the best estimation of surgical case durations. The other solution is to construct an effective surgical case plan and schedule. The operating theatre planning and scheduling is the two important steps, which aim to make a surgical case programming with an objective of obtaining a realizable and efficient surgical case schedule. This paper focuses on the first step, the operating theatre planning problem. Two planning methods are introduced and compared. Real data of a Belgian university hospital "Tivoli" are used for the experiments.
Mans, Ronny S.; Russell, Nick C.; van der Aalst, Wil M. P.; Moleman, Arnold J.; Bakker, Piet J. M.
Contemporary workflow management systems offer work-items to users through specific work-lists. Users select the work-items they will perform without having a specific schedule in mind. However, in many environments work needs to be scheduled and performed at particular times. For example, in hospitals many work-items are linked to appointments, e.g., a doctor cannot perform surgery without reserving an operating theater and making sure that the patient is present. One of the problems when applying workflow technology in such domains is the lack of calendar-based scheduling support. In this paper, we present an approach that supports the seamless integration of unscheduled (flow) and scheduled (schedule) tasks. Using CPN Tools we have developed a specification and simulation model for schedule-aware workflow management systems. Based on this a system has been realized that uses YAWL, Microsoft Exchange Server 2007, Outlook, and a dedicated scheduling service. The approach is illustrated using a real-life case study at the AMC hospital in the Netherlands. In addition, we elaborate on the experiences obtained when developing and implementing a system of this scale using formal techniques.
Liu, Mengqi; Shan, Miyuan; Wu, Juan
For most enterprises, in order to win the initiative in the fierce competition of market, a key step is to improve their R&D ability to meet the various demands of customers more timely and less costly. This paper discusses the features of multiple R&D environments in large make-to-order enterprises under constrained human resource and budget, and puts forward a multi-project scheduling model during a certain period. Furthermore, we make some improvements to existed particle swarm algorithm and apply the one developed here to the resource-constrained multi-project scheduling model for a simulation experiment. Simultaneously, the feasibility of model and the validity of algorithm are proved in the experiment.
Meurer, Steven J; Counte, Michael A; Rubio, Doris M; Arrington, Barbara
The aim of this study was to test whether a recently developed measure of Continuous Quality Improvement (CQI) implementation can provide health care researchers and administrators with a tool to assist in understanding and with developing an appropriate structure for improvement efforts in hospitals. Two hundred respondents from 40 Missouri hospitals completed a 28-item survey addressing 8 domains of CQI. Overall, hospital scores showed low implementation of a structure that supports improvement efforts. All survey domains showed acceptable psychometric results. Leadership proved to be the most important domain of CQI because it differentiated well between all levels of the scale. Because of its ease of administration and analysis, and its reliability, validity, and level differentiation results, the researchers recommend the widespread use of this tool to understand and develop a hospital's organizational structure to support improvement activities.
Kullberg, Anna; Bergenmar, Mia; Sharp, Lena
To evaluate fixed scheduling compared with self-scheduling for nursing staff in oncological inpatient care with regard to patient and staff outcomes. Various scheduling models have been tested to attract and retain nursing staff. Little is known about how these schedules affect staff and patients. Fixed scheduling and self-scheduling have been studied to a small extent, solely from a staff perspective. We implemented fixed scheduling on two of four oncological inpatient wards. Two wards kept self-scheduling. Through a quasi-experimental design, baseline and follow-up measurements were collected among staff and patients. The Safety Attitudes Questionnaire was used among staff, as well as study-specific questions for patients and staff. Fixed scheduling was associated with less overtime and fewer possibilities to change shifts. Self-scheduling was associated with more requests from management for short notice shift changes. The type of scheduling did not affect patient-reported outcomes. Fixed scheduling should be considered in order to lower overtime. Further research is necessary and should explore patient outcomes to a greater extent. Scheduling is a core task for nurse managers. Our study suggests fixed scheduling as a strategy for managers to improve the effective use of resources and safety. © 2016 John Wiley & Sons Ltd.
Garcia, Hong-Mei C.; Yun, David Y.; Ge, Yiqun; Khan, Javed I.
There exists tremendous opportunity in hospital-wide resource optimization based on system integration. This paper defines the resource planning and scheduling requirements integral to PACS, RIS and HIS integration. An multi-site case study is conducted to define the requirements. A well-tested planning and scheduling methodology, called Constrained Resource Planning model, has been applied to the chosen problem of radiological service optimization. This investigation focuses on resource optimization issues for minimizing the turnaround time to increase clinical efficiency and customer satisfaction, particularly in cases where the scheduling of multiple exams are required for a patient. How best to combine the information system efficiency and human intelligence in improving radiological services is described. Finally, an architecture for interfacing a computer-aided resource planning and scheduling tool with the existing PACS, HIS and RIS implementation is presented.
Quality Improvement , Inventory Management, Lead Time Reduction and Production Scheduling in High-mix Manufacturing Environments by Sean Daigle B.S...Mechanical Engineering Chairman, Department Committee on Graduate Theses 2 Quality Improvement , Inventory Management, Lead Time Reduction and... Production Scheduling in High-mix Manufacturing Environments by Sean Daigle Submitted to the Department of Mechanical Engineering on January 13, 2017, in
Full Text Available High-speed railway is one of the most important ways to solve the long-standing travel difficulty problem in China. However, due to the high acquisition and maintenance cost, it is impossible for decision-making departments to purchase enough EMUs to satisfy the explosive travel demand. Therefore, there is an urgent need to study how to utilize EMU more efficiently and reduce costs in the case of completing a given task in train diagram. In this paper, an EMU circulation scheduling model is built based on train diagram constraints, maintenance constraints, and so forth; in the model solving process, an improved ACA algorithm has been designed. A case study is conducted to verify the feasibility of the model. Moreover, contrast tests have been carried out to compare the efficiency between the improved ACA and the traditional approaches. The results reveal that improved ACA method can solve the model with less time and the quality of each representative index is much better, which means that efficiency of the improved ACA method is higher and better scheduling scheme can be obtained.
SUMMARY This letter proposes a multiuser switched scheduling scheme with per-user threshold and post user selection and provides a generic analytical framework for determining the optimal feedback thresholds. The proposed scheme applies an individual feedback threshold for each user rather than a single common threshold for all users to achieve some capacity gain due to the flexibility of threshold selection as well as a lower scheduling outage probability. In addition, since scheduling outage may occur with a non-negligible probability, the proposed scheme employs post user selection in order to further improve the ergodic capacity, where the user with the highest potential for a higher channel quality than other users is selected. Numerical and simulation results show that the capacity gain by post user selection is significant when random sequence is used. Copyright © 2013 The Institute of Electronics, Information and Communication Engineers.
Yarnell, Christopher J; Shadowitz, Steven; Redelmeier, Donald A
Physician call schedules are a critical element for medical practice and hospital efficiency. We compared readmission rates prior to and after a change in physician call system at Sunnybrook Health Sciences Centre. We studied patients discharged over a decade (2004 through 2013) and identified whether or not each patient was readmitted within the subsequent 28 days. We excluded patients discharged for a surgical, obstetrical, or psychiatric diagnosis. We used time-to-event analysis and time-series analysis to compare rates of readmission prior to and after the physician call system change (January 1, 2009). A total of 89,697 patients were discharged, of whom 10,001 (11%) were subsequently readmitted and 4280 died. The risk of readmission was increased by about 26% following physician call system change (9.7% vs 12.2%, P system change (95% confidence interval, 22%-31%; P system change persisted across patients with diverse ages, estimated readmission risks, and medical diagnoses. The net effect was equal to 7240 additional patient days in the hospital following call system change. A modest increase was observed at a nearby acute care hospital that did not change physician call system, and no increase in risk of death was observed with increased hospital readmissions. We suggest that changes in physician call systems sometimes increase subsequent hospital readmission rates. Further reductions in readmissions may instead require additional resources or ingenuity. Copyright © 2016 Elsevier Inc. All rights reserved.
Olson, John R; Belohlav, James A; Cook, Lori S; Hays, Julie M
To determine if there is a hierarchy of improvement program adoption by hospitals and outline that hierarchy. Primary data were collected in the spring of 2007 via e-survey from 210 individuals representing 109 Minnesota hospitals. Secondary data from 2006 were assembled from the Leapfrog database. As part of a larger survey, respondents were given a list of improvement programs and asked to identify those programs that are used in their hospital. DATA COLLECTION/DATA EXTRACTION: Rasch Model Analysis was used to assess whether a unidimensional construct exists that defines a hospital's ability to implement performance improvement programs. Linear regression analysis was used to assess the relationship of the Rasch ability scores with Leapfrog Safe Practices Scores to validate the research findings. Principal Findings. The results of the study show that hospitals have widely varying abilities in implementing improvement programs. In addition, improvement programs present differing levels of difficulty for hospitals trying to implement them. Our findings also indicate that the ability to adopt improvement programs is important to the overall performance of hospitals. There is a hierarchy of improvement programs in the health care context. A hospital's ability to successfully adopt improvement programs is a function of its existing capabilities. As a hospital's capability increases, the ability to successfully implement higher level programs also increases.
8a. NAME OF FUNDING/SPONSORING 8b. OFFICE SYMBOL 9. PROCUREMENT INSTRUMENT IDENTIFICATION NUMBER ORGANIZATION (If applicable) 8c. ADDRESS (City, State...Services are provided in General Dentistry, Oral Surgery, Periodontics, Prosthodontics, Endodontics , and Orthodontics (MHR 1987, 4-5). The hospital also...appointment D. Shields 4 clerks using a rotary wheel file. Schedules were forwarded to outpatien records to pull the patient record prior to the clinic
Taylor, D. K.; Chance, D. R.; Jordan, I. J. E.; Patterson, A. P.; Stanley, M.; Taylor, D. C.
The planning and scheduling (P&S) systems used in operating the Hubble Space Telescope (HST) have undergone such substantial and pervasive re-engineering that today they dimly resemble those used when HST was launched. Processes (i.e., software, procedures, networking, etc.) which allow program implementation, the generation of a Long Range Plan (LRP), and the scheduling of science and mission activities have improved drastically in nearly 12 years, resulting in a consistently high observing efficiency, a stable LRP that principal investigators can use, exceptionally clean command loads uplinked to the spacecraft, and the capability of a very fast response time due to onboard anomalies or targets of opportunity. In this presentation we describe many of the systems which comprise the P&S ("front-end") system for HST, how and why they were improved, and what benefits have been realized by either the HST user community or the STScI staff. The systems include the Guide Star System, the Remote Proposal Submission System - 2 (RPS2), Artificial Intelligence (AI) planning tools such as Spike, and the science and mission scheduling software. We also describe how using modern software languages such as Python and better development practices allow STScI staff to do more with HST (e.g., to handle much more science data when ACS is installed) without increasing the cost to HST operations.
Full Text Available Background Job burnout, defined as a syndrome derived from prolonged exposure to stressors at work, is often observed in health care workers. Shift work and job satisfaction are considered two of the occupational risks for burnout in nurses. Nurses have stress and health complaints. In addition, nurses are likely to job burnout. Objectives The current study aimed to determine the prevalence of job burnout and its association with work schedules and job satisfaction among Iranian nurses in a public hospital. Methods This cross-sectional study was conducted in one of the largest Iranian public hospitals among 362 nurses (response rate: 80.44% in Tehran, Iran. The Maslach burnout inventory (MBI-22 and demographic factors questionnaire were used in the present study. The relationship between job burnout with work schedules and job satisfaction was investigated with multiple logistic regression analysis. Results The mean age and work experience of the participants were 36.14 ± 8.59 and 15.23 ±9.30 years, respectively. The result indicated a relatively high prevalence of burnout (particularly, personal accomplishment among the study population. In general, 64.4% of participants reported low personal accomplishment level. The nurses engaged in shift work reported higher levels of emotional exhaustion (odds ratio (OR = 1.02, 95% confidence interval (CI = 1.006 - 1.041, P-value = 0.008; there was no relationship between work schedules with depersonalization and personal accomplishment. The result showed significant relationship between job satisfaction and emotional exhaustion (OR = 0.945, 95% CI = 0.928 - 0.963, P-value < 0.001 and personal accomplishment (OR = 1.003, 95% CI = 1.014 - 1.058, P-value = 0.001. Conclusions The current study revealed that the Iranian nurses are exposed to a considerable risk of personal accomplishment. Also, job burnout is in association with shift working and low job satisfaction level. In this regard, working pressure
Hakim, L.; Bakhtiar, T.; Jaharuddin
Nurses scheduling is an activity of allocating nurses to conduct a set of tasks at certain room at a hospital or health centre within a certain period. One of obstacles in the nurse scheduling is the lack of resources in order to fulfil the needs of the hospital. Nurse scheduling which is undertaken manually will be at risk of not fulfilling some nursing rules set by the hospital. Therefore, this study aimed to perform scheduling models that satisfy all the specific rules set by the management of Bogor State Hospital. We have developed three models to overcome the scheduling needs. Model 1 is designed to schedule nurses who are solely assigned to a certain inpatient unit and Model 2 is constructed to manage nurses who are assigned to an inpatient room as well as at Polyclinic room as conjunct nurses. As the assignment of nurses on each shift is uneven, then we propose Model 3 to minimize the variance of the workload in order to achieve equitable assignment on every shift. The first two models are formulated in goal programming framework, while the last model is in nonlinear optimization form.
Hang, Y.; Jiale, Z.; Keskin, U.; Bril, R.J.
The schedulability analysis for fixed-priority preemptive scheduling (FPPS) plays a significant role in the real-time systems domain. The so-called Hyperplanes Exact Test (HET)  is an example of an exact schedulability test for FPPS. In this paper, we aim at improving the efficiency of HET by
Beynon, C; Burke, J; Doran, D; Nevill, A
Workers in physically demanding occupations require rest breaks to recover from physiological stress and biomechanical loading. Physiological stress can increase the risk of developing musculoskeletal disorders and repeated loading of the spine may increase the potential for incurring back pain. The aim of the study was to assess the impact of an altered activity-rest schedule on physiological and spinal loading in hospital-based porters. An existing 4-h activity-rest schedule was obtained from observations on eight male porters. This schedule formed the normal trial, which included two 5- and one 15-min breaks. An alternative 4-h schedule was proposed (experimental condition) that had two breaks each of 12.5 min. It was hypothesized that the experimental trial is more effective in promoting recovery from physiological strain and spinal shrinkage than the normal trial, due to the 5-min breaks being insufficient to allow physiological variables to return to resting levels or the intervertebral discs to reabsorb fluid. Ten males performed both test conditions and oxygen uptake VO2, heart rate, minute ventilation VE, perceived exertion and spinal shrinkage were recorded. There were no significant differences in any of the measured variables between the two trials (p > 0.05). Median heart rates were 78 (range 71-93) and 82 (71-90) beats.min(-1) for the normal trial and the experimental trial respectively, indicating that the activity was of low intensity. The light intensity was corroborated by the oxygen uptakes (0.75, range 0.65-0.94 1.min(-1)). Spinal shrinkage occurred to the same extent in the two trials (2.12 +/- 3.16 mm and 2.88 +/- 2.92 mm in the normal trial and the experimental trial respectively). Varying the length and positioning of the rest breaks did not significantly affect the physiological responses or magnitude of spinal shrinkage between the two trials. More physically demanding work than the porters' schedule should induce greater physiological
Henry, Kari; Maddalena, Ronald
The Robert C Byrd Green Bank Telescope (GBT) uses a software system that dynamically schedules observations based on models of vertical weather forecasts produced by the National Weather Service (NWS). The NWS provides hourly forecasted values for ~60 layers that extend into the stratosphere over the observatory. We use models, recommended by the Radiocommunication Sector of the International Telecommunications Union, to derive the absorption coefficient in each layer for each hour in the NWS forecasts and for all frequencies over which the GBT has receivers, 0.1 to 115 GHz. We apply radiative transfer models to derive the opacity and the atmospheric contributions to the system temperature, thereby deriving forecasts applicable to scheduling radio observations for up to 10 days into the future. Additionally, the algorithms embedded in the data processing pipeline use historical values of the forecasted opacity to calibrate observations. Until recently, we have concentrated on predictions for high frequency (> 15 GHz) observing, as these need to be scheduled carefully around bad weather. We have been using simple models for the contribution of rain and clouds since we only schedule low-frequency observations under these conditions. In this project, we wanted to improve the scheduling of the GBT and data calibration at low frequencies by deriving better algorithms for clouds and rain. To address the limitation at low frequency, the observatory acquired a Radiometrics Corporation MP-1500A radiometer, which operates in 27 channels between 22 and 30 GHz. By comparing 16 months of measurements from the radiometer against forecasted system temperatures, we have confirmed that forecasted system temperatures are indistinguishable from those measured under good weather conditions. Small miss-calibrations of the radiometer data dominate the comparison. By using recalibrated radiometer measurements, we looked at bad weather days to derive better models for forecasting the
Krenczyk, D.; Paprocka, I.; Kempa, W. M.; Grabowik, C.; Kalinowski, K.
The increased availability of data and computer-aided technologies such as MRPI/II, ERP and MES system, allowing producers to be more adaptive to market dynamics and to improve production scheduling. Integration of production scheduling and computer modelling, simulation and visualization systems can be useful in the analysis of production system constraints related to the efficiency of manufacturing systems. A integration methodology based on semi-automatic model generation method for eliminating problems associated with complexity of the model and labour-intensive and time-consuming process of simulation model creation is proposed. Data mapping and data transformation techniques for the proposed method have been applied. This approach has been illustrated through examples of practical implementation of the proposed method using KbRS scheduling system and Enterprise Dynamics simulation system.
Yunqing Rao; Dezhong Qi; Jinling Li
For the first time, an improved hierarchical genetic algorithm for sheet cutting problem which involves n cutting patterns for m non-identical parallel machines with process constraints has been proposed in the integrated cutting stock model. The objective of the cutting scheduling problem is minimizing the weighted completed time. A mathematical model for this problem is presented, an improved hierarchical genetic algorithm (ant colony—hierarchical genetic algorithm) is developed for better ...
Sundari, V. E.; Mardiyati, S.
Nurse scheduling system in a hospital is being modeled as a preemptive goal programming problem that is solved by using LINGO software with the objective function to minimize deviation variable at each goal. The scheduling is done cyclically, so every nurse is treated fairly since they have the same work shift portion with the other nurses. By paying attention to the hospital's rules regarding nursing work shift cyclically, it can be obtained that numbers of nurse needed in every ward are 18 nurses and the numbers of scheduling periods are 18 periods where every period consists of 21 days.
Full Text Available In this article we present an approach designed to solve a real world problem: the Anesthesiology Nurse Scheduling Problem (ANSP at a public French hospital. The anesthesiology nurses are one of the most shared resources in the hospital and we attempt to find a fair/balanced schedule for them, taking into account a set of constraints and the nursesarsquo; stated preferences, concerning the different shifts. We propose a particle swarm optimization algorithm to solve the ANSP. Finally, we compare our technique with previous results obtained using integer programming.
Irvin, S A; Brown, H N
Excessive time was being spent by the emergency department (ED) staff, head nurse, and unit secretary on a complex 6-week manual self-scheduling system. This issue, plus inevitable errors and staff dissatisfaction, resulted in a manager-lead initiative to automate elements of the scheduling process using Microsoft Excel. The implementation of this initiative included: common coding of all 8-hour and 12-hour shifts, with each 4-hour period represented by a cell; the creation of a 6-week master schedule using the "count-if" function of Excel based on current staffing guidelines; staff time-off requests then entered by the department secretary; the head nurse, with staff input, then fine-tuned the schedule to provide even unit coverage. Outcomes of these changes included an increase in staff satisfaction, time saved by the head nurse, and staff work time saved because there was less arguing about the schedule. Ultimately, the automated self-scheduling method was expanded to the entire 700-bed hospital.
Jongerden, M.R.; Schmitt, Jens B.; Haverkort, Boudewijn R.H.M.
The use of mobile devices is often limited by the lifetime of their batteries. For devices that have multiple batteries or that have the option to connect an extra battery, battery scheduling, thereby exploiting the recovery properties of the batteries, can help to extend the system lifetime. Due to
Jongerden, M.R.; Haverkort, Boudewijn R.H.M.
The use of mobile devices is often limited by the lifetime of its battery. For devices that have multiple batteries or that have the option to connect an extra battery, battery scheduling, thereby exploiting the recovery properties of the batteries, can help to extend the system lifetime. Due to the
Lukasz M. Mazur
Full Text Available Improving operational performance in hospitals is complicated, particularly if process improvement requires complex behavioral changes. Using single-loop and double-loop learning theory as a foundation, the purpose of this research is to empirically uncover key improvement behaviors and the factors that may be associated with such behaviors in hospitals. A two-phased approach was taken to collect data regarding improvement behaviors and associated factors, and data analysis was conducted using methods proposed by grounded theorists. The contributions of this research are twofold. First, five key behaviors related to process improvement are identified, namely Quick Fixing, Initiating, Conforming, Expediting, and Enhancing. Second, based on these observed behaviors, a set of force field diagrams is developed to structure and organize possible factors that are important to consider when attempting to change improvement behaviors. This begins to fill the gap in the knowledge about what factors drive effective improvement efforts in hospital settings.
EPA issued a schedule to act on more than 40 state pollution reduction plans that will improve visibility in national parks and wilderness areas and protect public health from the damaging effects of the pollutants that cause regional haze.
Liu, Hongwei; Zhang, Tianyi; Luo, Shuai; Xu, Dan
Scientific management methods are urgently needed to balance the demand and supply of heath care services in Chinese hospitals. Operating theatre is the bottleneck and costliest department. Therefore, the surgery scheduling is crucial to hospital management. To increase the utilization and reduce the cost of operating theatre, and to improve surgeons' satisfaction in the meantime, a practical surgery scheduling which could assign the operating room (OR) and surgeon for the surgery and sequence surgeries in each OR was provided for hospital managers. Surgery durations were predicted by fitting the distributions. A two-step mixed integer programming model considering surgery duration uncertainty was proposed, and sample average approximation (SAA) method was applied to solve the model. Durations of various surgeries were log-normal distributed respectively. Numerical experiments showed the model and method could get good solutions with different sample sizes. Real-life constraints and duration uncertainty were considered in the study, and the model was also very applicable in practice. Average overtime of each OR was reducing and tending to be stable with the number of surgeons increasing, which is a discipline for OR management.
Full Text Available As an extension of the classical job shop scheduling problem, the flexible job shop scheduling problem (FJSP plays an important role in real production systems. In FJSP, an operation is allowed to be processed on more than one alternative machine. It has been proven to be a strongly NP-hard problem. Ant colony optimization (ACO has been proven to be an efficient approach for dealing with FJSP. However, the basic ACO has two main disadvantages including low computational efficiency and local optimum. In order to overcome these two disadvantages, an improved ant colony optimization (IACO is proposed to optimize the makespan for FJSP. The following aspects are done on our improved ant colony optimization algorithm: select machine rule problems, initialize uniform distributed mechanism for ants, change pheromone’s guiding mechanism, select node method, and update pheromone’s mechanism. An actual production instance and two sets of well-known benchmark instances are tested and comparisons with some other approaches verify the effectiveness of the proposed IACO. The results reveal that our proposed IACO can provide better solution in a reasonable computational time.
Ghosh, Manimay; Sobek Ii, Durward K
The purpose of this paper is to examine empirically why a systematic problem-solving routine can play an important role in the process improvement efforts of hospitals. Data on 18 process improvement cases were collected through semi-structured interviews, reports and other documents, and artifacts associated with the cases. The data were analyzed using a grounded theory approach. Adherence to all the steps of the problem-solving routine correlated to greater degrees of improvement across the sample. Analysis resulted in two models. The first partially explains why hospital workers tended to enact short-term solutions when faced with process-related problems; and tended not seek longer-term solutions that prevent problems from recurring. The second model highlights a set of self-reinforcing behaviors that are more likely to address problem recurrence and result in sustained process improvement. The study was conducted in one hospital setting. Hospital managers can improve patient care and increase operational efficiency by adopting and diffusing problem-solving routines that embody three key characteristics. This paper offers new insights on why caregivers adopt short-term approaches to problem solving. Three characteristics of an effective problem-solving routine in a healthcare setting are proposed.
T. Vigneswari; M. A. Maluk Mohamed
Job Scheduling plays an important role for efficient utilization of grid resources available across different domains and geographical zones. Scheduling of jobs is challenging and NPcomplete. Evolutionary / Swarm Intelligence algorithms have been extensively used to address the NP problem in grid scheduling. Artificial Bee Colony (ABC) has been proposed for optimization problems based on foraging behaviour of bees. This work proposes a modified ABC algorithm, Cluster Hete...
Full Text Available Spatial data processing often requires massive datasets, and the task/data scheduling efficiency of these applications has an impact on the overall processing performance. Among the existing scheduling strategies, hypergraph-based algorithms capture the data sharing pattern in a global way and significantly reduce total communication volume. Due to heterogeneous processing platforms, however, single hypergraph partitioning for later scheduling may be not optimal. Moreover, these scheduling algorithms neglect the overlap between task execution and data transfer that could further decrease execution time. In order to address these problems, an extended hypergraph-based task-scheduling algorithm, named Hypergraph+, is proposed for massive spatial data processing. Hypergraph+ improves upon current hypergraph scheduling algorithms in two ways: (1 It takes platform heterogeneity into consideration offering a metric function to evaluate the partitioning quality in order to derive the best task/file schedule; and (2 It can maximize the overlap between communication and computation. The GridSim toolkit was used to evaluate Hypergraph+ in an IDW spatial interpolation application on heterogeneous master-slave platforms. Experiments illustrate that the proposed Hypergraph+ algorithm achieves on average a 43% smaller makespan than the original hypergraph scheduling algorithm but still preserves high scheduling efficiency.
Morisseau, D.S.; Lewis, P.M.; Persensky, J.J.
The Nuclear Regulatory Commission (NRC) has had a policy, Generic Letter 82-12, on hours of work since 1982. The policy states that licensees should establish controls to prevent situations where fatigue could reduce the ability of operating personnel to perform their duties safely (USNRC 1982). While that policy does give guidance on hours of work and overtime, it does not address periods of longer than 7 days or work schedules other than the routine 8-hour day, 40-hour week. Recognizing that NRC policy could provide broader guidance for shift schedules and hours of overtime work, the Division of Human Factors Safety conducted a project with Pacific Northwest Laboratories (PNL) to help the NRC better understand the human factors principles and issues concerning hours of work so that the NRC could consider updating their policy as necessary. The results of this project are recommendations for guidelines and limits for periods of 14 days, 28 days, and 1 year to take into account the cumulative effects of fatigue. In addition, routine 12-hour shifts are addressed. This latter type of shift schedule has been widely adopted in the petroleum and chemical industries and several utilities operating nuclear power plants have adopted it as well. Since this is the case, it is important to consider including guidelines for implementing this type of schedule. This paper discusses the bases for the PNL recommendations which are currently being studied by the NRC
Branco, Daniel; Wicks, Angela M; Visich, John K
The authors identify the quality tools and methodologies most frequently used by quality-positioned hospitals versus nonquality hospitals. Northeastern U.S. hospitals in both groups received a brief, 12-question survey. The authors found that 93.75% of the quality hospitals and 81.25% of the nonquality hospitals used some form of process improvement methodologies. However, there were significant differences between the groups regarding the impact of quality improvement initiatives on patients. The findings indicate that in quality hospitals the use of quality improvement initiatives had a significantly greater positive impact on patient satisfaction and patient outcomes when compared to nonquality hospitals.
Xu, Q. S.; Luo, C. J.; Yang, D. J.; Fan, Y. H.; Sang, Z. X.; Lei, H.
This paper puts forth a rolling modification strategy for day-ahead scheduling of electric power system with wind power, which takes the operation cost increment of unit and curtailed wind power of power grid as double modification functions. Additionally, an improved Nondominated Neighbor Immune Algorithm (NNIA) is proposed for solution. The proposed rolling scheduling model has further improved the operation cost of system in the intra-day generation process, enhanced the system’s accommodation capacity of wind power, and modified the key transmission section power flow in a rolling manner to satisfy the security constraint of power grid. The improved NNIA algorithm has defined an antibody preference relation model based on equal incremental rate, regulation deviation constraints and maximum & minimum technical outputs of units. The model can noticeably guide the direction of antibody evolution, and significantly speed up the process of algorithm convergence to final solution, and enhance the local search capability.
Asamoah, Daniel A; Sharda, Ramesh; Rude, Howard N; Doran, Derek
Long queues and wait times often occur at hospitals and affect smooth delivery of health services. To improve hospital operations, prior studies have developed scheduling techniques to minimize patient wait times. However, these studies lack in demonstrating how such techniques respond to real-time information needs of hospitals and efficiently manage wait times. This article presents a multi-method study on the positive impact of providing real-time scheduling information to patients using the RFID technology. Using a simulation methodology, we present a generic scenario, which can be mapped to real-life situations, where patients can select the order of laboratory services. The study shows that information visibility offered by RFID technology results in decreased wait times and improves resource utilization. We also discuss the applicability of the results based on field interviews granted by hospital clinicians and administrators on the perceived barriers and benefits of an RFID system.
The 2016 immunization schedule published by the Swiss Federal Office of Public Health includes three new clauses: reimbursement of the additional Human Papillomavirus (HPV) vaccination in young males (11-26 years) as recommended by local canton programs, the end of franchise exemption for the measles, mumps and rubella (MMR) vaccination, and the creation of a new system of indemnities and moral compensation in the event of personal injury resulting from vaccinations. This article presents the main features of the 2016 immunization schedule with details of the technology available to physicians to improve vaccine management.
Li, Lin; Sun, Zeyi; Yao, Xufeng; Wang, Donghai
Biofuel is considered a promising alternative to traditional liquid transportation fuels. The large-scale substitution of biofuel can greatly enhance global energy security and mitigate greenhouse gas emissions. One major concern of the broad adoption of biofuel is the intensive energy consumption in biofuel manufacturing. This paper focuses on the energy efficiency improvement of biofuel feedstock preprocessing, a major process of cellulosic biofuel manufacturing. An improved scheme of the feedstock preprocessing considering work-in-process particle separation is introduced to reduce energy waste and improve energy efficiency. A scheduling model based on the improved scheme is also developed to identify an optimal production schedule that can minimize the energy consumption of the feedstock preprocessing under production target constraint. A numerical case study is used to illustrate the effectiveness of the proposed method. The research outcome is expected to improve the energy efficiency and enhance the environmental sustainability of biomass feedstock preprocessing. - Highlights: • A novel method to schedule production in biofuel feedstock preprocessing process. • Systems modeling approach is used. • Capable of optimize preprocessing to reduce energy waste and improve energy efficiency. • A numerical case is used to illustrate the effectiveness of the method. • Energy consumption per unit production can be significantly reduced.
Vo Ngoc Dieu; Ongsakul, Weerakorn
This paper proposes an improved merit order (IMO) combined with an augmented Lagrangian Hopfield network (ALHN) for solving short term hydrothermal scheduling (HTS) with pumped-storage hydro plants. The proposed IMO-ALHN consists of a merit order based on the average production cost of generating units enhanced by heuristic search algorithm for finding unit scheduling and a continuous Hopfield neural network with its energy function based on augmented Lagrangian relaxation for solving constrained economic dispatch (CED). The proposed method is applied to solve the HTS problem in five stages including thermal, hydro and pumped-storage unit commitment by IMO and heuristic search, constraint violations repairing by heuristic search and CED by ALHN. The proposed method is tested on the 24-bus IEEE RTS with 32 units including 4 fuel-constrained, 4-hydro, and 2 pumped-storage units scheduled over a 24-h period. Test results indicate that the proposed IMO-ALHN is efficient for hydrothermal systems with various constraints.
Kuhlmann, Stephanie; Ahlers-Schmidt, Carolyn R; Lukasiewicz, Gloria; Truong, Therese Macasiray
Within hospital pediatric units, there is a lack of consistent application or modeling of the American Academy of Pediatrics recommendations for safe infant sleep. The purpose of this study was to improve safe sleep practices for infants in nonneonatal pediatric units with implementation of specific interventions. This multi-institutional study was conducted by using baseline observations collected for sleep location, position, and environment (collectively, "safe sleep") of infants admitted to pediatric units. Interventions consisted of: (1) staff education, including a commitment to promote safe sleep; (2) implementing site-generated safe sleep policies; (3) designating supply storage in patient rooms; and/or (4) caregiver education. Postintervention observations of safe sleep were collected. Eight hospitals participated from the Inpatient FOCUS Group of the Children's Hospital Association. Each site received institutional review board approval/exemption. Safe sleep was observed for 4.9% of 264 infants at baseline and 31.2% of 234 infants postintervention (Ppresent in 77% of cribs at baseline and 44% postintervention. However, the mean number of unsafe items observed in each sleeping environment was reduced by >50% (P=.001). Implementation of site-specific interventions seems to improve overall safe sleep in inpatient pediatric units, although continued improvement is needed. Specifically, extra items are persistently left in the sleeping environment. Moving forward, hospitals should evaluate their compliance with American Academy of Pediatrics recommendations and embrace initiatives to improve modeling of safe sleep. Copyright © 2016 by the American Academy of Pediatrics.
Jamal, Ahmed; O'Grady, G; Harnett, E; Dalton, D; Andresen, D
Effective hand hygiene has long been recognised as an important way to reduce the transmission of bacterial and viral pathogens in healthcare settings. However, many studies have shown that adherence to hand hygiene remains low, and improvement efforts have often not delivered sustainable results. The Children's Hospital at Westmead is the largest tertiary paediatric hospital in Sydney, Australia. The hospital participated in a state-wide 'Clean hands save lives' campaign which was initiated in 2006. Strong leadership, good stakeholder engagement, readily accessible alcohol-based hand rub at the point of patient care, a multifaceted education programme, monitoring of staff, adherence to recommended hand hygiene practices and contemporaneous feedback of performance data have significantly improved and maintained compliance with hand hygiene. Hand hygiene compliance has increased from 23% in 2006 to 87% in 2011 (phand hygiene has been evident in the last 4 years. A decline in a set of hospital-acquired infections (including rotavirus, multiresistant organism transmission, and nosocomial bacteraemia) has also been noted as hand hygiene rates have improved. Monthly usage of alcohol-based hand rub has increased from 16 litres/1000 bed days to 51 litres/1000 bed days during this same period. This project has delivered sustained improvement in hand hygiene compliance by establishing a framework of multimodal evidence-based strategies.
Al-Amin, Mona; Makarem, Suzanne C; Rosko, Michael
Efficiency has emerged as a central goal to the operations of health care organizations. There are two competing perspectives on the relationship between efficiency and organizational performance. Some argue that organizational slack is a waste and that efficiency contributes to organizational performance, whereas others maintain that slack acts as a buffer, allowing organizations to adapt to environmental demands and contributing to organizational performance. As value-based purchasing becomes more prevalent, health care organizations are incented to become more efficient and, at the same time, improve their patients' experiences and outcomes. Unused slack resources might facilitate the timely implementation of these improvements. Building on previous research on organizational slack and inertia, we test whether efficiency and other organizational factors predict organizational effectiveness in improving Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ratings. We rely on data from the American Hospital Association and HCAHPS. We estimate hospital cost-efficiency by Stochastic Frontier Analysis and use regression analysis to determine whether efficiency, competition, hospital size, and other organizational factors are significant predictors of hospital effectiveness. Our findings indicate that efficiency and hospital size have a significant negative association with organizational ability to improve HCAHPS ratings. Although achieving organizational efficiency is necessary for health care organizations, given the changes that are currently occurring in the U.S. health care system, it is important for health care managers to maintain a certain level of slack to respond to environmental demands and have the resources needed to improve their performance.
Behnam, M.; Bril, R.J.; Nolte, T.
We present our ongoing work on synchronization in hierarchical scheduled real-time systems, where tasks are scheduled using fixed-priority pre-emptive scheduling. In this paper, we show that the original local schedulability analysis of the synchronization protocol SIRAP  is very pessimistic when
Full Text Available In real-world manufacturing systems, production scheduling systems are often implemented under random or dynamic events like machine failure, unexpected processing times, stochastic arrival of the urgent orders, cancellation of the orders, and so on. These dynamic events will lead the initial scheduling scheme to be nonoptimal and/or infeasible. Hence, appropriate dynamic rescheduling approaches are needed to overcome the dynamic events. In this paper, we propose a dynamic rescheduling method based on variable interval rescheduling strategy (VIRS to deal with the dynamic flexible job shop scheduling problem considering machine failure, urgent job arrival, and job damage as disruptions. On the other hand, an improved genetic algorithm (GA is proposed for minimizing makespan. In our improved GA, a mix of random initialization population by combining initialization machine and initialization operation with random initialization is designed for generating high-quality initial population. In addition, the elitist strategy (ES and improved population diversity strategy (IPDS are used to avoid falling into the local optimal solution. Experimental results for static and several dynamic events in the FJSP show that our method is feasible and effective.
Full Text Available Lacey M Eden, Janelle LB Macintosh, Karlen E Luthy, Renea L Beckstrand College of Nursing, Brigham Young University, Provo, UT, USA Abstract: Pain experienced in childhood can lead to long-term and psychologically detrimental effects. Unfortunately, the most common pain experienced in childhood is caused by vaccinations and may lead to non-adherence to the recommended vaccination schedule. As a result, it is the health care provider's responsibility to take measures to reduce vaccination pain; however, there are a plethora of pain relieving interventions during immunizations and it is unclear which interventions are most cost efficient, timely, and effective. Studies have been conducted to investigate the efficacy of different pain management interventions during vaccinations. This review evaluates various pain relieving interventions and provide health care providers age appropriate guidance on pain relieving interventions during vaccinations. Employment of these strategies may successfully reduce vaccination-associated pain in infants, children, and adolescents, and may improve compliance with the vaccination schedule. Keywords: immunization, intervention, effective, compliance
There are so many obvious delays and inefficiencies in our traditional system of acute hospital care; it is clear that if outcomes are to be improved prompt accurate assessment immediately followed by competent and efficient treatment is essential. Early warning scores (EWS) help detect acutely ill patients who are seriously ill and likely to deteriorate. However, it is not known if any EWS has universal applicability to all patient populations. The benefit of Rapid Response Systems (RRS) such as Medical Emergency Teams has yet to be proven, possibly because doctors and nurses are reluctant to call the RRS for help. Reconfiguration of care delivery in an Acute Medical Assessment Unit has been suggested as a "proactive" alternative to the "reactive" approach of RRS. This method ensures every patient is in an appropriate and safe environment from the moment of first contact with the hospital. Further research is needed into what interventions are most effective in preventing the deterioration and\\/or resuscitating seriously ill patients. Although physicians expert in hospital care decrease the cost and length of hospitalization without compromising outcomes hospital care will continue to be both expensive and potentially dangerous.
Harrison, Jeffrey P; Sexton, Christopher
By using data-envelopment analysis (DEA), this study evaluates the efficiency of religious not-for-profit hospitals. Hospital executives, healthcare policy makers, taxpayers, and other stakeholders benefit from studies that improve hospital efficiency. Results indicate that overall efficiency in religious hospitals improved from 72% in 1998 to 74% in 2001. What is more important is that the number of religious hospitals operating on the efficiency frontier increased from 40 in 1998 to 47 in 2001. This clearly documents that religious hospitals are becoming more efficient in the management of resources. From a policy perspective, this study highlights the economic importance of encouraging increased efficiency throughout the healthcare industry.
Ko, Do Young
The construction technology for reactor vessel internals (RVI) modularization is one of the most important factors to be considered in reducing the construction period of nuclear power plants. For RVI modularization, gaps between the reactor vessel (RV) core-stabilizing lug and the core support barrel (CSB) snubber lug must be measured using a remote method from outside the RV. In order to measure RVI gaps remotely at nuclear power plant construction sites, certain core technologies must be developed and verified. These include a remote measurement system to measure the gaps between the RV core-stabilizing lug and the CSB snubber lug, an RVI mockup to perform the gap measurement tests, and a new procedure and schedule for RVI installation. A remote measurement system was developed previously, and a gap measurement test was completed successfully using the RVI mockup. We also developed a new procedure and schedule for RVI installation. This paper presents the new and improved installation procedure and schedule for RVI modularization. These are expected to become core technologies that will allow us to shorten the construction period by a minimum of two months compared to the existing installation procedure and schedule
Carden, Robert; DelliFraine, Jami L
The purpose of this study was to identify factors that predict overall hospital satisfaction with blood suppliers. The data for this study came from a 2001 satisfaction survey of hospital blood bank managers conducted by the National Blood Data Resource Center. A total of 1325 blood-utilizing hospitals were included in the final study database. The measurement of hospital satisfaction with its blood supplier encompasses the five composites of the SERVQUAL model. The five composites are 1) tangibles, 2) reliability, 3) responsiveness, 4) assurance, and 5) empathy. Linear regression was performed with overall hospital satisfaction as the dependent variable and the five composites of the SERVQUAL model and control variables as predictors of overall hospital satisfaction with blood suppliers. Significant predictors of hospital satisfaction with blood suppliers are satisfaction with medical and clinical support provided by the blood center, satisfaction with the routine delivery schedule, and price (service fee) of red cells. Prior studies have demonstrated the importance of customer satisfaction to organizations. As organizations, blood centers can benefit from improved satisfaction from their hospital customers. Blood center strategies that focus on improving these three predictors of overall hospital satisfaction with primary blood suppliers will be the most likely to improve and/or maintain hospital customer satisfaction with primary blood suppliers.
Harari, Paul M.
Purpose/Objective: This refresher course reviews current research activity and treatment results in the field of radiation therapy fractionation. The presentation emphasizes worldwide studies of altered fractionation, highlighting head and neck cancer as the primary teaching model. Basic radiobiological principles guiding the development of altered fractionation regimens, and advancing the understanding of fractionation effects on normal and tumor tissue are reviewed. A 'standard' prescription of 2 Gy x 35 fractions = 70 Gy may not provide the optimal balance between primary tumor control and late normal tissue effects for all patients with squamous cell carcinoma of the head and neck. The last decade has witnessed the treatment of thousands of head and neck cancer patients with curative radiotherapy using altered fractination schedules designed to improve overall treatment results. Although the number of different fractionation regimens currently being investigated continues to increase, the common guiding principles behind their design are relatively simple. Common fractionation terminology (i.e., accelerated hyperfractionation) will be reviewed, as well as a brief summary of radiobiological concepts pertaining to tumor potential doubling time, tumor proliferation kinetics, overall treatment time and fraction size-dependence of acute and late tissue effects. Several well known head and neck fractionation schedules from around the world (Manchester Christie Hospital-United Kingdom, Princess Margaret Hospital-Canada, Massachusetts General Hospital-USA, MD Anderson Hospital-USA, University of Florida-USA, Mount Vernon Hospital CHART-United Kingdom, RTOG and EORTC trials-USA and Europe) will be summarized with regard to design-rationale, treatment technique and results. The design of several current cooperative group trials investigating altered head and neck fractionation will be presented, as well as concepts prompting the pilot evaluation of several brand new
London, J A; Mock, C N; Quansah, R E; Abantanga, F A; Jurkovich, G J
This study sought to identify potential cost-effective methods to improve trauma care in hospitals in the developing world. Injured patients admitted to an urban hospital in Ghana over a 1-year period were analyzed prospectively for mechanism of injury, mode of transport to the hospital, injury severity, region of principal injury, operations performed, and mortality. In addition, time from injury until arrival at the hospital and time from arrival at the hospital until emergency surgery were evaluated. Mortality was 9.4%. Most deaths (65%) occurred within 24 hours of admission. Sixty percent of emergency operations were performed over 6 hours after arrival. Tube thoracostomy was performed on only 13 patients (0.6%). Only 58% of patients received intravenous crystalloid and only 3.6% received 1 or more units of blood. We identified several specific interventions as potential low-cost measures to improve hospital-based trauma care in this setting, including shorter times to emergency surgery and improvements in initial resuscitation. In addition to addressing each of these aspects of trauma care individually, quality improvement programs may represent a feasible and sustainable method to improve trauma care in hospitals in the developing world.
Epstein, Nancy E
The use of multidisciplinary in-hospital teams limits adverse events (AE), improves outcomes, and adds to patient and employee satisfaction. Acting like "well-oiled machines," multidisciplinary in-hospital teams include "staff" from different levels of the treatment pyramid (e.g. staff including nurses' aids, surgical technicians, nurses, anesthesiologists, attending physicians, and others). Their enhanced teamwork counters the "silo effect" by enhancing communication between the different levels of healthcare workers and thus reduces AE (e.g. morbidity/mortality) while improving patient and healthcare worker satisfaction. Multiple articles across diverse disciplines incorporate a variety of concepts of "teamwork" for staff covering emergency rooms (ERs), hospital wards, intensive care units (ICUs), and most critically, operating rooms (ORs). Cohesive teamwork improved communication between different levels of healthcare workers, and limited adverse events, improved outcomes, decreased the length of stay (LOS), and yielded greater patient "staff" satisfaction. Within hospitals, delivering the best medical/surgical care is a "team sport." The goals include: Maximizing patient safety (e.g. limiting AE) and satisfaction, decreasing the LOS, and increasing the quality of outcomes. Added benefits include optimizing healthcare workers' performance, reducing hospital costs/complications, and increasing job satisfaction. This review should remind hospital administrators of the critical need to keep multidisciplinary teams together, so that they can continue to operate their "well-oiled machines" enhancing the quality/safety of patient care, while enabling "staff" to optimize their performance and enhance their job satisfaction.
van Schaik, Rian; Van den Abeele, Kurt; Melsens, Glenn; Schepens, Peter; Lanssens, Truus; Vlaemynck, Bernadette; Devisch, Maria; Niewold, Theo A
Malnutrition and the use of Total Parenteral Nutrition (TPN) contribute considerably to hospital costs. Recently, we reported on the introduction of malnutrition screening and monitoring of TPN use in our hospital, which resulted in a large (40%) reduction in TPN and improved quality of nutritional care in two years (2011/12). Here, we aimed to assure continuation of improved care by developing a detailed malnutrition screening and TPN use protocol involving instruction tools for hospital staff, while monitoring the results in the following two years (2013/14). A TPN decision tree for follow up of TPN in patients and a TP-EN instruction card for caregivers was introduced, showing TPN/EN introduction schedules based on the energy needs of patients according to EB guidelines, also addressing the risk of refeeding syndrome. TPN patients were monitored by dietitians and TPN usage and costs were presented to the (medical) staff. Screening and treatment of malnourished patients by dietitians is simultaneously ongoing. In 2014 48% of patients, hospitalized for at least 48 h, were screened on malnutrition, 17% of them were diagnosed at risk, 7.9% malnourished and treated by dietitians. TPN usage dropped by 53% and cost savings of 51% were obtained due to 50% decrease of TPN users in 2014 versus 2010. TPN over EN ratio dropped from 2.4 in 2010 to 1.2 in 2014. Sustained improvement of nutritional care and reduction of TPN usage and costs is possible by introduction of procedures embedded in the existing structures. Copyright © 2016 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.
Oshiro, Bryan T; Kowalewski, Leslie; Sappenfield, William; Alter, Caroline C; Bettegowda, Vani R; Russell, Rebecca; Curran, John; Reeves, Lori; Kacica, Marilyn; Andino, Nelson; Mason-Marti, Peyton; Crouse, Dennis; Knight, Susan; Littlejohn, Karen; Malatok, Sharyn; Dudley, Donald J; Berns, Scott D
Nonmedically indicated (elective) deliveries before 39 weeks of gestation result in unnecessary neonatal morbidity. We sought to determine whether implementation of a process improvement program will decrease the rate of elective scheduled singleton early-term deliveries (37 0/7-38 6/7 weeks of gestation) in a group of diverse community and academic hospitals. Policies and procedures for scheduling inductions and cesarean deliveries were implemented and patient and health care provider education was provided. Outcomes for scheduled singleton deliveries at 34 weeks of gestation or higher were submitted through a web-based data entry system. The rate of scheduled singleton elective early-term deliveries as well as the rates of early-term medically indicated and unscheduled deliveries, neonatal intensive care unit admissions, and singleton term fetal mortality rate were evaluated. A total of 29,030 scheduled singletons at 34 weeks of gestation or higher were delivered in 26 participating hospitals between January 2011 and December 2011. Elective scheduled early-term deliveries decreased from 27.8% in the first month to 4.8% in the 12th month (Pscheduled singleton early-term inductions (72%, P=.029) and cesarean deliveries (84%; Pscheduled early-term singletons decreased nonsignificantly from 1.5% to 1.2% (P=.24). There was no increase in the term fetal mortality rate. A rapid-cycle process improvement program substantially decreased elective scheduled early-term deliveries to less than 5% in a group of diverse hospitals across multiple states. III.
Jäger, Matthias; Ospelt, Isabelle; Kawohl, Wolfram; Theodoridou, Anastasia; Rössler, Wulf; Hoff, Paul
This study aims at investigating the formal and content-related quality of medical certificates directing compulsory hospital admissions before the scheduled alteration of the Swiss civil legislation in January 2013. A comparison between physicians with different professional backgrounds concerning certificates and patients was conducted. Retrospective investigation of medical records of involuntary inpatients at the University Hospital of Psychiatry in Zurich during a period of six months (N=489). Considerable deficits concerning formal and particularly content-related aspects of the certificates were found. Psychiatrists issued certificates of the highest quality followed by emergency physicians, hospital doctors and general practitioners. Patients differed with respect to several sociodemographic and clinical variables. The quality of certificates directing involuntary hospital admission has to be improved considering the impact on the individual concerned. The consequences of the new legislation on the quality of the admission practices should be inquired in order to improve professional training on the issue.
A practical algorithm that recovers AES key schedules from decayed memory images is presented. Halderman et al.  established this recovery capability, dubbed the cold-boot attack, as a serious vulnerability for several widespread software-based encryption packages. Our algorithm recovers AES-128 key schedules tens of millions of times faster than the original proof-of-concept release. In practice, it enables reliable recovery of key schedules at 70% decay, well over twice the decay capacity of previous methods. The algorithm is generalized to AES-256 and is empirically shown to recover 256-bit key schedules that have suffered 65% decay. When solutions are unique, the algorithm efficiently validates this property and outputs the solution for memory images decayed up to 60%.
Background: Cancellation of scheduled surgery creates a financial burden for hospitals, caregivers and ..... costs and disregard some of the aspects mentioned in the ..... cancellation of elective surgical procedures in a Spanish general.
No abstract available. Article truncated at 150 words. The Annals of Internal Medicine posted a manuscript online today reporting that the growing trend of physician employment by hospitals does not improve quality (1). In 2003, approximately 29% of hospitals employed members of their physician workforce, a number that rose to 42% by 2012. The authors conducted a retrospective cohort study of U.S. acute care hospitals between 2003 and 2012 and examined mortality rates, 30-day readmission rate...
Bailey, Shari; Franklin, David; Hearle, Keith
IRS Form 990 Schedule H requires hospitals to estimate the amount of bad debt expense attributable to patients eligible for charity under the hospital's charity care policy. Responses to Schedule H, Part III.A.3 open up the entire patient collection process to examination by the IRS, state officials, and the public. Using predictive analytics can help hospitals efficiently identify charity-eligible patients when answering Part III.A.3.
Holst, M; Beermann, T; Mortensen, M N
BACKGROUND: Good nutritional practice (GNP) includes screening, nutrition plan and monitoring, and is mandatory for targeted treatment of malnourished patients in hospital. AIMS: To optimize energy- and protein-intake in patients at nutritional risk and to improve GNP in a hospital setting. METHODS......: A 12-months observational multi-modal intervention study was done, using the top-down and bottom-up principle. All hospitalized patients (>3 days) were included. Setting: A university hospital with 758 beds and all specialities. Measurements: Record audit of GNP, energy- and protein-intake by 24-h...... recall, patient interviews and staff questionnaire before and after the intervention. Interventions: Based on pre-measurements, nutrition support teams in each department made targeted action plans, supervised by an expert team. Education, diagnose-specific nutrition plans, improved menus and eating...
Kleibeuker, Esther A; Hooven, Matthijs A ten; Castricum, Kitty C; Honeywell, Richard; Griffioen, Arjan W; Verheul, Henk M; Slotman, Ben J; Thijssen, Victor L
The combination of radiotherapy with sunitinib is clinically hampered by rare but severe side effects and varying results with respect to clinical benefit. We studied different scheduling regimes and dose reduction in sunitinib and radiotherapy in preclinical tumor models to improve potential outcome of this combination treatment strategy. The chicken chorioallantoic membrane (CAM) was used as an angiogenesis in vivo model and as a xenograft model with human tumor cells (HT29 colorectal adenocarcinoma, OE19 esophageal adenocarcinoma). Treatment consisted of ionizing radiation (IR) and sunitinib as single therapy or in combination, using different dose-scheduling regimes. Sunitinib potentiated the inhibitory effect of IR (4 Gy) on angiogenesis. In addition, IR (4 Gy) and sunitinib (4 days of 32.5 mg/kg per day) inhibited tumor growth. Ionizing radiation induced tumor cell apoptosis and reduced proliferation, whereas sunitinib decreased tumor angiogenesis and reduced tumor cell proliferation. When IR was applied before sunitinib, this almost completely inhibited tumor growth, whereas concurrent IR was less effective and IR after sunitinib had no additional effect on tumor growth. Moreover, optimal scheduling allowed a 50% dose reduction in sunitinib while maintaining comparable antitumor effects. This study shows that the therapeutic efficacy of combination therapy improves when proper dose-scheduling is applied. More importantly, optimal treatment regimes permit dose reductions in the angiogenesis inhibitor, which will likely reduce the side effects of combination therapy in the clinical setting. Our study provides important leads to optimize combination treatment in the clinical setting
Pedro Gabriel Melo de Barros e Silva
Full Text Available ABSTRACT OBJECTIVE: To report the initial changes after quality-improvement programs based on STS-database in a Brazilian hospital. METHODS: Since 2011 a Brazilian hospital has joined STS-Database and in 2012 multifaceted actions based on STS reports were implemented aiming reductions in the time of mechanical ventilation and in the intensive care stay and also improvements in evidence-based perioperative therapies among patients who underwent coronary artery bypass graft surgeries. RESULTS: All the 947 patients submitted to coronary artery bypass graft surgeries from July 2011 to June 2014 were analyzed and there was an improvement in all the three target endpoints after the implementation of the quality-improvement program but the reduction in time on mechanical ventilation was not statistically significant after adjusting for prognostic characteristics. CONCLUSION: The initial experience with STS registry in a Brazilian hospital was associated with improvement in most of targeted quality-indicators.
Full Text Available Objective: The objective of this study is to determine if a model for patient-centered care that integrates medication management between hospital and community pharmacists is feasible and can improve medication adherence. Design: This was a randomized, non-blinded, interventional study of 69 patients discharged from a hospital to home. Process measures include the number and type of medication-related discrepancies or problems identified, patient willingness to participate, the quality and quantity of interactions with community pharmacists, hospital readmissions, and medication adherence. Setting: A 214-bed acute care hospital in Northeastern Pennsylvania and seventeen regional community pharmacies. Patients: Enrolled patients were hospitalized with a primary or secondary diagnosis of heart failure or COPD, had a planned discharge to home, and agreed to speak to one of seventeen community pharmacists within the study network (i.e., a network community pharmacist following hospital discharge. Intervention: Information about a comprehensive medication review completed by the hospital pharmacist was communicated with the network community pharmacist to assist with providing medication therapy management following hospital discharge. Results: Of 180 patients eligible for the study, 111 declined to participate. Many patients were reluctant to talk to an additional pharmacist, however if the patient’s pharmacist was already within the network of 17 pharmacies, they usually agreed to participate. The study enrolled 35 patients in the intervention group and 34 in the control group. An average of 6 medication-related problems per patient were communicated to the patient’s network community pharmacist after discharge. In the treatment group, 44% of patients had at least one conversation with the network community pharmacist following hospital discharge. There was no difference in post-discharge adherence between the groups (Proportion of Days
Haneyah, S.W.A.; Schutten, Johannes M.J.; Fikse, K.
This paper addresses the inbound containers scheduling problem for automated sorter systems in two different industrial sectors: parcel & postal sorting and baggage handling. We build on existing literature, particularly on the dynamic load balancing algorithm designed for the parcel hub scheduling
The GERRY scheduling system developed by NASA Ames with assistance from the Lockheed Space Operations Company, and the Lockheed Artificial Intelligence Center, uses a method called constraint-based iterative repair. Using this technique, one encodes both hard rules and preference criteria into data structures called constraints. GERRY repeatedly attempts to improve schedules by seeking repairs for violated constraints. The system provides a general scheduling framework which is being tested on two NASA applications. The larger of the two is the Space Shuttle Ground Processing problem which entails the scheduling of all the inspection, repair, and maintenance tasks required to prepare the orbiter for flight. The other application involves power allocation for the NASA Ames wind tunnels. Here the system will be used to schedule wind tunnel tests with the goal of minimizing power costs. In this paper, we describe the GERRY system and its application to the Space Shuttle problem. We also speculate as to how the system would be used for manufacturing, transportation, and military problems.
Watson, Julie; McGuire, William
Scheduled feeding of prescribed enteral volumes remains standard practice for preterm infants. However, feeding preterm infants in response to their feeding and satiation cues (responsive, cue-based, or infant led feeding) rather than at scheduled intervals might enhance parent experience and satisfaction, help in the establishment of independent oral feeding, increase nutrient intake and growth rates, and allow earlier hospital discharge.\\ud \\ud Objectives: To assess the effect of feeding pr...
Schleyer, Anneliese M; Robinson, Ellen; Dumitru, Roxana; Taylor, Mark; Hayes, Kimberly; Pergamit, Ronald; Beingessner, Daphne M; Zaros, Mark C; Cuschieri, Joseph
Hospital-acquired venous thromboembolism (HA-VTE) is a potentially preventable cause of morbidity and mortality. Despite high rates of venous thromboembolism (VTE) prophylaxis in accordance with an institutional guideline, VTE remains the most common hospital-acquired condition in our institution. To improve the safety of all hospitalized patients, examine current VTE prevention practices, identify opportunities for improvement, and decrease rates of HA-VTE. Pre/post assessment. Urban academic tertiary referral center, level 1 trauma center, safety net hospital; all patients. We formed a multidisciplinary VTE task force to review all HA-VTE events, assess prevention practices relative to evidence-based institutional guidelines, and identify improvement opportunities. The task force developed an electronic tool to facilitate efficient VTE event review and designed decision-support and reporting tools, now integrated into the electronic health record, to bring optimal VTE prevention practices to the point of care. Performance is shared transparently across the institution. Harborview benchmarks process and outcome performance, including patient safety indicators and core measures, against hospitals nationally using Hospital Compare and Vizient data. Our program has resulted in >90% guideline-adherent VTE prevention and zero preventable HA-VTEs. Initiatives have resulted in a 15% decrease in HA-VTE and a 21% reduction in postoperative VTE. Keys to success include the multidisciplinary approach, clinical roles of task force members, senior leadership support, and use of quality improvement analytics for retrospective review, prospective reporting, and performance transparency. Ongoing task force collaboration with frontline providers is critical to sustained improvements. Journal of Hospital Medicine 2016;11:S38-S43. © 2016 Society of Hospital Medicine. © 2016 Society of Hospital Medicine.
Reed, Carrie; Kirley, Pam Daily; Aragon, Deborah; Meek, James; Farley, Monica M.; Ryan, Patricia; Collins, Jim; Lynfield, Ruth; Baumbach, Joan; Zansky, Shelley; Bennett, Nancy M.; Fowler, Brian; Thomas, Ann; Lindegren, Mary L.; Atkinson, Annette; Finelli, Lyn; Chaves, Sandra S.
Diagnostic test sensitivity affects rate estimates for laboratory-confirmed influenza–associated hospitalizations. We used data from FluSurv-NET, a national population-based surveillance system for laboratory-confirmed influenza hospitalizations, to capture diagnostic test type by patient age and influenza season. We calculated observed rates by age group and adjusted rates by test sensitivity. Test sensitivity was lowest in adults >65 years of age. For all ages, reverse transcription PCR was the most sensitive test, and use increased from 65 years. After 2009, hospitalization rates adjusted by test sensitivity were ≈15% higher for children 65 years of age. Test sensitivity adjustments improve the accuracy of hospitalization rate estimates. PMID:26292017
Jacobsen, Peter; Jørgensen, Pelle Morten Thomas
In order to cope with the future challenges of the health care sector, there is an urging need for improving efficiency at hospitals. The study presents a framework enabling health care managers of improving the in-house logistics. The distinctiveness of the framework is the way in which it relates...... technology, logistics, structure and procedures to efficiency. Changing one factor e.g. technology, initiates an iterative loop focusing on change in the related factors in order to obtain the optimal efficiency. The search for an optimal efficient solution is the driving force of the framework...... at a Danish hospital. The framework is tested on the blood sample logistics between the emergency department and laboratory with the goal of enhancing the efficiency of the emergency department....
O'Leary, Kevin J; Sehgal, Niraj L; Terrell, Grace; Williams, Mark V
Recognizing the importance of teamwork in hospitals, senior leadership from the American College of Physician Executives (ACPE), the American Hospital Association (AHA), the American Organization of Nurse Executives (AONE), and the Society of Hospital Medicine (SHM) established the High Performance Teams and the Hospital of the Future project. This collaborative learning effort aims to redesign care delivery to provide optimal value to hospitalized patients. With input from members of this initiative, we prepared this report which reviews the literature related to teamwork in hospitals. Teamwork is critically important to provide safe and effective hospital care. Hospitals with high teamwork ratings experience higher patient satisfaction, higher nurse retention, and lower hospital costs. Elements of effective teamwork have been defined and provide a framework for assessment and improvement efforts in hospitals. Measurement of teamwork is essential to understand baseline performance, and to demonstrate the utility of resources invested to enhance it and the subsequent impact on patient care. Interventions designed to improve teamwork in hospitals include localization of physicians, daily goals of care forms and checklists, teamwork training, and interdisciplinary rounds. Though additional research is needed to evaluate the impact on patient outcomes, these interventions consistently result in improved teamwork knowledge, ratings of teamwork climate, and better understanding of patients' plans of care. The optimal approach is implementation of a combination of interventions, with adaptations to fit unique clinical settings and local culture. Copyright © 2011 Society of Hospital Medicine.
Murugasu, G Dr.
Under the Quality and Continuing Care Directorate (QCCD) in stroke care Cavan General Hospital was identified as a hospital that received a large number of stroke and TIA patients. A programme was established to improve services to this population.
Full Text Available This paper investigates a special single machine scheduling problem derived from practical industries, namely, the selective single machine scheduling with sequence dependent setup costs and downstream demands. Different from traditional single machine scheduling, this problem further takes into account the selection of jobs and the demands of downstream lines. This problem is formulated as a mixed integer linear programming model and an improved particle swarm optimization (PSO is proposed to solve it. To enhance the exploitation ability of the PSO, an adaptive neighborhood search with different search depth is developed based on the decision characteristics of the problem. To improve the search diversity and make the proposed PSO algorithm capable of getting out of local optimum, an elite solution pool is introduced into the PSO. Computational results based on extensive test instances show that the proposed PSO can obtain optimal solutions for small size problems and outperform the CPLEX and some other powerful algorithms for large size problems.
Full Text Available No abstract available. Article truncated at 150 words. The Annals of Internal Medicine posted a manuscript online today reporting that the growing trend of physician employment by hospitals does not improve quality (1. In 2003, approximately 29% of hospitals employed members of their physician workforce, a number that rose to 42% by 2012. The authors conducted a retrospective cohort study of U.S. acute care hospitals between 2003 and 2012 and examined mortality rates, 30-day readmission rates, length of stay, and patient satisfaction scores for common medical conditions for 803 hospitals that switched to the employment model compared with 2085 control hospitals that did not switch. Switching hospitals were more likely to be large (11.6% vs. 7.1% or major teaching hospitals (7.5% vs. 4.5% and less likely to be for-profit institutions (8.8% vs. 19.9% (all p values <0.001. The authors used Medicare Provider Analysis and Review File (MedPAR from 2002 to 2013 to calculate hospital-level risk-adjusted performance on mortality ...
Bertoli, Paola; Grembi, Veronica
We assess the impact of the introduction of schedules of non-economic damages (i.e. tiered caps systems) on the behavior of insurers operating in the medical liability market for hospitals while controlling the performance of the judicial system, measured as court backlog. Using a difference......-in-differences strategy on Italian data, we find that the introduction of schedules increases the presence of insurers (i.e. medical liability market attractiveness) only in inefficient judicial districts. In the same way, court inefficiency is attractive to insurers for average values of schedules penetration...... of the market, with an increasing positive impact of inefficiency as the territorial coverage of schedules increases. Finally, no significant impact is registered on paid premiums. Our analysis sheds light on a complex set of elements affecting the decisions of insurers in malpractice markets. The analysis...
Zhang, Zhong; Wang, Jianxue; Wang, Xiuli
Highlights: • A quantitative depreciation cost model is put forward for lithium batteries. • A practical charging/discharging strategy is applied to battery management. • The depth of discharge of the battery storage is scheduled more rationally. • The proposed strategy improves the cost efficiency of lithium batteries in MGs. - Abstract: An energy storage system is critical for the safe and stable operation of a microgrid (MG) and has a promising prospect in future power system. Economical and safe operation of storage system is of great significance to MGs. This paper presents an improved management strategy for lithium battery storage by establishing a battery depreciation cost model and employing a practical charging/discharging strategy. Firstly, experimental data of lithium battery cycle lives, which are functions of the depth of discharge, are investigated and synthesized. A quantitative depreciation cost model is put forward for lithium batteries from the perspective of cycle life. Secondly, a practical charging/discharging strategy is applied to the lithium battery management in MGs. Then, an optimal scheduling model is developed to minimize MG operational cost including battery depreciation cost. Finally, numerical tests are conducted on a typical grid-connected MG. Results show that the depth of discharge of storage is scheduled more rationally, and operational cost is simultaneously saved for MG under the proposed management strategy. This study helps to improve the cost efficiency and alleviate the aging process for lithium batteries.
Gantwerker, Eric A; Bannos, Cassandra; Cunningham, Michael J; Rahbar, Reza
To describe a surgical categorization system to create a universal nomenclature, delineating patient complexity as a first step toward developing a true risk stratification system. Retrospective database review of all otolaryngology surgical procedures performed in a tertiary pediatric hospital system over one academic year (July 2012-June 2013). All otolaryngology surgical procedures were reviewed, encompassing 8478 procedures on 5711 patients. The attending otolaryngologist assigned surgical scheduling category (SSCS) at the time of case booking based on an institution specific guidelines. The guidelines are as follow: Category I was assigned to American Society of Anesthesiologists physical status classification (ASA) I/II patients, designating them appropriate for institution's suburban ambulatory surgery centers; Category II was ASA I/II patients with social or transportation issues; Category III was ASA I/II patients who required case coordination with other medical or surgical departments; Category IV was reserved for patients of any ASA class whom the surgeon designated to be of a higher complexity. 8478 total procedures analyzed with 7198 having complete records. 48% were Category I, 13.6% were Category II, 1.9% were Category III and 36.5% were Category IV. The ASA were 34.7% ASA I, 50% ASA II, 13.39% ASA III, and 1.9% ASA IV. Although the largest proportion of patients were ASA II (50%), 39.6% of all ASA II were Category IV. Category IV was split into 54.2% ASA II and 34% ASA III and shows that peri-operative surgical concerns were not encompassed by the ASA system. This surgical categorization system streamlines surgical scheduling in a tertiary pediatric hospital system, particularly with respect to the designation of cases as ambulatory surgery center or main operating room appropriate. The case mix complexity is also readily apparent, enhancing recognition of the coordination and attention required for the perioperative management of high complexity
Andersson, Niclas; Büchmann-Slorup, Rolf
The potential of BIM is generally recognized in the construction industry, but the practical application of BIM for management purposes is, however, still limited among contractors. The objective of this study is to review the current scheduling process of construction in light of BIM...... and communicate. Scheduling on the detailed level, on the other hand, follows a stipulated approach to scheduling, i.e. the Last Planner System (LPS), which is characterized by involvement of all actors in the construction phase. Thus, the major challenge when implementing BIM-based scheduling is to improve...
Shamsuddin Alaraki, Mohammad
The health care system in Saudi Arabia has serious problems with quality and safety that can be reduced through systematic quality improvement (QI) activities. Despite the use of different QI models to improve health care in Saudi hospitals during the last 2 decades, consistent improvements have not yet been achieved and the results are still far below expectations. This may reflect a problem in introducing and implementing the QI models in the local contexts. The objective of this study is to assess the extent of QI implementation in Saudi hospitals and to identify the organizational characteristics that make Saudi hospitals particularly challenging for QI. Understanding these characteristics can inform efforts to improve them and may lead to more successful implementation. A mixed-methods approach was conducted using 2 data collection tools: questionnaires and interviews. The quantitative phase (questionnaires) aimed to uncover the current level of QI implementation in Saudi hospital as measured by 7 critical dimensions adapted from the literature. The qualitative phase (interviews) aimed to understand the organizational characteristics that impede or underpin QI in Saudi hospitals. The QI implementation was found to be significantly poor across the 7 dimensions with average score ranging between 22.80 ± 0.57 and 2.11 ± 0.69 on a 5-point Likert scale and with P value of less than .05. We also found that the current level of QI implementation helped Saudi hospitals neither to improve "customer satisfaction" nor to achieve measurable improvements in "quality results" scoring significantly low at 2.11 ± 0.69 with P value of .000 and 2.47 ± 0.57 with P value of .000, respectively. Our study confirms the presence of a multitude of organizational barriers that impede QI in Saudi hospitals. These are related to organizational culture, human resources management, processes and systems, and structure. These 4 were found to have the strongest impact on QI in Saudi
van Lent Wineke AM
Full Text Available Abstract Background Research showed that promising approaches such as benchmarking, operations research, lean management and six sigma, could be adopted to improve patient logistics in healthcare. To our knowledge, little research has been conducted to obtain an overview on the use, combination and effects of approaches to improve patient logistics in hospitals. We therefore examined the approaches and tools used to improve patient logistics in Dutch hospitals, the reported effects of these approaches on performance, the applied support structure and the methods used to evaluate the effects. Methods A survey among experts on patient logistics in 94 Dutch hospitals. The survey data were analysed using cross tables. Results Forty-eight percent of all hospitals participated. Ninety-eight percent reported to have used multiple approaches, 39% of them used five or more approaches. Care pathways were the preferred approach by 43% of the hospitals, followed by business process re-engineering and lean six sigma (both 13%. Flowcharts were the most commonly used tool, they were used on a regular basis by 94% of the hospitals. Less than 10% of the hospitals used data envelopment analysis and critical path analysis on a regular basis. Most hospitals (68% relied on external support for process analyses and education on patient logistics, only 24% had permanent internal training programs on patient logistics. Approximately 50% of the hospitals that evaluated the effects of approaches on efficiency, throughput times and financial results, reported that they had accomplished their goals. Goal accomplishment in general hospitals ranged from 63% to 67%, in academic teaching hospitals from 0% to 50%, and in teaching hospitals from 25% to 44%. More than 86% performed an evaluation, 53% performed a post-intervention measurement. Conclusions Patient logistics appeared to be a rather new subject as most hospitals had not selected a single approach, they relied on
Background Research showed that promising approaches such as benchmarking, operations research, lean management and six sigma, could be adopted to improve patient logistics in healthcare. To our knowledge, little research has been conducted to obtain an overview on the use, combination and effects of approaches to improve patient logistics in hospitals. We therefore examined the approaches and tools used to improve patient logistics in Dutch hospitals, the reported effects of these approaches on performance, the applied support structure and the methods used to evaluate the effects. Methods A survey among experts on patient logistics in 94 Dutch hospitals. The survey data were analysed using cross tables. Results Forty-eight percent of all hospitals participated. Ninety-eight percent reported to have used multiple approaches, 39% of them used five or more approaches. Care pathways were the preferred approach by 43% of the hospitals, followed by business process re-engineering and lean six sigma (both 13%). Flowcharts were the most commonly used tool, they were used on a regular basis by 94% of the hospitals. Less than 10% of the hospitals used data envelopment analysis and critical path analysis on a regular basis. Most hospitals (68%) relied on external support for process analyses and education on patient logistics, only 24% had permanent internal training programs on patient logistics. Approximately 50% of the hospitals that evaluated the effects of approaches on efficiency, throughput times and financial results, reported that they had accomplished their goals. Goal accomplishment in general hospitals ranged from 63% to 67%, in academic teaching hospitals from 0% to 50%, and in teaching hospitals from 25% to 44%. More than 86% performed an evaluation, 53% performed a post-intervention measurement. Conclusions Patient logistics appeared to be a rather new subject as most hospitals had not selected a single approach, they relied on external support and they did
van Lent, Wineke A M; Sanders, E Marloes; van Harten, Wim H
Research showed that promising approaches such as benchmarking, operations research, lean management and six sigma, could be adopted to improve patient logistics in healthcare. To our knowledge, little research has been conducted to obtain an overview on the use, combination and effects of approaches to improve patient logistics in hospitals. We therefore examined the approaches and tools used to improve patient logistics in Dutch hospitals, the reported effects of these approaches on performance, the applied support structure and the methods used to evaluate the effects. A survey among experts on patient logistics in 94 Dutch hospitals. The survey data were analysed using cross tables. Forty-eight percent of all hospitals participated. Ninety-eight percent reported to have used multiple approaches, 39% of them used five or more approaches. Care pathways were the preferred approach by 43% of the hospitals, followed by business process re-engineering and lean six sigma (both 13%). Flowcharts were the most commonly used tool, they were used on a regular basis by 94% of the hospitals. Less than 10% of the hospitals used data envelopment analysis and critical path analysis on a regular basis. Most hospitals (68%) relied on external support for process analyses and education on patient logistics, only 24% had permanent internal training programs on patient logistics. Approximately 50% of the hospitals that evaluated the effects of approaches on efficiency, throughput times and financial results, reported that they had accomplished their goals. Goal accomplishment in general hospitals ranged from 63% to 67%, in academic teaching hospitals from 0% to 50%, and in teaching hospitals from 25% to 44%. More than 86% performed an evaluation, 53% performed a post-intervention measurement. Patient logistics appeared to be a rather new subject as most hospitals had not selected a single approach, they relied on external support and they did not have permanent training programs
Hanchate, Amresh D; Stolzmann, Kelly L; Rosen, Amy K; Fink, Aaron S; Shwartz, Michael; Ash, Arlene S; Abdulkerim, Hassen; Pugh, Mary Jo V; Shokeen, Priti; Borzecki, Ann
Hospital performance measures based on patient mortality and readmission have indicated modest rates of agreement. We examined if combining clinical data on laboratory tests and vital signs with administrative data leads to improved agreement with each other, and with other measures of hospital performance in the nation's largest integrated health care system. We used patient-level administrative and clinical data, and hospital-level data on quality indicators, for 2007-2010 from the Veterans Health Administration (VA). For patients admitted for acute myocardial infarction (AMI), heart failure (HF) and pneumonia we examined changes in hospital performance on 30-d mortality and 30-d readmission rates as a result of adding clinical data to administrative data. We evaluated whether this enhancement yielded improved measures of hospital quality, based on concordance with other hospital quality indicators. For 30-d mortality, data enhancement improved model performance, and significantly changed hospital performance profiles; for 30-d readmission, the impact was modest. Concordance between enhanced measures of both outcomes, and with other hospital quality measures - including Joint Commission process measures, VA Surgical Quality Improvement Program (VASQIP) mortality and morbidity, and case volume - remained poor. Adding laboratory tests and vital signs to measure hospital performance on mortality and readmission did not improve the poor rates of agreement across hospital quality indicators in the VA. Efforts to improve risk adjustment models should continue; however, evidence of validation should precede their use as reliable measures of quality. Published by Elsevier Inc.
Cole, G. M.
(Abstract only) Automated scheduling makes it possible for a small telescope to observe a large number of targets in a single night. But when used in areas which have less-than-perfect sky conditions such automation can lead to large numbers of observations of clouds and haze. This paper describes the development of a "sky-aware" telescope automation system that integrates the data flow from an SBIG AllSky340c camera with an enhanced dispatch scheduler to make optimum use of the available observing conditions for two highly instrumented backyard telescopes. Using the minute-by-minute time series image stream and a self-maintained reference database, the software maintains a file of sky brightness, transparency, stability, and forecasted visibility at several hundred grid positions. The scheduling software uses this information in real time to exclude targets obscured by clouds and select the best observing task, taking into account the requirements and limits of each instrument.
Boyle, A A; Robinson, S M; Whitwell, D; Myers, S; Bennett, T J H; Hall, N; Haydock, S; Fritz, Z; Atkinson, P
There is uncertainty about the most efficient model of emergency care. An attempt has been made to improve the process of emergency care in one hospital by developing an integrated model. The medical admissions unit was relocated into the existing emergency department and came under the 4-hour target. Medical case records were redesigned to provide a common assessment document for all patients presenting as an emergency. Medical, surgical and paediatric short-stay wards were opened next to the emergency department. A clinical decision unit replaced the more traditional observation unit. The process of patient assessment was streamlined so that a patient requiring admission was fully clerked by the first attending doctor to a level suitable for registrar or consultant review. Patients were allocated directly to specialty on arrival. The effectiveness of this approach was measured with routine data over the same 3-month periods in 2005 and 2006. There was a 16.3% decrease in emergency medical admissions and a 3.9% decrease in emergency surgical admissions. The median length of stay for emergency medical patients was reduced from 7 to 5 days. The efficiency of the elective surgical services was also improved. Performance against the 4-hour target declined but was still acceptable. The number of bed days for admitted surgical and medical cases rose slightly. There was an increase in the number of medical outliers on surgical wards, a reduction in the number of incident forms and formal complaints and a reduction in income for the hospital. Integrated emergency care has the ability to use spare capacity within emergency care. It offers significant advantages beyond the emergency department. However, improved efficiency in processing emergency patients placed the hospital at a financial disadvantage.
Lucy Gongtao Chen; Srinagesh Gavirneni
We study a supply chain with one supplier and many retailers that face exogenous end-customer demands. The supplier and the retailers all try to minimize their own inventory-related costs. In contrast to the retailers' newsvendor-type ordering behavior (under which retailers may place orders freely in every period), we propose two scheduled ordering policies: the scheduled balanced ordering policy (SBOP) and the scheduled synchronized ordering policy (SSOP). Under both the SBOP and SSOP, reta...
Mizouni, Rabeb; Lazarova-Molnar, Sanja
overrun both their budget and time. To improve the quality of initial project plans, we show in this paper the importance of (1) reflecting features’ priorities/risk in task schedules and (2) considering uncertainties related to human factors in plan schedules. To make simulation tasks reflect features......’ priority as well as multimodal team allocation, enhanced project schedules (EPS), where remedial actions scenarios (RAS) are added, were introduced. They reflect potential schedule modifications in case of uncertainties and promote a dynamic sequencing of involved tasks rather than the static conventional...... this document as an instruction set. The electronic file of your paper will be formatted further at Journal of Software. Define all symbols used in the abstract. Do not cite references in the abstract. Do not delete the blank line immediately above the abstract; it sets the footnote at the bottom of this column....
Pratap, Jayant Nick; Varughese, Anna M; Mercurio, Patti; Lynch, Terri; Lonnemann, Teresa; Ellis, Andrea; Rugg, John; Stone, W Ray; Bedinghaus, Cindi
Cancelation on the day of surgery (DoSC) represents a costly wastage of operating room (OR) time and causes inconvenience, emotional distress, and financial cost to families. A quality improvement project sought to reduce lost OR time due to cancelation. Key drivers of the process included effective 2-way communication with families, compliance with fasting rules, and decision-making on patient illness before the day of surgery. A multidisciplinary team conducted serial tests of change addressing the various key drivers. Interventions were simplified, colorful, personalized preoperative instruction sheets and text-message reminders to caregivers' cellphones, as well as a defined institutional decision-making pathway to permit rescheduling before the day of surgery in case of patient illness concerns. After initial smaller-scale testing, the interventions were implemented across all patients and sites. Data were collected from the hospital information technology system and analyzed by using control charts and statistical process control methods. Mean OR time lost due to DoSC was decreased from a baseline of 5.7 to 3.6 hours/day in testing with a subset of surgical services at the hospital's base campus, and then from 6.6 hours to 5.5 hours/day when implemented across all services at both surgical sites. By applying quality improvement methods, significant reductions were made in time lost due to DoSC. The impact can be significant by improving institutional resource utilization. Copyright © 2015 by the American Academy of Pediatrics.
Whitfill, Travis; Gawel, Marcie; Auerbach, Marc
The National Pediatric Readiness Project Pediatric Readiness Survey (PRS) measured pediatric readiness in 4149 US emergency departments (EDs) and noted an average score of 69 on a 100-point scale. This readiness score consists of 6 domains: coordination of pediatric patient care (19/100), physician/nurse staffing and training (10/100), quality improvement activities (7/100), patient safety initiatives (14/100), policies and procedures (17/100), and availability of pediatric equipment (33/100). We aimed to assess and improve pediatric emergency readiness scores across Connecticut's hospitals. The aim of this study was to compare the National Pediatric Readiness Project readiness score before and after an in situ simulation-based assessment and quality improvement program in Connecticut hospitals. We leveraged in situ simulations to measure the quality of resuscitative care provided by interprofessional teams to 3 simulated patients (infant septic shock, infant seizure, and child cardiac arrest) presenting to their ED resuscitation bay. Assessments of EDs were made based on a composite quality score that was measured as the sum of 4 distinct domains: (1) adherence to sepsis guidelines, (2) adherence to cardiac arrest guidelines, (3) performance on seizure resuscitation, and (4) teamwork. After the simulation, a detailed report with scores, comparisons to other EDs, and a gap analysis were provided to sites. Based on this report, a regional children's hospital team worked collaboratively with each ED to develop action items and a timeline for improvements. The National Pediatric Readiness Project PRS scores, the primary outcome of this study, were measured before and after participation. Twelve community EDs in Connecticut participated in this project. The PRS scores were assessed before and after the intervention (simulation-based assessment and gap analysis/report-out). The average time between PRS assessments was 21 months. The PRS scores significantly improved 12
Šklebar, Ivan; Mustajbegović, Jadranka; Šklebar, Duška; Cesarik, Marijan; Milošević, Milan; Brborović, Hana; Šporčić, Krunoslav; Petrić, Petar; Husedžinović, Ino
Patient safety culture (PCS) has a crucial impact on the safety practices of healthcare delivery systems. The purpose of this study was to assess the state of PSC in Croatian hospitals and compare it with hospitals in the United States. The study was conducted in three public general hospitals in Croatia using the Croatian translation of the Hospital Survey of Patient Safety Culture (HSOPSC). A comparison of the results from Croatian and American hospitals was performed using a T-square test. We found statistically significant differences in all 12 PSC dimensions. Croatian responses were more positive in the two dimensions of Handoff s and Transitions and Overall Perceptions of Patient Safety. In the remaining ten dimensions, Croatian responses were less positive than in US hospitals, with the most prominent areas being Nonpunitive Response to Error, Frequency of Events Reported, Communication Openness, Teamwork within Units, Feedback & Communication about Error, Management Support for Patient Safety, and Staffing. Our findings show that PSC is significantly lower in Croatian than in American hospitals, particularly in the areas of Nonpunitive Response to Error, Leadership, Teamwork, Communication Openness and Staffing. This suggests that a more comprehensive system for the improvement of patient safety within the framework of the Croatian healthcare system needs to be developed. Our findings also help confirm that HSOPSC is a useful and appropriate tool for the assessment of PSC. HSOPSC highlights the PSC components in need of improvement and should be considered for use in national and international benchmarking.
Zocchi, Mark S; McClelland, Mark S; Pines, Jesse M
An 18-month collaborative in 42 hospitals across 16 communities in the United States to improve emergency department (ED) flow was conducted from October 2010 through March 2012. Hospitals were invited to participate through the Aligning Forces for Quality (AF4Q) program. Each participating hospital identified one or more interventions to improve ED flow and submitted data on four measures of ED flow: discharged length of stay (LOS), admitted LOS, boarding time, and left without being seen (LWBS) rates. Participating hospitals also provided quarterly progress reports on challenges encountered and lessons learned. Univariate linear regression was used to assess the effectiveness of interventions at the hospital level, where an improvement was defined as a negative slope in one or more of the throughput indicators. Challenges and lessons learned were tabulated and described. A total of 172 interventions were implemented across the 42 hospitals. Two thirds (n = 28) demonstrated improvement on at least one measure of ED flow. Among hospitals demonstrating improvement, the average reduction in discharged LOS was 26 minutes (95% confidence interval [CI] 11 to 41); admitted LOS, 36.5 minutes (95% CI 20 to 53), boarding time, 20.9 minutes (95% CI 12 to 30), and LWBS seen rates decreased by 1.4 absolute percentage points (95% CI 0.2 to 2.7). Teams were frequently challenged by issues related to leadership, staff buy-in, and resource constraints. The majority of hospitals in this collaborative improved on one or more ED flow measures. Many challenges were shared across hospitals, demonstrating that successful approaches to ED flow improvement require certain fundamental elements, including engaged leadership and staff, and sufficient resources.
Purcell, W.J.; Martin, E.M.; Shivley, J.M.
The construction schedule for the Clinch River Breeder Reactor Plant and its evolution are described. The initial schedule basis, changes necessitated by the evaluation of the overall plant design, and constructability improvements that have been effected to assure adherence to the schedule are presented. The schedule structure and hierarchy are discussed, as are tools used to define, develop, and evaluate the schedule
Zelinski, Shannon; Windhorst, Robert
A departure metering concept to be demonstrated at Charlotte Douglas International Airport (CLT) will integrate strategic and tactical surface scheduling components to enable the respective collaborative decision making and improved efficiency benefits these two methods of scheduling provide. This study analyzes the effect of tactical scheduling on strategic scheduler predictability. Strategic queue predictions and target gate pushback times to achieve a desired queue length are compared between fast time simulations of CLT surface operations with and without tactical scheduling. The use of variable departure rates as a strategic scheduler input was shown to substantially improve queue predictions over static departure rates. With target queue length calibration, the strategic scheduler can be tuned to produce average delays within one minute of the tactical scheduler. However, root mean square differences between strategic and tactical delays were between 12 and 15 minutes due to the different methods the strategic and tactical schedulers use to predict takeoff times and generate gate pushback clearances. This demonstrates how difficult it is for the strategic scheduler to predict tactical scheduler assigned gate delays on an individual flight basis as the tactical scheduler adjusts departure sequence to accommodate arrival interactions. Strategic/tactical scheduler compatibility may be improved by providing more arrival information to the strategic scheduler and stabilizing tactical scheduler changes to runway sequence in response to arrivals.
Kuttumuratova, Aigul; Monolbaev, Kubanychbek; Boderscova, Larisa; Pirova, Zulfiya; Weber, Martin W.
Abstract There is a recognized need to raise evidence on how to adopt human rights-based approaches (HRBAs) to health and to assess their impact. In 2013 and 2014, the World Health Organization (WHO) Regional Office for Europe used a set of tools to assess and improve the situation of children’s rights in 11 hospitals in Kyrgyzstan, 10 hospitals in Tajikistan, and 21 hospitals in Moldova, by applying a HRBA to health, taking as a reference the Convention on the Rights of the Child (CRC). The assessment results show a similar situation across countries in some areas, and more or less significant variation in others. Common gaps include the need to improve adolescent-friendly health services, the rights to privacy and play; and infrastructure and equipment. In Kyrgyzstan and Tajikistan, a second round of assessment, was carried out, which showed an effective change in several areas, whilst other areas showed persistent gaps. Moldova did not carry out a second round of assessment. Involving children and parents in the assessment was crucial to obtain more reliable data; the project showed how to use the CRC as a framework to improve quality of care for children (QoC); and the tools were proven useful for self-assessment. PMID:27781013
Ward, Laura P; Williamson, Susan; Burke, Stephanie; Crawford-Hemphill, Ruby; Thompson, Amy M
Breastfeeding has many well-established health benefits for infants and mothers. There is greater risk reduction in health outcomes with exclusive breastfeeding (EBF). Our urban academic facility has had long-standing low EBF rates, serving a population with breastfeeding disparities. We sought to improve EBF rates through a Learning Collaborative model by participating in the Best Fed Beginnings project. Formal improvement science methods were used, including the development of a key driver diagram and plan-do-study-act cycles. Improvement activities followed the Ten Steps to Successful Breastfeeding. We demonstrated significant improvement in the median adherence to 2 process measures, rooming in and skin-to-skin after delivery. Subsequently, the proportion of infants exclusively breastfed at hospital discharge in our facility increased from 37% to 59%. We demonstrated an increase in sustained breastfeeding in a subset of patients at a postpartum follow-up visit. These improvements led to Baby-Friendly designation at our facility. This quality improvement initiative resulted in a higher number of infants exclusively breastfed in our patient population at "high risk not to breastfeed." Other hospitals can use these described methods and techniques to improve their EBF rates. Copyright © 2017 by the American Academy of Pediatrics.
Full Text Available The Grid scheduler, schedules user jobs on the best available resource in terms of resource characteristics by optimizing job execution time. Resource failure in Grid is no longer an exception but a regular occurring event as resources are increasingly being used by the scientific community to solve computationally intensive problems which typically run for days or even months. It is therefore absolutely essential that these long-running applications are able to tolerate failures and avoid re-computations from scratch after resource failure has occurred, to satisfy the user's Quality of Service (QoS requirement. Job Scheduling with Fault Tolerance in Grid Computing using Ant Colony Optimization is proposed to ensure that jobs are executed successfully even when resource failure has occurred. The technique employed in this paper, is the use of resource failure rate, as well as checkpoint-based roll back recovery strategy. Check-pointing aims at reducing the amount of work that is lost upon failure of the system by immediately saving the state of the system. A comparison of the proposed approach with an existing Ant Colony Optimization (ACO algorithm is discussed. The experimental results of the implemented Fault Tolerance scheduling algorithm show that there is an improvement in the user's QoS requirement over the existing ACO algorithm, which has no fault tolerance integrated in it. The performance evaluation of the two algorithms was measured in terms of the three main scheduling performance metrics: makespan, throughput and average turnaround time.
Objectives. To determine if a physician education programme and a structured consultation schedule would improve the quality of diabetes patient care in a diabetes clinic. Setting. Two tertiary care diabetes clinics at Kalafong Hospital, Pretoria. Study design. Quasi-experimental controlled before-and-after study. Methods.
Title 44 United States Code, ''Public Printing and Documents,'' regulations cited in the General Services Administration's (GSA) ''Federal Information Resources Management Regulations'' (FIRMR), Part 201-9, ''Creation, Maintenance, and Use of Records,'' and regulation issued by the National Archives and Records Administration (NARA) in 36 CFR Chapter XII, Subchapter B, ''Records Management,'' require each agency to prepare and issue a comprehensive records disposition schedule that contains the NARA approved records disposition schedules for records unique to the agency and contains the NARA's General Records Schedules for records common to several or all agencies. The approved records disposition schedules specify the appropriate duration of retention and the final disposition for records created or maintained by the NRC. NUREG-0910, Rev. 2, contains ''NRC's Comprehensive Records Disposition Schedule,'' and the original authorized approved citation numbers issued by NARA. Rev. 2 totally reorganizes the records schedules from a functional arrangement to an arrangement by the host office. A subject index and a conversion table have also been developed for the NRC schedules to allow staff to identify the new schedule numbers easily and to improve their ability to locate applicable schedules
Fernández-Prada, María; Rodríguez-Martínez, María; García-García, Rebeca; García-Corte, María Dolores; Martínez-Ortega, Carmen
Children undergoing chemotherapy for cancer have special vaccination needs after completion of the treatment. The aim of this study was to evaluate the adaptation of post-chemotherapy vaccination schedules. An observational study was performed on a retrospective cohort that included all children aged from 0 to 14 years, who completed chemotherapy in a tertiary hospital between 2009 and 2015. Inclusion and exclusion criteria were applied. Immunisation was administered in accordance with the guidelines of the Vaccine Advisory Committee of the Spanish Association of Paediatrics. Primary Care immunisation and clinical records of the Preventive Medicine and Public Health Department were reviewed. Of the 99 children who had received chemotherapy, 51 (70.6% males) were included in the study. As regards the type of tumour, 54.9% had a solid organ tumour, and 45.1% had a haematological tumour. Post-chemotherapy immunisation was administered to 70.6%. The most common vaccines received were: diphtheria-tetanus-pertussis or diphtheria-tetanus (54.9%), meningococcus C (41.2%), and seasonal influenza (39.2%). The rate of adaptation of the immunisation schedule after chemotherapy was 9.8%. The pneumococcal conjugate vaccine against 7v or 13v was administered to 21.6% of study subjects. However, only 17.6% received polysaccharide 23v. None received vaccination against hepatitis A. No statistically significant differences were observed between adherence to immunisation schedules and type of tumour (P=.066), gender (P=.304), or age (P=.342). Post-chemotherapy immunisation of children with cancer is poor. The participation of health professionals in training programs and referral of paediatric cancer patients to Vaccine Units could improve the rate of schedule adaptation and proper immunisation of this population. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.
Full Text Available For the first time, an improved hierarchical genetic algorithm for sheet cutting problem which involves n cutting patterns for m non-identical parallel machines with process constraints has been proposed in the integrated cutting stock model. The objective of the cutting scheduling problem is minimizing the weighted completed time. A mathematical model for this problem is presented, an improved hierarchical genetic algorithm (ant colony—hierarchical genetic algorithm is developed for better solution, and a hierarchical coding method is used based on the characteristics of the problem. Furthermore, to speed up convergence rates and resolve local convergence issues, a kind of adaptive crossover probability and mutation probability is used in this algorithm. The computational result and comparison prove that the presented approach is quite effective for the considered problem.
Rao, Yunqing; Qi, Dezhong; Li, Jinling
For the first time, an improved hierarchical genetic algorithm for sheet cutting problem which involves n cutting patterns for m non-identical parallel machines with process constraints has been proposed in the integrated cutting stock model. The objective of the cutting scheduling problem is minimizing the weighted completed time. A mathematical model for this problem is presented, an improved hierarchical genetic algorithm (ant colony--hierarchical genetic algorithm) is developed for better solution, and a hierarchical coding method is used based on the characteristics of the problem. Furthermore, to speed up convergence rates and resolve local convergence issues, a kind of adaptive crossover probability and mutation probability is used in this algorithm. The computational result and comparison prove that the presented approach is quite effective for the considered problem.
Larco Martinelli, J.A.; Wiers, V.C.S.; Fransoo, J.C.
Time is the most critical resource at the disposal of schedulers. Hence, an adequate management of time from the schedulers may impact positively on the scheduler’s productivity and responsiveness to uncertain scheduling environments. This paper presents a field study of how schedulers make use of
Darmoni, S J; Fajner, A; Mahé, N; Leforestier, A; Vondracek, M; Stelian, O; Baldenweck, M
Nurse scheduling is a difficult and time consuming task. The schedule has to determine the day to day shift assignments of each nurse for a specified period of time in a way that satisfies the given requirements as much as possible, taking into account the wishes of nurses as closely as possible. This paper presents a constraint-based, artificial intelligence approach by describing a prototype implementation developed with the Charme language and the first results of its use in the Rouen University Hospital. Horoplan implements a non-cyclical constraint-based scheduling, using some heuristics. Four levels of constraints were defined to give a maximum of flexibility: French level (e.g. number of worked hours in a year), hospital level (e.g. specific day-off), department level (e.g. specific shift) and care unit level (e.g. specific pattern for week-ends). Some constraints must always be verified and can not be overruled and some constraints can be overruled at a certain cost. Rescheduling is possible at any time specially in case of an unscheduled absence.
Kollerup, Mette Geil; Curtis, Tine; Schantz Laursen, Birgitte
implementation rate, which involved 31 out of the 38 patients in the target group. CONCLUSION: For patients with complex care needs, post-hospital medication management may be improved by a reconsideration of the activity-based funding of home healthcare, a recognition of the importance of organising work......AIMS AND OBJECTIVES: This study evaluates an intervention developed to improve patient safety in post-hospital medication management carried out by visiting nurses working in a municipality in Denmark. The intervention consisted of three elements: an initial inter-disciplinary home visit by nurses...... management is identified as the most challenging component of a discharge from the hospital to the home, in which discrepancies have been found in up to 94% of medication lists. DESIGN: A process evaluation inspired by the UK Medical Research Council's guidance. METHODS: The process evaluation was conducted...
Jun 12, 2014 ... the mine scheduling optimisation problem for both open pit and ... that involves the iterative solving of the linear programming ... methods is discussed in §4 and the concept of a mining-method-dependent grade tonnage.
Akkerman, Renzo; van Donk, Dirk Pieter
Production scheduling has been widely studied in several research areas, resulting in a large number of methods, prescriptions, and approaches. However, the impact on scheduling practice seems relatively low. This is also the case in the food-processing industry, where industry......-specific characteristics induce specific and complex scheduling problems. Based on ideas about decomposition of the scheduling task and the production process, we develop an analysis methodology for scheduling problems in food processing. This combines an analysis of structural (technological) elements of the production...... process with an analysis of the tasks of the scheduler. This helps to understand, describe, and structure scheduling problems in food processing, and forms a basis for improving scheduling and applying methods developed in literature. It also helps in evaluating the organisational structures...
Martínez-Brocca, María Asunción; Morales, Cristóbal; Rodríguez-Ortega, Pilar; González-Aguilera, Beatriz; Montes, Cristina; Colomo, Natalia; Piédrola, Gonzalo; Méndez-Muros, Mariola; Serrano, Isabel; Ruiz de Adana, Maria Soledad; Moreno, Alberto; Fernández, Ignacio; Aguilar, Manuel; Acosta, Domingo; Palomares, Rafael
In 2009, the Andalusian Society of Endocrinology and Nutrition designed a protocol for subcutaneous insulin treatment in hospitalized non-critically ill patients (HIP). To analyze implementation of HIP at tertiary care hospitals from the Andalusian Public Health System. A descriptive, multicenter study conducted in 8 tertiary care hospitals on a random sample of non-critically ill patients with diabetes/hyperglycemia (n=306) hospitalized for ≥48 hours in 5 non-surgical (SM) and 2 surgical (SQ) departments. Type 1 and other specific types of diabetes, pregnancy and nutritional support were exclusion criteria. 288 patients were included for analysis (62.5% males; 70.3±10.3 years; 71.5% SM, 28.5% SQ). A scheduled subcutaneous insulin regimen based on basal-bolus-correction protocol was started in 55.9% (95%CI: 50.5-61.2%) of patients, 63.1% SM vs. 37.8% SQ (P<.05). Alternatives to insulin regimen based on basal-bolus-correction included sliding scale insulin (43.7%), diet (31.3%), oral antidiabetic drugs (17.2%), premixed insulin (1.6%), and others (6.2%). For patients previously on oral antidiabetic drugs, in-hospital insulin dose was 0.32±0.1 IU/kg/day. In patients previously on insulin, in-hospital insulin dose was increased by 17% [-13-53], and in those on insulin plus oral antidiabetic drugs, in-hospital insulin dose was increased by 26.4% [-6-100]. Supplemental insulin doses used for<40 IU/day and 40-80 IU/day were 72.2% and 56.7% respectively. HbA1c was measured in 23.6% of patients (95CI%: 18.8-28.8); 27.7% SM vs. 13.3% SQ (P<.05). Strategies are needed to improve implementation of the inpatient subcutaneous insulin protocol, particularly in surgical departments. Sliding scale insulin is still the most common alternative to insulin regimen based on basal-bolus-correction scheduled insulin. Metabolic control assessment during hospitalization should be encouraged. Copyright © 2014 SEEN. Published by Elsevier España, S.L.U. All rights reserved.
Asgar Aghaei Hashjin
Full Text Available RESEARCH OBJECTIVE: This study examines the perspectives of a range of key hospital staff on the use, importance, scientific background, availability of data, feasibility of data collection, cost benefit aspects and availability of professional personnel for measurement of quality indicators among Iranian hospitals. The study aims to facilitate the use of quality indicators to improve quality of care in hospitals. STUDY DESIGN: A cross-sectional study was conducted over the period 2009 to 2010. Staff at Iranian hospitals completed a self-administered questionnaire eliciting their views on organizational, clinical process, and outcome (clinical effectiveness, patient safety and patient centeredness indicators. POPULATION STUDIED: 93 hospital frontline staff including hospital/nursing managers, medical doctors, nurses, and quality improvement/medical records officers in 48 general and specialized hospitals in Iran. PRINCIPAL FINDINGS: On average, only 69% of respondents reported using quality indicators in practice at their affiliated hospitals. Respondents varied significantly in their reported use of organizational, clinical process and outcome quality indicators. Overall, clinical process and effectiveness indicators were reported to be least used. The reported use of indicators corresponded with their perceived level of importance. Quality indicators were reported to be used among clinical staff significantly more than among managerial staff. In total, 74% of the respondents reported to use obligatory indicators, while this was 68% for voluntary indicators (p<0.05. CONCLUSIONS: There is a general awareness of the importance and usability of quality indicators among hospital staff in Iran, but their use is currently mostly directed towards external accountability purposes. To increase the formative use of quality indicators, creation of a common culture and feeling of shared ownership, alongside an increased uptake of clinical process and
Singh, Simone Rauscher; Wheeler, John
Effective revenue cycle management--from appointment scheduling and patient registration at the front end of the revenue cycle to billing and cash collections at the back end--plays a crucial role in hospitals' efforts to improve their financial performance. Using data for 1,397 bond-issuing, not-for-profit US hospitals for 2000 to 2007, this study analyzed the relationship between hospitals' performance at managing the revenue cycle and their profitability and ability to build equity capital. Hospital-level fixed effects regression analysis was used to model four different measures of profitability and equity capital as functions of two key financial indicators of revenue cycle management--amount of patient revenue and speed of revenue collection. The results indicated that higher amounts of patient revenue in relation to a hospital's assets were associated with statistically significant increases in operating and total profit margins, free cash flow, and equity capital (p < 0.01 for all four models); that is, hospitals that generated more patient revenue per dollar of assets invested reported improved financial performance. Likewise, a statistically significant link existed between lower revenue collection periods and all four indicators of hospital financial performance (p < 0.01 for three models; p < 0.05 for one model). Hospitals that collected faster on their patient revenue reported higher profit margins and larger equity values. For revenue cycle managers, these findings represent good news: Streamlining a hospital's management of the patient revenue cycle can advance the organization's financial viability by improving profitability and enabling equity growth.
Filardo, Giovanni; Nicewander, David; Herrin, Jeph; Edwards, Janine; Galimbertti, Percy; Tietze, Mari; McBride, Susan; Gunderson, Julie; Collinsworth, Ashley; Haydar, Ziad; Williams, Josie; Ballard, David J
To investigate the effectiveness of a quality improvement educational program in rural hospitals. Hospital-randomized controlled trial. A total of 47 rural and small community hospitals in Texas that had previously received a web-based benchmarking and case-review tool. The 47 hospitals were randomized either to receive formal quality improvement educational program or to a control group. The educational program consisted of two 2-day didactic sessions on continuous quality improvement techniques, followed by the design, implementation and reporting of a local quality improvement project, with monthly coaching conference calls and annual follow-up conclaves. Performance on core measures for community-acquired pneumonia and congestive heart failure were compared between study groups to evaluate the impact of the educational program. No significant differences were observed between the study groups on any measures. Of the 23 hospitals in the intervention group, only 16 completed the didactic program and 6 the full training program. Similar results were obtained when these groups were compared with the control group. While the observed results suggest no incremental benefit of the quality improvement educational program following implementation of a web-based benchmarking and case-review tool in rural hospitals, given the small number of hospitals that completed the program, it is not conclusive that such programs are ineffective. Further research incorporating supporting infrastructure, such as physician champions, financial incentives and greater involvement of senior leadership, is needed to assess the value of quality improvement educational programs in rural hospitals.
Stordeur, Sabine; D'Hoore, William
This paper contrasts structural and managerial characteristics of low- and high-turnover hospitals, and describes the organizational configuration of attractive hospitals. In countries facing nurse shortages and turnover, some hospitals succeed in recruiting and retaining nurses. In Magnet Hospitals, managerial practices and environmental characteristics increase nurses' job satisfaction and their commitment to the organization, which in turn decreases nurse turnover. Such an approach suggests that organizations are best understood as clusters of interconnected structures and practices, i.e. organizational configurations rather than entities whose components can be understood in isolation. From a sample of 12 hospitals whose nurse turnover was studied for 1 year, structural and organizational features of hospitals in the first and fourth quartiles, i.e. attractive (turnover 11.8%) were contrasted. A questionnaire, including perceptions of health-related factors, job demands, stressors, work schedules, organizational climate, and work adjustments antecedent to turnover, was received from 401 nurses working in attractive hospitals (response rate = 53.8%) and 774 nurses in conventional hospitals (response rate = 54.5%). Structural characteristics did not differentiate attractive and conventional hospitals, but employee perceptions towards the organization differed strikingly. Differences were observed for risk exposure, emotional demands, role ambiguity and conflicts, work-family conflicts, effort-reward imbalance and the meaning of work, all in favour of attractive hospitals (P satisfaction with working time, handover shifts and schedules were also better in attractive hospitals (P Job satisfaction and commitment were higher in attractive hospitals, whereas burnout and intention to leave were lower (P retention. Nurses face difficulties in their work situations, but some hospitals are perceived as healthy organizations. The concept of attractive institutions could
Xiang, Wei; Yin, Jiao; Lim, Gino
Operating room (OR) surgery scheduling determines the individual surgery's operation start time and assigns the required resources to each surgery over a schedule period, considering several constraints related to a complete surgery flow and the multiple resources involved. This task plays a decisive role in providing timely treatments for the patients while balancing hospital resource utilization. The originality of the present study is to integrate the surgery scheduling problem with real-life nurse roster constraints such as their role, specialty, qualification and availability. This article proposes a mathematical model and an ant colony optimization (ACO) approach to efficiently solve such surgery scheduling problems. A modified ACO algorithm with a two-level ant graph model is developed to solve such combinatorial optimization problems because of its computational complexity. The outer ant graph represents surgeries, while the inner graph is a dynamic resource graph. Three types of pheromones, i.e. sequence-related, surgery-related, and resource-related pheromone, fitting for a two-level model are defined. The iteration-best and feasible update strategy and local pheromone update rules are adopted to emphasize the information related to the good solution in makespan, and the balanced utilization of resources as well. The performance of the proposed ACO algorithm is then evaluated using the test cases from (1) the published literature data with complete nurse roster constraints, and 2) the real data collected from a hospital in China. The scheduling results using the proposed ACO approach are compared with the test case from both the literature and the real life hospital scheduling. Comparison results with the literature shows that the proposed ACO approach has (1) an 1.5-h reduction in end time; (2) a reduction in variation of resources' working time, i.e. 25% for ORs, 50% for nurses in shift 1 and 86% for nurses in shift 2; (3) an 0.25h reduction in
Full Text Available The task scheduling strategy based on cultural genetic algorithm(CGA is proposed in order to improve the efficiency of task scheduling in the cloud computing platform, which targets at minimizing the total time and cost of task scheduling. The improved genetic algorithm is used to construct the main population space and knowledge space under cultural framework which get independent parallel evolution, forming a mechanism of mutual promotion to dispatch the cloud task. Simultaneously, in order to prevent the defects of the genetic algorithm which is easy to fall into local optimum, the non-uniform mutation operator is introduced to improve the search performance of the algorithm. The experimental results show that CGA reduces the total time and lowers the cost of the scheduling, which is an effective algorithm for the cloud task scheduling.
Samiha Abou El-Fetouh Hamed Ouda
Full Text Available The developed model is MS excel sheet called “Irrigation Scheduling Calculator, ISC”. The model requires to input daily weather data to calculate daily evapotranspiration using Penman-Monteith equation. The model calculates water depletion from the root zone to determine when to irrigate and how much water should be applied. The charge from irrigation pump is used to calculate how many hours should the farmer run the pump to deliver the needed amount of water. ISC model was used to developed irrigation schedule for wheat and maize planted in El-Gharbia governorate. The developed schedules were compared to the actual schedules for both crops. Furthermore, CropSyst model was calibrated for both crops and run using the developed schedules by ISC model. The simulation results indicated that the calculated irrigation amount by ISC model for wheat was lower than actual schedule by 6.0 mm. Furthermore, the simulated wheat productivity by CropSyst was higher than measured grain and biological by 2%. Similarly, the calculated applied irrigation amount by ISC model for maize was lower than actual schedule by 79.0 mm and the productivity was not changed.
The goal of this research is to improve the performance of automated schedulers by designing and implementing an algorithm by automatically generating heuristics by selecting a schedule. The particular application selected by applying this method solves the problem of scheduling telescope observations, and is called the Associate Principal Astronomer. The input to the APA scheduler is a set of observation requests submitted by one or more astronomers. Each observation request specifies an observation program as well as scheduling constraints and preferences associated with the program. The scheduler employs greedy heuristic search to synthesize a schedule that satisfies all hard constraints of the domain and achieves a good score with respect to soft constraints expressed as an objective function established by an astronomer-user.
Tuominen, Outi Anneli; Lundgren-Laine, Heljä; Kauppila, Wiveka; Hupli, Maija; Salanterä, Sanna
Aim This article describes the development and testing of an Excel-based scheduling solution for the flexible allocation and reallocation of nurses to cover sudden, unplanned absences among permanent nursing staff. Method A quasi-experimental, one group, pre- and post-test study design was used ( Box 1 ) with total sampling. Participants (n=17) were selected purposefully by including all ward managers (n=8) and assistant ward managers (n=9) from one university hospital department. The number of sudden absences among the nursing staff was identified during two 4-week data collection periods (pre- and post-test). Results During the use of the paper-based scheduling system, 121 absences were identified; during the use of the Excel-based system, 106 were identified. The main reasons for the use of flexible 'floating' nurses were sick leave (n=66) and workload (n=31). Other reasons (n=29) included patient transfer to another hospital, scheduling errors and the start or end of employment. Conclusion The Excel-based scheduling solution offered better support in obtaining substitute labour inside the organisation, with smaller employment costs. It also reduced the number of tasks ward managers had to carry out during the process of reallocating staff.
Ly, Dan P; Cutler, David M
Hospitals face financial pressure from decreased margins from Medicare and Medicaid and lower reimbursement from consolidating insurers. The objectives of this study are to determine whether hospitals that became more profitable increased revenues or decreased costs more and to examine characteristics associated with improved financial performance over time. The design of this study is retrospective analyses of U.S. non-federal acute care hospitals between 2003 and 2013. There are 2824 hospitals as subjects of this study. The main measures of this study are the change in clinical operating margin, change in revenues per bed, and change in expenses per bed between 2003 and 2013. Hospitals that became more profitable had a larger magnitude of increases in revenue per bed (about $113,000 per year [95% confidence interval: $93,132 to $133,401]) than of decreases in costs per bed (about - $10,000 per year [95% confidence interval: - $28,956 to $9617]), largely driven by higher non-Medicare reimbursement. Hospitals that improved their margins were larger or joined a hospital system. Not-for-profit status was associated with increases in operating margin, while rural status and having a larger share of Medicare patients were associated with decreases in operating margin. There was no association between improved hospital profitability and changes in diagnosis related group weight, in number of profitable services, or in payer mix. Hospitals that became more profitable were more likely to increase their admissions per bed per year. Differential price increases have led to improved margins for some hospitals over time. Where significant price increases are not possible, hospitals will have to become more efficient to maintain profitability.
This research project examined academic scheduling problems at the U.S. Naval Academy. The focus was on devising methods to construct good final exam schedules and improve existing course schedules by facilitation course changes...
Atkins, Dianne L; Berger, Stuart
Out-of-hospital cardiac arrest (OHCA) is an unusual but devastating occurrence in a young person. Years of life-lost are substantial and long-term health care costs of survivors can be high. However, there have been noteworthy improvements in cardiopulmonary resuscitation (CPR) standards, out-of hospital care, and postcardiac arrest therapies that have resulted in a several-fold improvement in resuscitation outcomes. Recent interest and research in resuscitation of children has the promise of generating improvements in the outcomes of these patients. Integrated and coordinated care in the out-of-hospital and hospital settings are required. This article will review the epidemiology of OHCA, the 2010 CPR guidelines, and developments in public access defibrillation for children.
Mackrill, J B; Jennings, P A; Cain, R
Work on the perception of urban soundscapes has generated a number of perceptual models which are proposed as tools to test and evaluate soundscape interventions. However, despite the excessive sound levels and noise within hospital environments, perceptual models have not been developed for these spaces. To address this, a two-stage approach was developed by the authors to create such a model. First, semantics were obtained from listening evaluations which captured the feelings of individuals from hearing hospital sounds. Then, 30 participants rated a range of sound clips representative of a ward soundscape based on these semantics. Principal component analysis extracted a two-dimensional space representing an emotional-cognitive response. The framework enables soundscape interventions to be tested which may improve the perception of these hospital environments.
Sun, Haisheng; Xu, Rui; Chen, Huaping
To minimize makespan for scheduling independent tasks in cloud computing, an improved estimation of distribution algorithm (IEDA) is proposed to tackle the investigated problem in this paper. Considering that the problem is concerned with multi-dimensional discrete problems, an improved population-based incremental learning (PBIL) algorithm is applied, which the parameter for each component is independent with other components in PBIL. In order to improve the performance of PBIL, on the one hand, the integer encoding scheme is used and the method of probability calculation of PBIL is improved by using the task average processing time; on the other hand, an effective adaptive learning rate function that related to the number of iterations is constructed to trade off the exploration and exploitation of IEDA. In addition, both enhanced Max-Min and Min-Min algorithms are properly introduced to form two initial individuals. In the proposed IEDA, an improved genetic algorithm (IGA) is applied to generate partial initial population by evolving two initial individuals and the rest of initial individuals are generated at random. Finally, the sampling process is divided into two parts including sampling by probabilistic model and IGA respectively. The experiment results show that the proposed IEDA not only gets better solution, but also has faster convergence speed.
Zeng Zhenglin; Wang Wenying; Peng Fei
This paper introduces the planning construction of integrative schedule management for Nuclear Power Project. It details schedule management system and the requirement of schedulers and the mode of three schedule management flats. And analysis it combing with the implementation of construction water and all special schedules before FCD to further propose the improving and researching direction for the integrative schedule management. (authors)
Full Text Available Nurse scheduling is a type of manpower allocation problem that tries to satisfy hospital managers objectives and nurses preferences as much as possible by generating fair shift schedules. This paper presents a nurse scheduling problem based on a real case study, and proposes two meta-heuristics a differential evolution algorithm (DE and a greedy randomised adaptive search procedure (GRASP to solve it. To investigate the efficiency of the proposed algorithms, two problems are solved. Furthermore, some comparison metrics are applied to examine the reliability of the proposed algorithms. The computational results in this paper show that the proposed DE outperforms the GRASP.
Singer, Sara J; Rosen, Amy; Zhao, Shibei; Ciavarelli, Anthony P; Gaba, David M
Evidence of variation in safety climate suggests the need for improvement among at least some hospitals. However, comparisons only among hospitals may underestimate the improvement required. Comparison of hospitals with analogous industries may provide a broader perspective on the safety status of our nation's hospitals. The purpose of this study was to compare safety climate among hospital workers with personnel from naval aviation, an organization that operates with high reliability despite intrinsically hazardous conditions. We surveyed a random sample of health care workers in 67 U.S. hospitals and, for generalizability, 30 veterans affairs hospitals using questions comparable with those posed at approximately the same time (2007) to a census of personnel from 35 squadrons of U.S. naval aviators. We received 13,841 (41%) completed surveys in U.S. hospitals, 5,511 (50%) in veterans affairs hospitals, and 14,854 (82%) among naval aviators. We examined differences in respondents' perceptions of safety climate at their institution overall and for 16 individual items. Safety climate was three times better on average among naval aviators than among hospital personnel. Naval aviators perceived a safer climate (up to seven times safer) than hospital personnel with respect to each of the 16 survey items. Compared with hospital managers, naval commanders perceived climate more like frontline personnel did. When contrasting naval aviators with hospital personnel working in comparably hazardous areas, safety climate discrepancies increased rather than decreased. One individual hospital performed as well as naval aviation on average, and at least one hospital outperformed the Navy benchmark for all but three individual survey items. Results suggest that hospitals have not sufficiently created a uniform priority of safety. However, if each hospital performed as well as the top-performing hospital in each area measured, hospitals could achieve safety climate levels comparable
St Germain, Shawn Walter [Idaho National Lab. (INL), Idaho Falls, ID (United States); Farris, Ronald Keith [Idaho National Lab. (INL), Idaho Falls, ID (United States); Thomas, Kenneth David [Idaho National Lab. (INL), Idaho Falls, ID (United States)
; Provide real-time requirements monitoring; Maximize their collective situational awareness to improve decision-making; and Leverage macro data to better support resource allocation. INL has partnered with several commercial NPP utilities to develop a number of advanced outage management technologies. These outage management technologies have focused on both collaborative technologies for control centers and developing mobile technologies for NPP field workers. This report describes recent efforts made in developing a suite of outage technologies to support more effective schedule management. Currently, a master outage schedule is created months in advance using the plant’s existing scheduling software (e.g., Primavera P6). Typically, during the outage, the latest version of the schedule is printed at the beginning of each shift. INL and its partners are developing technologies that will have capabilities such as Automatic Schedule Updating, Automatic Pending Support Notifications, and the ability to allocate and schedule outage support task resources on a sub-hour basis (e.g., outage Micro-Scheduling). The remaining sections of this report describe in more detail the scheduling challenges that occur during outages, how the outage scheduling technologies INL is developing helps address those challenges, and the latest developments on this task (e.g., work accomplished to date and the path forward)
St Germain, Shawn Walter; Farris, Ronald Keith; Thomas, Kenneth David
; Provide real-time requirements monitoring; Maximize their collective situational awareness to improve decision-making; and Leverage macro data to better support resource allocation. INL has partnered with several commercial NPP utilities to develop a number of advanced outage management technologies. These outage management technologies have focused on both collaborative technologies for control centers and developing mobile technologies for NPP field workers. This report describes recent efforts made in developing a suite of outage technologies to support more effective schedule management. Currently, a master outage schedule is created months in advance using the plant's existing scheduling software (e.g., Primavera P6). Typically, during the outage, the latest version of the schedule is printed at the beginning of each shift. INL and its partners are developing technologies that will have capabilities such as Automatic Schedule Updating, Automatic Pending Support Notifications, and the ability to allocate and schedule outage support task resources on a sub-hour basis (e.g., outage Micro-Scheduling). The remaining sections of this report describe in more detail the scheduling challenges that occur during outages, how the outage scheduling technologies INL is developing helps address those challenges, and the latest developments on this task (e.g., work accomplished to date and the path forward)
Gold, D. R.; Rogacz, S.; Bock, N.; Tosteson, T. D.; Baum, T. M.; Speizer, F. E.; Czeisler, C. A.
A hospital-based survey on shift work, sleep, and accidents was carried out among 635 Massachusetts nurses. In comparison to nurses who worked only day/evening shifts, rotators had more sleep/wake cycle disruption and nodded off more at work. Rotators had twice the odds of nodding off while driving to or from work and twice the odds of a reported accident or error related to sleepiness. Application of circadian principles to the design of hospital work schedules may result in improved health and safety for nurses and patients.
Lukasz Maciej Mazur
Full Text Available The failures to properly educate students about process improvement can be seen as major factor leading to increased risks of patient safety and increased wastes in hospital settings. The purpose of this research was two-fold: 1 to identify characteristics that explain the efficacy of Plan-Do-Study-Act (PDSA based-tools while used by Industrial Engineering (IE students on multidisciplinary teams in hospital; 2 to identify competencies needed by IEs for effective process improvement in hospital using PDSA based-tools. Exploratory mixed method design approach with survey study, unstructured interviews, and focus group discussions was used to collect the data. A regression analysis was used to identify PDSA based-tool characteristics perceived by IE students as instrumental for process improvement. Next, the abductive inference was applied to analyze qualitative data in order to investigate competencies needed for effective process improvement using PDSA based-tools.Using regression analysis, we found the brainstorming via visualization, recognizing root-cause(s of the problem and selecting improvement measures via linking the process flow with task(s characteristics to be the significant characteristics. From qualitative data analysis, we learned that IE students strived in technical analysis but lacked competencies in analyzing qualitative data needed for change implementation efforts. There is increasing evidence that success in achieving process improvement goals is at least partially attributable to implementation processes and contexts and not just to the nature of the technical solution. Therefore, IE students interested in working in hospitals must develop new competencies related to qualitative data analysis to manage change initiatives.
Full Text Available In order to improve the performance of a real-time system, asymmetric multiprocessors have been proposed. The benefits of improved system performance and reduced power consumption from such architectures cannot be fully exploited unless suitable task scheduling and task allocation approaches are implemented at the operating system level. Unfortunately, most of the previous research on scheduling algorithms for performance asymmetric multiprocessors is focused on task priority assignment. They simply assign the highest priority task to the fastest processor. In this paper, we propose BSF-EDF (best speed fit for earliest deadline first for performance asymmetric multiprocessor scheduling. This approach chooses a suitable processor rather than the fastest one, when allocating tasks. With this proposed BSF-EDF scheduling, we also derive an effective schedulability test.
Habib-Agahi, Hamid; Mrozinski, Joe; Fox, George
NASA's Office of Independent Program and Cost Evaluation (IPCE) has established a number of initiatives to improve its cost and schedule estimating capabilities. 12One of these initiatives has resulted in the JPL developed NASA Instrument Cost Model. NICM is a cost and schedule estimator that contains: A system level cost estimation tool; a subsystem level cost estimation tool; a database of cost and technical parameters of over 140 previously flown remote sensing and in-situ instruments; a schedule estimator; a set of rules to estimate cost and schedule by life cycle phases (B/C/D); and a novel tool for developing joint probability distributions for cost and schedule risk (Joint Confidence Level (JCL)). This paper describes the development and use of NICM, including the data normalization processes, data mining methods (cluster analysis, principal components analysis, regression analysis and bootstrap cross validation), the estimating equations themselves and a demonstration of the NICM tool suite.
LariSemnani, Behrouz; Mohebbi Far, Rafat; Shalipoor, Elham; Mohseni, Mohammad
TRIZ is an initiative and SERVQUAL is a structured methodology for quality improvement. Using these tools, inventive problem solving can be applied for quality improvement, and the highest quality can be reached using creative quality improvement methodology. The present study seeks to determine the priority of quality aspects of services provided for patients in the hospital as well as how TRIZ can help in improving the quality of those services. This Study is an applied research which used a dynamic qualitative descriptive survey method during year 2011. Statistical population includes every patient who visited in one of the University Hospitals from March 2011. There existed a big gap between patients' expectations from what seemingly is seen (the design of the hospital) and timely provision of services with their perceptions. Also, quality aspects of services were prioritized as follows: keeping the appearance of hospital (the design), accountability, assurance, credibility and having empathy. Thus, the only thing which mattered most for all staff and managers of studied hospital was the appearance of hospital as well as its staff look. This can grasp a high percentage of patients' satisfaction. By referring to contradiction matrix, the most important principles of TRIZ model were related to tangible factors including principles No. 13 (discarding and recovering), 25 (self-service), 35 (parameter changes), and 2 (taking out). Furthermore, in addition to these four principles, principle No. 24 (intermediary) was repeated most among the others. By utilizing TRIZ, hospital problems can be examined with a more open view, Go beyond The conceptual framework of the organization and responded more quickly to patients ' needs.
The purpose of schedule management is to provide the framework for time-phasing, resource planning, coordination, and communicating the necessary tasks within a work effort. The intent is to improve schedule management by providing recommended concepts, processes, and techniques used within the Agency and private industry. The intended function of this handbook is two-fold: first, to provide guidance for meeting the scheduling requirements contained in NPR 7120.5, NASA Space Flight Program and Project Management Requirements, NPR 7120.7, NASA Information Technology and Institutional Infrastructure Program and Project Requirements, NPR 7120.8, NASA Research and Technology Program and Project Management Requirements, and NPD 1000.5, Policy for NASA Acquisition. The second function is to describe the schedule management approach and the recommended best practices for carrying out this project control function. With regards to the above project management requirements documents, it should be noted that those space flight projects previously established and approved under the guidance of prior versions of NPR 7120.5 will continue to comply with those requirements until project completion has been achieved. This handbook will be updated as needed, to enhance efficient and effective schedule management across the Agency. It is acknowledged that most, if not all, external organizations participating in NASA programs/projects will have their own internal schedule management documents. Issues that arise from conflicting schedule guidance will be resolved on a case by case basis as contracts and partnering relationships are established. It is also acknowledged and understood that all projects are not the same and may require different levels of schedule visibility, scrutiny and control. Project type, value, and complexity are factors that typically dictate which schedule management practices should be employed.
Sulo, Suela; Feldstein, Josh; Partridge, Jamie; Schwander, Bjoern; Sriram, Krishnan; Summerfelt, Wm Thomas
Nutrition interventions can alleviate the burden of malnutrition by improving patient outcomes; however, evidence on the economic impact of medical nutrition intervention remains limited. A previously published nutrition-focused quality improvement program targeting malnourished hospitalized patients showed that screening patients with a validated screening tool at admission, rapidly administering oral nutritional supplements, and educating patients on supplement adherence result in significant reductions in 30-day unplanned readmissions and hospital length of stay. To assess the potential cost-savings associated with decreased 30-day readmissions and hospital length of stay in malnourished inpatients through a nutrition-focused quality improvement program using a web-based budget impact model, and to demonstrate the clinical and fiscal value of the intervention. The reduction in readmission rate and length of stay for 1269 patients enrolled in the quality improvement program (between October 13, 2014, and April 2, 2015) were compared with the pre-quality improvement program baseline and validation cohorts (4611 patients vs 1319 patients, respectively) to calculate potential cost-savings as well as to inform the design of the budget impact model. Readmission rate and length-of-stay reductions were calculated by determining the change from baseline to post-quality improvement program as well as the difference between the validation cohort and the post-quality improvement program, respectively. As a result of improved health outcomes for the treated patients, the nutrition-focused quality improvement program led to a reduction in 30-day hospital readmissions and length of stay. The avoided hospital readmissions and reduced number of days in the hospital for the patients in the quality improvement program resulted in cost-savings of $1,902,933 versus the pre-quality improvement program baseline cohort, and $4,896,758 versus the pre-quality improvement program in the
Full Text Available Efficient scheduling for the supporting operations of aircrafts in flight deck is critical to the aircraft carrier, and even several seconds’ improvement may lead to totally converse outcome of a battle. In the paper, we ameliorate the supporting operations of carrier-based aircrafts and investigate three simultaneous operation relationships during the supporting process, including precedence constraints, parallel operations, and sequence flexibility. Furthermore, multifunctional aircrafts have to take off synergistically and participate in a combat cooperatively. However, their takeoff order must be restrictively prioritized during the scheduling period accorded by certain operational regulations. To efficiently prioritize the takeoff order while minimizing the total time budget on the whole takeoff duration, we propose a novel mixed integer liner programming formulation (MILP for the flight deck scheduling problem. Motivated by the hardness of MILP, we design an improved differential evolution algorithm combined with typical local search strategies to improve computational efficiency. We numerically compare the performance of our algorithm with the classical genetic algorithm and normal differential evolution algorithm and the results show that our algorithm obtains better scheduling schemes that can meet both the operational relations and the takeoff priority requirements.
Heitmann, Rachel; Nilles, Ester K; Jeans, Ashley; Moreland, Jackie; Clarke, Chris; McDonald, Morgan F; Warren, Michael D
Introduction Sleep-related infant deaths are major contributors to Tennessee's high infant mortality rate. The purpose of this initiative was to evaluate the impact of policy-based efforts to improve modeling of safe sleep practices by health care providers in hospital settings across Tennessee. Methods Safe sleep policies were developed and implemented at 71 hospitals in Tennessee. Policies, at minimum, were required to address staff training on the American Academy of Pediatrics' safe sleep recommendations, correct modeling of infant safe sleep practices, and parent education. Hospital data on process measures related to training and results of crib audits were compiled for analysis. Results The overall observance of infants who were found with any risk factors for unsafe sleep decreased 45.6% (p ≤ 0.001) from the first crib audit to the last crib audit. Significant decreases were noted for specific risk factors, including infants found asleep not on their back, with a toy or object in the crib, and not sleeping in a crib. Significant improvements were observed at hospitals where printed materials or video were utilized for training staff compared to face-to-face training. Discussion Statewide implementation of the hospital policy intervention resulted in significant reductions in infants found in unsafe sleep situations. The most common risk factors for sleep-related infant deaths can be modeled in hospitals. This effort has the potential to reduce sleep-related infant deaths and ultimately infant mortality.
Michael J. Pelosi
Full Text Available Development teams and programmers must retain critical information about their work during work intervals and gaps in order to improve future performance when work resumes. Despite time lapses, project managers want to maximize coding efficiency and effectiveness. By developing a mathematically justified, practically useful, and computationally tractable quantitative and cognitive model of learning and memory retention, this study establishes calculations designed to maximize scheduling payoff and optimize developer efficiency and effectiveness.
Pryce, Joanna; Albertsen, Karen; Nielsen, Karina
To evaluate the impact of an open-rota scheduling system on the health, work-life balance and job satisfaction of nurses working in a psychiatric ward in Denmark. The effects of shift rotation and scheduling are well known; however, little is known about the wider benefits of open-rota systems. Method A structured questionnaire was distributed to control and intervention groups preintervention and postintervention (20 months). Nurses within the intervention group trialed an open-rota system in which nurses designed their own work-rest schedules. Nurses in the intervention group reported that they were more satisfied with their work hours, less likely to swap their shift when working within the open-rota system and reported significant increases in work-life balance, job satisfaction, social support and community spirit when compared with nurses in the control groups. The ownership and choice over work-rest schedules has benefits for nurses, and potentially the hospital.
Lokhandwala, Parvez M; Shike, Hiroko; Wang, Ming; Domen, Ronald E; George, Melissa R
Typical approach for increasing apheresis platelet collections is to recruit new donors. Here, we investigated the effectiveness of an alternative strategy: optimizing donor scheduling, prior to recruitment, at a hospital-based blood donor center. Analysis of collections, during the 89 consecutive months since opening of donor center, was performed. Linear regression and segmented time-series analyses were performed to calculate growth rates of collections and to test for statistical differences, respectively. Pre-intervention donor scheduling capacity was 39/month. In the absence of active donor recruitment, during the first 29 months, the number of collections rose gradually to 24/month (growth-rate of 0.70/month). However, between month-30 and -55, collections exhibited a plateau at 25.6 ± 3.0 (growth-rate of -0.09/month) (pcollection days/week (month-72). Consequently, the scheduling capacity increased to 130/month. Post-interventions, apheresis platelet collections between month-56 and -81 exhibited a spontaneous renewed growth at a rate of 0.62/month (pcollections. Apheresis platelet collections plateau at nearly 2/3rd of the scheduling capacity. Optimizing the scheduling capacity prior to active donor recruitment is an effective strategy to increase platelet collections at a hospital-based donor center.
Ferreira, Rodrigo B; Coelli, Fernando C; Pereira, Wagner C A; Almeida, Renan M V R
This study used the discrete-events computer simulation methodology to model a large hospital surgical centre (SC), in order to analyse the impact of increases in the number of post-anaesthetic beds (PABs), of changes in surgical room scheduling strategies and of increases in surgery numbers. The used inputs were: number of surgeries per day, type of surgical room scheduling, anaesthesia and surgery duration, surgical teams' specialty and number of PABs, and the main outputs were: number of surgeries per day, surgical rooms' use rate and blocking rate, surgical teams' use rate, patients' blocking rate, surgery delays (minutes) and the occurrence of postponed surgeries. Two basic strategies were implemented: in the first strategy, the number of PABs was increased under two assumptions: (a) following the scheduling plan actually used by the hospital (the 'rigid' scheduling - surgical rooms were previously assigned and assignments could not be changed) and (b) following a 'flexible' scheduling (surgical rooms, when available, could be freely used by any surgical team). In the second, the same analysis was performed, increasing the number of patients (up to the system 'feasible maximum') but fixing the number of PABs, in order to evaluate the impact of the number of patients over surgery delays. It was observed that the introduction of a flexible scheduling/increase in PABs would lead to a significant improvement in the SC productivity.
Jones, S B
The philosophy of W.E. Deming suggests that continuous quality improvement efforts, when properly applied, ultimately will lead to financial dividends and will help ensure business longevity. Reducing hospital charges can be exciting for the participants and can provide an impetus for expanding quality improvement efforts. Americans, however, tend to demand almost instant gratification and have limited patience for longer-term results. This factor, coupled with minimal knowledge of actual operational costs and inaccurate charge accounting systems, may lead hospital managers to misinterpret the potential net long-term effects of their quality improvement efforts. In the approaching environment of capitated reimbursement, such mistakes may have serious consequences.
Full Text Available Increased healthcare costs are pushing hospitals to reduce costs and increase the quality of care. Operating rooms are the most important source of income and expense for hospitals. Therefore, the hospital management focuses on the effectiveness of schedules and plans. This study includes analyses of recent research on operating room scheduling and planning. Most studies in the literature, from 2000 to the present day, were evaluated according to patient characteristics, performance measures, solution techniques used in the research, the uncertainty of the problem, applicability of the research, and the planning strategy to be dealt within the solution. One hundred seventy studies were examined in detail, after scanning the Emerald, Science Direct, JSTOR, Springer, Taylor and Francis, and Google Scholar databases. To facilitate the identification of these studies, they are grouped according to the different criteria of concern and then, a detailed overview is presented.
Lee, Kathryn A; Gay, Caryl L
To evaluate feasibility and efficacy of a hospital-based protocol for improving sleep in high- risk antepartum patients. Sleep measures were compared during 1 week of hospitalization before and after implementing a Sleep Improvement Protocol for Antepartum Patients (SIP-AP). A non-randomized convenience sample of usual care controls was compared to a subsequent intervention sample after the protocol was implemented. Women were eligible if they spoke English, were medically stable, pregnant for at least 20 weeks, and hospitalized at least 24 hours; 25 pregnant women had sufficient data for analyses (11 controls, 14 intervention). Sleep was assessed in 3 ways: the Pittsburgh Sleep Quality Index was completed after obtaining consent to estimate sleep quality prior to hospital admission; sleep diary completed each hospital day; and General Sleep Disturbance Scale completed at 7 days or prior to hospital discharge. Symptoms that could affect sleep were assessed with the Memorial Symptom Assessment Scale. Both groups recorded similar sleep duration (7 hours) but the intervention group had fewer symptoms and significantly ( P = .015) lower sleep disturbance scores (53.1 ± 14.5) than controls (71.9 ± 18.8). Participant feedback about the intervention was positive, although adherence to components of the intervention protocol was variable. This pilot study provides evidence of the feasibility and preliminary efficacy of the SIP-AP intervention for reducing symptoms and improving sleep of antepartum patients during hospitalization. Further detailed evaluation of specific components of this protocol is warranted, and other types of hospitalized patients may benefit from unit-based modifications to this SIP-AP protocol. © 2017 American Academy of Sleep Medicine
Liu, Tongzhu; Shen, Aizong; Hu, Xiaojian; Tong, Guixian; Gu, Wei
We aimed to apply collaborative business intelligence (BI) system to hospital supply, processing and distribution (SPD) logistics management model. We searched Engineering Village database, China National Knowledge Infrastructure (CNKI) and Google for articles (Published from 2011 to 2016), books, Web pages, etc., to understand SPD and BI related theories and recent research status. For the application of collaborative BI technology in the hospital SPD logistics management model, we realized this by leveraging data mining techniques to discover knowledge from complex data and collaborative techniques to improve the theories of business process. For the application of BI system, we: (i) proposed a layered structure of collaborative BI system for intelligent management in hospital logistics; (ii) built data warehouse for the collaborative BI system; (iii) improved data mining techniques such as supporting vector machines (SVM) and swarm intelligence firefly algorithm to solve key problems in hospital logistics collaborative BI system; (iv) researched the collaborative techniques oriented to data and business process optimization to improve the business processes of hospital logistics management. Proper combination of SPD model and BI system will improve the management of logistics in the hospitals. The successful implementation of the study requires: (i) to innovate and improve the traditional SPD model and make appropriate implement plans and schedules for the application of BI system according to the actual situations of hospitals; (ii) the collaborative participation of internal departments in hospital including the department of information, logistics, nursing, medical and financial; (iii) timely response of external suppliers.
Sitepu, Suryati; Mawengkang, Herman; Husein, Ismail
Hospital is a very important institution to provide health care for people. It is not surprising that nowadays the people’s demands for hospital is increasing.. However, due to the rising cost of healthcare services, hospitals need to consider efficiencies in order to overcome these two problems. This paper deals with an integrated strategy of staff capacity management and bed allocation planning to tackle these problems. Mathematically, the strategy can be modeled as an integer linear programming problem. We solve the model using a direct neighborhood search approach, based on the notion of superbasic variables.
Aguilar-Escobar, V G; Garrido-Vega, P; Godino-Gallego, N
Supply management is an area where hospitals have significant opportunities for improvement. The main objective of this paper has been to analyze how the application of Lean principles can improve logistics costs and user satisfaction. In connection with satisfaction, it also aimed to examine which aspects of the service define it and check for differences between different groups of users. The results of an experience to reorganize the hospital logistic system based on some Lean principles have been studied. This is therefore a case study, which combine different methods of data collection. The logistics cost calculation was carried out using the full costing method. To measure satisfaction of healthcare personnel, the internal logistics service users, an anonymous survey was conducted. Processing of the data obtained from the survey have included exploratory analysis, factor analysis and ANOVAs. The data have showed an improvement in logistics management after the implementation of Lean principles. Logistics costs were reduced and the satisfaction level of the internal users with the new logistics system was increased. Some differences in the degree of satisfaction by different groups of users were also detected, although they did not seem to distinguish between different aspects of logistic service. The analyzed experience shows the applicability and suitability of Lean principles to improve logistics operational costs and increase user satisfaction. Copyright © 2012 SECA. Published by Elsevier Espana. All rights reserved.
Background: When it was found by the Brits Hospital Pharmacy and Therapeutics Committee (PTC) in 2000 that simvastatin was responsible for extremely high costs in a district hospital, it was decided to undertake a quality improvement study to assess and, if appropriate, rectify the situation. Methods: A Quality ...
Weiland, D E
Marketing the results of continuous quality improvement in hospitals builds a growing bank of loyal customers in an increasingly competitive and quality-oriented environment: If healthcare institutions want to survive and flourish, they must develop a lasting relationship with their customers. The long-term goal of CQI is to provide quality products and services. If marketing managers can sell these improved services, hospitals will build a solid client foundation.
Young, John Q; Wachter, Robert M
Health care organizations have increasingly embraced industrial methods, such as the Toyota Production System (TPS), to improve quality, safety, timeliness, and efficiency. However, the use of such methods in psychiatric hospitals has been limited. A psychiatric hospital applied TPS principles to patient transfers to the outpatient medication management clinics (MMCs) from all other inpatient and outpatient services within the hospital's system. Sources of error and delay were identified, and a new process was designed to improve timely access (measured by elapsed time from request for transfer to scheduling of an appointment and to the actual visit) and patient safety by decreasing communication errors (measured by number of failed transfers). Complexity was substantially reduced, with one streamlined pathway replacing five distinct and more complicated pathways. To assess sustainability, the postintervention period was divided into Period 1 (first 12 months) and Period 2 (next 24 months). Time required to process the transfer and schedule the first appointment was reduced by 74.1% in Period 1 (p < .001) and by an additional 52.7% in Period 2 (p < .0001) for an overall reduction of 87% (p < .0001). Similarly, time to the actual appointment was reduced 31.2% in Period 1 (p < .0001), but was stable in Period 2 (p = .48). The number of transfers per month successfully processed and scheduled increased 95% in the postintervention period compared with the pre-implementation period (p = .015). Finally, data for failed transfers were only available for the postintervention period, and the rate decreased 89% in Period 2 compared with Period 1 (p = .017). The application of TPS principles enhanced access and safety through marked and sustained improvements in the transfer process's timeliness and reliability. Almost all transfer processes have now been standardized.
Collum, Taleah H; Menachemi, Nir; Sen, Bisakha
The aim of this study was to examine the impact of electronic health record (EHR) adoption on hospital financial performance. We constructed a longitudinal panel using data from the three secondary sources: (a) the 2007-2010 American Hospital Association (AHA) Annual Survey, (b) the 2007-2010 AHA Annual Survey Information Technology Supplement, and (c) the 2007-2011 Medicare Cost Reports from Centers for Medicare and Medicaid Services. Because potential financial benefits attributable to EHR adoption may take some time to accrue, we ran regressions with lags of 1 and 2 years that included hospital and year fixed effects to examine the relationship between the level of EHR adoption and three hospital financial performance measures. A change in the level of EHR adoption was not associated with changes in operating margin or return on assets within hospitals. However, total margin was significantly improved, after 2 years, in hospitals that moved from no EHR to having a comprehensive EHR in all areas of their hospital (β = 0.030, p financial performance measures examined. The improvements in total margin, as opposed to operating margin, are likely due to hospital incentive payments under the Health Information Technology for Economic and Clinical Health Act that are reflected in nonpatient revenues and therefore show up in total margin calculations. Thus, after 2 years of EHR adoption, hospital financial performance is observed to improve based only on meaningful use incentive payments. More research will be needed to determine whether EHR adoption impacts financial performance on a longer time horizon.
Liu, Mingshan; Liu, Shanshan; Zhou, Yuan; Jiang, Xue
The conventional message-passing schedule for LDPC decoding algorithms is the so-called flooding schedule. It has the disadvantage that the updated messages cannot be used until next iteration, thus reducing the convergence speed . In this case, the Layered Decoding algorithm (LBP) based on serial message-passing schedule is proposed. In this paper the decoding principle of LBP algorithm is briefly introduced, and then proposed its two improved algorithms, the grouped serial decoding algorithm (Grouped LBP) and the semi-serial decoding algorithm .They can improve LBP algorithm's decoding speed while maintaining a good decoding performance.
Supic, Zorica Terzic; Bjegovic, Vesna; Marinkovic, Jelena; Milicevic, Milena Santric; Vasic, Vladimir
The purpose of this study was to analyze the improvement of managerial skills of hospitals' top managers after a specific management training programme, and to explore possible predictors and relations. The study was conducted during the years 2006 and 2007 with cohort of 107 managers from 20 Serbian general hospitals. The managers self-assessed the improvement in their managerial skills before and after the training programme. After the training programme, all managers' skills had improved. The biggest improvement was in the following skills: organizing daily activities, motivating and guiding others, supervising the work of others, group discussion, and situation analysis. The least improved were: applying creative techniques, working well with peers, professional self-development, written communication, and operational planning. Identified predictors of improvement were: shorter years of managerial experience, type of manager, type of profession, and recognizing the importance of the managerial skills in oral communication, evidence-based decision making, and supervising the work of others. Specific training programme related to strategic management can increase managerial competencies, which are an important source of competitive advantage for organizations. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.
Buttigieg, Sandra C; Gauci, Dorothy; Dey, Prasanta
Purpose The purpose of this paper is to present the application of logical framework analysis (LFA) for implementing continuous quality improvement (CQI) across multiple settings in a tertiary care hospital. Design/methodology/approach This study adopts a multiple case study approach. LFA is implemented within three diverse settings, namely, intensive care unit, surgical ward, and acute in-patient psychiatric ward. First, problem trees are developed in order to determine the root causes of quality issues, specific to the three settings. Second, objective trees are formed suggesting solutions to the quality issues. Third, project plan template using logical framework (LOGFRAME) is created for each setting. Findings This study shows substantial improvement in quality across the three settings. LFA proved to be effective to analyse quality issues and suggest improvement measures objectively. Research limitations/implications This paper applies LFA in specific, albeit, diverse settings in one hospital. For validation purposes, it would be ideal to analyse in other settings within the same hospital, as well as in several hospitals. It also adopts a bottom-up approach when this can be triangulated with other sources of data. Practical implications LFA enables top management to obtain an integrated view of performance. It also provides a basis for further quantitative research on quality management through the identification of key performance indicators and facilitates the development of a business case for improvement. Originality/value LFA is a novel approach for the implementation of CQI programs. Although LFA has been used extensively for project development to source funds from development banks, its application in quality improvement within healthcare projects is scant.
Zingmond, David S; Parikh, Punam; Louie, Rachel; Lichtensztajn, Daphne Y; Ponce, Ninez; Hasnain-Wynia, Romana; Gomez, Scarlett Lin
To investigate new metrics to improve the reporting of patient race and ethnicity (R/E) by hospitals. California Patient Discharge Database (PDD) and birth registry, 2008-2009, Healthcare and Cost Utilization Project's State Inpatient Database, 2008-2011, cancer registry 2000-2008, and 2010 US Census Summary File 2. We examined agreement between hospital reported R/E versus self-report among mothers delivering babies and a cancer cohort in California. Metrics were created to measure root mean squared differences (RMSD) by hospital between reported R/E distribution and R/E estimates using R/E distribution within each patient's zip code of residence. RMSD comparisons were made to corresponding "gold standard" facility-level measures within the maternal cohort for California and six comparison states. Maternal birth hospitalization (linked to the state birth registry) and cancer cohort records linked to preceding and subsequent hospitalizations. Hospital discharges were linked to the corresponding Census zip code tabulation area using patient zip code. Overall agreement between the PDD and the gold standard for the maternal cohort was 86 percent for the combined R/E measure and 71 percent for race alone. The RMSD measure is modestly correlated with the summary level gold standard measure for R/E (r = 0.44). The RMSD metric revealed general improvement in data agreement and completeness across states. "Other" and "unknown" categories were inconsistently applied within inpatient databases. Comparison between reported R/E and R/E estimates using zip code level data may be a reasonable first approach to evaluate and track hospital R/E reporting. Further work should focus on using more granular geocoded data for estimates and tracking data to improve hospital collection of R/E data. © Health Research and Educational Trust.
Full Text Available BACKGROUND: The demand for high quality hospital care for children in low resource countries is not being met. This paper describes a number of strategies to improve emergency care at a children's hospital and evaluates the impact of these on inpatient mortality. In addition, the cost-effectiveness of improving emergency care is estimated. METHODS AND FINDINGS: A team of local and international staff developed a plan to improve emergency care for children arriving at The Ola During Children's Hospital, Freetown, Sierra Leone. Following focus group discussions, five priority areas were identified to improve emergency care; staff training, hospital layout, staff allocation, medical equipment, and medical record keeping. A team of international volunteers worked with local staff for six months to design and implement improvements in these five priority areas. The improvements were evaluated collectively rather than individually. Before the intervention, the inpatient mortality rate was 12.4%. After the intervention this improved to 5.9%. The relative risk of dying was 47% (95% CI 0.369-0.607 lower after the intervention. The estimated number of lives saved in the first two months after the intervention was 103. The total cost of the intervention was USD 29 714, the estimated cost per death averted was USD 148. There are two main limitation of the study. Firstly, the brevity of the study and secondly, the assumed homogeneity of the clinical cases that presented to the hospital before and after the intervention. CONCLUSIONS: This study demonstarted a signficant reductuion in inpatient mortality rate after an intervention to improve emergency hospital care If the findings of this paper could be reproduced in a larger more rigorous study, improving the quality of care in hospitals would be a very cost effective strategy to save children's lives in low resource settings.
This article describes how new shift scheduling concepts can save utility operations millions of dollars every year and yet maintain safety and improve employee morale. The key to scheduling is to define and match the work load. This includes discretionary as well as daily, weekly, and yearly core work loads. In most power plants the overall work load (including maintenance, operations, materials handling, etc.) on day shift is greater than on other shifts, hence an unbalanced schedule would be appropriate
Kesteloot, K; Voet, N
Up to now, few analytical models have studied the incentives for cooperation in quality improvements among hospitals. Only those dealing with reimbursement systems have shown that, from the point of view of individual or competing hospitals, retrospective reimbursement is more likely to encourage quality improvements than prospective financing, while the reverse holds for efficiency improvements. This paper studies the incentives to improve the quality of hospital care, in an analytical model, taking into account the possibility of cooperative agreements, price besides non-price (quality) competition and quality improvements that may simultaneously increase demand, increase or reduce costs and spill over to rival hospitals. In this setting quality improvement efforts rise with the rate of prospective reimbursement, while the impact of the rate of retrospective reimbursement is ambiguous, but likely to be negative for quality improvements that are highly cost-reducting and create large spillovers. Cooperation may lead to more or less quality improvement than non-cooperative conduct, depending on the magnitude of spillovers and the degree of product market competition, relative to the net effect of quality on profits and the share of costs that is reimbursed retrospectively. Finally, the stability of cooperative agreements, supported by grim trigger strategies, is shown to depend upon exactly the opposite interaction between these factors.
Full Text Available An increasing number of high performance computing parallel applications leverages the power of the cloud for parallel processing. How to schedule the parallel applications to improve the quality of service is the key to the successful host of parallel applications in the cloud. The large scale of the cloud makes the parallel job scheduling more complicated as even simple parallel job scheduling problem is NP-complete. In this paper, we propose a parallel job scheduling algorithm named MEASY. MEASY adopts migration and consolidation to enhance the most popular EASY scheduling algorithm. Our extensive experiments on well-known workloads show that our algorithm takes very good care of the quality of service. For two common parallel job scheduling objectives, our algorithm produces an up to 41.1% and an average of 23.1% improvement on the average response time; an up to 82.9% and an average of 69.3% improvement on the average slowdown. Our algorithm is robust even in terms that it allows inaccurate CPU usage estimation and high migration cost. Our approach involves trivial modification on EASY and requires no additional technique; it is practical and effective in the cloud environment.
J.M. van Oostrum (Jeroen); E. Bredenhoff (Eelco); E.W. Hans (Erwin)
textabstractAbstract: Operating room (OR) planning and scheduling is a popular and challenging subject within the operational research applied to health services research (ORAHS). However, the impact in practice is very limited. The organization and culture of a hospital and the inherent
TariVerdi, Mersedeh; Miller-Hooks, Elise; Kirsch, Thomas
Mass casualty incidents are a concern in many urban areas. A community's ability to cope with such events depends on the capacities and capabilities of its hospitals for handling a sudden surge in demand of patients with resource-intensive and specialized medical needs. This paper uses a whole-hospital simulation model to replicate medical staff, resources, and space for the purpose of investigating hospital responsiveness to mass casualty incidents. It provides details of probable demand patterns of different mass casualty incident types in terms of patient categories and arrival patterns, and accounts for related transient system behavior over the response period. Using the layout of a typical urban hospital, it investigates a hospital's capacity and capability to handle mass casualty incidents of various sizes with various characteristics, and assesses the effectiveness of designed demand management and capacity-expansion strategies. Average performance improvements gained through capacity-expansion strategies are quantified and best response actions are identified. Capacity-expansion strategies were found to have superadditive benefits when combined. In fact, an acceptable service level could be achieved by implementing only 2 to 3 of the 9 studied enhancement strategies. (Disaster Med Public Health Preparedness. 2018;page 1 of 13).
Full Text Available Managing multiple project is a complex task involving the unrelenting pressures of time and cost. Many studies have proposed various tools and techniques for single-project scheduling; however, the literature further considering multimode or multiproject issues occurring in the real world is rather scarce. In this paper, design structure matrix (DSM and an improved artificial immune network algorithm (aiNet are developed to solve a multi-mode resource-constrained scheduling problem. Firstly, the DSM is used to simplify the mathematic model of multi-project scheduling problem. Subsequently, aiNet algorithm comprised of clonal selection, negative selection, and network suppression is adopted to realize the local searching and global searching, which will assure that it has a powerful searching ability and also avoids the possible combinatorial explosion. Finally, the approach is tested on a set of randomly cases generated from ProGen. The computational results validate the effectiveness of the proposed algorithm comparing with other famous metaheuristic algorithms such as genetic algorithm (GA, simulated annealing algorithm (SA, and ant colony optimization (ACO.
van Lent, Wineke Agnes Marieke; van Lent, W.A.M.
This dissertation contributed to the knowledge on the translation of approaches from businesses and services to improve the resource capacity planning on tactical and operational level in (oncologic) hospital care. The following studies were presented: * Chapter 2 surveyed the business approaches
Alrifai, Mohammad; Balke, Wolf-Tilo; Dolog, Peter
. In this paper, we propose a novel nonblocking scheduling mechanism that is used prior to the actual service invocations. Its aim is to reach an agreement between the client and all participating providers on what transaction processing times have to be expected, accepted, and guaranteed. This enables service......For improved flexibility and concurrent usage existing transaction management models for Web services relax the isolation property of Web service-based transactions. Correctness of the concurrent execution then has to be ensured by commit order-preserving transaction schedulers. However, local...... schedulers of service providers typically do take into account neither time constraints for committing the whole transaction, nor the individual services' constraints when scheduling decisions are made. This often leads to an unnecessary blocking of transactions by (possibly long-running) others...
This integrative review synthesized evidence on the consequences of the Centers for Medicare & Medicaid Services (CMS) nonpayment policy on quality improvement initiatives and hospital-acquired conditions. Fourteen articles were included. This review presents strong evidence that the CMS policy has spurred quality improvement initiatives; however, the relationships between the CMS policy and hospital-acquired conditions are inconclusive. In future research, a comprehensive model of implementation of the CMS nonpayment policy would help us understand the effectiveness of this policy.
Nuijten, W.P.M.; Le Pape, C.
We introduce constraint-based scheduling and discuss its main principles. An approximation algorithm based on tree search is developed for the job shop scheduling problem using ILOG SCHEDULER. A new way of calculating lower bounds on the makespan of the job shop scheduling problem is presented and
Liu Wei; Wang Yongqing; Tian Li
Based on the project management experience abroad and at home, a cost-schedule integration control model was developed to improve nuclear power project management. The model integrates cost data with the scheduling data by unity coding to efficiently implement cost-schedule integration control on line. The software system architecture and database is designed and implemented. The system functions include estimating and forecasting dynamically cash flow, scheduling and evaluating deviation from the cost-schedule plan, etc. The research and development of the system should improve the architecture of computer integrated management information systems for nuclear power projects in China
Chinoy, Evan D.; Harris, Michael P.; Kim, Min Ju; Wang, Wei; Duffy, Jeanne F.
Objectives We tested whether a sleep and circadian-based treatment shown to improve circadian adaptation to night shifts and attenuate negative effects on alertness, performance, and sleep in young adults would also be effective in older adults. Methods We assessed subjective alertness, sustained attention (psychomotor vigilance task, PVT), sleep duration (actigraphy), and circadian timing (salivary dim-light melatonin onset, DLMO) in eighteen older adults (57.2±3.8 y; mean±SD) in a simulated shift work protocol. Four day shifts were followed by three night shifts in the laboratory. Participants slept at home and were randomized to either the Treatment Group (scheduled evening sleep and enhanced lighting during the latter half of night shifts), or Control Group (ad lib sleep and typical lighting during night shifts). Results Compared to day shifts, alertness and sustained attention declined on the first night shift in both groups, and was worse in the latter half of the night shifts. Alertness and attention improved on nights 2 and 3 for the Treatment Group but remained lower for the Control Group. Sleep duration in the Treatment Group remained similar to baseline (6–7 h) following night shifts, but was shorter (3–5 h) following night shifts in the Control Group. Treatment Group circadian timing advanced by 169.3±16.1 min (mean±SEM) but did not shift (−9.7±9.9 min) in the Control Group. Conclusions The combined treatment of scheduled evening sleep and enhanced lighting increased sleep duration and partially aligned circadian phase with sleep and work timing, resulting in improved night shift alertness and performance. PMID:27566781
Song, Wenqi; Shen, Ying; Peng, Xiaoxia; Tian, Jian; Wang, Hui; Xu, Lili; Nie, Xiaolu; Ni, Xin
The program of continuous quality improvement in clinical laboratory processes for complete blood count (CBC) was launched via the platform of Beijing Children's Hospital Group in order to improve the quality of pediatric clinical laboratories. Fifteen children's hospitals of Beijing Children's Hospital group were investigated using the method of Chinese adapted continuous quality improvement with PDCA (Plan-Do-Check-Action). The questionnaire survey and inter-laboratory comparison was conducted to find the existing problems, to analyze reasons, to set forth quality targets and to put them into practice. Then, targeted training was conducted to 15 children's hospitals and the second questionnaire survey, self examinations by the clinical laboratories was performed. At the same time, the Group's online internal quality control platform was established. Overall effects of the program were evaluated so that lay a foundation for the next stage of PDCA. Both quality of control system documents and CBC internal quality control scheme for all of clinical laboratories were improved through this program. In addition, standardization of performance verification was also improved, especially with the comparable verification rate of precision and internal laboratory results up to 100%. In terms of instrument calibration and mandatory diagnostic rates, only three out of the 15 hospitals (20%) failed to pass muster in 2014 from 46.67% (seven out of the 15 hospitals) in 2013. The abnormal data of intraday precision variance coefficients of the five CBC indicator parameters (WBC, RBC, Hb, Plt and Hct) of all the 15 laboratories accounted for 1.2% (2/165) in 2014, a marked decrease from 9.6% (14/145) in 2013. While the number of the hospitals using only one horizontal quality control object for daily quality control has dropped to three from five. The 15 hospitals organized a total of 263 times of training in 2014 from 101 times in 2013, up 160%. The quality improvement program for
Cristani, Matteo; Karafili, Erisa; Tomazzoli, Claudio
Energy saving is one of the most challenging aspects of modern ambient intelligence technologies, for both domestic and business usages. In this paper we show how to combine Ambient Intelligence and Artificial Intelligence techniques to solve the problem of scheduling a set of devices under a given...... for Ambient Intelligence to a specific framework and exhibit a sample usage for a real life system, Elettra, that is in use in an industrial context....
LIU, Tongzhu; SHEN, Aizong; HU, Xiaojian; TONG, Guixian; GU, Wei
Background: We aimed to apply collaborative business intelligence (BI) system to hospital supply, processing and distribution (SPD) logistics management model. Methods: We searched Engineering Village database, China National Knowledge Infrastructure (CNKI) and Google for articles (Published from 2011 to 2016), books, Web pages, etc., to understand SPD and BI related theories and recent research status. For the application of collaborative BI technology in the hospital SPD logistics management model, we realized this by leveraging data mining techniques to discover knowledge from complex data and collaborative techniques to improve the theories of business process. Results: For the application of BI system, we: (i) proposed a layered structure of collaborative BI system for intelligent management in hospital logistics; (ii) built data warehouse for the collaborative BI system; (iii) improved data mining techniques such as supporting vector machines (SVM) and swarm intelligence firefly algorithm to solve key problems in hospital logistics collaborative BI system; (iv) researched the collaborative techniques oriented to data and business process optimization to improve the business processes of hospital logistics management. Conclusion: Proper combination of SPD model and BI system will improve the management of logistics in the hospitals. The successful implementation of the study requires: (i) to innovate and improve the traditional SPD model and make appropriate implement plans and schedules for the application of BI system according to the actual situations of hospitals; (ii) the collaborative participation of internal departments in hospital including the department of information, logistics, nursing, medical and financial; (iii) timely response of external suppliers. PMID:28828316
Fitzpatrick, Eileen; Dennison, Barbara A; Welge, Sara Bonam; Hisgen, Stephanie; Boyce, Patricia Simino; Waniewski, Patricia A
Exclusive breastfeeding is a public health priority. A strong body of evidence links maternity care practices, based on the Ten Steps to Successful Breastfeeding, to increased breastfeeding initiation, duration and exclusivity. Despite having written breastfeeding policies, New York (NY) hospitals vary widely in reported maternity care practices and in prevalence rates of breastfeeding, especially exclusive breastfeeding, during the birth hospitalization. To improve hospital maternity care practices, breastfeeding support, and the percentage of infants exclusively breastfeeding, the NY State Department of Health developed the Breastfeeding Quality Improvement in Hospitals (BQIH) Learning Collaborative. The BQIH Learning Collaborative was the first to use the Institute for Health Care Improvement's Breakthrough Series methodology to specifically focus on increasing hospital breastfeeding support. The evidence-based maternity care practices from the Ten Steps to Successful Breastfeeding provided the basis for the Change Package and Data Measurement Plan. The present article describes the development of the BQIH Learning Collaborative. The engagement of breastfeeding experts, partners, and stakeholders in refining the Learning Collaborative design and content, in defining the strategies and interventions (Change Package) that drive hospital systems change, and in developing the Data Measurement Plan to assess progress in meeting the Learning Collaborative goals and hospital aims is illustrated. The BQIH Learning Collaborative is a model program that was implemented in a group of NY hospitals with plans to spread to additional hospitals in NY and across the country.
van Oostrum, Jeroen M.; Bredenhoff, Eelco; Bredenhoff, E.; Hans, Elias W.
Operating room (OR) planning and scheduling is a popular and challenging subject within the operational research applied to health services research (ORAHS). However, the impact in practice is very limited. The organization and culture of a hospital and the inherent characteristics of its processes
Sutphin, Patrick D; Reis, Stephen P; McKune, Angie; Ravanzo, Maria; Kalva, Sanjeeva P; Pillai, Anil K
To design a sustainable process to improve optional inferior vena cava (IVC) filter retrieval rates based on the Define, Measure, Analyze, Improve, Control (DMAIC) methodology of the Six Sigma process improvement paradigm. DMAIC, an acronym for Define, Measure, Analyze, Improve, and Control, was employed to design and implement a quality improvement project to increase IVC filter retrieval rates at a tertiary academic hospital. Retrievable IVC filters were placed in 139 patients over a 2-year period. The baseline IVC filter retrieval rate (n = 51) was reviewed through a retrospective analysis, and two strategies were devised to improve the filter retrieval rate: (a) mailing of letters to clinicians and patients for patients who had filters placed within 8 months of implementation of the project (n = 43) and (b) a prospective automated scheduling of a clinic visit at 4 weeks after filter placement for all new patients (n = 45). The effectiveness of these strategies was assessed by measuring the filter retrieval rates and estimated increase in revenue to interventional radiology. IVC filter retrieval rates increased from a baseline of 8% to 40% with the mailing of letters and to 52% with the automated scheduling of a clinic visit 4 weeks after IVC filter placement. The estimated revenue per 100 IVC filters placed increased from $2,249 to $10,518 with the mailing of letters and to $17,022 with the automated scheduling of a clinic visit. Using the DMAIC methodology, a simple and sustainable quality improvement intervention was devised that markedly improved IVC filter retrieval rates in eligible patients. Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.
Somatunga L C
Full Text Available Abstract Health care systems are accountable to their patients and society to provide quality cost effective care and to seek ways to improve that care. By doing this positive patient outcomes are ensured. Those factors which affect the delivery of a good service have to be identified. It is important to determine whether the environment of an organization type of hospitals plays an important role in determining the implementation of quality improvement programmes Methodology This was a hospital-based descriptive cross-sectional survey carried out in selected hospitals in Sri Lanka. Sixteen Line Ministry Hospitals where Quality Management Units are already in place were selected for the study. Staff working in these hospitals including doctors nurses and allied health staff was included. The data was collected using a self-administered questionnaire. The questionnaire was repeated after three weeks. Findings A total of 378 participants responded in the study. This study identified top management commitment training teamwork physical structure and monitoring system as independent variables that influence the CQI implementation programme. All the participants rated lower for teamwork and felt that teamwork had little influence on CQI programme implementation. The type of hospital has not influenced the implementation of CQI programme.
Curatolo, N; Lamouri, S; Huet, J-C; Rieutord, A
Hospitals have to deal strong with economic constraints and increasing requirements in terms of quality and safety of care. To address these constraints, one solution could be the adoption of approaches from the industry sector. Following the decree of April 6, 2011 on the quality management of the medication use process, some of these approaches, such as risk management, are now part of the everyday work of healthcare professionals. However, other approaches, such as business process improvement, are still poorly developed in the hospital setting. In this general review, we discuss the main approaches of business process improvements that have been used in hospitals by focusing specifically on one of the newest and most currently used: Lean. Copyright © 2014. Published by Elsevier Masson SAS.
Vogus, Douglas R; Pusuluri, Anusha; Chen, Renwei; Mitragotri, Samir
Combination chemotherapy is commonly used to treat late stage cancer; however, treatment is often limited by systemic toxicity. Optimizing drug ratio and schedule can improve drug combination activity and reduce dose to lower toxicity. Here, we identify gemcitabine (GEM) and doxorubicin (DOX) as a synergistic drug pair in vitro for the triple negative breast cancer cell line MDA-MB-231. Drug synergy and caspase activity were increased the most by exposing cells to GEM prior to DOX in vitro. While the combination was more effective than the single drugs at inhibiting MDA-MB-231 growth in vivo, the clear schedule dependence observed in vitro was not observed in vivo. Differences in drug exposure and cellular behavior in vivo compared to in vitro are likely responsible. This study emphasizes the importance in understanding how schedule impacts drug synergy and the need to develop more advanced strategies to translate synergy to the clinic.
James M. Learning
Full Text Available Introduction: Surge capacity for optimization of access to hospital beds is a limiting factor in response to catastrophic events. Medical facilities, communication tools, manpower, and resource reserves exist to respond to these events. However, these factors may not be optimally functioning to generate an effective and efficient surge response. The objective was to improve the function of these factors.Methods: Regional healthcare facilities and supporting local emergency response agencies developed a coalition (the Healthcare Facilities Partnership of South Central Pennsylvania; HCFP¬SCPA to increase regional surge capacity and emergency preparedness for healthcare facilities. The coalition focused on 6 objectives: (1 increase awareness of capabilities and assets, (2 develop and pilot test advanced planning and exercising of plans in the region, (3 augment written medical mutual aid agreements, (4 develop and strengthen partnership relationships, (5 ensure National Incident Management System compliance, and (6 develop and test a plan for effective utilization of volunteer healthcare professionals.Results: In comparison to baseline measurements, the coalition improved existing areas covered under all 6 objectives documented during a 24-month evaluation period. Enhanced communications between the hospital coalition, and real-time exercises, were used to provide evidence of improved preparedness for putative mass casualty incidents.Conclusion: The HCFP-SCPA successfully increased preparedness and surge capacity through a partnership of regional healthcare facilities and emergency response agencies.
Blegen, Mary A; Spector, Nancy; Ulrich, Beth T; Lynn, Mary R; Barnsteiner, Jane; Silvestre, Josephine
The aim of this study was to describe newly licensed RN (NLRN) preceptorships and the effects on competency and retention. Preceptors are widely used, but little is known about the benefit from the perspective of the NLRN or about the models of the relationships. The National Council of State Boards of Nursing added questions about the preceptor experience in a study of transition-to-practice programs. Hospitals were coded as having high or low preceptor support in regard to scheduling NLRN on the same shifts as their preceptors, assignment sharing, and preceptor release time and a low number of preceptors per preceptee. Half of the 82 hospitals were classified as high, and half as low preceptor support. NLRNs and their preceptors in high-support hospitals evaluated the preceptor experience and NLRN competence higher. In addition, NLRN retention was higher in the high-support hospitals. To improve NLRN competence and retention, preceptors should have adequate time with each NLRN, share shift and patient assignments, and have few preceptees assigned to each preceptor concurrently.
Haerkens, Marck H T M; Beekmann, Roland T A; van den Elzen, Guus J P; Lansbergen, Michael D I; Berlijn, Dick L
Failing teamwork is a major cause of adverse events in hospitals in the Netherlands. Training team-skills can improve the safety standards in clinical heath care. An adapted version of Crew Resource Management (CRM) training is proving to be a usable format in the hospital environment. We emphasize that paying attention to the subject of safety has to start early in medical education in order to incorporate non-technical skills into the hospital culture.
Samer Ben Issa
Full Text Available Planning and scheduling processes in project management are carried out sequentially in prac-tice, i.e. planning project activities first without visibility of resource limitation, and then schedul-ing the project according to these pre-planned activities. This is a need to integrate these two pro-cesses. In this paper, we use Branch and Bound approach for generating all the feasible and non-feasible project schedules with/without activity splitting, and with a new criterion called “the Minimum Moments of Resources Required around X-Y axes (MMORR”, we select the best feasible project schedule to integrate plan processing and schedule processing for engineering projects. The results illustrate that this integrated approach can effectively select the best feasible project schedule among alternatives, improves the resource utilization, and shortens the project lead time.
Svetlana A. Mukhortova
Full Text Available Improving the quality of medical care is a priority in countries with developed and developing health care system. There are various approaches to improve the quality and safety of patient’s care, as well as various strategies to encourage hospitals to achieve this goal. The purpose of the presented literature review was to analyze existing experience of the implementation of technology of supportive supervision in health care facilities to improve the quality of hospital care delivery. The data sources for publication were obtained from the following medical databases: PubMed, Cochrane Library, Medscape, e-library, and books on the topic of the review written by experts. The article discusses the results of the research studies demonstrating the successes and failures of supportive supervision technology application. Implementation of supportive supervision in medical facilities based on generalized experience of different countries is a promising direction in improving the quality of medical care delivery. This technology opens up opportunities to improve skills and work quality of the staff at pediatric hospitals in the Russian Federation.
Navarro, Daniela Abigail; Boaz, Mona; Krause, Ilan; Elis, Avishay; Chernov, Karina; Giabra, Mursi; Levy, Miriam; Giboreau, Agnes; Kosak, Sigrid; Mouhieddine, Mohamed; Singer, Pierre
Reduced food intake is a frequent problem at a hospital setting, being a cause and/or consequence of malnutrition. Food presentation can affect food intake and induce nutritional benefit. To investigate the effect of improved meal presentation supported by gastronomy expertise on the food intake in adults hospitalized in internal medicine departments. Controlled before and after study. Two hundred and six newly hospitalized patients in internal medicine departments were included and divided in two groups, a) control: receiving the standard lunch from the hospital and b) experimental: receiving a lunch improved in terms of presentation by the advices received by the Institut Paul Bocuse, Ecully, Lyon, France together with the hospital kitchen of the Beilinson Hospital, without change in the composition of the meal. The amount of food left at the participants' plates was estimated using the Digital Imaging Method, which consisted in photographing the plates immediately to previous tray collection by the researcher. In addition, the nutritionDay questionnaire was used to measure other variables concerned to their food intake during hospitalization. Charlson Comorbidity Index was calculated. There was no significant difference between the groups regarding demography or Charlson Comorbidity Index. Patients who received the meal with the improved presentation showed significantly higher food intake than those who received the standard meal, despite reported loss in appetite. Participants from the experimental group left on their plate less starch (0.19 ± 0.30 vs. 0.52 + 0.41) (p 0.05). Both of the groups were asked how hungry they were before the meal and no significance was shown. More participants from the experimental group reported their meal to be tasty in comparison to those in the control group (49.5% vs. 33.7% p < 0.005). Length of stay was not different but readmission rate decreased significantly in the study group (p < 0.02) from 31.2% to 13
Magalhaes, Marcus V.; Fraga, Eder T. [PETROBRAS, Rio de Janeiro, RJ (Brazil); Shah, Nilay [Imperial College, London (United Kingdom)
This work addresses the refinery scheduling problem using mathematical programming techniques. The solution adopted was to decompose the entire refinery model into a crude oil scheduling and a product scheduling problem. The envelope for the crude oil scheduling problem is composed of a terminal, a pipeline and the crude area of a refinery, including the crude distillation units. The solution method adopted includes a decomposition technique based on the topology of the system. The envelope for the product scheduling comprises all tanks, process units and products found in a refinery. Once crude scheduling decisions are Also available the product scheduling is solved using a rolling horizon algorithm. All models were tested with real data from PETROBRAS' REFAP refinery, located in Canoas, Southern Brazil. (author)
Austin, Jodie A; Smith, Ian R; Tariq, Amina
Closed-loop electronic medication management systems (EMMS) are recognised as an effective intervention to improve medication safety, yet evidence of their effectiveness in hospitals is limited. Few studies have compared medication turnaround time for a closed-loop electronic versus paper-based medication management environment. To compare medication turnaround times in a paper-based hospital environment with a digital hospital equipped with a closed-loop EMMS, consisting of computerised physician order entry, profiled automated dispensing cabinets packaged with unit dose medications and barcode medication administration. Data were collected during 2 weeks at three private hospital sites (one with closed-loop EMMS) within the same organisation network in Queensland, Australia. Time between scheduled and actual administration times was analysed for first dose of time-critical and non-critical medications located on the ward or sourced via pharmacy. Medication turnaround times at the EMMS site were less compared to the paper-based sites (median, IQR: 35 min, 8-57 min versus 120 min, 30-180 min, P medications, 77% were administered within 60 min of scheduled time at the EMMS site versus 38% for the paper-based sites. Similar difference was observed for non-critical medications, 80% were administered within 60 min of their scheduled time at the EMMS site versus 41% at the paper-based facilities. The study indicates medication turnaround times utilising a closed-loop EMMS are less compared to paper-based systems. This improvement may be attributable to increased accessibility of medications using automated dispensing cabinets and electronic medication administration records flagging tasks to nurses in real time. © 2018 Royal Pharmaceutical Society.
Nuclear power design is the important part of project management of nuclear power project, it is the way to control the project organization, design schedule, design progress, design quality and cost control. The good schedule system and control is the key to the success for the project. It is also analyzed the problem during the project, by using some theory and analyze the project structure, design schedule management, IED and document management and interface management propose some new idea for better improve the design management to finally better improve the management quality and efficiency. (author)
Spaulding, Aaron; Zhao, Mei; Haley, D Rob
To determine if the Value-Based Purchasing Performance Scoring system correlates with hospital acquired condition quality indicators. This study utilizes the following secondary data sources: the American Hospital Association (AHA) annual survey and the Centers for Medicare and Medicaid (CMS) Value-Based Purchasing and Hospital Acquired Conditions databases. Zero-inflated negative binomial regression was used to examine the effect of CMS total performance score on counts of hospital acquired conditions. Hospital structure variables including size, ownership, teaching status, payer mix, case mix, and location were utilized as control variables. The secondary data sources were merged into a single database using Stata 10. Total performance scores, which are used to determine if hospitals should receive incentive money, do not correlate well with quality outcome in the form of hospital acquired conditions. Value-based purchasing does not appear to correlate with improved quality and patient safety as indicated by Hospital Acquired Condition (HAC) scores. This leads us to believe that either the total performance score does not measure what it should, or the quality outcome measurements do not reflect the quality of the total performance scores measure. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Full Text Available Scheduling of Elevator Group Control System (EGCS is a typical combinatorial optimization problem. Uncertain group scheduling under peak traffic flows has become a research focus and difficulty recently. RO (Robust Optimization method is a novel and effective way to deal with uncertain scheduling problem. In this paper, a peak scheduling method based on RO model for multi-elevator system is proposed. The method is immune to the uncertainty of peak traffic flows, optimal scheduling is realized without getting exact numbers of each calling floor's waiting passengers. Specifically, energy-saving oriented multi-objective scheduling price is proposed, RO uncertain peak scheduling model is built to minimize the price. Because RO uncertain model could not be solved directly, RO uncertain model is transformed to RO certain model by elevator scheduling robust counterparts. Because solution space of elevator scheduling is enormous, to solve RO certain model in short time, ant colony solving algorithm for elevator scheduling is proposed. Based on the algorithm, optimal scheduling solutions are found quickly, and group elevators are scheduled according to the solutions. Simulation results show the method could improve scheduling performances effectively in peak pattern. Group elevators' efficient operation is realized by the RO scheduling method.
Liu, Yunchang; Li, Chunlin; Luo, Youlong; Shao, Yanling; Zhang, Jing
Currently, security is a critical factor for multimedia services running in the cloud computing environment. As an effective mechanism, trust can improve security level and mitigate attacks within cloud computing environments. Unfortunately, existing scheduling strategy for multimedia service in the cloud computing environment do not integrate trust mechanism when making scheduling decisions. In this paper, we propose a scheduling scheme for multimedia services in multi clouds. At first, a novel scheduling architecture is presented. Then, We build a trust model including both subjective trust and objective trust to evaluate the trust degree of multimedia service providers. By employing Bayesian theory, the subjective trust degree between multimedia service providers and users is obtained. According to the attributes of QoS, the objective trust degree of multimedia service providers is calculated. Finally, a scheduling algorithm integrating trust of entities is proposed by considering the deadline, cost and trust requirements of multimedia services. The scheduling algorithm heuristically hunts for reasonable resource allocations and satisfies the requirement of trust and meets deadlines for the multimedia services. Detailed simulated experiments demonstrate the effectiveness and feasibility of the proposed trust scheduling scheme.
Broughton, Edward I; Gomez, Ivonne; Nuñez, Oscar; Wong, Yudy
To determine the costs and cost-effectiveness of an intervention to improve quality of care for children with diarrhea or pneumonia in 14 hospitals in Nicaragua, based on expenditure data and impact measures. Hospital length of stay (LOS) and deaths were abstracted from a random sample of 1294 clinical records completed at seven of the 14 participating hospitals before the intervention (2003) and 1505 records completed after two years of intervention implementation ("post-intervention"; 2006). Disability-adjusted life years (DALYs) were derived from outcome data. Hospitalization costs were calculated based on hospital and Ministry of Health records and private sector data. Intervention costs came from project accounting records. Decision-tree analysis was used to calculate incremental cost-effectiveness. Average LOS decreased from 3.87 and 4.23 days pre-intervention to 3.55 and 3.94 days post-intervention for diarrhea (P = 0.078) and pneumonia (P = 0.055), respectively. Case fatalities decreased from 45/10 000 and 34/10 000 pre-intervention to 30/10 000 and 27/10 000 post-intervention for diarrhea (P = 0.062) and pneumonia (P = 0.37), respectively. Average total hospitalization and antibiotic costs for both diagnoses were US$ 451 (95% credibility interval [CI]: US$ 419-US$ 482) pre-intervention and US$ 437 (95% CI: US$ 402-US$ 464) post-intervention. The intervention was cost-saving in terms of DALYs (95% CI: -US$ 522- US$ 32 per DALY averted) and cost US$ 21 per hospital day averted (95% CI: -US$ 45- US$ 204). After two years of intervention implementation, LOS and deaths for diarrhea decreased, along with LOS for pneumonia, with no increase in hospitalization costs. If these changes were entirely attributable to the intervention, it would be cost-saving.
Chinoy, Evan D; Harris, Michael P; Kim, Min Ju; Wang, Wei; Duffy, Jeanne F
We tested whether a sleep and circadian-based treatment shown to improve circadian adaptation to night shifts and attenuate negative effects on alertness, performance and sleep in young adults would also be effective in older adults. We assessed subjective alertness, sustained attention (psychomotor vigilance task, PVT), sleep duration (actigraphy) and circadian timing (salivary dim-light melatonin onset, DLMO) in 18 older adults (57.2±3.8 years; mean±SD) in a simulated shift work protocol. 4 day shifts were followed by 3 night shifts in the laboratory. Participants slept at home and were randomised to either the treatment group (scheduled evening sleep and enhanced lighting during the latter half of night shifts) or control group (ad-lib sleep and typical lighting during night shifts). Compared with day shifts, alertness and sustained attention declined on the first night shift in both groups, and was worse in the latter half of the night shifts. Alertness and attention improved on nights 2 and 3 for the treatment group but remained lower for the control group. Sleep duration in the treatment group remained similar to baseline (6-7 hours) following night shifts, but was shorter (3-5 hours) following night shifts in the control group. Treatment group circadian timing advanced by 169.3±16.1 min (mean±SEM) but did not shift (-9.7±9.9 min) in the control group. The combined treatment of scheduled evening sleep and enhanced lighting increased sleep duration and partially aligned circadian phase with sleep and work timing, resulting in improved night shift alertness and performance. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Bosse, Goetz; Abels, Wiltrud; Mtatifikolo, Ferdinand; Ngoli, Baltazar; Neuner, Bruno; Wernecke, Klaus-Dieter; Spies, Claudia
Surgical services are increasingly seen to reduce death and disability in Sub-Saharan Africa, where hospital-based mortality remains alarmingly high. This study explores two implementation approaches to improve the quality of perioperative care in a Tanzanian hospital. Effects were compared to a control group of two other hospitals in the region without intervention. All hospitals conducted quality assessments with a Hospital Performance Assessment Tool. Changes in immediate outcome indicators after one and two years were compared to final outcome indicators such as Anaesthetic Complication Rate and Surgical Case Fatality Rate. Immediate outcome indicators for Preoperative Care in the intervention hospital improved (52.5% in 2009; 84.2% in 2011, pcontrol group, preoperative care declined from 50.8% (2009) to 32.8% (2011, p hospital declined (1.89% before intervention; 0.96% after intervention, p = 0.006). Surgical Case Fatality Rate in the intervention hospital declined from 5.67% before intervention to 2.93% after intervention (pcontrol group was 4% before intervention and 3.8% after intervention (p = 0.411). Anaesthetic Complication Rate in the control group was not available. Immediate outcome indicators initially improved, while at the same time final outcome declined (Surgical Case Fatality, Anaesthetic Complication Rate). Compared to the control group, final outcome improved more in the intervention hospital, although the effect was not significant over the whole study period. Documentation of final outcome indicators seemed inconsistent. Immediate outcome indicators seem more helpful to steer the Continuous Quality Improvement program. Specific interventions as part of Continuous Quality Improvement might lead to sustainable improvement of the quality of care, if embedded in a multi-faceted approach.
He, Yaoyao; Yang, Shanlin; Xu, Qifa
In order to solve the model of short-term cascaded hydroelectric system scheduling, a novel chaotic particle swarm optimization (CPSO) algorithm using improved logistic map is introduced, which uses the water discharge as the decision variables combined with the death penalty function. According to the principle of maximum power generation, the proposed approach makes use of the ergodicity, symmetry and stochastic property of improved logistic chaotic map for enhancing the performance of particle swarm optimization (PSO) algorithm. The new hybrid method has been examined and tested on two test functions and a practical cascaded hydroelectric system. The experimental results show that the effectiveness and robustness of the proposed CPSO algorithm in comparison with other traditional algorithms.
Full Text Available Multilevel feedback queue scheduler suffers from major issues of scheduling such as starvation for long tasks, fixed number of queues, and static length of time quantum in each queue. These factors directly affect the performance of the scheduler. At many times impreciseness exists in attributes of tasks which make the performance even worse. In this paper, our intent is to improve the performance by providing a solution to these issues. We design a multilevel feedback queue scheduler using a vague set which we call as VMLFQ scheduler. VMLFQ scheduler intelligently handles the impreciseness and defines the optimum number of queues as well as the optimal size of time quantum for each queue. It also resolves the problem of starvation. This paper simulates and analyzes the performance of VMLFQ scheduler with the other multilevel feedback queue techniques using MatLab.
Saint Francis Health System (SFHS) consists of three hospitals and one clinic: Saint Francis Hospital (SFH); Broken Arrow Medical Center; Laureate Psychiatric Hospital; and Warren Clinic. SFHS has 670 physicians on staff and serves medical (oncology, orthopedic, neurology, and renal), surgical, cardiac, women and infant, pediatric, transplant, and trauma patients in Tulsa County, Oklahoma, which has a population of 660,000. SFH incorporates 706 staffed beds, including 126 pediatric beds and 119 critical care beds. Each year, the health system averages 38,000 admissions, 70,000 emergency department visits, 25,000 surgeries, and 3,500 births. Saint Francis Laboratory is located within the main hospital facility (SFH) and functions as a core lab for the health system. The lab also coordinates lab services with Saint Francis Heart Hospital, a physician-system joint venture. The Optimal Equipment Configuration (OEC) Project was designed by the Clinical Laboratory Services division of Premier, a group purchasing organization, with the goal of determining whether laboratories could improve efficiency and decrease unit cost by using a single-source vendor. Participants included seven business partners (Abbott, Bayer, Beckman/Coulter, Dade/Behring, J&J/ Ortho, Olympus, and Roche) and 21 laboratory sites (a small, mid-sized, and large site for each vendor). SFH laboratory staff embraced Premier's concept and viewed the OEC project as an opportunity to "energize" laboratory operations. SFH partnered with Abbott, their primary equipment vendor, for the project. Using resources and tools made available through the project, the laboratory was re-engineered to simplify workflow, increase productivity, and decrease costs by adding automation and changing to centralized specimen processing. Abbott and SFH shared a common vision for the project and enhanced their partnership through increased communication and problem solving. Abbott's area representatives provided for third
Full Text Available Abstract Background In-hospital case-fatality rates in patients, admitted for acute myocardial infarction (AMI-CFRs, are internationally used as a quality indicator. Attempting to encourage the hospitals to assume responsibility, the Belgian Ministry of Health decided to stimulate initiatives of quality improvement by means of a limited set of indicators, among which AMI-CFR, to be routinely analyzed. In this study we aimed, by determining the existence of inter-hospital differences in AMI-CFR, (1 to evaluate to which extent Belgian discharge records allow the assessment of quality of care in the field of AMI, and (2 to identify starting points for quality improvement. Methods Hospital discharge records from all the Belgian short-term general hospitals in the period 2002-2005. The study population (N = 46,287 included patients aged 18 years and older, hospitalized for AMI. No unique patient identifier being present, we tried to track transferred patients. We assessed data quality through a comparison of MCD with data from two registers for acute coronary events and through transfer and sensitivity analyses. We compared AMI-CFRs across hospitals, using multivariable logistic regression models. In the main model hospitals, Charlson's co-morbidity index, age, gender and shock constituted the covariates. We carried out two types of analyses: a first one wherein transferred-out cases were excluded, to avoid double counting of patients when computing rates, and a second one with exclusion of all transferred cases, to allow the study of patients admitted into, treated in and discharged from the same hospital. Results We identified problems regarding both the CFR's numerator and denominator. Sensitivity analyses revealed differential coding and/or case management practices. In the model with exclusion of transfer-out cases, the main determinants of AMI-CFR were cardiogenic shock (ORadj 23.0; 95% CI [20.9;25.2], and five-year age groups ORadj 1.23; 95
Aelvoet, Willem; Terryn, Nathalie; Molenberghs, Geert; De Backer, Guy; Vrints, Christiaan; van Sprundel, Marc
In-hospital case-fatality rates in patients, admitted for acute myocardial infarction (AMI-CFRs), are internationally used as a quality indicator. Attempting to encourage the hospitals to assume responsibility, the Belgian Ministry of Health decided to stimulate initiatives of quality improvement by means of a limited set of indicators, among which AMI-CFR, to be routinely analyzed. In this study we aimed, by determining the existence of inter-hospital differences in AMI-CFR, (1) to evaluate to which extent Belgian discharge records allow the assessment of quality of care in the field of AMI, and (2) to identify starting points for quality improvement. Hospital discharge records from all the Belgian short-term general hospitals in the period 2002-2005. The study population (N = 46,287) included patients aged 18 years and older, hospitalized for AMI. No unique patient identifier being present, we tried to track transferred patients. We assessed data quality through a comparison of MCD with data from two registers for acute coronary events and through transfer and sensitivity analyses. We compared AMI-CFRs across hospitals, using multivariable logistic regression models. In the main model hospitals, Charlson's co-morbidity index, age, gender and shock constituted the covariates. We carried out two types of analyses: a first one wherein transferred-out cases were excluded, to avoid double counting of patients when computing rates, and a second one with exclusion of all transferred cases, to allow the study of patients admitted into, treated in and discharged from the same hospital. We identified problems regarding both the CFR's numerator and denominator.Sensitivity analyses revealed differential coding and/or case management practices. In the model with exclusion of transfer-out cases, the main determinants of AMI-CFR were cardiogenic shock (OR(adj) 23.0; 95% CI [20.9;25.2]), and five-year age groups OR(adj) 1.23; 95% CI [1.11;1.36]). Sizable inter-hospital and inter
Connolly, J.J.; Moore-Ede, M.C.
Nuclear power plants must operate 24 h, 7 days a week. For the most part, shift schedules currently in use at nuclear power plants have been designed to meet operational needs without considering the biological clocks of the human operators. The development of schedules that also take circadian principles into account is a positive step that can be taken to improve plant safety by optimizing operator alertness. These schedules reduce the probability of human errors especially during backshifts. In addition, training programs that teach round-the-clock workers how to deal with the problems of shiftwork can help to optimize performance and alertness. These programs teach shiftworkers the underlying causes of the sleep problems associated with shiftwork and also provide coping strategies for improving sleep and dealing with the transition between shifts. When these training programs are coupled with an improved schedule, the problems associated with working round-the-clock can be significantly reduced
Felipe Ribeiro Souza
Full Text Available Abstract This study is focused on Direct Block Scheduling testing (Direct Multi-Period Scheduling methodology which schedules mine production considering the correct discount factor of each mining block, resulting in the final pit. Each block is analyzed individually in order to define the best target period. This methodology presents an improvement of the classical methodology derived from Lerchs-Grossmann's initial proposition improved by Whittle. This paper presents the differences between these methodologies, specially focused on the algorithms' avidity. Avidity is classically defined by the voracious search algorithms, whereupon some of the most famous greedy algorithms are Branch and Bound, Brutal Force and Randomized. Strategies based on heuristics can accentuate the voracity of the optimizer system. The applied algorithm use simulated annealing combined with Tabu Search. The most avid algorithm can select the most profitable blocks in early periods, leading to higher present value in the first periods of mine operation. The application of discount factors to blocks on the Lerchs-Grossmann's final pit has an accentuated effect with time, and this effect may make blocks scheduled for the end of the mine life unfeasible, representing a trend to a decrease in reported reserves.
Smalley, Hannah K; Keskinocak, Pinar
At academic teaching hospitals around the country, the majority of clinical care is provided by resident physicians. During their training, medical residents often rotate through various hospitals and/or medical services to maximize their education. Depending on the size of the training program, manually constructing such a rotation schedule can be cumbersome and time consuming. Further, rules governing allowable duty hours for residents have grown more restrictive in recent years (ACGME 2011), making day-to-day shift scheduling of residents more difficult (Connors et al., J Thorac Cardiovasc Surg 137:710-713, 2009; McCoy et al., May Clin Proc 86(3):192, 2011; Willis et al., J Surg Edu 66(4):216-221, 2009). These rules limit lengths of duty periods, allowable duty hours in a week, and rest periods, to name a few. In this paper, we present two integer programming models (IPs) with the goals of (1) creating feasible assignments of residents to rotations over a one-year period, and (2) constructing night and weekend call-shift schedules for the individual rotations. These models capture various duty-hour rules and constraints, provide the ability to test multiple what-if scenarios, and largely automate the process of schedule generation, solving these scheduling problems more effectively and efficiently compared to manual methods. Applying our models on data from a surgical residency program, we highlight the infeasibilities created by increased duty-hour restrictions placed on residents in conjunction with current scheduling paradigms.
Forster, Alan J; Turnbull, Jeff; McGuire, Shaun; Ho, Michael L; Worthington, JR
Abstract The lack of systematic oversight of physician performance has led to some serious cases related to physician competence and behaviour. We are currently implementing a hospital-wide approach to improve physician oversight by incorporating it into the hospital credentialing process. Our proposed credentialing method involves four systems: (1) a system for monitoring and reporting clinical performance; (2) a system for evaluating physician behaviour; (3) a complaints management system; ...
Singh, G; Harvey, R; Dyne, A; Said, A; Scott, I
We assessed the impact of completion and feedback of discharge summary scorecards on the quality of discharge summaries written by interns in a general medicine service of a tertiary hospital. The scorecards significantly improved summary quality in the first three rotations of the intern year and could be readily adopted by other units as a quality improvement intervention for optimizing clinical handover to primary care providers. © 2015 Royal Australasian College of Physicians.
The primary objective of the Australia Post eLetter project 1 was to determine the feasibility of using the eLetter service with the Patient Administration System Appointment Scheduling Module to provide a fully automated mailing function that would eliminate the need for manual processing of mail delivery. Issues with timely delivery of letters throughout all outpatient sites at the Royal Hobart Hospital (RHH) have been identified as being mainly due to limited human resources being available to perform mailing duties and the like. This new desktop service enables staff to transmit data electronically in conjunction with the appointment software for large quantity mail postings to Australia Post via a secure line. Australia Post then validates the address, appends a barcode, prints the letter, envelopes it and inserts it into the mail distribution network in the state of the recipient. This article depicts the process that has eliminated the manual processing of a letter via the traditional Microsoft application, Wordmate, a system at RHH that was always difficult to use. With the introduction of eLetter, the RHH's Specialist Clinics have significantly improved the timeliness and quality of communication with patients as well as reducing administration tasks for staff.
Whitmire, Alexandra; Johnston, Smith; Lockley, Steven
The NASA Fatigue Management Team is developing recommendations for managing fatigue during travel and for shift work operations, as Clinical Practice Guidelines for the Management of Circadian Desynchrony in ISS Operations. The Guidelines provide the International Space Station (ISS ) flight surgeons and other operational clinicians with evidence-based recommendations for mitigating fatigue and other factors related to sleep loss and circadian desynchronization. As much international travel is involved both before and after flight, the guidelines provide recommendations for: pre-flight training, in-flight operations, and post-flight rehabilitation. The objective of is to standardize the process by which care is provided to crewmembers, ground controllers, and other support personnel such as trainers, when overseas travel or schedule shifting is required. Proper scheduling of countermeasures - light, darkness, melatonin, diet, exercise, and medications - is the cornerstone for facilitating circadian adaptation, improving sleep, enhancing alertness, and optimizing performance. The Guidelines provide, among other things, prescribed travel schedules that outline the specific implementation of these mitigation strategies. Each travel schedule offers evidence based protocols for properly using the NASA identified countermeasures for fatigue. This presentation will describe the travel implementation schedules and how these can be used to alleviate the effects of jet lag and/or schedule shifts.
Hesselink, Gijs; Vernooij-Dassen, Myrra; Pijnenborg, Loes; Barach, Paul; Gademan, Petra; Dudzik-Urbaniak, Ewa; Flink, Maria; Orrego, Carola; Toccafondi, Giulio; Johnson, Julie K; Schoonhoven, Lisette; Wollersheim, Hub
Organizational culture is seen as having a growing impact on quality and safety of health care, but its impact on hospital to community patient discharge is relatively unknown. To explore aspects of organizational culture to develop a deeper understanding of the discharge process. A qualitative study of stakeholders in the discharge process. Grounded Theory was used to analyze the data. In 5 European Union countries, 192 individual and 25 focus group interviews were conducted with patients and relatives, hospital physicians, hospital nurses, general practitioners, and community nurses. Three themes emerged representing aspects of organizational culture: a fragmented hospital to primary care interface, undervaluing administrative tasks relative to clinical tasks in the discharge process, and lack of reflection on the discharge process or process improvement. Nine categories were identified: inward focus of hospital care providers, lack of awareness to needs, skills, and work patterns of the professional counterpart, lack of a collaborative attitude, relationship between hospital and primary care providers, providing care in a "here and now" situation, administrative work considered to be burdensome, negative attitude toward feedback, handovers at discharge ruled by habits, and appreciating and integrating new practices. On the basis of the data, we hypothesize that the extent to which hospital care providers value handovers and the outreach to community care providers is critical to effective hospital discharge. Community care providers often are insufficiently informed about patient outcomes. Ongoing challenges with patient discharge often remain unspoken with opportunities for improvement overlooked. Interventions that address organizational culture as a key factor in discharge improvement efforts are needed.
Sa'avu, Martin; Duke, Trevor; Matai, Sens
In developing countries such as Papua New Guinea (PNG), district hospitals play a vital role in clinical care, training health-care workers, implementing immunization and other public health programmes and providing necessary data on disease burdens and outcomes. Pneumonia and neonatal conditions are a major cause of child admission and death in hospitals throughout PNG. Oxygen therapy is an essential component of the management of pneumonia and neonatal conditions, but facilities for oxygen and care of the sick newborn are often inadequate, especially in district hospitals. Improving this area may be a vehicle for improving overall quality of care. A qualitative study of five rural district hospitals in the highlands provinces of Papua New Guinea was undertaken. A structured survey instrument was used by a paediatrician and a biomedical technician to assess the quality of paediatric care, the case-mix and outcomes, resources for delivery of good-quality care for children with pneumonia and neonatal illnesses, existing oxygen systems and equipment, drugs and consumables, infection-control facilities and the reliability of the electricity supply to each hospital. A floor plan was drawn up for the installation of the oxygen concentrators and a plan for improving care of sick neonates, and a process of addressing other priorities was begun. In remote parts of PNG, many district hospitals are run by under-resourced non-government organizations. Most hospitals had general wards in which both adults and children were managed together. Paediatric case-loads ranged between 232 and 840 patients per year with overall case-fatality rates (CFR) of 3-6% and up to 15% among sick neonates. Pneumonia accounts for 28-37% of admissions with a CFR of up to 8%. There were no supervisory visits by paediatricians, and little or no continuing professional development of staff. Essential drugs were mostly available, but basic equipment for the care of sick neonates was often absent or
Karlsen, Anders; Loeb, Mads Rohde; Andersen, Kristine Bramsen
OBJECTIVE: The aim of this work was to evaluate the time course of changes in strength and functional performance in elderly hospitalized medical patients. DESIGN: This was a prospective observational study in elderly medical patients of age 65 years or older at a geriatric department.Measurement......OBJECTIVE: The aim of this work was to evaluate the time course of changes in strength and functional performance in elderly hospitalized medical patients. DESIGN: This was a prospective observational study in elderly medical patients of age 65 years or older at a geriatric department.......Measurements were obtained on days 2 to 4, day 5 to 8, and days 9 to 13. Functional performance was measured with De Morton Mobility Index (DEMMI) test and a 30-second chair stand test (30-s CST). Muscular strength was measured with handgrip strength. Activity level was determined with accelerometry (Activ...... in 30-s CST (P performance of the lower extremities in geriatric patients improves moderately over the time of a hospital stay...
Moe, Karen; Happell, Nadine; Hayden, B. J.; Barclay, Cathy
This paper describes a detailed proof-of-concept activity to evaluate flexible scheduling technology as implemented in the Request Oriented Scheduling Engine (ROSE) and applied to Space Network (SN) scheduling. The criteria developed for an operational evaluation of a reusable scheduling system is addressed including a methodology to prove that the proposed system performs at least as well as the current system in function and performance. The improvement of the new technology must be demonstrated and evaluated against the cost of making changes. Finally, there is a need to show significant improvement in SN operational procedures. Successful completion of a proof-of-concept would eventually lead to an operational concept and implementation transition plan, which is outside the scope of this paper. However, a high-fidelity benchmark using actual SN scheduling requests has been designed to test the ROSE scheduling tool. The benchmark evaluation methodology, scheduling data, and preliminary results are described.
Hirose, Masahiro; Kawamura, Toshihiko; Igawa, Mikio; Imanaka, Yuichi
Little is known about patient safety performance under the social insurance medical fee schedule in Japan. The Health Ministry in Japan introduced the preferential patient safety countermeasure fee (PPSCF) to promote patient safety in 2006 and revised the PPSCF system in 2010. This study aims to address the patient safety performance status at hospitals implementing the PPSCF. A nationwide questionnaire survey targeting 2674 hospitals with the PPSCF was performed in 2010 to 2011. The 627 participant hospitals were divided into the following three groups: 178 hospitals implementing PPSCF 1 with 400 beds or more (group A), 286 hospitals implementing PPSCF 1 with 399 beds or fewer (group B), and 163 hospitals implementing PPSCF 2 (group C). The mean numbers (standard errors) of patient safety managers were 1.45 (0.07) in group A, 1.12 (0.04) in group B, and 0.37 (0.12) in group C (P fee schedule in Japan.
Decentralized scheduling algorithm to improve the rate of production without increasing the stocks of intermediates; Zaiko wo fuyasu kotonaku seisan sokudo wo kojo saseru jiritsu bunsangata sukejuringu arugorizumu
Takeda, Kazuhiro; Shiigi, Daisuke; Tsuge, Yoshifumi; Matsuyama, Hisayoshi [Kyushu University, Fukuoka (Japan). Department of Chemical Engineering
In a factory with a multi-stage production system, push-type scheduling methods can hardly improve the production rate without increasing the stocks of intermediates. For products whose specifications are known before their orders, a pull-type scheduling method named Kanban system has been developed, and has succeeded to improve the production rate without increasing the stocks of intermediates. The Kanban system, however, is not applicable to custom-made products whose specifications are not known before their orders. In this paper, a 'Virtual Kanban (VK) system' is presented as a pull-type scheduling method which is applicable to custom-made products, and its usefulness is demonstrated by simulation of an application specific integrated circuit manufacturing facility. (author)
Pakpahan, Eka KA; Kristina, Sonna; Setiawan, Ari
This paper deals with the determination of job shop production schedule on an automatic environment. On this particular environment, machines and material handling system are integrated and controlled by a computer center where schedule were created and then used to dictate the movement of parts and the operations at each machine. This setting is usually designed to have an unmanned production process for a specified interval time. We consider here parts with various operations requirement. Each operation requires specific cutting tools. These parts are to be scheduled on machines each having identical capability, meaning that each machine is equipped with a similar set of cutting tools therefore is capable of processing any operation. The availability of a particular machine to process a particular operation is determined by the remaining life time of its cutting tools. We proposed an algorithm based on the ant colony optimization method and embedded them on matlab software to generate production schedule which minimize the total processing time of the parts (makespan). We test the algorithm on data provided by real industry and the process shows a very short computation time. This contributes a lot to the flexibility and timelines targeted on an automatic environment.
van Daalen, F.V.
Better use of current antibiotic agents is necessary to help control antimicrobial resistance (AMR). Antibiotic stewardship programs (ASPs) are introduced to coordinate activities to measure and improve appropriate antibiotic use in daily hospital practice. This thesis shows how the introduction of
Groene, Oliver; Klazinga, Niek; Kazandjian, Vahé; Lombrail, Pierre; Bartels, Paul
OBJECTIVE: To evaluate the pilot implementation of the World Health Organization Performance Assessment Tool for Quality Improvement in hospitals (PATH). DESIGN: Semi-structured interviews with regional/country coordinators and Internet-based survey distributed to hospital coordinators. SETTING: A
Urban, Ann-Marie; Wagner, Joan I
Hospitals are situated within historical and socio-political contexts; these influence the provision of patient care and the work of registered nurses (RNs). Since the early 1990s, restructuring and the increasing pressure to save money and improve efficiency have plagued acute care hospitals. These changes have affected both the work environment and the work of nurses. After recognizing this impact, healthcare leaders have dedicated many efforts to improving the work environment in hospitals. Admirable in their intent, these initiatives have made little change for RNs and their work environment, and thus, an opportunity exists for other efforts. Research indicates that spirit at work (SAW) not only improves the work environment but also strengthens the nurse's power to improve patient outcomes and contribute to a high-quality workplace. In this paper, we present findings from our research that suggest SAW be considered an important component in improving the work environment in acute care hospitals.
Watson, Julie; McGuire, William
Version 5\\ud Background\\ud \\ud Feeding preterm infants in response to their hunger and satiation cues (responsive, cue-based, or infant-led feeding) rather than at scheduled intervals might enhance infants' and parents' experience and satisfaction, help in the establishment of independent oral feeding, increase nutrient intake and growth rates, and allow earlier hospital discharge.\\ud \\ud \\ud Objectives\\ud \\ud To assess the effect of a policy of feeding preterm infants on a responsive basis v...
A suitable indicator for scheduling pear-jujube (Ziziphus jujuba Mill.) irrigation in China was developed based on trunk diameter fluctuations (TDF). Parameters derived from TDF responses to variations in soil matrix potential (Ψsoil) were compared under deficit and well irrigation. Maximum daily shrinkage (MDS) increased ...
Khan, Atif J., E-mail: firstname.lastname@example.org [Department of Radiation Oncology, Robert Wood Johnson Medical School/Cancer Institute of New Jersey, New Brunswick, New Jersey (United States); Rafique, Raza [Suleman Dawood School of Business, Lahore University of Management Sciences, Lahore (Pakistan); Zafar, Waleed [Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore (Pakistan); Shah, Chirag [Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (United States); Haffty, Bruce G. [Department of Radiation Oncology, Robert Wood Johnson Medical School/Cancer Institute of New Jersey, New Brunswick, New Jersey (United States); Vicini, Frank [Michigan HealthCare Professionals, Farmington Hills, Michigan (United States); Jamshed, Arif [Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore (Pakistan); Zhao, Yao [Rutgers University School of Business, Newark, New Jersey (United States)
Purpose: Hypofractionated whole breast irradiation and accelerated partial breast irradiation (APBI) offer women options for shorter courses of breast radiation therapy. The impact of these shorter schedules on the breast cancer populations of emerging economies with limited radiation therapy resources is unknown. We hypothesized that adoption of these schedules would improve throughput in the system and, by allowing more women access to life-saving treatments, improve patient survival within the system. Methods and Materials: We designed a Markov chain model to simulate the different health states that a postlumpectomy or postmastectomy patient could enter over the course of a 20-year follow-up period. Transition rates between health states were adapted from published data on recurrence rates. We used primary data from a tertiary care hospital in Lahore, Pakistan, to populate the model with proportional use of mastectomy versus breast conservation and to estimate the proportion of patients suitable for APBI. Sensitivity analyses on the use of APBI and relative efficacy of APBI were conducted to study the impact on the population. Results: The shorter schedule resulted in more women alive and more women remaining without evidence of disease (NED) compared with the conventional schedule, with an absolute difference of about 4% and 7% at 15 years, respectively. Among women who had lumpectomies, the chance of remaining alive and with an intact breast was 62% in the hypofractionation model and 54% in the conventional fractionation model. Conclusions: Increasing throughput in the system can result in improved survival, improved chances of remaining without evidence of disease, and improved chances of remaining alive with a breast. These findings are significant and suggest that adoption of hypofractionation in emerging economies is not simply a question of efficiency and cost but one of access to care and patient survivorship.
Khan, Atif J.; Rafique, Raza; Zafar, Waleed; Shah, Chirag; Haffty, Bruce G.; Vicini, Frank; Jamshed, Arif; Zhao, Yao
Purpose: Hypofractionated whole breast irradiation and accelerated partial breast irradiation (APBI) offer women options for shorter courses of breast radiation therapy. The impact of these shorter schedules on the breast cancer populations of emerging economies with limited radiation therapy resources is unknown. We hypothesized that adoption of these schedules would improve throughput in the system and, by allowing more women access to life-saving treatments, improve patient survival within the system. Methods and Materials: We designed a Markov chain model to simulate the different health states that a postlumpectomy or postmastectomy patient could enter over the course of a 20-year follow-up period. Transition rates between health states were adapted from published data on recurrence rates. We used primary data from a tertiary care hospital in Lahore, Pakistan, to populate the model with proportional use of mastectomy versus breast conservation and to estimate the proportion of patients suitable for APBI. Sensitivity analyses on the use of APBI and relative efficacy of APBI were conducted to study the impact on the population. Results: The shorter schedule resulted in more women alive and more women remaining without evidence of disease (NED) compared with the conventional schedule, with an absolute difference of about 4% and 7% at 15 years, respectively. Among women who had lumpectomies, the chance of remaining alive and with an intact breast was 62% in the hypofractionation model and 54% in the conventional fractionation model. Conclusions: Increasing throughput in the system can result in improved survival, improved chances of remaining without evidence of disease, and improved chances of remaining alive with a breast. These findings are significant and suggest that adoption of hypofractionation in emerging economies is not simply a question of efficiency and cost but one of access to care and patient survivorship.
Haroon, S.S.; Malik, T.N.
Due to the increasing environmental concerns, the demand of clean and green energy and concern of atmospheric pollution is increasing. Hence, the power utilities are forced to limit their emissions within the prescribed limits. Therefore, the minimization of fuel cost as well as exhaust gas emissions is becoming an important and challenging task in the short-term scheduling of hydro-thermal energy systems. This paper proposes a novel algorithm known as WCA-ER (Water Cycle Algorithm with Evaporation Rate) to inspect the short term EEPSHES (Economic Emission Power Scheduling of Hydrothermal Energy Systems). WCA has its ancestries from the natural hydrologic cycle i.e. the raining process forms streams and these streams start flowing towards the rivers which finally flow towards the sea. The worth of WCA-ER has been tested on the standard economic emission power scheduling of hydrothermal energy test system consisting of four hydropower and three thermal plants. The problem has been investigated for the three case studies (i) ECS (Economic Cost Scheduling), (ii) ES (Economic Emission Scheduling) and (iii) ECES (Economic Cost and Emission Scheduling). The results obtained show that WCA-ER is superior to many other methods in the literature in bringing lower fuel cost and emissions. (author)
Sitek, Mateusz; Witczak, Izabela; Kiedik, Dorota
Prevention and control of nosocomial infections is one of the main pillars of security in each medical facility. This affects the quality of services and helps to minimize the economic losses incurred as a result of such infections. (Prolonged hospitalization, expensive antibiotic therapies, court costs of damages). Nosocomial infections occur in every medical facility in the hospitals in terms of risk of infection compared to other medicinal entities are at greater risk of environmental (number of hospitalizations for one bed, the amount of disinfectants, etc.). The number and diverse category of employment of medical and auxiliary, which should meet certain standards for the prevention of hospital infections, has an impact on the incidence of infection. It is impossible to eliminate hospital-acquired infections, but can be limited by appropriate measures, ranging from monitoring through the use of risk management methods, which are one of the elements supporting the improvement of the quality of medical entities. Hospital infection is a threat not only for patients but also for workers exposed to the risk of so-called occupational exposure. A comprehensive approach including elements of active surveillance and effective monitoring can help to minimize the risk of nosocomial infections.
McIntosh, Nathalie; Grabowski, Aria; Jack, Brian; Nkabane-Nkholongo, Elizabeth Limakatso; Vian, Taryn
Health care public-private partnerships (PPPs) between a government and the private sector are based on a business model that aims to leverage private-sector expertise to improve clinical performance in hospitals and other health facilities. Although the financial implications of such partnerships have been analyzed, few studies have examined the partnerships' impact on clinical performance outcomes. Using quantitative measures that reflected capacity, utilization, clinical quality, and patient outcomes, we compared a government-managed hospital network in Lesotho, Africa, and the new PPP-managed hospital network that replaced it. In addition, we used key informant interviews to help explain differences in performance. We found that the PPP-managed network delivered more and higher-quality services and achieved significant gains in clinical outcomes, compared to the government-managed network. We conclude that health care public-private partnerships may improve hospital performance in developing countries and that changes in management and leadership practices might account for differences in clinical outcomes. Project HOPE—The People-to-People Health Foundation, Inc.
Full Text Available ÖZ: Müşteri tatmininin her geçen gün daha da zorlaştığı hizmet sektörlerinde, işverenler sunulan hizmetin kalitesini arttırmak ve hizmetin devamlılığını sağlamak için yeni arayışlar içine girmekteler. İşverenler, müşteriden önce hizmeti sunan kişilerin memnuniyetini sağlayarak rekabet gücünü arttırma yollarına başvurmaktadırlar. Bu yollardan biri de çalışma sürelerinin esnekleştirilmesidir. Bu çalışmada, hizmet sektörleri arasında önemli bir yere sahip olan hastanelerde ki hemşire çizelgeleme problemi için tam sayılı matematiksel bir model oluşturulmuştur. Oluşturulan modelde, klasik çizelgeleme modellerinin aksine hemşirelerin işe başlama saatlerine esneklik getirilmiştir. Modelin başlıca amacı, hemşirelerin kendi tercihlerine göre haftalık çizelgelerinin oluşturulmasıdır. Oluşturulan model, gerçek veriler kullanılarak bir üniversite hastanesinin genel cerrahi bölümünde denenmiştir. Modelin, %99,6 oranında hemşire tercihlerini yerine getirdiği görülmektedir. Anahtar Kelimeler: Esnek Çalışma Saatleri, Hemşire Çizelgelemesi, Matematiksel Model, Tam Sayılı Programlama. ABSTRACT: In the service industry, customer satisfaction becomes more difficult with each passing day, employers have looked for new paradigms and ways to make service quality better and to keep service facilities reliable. Therefore, with the purpose of increasing their competitive power, employers give more importance to their employees who have direct relation with customers than they do to their customer. One of the new paradigms is make working hours flexible. In this study, an integer programming model is proposed for the nurse scheduling problem in the hospitals which are one of the most important service industries. On the contrary of classical nurse scheduling model, developed model has made flexible to starting time. The main aim of the model is make a schedule for nurses according to
Maenhout, Broos; Vanhoucke, Mario
The efficient and effective management of nursing personnel is of critical importance in a hospital's environment comprising approximately 25 % of the hospital's operational costs. The nurse organizational structure and the organizational processes highly affect the nurses' working conditions and the provided quality of care. In this paper, we investigate the impact of different nurse organization structures and different organizational processes for a real-life situation in a Belgian university hospital. In order to make accurate nurse staffing decisions, the employed solution methodology incorporates shift scheduling characteristics in order to overcome the deficiencies of the many phase-specific methodologies that are proposed in the academic literature.
Henriksen, Hanne Herborg; Rahbar, Elaheh; Baer, Lisa A
hypothesized that pre-hospital plasma would improve hemostatic function as evaluated by rapid thrombelastography (rTEG). METHODS: We conducted a prospective observational study recruiting 257 trauma patients admitted to a Level I trauma center having received either blood products pre-hospital or in......BACKGROUND: The early use of blood products has been associated with improved patient outcomes following severe hemorrhage or traumatic injury. We aimed to investigate the influence of pre-hospital blood products (i.e. plasma and/or RBCs) on admission hemostatic properties and patient outcomes. We......-hospital within 6 hours of admission. Clinical data on patient demographics, blood biochemistry, injury severity score and mortality were collected. Admission rTEG was conducted to characterize the coagulation profile and hemostatic function. RESULTS: 75 patients received pre-hospital plasma and/or RBCs (PH group...
Full Text Available Time Synchronized Channel Hopping (TSCH is an existing Medium Access Control scheme which enables robust communication through channel hopping and high data rates through synchronization. It is based on a time-slotted architecture, and its correct functioning depends on a schedule which is typically computed by a central node. This paper presents, to our knowledge, the first scheduling algorithm for TSCH networks which both is distributed and which copes with mobile nodes. Two variations on scheduling algorithms are presented. Aloha-based scheduling allocates one channel for broadcasting advertisements for new neighbors. Reservation- based scheduling augments Aloha-based scheduling with a dedicated timeslot for targeted advertisements based on gossip information. A mobile ad hoc motorized sensor network with frequent connectivity changes is studied, and the performance of the two proposed algorithms is assessed. This performance analysis uses both simulation results and the results of a field deployment of floating wireless sensors in an estuarial canal environment. Reservation-based scheduling performs significantly better than Aloha-based scheduling, suggesting that the improved network reactivity is worth the increased algorithmic complexity and resource consumption.
Mehra, Avi; Henein, Christin
Clinical Handover remains one of the most perilous procedures in medicine (1). Weekend handover has emerged as a key area of concern with high variability in handover processes across hospitals (1,2,4, 5-10). Studying weekend handover processes within medicine at an acute teaching hospital revealed huge variability in documented content and structure. A total of 12 different pro formas were in use by the medical day-team to handover to the weekend team on-call. A Likert-survey of doctors revealed 93% felt the current handover system needed improvement with 71% stating that it did not ensure patient safety (Chi-squared, p-value RCP) guidelines (2), with direct end-user input. Results following implementation revealed a considerable improvement in documented ceiling of care, urgency of task and team member assignment with 100% uptake of the new proforma at both 4-week and 6-month post-implementation analyses. 88% of doctors surveyed perceived that the new proforma improved patient safety (p<0.01, n=25), with 62% highlighting that it allowed doctors to work more efficiently. Results also revealed that 44% felt further improvements were needed and highlighted electronic solutions and handover training as main priorities. Handover briefing was subsequently incorporated into junior doctor induction and education modules delivered, with good feedback. Following collaboration with key stakeholders and with end-user input, integrated electronic handover software was designed and funding secured. The software is currently under final development. Introducing a standardized handover proforma can be an effective initial step in improving weekend handover. Handover education and end-user involvement are key in improving the process. Electronic handover solutions have been shown to significantly increase the quality of handover and are worth considering (9, 10).
Zhang, Xing; Tone, Kaoru; Lu, Yingzhe
To assess the change in efficiency and total factor productivity (TFP) of the local public hospitals in Japan after the local public hospital reform launched in late 2007, which was aimed at improving the financial capability and operational efficiency of hospitals. Secondary data were collected from the Ministry of Internal Affairs and Communications on 213 eligible medium-sized hospitals, each operating 100-400 beds from FY2006 to FY2011. The improved slacks-based measure nonoriented data envelopment analysis models (Quasi-Max SBM nonoriented DEA models) were used to estimate dynamic efficiency score and Malmquist Index. The dynamic efficiency measure indicated an efficiency gain in the first several years of the reform and then was followed by a decrease. Malmquist Index analysis showed a significant decline in the TFP between 2006 and 2011. The financial improvement of medium-sized hospitals was not associated with enhancement of efficiency. Hospital efficiency was not significantly different among ownership structure and law-application system groups, but it was significantly affected by hospital location. The results indicate a need for region-tailored health care policies and for a more comprehensive reform to overcome the systemic constraints that might contribute to the decline of the TFP. © Health Research and Educational Trust.
Aeyels, Daan; Seys, Deborah; Sinnaeve, Peter R; Claeys, Marc J; Gevaert, Sofie; Schoors, Danny; Sermeus, Walter; Panella, Massimiliano; Bruyneel, Luk; Vanhaecht, Kris
A focus on specific priorities increases the success rate of quality improvement efforts for broad and complex-care processes. Importance-performance analysis presents a possible approach to set priorities around which to design and implement effective quality improvement initiatives. Persistent variation in hospital performance makes ST-elevation myocardial infarction care relevant to consider for importance-performance analysis. The purpose of this study was to identify quality improvement priorities in ST-elevation myocardial infarction care. Importance and performance levels of ST-elevation myocardial infarction key interventions were combined in an importance-performance analysis. Content validity indexes on 23 ST-elevation myocardial infarction key interventions of a multidisciplinary RAND Delphi Survey defined importance levels. Structured review of 300 patient records in 15 acute hospitals determined performance levels. The significance of between-hospital variation was determined by a Kruskal-Wallis test. A performance heat-map allowed for hospital-specific priority setting. Seven key interventions were each rated as an overall improvement priority. Priority key interventions related to risk assessment, timely reperfusion by percutaneous coronary intervention and secondary prevention. Between-hospital performance varied significantly for the majority of key interventions. The type and number of priorities varied strongly across hospitals. Guideline adherence in ST-elevation myocardial infarction care is low and improvement priorities vary between hospitals. Importance-performance analysis helps clinicians and management in demarcation of the nature, number and order of improvement priorities. By offering a tailored improvement focus, this methodology makes improvement efforts more specific and achievable.
Yoo, Sooyoung; Jung, Se Young; Kim, Seok; Kim, Eunhye; Lee, Kee-Hyuck; Chung, Eunja; Hwang, Hee
The present study focused on the design, implementation, and evaluation of a personalized mobile patient guide system that utilizes smart phones, indoor navigation technology and a hospital information system (HIS) to address the difficulties that outpatients face in finding hospital facilities, recognizing their daily treatment schedule, and accessing personalized medical and administrative information. The present study was conducted in a fully digitized tertiary university hospital in South Korea. We developed a real-time location-based outpatient guide system that consists of Bluetooth access points (APs) for indoor navigation, an Android-based guide application, a guide server, and interfaces with the HIS. A total of 33 subjects and 43 outpatients participated in the usability test (UT) and the satisfaction survey, respectively. We confirmed that the indoor navigation feature can be applied to outpatient departments with precision using a position error test. The participants in the UT completed each scenario with an average success rate of 67.4%. According to the results, we addressed the problems and made improvements to the user interface by providing users with context-based guidance information. The satisfaction rating of the system was high, with an average score of 4.0 out of 5.0, showing its utility as a patient-centered hospital service. The innovative mobile patient guide system for outpatients is feasible and can be successfully implemented to provide personalized information with high satisfaction. Additionally, the issues identified and lessons learned from our experiences regarding task scheduling, indoor navigation, and usability should be considered when developing the system. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Wood, Jody L; Whitman, Beverly J; Mackley, Lisa A; Armstrong, Robert; Shotto, Robert T
Scheduling is essential for running a facility smoothly and for summarizing activities in use reports. The Penn State Hershey Clinical Simulation Center has developed a scheduling interface that uses off-the-shelf components, with customizations that adapt to each institution's data collection and reporting needs. The system is designed using programs within the Microsoft Office 2010 suite. Outlook provides the scheduling component, while the reporting is performed using Access or Excel. An account with a calendar is created for the main schedule, with separate resource accounts created for each room within the center. The Outlook appointment form's 2 default tabs are used, in addition to a customized third tab. The data are then copied from the calendar into either a database table or a spreadsheet, where the reports are generated.Incorporating this system into an institution-wide structure allows integration of personnel lists and potentially enables all users to check the schedule from their desktop. Outlook also has a Web-based application for viewing the basic schedule from outside the institution, although customized data cannot be accessed. The scheduling and reporting functions have been used for a year at the Penn State Hershey Clinical Simulation Center. The schedule has increased workflow efficiency, improved the quality of recorded information, and provided more accurate reporting. The Penn State Hershey Clinical Simulation Center's scheduling and reporting system can be adapted easily to most simulation centers and can expand and change to meet future growth with little or no expense to the center.
Goldblatt, S J
The Economic Recovery Tax Act of 1981 left tax-exempt hospitals at a significant disadvantage in the competition for capital. Although the new law's accelerated depreciation schedules and liberalized investment tax credits contain some marginal benefits for tax-exempt hospitals, these benefits are probably more than offset by the impact of the law on charitable giving.
Zhou, Longfei; Zhang, Lin; Zhao, Chun; Laili, Yuanjun; Xu, Lida
Cloud manufacturing (CMfg) has emerged as a new manufacturing paradigm that provides ubiquitous, on-demand manufacturing services to customers through network and CMfg platforms. In CMfg system, task scheduling as an important means of finding suitable services for specific manufacturing tasks plays a key role in enhancing the system performance. Customers' requirements in CMfg are highly individualized, which leads to diverse manufacturing tasks in terms of execution flows and users' preferences. We focus on diverse manufacturing tasks and aim to address their scheduling issue in CMfg. First of all, a mathematical model of task scheduling is built based on analysis of the scheduling process in CMfg. To solve this scheduling problem, we propose a scheduling method aiming for diverse tasks, which enables each service demander to obtain desired manufacturing services. The candidate service sets are generated according to subtask directed graphs. An improved genetic algorithm is applied to searching for optimal task scheduling solutions. The effectiveness of the scheduling method proposed is verified by a case study with individualized customers' requirements. The results indicate that the proposed task scheduling method is able to achieve better performance than some usual algorithms such as simulated annealing and pattern search.
Hill, Duncan L.
Focusing on the current timetabling process at the University of Toronto Mississauga (UTM), I apply David Wesson's theoretical framework in order to understand (1) how increasing enrollment interacts with a decentralized timetabling process to limit the flexibility of course schedules and (2) the resultant impact on educational quality. I then…
Full Text Available Fuzzy based CPU scheduler has become of great interest by operating system because of its ability to handle imprecise information associated with task. This paper introduces an extension to the fuzzy based round robin scheduler to a Vague Logic Based Round Robin (VBRR scheduler. VBRR scheduler works on 2-layered framework. At the first layer, scheduler has a vague inference system which has the ability to handle the impreciseness of task using vague logic. At the second layer, Vague Logic Based Round Robin (VBRR scheduling algorithm works to schedule the tasks. VBRR scheduler has the learning capability based on which scheduler adapts intelligently an optimum length for time quantum. An optimum time quantum reduces the overhead on scheduler by reducing the unnecessary context switches which lead to improve the overall performance of system. The work is simulated using MATLAB and compared with the conventional round robin scheduler and the other two fuzzy based approaches to CPU scheduler. Given simulation analysis and results prove the effectiveness and efficiency of VBRR scheduler.
Yonemoto, Naohiro; Dowswell, Therese; Nagai, Shuko; Mori, Rintaro
involving different models of care (three studies), and home versus hospital clinic postnatal check-ups (four studies). In all but two of the included studies, postnatal care at home was delivered by healthcare professionals. The aim of all interventions was broadly to assess the wellbeing of mothers and babies, and to provide education and support, although some interventions had more specific aims such as to encourage breastfeeding, or to provide practical support.For most of our outcomes only one or two studies provided data, and overall results were inconsistent.There was no evidence that home visits were associated with improvements in maternal and neonatal mortality, and no consistent evidence that more postnatal visits at home were associated with improvements in maternal health. More intensive schedules of home visits did not appear to improve maternal psychological health and results from two studies suggested that women receiving more visits had higher mean depression scores. The reason for this finding was not clear. In a cluster randomised trial comparing usual care with individualised care by midwives extended up to three months after the birth, the proportions of women with Edinburgh postnatal depression scale (EPDS) scores ≥ 13 at four months was reduced in the individualised care group (RR 0.68, 95% CI 0.53 to 0.86). There was some evidence that postnatal care at home may reduce infant health service utilisation in the weeks following the birth, and that more home visits may encourage more women to exclusively breastfeed their babies. There was some evidence that home visits are associated with increased maternal satisfaction with postnatal care. Increasing the number of postnatal home visits may promote infant health and maternal satisfaction and more individualised care may improve outcomes for women, although overall findings in different studies were not consistent. The frequency, timing, duration and intensity of such postnatal care visits should be
Hayes, S C; Brownstein, A J; Haas, J R; Greenway, D E
Schedule sensitivity has usually been examined either through a multiple schedule or through changes in schedules after steady-state responding has been established. This study compared the effects of these two procedures when various instructions were given. Fifty-five college students responded in two 32-min sessions under a multiple fixed-ratio 18/differential-reinforcement-of-low-rate 6-s schedule, followed by one session of extinction. Some subjects received no instructions regarding the appropriate rates of responding, whereas others received instructions to respond slowly, rapidly, or both. Relative to the schedule in operation, the instructions were minimal, partially inaccurate, or accurate. When there was little schedule sensitivity in the multiple schedule, there was little in extinction. When apparently schedule-sensitive responding occurred in the multiple schedule, however, sensitivity in extinction occurred only if differential responding in the multiple schedule could not be due to rules supplied by the experimenter. This evidence shows that rule-governed behavior that occurs in the form of schedule-sensitive behavior may not in fact become schedule-sensitive even though it makes contact with the scheduled reinforcers.
Yarmohammadian, Mohammad H; Ebrahimipour, Hossein; Doosty, Farzaneh
In a world of continuously changing business environments, organizations have no option; however, to deal with such a big level of transformation in order to adjust the consequential demands. Therefore, many companies need to continually improve and review their processes to maintain their competitive advantages in an uncertain environment. Meeting these challenges requires implementing the most efficient possible business processes, geared to the needs of the industry and market segments that the organization serves globally. In the last 10 years, total quality management, business process reengineering, and business process management (BPM) have been some of the management tools applied by organizations to increase business competiveness. This paper is an original article that presents implementation of "BPM" approach in the healthcare domain that allows an organization to improve and review its critical business processes. This project was performed in "Qaem Teaching Hospital" in Mashhad city, Iran and consists of four distinct steps; (1) identify business processes, (2) document the process, (3) analyze and measure the process, and (4) improve the process. Implementing BPM in Qaem Teaching Hospital changed the nature of management by allowing the organization to avoid the complexity of disparate, soloed systems. BPM instead enabled the organization to focus on business processes at a higher level.
Day, G; Gardner, S; Herba, C
Like many other healthcare organizations today, the authors' facility, a 306-bed acute care community hospital in Michigan, strives to visualize and make a transition from traditional quality assurance to continuous quality improvement. The Juran Trilogy provided the insight that strategic planning, measurement, and continuous improvement must exist side by side. At the authors' facility, this realization resulted in the hospital quality plan, which treats each of these components as part of the foundation for quality. The authors explain this model and the reporting and communication mechanisms that support it.
Buddala, Raviteja; Mahapatra, Siba Sankar
Flexible flow shop (or a hybrid flow shop) scheduling problem is an extension of classical flow shop scheduling problem. In a simple flow shop configuration, a job having `g' operations is performed on `g' operation centres (stages) with each stage having only one machine. If any stage contains more than one machine for providing alternate processing facility, then the problem becomes a flexible flow shop problem (FFSP). FFSP which contains all the complexities involved in a simple flow shop and parallel machine scheduling problems is a well-known NP-hard (Non-deterministic polynomial time) problem. Owing to high computational complexity involved in solving these problems, it is not always possible to obtain an optimal solution in a reasonable computation time. To obtain near-optimal solutions in a reasonable computation time, a large variety of meta-heuristics have been proposed in the past. However, tuning algorithm-specific parameters for solving FFSP is rather tricky and time consuming. To address this limitation, teaching-learning-based optimization (TLBO) and JAYA algorithm are chosen for the study because these are not only recent meta-heuristics but they do not require tuning of algorithm-specific parameters. Although these algorithms seem to be elegant, they lose solution diversity after few iterations and get trapped at the local optima. To alleviate such drawback, a new local search procedure is proposed in this paper to improve the solution quality. Further, mutation strategy (inspired from genetic algorithm) is incorporated in the basic algorithm to maintain solution diversity in the population. Computational experiments have been conducted on standard benchmark problems to calculate makespan and computational time. It is found that the rate of convergence of TLBO is superior to JAYA. From the results, it is found that TLBO and JAYA outperform many algorithms reported in the literature and can be treated as efficient methods for solving the FFSP.
Janati, Ali; Sadeghi-Bazargani, Homayoun; Hasanpoor, Edris; Sokhanvar, Mobin; HaghGoshyie, Elaheh; Salehi, Abdollah
Hospital emergency management is a continuous process that requires monolithic integration of planning and response attempts with local and national schemes. The aim of the current study is to evaluate emergency response by hospitals against potential disasters in Tabriz, north-west Iran. A cross-sectional study was conducted in the city of Tabriz, in Iran, in 2016. The study population included all hospitals in Tabriz. A total of 18 hospitals were assessed. The hospital emergency response checklist was used to collect data. Tool components included command and control, communication, safety and security, triage, surge capacity, continuity of essential services, human resources, logistics and supply management, and post-disaster recovery. Data entry and analysis were carried out using SPSS software (version 20). The results showed that the emergency response rate of hospitals was 54.26% in Tabriz. The lowest response rates were for Shafaa hospital (18.89%) and the highest response rates were for Razi Hospital (91.67%). The components of hospital emergency response were assessed to be between 48.07% (surge capacity) and 58.95% (communication). On the basis of the World Health Organization checklist, the emergency response rate for hospitals in Tabriz was only 54.26%. Therefore, hospital emergency responses against disasters have to be improved and must be made to reach 100%. It is essential to design a comprehensive framework for hospital emergency response. (Disaster Med Public Health Preparedness. 2018;12:166-171).
Menahem, Sasson; Roitgarz, Ina; Shvartzman, Pesach
HospitaL admission is a crisis for the patient and his family and can interfere with the continuity of care. It may lead to mistakes due to communication problems between the primary care physician and the hospital medical staff. To explore the communication between the primary care physician, the hospital medical staff, the patient and his family during hospitalization. A total of 269 questionnaires were sent to all Clalit Health Services-South District, primary care physicians; 119 of these questionnaires (44.2%) were completed. Half of the primary care physicians thought that they should, always or almost always, have contact with the admitting ward in cases of internal medicine, oncology, surgery or pediatric admissions. However, the actual contact rate, according to their report, was only in a third of the cases. A telephone contact was more common than an actual visit of the patient in the ward. Computer communication between the hospital physicians and the primary care physicians is still insufficiently developed, although 96.6% of the primary care physicians check, with the aid of computer software, for information on their hospitalized patients. The main reasons to visit the hospitalized patient were severe medical conditions or uncertainty about the diagnosis; 79% of the physicians thought that visiting their patients strengthened the level of trust between them and their patients. There are sometimes communication difficulties and barriers between the primary care physicians and the ward's physicians due to partial information delivery and rejection from the hospital physicians. The main barriers for visiting admitted patients were workload and lack of pre-allocated time on the work schedule. No statistically significant differences were found between communication variables and primary care physician's personal and demographic characteristics. The communication between the primary care physician and the hospital physicians should be improved through
Djukic, Maja; Kovner, Christine T; Brewer, Carol S; Fatehi, Farida K; Bernstein, Ilya
We surveyed 2 cohorts of early-career registered nurses from 15 states in the US, 2 years apart, to compare their reported participation in hospital quality improvement (QI) activities. We anticipated differences between the 2 cohorts because of the growth of several initiatives for engaging nurses in QI. There were no differences between the 2 cohorts across 14 measured activities, except for their reported use of appropriate strategies to improve hand-washing compliance to reduce nosocomial infection rates.
Amaral-Garcia, Sofia; Bertoli, Paola; Grembi, Veronica
strategy exploits the exogenous location of public hospitals in court districts with and without schedules for noneconomic damages. We perform difference-in-differences and difference-in-discontinuities analyses. We find that the increase in medical malpractice pressure is associated with a decrease...... by the introduction of experience-rated malpractice liability insurance. Our identification strategy exploits the exogenous location of public hospitals in court districts with and without schedules for noneconomic damages. We perform difference-in-differences and difference-in-discontinuities analyses. We find...
Full Text Available ABSTRACT Shop Scheduling is an important factor affecting the efficiency of production, efficient scheduling method and a research and application for optimization technology play an important role for manufacturing enterprises to improve production efficiency, reduce production costs and many other aspects. Existing studies have shown that improved genetic algorithm has solved the limitations that existed in the genetic algorithm, the objective function is able to meet customers' needs for shop scheduling, and the future research should focus on the combination of genetic algorithm with other optimized algorithms. In this paper, in order to overcome the shortcomings of early convergence of genetic algorithm and resolve local minimization problem in search process,aiming at mixed flow shop scheduling problem, an improved cyclic search genetic algorithm is put forward, and chromosome coding method and corresponding operation are given.The operation has the nature of inheriting the optimal individual ofthe previous generation and is able to avoid the emergence of local minimum, and cyclic and crossover operation and mutation operation can enhance the diversity of the population and then quickly get the optimal individual, and the effectiveness of the algorithm is validated. Experimental results show that the improved algorithm can well avoid the emergency of local minimum and is rapid in convergence.
The Administrator of the Drug Enforcement Administration is issuing this temporary scheduling order to schedule the synthetic opioid, N-(4-fluorophenyl)-N-(1-phenethylpiperidin-4-yl)isobutyramide (4-fluoroisobutyryl fentanyl or para-fluoroisobutyryl fentanyl), and its isomers, esters, ethers, salts and salts of isomers, esters, and ethers, into schedule I pursuant to the temporary scheduling provisions of the Controlled Substances Act. This action is based on a finding by the Administrator that the placement of 4-fluoroisobutyryl fentanyl into schedule I of the Controlled Substances Act is necessary to avoid an imminent hazard to the public safety. As a result of this order, the regulatory controls and administrative, civil, and criminal sanctions applicable to schedule I controlled substances will be imposed on persons who handle (manufacture, distribute, reverse distribute, import, export, engage in research, conduct instructional activities or chemical analysis, or possess), or propose to handle, 4-fluoroisobutyryl fentanyl.
Meehan, Thomas P; Qazi, Daniel J; Van Hoof, Thomas J; Ho, Shih-Yieh; Eckenrode, Sheila; Spenard, Ann; Pandolfi, Michelle; Johnson, Florence; Quetti, Deborah
To describe and evaluate the impact of quality improvement (QI) support provided to skilled nursing facilities (SNFs) by a Quality Improvement Organization (QIO). Retrospective, mixed-method, process evaluation of a QI project intended to decrease preventable hospital readmissions from SNFs. Five SNFs in Connecticut. SNF Administrators, Directors of Nursing, Assistant Directors of Nursing, Admissions Coordinators, Registered Nurses, Certified Nursing Assistants, Receptionists, QIO Quality Improvement Consultant. QIO staff provided training and technical assistance to SNF administrative and clinical staff to establish or enhance QI infrastructure and implement an established set of QI tools [Interventions to Reduce Acute Care Transfers (INTERACT) tools]. Baseline SNF demographic, staffing, and hospital readmission data; baseline and follow-up SNF QI structure (QI Committee), processes (general and use of INTERACT tools), and outcome (30-day all-cause hospital readmission rates); details of QIO-provided training and technical assistance; QIO-perceived barriers to quality improvement; SNF leadership-perceived barriers, accomplishments, and suggestions for improvement of QIO support. Success occurred in establishing QI Committees and targeting preventable hospital readmissions, as well as implementing INTERACT tools in all SNFs; however, hospital readmission rates decreased in only 2 facilities. QIO staff and SNF leaders noted the ongoing challenge of engaging already busy SNF staff and leadership in QI activities. SNF leaders reported that they appreciated the training and technical assistance that their institutions received, although most noted that additional support was needed to bring about improvement in readmission rates. This process evaluation documented mixed clinical results but successfully identified opportunities to improve recruitment of and provision of technical support to participating SNFs. Recommendations are offered for others who wish to conduct
Dean, Dennis A; Forger, Daniel B; Klerman, Elizabeth B
Travel across multiple time zones results in desynchronization of environmental time cues and the sleep-wake schedule from their normal phase relationships with the endogenous circadian system. Circadian misalignment can result in poor neurobehavioral performance, decreased sleep efficiency, and inappropriately timed physiological signals including gastrointestinal activity and hormone release. Frequent and repeated transmeridian travel is associated with long-term cognitive deficits, and rodents experimentally exposed to repeated schedule shifts have increased death rates. One approach to reduce the short-term circadian, sleep-wake, and performance problems is to use mathematical models of the circadian pacemaker to design countermeasures that rapidly shift the circadian pacemaker to align with the new schedule. In this paper, the use of mathematical models to design sleep-wake and countermeasure schedules for improved performance is demonstrated. We present an approach to designing interventions that combines an algorithm for optimal placement of countermeasures with a novel mode of schedule representation. With these methods, rapid circadian resynchrony and the resulting improvement in neurobehavioral performance can be quickly achieved even after moderate to large shifts in the sleep-wake schedule. The key schedule design inputs are endogenous circadian period length, desired sleep-wake schedule, length of intervention, background light level, and countermeasure strength. The new schedule representation facilitates schedule design, simulation studies, and experiment design and significantly decreases the amount of time to design an appropriate intervention. The method presented in this paper has direct implications for designing jet lag, shift-work, and non-24-hour schedules, including scheduling for extreme environments, such as in space, undersea, or in polar regions.
Williams, R; Virtue, K; Adkins, A
Cancer therapy causes side effects that interfere with oral intake. Frequently, patients undergoing such therapy suffer from anorexia, nausea, vomiting, food aversions, dysgeusia, and xerostomia, all which adversely affect oral intake. Adequate nutrition intake is an important part of therapy for the cancer patient, especially when that patient is a child. Children who are well nourished are better able to withstand infection and tolerate therapy. Parents and staff at our hospital have worked diligently to improve patient's oral intake with limited success. Hence, a multidisciplinary team was organized to develop a new approach to food services that would improve patients' oral intake. The team initiated patient "room service," and patients were allowed to call the kitchen when they were ready to eat. The system works much like room service in a hotel. After the introduction of room service, patients' caloric intake improved significantly (P = .008), and protein intake increased by 18%. Patient satisfaction with hospital food service also improved; excellent ratings increased by as much as 35%. We conclude that room service is a viable alternative to traditional food services in the pediatric oncology setting and may be useful in other patient populations, such as maternity and general pediatrics.
El-Eid, Ghada R; Kaddoum, Roland; Tamim, Hani; Hitti, Eveline A
Delays in discharging patients can impact hospital and emergency department (ED) throughput. The discharge process is complex and involves setting specific challenges that limit generalizability of solutions. The aim of this study was to assess the effectiveness of using Six Sigma methods to improve the patient discharge process. This is a quantitative pre and post-intervention study. Three hundred and eighty-six bed tertiary care hospital. A series of Six Sigma driven interventions over a 10-month period. The primary outcome was discharge time (time from discharge order to patient leaving the room). Secondary outcome measures included percent of patients whose discharge order was written before noon, percent of patients leaving the room by noon, hospital length of stay (LOS), and LOS of admitted ED patients. Discharge time decreased by 22.7% from 2.2 hours during the preintervention period to 1.7 hours post-intervention (P Six Sigma methodology can be an effective change management tool to improve discharge time. The focus of institutions aspiring to tackle delays in the discharge process should be on adopting the core principles of Six Sigma rather than specific interventions that may be institution-specific.
4~4and overused statement but true nonrAýheless. Arid, if some- "thing is information fur one and not Cor another, what is it for the latter? It is...scheduling your projects, fantastic! Keep doing itl If you schedule your projects according to a combination of your horoscope , the stock market, and...hospital functions. It is true that knowledge of the tools used in the Systems Development Life Cycle can allow one to go into 4.. any setting and
Stapleton, F Bruder; Hendricks, James; Hagan, Patrick; DelBeccaro, Mark
The Toyota Production System (TPS) has become a successful model for improving efficiency and eliminating errors in manufacturing processes. In an effort to provide patients and families with the highest quality clinical care, our academic children's hospital has modified the techniques of the TPS for a program in continuous performance improvement (CPI) and has expanded its application to educational and research programs. Over a period of years, physicians, nurses, residents, administrators, and hospital staff have become actively engaged in a culture of continuous performance improvement. This article provides background into the methods of CPI and describes examples of how we have applied these methods for improvement in clinical care, resident teaching, and research administration.
Fox, Cherie; Wavra, Teresa; Drake, Diane Ash; Mulligan, Debbie; Bennett, Yvonne Pacheco; Nelson, Carla; Kirkwood, Peggy; Jones, Louise; Bader, Mary Kay
Critically ill patients are at marked risk of hospital-acquired infections, which increase patients' morbidity and mortality. Registered nurses are the main health care providers of physical care, including hygiene to reduce and prevent hospital-acquired infections, for hospitalized critically ill patients. To investigate a new patient hand hygiene protocol designed to reduce hospital-acquired infection rates and improve nurses' hand-washing compliance in an intensive care unit. A preexperimental study design was used to compare 12-month rates of 2 common hospital-acquired infections, central catheter-associated bloodstream infection and catheter-associated urinary tract infection, and nurses' hand-washing compliance measured before and during use of the protocol. Reductions in 12-month infection rates were reported for both types of infections, but neither reduction was statistically significant. Mean 12-month nurse hand-washing compliance also improved, but not significantly. A hand hygiene protocol for patients in the intensive care unit was associated with reductions in hospital-acquired infections and improvements in nurses' hand-washing compliance. Prevention of such infections requires continuous quality improvement efforts to monitor lasting effectiveness as well as investigation of strategies to eliminate these infections. ©2015 American Association of Critical-Care Nurses.
Li, Chunlong; Zhou, Jianzhong; Lu, Peng; Wang, Chao
Highlights: • Improved multi-objective gravitational search algorithm. • An elite archive set is proposed to guide evolutionary process. • Neighborhood searching mechanism to improve local search ability. • Adopt chaotic mutation for avoiding premature convergence. • Propose feasible space method to handle hydro plant constrains. - Abstract: With growing concerns about energy and environment, short-term economic environmental hydrothermal scheduling (SEEHS) plays a more and more important role in power system. Because of the two objectives and various constraints, SEEHS is a complex multi-objective optimization problem (MOOP). In order to solve the problem, we propose an improved multi-objective gravitational search algorithm (IMOGSA) in this paper. In IMOGSA, the mass of the agent is redefined by multiple objectives to make it suitable for MOOP. An elite archive set is proposed to keep Pareto optimal solutions and guide evolutionary process. For balancing exploration and exploitation, a neighborhood searching mechanism is presented to cooperate with chaotic mutation. Moreover, a novel method based on feasible space is proposed to handle hydro plant constraints during SEEHS, and a violation adjustment method is adopted to handle power balance constraint. For verifying its effectiveness, the proposed IMOGSA is applied to a hydrothermal system in two different case studies. The simulation results show that IMOGSA has a competitive performance in SEEHS when compared with other established algorithms
Yadav, Parikshit; Kumar, Rajesh; Panda, S.K.; Chang, C.S. [Department of Electrical and Computer Engineering, National University of Singapore, Singapore 117576 (Singapore)
Harmony Search (HS) algorithm is music based meta-heuristic optimization method which is analogous with the music improvisation process where musician continue to polish the pitches in order to obtain better harmony. The paper focuses on the optimal scheduling of the generators to reduce the fuel consumption in the oil rig platform. The accurate modeling of the specific fuel consumption is significant in this optimization. The specific fuel consumption has been modeled using cubic spline interpolation. The SFC curve is non-linear and discrete in nature, hence conventional methods fail to give optimal solution. HS algorithm has been used for optimal scheduling of the generators of both equal and unequal rating. Furthermore an Improved Harmony Search (IHS) method for generating new solution vectors that enhances accuracy and convergence rate of HS has been employed. The paper also focuses on the impacts of constant parameters on Harmony Search algorithm. Numerical results show that the IHS method has good convergence property. Moreover, the fuel consumption for IHS algorithm is lower when compared to HS and other heuristic or deterministic methods and is a powerful search algorithm for various engineering optimization problems. (author)
Yadav, Parikshit; Kumar, Rajesh; Panda, S.K.; Chang, C.S.
Harmony Search (HS) algorithm is music based meta-heuristic optimization method which is analogous with the music improvisation process where musician continue to polish the pitches in order to obtain better harmony. The paper focuses on the optimal scheduling of the generators to reduce the fuel consumption in the oil rig platform. The accurate modeling of the specific fuel consumption is significant in this optimization. The specific fuel consumption has been modeled using cubic spline interpolation. The SFC curve is non-linear and discrete in nature, hence conventional methods fail to give optimal solution. HS algorithm has been used for optimal scheduling of the generators of both equal and unequal rating. Furthermore an Improved Harmony Search (IHS) method for generating new solution vectors that enhances accuracy and convergence rate of HS has been employed. The paper also focuses on the impacts of constant parameters on Harmony Search algorithm. Numerical results show that the IHS method has good convergence property. Moreover, the fuel consumption for IHS algorithm is lower when compared to HS and other heuristic or deterministic methods and is a powerful search algorithm for various engineering optimization problems.
Zoch, David R.
Scheduling techniques in the ROSE are presented in the form of the viewgraphs. The following subject areas are covered: agenda; ROSE summary and history; NCC-ROSE task goals; accomplishments; ROSE timeline manager; scheduling concerns; current and ROSE approaches; initial scheduling; BFSSE overview and example; and summary.
Maynard, Gregory A; Holdych, Janet; Kendall, Heather; Harrison, Karen; Montgomery, Patricia A; Kulasa, Kristen
Safely improve glycemic control in the critical care units of nine hospitals. Critical care adult inpatients from nine hospitals with ≥4 point-of-care blood glucose (BG) readings over ≥2 days were targeted by collaborative improvement efforts to reduce hyper- and hypoglycemia. Balanced glucometric goals for each hospital were set targeting improvement from baseline or goals deemed desirable from Society of Hospital Medicine (SHM) benchmarking data. Collaborative interventions included standardized insulin infusion protocols, hypoglycemia prevention bundles, audit and feedback, education, and measure-vention (coupling measurement of patients "off protocol" with concurrent interventions to correct suboptimal care). All sites improved glycemic control. Six reached prespecified levels of improvement of the day-weighted mean BG. The day-weighted mean BG for the cohort decreased by 7.7 mg/dL (95% confidence interval [CI], 7.0 mg/dL to 8.4 mg/dL) to 151.3 mg/dL. Six of nine sites showed improvement in the percent intensive care unit (ICU) days with severe hyperglycemia (any BG >299 mg/dL). ICU severe hyperglycemic days declined from 8.6 to 7.2% for the cohort (relative risk, 0.84; 95% CI, 0.80 to 0.88). Patient days with any BG <70 mg/dL were reduced by 0.4% (95% CI, 0.06% to 0.6%), from 4.5 to 4.1%, for a small but statistically significant reduction in hypoglycemia. Seven of nine sites showed improvement. Multihospital improvements in ICU glycemic control, severe hyperglycemia, and hypoglycemia are feasible. Balanced goals for glycemic control and hypoglycemia in the ICU using SHM benchmarks and metrics enhanced successful improvement efforts with good staff acceptance and sustainability. BG = blood glucose CMI = case-mix index CY = calendar year DKA = diabetic ketoacidosis EMR = electronic medical record GBMF = Gordon and Betty Moore Foundation ICU = intensive care unit IIP = insulin infusion protocol SHM = Society of z Hospital Medicine.
Twelve-hour scheduling has been a mainstay of the petrochemical industry, is common in the papermill industry, and is relatively new to the nuclear utility industry. A review of industry experiences, research, and a federal Nuclear Regulatory Commission (NRC) study of the 12-hour shift (NUREG/CR-4248) demonstrate that the advantages outweigh the disadvantages. The primary advantages are greater job satisfaction, fewer errors, and the better communications inherent in two shift turnovers versus three. Several companies that implemented the 12-hour shift found an increase in employee morale, no adverse effect on worker health, and no decline in safety. They experienced greater productivity, fewer operator errors, and better communication
Callie M. Cox Bauer
Full Text Available Purpose: Operating room delays decrease health care system efficiency and increase costs. To improve operating room efficiency in our system, we retrospectively investigated delay frequencies, causes and costs. Methods: We studied all first-of-the-day nonemergent surgical cases performed at three high-volume urban hospitals of a large health system from July 2012 to November 2013. Times for patient flow from arrival to procedure start and documented reasons for delay were obtained from electronic medical records. Delay was defined as patient placement in the operating room later than scheduled surgery time. Effects of patient characteristics, late patient arrival to the hospital, number of planned procedures, years of surgeon experience, service department and hospital facility on odds of delay were examined using logistic regression. Results: Of 5,598 cases examined, 88% were delayed. Patients arrived late to the hospital (surgery in 65% of first cases. Mean time from arrival to scheduled surgery and in-room placement was 104.6 and 127.4 minutes, respectively. Mean delay time was 28.2 minutes. Nearly 60% of delayed cases had no documented reason for delay. For cases with documentation, causes included the physician (52%, anesthesia (15%, patient (13%, staff (9%, other sources (6% and facility (5%. Regression analysis revealed age, late arrival, department and facility as significant predictors of delay. Estimated delay costs, based on published figures and representing lost revenue, were $519,388. Conclusions: To improve operating room efficiency, multidisciplinary strategies are needed for increasing patient adherence to recommended arrival times, documentation of delay by medical staff and consistency in workflow patterns among facilities and departments.
Zaghi, Justin; Zhou, Jing; Graham, Dionne A; Potter-Bynoe, Gail; Sandora, Thomas J
Stethoscopes are contaminated with pathogenic bacteria and pose a risk for transmission of infections, but few clinicians disinfect their stethoscope after every use. We sought to improve stethoscope disinfection rates among pediatric healthcare providers by providing access to disinfection materials and visual reminders to disinfect stethoscopes. Prospective intervention study. Inpatient units and emergency department of a major pediatric hospital. Physicians and nurses with high anticipated stethoscope use. Baskets filled with alcohol prep pads and a sticker reminding providers to regularly disinfect stethoscopes were installed outside of patient rooms. Healthcare providers' stethoscope disinfection behaviors were directly observed before and after the intervention. Multivariable logistic regression models were created to identify independent predictors of stethoscope disinfection. Two hundred twenty-six observations were made in the preintervention period and 261 in the postintervention period (83% were of physicians). Stethoscope disinfection compliance increased significantly from a baseline of 34% to 59% postintervention (P stethoscope disinfection supplies and visible reminders outside of patient rooms significantly increased stethoscope disinfection rates among physicians and nurses at a children's hospital. This simple intervention could be replicated at other healthcare facilities. Future research should assess the impact on patient infections.
Full Text Available Wireless sensor networks (WSNs have been widely used in industrial systems. Their real-time performance and reliability are fundamental to industrial production. Many works have studied the two aspects, but only focus on single criticality WSNs. Mixed criticality requirements exist in many advanced applications in which different data flows have different levels of importance (or criticality. In this paper, first, we propose a scheduling algorithm, which guarantees the real-time performance and reliability requirements of data flows with different levels of criticality. The algorithm supports centralized optimization and adaptive adjustment. It is able to improve both the scheduling performance and flexibility. Then, we provide the schedulability test through rigorous theoretical analysis. We conduct extensive simulations, and the results demonstrate that the proposed scheduling algorithm and analysis significantly outperform existing ones.
Adler-Milstein, Julia; Woody Scott, Kirstin; Jha, Ashish K
Recent studies fail to find a consistent relationship between adoption of electronic health records (EHRs) and improved hospital performance. We sought to examine whether the quality of hospital management modifies the association between EHR adoption and outcomes related to cost and quality. Retrospective study of a random sample of US acute care hospitals. Management quality was assessed via phone interviews with clinical managers predominantly from cardiac units in a random sample of 325 hospitals using a validated scale of management practices in 4 areas: operations, performance monitoring, target setting, and talent management. American Hospital Association InformationTechnology Supplement data captured whether or not these hospitals had at least a basic EHR. Acute myocardial infarction (AMI) outcomes included risk-adjusted 30-day mortality, average length-of-stay, and average payment per discharge measured using MedPAR data. Ordinary least squares regressions assessed whether management quality modifies the relationship between EHR adoption and AMI outcomes. While we found no association between EHR adoption and our outcomes, management quality modified the relationship in the predicted direction. For length of stay, the coefficient on the interaction between EHR and management was -1.48 (P = .05) and for payment, it was -7786.74 (P = .014). We did not find strong evidence of effect modification for mortality (coefficient = -0.05; P = .37). Coupled with ongoing policy efforts to achieve nationwide EHR adoption is a growing unease that our national investment may not result in better, more efficient care. Our study is among the first to offer empirical evidence that management quality may help explain why some hospitals see substantial gains from EHR adoption while others do not.
Bosse, Goetz; Mtatifikolo, Ferdinand; Abels, Wiltrud; Strosing, Christian; Breuer, Jan-Philipp; Spies, Claudia
Outcome assessment is the standard for evaluating the quality of health services worldwide. In this study, outcome has been divided into immediate and final outcome. Aim was to compare an intervention hospital with a Continuous Quality Improvement approach to a control group using benchmark assessments of immediate outcome indicators in surgical care. Results were compared to final outcome indicators. Surgical care quality in six hospitals in Tanzania was assessed from 2006-2011, using the Hospital Performance Assessment Tool. Independent observers assessed structural, process and outcome quality using checklists based on evidence-based guidelines. The number of surgical key procedures over the benchmark of 80% was compared between the intervention hospital and the control group. Results were compared to Case Fatality Rates. In the intervention hospital, in 2006, two of nine key procedures reached the benchmark, one in 2009, and four in 2011. In the control group, one of nine key procedures reached the benchmark in 2006, one in 2009, and none in 2011. Case Fatality Rate for all in-patients in the intervention hospital was 5.5% (n = 12,530) in 2006, 3.5% (n = 21,114) in 2009 and 4.6% (n = 18,840) in 2011. In the control group it was 3.1% (n = 17,827) in 2006, 4.2% (n = 13,632) in 2009 and 3.8% (n = 17,059) in 2011. Results demonstrated that quality assurance improved performance levels in both groups. After the introduction of Continuous Quality Improvement, performance levels improved further in the intervention hospital while quality in the district hospital did not. Immediate outcome indicators appeared to be a better steering tool for quality improvement compared to final outcome indicators. Immediate outcome indicators revealed a need for improvement in pre- and postoperative care. Quality assurance programs based on immediate outcome indicators can be effective if embedded in Continuous Quality Improvement. Nevertheless, final outcome
Corral Baena, S; Garabito Sánchez, M J; Ruíz Rómero, M V; Vergara Díaz, M A; Martín Chacón, E R; Fernández Moyano, A
To assess the impact of a software application to improve the quality of information concerning current patient medications and changes on the discharge report after hospitalization. To analyze the incidence of errors and to classify them. Quasi-experimental pre / post study with non-equivalent control group study. Medical patients at hospital discharge. implementation of a software application. Percentage of reconciled patient medication on discharge, and percentage of patients with more than one unjustified discrepancy. A total of 349 patients were assessed; 199 (pre-intervention phase) and 150 (post-intervention phase). Before the implementation of the application in 157 patients (78.8%) medication reconciliation had been completed; finding reconciliation errors in 99 (63.0%). The most frequent type of error, 339 (78.5%), was a missing dose or administration frequency information. After implementation, all the patient prescriptions were reconciled when the software was used. The percentage of patients with unjustified discrepancies decreased from 63.0% to 11.8% with the use of the application (psoftware application has been shown to improve the quality of the information on patient treatment on the hospital discharge report, but it is still necessary to continue development as a strategy for improving medication reconciliation. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.
Yousefinezhadi, Taraneh; Mohamadi, Efat; Safari Palangi, Hossein; Akbari Sari, Ali
This study aimed to explore the effect of the International Organization for Standardization (ISO) ISO 9001 standard and the European foundation for quality management (EFQM) model on improving hospital performance. PubMed, Embase and the Cochrane Library databases were searched. In addition, Elsevier and Springer were searched as main publishers in the field of health sciences. We included empirical studies with any design that had used ISO 9001 or the EFQM model to improve the quality of healthcare. Data were collected and tabulated into a data extraction sheet that was specifically designed for this study. The collected data included authors' names, country, year of publication, intervention, improvement aims, setting, length of program, study design, and outcomes. Seven out of the 121 studies that were retrieved met the inclusion criteria. Three studies assessed the EFQM model and four studies assessed the ISO 9001 standard. Use of the EFQM model increased the degree of patient satisfaction and the number of hospital admissions and reduced the average length of stay, the delay on the surgical waiting list, and the number of emergency re-admissions. ISO 9001 also increased the degree of patient satisfaction and patient safety, increased cost-effectiveness, improved the hospital admissions process, and reduced the percentage of unscheduled returns to the hospital. Generally, there is a lack of robust and high quality empirical evidence regarding the effects of ISO 9001 and the EFQM model on the quality care provided by and the performance of hospitals. However, the limited evidence shows that ISO 9001 and the EFQM model might improve hospital performance.
Silvestre, Maria Asuncion A; Mannava, Priya; Corsino, Marie Ann; Capili, Donna S; Calibo, Anthony P; Tan, Cynthia Fernandez; Murray, John C S; Kitong, Jacqueline; Sobel, Howard L
To determine whether intrapartum and newborn care practices improved in 11 large hospitals between 2008 and 2015. Secondary data analysis of observational assessments conducted in 11 hospitals in 2008 and 2015. Eleven large government hospitals from five regions in the Philippines. One hundred and seven randomly sampled postpartum mother-baby pairs in 2008 and 106 randomly sampled postpartum mothers prior to discharge from hospitals after delivery. A national initiative to improve quality of newborn care starting in 2009 through development of a standard package of intrapartum and newborn care services, practice-based training, formation of multidisciplinary hospital working groups, and regular assessments and meetings in hospitals to identify actions to improve practices, policies and environments. Quality improvement was supported by policy development, health financing packages, health facility standards, capacity building and health communication. Sixteen intrapartum and newborn care practices. Between 2008 and 2015, initiation of drying within 5 s of birth, delayed cord clamping, dry cord care, uninterrupted skin-to-skin contact, timing and duration of the initial breastfeed, and bathing deferred until 6 h after birth all vastly improved (P<0.001). The proportion of newborns receiving hygienic cord handling and the hepatitis B birth dose decreased by 11-12%. Except for reduced induction of labor, inappropriate maternal care practices persisted. Newborn care practices have vastly improved through an approach focused on improving hospital policies, environments and health worker practices. Maternal care practices remain outdated largely due to the ineffective didactic training approaches adopted for maternal care.
McCormick, Felicia M; Tosh, Karen; McGuire, William
Scheduled interval feeding of prescribed enteral volumes is current standard practice for preterm infants. However, feeding preterm infants in response to their hunger and satiation cues (ad libitum or demand/semi demand) rather than at scheduled intervals might help in the establishment of independent oral feeding, increase nutrient intake and growth rates, and allow earlier hospital discharge. To assess the effect of a policy of feeding preterm infants on an ad libitum or demand/semi-demand basis versus feeding prescribed volumes at scheduled intervals on growth rates and the time to hospital discharge. We used the standard search strategy of the Cochrane Neonatal Review Group. This included searches of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4, 2009), MEDLINE (1966 to Oct 2009), EMBASE (1980 to Oct 2009), CINAHL (1982 to Oct 2009), conference proceedings, and previous reviews. Randomised or quasi-randomised controlled trials (including cluster randomised trials) that compared a policy of feeding preterm infants on an ad libitum or demand/semi-demand basis versus feeding at scheduled intervals. We used the standard methods of the Cochrane Neonatal Review Group with separate evaluation of trial quality and data extraction by two review authors. We found eight randomised controlled trials that compared ad libitum or demand/semi-demand regimens with scheduled interval regimes in preterm infants in the transition phase from intragastric tube to oral feeding. The trials were generally small and of variable methodological quality. The duration of the intervention and the duration of data collection and follow-up in most of the trials was not likely to have allowed detection of measurable effects on growth. Three trials reported that feeding preterm infants using an ad libitum or demand/semi-demand feeding regimen allowed earlier discharge from hospital (by about two to four days) but other trials did not confirm this
Full Text Available Data Grids deal with geographically-distributed large-scale data-intensive applications. Schemes scheduled for data grids attempt to not only improve data access time, but also aim to improve the ratio of data availability to a node, where the data requests are generated. Data replication techniques manage large data by storing a number of data files efficiently. In this paper, we propose centralized dynamic scheduling strategy-replica placement strategies (CDSS-RPS. CDSS-RPS schedule the data and task so that it minimizes the implementation cost and data transfer time. CDSS-RPS consists of two algorithms, namely (a centralized dynamic scheduling (CDS and (b replica placement strategy (RPS. CDS considers the computing capacity of a node and finds an appropriate location for the job. RPS attempts to improve file access time by using replication on the basis of number of accesses, storage capacity of a computing node, and response time of a requested file. Extensive simulations are carried out to demonstrate the effectiveness of the proposed strategy. Simulation results demonstrate that the replication and scheduling strategies improve the implementation cost and average access time significantly.
Lindhard, Søren; Wandahl, Søren
Scheduling in onsite construction is based on commitments. Unmet commitments result in non-completions which leads to waste. Moreover, it is important that commitments are realistic to avoid both positive and negative variation in duration. Negative variation is destructive to plans and schedules...... and results in delays, while positive variation is destructive to productivity by creating unexploited gaps between activities, thus inducing unexploited capacity. By registering non-completion at three construction sites, the magnitude of activities inducing negative variation has been mapped. In total, 5424...
For years now, rationalization has been the prime goal that put hospitals under pressure to establish appropriate procedures. Work scheduling is of great significance in this context, especially in the light of modified framework conditions of the hospital's financing terms. The book in hand comprehensively discusses the problem of patient flow control, which has to serve two somewhat contradictory purposes, namely to achieve best possible capacity utilization in terms of equipment and personnel, and shortest possible waiting time for patients. The contributions offered by methods of the quantitative operations analysis for problem solving are set forth, as well as the role of computerized information systems in patient-related work scheduling. As both approaches reveal considerable weak points, a concept is presented that aims at integrating patient-related appointment methods into hospital information systems. The concept is explained by the example of a radiology department. Some scheduling heuristics are set up and are verified by empirical data. (orig./HSCH) [de
Full Text Available Mobile cloud computing (MCC combines cloud computing and mobile internet to improve the computational capabilities of resource-constrained mobile devices (MDs. In MCC, mobile users could not only improve the computational capability of MDs but also save operation consumption by offloading the mobile applications to the cloud. However, MCC faces the problem of energy efficiency because of time-varying channels when the offloading is being executed. In this paper, we address the issue of energy-efficient scheduling for wireless uplink in MCC. By introducing Lyapunov optimization, we first propose a scheduling algorithm that can dynamically choose channel to transmit data based on queue backlog and channel statistics. Then, we show that the proposed scheduling algorithm can make a tradeoff between queue backlog and energy consumption in a channel-aware MCC system. Simulation results show that the proposed scheduling algorithm can reduce the time average energy consumption for offloading compared to the existing algorithm.
Decreases Hospital Stay, Improves Mental Health , and Physical Performance 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Oscar E. Suman, PhD...Multicenter Study of the Effect of In-Patient Exercise Training on Length of Hospitalization, Mental Health , and Physical Performance in Burned...Intensive Care Unit Decreases Hospital Stay, Improves Mental Health , and Physical Performance,” Proposal Log Number 13214039, Award Number W81XWH-14
Cromwell, Susan; Chiasson, David A; Cassidy, Debra; Somers, Gino R
The autopsy is an integral part of the service of a large academic pathology department. Timely reporting is central to providing good service and is beneficial for many stakeholders, including the families, the clinical team, the hospital, and the wider community. The current study aimed to improve hospital-consented autopsy reporting times (turnaround time, TAT) by using lean principles modified for a healthcare setting, with an aim of signing out 90% of autopsies in 90 days. An audit of current and historical TATs was performed, and a working group incorporating administrative, technical, and professional staff constructed a value stream map documenting the steps involved in constructing an autopsy report. Two areas of delay were noted: examination of the microscopy and time taken to sign-out the report after the weekly autopsy conference. Several measures were implemented to address these delays, including visual tracking using a whiteboard and individualized tracking sheets, weekly whiteboard huddles, and timelier scheduling of clinicopathologic conference rounds. All measures resulted in an improvement of TATs. In the 30 months prior to the institution of lean, 37% of autopsies (53/144) were signed out in 90 days, with a wide variation in reporting times. In the 30 months following the institution of lean, this improved to 74% (136/185) ( P lean; 63 days post-lean). The application of lean principles to autopsy sign-out workflow can significantly improve TATs and reduce variability, without changing staffing levels or significantly altering scheduling structure.
Dennis A Dean
Full Text Available Travel across multiple time zones results in desynchronization of environmental time cues and the sleep-wake schedule from their normal phase relationships with the endogenous circadian system. Circadian misalignment can result in poor neurobehavioral performance, decreased sleep efficiency, and inappropriately timed physiological signals including gastrointestinal activity and hormone release. Frequent and repeated transmeridian travel is associated with long-term cognitive deficits, and rodents experimentally exposed to repeated schedule shifts have increased death rates. One approach to reduce the short-term circadian, sleep-wake, and performance problems is to use mathematical models of the circadian pacemaker to design countermeasures that rapidly shift the circadian pacemaker to align with the new schedule. In this paper, the use of mathematical models to design sleep-wake and countermeasure schedules for improved performance is demonstrated. We present an approach to designing interventions that combines an algorithm for optimal placement of countermeasures with a novel mode of schedule representation. With these methods, rapid circadian resynchrony and the resulting improvement in neurobehavioral performance can be quickly achieved even after moderate to large shifts in the sleep-wake schedule. The key schedule design inputs are endogenous circadian period length, desired sleep-wake schedule, length of intervention, background light level, and countermeasure strength. The new schedule representation facilitates schedule design, simulation studies, and experiment design and significantly decreases the amount of time to design an appropriate intervention. The method presented in this paper has direct implications for designing jet lag, shift-work, and non-24-hour schedules, including scheduling for extreme environments, such as in space, undersea, or in polar regions.
Flexible work schedules give nurses the freedom and control to manage the demands of work and home, allow organisations to meet their staffing needs and can improve job satisfaction. This article reports the results of an integrative review of published peer-reviewed research and personal narratives that examined nurses' perceptions of the relationship between job satisfaction and a self-scheduling system. Results suggest that self-scheduling is one of a number of factors that influence job satisfaction, but that implementing and sustaining such a system can be challenging. The review also found that self-scheduling programmes underpin more flexible work schedules and can benefit nurses and their organisations.
Chen, Tao; Li, Jiawen; Jin, Ping; Cai, Guobiao
This paper deals with the preventive maintenance (PM) scheduling problem of reusable rocket engine (RRE), which is different from the ordinary repairable systems, by genetic algorithm. Three types of PM activities for RRE are considered and modeled by introducing the concept of effective age. The impacts of PM on all subsystems' aging processes are evaluated based on improvement factor model. Then the reliability of engine is formulated by considering the accumulated time effect. After that, optimization model subjected to reliability constraint is developed for RRE PM scheduling at fixed interval. The optimal PM combination is obtained by minimizing the total cost in the whole life cycle for a supposed engine. Numerical investigations indicate that the subsystem's intrinsic reliability characteristic and the improvement factor of maintain operations are the most important parameters in RRE's PM scheduling management
In this thesis we consider production planning and scheduling in refinery industry, in particular we study the planning and scheduling at the Nynaes AB refinery and at the Scanraff AB refinery. The purpose is to contribute to the development and the use of optimization models to support efficient decision making. We identify various decision problems concerning the aggregated production planning, the shipment planning, the scheduling of operation modes, and the utilization of pipes and tanks; and we discuss the potential to successfully apply optimization models on these problems. We formulate a mixed integer linear programming model for the scheduling of operation modes at Nynaes. The model concerns decisions about which mode of operation to use at a particular point in time in order to minimize costs of changing modes and costs of keeping inventories, given demands for products. We derive several types of valid inequalities for this mathematical problem and show how these inequalities can improve the lower bound obtained from the linear programming relaxation of the problem. We also show how the valid inequalities can be used to improve the performance of a branch and bound solution approach. Further, a tabu search heuristic is developed for the scheduling problem. The solution methods are tested on data provided by the Nynaes refinery, and the performance of the methods are discussed. We present several extensions of the proposed model, and illustrate how the model can be used to support both operational and strategic decision making at the refinery. 66 refs, 6 figs, 32 tabs. Also published as: Dissertation from the International Graduate School of Management and Industrial Engineering, No 25, Licenciate Thesis
In this thesis we consider production planning and scheduling in refinery industry, in particular we study the planning and scheduling at the Nynaes AB refinery and at the Scanraff AB refinery. The purpose is to contribute to the development and the use of optimization models to support efficient decision making. We identify various decision problems concerning the aggregated production planning, the shipment planning, the scheduling of operation modes, and the utilization of pipes and tanks; and we discuss the potential to successfully apply optimization models on these problems. We formulate a mixed integer linear programming model for the scheduling of operation modes at Nynaes. The model concerns decisions about which mode of operation to use at a particular point in time in order to minimize costs of changing modes and costs of keeping inventories, given demands for products. We derive several types of valid inequalities for this mathematical problem and show how these inequalities can improve the lower bound obtained from the linear programming relaxation of the problem. We also show how the valid inequalities can be used to improve the performance of a branch and bound solution approach. Further, a tabu search heuristic is developed for the scheduling problem. The solution methods are tested on data provided by the Nynaes refinery, and the performance of the methods are discussed. We present several extensions of the proposed model, and illustrate how the model can be used to support both operational and strategic decision making at the refinery. 66 refs, 6 figs, 32 tabs. Also published as: Dissertation from the International Graduate School of Management and Industrial Engineering, No 25, Licenciate Thesis.
In this thesis we consider production planning and scheduling in refinery industry, in particular we study the planning and scheduling at the Nynaes AB refinery and at the Scanraff AB refinery. The purpose is to contribute to the development and the use of optimization models to support efficient decision making. We identify various decision problems concerning the aggregated production planning, the shipment planning, the scheduling of operation modes, and the utilization of pipes and tanks; and we discuss the potential to successfully apply optimization models on these problems. We formulate a mixed integer linear programming model for the scheduling of operation modes at Nynaes. The model concerns decisions about which mode of operation to use at a particular point in time in order to minimize costs of changing modes and costs of keeping inventories, given demands for products. We derive several types of valid inequalities for this mathematical problem and show how these inequalities can improve the lower bound obtained from the linear programming relaxation of the problem. We also show how the valid inequalities can be used to improve the performance of a branch and bound solution approach. Further, a tabu search heuristic is developed for the scheduling problem. The solution methods are tested on data provided by the Nynaes refinery, and the performance of the methods are discussed. We present several extensions of the proposed model, and illustrate how the model can be used to support both operational and strategic decision making at the refinery. 66 refs, 6 figs, 32 tabs. Also published as: Dissertation from the International Graduate School of Management and Industrial Engineering, No 25, Licenciate Thesis
United States. Bonneville Power Administration.
This schedule is available for the contract purchase of Firm Power to be used within the Pacific Northwest (PNW). Priority Firm (PF) Power may be purchased by public bodies, cooperatives, and Federal agencies for resale to ultimate consumers, for direct consumption, and for Construction, Test and Start-Up, and Station Service. Rates in this schedule are in effect beginning October 1, 2006, and apply to purchases under requirements Firm Power sales contracts for a three-year period. The Slice Product is only available for public bodies and cooperatives who have signed Slice contracts for the FY 2002-2011 period. Utilities participating in the Residential Exchange Program (REP) under Section 5(c) of the Northwest Power Act may purchase Priority Firm Power pursuant to the Residential Exchange Program. Rates under contracts that contain charges that escalate based on BPA's Priority Firm Power rates shall be based on the three-year rates listed in this rate schedule in addition to applicable transmission charges. This rate schedule supersedes the PF-02 rate schedule, which went into effect October 1, 2001. Sales under the PF-07 rate schedule are subject to BPA's 2007 General Rate Schedule Provisions (2007 GRSPs). Products available under this rate schedule are defined in the 2007 GRSPs. For sales under this rate schedule, bills shall be rendered and payments due pursuant to BPA's 2007 GRSPs and billing process.
McCreary, Jason; Hausman, Charles
Despite the popularity of schedule modifications as a cost-effective reform to improve student outcomes, little empirical research on the consequences of alternative schedules has been conducted. The literature has been dominated by anecdotal reports. Even when empirical evidence is examined, causal comparisons of school outcomes between schedules…
Good sleep is advantageous to the quality of life. Sleep-related benefits are particularly helpful for the working class, since poor or inadequate amounts of sleep degrade work productivity and overall health. This review paper explores the essential role of sleep in healthy work schedules and primarily focuses on the timing of sleep in relation to the work period (that is, before, during and after work). Data from laboratory, field and modeling studies indicate that consistent amounts of sleep prior to work are fundamental to improved performance and alertness in the workplace. In addition, planned naps taken during work maintain appropriate levels of waking function for both daytime and night-time work. Clearly, sufficient sleep after work is vital in promoting recovery from fatigue. Recent data also suggest that the time interval between shifts should be adjusted according to the biological timing of sleep. Although sleep is more likely to be replaced by job and other activities in the real life, research shows that it is worthwhile to revise the work schedules in order to optimize sleep before, sometime during and after the work period. Therefore, we suggest establishing work-sleep balance, similar to work-life balance, as a principle for designing and improving work schedules. PMID:22738292
Full Text Available Abstract Good sleep is advantageous to the quality of life. Sleep-related benefits are particularly helpful for the working class, since poor or inadequate amounts of sleep degrade work productivity and overall health. This review paper explores the essential role of sleep in healthy work schedules and primarily focuses on the timing of sleep in relation to the work period (that is, before, during and after work. Data from laboratory, field and modeling studies indicate that consistent amounts of sleep prior to work are fundamental to improved performance and alertness in the workplace. In addition, planned naps taken during work maintain appropriate levels of waking function for both daytime and night-time work. Clearly, sufficient sleep after work is vital in promoting recovery from fatigue. Recent data also suggest that the time interval between shifts should be adjusted according to the biological timing of sleep. Although sleep is more likely to be replaced by job and other activities in the real life, research shows that it is worthwhile to revise the work schedules in order to optimize sleep before, sometime during and after the work period. Therefore, we suggest establishing work-sleep balance, similar to work-life balance, as a principle for designing and improving work schedules.
Good sleep is advantageous to the quality of life. Sleep-related benefits are particularly helpful for the working class, since poor or inadequate amounts of sleep degrade work productivity and overall health. This review paper explores the essential role of sleep in healthy work schedules and primarily focuses on the timing of sleep in relation to the work period (that is, before, during and after work). Data from laboratory, field and modeling studies indicate that consistent amounts of sleep prior to work are fundamental to improved performance and alertness in the workplace. In addition, planned naps taken during work maintain appropriate levels of waking function for both daytime and night-time work. Clearly, sufficient sleep after work is vital in promoting recovery from fatigue. Recent data also suggest that the time interval between shifts should be adjusted according to the biological timing of sleep. Although sleep is more likely to be replaced by job and other activities in the real life, research shows that it is worthwhile to revise the work schedules in order to optimize sleep before, sometime during and after the work period. Therefore, we suggest establishing work-sleep balance, similar to work-life balance, as a principle for designing and improving work schedules.
The topic of this book is known as dynamic scheduling, and is used to refer to three dimensions of project management and scheduling: the construction of a baseline schedule and the analysis of a project schedule's risk as preparation of the project control phase during project progress. This dynamic scheduling point of view implicitly assumes that the usability of a project's baseline schedule is rather limited and only acts as a point of reference in the project life cycle.
Aarts, E.H.L.; Lenstra, J.K.; Laarhoven, van P.J.M.; Ulder, N.L.J.
We present a computational performance analysis of local search algorithms for job shop scheduling. The algorithms under investigation are iterative improvement, simulated annealing, threshold accepting and genetic local search. Our study shows that simulated annealing performs best in the sense
Adair, Jerry R.
This paper is a consolidated report on ten major planning and scheduling systems that have been developed by the National Aeronautics and Space Administration (NASA). A description of each system, its components, and how it could be potentially used in private industry is provided in this paper. The planning and scheduling technology represented by the systems ranges from activity based scheduling employing artificial intelligence (AI) techniques to constraint based, iterative repair scheduling. The space related application domains in which the systems have been deployed vary from Space Shuttle monitoring during launch countdown to long term Hubble Space Telescope (HST) scheduling. This paper also describes any correlation that may exist between the work done on different planning and scheduling systems. Finally, this paper documents the lessons learned from the work and research performed in planning and scheduling technology and describes the areas where future work will be conducted.
Amar N. Katre
Full Text Available Introduction. The practice of modern pediatric dentistry requires delivery of quality care in combination with adherence to excellent business as well as time management principles. A definite appointment schedule should be presented to the parents on the first or second appointment. More importantly, the prescribed schedule should be followed to the best of the professional abilities of the pediatric dentist. Aims. The aim of the study was to assess the co-relation between appointment scheduling and patient satisfaction in a pediatric dental setup with the objective of understanding the parameters related to appointment scheduling to increase patient satisfaction. Method. A total of 40 patients, who visited the Department of Pediatric and Preventive Dentistry, YMT Dental College & Hospital, for dental treatment were selected on a random basis. A questionnaire with a set of 6 questions with a rating scale of 1–5 to assess the patient satisfaction related to appointment scheduling was prepared. Results. A significant number of the patients were happy with the existing appointment scheduling system barring a few exceptions.
.../or continuing information collections, as required by the Paperwork Reduction Act of 1995, Public Law... Income, Credits, Deductions and Other Items), Schedule L (Balance Sheets per Books), Schedule M-1 (Reconciliation of Income (Loss) per Books With Income (Loss) per Return)), Schedule M-2 (Analysis of Partners...
In this paper, we propose an effective mutation operators for Cooperative Genetic Algorithm (CGA) to be applied to a practical Nurse Scheduling Problem (NSP). The nurse scheduling is a very difficult task, because NSP is a complex combinatorial optimizing problem for which many requirements must be considered. In real hospitals, the schedule changes frequently. The changes of the shift schedule yields various problems, for example, a fall in the nursing level. We describe a technique of the reoptimization of the nurse schedule in response to a change. The conventional CGA is superior in ability for local search by means of its crossover operator, but often stagnates at the unfavorable situation because it is inferior to ability for global search. When the optimization stagnates for long generation cycle, a searching point, population in this case, would be caught in a wide local minimum area. To escape such local minimum area, small change in a population should be required. Based on such consideration, we propose a mutation operator activated depending on the optimization speed. When the optimization stagnates, in other words, when the optimization speed decreases, the mutation yields small changes in the population. Then the population is able to escape from a local minimum area by means of the mutation. However, this mutation operator requires two well-defined parameters. This means that user have to consider the value of these parameters carefully. To solve this problem, we propose a periodic mutation operator which has only one parameter to define itself. This simplified mutation operator is effective over a wide range of the parameter value.
Richards, Stephen F.
Although computerized operations have significant gains realized in many areas, one area, scheduling, has enjoyed few benefits from automation. The traditional methods of industrial engineering and operations research have not proven robust enough to handle the complexities associated with the scheduling of realistic problems. To address this need, NASA has developed the computer-aided scheduling system (COMPASS), a sophisticated, interactive scheduling tool that is in wide-spread use within NASA and the contractor community. Therefore, COMPASS provides no explicit support for the large class of problems in which several people, perhaps at various locations, build separate schedules that share a common pool of resources. This research examines the issue of distributing scheduling, as applied to application domains characterized by the partial ordering of tasks, limited resources, and time restrictions. The focus of this research is on identifying issues related to distributed scheduling, locating applicable problem domains within NASA, and suggesting areas for ongoing research. The issues that this research identifies are goals, rescheduling requirements, database support, the need for communication and coordination among individual schedulers, the potential for expert system support for scheduling, and the possibility of integrating artificially intelligent schedulers into a network of human schedulers.
Fox, Lindsay Anne; Walsh, Kathleen E; Schainker, Elisabeth G
Leaders of pediatric hospital medicine (PHM) recommended a clinical dashboard to monitor clinical practice and make improvements. To date, however, no programs report implementing a dashboard including the proposed broad range of metrics across multiple sites. We sought to (1) develop and populate a clinical dashboard to demonstrate productivity, quality, group sustainability, and value added for an academic division of PHM across 4 inpatient sites; (2) share dashboard data with division members and administrations to improve performance and guide program development; and (3) revise the dashboard to optimize its utility. Division members proposed a dashboard based on PHM recommendations. We assessed feasibility of data collection and defined and modified metrics to enable collection of comparable data across sites. We gathered data and shared the results with division members and administrations. We collected quarterly and annual data from October 2011 to September 2013. We found comparable metrics across all sites for descriptive, productivity, group sustainability, and value-added domains; only 72% of all quality metrics were tracked in a comparable fashion. After sharing the data, we saw increased timeliness of nursery discharges and an increase in hospital committee participation and grant funding. PHM dashboards have the potential to guide program development, mobilize faculty to improve care, and demonstrate program value to stakeholders. Dashboard implementation at other institutions and data sharing across sites may help to better define and strengthen the field of PHM by creating benchmarks and help improve the quality of pediatric hospital care. Copyright © 2016 by the American Academy of Pediatrics.
Govindarajan, R; Perelló-Juncá, A; Parès-Marimòn, R M; Serrais-Benavente, J; Ferrandez-Martí, D; Sala-Robinat, R; Camacho-Calvente, A; Campabanal-Prats, C; Solà-Anderiu, I; Sanchez-Caparrós, S; Gonzalez-Estrada, J; Martinez-Olalla, P; Colomer-Palomo, J; Perez-Mañosas, R; Rodríguez-Gallego, D
To define a process management model for a hospital pharmacy in order to measure, analyse and make continuous improvements in patient safety and healthcare quality. In order to implement process management, Igualada Hospital was divided into different processes, one of which was the Hospital Pharmacy. A multidisciplinary management team was given responsibility for each process. For each sub-process one person was identified to be responsible, and a working group was formed under his/her leadership. With the help of each working group, a risk analysis using failure modes and effects analysis (FMEA) was performed, and the corresponding improvement actions were implemented. Sub-process indicators were also identified, and different process management mechanisms were introduced. The first risk analysis with FMEA produced more than thirty preventive actions to improve patient safety. Later, the weekly analysis of errors, as well as the monthly analysis of key process indicators, permitted us to monitor process results and, as each sub-process manager participated in these meetings, also to assume accountability and responsibility, thus consolidating the culture of excellence. The introduction of different process management mechanisms, with the participation of people responsible for each sub-process, introduces a participative management tool for the continuous improvement of patient safety and healthcare quality. Copyright © 2012 SECA. Published by Elsevier Espana. All rights reserved.
Khan, M.R.; Riaz, M
Systematic disposal of hospital waste is a major problem encountered by different countries including Pakistan. Efforts are on the way to achieve this objective techno-economically. To quantify infectious and total waste produced by the hospitals of Lahore, classify it to know the nature of their components and to collect information about its management. The background information and secondary data were collected by consultation of literature in the libraries and visiting different websites on Internet. The primary data were collected by gathering the responses of the Chief Executives, Medical Superintendents and Medical and Environmental Staff of all hospitals scheduled as reference models through interview. The total quantity of infectious waste produced by the hospitals and other health care units is approximately 785 million tons per annum while the total waste including municipal component is approximately 3,925 million tons per annum. The current status of awareness about proper health care waste disposal is improving but at a slow pace. It may be concluded that the management of hospital waste in five hospitals of Lahore city is systematic. However, the staff handling the waste was not fully trained for proper segregation of the hospital wastes. Incinerators being used for waste disposal are a major source of secondary air pollution therefore, this method should be discouraged. Instead, the feasibility of thermoelectric power generation may be looked into. Proper disposal of hospital wastes should be in placed in every hospital and trained staff should be employed for the job. (author)
The paper concerns a new research area that is Quality of Web Service (QoWS). The need for QoWS is motivated by a still growing number of Internet users, by a steady development and diversification of Web services, and especially by popularization of e-commerce applications. The goal of the paper is a critical analysis of the literature concerning scheduling algorithms for e-commerce Web servers. The paper characterizes factors affecting the load of the Web servers and discusses ways of improving their efficiency. Crucial QoWS requirements of the business Web server are identified: serving requests before their individual deadlines, supporting user session integrity, supporting different classes of users and minimizing a number of rejected requests. It is justified that meeting these requirements and implementing them in an admission control (AC) and scheduling algorithm for the business Web server is crucial to the functioning of e-commerce Web sites and revenue generated by them. The paper presents results of the literature analysis and discusses algorithms that implement these important QoWS requirements. The analysis showed that very few algorithms take into consideration the above mentioned factors and that there is a need for designing an algorithm implementing them.
Watson, Julie; McGuire, William
Feeding preterm infants in response to their hunger and satiation cues (responsive, cue-based, or infant-led feeding) rather than at scheduled intervals might enhance infants' and parents' experience and satisfaction, help in the establishment of independent oral feeding, increase nutrient intake and growth rates, and allow earlier hospital discharge. To assess the effect of feeding preterm infants on a responsive basis versus feeding prescribed volumes at scheduled intervals on growth, duration of hospital stay, and parental satisfaction. We used the standard search strategy of the Cochrane Neonatal Review Group. This included searches of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 9, 2015), MEDLINE (1966 to September 2015), EMBASE (1980 to September 2015), and CINAHL (1982 to September 2015), conference proceedings, previous reviews, and trial registries. Randomised controlled trials (RCTs) or quasi-RCTs that compared a policy of feeding preterm infants on a responsive basis versus feeding at scheduled intervals. Two review authors assessed trial eligibility and risk of bias and undertook data extraction independently. We analysed the treatment effects in the individual trials and reported the risk ratio and risk difference for dichotomous data and mean difference (MD) for continuous data, with respective 95% confidence intervals (CIs). We used a fixed-effect model in meta-analyses and explored the potential causes of heterogeneity in sensitivity analyses. We found nine eligible RCTs including 593 infants in total. These trials compared responsive with scheduled interval regimens in preterm infants in the transition phase from intragastric tube to oral feeding. The trials were generally small and contained various methodological weaknesses including lack of blinding and incomplete assessment of all randomised participants. Meta-analyses, although limited by data quality and availability, suggest that responsive feeding
Malhotra, N K
The author presents a conceptual framework for the a priori and clustering-based approaches to segmentation and evaluates them in the context of segmenting institutional health care markets. An empirical study is reported in which the hospital market is segmented on three state-of-being variables. The segmentation approach also takes into account important organizational decision-making variables. The sophisticated Thurstone Case V procedure is employed. Several marketing implications for hospitals, other health care organizations, hospital suppliers, and donor publics are identified.
Implementing a working together model for Aboriginal patients with acute coronary syndrome: an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse working together to improve hospital care.
Daws, Karen; Punch, Amanda; Winters, Michelle; Posenelli, Sonia; Willis, John; MacIsaac, Andrew; Rahman, Muhammad Aziz; Worrall-Carter, Linda
Acute coronary syndrome (ACS) contributes to the disparity in life expectancy between Aboriginal and non-Aboriginal Australians. Improving hospital care for Aboriginal patients has been identified as a means of addressing this disparity. This project developed and implemented a working together model of care, comprising an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse, providing care coordination specifically directed at improving attendance at cardiac rehabilitation services for Aboriginal Australians in a large metropolitan hospital in Melbourne. A quality improvement framework using a retrospective case notes audit evaluated Aboriginal patients' admissions to hospital and identified low attendance rates at cardiac rehabilitation services. A working together model of care coordination by an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse was implemented to improve cardiac rehabilitation attendance in Aboriginal patients admitted with ACS to the cardiac wards of the hospital. A retrospective medical records audit showed that there were 68 Aboriginal patients admitted to the cardiac wards with ACS from 1 July 2008 to 30 June 2011. A referral to cardiac rehabilitation was recorded for 42% of these. During the implementation of the model of care, 13 of 15 patients (86%) received a referral to cardiac rehabilitation and eight of the 13 (62%) attended. Implementation of the working together model demonstrated improved referral to and attendance at cardiac rehabilitation services, thereby, has potential to prevent complications and mortality. WHAT IS KNOWN ABOUT THE TOPIC?: Aboriginal Australians experience disparities in access to recommended care for acute coronary syndrome. This may contribute to the life expectancy gap between Aboriginal and non-Aboriginal Australians. WHAT DOES THIS PAPER ADD?: This paper describes a model of care involving an Aboriginal Hospital Liaisons Officer and a specialist cardiac nurse working
Ponton, Kevin T; Sandrick, Karen M
Hospitals need to actively position themselves in the next 18 to 24 months to ensure continued access to financing. Hospitals need to shift their focus from investment income to operations. Hospitals should recognize the importance of balance-sheet liquidity to institutional investors. Not-for-profit hospitals should focus on both sides of the balance sheet. Healthcare executives need to develop effective leadership and investor-relations skills.
This paper aims at identifying the extent to which the Nottingham University Hospitals NHS Trust has fulfilled literature requirements for successful continuous improvement as exemplified by its Better for You programme and chemotherapy service improvement project. Both the theory and ideals of the continuous improvement programme, along with the actualization of these philosophies and methodologies in the context of the particular project,were compared against a framework for the enabling...
Bois de Fer, Béatrice; Host, Sabine; Chardon, Benoît; Chatignoux, Edouard; Beaujouan, Laure; Brun-Ney, Dominique; Grémy, Isabelle
The study of the short-term effects and health impact of air pollution is carrier out by the ERPURS regional surveillance program which utilizes hospitalization data obtained from the French hospital information system (PMSI) to determine these links. This system does not permit the distinction between emergency hospital admissions from scheduled ones, which cannot be related to short term changes in air pollution levels. This study examines how scheduled admissions affect the quality of the health indicators used to estimate air pollution effects. This indicator is compared to three new emergency hospitalisation indicators reconstructed based on data from the public hospitals in Paris, partly from the PMSI data and partly with data from an on-line emergency network that regroups all of the computerized emergency services. According to the pathology, scheduled admissions present a difficulty which affects the capacity to highlight the weakest risks with any precision.
Full Text Available Cell Superscalar's (CellSs main goal is to provide a simple, flexible and easy programming approach for the Cell Broadband Engine (Cell/B.E. that automatically exploits the inherent concurrency of the applications at a task level. The CellSs environment is based on a source-to-source compiler that translates annotated C or Fortran code and a runtime library tailored for the Cell/B.E. that takes care of the concurrent execution of the application. The first efforts for task scheduling in CellSs derived from very simple heuristics. This paper presents new scheduling techniques that have been developed for CellSs for the purpose of improving an application's performance. Additionally, the design of a new scheduling algorithm is detailed and the algorithm evaluated. The CellSs scheduler takes an extension of the memory hierarchy for Cell/B.E. into account, with a cache memory shared between the SPEs. All new scheduling practices have been evaluated showing better behavior of our system.
Morris, Robert A.; Bresina, John L.; Rodgers, Stuart M.
This paper presents a technique, called GenH, that automatically generates search heuristics for scheduling problems. The impetus for developing this technique is the growing consensus that heuristics encode advice that is, at best, useful in solving most, or typical, problem instances, and, at worst, useful in solving only a narrowly defined set of instances. In either case, heuristic problem solvers, to be broadly applicable, should have a means of automatically adjusting to the idiosyncrasies of each problem instance. GenH generates a search heuristic for a given problem instance by hill-climbing in the space of possible multi-attribute heuristics, where the evaluation of a candidate heuristic is based on the quality of the solution found under its guidance. We present empirical results obtained by applying GenH to the real world problem of telescope observation scheduling. These results demonstrate that GenH is a simple and effective way of improving the performance of an heuristic scheduler.
Mazzocato, Pamela; Stenfors-Hayes, Terese; von Thiele Schwarz, Ulrica; Hasson, Henna; Nystr?m, Monica Elisabeth
OBJECTIVES: Kaizen, or continuous improvement, lies at the core of lean. Kaizen is implemented through practices that enable employees to propose ideas for improvement and solve problems. The aim of this study is to describe the types of issues and improvement suggestions that hospital employees feel empowered to address through kaizen practices in order to understand when and how kaizen is used in healthcare. METHODS: We analysed 186 structured kaizen documents containing improvement suggest...
Goldstein, Adam A.; Petrisor, Gregory C.; Jenkins, B. Keith
A gain and exposure schedule that theoretically eliminates the effect of photorefractive weight decay for the general class of outer-product neural-network learning algorithms (e.g., backpropagation, Widrow-Hoff, perceptron) is presented. This schedule compensates for photorefractive diffraction-efficiency decay by iteratively increasing the spatial-light-modulator transfer function gain and decreasing the weight-update exposure time. Simulation results for the scheduling procedure, as applied to backpropagation learning for the exclusive-OR problem, show improved learning performance compared with results for networks trained without scheduling.
Miller, James C
...) data input mode than using the graphic schedule input mode. The Grid input mode provided both a statistically and an operationally significant reduction in data input time, compared to the Graphic mode for both novice...
Stevens, Bonnie J; Yamada, Janet; Promislow, Sara; Stinson, Jennifer; Harrison, Denise; Victor, J Charles
Despite extensive research, institutional policies, and practice guidelines, procedural pain remains undertreated in hospitalized children. Knowledge translation (KT) strategies have been employed to bridge the research to practice gap with varying success. The most effective single or combination of KT strategies has not been found. A multifaceted KT intervention, Evidence-based Practice for Improving Quality (EPIQ), that included tailored KT strategies was effective in improving pain practices and clinical outcomes at the unit level in a prospective comparative cohort study in 32 hospital units (16 EPIQ intervention and 16 Standard Care), in eight pediatric hospitals in Canada. In a study of the 16 EPIQ units (two at each hospital) only, the objectives were to: determine the effectiveness of evidence-based KT strategies implemented to achieve unit aims; describe the KT strategies implemented and their influence on pain assessment and management across unit types; and identify facilitators and barriers to their implementation. Data were collected from each EPIQ intervention unit on targeted pain practices and KT strategies implemented, through chart review and a process evaluation checklist, following four intervention cycles over a 15-month period. Following the completion of the four cycle intervention, 78% of 23 targeted pain practice aims across units were achieved within 80% of the stated aims. A statistically significant improvement was found in the proportion of children receiving pain assessment and management, regardless of pre-determined aims (p strategies implemented was 35 and included reminders, educational outreach and materials, and audit and feedback. Units successful in achieving their aims implemented more KT strategies than units that did not. No specific type of single or combination of KT strategies was more effective in improving pain assessment and management outcomes. Tailoring KT strategies to unit context, support from unit leadership
Una formulación matemática y de solución para programar cirugías con restricciones de recursos humanos en el hospital público A mathematical formulation and solution to schedule surgeries with human resource constraints in a public hospital
Lorena Pradenas Rojas
Full Text Available Actualmente, los hospitales públicos nacionales e internacionales presentan demandas que sobrepasan la capacidad de atención, lo que ha provocado un creciente interés por usar herramientas de gestión en los centros clínicos que les permita realizar de forma eficiente y eficaz la entrega de servicios a los distintos pacientes. El presente estudio aporta una nueva forma de abordar el problema de programación de cirugías, desde la programación matemática, presentando un modelo de optimización multiobjetivo y un algoritmo metaheurístico implementado computacionalmente, que permite la programación semanal de intervenciones quirúrgicas, cumpliendo con los requerimientos de pabellones y personal especializado necesario para su realización. Se utiliza una instancia de prueba, donde el tiempo de ejecución del algoritmo, implementado en C++, fue de siete minutos para 191 cirugías en lista de espera. El tiempo alcanzado es considerablemente menor a la programación realizada con un sistema manual, como los actualmente usados en hospitales públicos.Currently, national and international public hospitals have demands that exceed their service capacity, which has caused a growing interest in management sciences to deliver these medical centers the tools that will enable them to perform efficiently and effectively, delivering services to different patients. This study provides a new way of approaching the problem of surgical scheduling using mathematical programming, presenting a multi-objective optimization model and a metaheuristic algorithm implemented computationall. The solution allows weekly schedule of surgical procedure and complying with the requirements of the flag and expertise necessary for realization. We ordered test instances where the execution time of the algorithm, coded in C++, was 7 minutes for a 191 surgeries waiting list, which is a considerable less amount of time to this schedule than using a manual approach. The latest
Chen, Qiwei; Yang, Lan; Feng, Qiming; Tighe, Scott S
Background . Township hospitals in China provide rural communities with basic but much needed critical health care services. The doctors working in these hospitals often feel unsatisfied when considering their work schedules and financial rewards. Method . To explore job satisfaction of health workers in a township hospital, a qualitative study was conducted of 39 doctors from five township hospitals in Guangxi Zhuang Autonomous Region. The goal was to understand the level of job satisfaction of doctors and to make recommendations for improvements. Results . About 75% (28/39) of the doctors expressed negative attitudes related to their work conditions. Slightly more than half (22/39) mentioned they should receive greater compensation for their work and more than one were seriously considering other options. Many participants (35/39) showed their satisfaction about the achievement of serving as a doctor. Conclusion . Their main concerns related to job satisfaction included working conditions, financial rewards, and the doctor's relationships with patients. Increasing the incomes and fringe benefits of healthcare workers, improving their work conditions, and providing training and continuing education opportunities would help rural clinics retain doctors and eliminate the current unsatisfactory conditions. The findings also highlight the need for the government to increase financial support of township hospitals.
Full Text Available Background. Township hospitals in China provide rural communities with basic but much needed critical health care services. The doctors working in these hospitals often feel unsatisfied when considering their work schedules and financial rewards. Method. To explore job satisfaction of health workers in a township hospital, a qualitative study was conducted of 39 doctors from five township hospitals in Guangxi Zhuang Autonomous Region. The goal was to understand the level of job satisfaction of doctors and to make recommendations for improvements. Results. About 75% (28/39 of the doctors expressed negative attitudes related to their work conditions. Slightly more than half (22/39 mentioned they should receive greater compensation for their work and more than one were seriously considering other options. Many participants (35/39 showed their satisfaction about the achievement of serving as a doctor. Conclusion. Their main concerns related to job satisfaction included working conditions, financial rewards, and the doctor’s relationships with patients. Increasing the incomes and fringe benefits of healthcare workers, improving their work conditions, and providing training and continuing education opportunities would help rural clinics retain doctors and eliminate the current unsatisfactory conditions. The findings also highlight the need for the government to increase financial support of township hospitals.
Brand, Caroline A; Barker, Anna L; Morello, Renata T; Vitale, Michael R; Evans, Sue M; Scott, Ian A; Stoelwinder, Johannes U; Cameron, Peter A
The objective of this review was to critically appraise the literature relating to associations between high-level structural and operational hospital characteristics and improved performance. The Cochrane Library, MEDLINE (Ovid), CINAHL, proQuest and PsychINFO were searched for articles published between January 1996 and May 2010. Reference lists of included articles were reviewed and key journals were hand searched for relevant articles. and data extraction Studies were included if they were systematic reviews or meta-analyses, randomized controlled trials, controlled before and after studies or observational studies (cohort and cross-sectional) that were multicentre, comparative performance studies. Two reviewers independently extracted data, assigned grades of evidence according to the Australian National Health and Medical Research Council guidelines and critically appraised the included articles. Data synthesis Fifty-seven studies were reported within 12 systematic reviews and 47 observational articles. There was heterogeneity in use and definition of performance outcomes. Hospital characteristics investigated were environment (incentives, market characteristics), structure (network membership, ownership, teaching status, geographical setting, service size) and operational design (innovativeness, leadership, organizational culture, public reporting and patient safety practices, information technology systems and decision support, service activity and planning, workforce design, staff training and education). The strongest evidence for an association with overall performance was identified for computerized physician order entry systems. Some evidence supported the associations with workforce design, use of financial incentives, nursing leadership and hospital volume. There is limited, mainly low-quality evidence, supporting the associations between hospital characteristics and healthcare performance. Further characteristic-specific systematic reviews are
Reducing operational inefficiencies represents one of the most promising sources of potential savings in hospitals today. Health Forum convened a panel of hospital executives and industry experts to discuss the daunting challenges and big opportunities that lie ahead.
Leineweber, Constanze; Chungkham, Holendro Singh; Lindqvist, Rikard; Westerlund, Hugo; Runesdotter, Sara; Smeds Alenius, Lisa; Tishelman, Carol
Nursing turnover is a major issue for health care managers, notably during the global nursing workforce shortage. Despite the often hierarchical structure of the data used in nursing studies, few studies have investigated the impact of the work environment on intention to leave using multilevel techniques. Also, differences between intentions to leave the current workplace or to leave the profession entirely have rarely been studied. The aim of the current study was to investigate how aspects of the nurse practice environment and satisfaction with work schedule flexibility measured at different organisational levels influenced the intention to leave the profession or the workplace due to dissatisfaction. Multilevel models were fitted using survey data from the RN4CAST project, which has a multi-country, multilevel, cross-sectional design. The data analysed here are based on a sample of 23,076 registered nurses from 2020 units in 384 hospitals in 10 European countries (overall response rate: 59.4%). Four levels were available for analyses: country, hospital, unit, and individual registered nurse. Practice environment and satisfaction with schedule flexibility were aggregated and studied at the unit level. Gender, experience as registered nurse, full vs. part-time work, as well as individual deviance from unit mean in practice environment and satisfaction with work schedule flexibility, were included at the individual level. Both intention to leave the profession and the hospital due to dissatisfaction were studied. Regarding intention to leave current workplace, there is variability at both country (6.9%) and unit (6.9%) level. However, for intention to leave the profession we found less variability at the country (4.6%) and unit level (3.9%). Intention to leave the workplace was strongly related to unit level variables. Additionally, individual characteristics and deviance from unit mean regarding practice environment and satisfaction with schedule flexibility were
Cowie, Martin R; Anker, Stefan D; Cleland, John G F; Felker, G Michael; Filippatos, Gerasimos; Jaarsma, Tiny; Jourdain, Patrick; Knight, Eve; Massie, Barry; Ponikowski, Piotr; López-Sendón, José
Acute heart failure (AHF) is a common and serious condition that contributes to about 5% of all emergency hospital admissions in Europe and the USA. Here, we present the recommendations from structured discussions among an author group of AHF experts in 2013. The epidemiology of AHF and current practices in diagnosis, treatment, and long-term care for patients with AHF in Europe and the USA are examined. Available evidence indicates variation in the quality of care across hospitals and regions. Challenges include the need for rapid diagnosis and treatment, the heterogeneity of precipitating factors, and the typical repeated episodes of decompensation requiring admission to hospital for stabilization. In hospital, care should involve input from an expert in AHF and auditing to ensure that guidelines and protocols for treatment are implemented for all patients. A smooth transition to follow-up care is vital. Patient education programmes could have a dramatic effect on improving outcomes. Information technology should allow, where appropriate, patient telemonitoring and sharing of medical records. Where needed, access to end-of-life care and support for all patients, families, and caregivers should form part of a high-quality service. Eight evidence-based consensus policy recommendations are identified by the author group: optimize patient care transitions, improve patient education and support, provide equity of care for all patients, appoint experts to lead AHF care across disciplines, stimulate research into new therapies, develop and implement better measures of care quality, improve end-of-life care, and promote heart failure prevention. © 2015 Oxford PharmaGenesis Ltd.
Antônio Artur de Souza
Full Text Available Hospitals are considered complex organizations mainly due to the high cost of the health care structure employed for care. Reducing operating costs is a challenge for hospital managers. Particularly in the clinical engineering sector, adequate hospital logistics can reduce costs. In this context, the aim of the research was to analyze the activities of hospital logistics of the Clinical Engineering department at a charity hospital, focusing on cost reduction. The paper presents a case study in a large charity hospital located in the metropolitan region of Belo Horizonte, MG. The analysis focuses on the activities of hospital logistics at this hospital clinical engineering sector. The work in this sector is concentrated in the realization and implementation of equipment maintenance, to the detriment of efforts to reduce costs and increase safety for all streams managed by the sector. It was also found that there are risks of increased costs with inadequate routines: (i acquisition of new and large equipment; (ii maintenance and release schedule for use; and (iii the theft of equipment.
Glintborg, Bente; Poulsen, Henrik E; Dalhoff, Kim P
What is already known about this subject: Structured medication interviews improve the medication history upon hospitalization. Pharmacy records are valid lists of the prescribed medications available to individual patients. In Denmark, treating doctors now have access to their patients' pharmacy...... records through a real-time online electronic database What this study adds: Omission errors are frequent among hospitalized patients despite structured drug interviews and home visits. Pharmacy records may be used to minimize patients' recall bias and improve the medication lists....
Sannar, Elise M; Palka, Tamara; Beresford, Carol; Peura, Christine; Kaplan, Desmond; Verdi, Mary; Siegel, Matthew; Kaplan, Shir; Grados, Marco
We examined the relationship between sleep duration and awakenings to Aberrant Behavior Checklist-Community (ABC-C) and Autism Diagnostic Observation Schedule (ADOS-2) scores in hospitalized youth with ASD and behavioral disturbance. Participants included 106 patients with a stay of at least 10 nights. Sleep in the hospital was recorded by staff observation. Higher scores on the ABC-C (irritability, stereotypy, and hyperactivity subscales) at admission were significantly associated with fewer minutes slept during the last five nights of hospitalization. There was no association between total awakenings and ABC-C scores or ADOS-2 comparison scores. Improved understanding of the relationship between sleep quality and maladaptive behavior in this challenging cohort of patients with ASD is vital to the definition and design of future effective interventions.
Seddon, Mary E; Hay, David
To improve communication between doctors and nurses after hours, by developing a tool to display ward tasks, allowing staff to prioritise their work, without constant interruption from pagers (beepers). Middlemore Hospital, a large metropolitan 800-bed hospital in Auckland, New Zealand. Introduction of computerised system (Task Manager) to identify, allocate and complete after-hours tasks. In the first 6 months 21,000 tasks have been completed in Task Manager. Paging of junior doctors has decreased by over 30% and there is broad acceptance of the tool by both nursing and medical staff. Task Manager has collected real-time data on the type of after hours tasks (nearly 50% are phlebotomy-related tasks), busy times of the day (1600 hours to 2400 hours) and who is performing most of the tasks. Task Manager is a simple yet powerful tool for prioritising routine tasks after hours. It allows staff to quickly create tasks, and communicate effectively with other members of the team. It has reduced the frequency of junior doctors paging so that they can continue their work with fewer interruptions. Whilst it was introduced to improve effective communication after hours, it has become apparent that there are multiple 'tasks' that are ordered in a multitude of ways in our hospital and many could be served by Task Manager.
Section 207(f)(2) of the E-Gov Act requires federal agencies to develop an inventory and establish a schedule of information to be published on their Web sites, make those schedules available for public comment. To post the schedules on the web site.
Full Text Available Scheduling EV user’s charging behavior based on charging price and applying renewable energy resources are the effective methods to release the load pressure of power grids brought about by the large-scale popularity of electric vehicles (EVs. This paper presents a novel approach for EV charging scheduling based on price negotiation. Firstly, the EV charging system framework based on price negotiation and renewable energy resources is discussed. Secondly, the price negotiation model is presented, including the initial price models and the conditions of transactions. Finally, an EV charging scheduling mechanism based on price negotiation (CSM-PN, including the price adjustment strategies of both the operator and EV users is proposed to seek a final transaction during multi-round price negotiation. Simulation results show that this novel approach can effectively improve the charging station operator’s income, reduce the EV users’ costs, and balance the load of the power grid while improving the efficiency of the EV charging system.
Korst, Lisa M; Aydin, Carolyn E; Signer, Jordana M K; Fink, Arlene
The development of readiness metrics for organizational participation in health information exchange is critical for monitoring progress toward, and achievement of, successful inter-organizational collaboration. In preparation for the development of a tool to measure readiness for data-sharing, we tested whether organizational capacities known to be related to readiness were associated with successful participation in an American data-sharing collaborative for quality improvement. Cross-sectional design, using an on-line survey of hospitals in a large, mature data-sharing collaborative organized for benchmarking and improvement in nursing care quality. Factor analysis was used to identify salient constructs, and identified factors were analyzed with respect to "successful" participation. "Success" was defined as the incorporation of comparative performance data into the hospital dashboard. The most important factor in predicting success included survey items measuring the strength of organizational leadership in fostering a culture of quality improvement (QI Leadership): (1) presence of a supportive hospital executive; (2) the extent to which a hospital values data; (3) the presence of leaders' vision for how the collaborative advances the hospital's strategic goals; (4) hospital use of the collaborative data to track quality outcomes; and (5) staff recognition of a strong mandate for collaborative participation (α=0.84, correlation with Success 0.68 [P<0.0001]). The data emphasize the importance of hospital QI Leadership in collaboratives that aim to share data for QI or safety purposes. Such metrics should prove useful in the planning and development of this complex form of inter-organizational collaboration. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
Full Text Available Purpose: The issue resource over-allocating is a big concern for project engineers in the process of scheduling project activities. Resource over-allocating drawback is frequently seen after scheduling of a project in practice which causes a schedule to be useless. Modifying an over-allocated schedule is very complicated and needs a lot of efforts and time. In this paper, a new and fast tracking method is proposed to schedule large scale projects which can help project engineers to schedule the project rapidly and with more confidence. Design/methodology/approach: In this article, a forward approach for maximizing net present value (NPV in multi-mode resource constrained project scheduling problem while assuming discounted positive cash flows (MRCPSP-DCF is proposed. The progress payment method is used and all resources are considered as pre-emptible. The proposed approach maximizes NPV using unscheduled resources through resource calendar in forward mode. For this purpose, a Genetic Algorithm is applied to solve. Findings: The findings show that the proposed method is an effective way to maximize NPV in MRCPSP-DCF problems while activity splitting is allowed. The proposed algorithm is very fast and can schedule experimental cases with 1000 variables and 100 resources in few seconds. The results are then compared with branch and bound method and simulated annealing algorithm and it is found the proposed genetic algorithm can provide results with better quality. Then algorithm is then applied for scheduling a hospital in practice. Originality/value: The method can be used alone or as a macro in Microsoft Office Project® Software to schedule MRCPSP-DCF problems or to modify resource over-allocated activities after scheduling a project. This can help project engineers to schedule project activities rapidly with more accuracy in practice.
Fabbruzzo-Cota, Christina; Frecea, Monica; Kozell, Kathryn; Pere, Katalin; Thompson, Tamara; Tjan Thomas, Julie; Wong, Angela
The purpose of this clinical nurse specialist-led interprofessional quality improvement project was to reduce hospital-acquired pressure ulcers (HAPUs) using evidence-based practice. Hospital-acquired pressure ulcers (PUs) have been linked to morbidity, poor quality of life, and increasing costs. Pressure ulcer prevention and management remain a challenge for interprofessional teams in acute care settings. Hospital-acquired PU rate is a critical nursing quality indicator for healthcare organizations and ties directly with Mount Sinai Hospital's (MSH's) mission and vision, which mandates providing the highest quality care to patients and families. This quality improvement project, guided by the Donabedian model, was based on the Registered Nurses' Association of Ontario Best Practice Guideline Risk Assessment & Prevention of Pressure Ulcers. A working group was established to promote evidence-based practice for PU prevention. Initiatives such as documentation standardization, development of staff education and patient and family educational resources, initiation of a hospital-wide inventory for support surfaces, and procurement of equipment were implemented to improve PU prevention and management across the organization. An 80% decrease in HAPUs has been achieved since the implementation of best practices by the Best Practice Guideline Pressure Ulcer working group. The implementation of PU prevention strategies led to a reduction in HAPU rates. The working group will continue to work on building interprofessional awareness and collaboration in order to prevent HAPUs and promote an organizational culture that supports staff development, teamwork and communication. This quality improvement project is a successful example of an interprofessional clinical nurse specialist-led initiative that impacts patient/family and organization outcomes through the identification and implementation of evidence-based nursing practice.
Wheeler, Derek S; Geis, Gary; Mack, Elizabeth H; LeMaster, Tom; Patterson, Mary D
In situ simulation training is a team-based training technique conducted on actual patient care units using equipment and resources from that unit, and involving actual members of the healthcare team. We describe our experience with in situ simulation training in a major children's medical centre. In situ simulations were conducted using standardised scenarios approximately twice per month on inpatient hospital units on a rotating basis. Simulations were scheduled so that each unit participated in at least two in situ simulations per year. Simulations were conducted on a revolving schedule alternating on the day and night shifts and were unannounced. Scenarios were preselected to maximise the educational experience, and frequently involved clinical deterioration to cardiopulmonary arrest. We performed 64 of the scheduled 112 (57%) in situ simulations on all shifts and all units over 21 months. We identified 134 latent safety threats and knowledge gaps during these in situ simulations, which we categorised as medication, equipment, and/or resource/system threats. Identification of these errors resulted in modification of systems to reduce the risk of error. In situ simulations also provided a method to reinforce teamwork behaviours, such as the use of assertive statements, role clarity, performance of frequent updating, development of a shared mental model, performance of independent double checks of high-risk medicines, and overcoming authority gradients between team members. Participants stated that the training programme was effective and did not disrupt patient care. In situ simulations can identify latent safety threats, identify knowledge gaps, and reinforce teamwork behaviours when used as part of an organisation-wide safety programme.
Full Text Available Objective: In order to improve the quality management of supply department in our hospital, develop the quality of our nursing work, control hospital infection. Methods: Make scientific and standard working procedures, pay attention to training of staff in supply department, make strict rules and regulations, attach importance to process management, improve the quality of nursing work, reinforce the protection of our staff. Results: We improved the method of management, developed the level of management. Conclusion: Supply Department up to standards, scientific and standardized level through a series of management measures, plays an important role in controlling Infection of hospital.
Majerowicz, Walt; Shinn, Stephen A.
This paper examines the relationship between schedule delays and cost overruns on complex projects. It is generally accepted by many project practitioners that cost overruns are directly related to schedule delays. But what does "directly related to" actually mean? Some reasons or root causes for schedule delays and associated cost overruns are obvious, if only in hindsight. For example, unrealistic estimates, supply chain difficulties, insufficient schedule margin, technical problems, scope changes, or the occurrence of risk events can negatively impact schedule performance. Other factors driving schedule delays and cost overruns may be less obvious and more difficult to quantify. Examples of these less obvious factors include project complexity, flawed estimating assumptions, over-optimism, political factors, "black swan" events, or even poor leadership and communication. Indeed, is it even possible the schedule itself could be a source of delay and subsequent cost overrun? Through literature review, surveys of project practitioners, and the authors' own experience on NASA programs and projects, the authors will categorize and examine the various factors affecting the relationship between project schedule delays and cost growth. The authors will also propose some ideas for organizations to consider to help create an awareness of the factors which could cause or influence schedule delays and associated cost growth on complex projects.
The objectives of a hospital are to improve patient care, while the objectives of a hospital library are to improve services to the staff which will support their efforts. This handbook dealing with hospital administration is designed to aid the librarian in either implementing a hospital library, or improving services in an existing medical…
Scheduling algorithms for multiprocessor real-time systems have been studied for years with many well-recognized algorithms proposed. However, it is still an evolving research area and many problems remain open due to their intrinsic complexities. With the emergence of multicore processors, it is necessary to re-investigate the scheduling problems and design/develop efficient algorithms for better system utilization, low scheduling overhead, high energy efficiency, and better system reliability. Focusing cluster schedulings with optimal global schedulers, we study the utilization bound and scheduling overhead for a class of cluster-optimal schedulers. Then, taking energy/power consumption into consideration, we developed energy-efficient scheduling algorithms for real-time systems, especially for the proliferating embedded systems with limited energy budget. As the commonly deployed energy-saving technique (e.g. dynamic voltage frequency scaling (DVFS)) will significantly affect system reliability, we study schedulers that have intelligent mechanisms to recuperate system reliability to satisfy the quality assurance requirements. Extensive simulation is conducted to evaluate the performance of the proposed algorithms on reduction of scheduling overhead, energy saving, and reliability improvement. The simulation results show that the proposed reliability-aware power management schemes could preserve the system reliability while still achieving substantial energy saving.
Peña, Adolfo; Estrada, Carlos A; Soniat, Debbie; Taylor, Benjamin; Burton, Michael
Pain management in hospitalized patients remains a priority area for improvement; effective strategies for consensus development are needed to prioritize interventions. To identify challenges, barriers, and perspectives of healthcare providers in managing pain among hospitalized patients. Qualitative and quantitative group consensus using a brainstorming technique for quality improvement-the nominal group technique (NGT). One medical, 1 medical-surgical, and 1 surgical hospital unit at a large academic medical center. Nurses, resident physicians, patient care technicians, and unit clerks. Responses and ranking to the NGT question: "What causes uncontrolled pain in your unit?" Twenty-seven health workers generated a total of 94 ideas. The ideas perceived contributing to a suboptimal pain control were grouped as system factors (timeliness, n = 18 ideas; communication, n = 11; pain assessment, n = 8), human factors (knowledge and experience, n = 16; provider bias, n = 8; patient factors, n = 19), and interface of system and human factors (standardization, n = 14). Knowledge, timeliness, provider bias, and patient factors were the top ranked themes. Knowledge and timeliness are considered main priorities to improve pain control. NGT is an efficient tool for identifying general and context-specific priority areas for quality improvement; teams of healthcare providers should consider using NGT to address their own challenges and barriers. Copyright © 2011 Society of Hospital Medicine.
McPake, Barbara; Yepes, Francisco Jose; Lake, Sally; Sanchez, Luz Helena
Many countries are experimenting with public hospital reform - both increasing the managerial autonomy with which hospitals conduct their affairs, and separating 'purchaser' and 'provider' sides of the health system, thus increasing the degree of market pressure brought to bear on hospitals. Evidence suggesting that such reform will improve hospital performance is weak. From a theoretical perspective, it is not clear why public hospitals should be expected to behave like firms and seek to maximize profits as this model requires. Empirically, there is very slight evidence that such reforms may improve efficiency, and reason to be concerned about their equity implications. In Colombia, an ambitious reform programme includes among its measures the attempt to universalize a segmented health system, the creation of a purchaser-provider split and the transformation of public hospitals into 'autonomous state entities'. By design, the Colombian reform programme avoids the forces that produce equity losses in other developing countries. This paper reports the results of a study that has tried to track hospital performance in other dimensions in the post-reform period in Bogotá. Trends in hospital inputs, production and productivity, quality and patient satisfaction are presented, and qualitative data based on interviews with hospital workers are analyzed. The evidence we have been able to collect is capable of providing only a partial response to the study question. There is some evidence of increased activity and productivity and sustained quality despite declining staffing levels. Qualitative data suggest that hospital workers have noticed considerable changes, which include greater responsiveness to patients but also a heavier administrative burden. It is difficult to attribute specific causality to all of the changes measured and this reflects the inherent difficulty of judging the effects of large-scale reform programmes as well as weaknesses and gaps in the data
Full Text Available Real-time systems (RTS are characterized by tasks executing in a timely manner to meet its deadlines as a real-time constraint. Most studies of RTS have focused on these criteria as primary design points. However, recent increases in security threats to various real-time systems have shown that enhanced security support must be included as an important design point, retro-fitting such support to existing systems as necessary. In this paper, we propose a new pre-flush technique referred to as flush task reservation for FP scheduling (FTR-FP to conditionally sanitize the state of resources shared by real-time tasks by invoking a flush task (FT in order to mitigate information leakage/corruption of real-time systems. FTR-FP extends existing works exploiting FTs to be applicable more general scheduling algorithms and security model. We also propose modifications to existing real-time scheduling algorithms to implement a pre-flush technique as a security constraint, and analysis technique to verify schedulability of the real-time scheduling. For better analytic capability, our analysis technique provides a count of the precise number of preemptions that a task experiences offline. Our evaluation results demonstrate that our proposed schedulability analysis improves the performance of existing scheduling algorithms in terms of schedulability and preemption cost.
Full Text Available Grid computing is a high performance computing environment to solve larger scale computational demands. Grid computing contains resource management, task scheduling, security problems, information management and so on. Task scheduling is a fundamental issue in achieving high performance in grid computing systems. A computational GRID is typically heterogeneous in the sense that it combines clusters of varying sizes, and different clusters typically contains processing elements with different level of performance. In this, heuristic approaches based on particle swarm optimization and ant colony optimization algorithms are adopted for solving task scheduling problems in grid environment. Particle Swarm Optimization (PSO is one of the latest evolutionary optimization techniques by nature. It has the better ability of global searching and has been successfully applied to many areas such as, neural network training etc. Due to the linear decreasing of inertia weight in PSO the convergence rate becomes faster, which leads to the minimal makespan time when used for scheduling. To make the convergence rate faster, the PSO algorithm is improved by modifying the inertia parameter, such that it produces better performance and gives an optimized result. The ACO algorithm is improved by modifying the pheromone updating rule. ACO algorithm is hybridized with PSO algorithm for efficient result and better convergence in PSO algorithm.
Renganathan, B S; Preejith, S P; Nagaiyan, Sridhar; Joseph, Jayaraj; Sivaprakasam, Mohanasankar
Hospital acquired pressure ulcers (HAPUs) is a major problem that affects around one in twenty patients who are admitted in hospital with sudden illness. These ulcers often occur when patients have limited mobility and cannot change positions in bed on their own. Traditionally, the occurrence of HAPUs has been minimized by turning the patient every 2 hours to alternating lateral and supine positions, and by using pressure redistributing mattresses. In many healthcare facilities, such a patient repositioning schedule is not always maintained owing to low caregiver compliance to turning protocols. Difficulty in monitoring patient position continuously, lack of turn reminders/alerts and suboptimal caregiver staffing ratio increases the occurrence of HAPUs. A novel method to address the need for improved pressure ulcer prevention is presented. The proposed method consists of a wearable device which continuously monitors the patient's position and communicates wirelessly with a tablet which enables alerts to be sent to the caregiver when a patient turn is due in accordance with the protocol adopted by the hospital. The patient's position is continuously monitored and the turning procedure carried out is logged and updated on the hospital's cloud system, thereby enabling centralized monitoring. Under a controlled setting, system was able to continuously monitor patient's position and can accurately detect standard patient positions.
Zhai, Wenzheng; Hu, Yue-Li; Ran, Feng
Efficient task scheduling is critical to achieve high performance in a heterogeneous multi-core computing environment. The paper focuses on the heterogeneous multi-core directed acyclic graph (DAG) task model and proposes a novel task scheduling method based on an improved chaotic quantum-behaved particle swarm optimization (CQPSO) algorithm. A task priority scheduling list was built. A processor with minimum cumulative earliest finish time (EFT) was acted as the object of the first task assignment. The task precedence relationships were satisfied and the total execution time of all tasks was minimized. The experimental results show that the proposed algorithm has the advantage of optimization abilities, simple and feasible, fast convergence, and can be applied to the task scheduling optimization for other heterogeneous and distributed environment.
Full Text Available For providing passengers with periodic operation trains and making trains’ time distribution better fit that of passengers, the multiperiod mixed train schedule is first proposed in this paper. It makes each type of train having same origin, destination, route, and stop stations operate based on a periodic basis and allows different types of train to have various operation periods. Then a model of optimizing multiperiod mixed train schedule is built to minimize passengers generalized travel costs with the constraints of trains of same type operating periodically, safe interval requirements of trains’ departure, and arrival times, and so forth. And its heuristic algorithm is designed to optimize the multiperiod mixed train schedule beginning with generating an initial solution by scheduling all types of train type by type and then repeatedly improving their periodic schedules until the objective value cannot be reduced or the iteration number reaches its maximum. Finally, example results illustrate that the proposed model and algorithm can effectively gain a better multiperiod mixed train schedule. However, its passengers deferred times and advanced times are a little higher than these of an aperiodic train schedule.
Dias, Casimiro; Escoval, Ana
The perspective of innovation as the strategic lever of organizational performance has been widespread in the hospital sector. While public value of innovation can be significant, it is not evident that innovation always ends up in higher levels of performance. Within this context, the purpose of the article was to critically analyze the relationship between innovation and performance,taking into account the specificities of the hospital sector. This article pulls together primary data on organizational flexibility, innovation, and performance from 95 hospitals in Portugal,collected through a survey, data from interviews to hospital administration boards, and a panel of 15 experts. The diversity of data sources allowed for triangulation. The article uses mixed methods to explore the relationship between innovation and performance in the hospital sector in Portugal. The relationship between innovation and performance is analyzed through cluster analysis, supplemented with content analysis of interviews and the technical nominal group. The main findings reveal that the cluster of efficient innovators has twice the level of performance than other clusters. Organizational flexibility and external cooperation are the 2 major factors explaining these differences. The article identifies various organizational strategies to use innovation in order to enhance hospital performance. Overall, it proposes the alignment of perspectives of different stakeholders on the value proposition of hospital services, the embeddedness of information loops, and continuous adjustments toward high-value services.
Astnell, Sandra; von Thiele Schwarz, Ulrica; Hasson, Henna; Augustsson, Hanna; Stenfors-Hayes, Terese
Integration of workplace employee health promotion (HP) and occupational health and safety (OHS) work into organizational quality improvement systems is suggested as a way to strengthen HP and OHS activities in an organization. The aim of this article was to study what consequences integration of HP, OHS and a quality improvement system called kaizen has on the frequency and type of HP and OHS activities. A quasi-experimental study design was used where an integration of the three systems for HP, OHS respectively kaizen, was performed at six intervention units at a Swedish hospital. The remaining six units served as controls. Document analysis of all employees' written improvement suggestions (kaizen notes) during 2013 was conducted. The findings show that the intervention group had more suggestions concerning HP and OHS (n = 114) when compared with the control group (n = 78) and a greater variety of HP and OHS suggestions. In addition, only the intervention group had included HP aspects. In both groups, most kaizen notes with health consideration had a preventive focus rather than rehabilitative. The intervention, i.e. the integration of HP, OHS and kaizen work, had a favourable effect on HP and OHS work when compared with the controls. The results of the study support that this system can work in practice at hospitals. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: email@example.com.
Yoshimoto, G.; Gargan, R. Jr.; Duggan, P.
The Electric Power Research Institute (EPRI), Nuclear Power Division, has identified the three major goals of high technology applications for nuclear power plants. These goals are to enhance power production through increasing power generation efficiency, to increase productivity of the operations, and to reduce the threats to the safety of the plant. Our project responds to the second goal by demonstrating that significant productivity increases can be achieved for outage maintenance operations based on existing knowledge-based scheduling technology. Its use can also mitigate threats to potential safety problems by means of the integration of risk assessment features into the scheduler. The scheduling approach uses advanced techniques enabling the automation of the routine scheduling decision process that previously was handled by people. The process of removing conflicts in scheduling is automated. This is achieved by providing activity representations that allow schedulers to express a variety of different scheduling constraints and by implementing scheduling mechanisms that simulate kinds of processes that humans use to find better solutions from a large number of possible solutions. This approach allows schedulers to express detailed constraints between activities and other activities, resources (material and personnel), and requirements that certain states exist for their execution. Our scheduler has already demonstrated its benefit to improving the shuttle processing flow management at Kennedy Space Center. Knowledge-based scheduling techniques should be examined by utilities industry researchers, developers, operators and management for application to utilities planning problems because of its great cost benefit potential. 4 refs., 4 figs
Range, Troels Martin; Lusby, Richard Martin; Larsen, Jesper
This paper addresses the Patient Admission Scheduling (PAS) problem. The PAS problem deals with assigning elective patients to beds, satisfying a number of soft and hard constraints. The problem can be seen as part of the functions of hospital management at an operational level. There exists a sm...... to produce new best solutions for ve out of six instances from a publicly available repository....
Jafari, Hamed; Salmasi, Nasser
The nurse scheduling problem (NSP) has received a great amount of attention in recent years. In the NSP, the goal is to assign shifts to the nurses in order to satisfy the hospital's demand during the planning horizon by considering different objective functions. In this research, we focus on maximizing the nurses' preferences for working shifts and weekends off by considering several important factors such as hospital's policies, labor laws, governmental regulations, and the status of nurses at the end of the previous planning horizon in one of the largest hospitals in Iran i.e., Milad Hospital. Due to the shortage of available nurses, at first, the minimum total number of required nurses is determined. Then, a mathematical programming model is proposed to solve the problem optimally. Since the proposed research problem is NP-hard, a meta-heuristic algorithm based on simulated annealing (SA) is applied to heuristically solve the problem in a reasonable time. An initial feasible solution generator and several novel neighborhood structures are applied to enhance performance of the SA algorithm. Inspired from our observations in Milad hospital, random test problems are generated to evaluate the performance of the SA algorithm. The results of computational experiments indicate that the applied SA algorithm provides solutions with average percentage gap of 5.49 % compared to the upper bounds obtained from the mathematical model. Moreover, the applied SA algorithm provides significantly better solutions in a reasonable time than the schedules provided by the head nurses.
Glaab, Patricia C.
The first phase of this study investigated the amount of time a flight can be delayed or expedited within the Terminal Airspace using only speed changes. The Arrival Capacity Calculator analysis tool was used to predict the time adjustment envelope for standard descent arrivals and then for CDA arrivals. Results ranged from 0.77 to 5.38 minutes. STAR routes were configured for the ACES simulation, and a validation of the ACC results was conducted comparing the maximum predicted time adjustments to those seen in ACES. The final phase investigated full runway-to-runway trajectories using ACES. The radial distance used by the arrival scheduler was incrementally increased from 50 to 150 nautical miles (nmi). The increased Planning Horizon radii allowed the arrival scheduler to arrange, path stretch, and speed-adjust flights to more fully load the arrival stream. The average throughput for the high volume portion of the day increased from 30 aircraft per runway for the 50 nmi radius to 40 aircraft per runway for the 150 nmi radius for a traffic set representative of high volume 2018. The recommended radius for the arrival scheduler s Planning Horizon was found to be 130 nmi, which allowed more than 95% loading of the arrival stream.
Moreno-Millán, Emilio; Molina-Morales, Agustin; Amate-Fortes, Ignacio
The main objective of this study is to verify the existence of a direct relation between age, ageing and hospital resources utilization. For this purpose, we use not only population variables, but also clinical parameters such as severity and complexity, as proxy of consumption and hospital costs. Through a comprehensive statistical analysis, quantitative variables of the Spanish Minimum Data Set of year 2006 (length of stay, relative weight, number of diagnoses and procedures) according to age groups and gender, types of admission (emergency or scheduled) and discharge (alive or dead), measuring the severity by weight, complications, comorbidities and mortality, and complexity by weight and length of stay. The highest severity was observed in 65-69 year-old males and the highest complexity in 75-79 year-old males and 85-89 year-old females (p<.0001). The severity and complexity are also higher among 65-69 year-old males and 70-79 year-old patients of both sexes with emergency access (p<.0001). The deceased patients are more aged with higher severity and complexity than the survivors (p<.0001). The age per se is not directly related to consumption of hospital resources. Therefore, aging does not necessarily imply higher consumption or increased hospital costs. Emergency admitted in-patients are older and more severe and complex than the scheduled ones, thus consuming more resources and implying higher hospital costs; the same is true for the deceased versus the survivors.
Dimitrova, D.C.; van den Berg, J.L.; Heijenk, G.; Litjens, R.; Sacchi, Claudio; Bellalta, Boris; Vinel, Alexey; Schlegel, Christian; Granelli, Fabrizio; Zhang, Yan
Long Term Evolution (LTE) is a cellular technology foreseen to extend the capacity and improve the performance of current 3G cellular networks. A key mechanism in the LTE traffic handling is the packet scheduler, which is in charge of allocating resources to active flows in both the frequency and
Dimitrova, D.C.; Berg, J.L. van den; Heijenk, G.; Litjens, R.
Long Term Evolution (LTE) is a cellular technology foreseen to extend the capacity and improve the performance of current 3G cellular networks. A key mechanism in the LTE traffic handling is the packet scheduler, which is in charge of allocating resources to active flows in both the frequency and
Behnam, M.; Nolte, T.; Bril, R.J.
We present our ongoing work to improve an existing synchronization protocol SIRAP for hierarchically scheduled real-time systems. A less pessimistic schedulability analysis is presented which can make the SIRAP protocol more efficient in terms of calculated CPU resource needs. In addition and for
Benning, Amirta; Ghaleb, Maisoon; Suokas, Anu; Dixon-Woods, Mary; Dawson, Jeremy; Barber, Nick; Franklin, Bryony Dean; Girling, Alan; Hemming, Karla; Carmalt, Martin; Rudge, Gavin; Naicker, Thirumalai; Nwulu, Ugochi; Choudhury, Sopna
Objectives To conduct an independent evaluation of the first phase of the Health Foundation’s Safer Patients Initiative (SPI), and to identify the net additional effect of SPI and any differences in changes in participating and non-participating NHS hospitals. Design Mixed method evaluation involving five substudies, before and after design. Setting NHS hospitals in the United Kingdom. Participants Four hospitals (one in each country in the UK) participating in the first phase of the SPI (SPI1); 18 control hospitals. Intervention The SPI1 was a compound (multi-component) organisational intervention delivered over 18 months that focused on improving the reliability of specific frontline care processes in designated clinical specialties and promoting organisational and cultural change. Results Senior staff members were knowledgeable and enthusiastic about SPI1. There was a small (0.08 points on a 5 point scale) but significant (Porganisational climate). Qualitative evidence showed only modest penetration of SPI1 at medical ward level. Although SPI1 was designed to engage staff from the bottom up, it did not usually feel like this to those working on the wards, and questions about legitimacy of some aspects of SPI1 were raised. Of the five components to identify patients at risk of deterioration—monitoring of vital signs (14 items); routine tests (three items); evidence based standards specific to certain diseases (three items); prescribing errors (multiple items from the British National Formulary); and medical history taking (11 items)—there was little net difference between control and SPI1 hospitals, except in relation to quality of monitoring of acute medical patients, which improved on average over time across all hospitals. Recording of respiratory rate increased to a greater degree in SPI1 than in control hospitals; in the second six hours after admission recording increased from 40% (93) to 69% (165) in control hospitals and from 37% (141) to 78% (296
Benning, Amirta; Ghaleb, Maisoon; Suokas, Anu; Dixon-Woods, Mary; Dawson, Jeremy; Barber, Nick; Franklin, Bryony Dean; Girling, Alan; Hemming, Karla; Carmalt, Martin; Rudge, Gavin; Naicker, Thirumalai; Nwulu, Ugochi; Choudhury, Sopna; Lilford, Richard
To conduct an independent evaluation of the first phase of the Health Foundation's Safer Patients Initiative (SPI), and to identify the net additional effect of SPI and any differences in changes in participating and non-participating NHS hospitals. Mixed method evaluation involving five substudies, before and after design. NHS hospitals in the United Kingdom. Four hospitals (one in each country in the UK) participating in the first phase of the SPI (SPI1); 18 control hospitals. The SPI1 was a compound (multi-component) organisational intervention delivered over 18 months that focused on improving the reliability of specific frontline care processes in designated clinical specialties and promoting organisational and cultural change. Senior staff members were knowledgeable and enthusiastic about SPI1. There was a small (0.08 points on a 5 point scale) but significant (P organisational climate). Qualitative evidence showed only modest penetration of SPI1 at medical ward level. Although SPI1 was designed to engage staff from the bottom up, it did not usually feel like this to those working on the wards, and questions about legitimacy of some aspects of SPI1 were raised. Of the five components to identify patients at risk of deterioration--monitoring of vital signs (14 items); routine tests (three items); evidence based standards specific to certain diseases (three items); prescribing errors (multiple items from the British National Formulary); and medical history taking (11 items)--there was little net difference between control and SPI1 hospitals, except in relation to quality of monitoring of acute medical patients, which improved on average over time across all hospitals. Recording of respiratory rate increased to a greater degree in SPI1 than in control hospitals; in the second six hours after admission recording increased from 40% (93) to 69% (165) in control hospitals and from 37% (141) to 78% (296) in SPI1 hospitals (odds ratio for "difference in difference" 2
... leave intermittently or on a reduced leave schedule for planned medical treatment, then the employee... 29 Labor 3 2010-07-01 2010-07-01 false Scheduling of intermittent or reduced schedule leave. 825... OF LABOR OTHER LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Employee Leave Entitlements Under the...
The goal during the last few months has been to freeze and baseline as much as possible the schedules of various ATLAS systems and activities. The main motivations for the re-baselining of the schedules have been the new LHC schedule aiming at first collisions in early 2006 and the encountered delays in civil engineering as well as in the production of some of the detectors. The process was started by first preparing a new installation schedule that takes into account all the new external constraints and the new ATLAS staging scenario. The installation schedule version 3 was approved in the March EB and it provides the Ready For Installation (RFI) milestones for each system, i.e. the date when the system should be available for the start of the installation. TCn is now interacting with the systems aiming at a more realistic and resource loaded version 4 before the end of the year. Using the new RFI milestones as driving dates a new summary schedule has been prepared, or is under preparation, for each system....
Full Text Available This paper presents the scheduling dispatch of a microgrid (MG, while considering renewable energy, battery storage systems, and time-of-use price. For the risk evaluation of an MG, the Value-at-Risk (VAR is calculated by using the Historical Simulation Method (HSM. By considering the various confidence levels of the VAR, a scheduling dispatch model of the MG is formulated to achieve a reasonable trade-off between the risk and cost. An Improved Bee Swarm Optimization (IBSO is proposed to solve the scheduling dispatch model of the MG. In the IBSO procedure, the Sin-wave Weight Factor (SWF and Forward-Backward Control Factor (FBCF are embedded in the bee swarm of the BSO to improve the movement behaviors of each bee, specifically, its search efficiency and accuracy. The effectiveness of the IBSO is demonstrated via a real MG case and the results are compared with other methods. In either a grid-connected scenario or a stand-alone scenario, an optimal scheduling dispatch of MGs is carried out, herein, at various confidence levels of risk. The simulation results provide more information for handling uncertain environments when analyzing the VAR of MGs.
Full Text Available The challenge of scheduling user transmissions on the downlink of a long-term evolution (LTE cellular communication system is addressed. In particular, a novel optimalmultiuser scheduler is proposed. Numerical results show that the system performance improves with increasing correlation among OFDMA subcarriers. It is found that only a limited amount of feedback information is needed to achieve relatively good performance. A suboptimal reduced-complexity scheduler is also proposed and shown to provide good performance. The suboptimal scheme is especially attractive when the number of users is large, in which case the complexity of the optimal scheme is high.
Chang, Chuan-Hui; Chiao, Yu-Ching; Tsai, Yafang
This study is based on competitive dynamics theory, and discusses competitive actions (including their implementation requirements, strategic orientation, and action complexity) that influence hospitals' performance, while also meeting the requirements of Taiwan's "global budget" insurance payment policy. In order to investigate the possible actions of hospitals, the study was conducted in two stages. The first stage investigated the actions of hospitals from March 1 to May 31, 2009. Semi-structured questionnaires were used, which included in-depth interviews with senior supervisors of 10 medium- and large-scale hospitals in central Taiwan. This stage collected data related to the types of actions adopted by the hospitals in previous years. The second stage was based on the data collected from the first stage and on developed questionnaires, which were distributed from June 29 to November 1, 2009. The questionnaires were given to 20 superintendents, deputy superintendents, and supervisors responsible for the management of a hospital, and focused on medical centers and regional hospitals in central Taiwan in order to determine the types and number of competitive actions. First, the strategic orientation of an action has a significantly positive influence on subjective performance. Second, action complexity has a significantly positive influence on the subjective and the objective performance of a hospital. Third, the implementation requirements of actions do not have a significantly positive impact on the subjective or the objective performance of a hospital. Managers facing a competitive healthcare environment should adopt competitive strategies to improve the performance of the hospital.
Today?s scientific and business applications generate mas- sive data sets that need to be transferred to remote sites for sharing, processing, and long term storage. Because of increasing data volumes and enhancement in current net- work technology that provide on-demand high-speed data access between collaborating institutions, data handling and scheduling problems have reached a new scale. In this paper, we present a new data scheduling model with ad- vance resource provisioning, in which data movement operations are defined with earliest start and latest comple- tion times. We analyze time-dependent resource assign- ment problem, and propose a new methodology to improve the current systems by allowing researchers and higher-level meta-schedulers to use data-placement as-a-service, so they can plan ahead and submit transfer requests in advance. In general, scheduling with time and resource conflicts is NP-hard. We introduce an efficient algorithm to organize multiple requests on the fly, while satisfying users? time and resource constraints. We successfully tested our algorithm in a simple benchmark simulator that we have developed, and demonstrated its performance with initial test results.
Vanberkel, P.T.; Boucherie, Richardus J.; Hans, Elias W.; Hurink, Johann L.; van Lent, Wineke A.M.; van Lent, W.A.M.; van Harten, Wim H.; van Harten, Willem H.
No other department influences the workload of a hospital more than the Department of Surgery and in particular, the activities in the operating room. These activities are governed by the master surgical schedule (MSS), which states which patient types receive surgery on which day. In this paper we
Vanberkel, P.T.; Boucherie, Richardus J.; Hans, Elias W.; Hurink, Johann L.; van Lent, W.A.M.; van Harten, Willem H.
No other department influences the workload of a hospital more than the Department of Surgery and in particular, the activities in the operating room. These activities are governed by the master surgical schedule (MSS), which states which patient types receive surgery on which day. In this paper, we
Sarkies, Mitchell N; Bowles, Kelly-Ann; Skinner, Elizabeth H; Haas, Romi; Mitchell, Deb; O'Brien, Lisa; May, Kerry; Ghaly, Marcelle; Ho, Melissa; Haines, Terry P
The aim of this study was to determine if the addition of daily ward interview data improves the capture of hospital quality and safety indicators compared with incident reporting systems alone. An additional aim was to determine the potential characteristics influencing under-reporting of hospital quality and safety indicators in incident reporting systems. A prospective, observational study was performed at two tertiary metropolitan public hospitals. Research assistants from allied health backgrounds met daily with the nurse in charge of the ward and discussed the occurrence of any falls, pressure injuries and rapid response medical team calls. Data were collected from four general medical wards, four surgical wards, an orthopaedic, neurosciences, plastics, respiratory, renal, sub-acute and acute medical assessment unit. An estimated total of 303 falls, 221 pressure injuries and 884 rapid response medical team calls occurred between 15 wards across two hospitals, over a period of 6 months. Hospital incident reporting systems underestimated falls by 30.0%, pressure injuries by 59.3% and rapid response medical team calls by 17.0%. The use of ward interview data collection in addition to hospital incident reporting systems improved data capture of falls by 23.8% (n = 72), pressure injuries by 21.7% (n = 48) and rapid response medical team calls by 12.7% (n = 112). Falls events were significantly less likely to be reported if they occurred on a Monday (P = 0.04) and pressure injuries significantly more likely to be reported if they occurred on a Wednesday (P = 0.01). Hospital quality and safety indicators (falls, pressure injuries and rapid response medical team calls) were under-reported in incident reporting systems, with variability in under-reporting between wards and the day of event occurrence. The use of ward interview data collection in addition to hospital incident reporting systems improved reporting of hospital quality and safety
Ahmed, Z; Elmekkawy, Ty; Bates, S
This study was undertaken to improve the performance of a Chemotherapy Treatment Unit by increasing the throughput and reducing the average patient's waiting time. In order to achieve this objective, a scheduling template has been built. The scheduling template is a simple tool that can be used to schedule patients' arrival to the clinic. A simulation model of this system was built and several scenarios, that target match the arrival pattern of the patients and resources availability, were designed and evaluated. After performing detailed analysis, one scenario provide the best system's performance. A scheduling template has been developed based on this scenario. After implementing the new scheduling template, 22.5% more patients can be served. 1. CancerCare Manitoba is a provincially mandated cancer care agency. It is dedicated to provide quality care to those who have been diagnosed and are living with cancer. MacCharles Chemotherapy unit is specially built to provide chemotherapy treatment to the cancer patients of Winnipeg. In order to maintain an excellent service, it tries to ensure that patients get their treatment in a timely manner. It is challenging to maintain that goal because of the lack of a proper roster, the workload distribution and inefficient resource allotment. In order to maintain the satisfaction of the patients and the healthcare providers, by serving the maximum number of patients in a timely manner, it is necessary to develop an efficient scheduling template that matches the required demand with the availability of resources. This goal can be reached using simulation modelling. Simulation has proven to be an excellent modelling tool. It can be defined as building computer models that represent real world or hypothetical systems, and hence experimenting with these models to study system behaviour under different scenarios.1, 2 A study was undertaken at the Children's Hospital of Eastern Ontario to identify the issues behind the long waiting
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ENGLISH ABSTRACT: Many projects are not completed on time or within the original budget. This is caused by uncertainty in project variables as well as the occurrence of risk events. A study was done to determine ways of measuring the risk in development projects executed by a mining company in South Africa. The main objective of the study was to determine whether historical project data would provide a more accurate means of estimating the total project duration. Original estimates and actual completion times for tasks of a number of projects were analysed and compared. The results of the study indicated that a more accurate total duration for a project could be obtained by making use of historical project data. The accuracy of estimates could be improved further by building a comprehensive project schedule database within a specific industry.
AFRIKAANSE OPSOMMING: Verskeie projekte word nie binne die oorspronklike skedule of begroting voltooi nie. Dit word dikwels veroorsaak deur onsekerheid oor projekveranderlikes en die voorkoms van risiko’s. 'n Studie is gedoen om 'n metode te ontwikkel om risiko te meet vir ontwikkelingsprojekte van 'n mynmaatskappy in Suid Afrika. Die hoofdoel van die studie was om te bepaal of historiese projekdata gebruik kon word om 'n akkurater tydsduur vir 'n projek te beraam. Die geraamde tydsduur van take vir 'n aantal projekte is ontleed en vergelyk met die werklike tydsduur. Die resultate van die studie het getoon dat 'n akkurater totale tydsduur vir die projek verkry kon word deur gebruik te maak van historiese projekdata. Die akkuraatheid kan verder verbeter word deur 'n databasis van projekskedules vir 'n bepaalde industrie te ontwikkel en by datum te hou.
Farokhzadian, Jamileh; Dehghan Nayeri, Nahid; Borhani, Fariba
Clinical risks have created major problems in healthcare system such as serious adverse effects on patient safety and enhancing the financial burden for the healthcare. Thus, clinical risk management (CRM) system has been introduced for improving the quality and safety of services to health care. The aim of this study was to assess the status of CRM in the hospitals. A cross-sectional study was conducted on 200 nursing staff from three teaching hospitals affiliated with the Kerman University of Medical Sciences in southeast of Iran. Data were collected from the participants using questionnaire and observational checklist in quality improvement offices and selected wards. The data were analyzed using SPSS version 20. Almost, 57% of persons participated in at least one of training sessions on CRM. The status of CRM system was rated from weak to moderate (2.93±0.72- 3.18±0.66). Among the six domains of CRM system, the highest mean belonged to domain the monitoring of analysis, evaluation and risk control (3.18±0.72); the lowest mean belonged to domain the staff's knowledge, recognition and understanding of CRM (2.93±0.66). There were no integrated electronic systems for recording and analyzing clinical risks and incidents in the hospitals. Attempts have been made to establish CRM through improvement quality approach such as clinical governance and accreditation, but not enough, however, health care should move toward quality improvement and safe practice through the effective integration of CRM in organizational process.
Wang, Haibo; Devendra, Devendra; Zhou, Xin
This paper investigates the Radio Resource Management (RRM) approaches for GSM/GPRS networks. The effort was put on Access Control(AC), Time-Slot (TS) allocation, and Radio Link Control (RLC) packet scheduling for down-link performance enhancement. A new credit-based algorithm was proposed...
Oja, Paula I; Kouri, Timo T; Pakarinen, Arto J
To find out the satisfaction of clinical units with laboratory services in a university hospital, to point out the most important problems and defects in services, to carry out corrective actions, and thereafter to identify the possible changes in satisfaction. and Senior physicians and nurses-in-charge of the clinical units at Oulu University Hospital, Finland. Customer satisfaction survey using a questionnaire was carried out in 2001, indicating the essential aspects of laboratory services. Customer-specific problems were clarified, corrective actions were performed, and the survey was repeated in 2004. In 2001, the highest dissatisfaction rates were recorded for computerized test requesting and reporting, turnaround times of tests, and the schedule of phlebotomy rounds. The old laboratory information system was not amenable to major improvements, and it was renewed in 2004-05. Several clinical units perceived turnaround times to be long, because the tests were ordered as routine despite emergency needs. Instructions about stat requesting were given to these units. However, no changes were evident in the satisfaction level in the 2004 survey. Following negotiations with the clinics, phlebotomy rounds were re-scheduled. This resulted in a distinct increase in satisfaction in 2004. Satisfaction survey is a screening tool that identifies topics of dissatisfaction. Without further clarifications, it is not possible to find out the specific problems of customers and to undertake targeted corrective actions. Customer-specific corrections are rarely seen as improvements in overall satisfaction rates.
Pan, Cheng-Sheng; Sui, Shi-Long; Liu, Chun-ling; Shi, Yu-Xin
In the satellite communication network system, in order to solve the problem of low system capacity and user fairness in multi-user access to satellite communication network in the downlink, combined with the characteristics of user data service, an algorithm study on throughput capacity and user fairness scheduling is proposed - Proportional Fairness Algorithm Based on Traffic(B-PF). The algorithm is improved on the basis of the proportional fairness algorithm in the wireless communication system, taking into account the user channel condition and caching traffic information. The user outgoing traffic is considered as the adjustment factor of the scheduling priority and presents the concept of traffic satisfaction. Firstly,the algorithm calculates the priority of the user according to the scheduling algorithm and dispatches the users with the highest priority. Secondly, when a scheduled user is the business satisfied user, the system dispatches the next priority user. The simulation results show that compared with the PF algorithm, B-PF can improve the system throughput, the business satisfaction and fairness.
This paper investigates an adaptive scheduling algorithm for multiuser environments with statistically independent but nonidentically distributed (i.n.d.) channel conditions. The algorithm aims to reduce feedback load by sequentially and arbitrarily examining the user channels. It also provides improved performance by realizing postexamining best user selection. The first part of the paper presents new formulations for the statistics of the signal-to-noise ratio (SNR) of the scheduled user under i.n.d. channel conditions. The second part capitalizes on the findings in the first part and presents various performance and processing complexity measures for adaptive discrete-time transmission. The results are then extended to investigate the effect of outdated channel estimates on the statistics of the scheduled user SNR, as well as some performance measures. Numerical results are provided to clarify the usefulness of the scheduling algorithm under perfect or outdated channel estimates. © 1967-2012 IEEE.
The operational theory of the neutron probe is briefly outlined and its application and uses discussed in relation to determination of soil compaction and irrigation scheduling. Graphic examples are given of alluvial soil moisture profiles and how this information can be used to improve trickle irrigation in vineyards. 3 refs., 7 figs
Little, Charles M; McStay, Christopher; Oeth, Justin; Koehler, April; Bookman, Kelly
The use of after-action reviews (AARs) following major emergency events, such as a disaster, is common and mandated for hospitals and similar organizations. There is a recurrent challenge of identified problems not being resolved and repeated in subsequent events. A process improvement technique called a rapid improvement event (RIE) was used to conduct an AAR following a complete information technology (IT) outage at a large urban hospital. Using RIE methodology to conduct the AAR allowed for the rapid development and implementation of major process improvements to prepare for future IT downtime events. Thus, process improvement methodology, particularly the RIE, is suited for conducting AARs following disasters and holds promise for improving outcomes in emergency management. Little CM , McStay C , Oeth J , Koehler A , Bookman K . Using rapid improvement events for disaster after-action reviews: experience in a hospital information technology outage and response. Prehosp Disaster Med. 2018;33(1):98-100.
Moran, Alyssa; Lederer, Ashley; Johnson Curtis, Christine
Most hospital patient meals are considered regular-diet meals; these meals are not required to meet comprehensive nutrition standards for a healthy diet. Although programs exist to improve nutrition in hospital food, the focus is on retail settings such as vending machines and cafeterias vs patient meals. New York City's Healthy Hospital Food Initiative (HHFI) provides nutrition standards for regular-diet meals that hospitals can adopt, in addition to retail standards. This study was undertaken to describe regular-diet patient menus before and after implementation of the HHFI nutrition standards. The study involved pre- and post- menu change analyses of hospitals participating in the HHFI between 2010 and 2014. Eight New York City hospitals, selected based on voluntary participation in the HHFI, were included in the analyses. Nutritional content of regular-diet menus were compared with the HHFI nutrition standards. Nutrient analysis and exact Wilcoxon signed-rank tests were used for the analysis of the data. At baseline, no regular-diet menu met all HHFI standards, and most exceeded the daily limits for percentage of calories from fat (n=5), percentage of calories from saturated fat (n=5), and milligrams of sodium (n=6), and they did not meet the minimum grams of fiber (n=7). Hospitals met all key nutrient standards after implementation, increasing fiber (25%, Pfood service operations, indicating feasibility of this framework in a range of hospital settings. Copyright © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.
Full Text Available The fuzzy processing time occasionally exists in job shop scheduling problem of flexible manufacturing system. To deal with fuzzy processing time, fuzzy flexible job shop model was established in several papers and has attracted numerous researchers’ attention recently. In our research, an improved version of discrete particle swarm optimization (IDPSO is designed to solve flexible job shop scheduling problem with fuzzy processing time (FJSPF. In IDPSO, heuristic initial methods based on triangular fuzzy number are developed, and a combination of six initial methods is applied to initialize machine assignment and random method is used to initialize operation sequence. Then, some simple and effective discrete operators are employed to update particle’s position and generate new particles. In order to guide the particles effectively, we extend global best position to a set with several global best positions. Finally, experiments are designed to investigate the impact of four parameters in IDPSO by Taguchi method, and IDPSO is tested on five instances and compared with some state-of-the-art algorithms. The experimental results show that the proposed algorithm can obtain better solutions for FJSPF and is more competitive than the compared algorithms.
Bergersen, Tone Kristin; Storheim, Elisabeth; Gundersen, Stina; Kleven, Linn; Johnson, Maria; Sandvik, Leiv; Kvaerner, Kari Jorunn; Ørjasæter, Nils-Otto
The aim of this study was to test the efficacy of a wound support network model between the primary home care service and the hospital. The impact on wound healing rate, cost benefit, and transfer of knowledge was investigated. The intervention group was exposed to a wound support network (n = 32), and the control group continued standard organization of treatment (n = 21). Nonrandomized controlled study; observations were made before (baseline) and after the implementation of the intervention (12 weeks). Patients with chronic wounds (lasting >6 weeks and with wound area >1 cm) in Oslo, Norway. Closure of the observation wound; wound size; total number of wounds; presence of eczema, edema, and pain; number of dressings per week; time spent per dressing; and number of control appointments at the hospital. The economic impact is calculated for the hospital and for the community of Oslo, Norway. The number of control appointments (t = 3.80, P home care service and the hospital is cost-effective, improves clinical efficacy of the home care services' work, and reduces the need for consultations at the hospital.
Dückers, Michel L A; Stegeman, Inge; Spreeuwenberg, Peter; Wagner, Cordula; Sanders, Karin; Groenewegen, Peter P
The success of a Dutch program to disseminate quality improvement projects depends on the participation of physicians working in program hospitals. The leadership of hospital executives (CEOs) is considered an important explanation. This study aims to determine whether the relation, between the extent to which physicians notice their CEOs stimulate improvement initiatives and the number of projects joined by physicians, is moderated by the consensus among physicians working in the same hospital. Multilevel analyses are applied on data of 286 physicians from eight hospitals to: (1) estimate whether participation depends on noticing if CEOs stimulate improvement, (2) test if an individual's participation differs when more colleagues have the same opinion (effect modification). Significant moderator effects are found. The participation of physicians, noticing that CEOs stimulate improvement is higher when more colleagues share this opinion. For physicians not knowing whether improvement is encouraged, higher consensus coincides with lower participation. Project involvement of physicians depends on their consensus about encouragement by CEOs. This confirms the importance of strategic leaders in dissemination programs. Further research is recommended into causes of CEO leadership visibility and methods to strengthen leadership climate.
Full Text Available Long-term scheduling of large cascade hydropower stations (LSLCHS is a complex problem of high dimension, nonlinearity, coupling and complex constraint. In view of the above problem, we present an improved differential evolution (iLSHADE algorithm based on LSHADE, a state-of-the-art evolutionary algorithm. iLSHADE uses new mutation strategies “current to pbest/2-rand” to obtain wider search range and accelerate convergence with the preventing individual repeated failure evolution (PIRFE strategy. The handling of complicated constraints strategy of ε-constrained method is presented to handle outflow, water level and output constraints in the cascade reservoir operation. Numerical experiments of 10 benchmark functions have been done, showing that iLSHADE has stable convergence and high efficiency. Furthermore, we demonstrate the performance of the iLSHADE algorithm by comparing it with other improved differential evolution algorithms for LSLCHS in four large hydropower stations of the Jinsha River. With the applications of iLSHADE in reservoir operation, LSLCHS can obtain more power generation benefit than other alternatives in dry, normal, and wet years. The results of numerical experiments and case studies show that the iLSHADE has a distinct optimization effect and good stability, and it is a valid and reliable tool to solve LSLCHS problem.
...) 786-4533, and Jana Lindquist, (410) 786-4533, Partial hospitalization and community mental health... Laboratory Fee Schedule CMHC Community Mental Health Center CMS Centers for Medicare & Medicaid Services CPT... community mental health centers (CMHCs)) and hospital outpatient services that are furnished to inpatients...
Fowler, Terri O; Wise, Holly H; Mauldin, Mary P; Ragucci, Kelly R; Scheurer, Danielle B; Su, Zemin; Mauldin, Patrick D; Bailey, Jennifer R; Borckardt, Jeffrey J
Assessment of interprofessional education (IPE) frequently focuses on students' learning outcomes including changes in knowledge, skills, and/or attitudes. While a foundational education in the values and information of their chosen profession is critical, interprofessional learning follows a continuum from formal education to practice. The continuum increases in significance and complexity as learning becomes more relationship based and dependent upon the ability to navigate complex interactions with patients, families, communities, co-workers, and others. Integrating IPE into collaborative practice is critical to enhancing students' experiential learning, developing teamwork competencies, and understanding the complexity of teams. This article describes a project that linked students with a hospital-based quality-improvement effort to focus on the acquisition and practice of teamwork skills and to determine the impact of teamwork on patient and quality outcome measures. A hospital unit was identified with an opportunity for improvement related to quality care, patient satisfaction, employee engagement, and team behaviours. One hundred and thirty-seven students from six health profession colleges at the Medical University of South Carolina underwent TeamSTEPPS® training and demonstrated proficiency of their teamwork-rating skills with the TeamSTEPPS® Team Performance Observation Tool (T-TPO). Students observed real-time team behaviours of unit staff before and after staff attended formal TeamSTEPPS® training. The students collected a total of 778 observations using the T-TPO. Teamwork performance on the unit improved significantly across all T-TPO domains (team structure, communication, leadership, situation monitoring, and mutual support). Significant improvement in each domain continued post-intervention and at 15-month follow-up, improvement remained significant compared to baseline. Student engagement in TeamSTEPPS® training and demonstration of their
Responding to changes in health care financing, government policy, technology, and clinical judgment, and the rise of managed care, hospitals are shifting services from inpatient to outpatient settings and moving them into the community. Institutions are evolving into integrated delivery systems, developing the capacity to provide a continuum of coordinated services in an array of settings and to share financial risk with physicians and managed care organizations. Over the past several years, hospitals in New York City have shifted considerable resources into ambulatory care. In their drive to expand and enhance services, however, they face serious challenges, including a well-established focus on hospitals as inpatient centers of tertiary care and medical education, a heavy reliance upon residents as providers of medical care, limited access to capital, and often inadequate physical plants. In 1995, the United Hospital Fund awarded $600,000 through its Ambulatory Care Services Initiative to support hospitals' efforts to meet the challenges of reorganizing services, compete in a managed care environment, and provide high-quality ambulatory care in more efficient ways. Through the initiative, 12 New York City hospitals started projects to reorganize service delivery and build an infrastructure of systems, technology, and personnel. Among the projects undertaken by the hospitals were:--broad-based reorganization efforts employing primary care models to improve and expand existing ambulatory care services, integrate services, and better coordinate care;--projects to improve information management, planning and testing new systems for scheduling appointments, registering patients, and tracking ambulatory care and its outcomes;--training programs to increase the supply of primary care providers (both nurse practitioners and primary care physicians), train clinical and support staff in the skills needed to deliver more efficient and better ambulatory care, prepare staff
Cui, Laizhong; Lu, Nan; Chen, Fu
Most large-scale peer-to-peer (P2P) live streaming systems use mesh to organize peers and leverage pull scheduling to transmit packets for providing robustness in dynamic environment. The pull scheduling brings large packet delay. Network coding makes the push scheduling feasible in mesh P2P live streaming and improves the efficiency. However, it may also introduce some extra delays and coding computational overhead. To improve the packet delay, streaming quality, and coding overhead, in this paper are as follows. we propose a QoS driven push scheduling approach. The main contributions of this paper are: (i) We introduce a new network coding method to increase the content diversity and reduce the complexity of scheduling; (ii) we formulate the push scheduling as an optimization problem and transform it to a min-cost flow problem for solving it in polynomial time; (iii) we propose a push scheduling algorithm to reduce the coding overhead and do extensive experiments to validate the effectiveness of our approach. Compared with previous approaches, the simulation results demonstrate that packet delay, continuity index, and coding ratio of our system can be significantly improved, especially in dynamic environments. PMID:25114968
Popovska Avramova, Andrijana; Yan, Ying; Dittmann, Lars
. This paper evaluates a cross layer scheduling algorithm that aims at minimizing the resource utilization. The algorithm makes decisions regarding the channel conditions and the size of transmission buffers and different QoS demands. The simulation results show that the new algorithm improves the resource...
Guzmán Laura, K P; Periañez Vasco, A; Falcón Neyra, M D; Croche Santander, B
Varicella (chickenpox) can cause serious complications and admission to hospital. Several countries included the varicella vaccine in their immunization schedules. A descriptive and retrospective study of hospitalizations due to varicella and its complications was conducted in a referral center from 2005 to 2011. A total of 1192 children with varicella were seen in the emergency room, of which 99 (8.5%) required admission. The annual incidence of admissions due to varicella and varicella complications was, 19.4 and 15.3 cases per 100,000 children under 14 years, respectively. Complications were more common in children under 5 years (79.5%), and with no underlying disease (78.2%). Infection of skin and soft tissue was the most common complication (62%). The mean hospital stay was 4.5 days (SD 4). Varicella causes high morbidity, and is more frequent in absolute terms in healthy children under 5 years of age. Therefore, routine vaccination recommended by the Immunization Advisory Committee should be mandatory. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.
Wald, Heidi L; Bandle, Brian; Richard, Angela A; Min, Sung-Joon; Capezuti, Elizabeth
Catheter-associated urinary tract infection (CAUTI) risk is directly related to duration of indwelling urinary catheters (IUCs), rising beyond 2 days of catheterization. We conducted a cluster randomized study in nonintensive care units of Nurses Improving Care for Healthsystem Elders (NICHE) hospitals. Electronic surveillance data were used in an audit and feedback intervention for frontline nurses to reduce IUC duration. Multivariable methods were used to identify the difference in average IUC duration and proportion of patients with IUC duration hospital characteristics. A total of 24 units at 19 NICHE hospitals reported 13,499 adult patients with IUCs over 18 months. Early and delayed intervention groups had important baseline differences in IUC utilization. Use of evidence-based CAUTI prevention measures increased during study participation. In multivariable analysis, the average IUC duration and proportion of patients with IUC duration Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
O’ Hanlon, M
Surgical site infection (SSI) rates are used extensively by hospitals as a basis for quality improvement. A 30-day post-discharge SSI programme for Caesarean section operations has been implemented in Our Lady of Lourdes Hospital since 2011. It has been shown that skin antisepsis and antibiotic prophylaxis are key factors in the prevention of SSI. Using quality improvement methodology, an infection prevention bundle was introduced to address these two factors. Skin antisepsis was changed from povidone-iodine to chlorhexidine-alcohol. Compliance with choice of antibiotic prophylaxis increased from 89.6% in 2014 to 98.5% in 2015. Compliance with timing also improved. The SSI rate of 7.5% was the lowest recorded to date, with the majority of SSIs (64%) diagnosed after hospital discharge. The level of variation was also reduced. However, the continued presence of variation and possibility of lower infection rates from the literature imply that further improvements are required.
Barana, Oliviero; Nouailletas, Rémy; Brémond, Sylvain; Moreau, Philippe; Allegretti, Ludovic; Balme, Stéphane; Ravenel, Nathalie; Mannori, Simone; Guillerminet, Bernard; Leroux, Fabrice; Douai, David; Nardon, Eric; Hertout, Patrick; Saint-Laurent, François
Highlights: ► Real-time event handling requires extended functionalities of pulse schedule editors and plasma control systems ► A new pulse schedule editor, conceived for parameterization of systematic off-normal event handling, is described ► A global, generic approach on off-normal event handling is highlighted ► The functional architecture of an off-normal event handling oriented plasma control system is discussed ► The main objects of the pulse schedule editor are the segment-descriptor object and the scenario-descriptor object. -- Abstract: Coping with unexpected events is an important issue of nuclear fusion experiments. The future machines, characterized by very long plasma discharges and actively cooled metallic plasma-facing components, will require a systematic intervention in real time, in order to maximize the performance and protect the investment. The real-time management of events will require extending the functionalities of the current pulse schedule editors with the possibility of using reference waveforms provided with acceptability margins and setting up advanced mitigation strategies and event countermeasures. With this purpose, a new pulse schedule editor, based on a time-segment approach for the preparation of experimental scenarios, is being conceived on Tore Supra, together with a new plasma control system. This paper will report on their conceptual design and give account of the preliminary results of a feasibility study currently under way in order to prepare a possible implementation on Tore Supra
Barana, Oliviero, E-mail: firstname.lastname@example.org [CEA, IRFM, F-13108 Saint-Paul-Lez Durance (France); Nouailletas, Rémy; Brémond, Sylvain; Moreau, Philippe; Allegretti, Ludovic; Balme, Stéphane; Ravenel, Nathalie [CEA, IRFM, F-13108 Saint-Paul-Lez Durance (France); Mannori, Simone [ENEA C.R. Brasimone, 40032 Camugnano (Italy); Guillerminet, Bernard; Leroux, Fabrice; Douai, David; Nardon, Eric; Hertout, Patrick; Saint-Laurent, François [CEA, IRFM, F-13108 Saint-Paul-Lez Durance (France)
Highlights: ► Real-time event handling requires extended functionalities of pulse schedule editors and plasma control systems ► A new pulse schedule editor, conceived for parameterization of systematic off-normal event handling, is described ► A global, generic approach on off-normal event handling is highlighted ► The functional architecture of an off-normal event handling oriented plasma control system is discussed ► The main objects of the pulse schedule editor are the segment-descriptor object and the scenario-descriptor object. -- Abstract: Coping with unexpected events is an important issue of nuclear fusion experiments. The future machines, characterized by very long plasma discharges and actively cooled metallic plasma-facing components, will require a systematic intervention in real time, in order to maximize the performance and protect the investment. The real-time management of events will require extending the functionalities of the current pulse schedule editors with the possibility of using reference waveforms provided with acceptability margins and setting up advanced mitigation strategies and event countermeasures. With this purpose, a new pulse schedule editor, based on a time-segment approach for the preparation of experimental scenarios, is being conceived on Tore Supra, together with a new plasma control system. This paper will report on their conceptual design and give account of the preliminary results of a feasibility study currently under way in order to prepare a possible implementation on Tore Supra.
Newell, Terry L; Steinmetz-Malato, Laura L; Van Dyke, Deborah L
The inpatient medication delivery system used at a large regional acute care hospital in the Midwest had become antiquated and inefficient. The existing 24-hr medication cart-fill exchange process with delivery to the patients' bedside did not always provide ordered medications to the nursing units when they were needed. In 2007 the principles of the Toyota Production System (TPS) were applied to the system. Project objectives were to improve medication safety and reduce the time needed for nurses to retrieve patient medications. A multidisciplinary team was formed that included representatives from nursing, pharmacy, informatics, quality, and various operational support departments. Team members were educated and trained in the tools and techniques of TPS, and then designed and implemented a new pull system benchmarking the TPS Ideal State model. The newly installed process, providing just-in-time medication availability, has measurably improved delivery processes as well as patient safety and satisfaction. Other positive outcomes have included improved nursing satisfaction, reduced nursing wait time for delivered medications, and improved efficiency in the pharmacy. After a successful pilot on two nursing units, the system is being extended to the rest of the hospital. © 2010 National Association for Healthcare Quality.
Downing, Amy; Morris, Eva Ja; Corrigan, Neil; Sebag-Montefiore, David; Finan, Paul J; Thomas, James D; Chapman, Michael; Hamilton, Russell; Campbell, Helen; Cameron, David; Kaplan, Richard; Parmar, Mahesh; Stephens, Richard; Seymour, Matt; Gregory, Walter; Selby, Peter
In 2001, the National Institute for Health Research Cancer Research Network (NCRN) was established, leading to a rapid increase in clinical research activity across the English NHS. Using colorectal cancer (CRC) as an example, we test the hypothesis that high, sustained hospital-level participation in interventional clinical trials improves outcomes for all patients with CRC managed in those research-intensive hospitals. Data for patients diagnosed with CRC in England in 2001-2008 (n=209 968) were linked with data on accrual to NCRN CRC studies (n=30 998). Hospital Trusts were categorised by the proportion of patients accrued to interventional studies annually. Multivariable models investigated the relationship between 30-day postoperative mortality and 5-year survival and the level and duration of study participation. Most of the Trusts achieving high participation were district general hospitals and the effects were not limited to cancer 'centres of excellence', although such centres do make substantial contributions. Patients treated in Trusts with high research participation (≥16%) in their year of diagnosis had lower postoperative mortality (presearch participation, with a reduction in postoperative mortality of 1.5% (6.5%-5%, pstudies for all patients with CRC treated in the hospital study participants. Improvement precedes and increases with the level and years of sustained participation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Castro Corredor, David; Cuadra Díaz, José Luis; Mateos Rodríguez, Javier José; Anino Fernández, Joaquín; Mínguez Sánchez, María Dolores; de Lara Simón, Isabel María; Tébar, María Ángeles; Añó, Encarnación; Sanz, María Dolores; Ballester, María Nieves
The rheumatology service of Ciudad Real Hospital, located in an autonomous community of that same name that is nearly in the center of Spain, implemented a self-management model of successive appointments more than 10 years ago. Since then, the physicians of the department schedule follow-up visits for their patients depending on the disease, its course and ancillary tests. The purpose of this study is to evaluate and compare the self-management model for successive appointments in the rheumatology service of Ciudad Real Hospital versus the model of external appointment management implemented in 8 of the hospital's 15 medical services. A comparative and multivariate analysis was performed to identify variables with statistically significant differences, in terms of activity and/or performance indicators and quality perceived by users. The comparison involved the self-management model for successive appointments employed in the rheumatology service of Ciudad Real Hospital and the model for external appointment management used in 8 hospital medical services between January 1 and May 31, 2016. In a database with more than 100,000 records of appointments involving the set of services included in the study, the mean waiting time and the numbers of non-appearances and rescheduling of follow-up visits in the rheumatology department were significantly lower than in the other services. The number of individuals treated in outpatient rheumatology services was 7,768, and a total of 280 patients were surveyed (response rate 63.21%). They showed great overall satisfaction, and the incidence rate of claims was low. Our results show that the self-management model of scheduling appointments has better results in terms of activity indicators and in quality perceived by users, despite the intense activity. Thus, this study could be fundamental for decision making in the management of health care organizations. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de
Li, Min; Huang, Chengyu; Lu, Xiangchan; Chen, Siyuan; Zhao, Pan; Lu, Hongzhou
Our goal is to establish criteria for evaluating satisfaction of medical staff and patients of Chinese hospitals and propose measures for improvement. A survey was conducted among medical staff and patients of infectious disease hospitals in three locations, i.e., Shanghai, Chongqing, and Nanning. The analyses included item analysis, factor analysis, reliability analysis, Pearson correlation and one-way analysis of variance. For the patient group, Kaiser-Meyer-Olkin (KMO) = 0.973, Cronbach's α = 0.962 and the Pearson correlation coefficients among the five dimensions of satisfaction ranged from 0.583 to 0.795. For the medical staff group, KMO = 0.972, Cronbach's α = 0.970, and the Pearson correlation coefficients among the five dimensions of satisfaction ranged from 0.603 to 0.854. The means on the five dimensions of satisfaction for the patient group were 0.74 to 1.34, 0.81 to 1.17, 0.78 to 1.07, 0.89 to 1.34, and 0.71 to 1.10. The means on the five dimensions of satisfaction for the medical staff group were 0.17 to 1.03, ‒ 0.16 to 0.60, ‒ 0.18 to 0.74, 0.23 to 0.72, and ‒ 0.39 to 0.37. The clinicians were less satisfied with the hospitals than the patients. Medical staff and patients in Shanghai were relatively more satisfied. Improving the evaluation criteria and survey methods with respect to medical staff and patient satisfaction with Chinese hospitals may increase clinician and patient satisfaction and improve the health care environment in China.
Full Text Available The task scheduling problem has been widely studied for assigning resources to tasks in heterogeneous grid environment. Effective task scheduling is an important issue for the performance of grid computing. Meanwhile, the task scheduling problem is an NP-complete problem. Hence, this investigation introduces a named “standard“ particle swarm optimization (PSO metaheuristic approach to efficiently solve the task scheduling problems in grid. Meanwhile, two promising heuristics based on multimode project scheduling are proposed to help in solving interesting scheduling problems. They are the best performance resource heuristic and the latest finish time heuristic. These two heuristics applied to the PSO scheme are for speeding up the search of the particle and improving the capability of finding a sound schedule. Moreover, both global communication topology and local ring communication topology are also investigated for efficient study of proposed scheme. Simulation results demonstrate that the proposed approach in this investigation can successfully solve the task-resource assignment problems in grid computing and similar scheduling problems.
Chawla, Sagar; Kurani, Shaheen; Wren, Sherry M; Stewart, Barclay; Burnham, Gilbert; Kushner, Adam; McIntyre, Thomas
Access to reliable energy has been identified as a global priority and codified within United Nations Sustainable Goal 7 and the Electrify Africa Act of 2015. Reliable hospital access to electricity is necessary to provide safe surgical care. The current state of electrical availability in hospitals in low- and middle-income countries (LMICs) throughout the world is not well known. This study aimed to review the surgical capacity literature and document the availability of electricity and generators. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search for surgical capacity assessments in LMICs in MEDLINE, PubMed, and World Health Organization Global Health Library was performed. Data regarding electricity and generator availability were extracted. Estimated percentages for individual countries were calculated. Of 76 articles identified, 21 reported electricity availability, totaling 528 hospitals. Continuous electricity availability at hospitals providing surgical care was 312/528 (59.1%). Generator availability was 309/427 (72.4%). Estimated continuous electricity availability ranged from 0% (Sierra Leone and Malawi) to 100% (Iran); estimated generator availability was 14% (Somalia) to 97.6% (Iran). Less than two-thirds of hospitals providing surgical care in 21 LMICs have a continuous electricity source or have an available generator. Efforts are needed to improve electricity infrastructure at hospitals to assure safe surgical care. Future research should look at the effect of energy availability on surgical care and patient outcomes and novel methods of powering surgical equipment. Copyright © 2017 Elsevier Inc. All rights reserved.
Baptiste, Philippe; Nuijten, Wim
Constraint Programming is a problem-solving paradigm that establishes a clear distinction between two pivotal aspects of a problem: (1) a precise definition of the constraints that define the problem to be solved and (2) the algorithms and heuristics enabling the selection of decisions to solve the problem. It is because of these capabilities that Constraint Programming is increasingly being employed as a problem-solving tool to solve scheduling problems. Hence the development of Constraint-Based Scheduling as a field of study. The aim of this book is to provide an overview of the most widely used Constraint-Based Scheduling techniques. Following the principles of Constraint Programming, the book consists of three distinct parts: The first chapter introduces the basic principles of Constraint Programming and provides a model of the constraints that are the most often encountered in scheduling problems. Chapters 2, 3, 4, and 5 are focused on the propagation of resource constraints, which usually are responsibl...
Isabel Fernandes Guerreiro, Ana; Kuttumuratova, Aigul; Monolbaev, Kubanychbek; Boderscova, Larisa; Pirova, Zulfiya; Weber, Martin W
There is a recognized need to raise evidence on how to adopt human rights-based approaches (HRBAs) to health and to assess their impact. In 2013 and 2014, the World Health Organization (WHO) Regional Office for Europe used a set of tools to assess and improve the situation of children's rights in 11 hospitals in Kyrgyzstan, 10 hospitals in Tajikistan, and 21 hospitals in Moldova, by applying a HRBA to health, taking as a reference the Convention on the Rights of the Child (CRC). The assessment results show a similar situation across countries in some areas, and more or less significant variation in others. Common gaps include the need to improve adolescent-friendly health services, the rights to privacy and play; and infrastructure and equipment. In Kyrgyzstan and Tajikistan, a second round of assessment, was carried out, which showed an effective change in several areas, whilst other areas showed persistent gaps. Moldova did not carry out a second round of assessment. Involving children and parents in the assessment was crucial to obtain more reliable data; the project showed how to use the CRC as a framework to improve quality of care for children (QoC); and the tools were proven useful for self-assessment.
Investigating organizational quality improvement systems, patient empowerment, organizational culture, professional involvement and the quality of care in European hospitals: the 'Deepening our Understanding of Quality Improvement in Europe (DUQuE)' project
Groene, O.; Klazinga, N.; Wagner, C.; Arah, O.A.; Thompson, A.; Bruneau, C.; Suñol, R.
Hospitals in European countries apply a wide range of quality improvement strategies. Knowledge of the effectiveness of these strategies, implemented as part of an overall hospital quality improvement system, is limited. We propose to study the relationships among organisational quality improvement
This paper describes the Project Scheduling system being employed by the Decommissioning Operations Contractor at the Shippingport Station Decommissioning Project (SSDP). Results from the planning system show that the project continues to achieve its cost and schedule goals. An integrated cost and schedule control system (C/SCS) which uses the concept of earned value for measurement of performance was instituted in accordance with DOE orders. The schedule and cost variances generated by the C/SCS system are used to confirm management's assessment of project status. This paper describes the types of schedules and tools used on the SSDP project to plan and monitor the work, and identifies factors that are unique to a decommissioning project that make scheduling critical to the achievement of the project's goals. 1 fig
This Program Reference Schedule Baseline (PRSB) provides the baseline Program-level milestones and associated schedules for the Civilian Radioactive Waste Management Program. It integrates all Program-level schedule-related activities. This schedule baseline will be used by the Director, Office of Civilian Radioactive Waste Management (OCRWM), and his staff to monitor compliance with Program objectives. Chapter 1 includes brief discussions concerning the relationship of the PRSB to the Program Reference Cost Baseline (PRCB), the Mission Plan, the Project Decision Schedule, the Total System Life Cycle Cost report, the Program Management Information System report, the Program Milestone Review, annual budget preparation, and system element plans. Chapter 2 includes the identification of all Level 0, or Program-level, milestones, while Chapter 3 presents and discusses the critical path schedules that correspond to those Level 0 milestones
Korsiak, Jill; Tranmer, Joan; Day, Andrew; Aronson, Kristan J
The main objective was to determine whether sleep duration on work shifts mediates the relationship between a current alternating day and night shift work schedule and metabolic syndrome among female hospital employees. The secondary objective was to assess whether cumulative lifetime shift work exposure was associated with metabolic syndrome. In this cross-sectional study of 294 female hospital employees, sleep duration was measured with the ActiGraph GT3X+. Shift work status was determined through self-report. Investigation of the total, direct and indirect effects between shift work, sleep duration on work shifts and metabolic syndrome was conducted using regression path analysis. Logistic regression was used to determine the association between cumulative shift work exposure and metabolic syndrome. Shift work is strongly associated with metabolic syndrome (OR Total =2.72, 95% CI 1.38 to 5.36), and the relationship is attenuated when work shift sleep duration is added to the model (OR Direct =1.18, 95% CI 0.49 to 2.89). Sleep duration is an important intermediate between shift work and metabolic syndrome (OR Indirect =2.25, 95% CI 1.27 to 4.26). Cumulative shift work exposure is not associated with metabolic syndrome in this population. Sleep duration mediates the association between a current alternating day-night shift work pattern and metabolic syndrome. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Dnyaneshwar, Mantri; Pawar, Pranav M.; Prasad, Neeli R.
In the Wireless Sensor Networks, (WSNs) a key challenge is to schedule the activities of the mobile node for improvement in throughput, energy consumption and delay. This paper proposes efficient schedule based data aggregation algorithm using node mobility (SDNM). It considers the cluster...
Foster, T A; Hackenberg, T D; Vaidya, M
Pigeons' key pecks produced food under second-order schedules of token reinforcement, with light-emitting diodes serving as token reinforcers. In Experiment 1, tokens were earned according to a fixed-ratio 50 schedule and were exchanged for food according to either fixed-ratio or variable-ratio exchange schedules, with schedule type varied across conditions. In Experiment 2, schedule type was varied within sessions using a multiple schedule. In one component, tokens were earned according to a fixed-ratio 50 schedule and exchanged according to a variable-ratio schedule. In the other component, tokens were earned according to a variable-ratio 50 schedule and exchanged according to a fixed-ratio schedule. In both experiments, the number of responses per exchange was varied parametrically across conditions, ranging from 50 to 400 responses. Response rates decreased systematically with increases in the fixed-ratio exchange schedules, but were much less affected by changes in the variable-ratio exchange schedules. Response rates were consistently higher under variable-ratio exchange schedules than tinder comparable fixed-ratio exchange schedules, especially at higher exchange ratios. These response-rate differences were due both to greater pre-ratio pausing and to lower local rates tinder the fixed-ratio exchange schedules. Local response rates increased with proximity to food under the higher fixed-ratio exchange schedules, indicative of discriminative control by the tokens.
Stevens, Bonnie J; Yamada, Janet; Promislow, Sara; Stinson, Jennifer; Harrison, Denise; Victor, J Charles
Background Despite extensive research, institutional policies, and practice guidelines, procedural pain remains undertreated in hospitalized children. Knowledge translation (KT) strategies have been employed to bridge the research to practice gap with varying success. The most effective single or combination of KT strategies has not been found. A multifaceted KT intervention, Evidence-based Practice for Improving Quality (EPIQ), that included tailored KT strategies was effective in improving ...
Dimitrova, D.C.; Berg, J.L. van den; Litjens, R.; Heijenk, G.
Long Term Evolution (LTE) is a cellular technology developed to support diversity of data traffic at potentially high rates. It is foreseen to extend the capacity and improve the performance of current 3G cellular networks. A key mechanism in the LTE traffic handling is the packet scheduler, which is in charge of allocating resources to active flows in both the frequency and time dimension. In this paper we present a performance comparison of two distinct scheduling schemes for LTE uplink (fa...
Scurich, Nicholas; John, Richard S
Security of infrastructure is a major concern. Traditional security schedules are unable to provide omnipresent coverage; consequently, adversaries can exploit predictable vulnerabilities to their advantage. Randomized security schedules, which randomly deploy security measures, overcome these limitations, but public perceptions of such schedules have not been examined. In this experiment, participants were asked to make a choice between attending a venue that employed a traditional (i.e., search everyone) or a random (i.e., a probability of being searched) security schedule. The absolute probability of detecting contraband was manipulated (i.e., 1/10, 1/4, 1/2) but equivalent between the two schedule types. In general, participants were indifferent to either security schedule, regardless of the probability of detection. The randomized schedule was deemed more convenient, but the traditional schedule was considered fairer and safer. There were no differences between traditional and random schedule in terms of perceived effectiveness or deterrence. Policy implications for the implementation and utilization of randomized schedules are discussed. © 2013 Society for Risk Analysis.
Full Text Available Abstract Background The Bangladesh government implemented a pilot Hospital Improvement Initiative (HII in five hospitals in Sylhet division between 1998 and 2003. This included management and behaviour change training for staff, waste disposal and procurement, and referral arrangements. Two linked cross-sectional surveys in 2000 and 2003 assessed the impact of the HII, assessing both patients' experience and satisfaction and public views and use of the hospitals. Methods In each survey we asked 300 consecutive outpatients and a stratified random sample of 300 inpatients in the five hospitals about waiting and consultation time, use of an agent for admission, and satisfaction with privacy, cleanliness, and staff behaviour. The field teams observed cleanliness and privacy arrangements, and visited a sample of households in communities near the hospitals to ask about their opinions and use of the hospital services. Analysis examined changes over time in patients' experience and views. Multivariate analysis took account of other variables potentially associated with the outcomes. Survey managers discussed the survey findings with gender stratified focus groups in each sample community. Results Compared with 2000, an outpatient in three of the hospitals in 2003 was more likely to be seen within 10 minutes and for at least five minutes by the doctor, but outpatients were less likely to report receiving all the prescribed medicines from the hospital. In 2003, inpatients were more likely to have secured admission without using an agent. Although patients’ satisfaction with several aspects of care improved, most changes were not statistically significant. Households in 2003 were significantly more likely to rate the hospitals as good than in 2000. Use of the hospitals did not change, except that more households used the medical college hospital for inpatient care in 2003. Focus groups confirmed criticisms of services and suggested improvements
Improving medication information transfer between hospitals, skilled-nursing facilities, and long-term-care pharmacies for hospital discharge transitions of care: A targeted needs assessment using the Intervention Mapping framework.
Kerstenetzky, Luiza; Birschbach, Matthew J; Beach, Katherine F; Hager, David R; Kennelty, Korey A
Patients transitioning from the hospital to a skilled nursing home (SNF) are susceptible to medication-related errors resulting from fragmented communication between facilities. Through continuous process improvement efforts at the hospital, a targeted needs assessment was performed to understand the extent of medication-related issues when patients transition from the hospital into a SNF, and the gaps between the hospital's discharge process, and the needs of the SNF and long-term care (LTC) pharmacy. We report on the development of a logic model that will be used to explore methods for minimizing patient care medication delays and errors while further improving handoff communication to SNF and LTC pharmacy staff. Applying the Intervention Mapping (IM) framework, a targeted needs assessment was performed using quantitative and qualitative methods. Using the hospital discharge medication list as reference, medication discrepancies in the SNF and LTC pharmacy lists were identified. SNF and LTC pharmacy staffs were also interviewed regarding the continuity of medication information post-discharge from the hospital. At least one medication discrepancy was discovered in 77.6% (n = 45/58) of SNF and 76.0% (n = 19/25) of LTC pharmacy medication lists. A total of 191 medication discrepancies were identified across all SNF and LTC pharmacy records. Of the 69 SNF staff interviewed, 20.3% (n = 14) reported patient care delays due to omitted documents during the hospital-to-SNF transition. During interviews, communication between the SNF/LTC pharmacy and the discharging hospital was described by facility staff as unidirectional with little opportunity for feedback on patient care concerns. The targeted needs assessment guided by the IM framework has lent to several planned process improvements initiatives to help reduce medication discrepancies during the hospital-to-SNF transition as well as improve communication between healthcare entities. Opening lines of
Harper, Richard W; Nasis, Arthur; Sundararajan, Vijaya
Rising health care costs above inflation are placing serious strains on the sustainability of the Australian Medicare system in its current structure. The Medicare Benefits Schedule (MBS), which lists rebates payable to patients for private medical services provided on a fee-for-service basis, is the cornerstone of the Australian health care system. Introduced in the 1980s, the MBS has changed little despite major advances in the evidence base for the practice of cardiology. We outline how we believe sensible changes to the MBS listings for four cardiac services--invasive coronary angiography, computed tomography coronary angiography, stress testing and percutaneous coronary intervention--would improve the clinical practice of cardiology and save substantial amounts of taxpayer money.
Huang, Chung-Chi; Liu, Hsiao-Man; Huang, Chung-Lin
Physical fitness and health of white collar business person is getting worse and worse in recent years. Therefore, it is necessary to develop a system which can enhance physical fitness and health for people. Although the exercise prescription can be generated after diagnosing for customized physical fitness and healthcare. It is hard to meet individual execution needs for general scheduling of physical fitness and healthcare system. So the main purpose of this research is to develop an intelligent scheduling of execution for customized physical fitness and healthcare system. The results of diagnosis and prescription for customized physical fitness and healthcare system will be generated by fuzzy logic Inference. Then the results of diagnosis and prescription for customized physical fitness and healthcare system will be scheduled and executed by intelligent computing. The scheduling of execution is generated by using genetic algorithm method. It will improve traditional scheduling of exercise prescription for physical fitness and healthcare. Finally, we will demonstrate the advantages of the intelligent scheduling of execution for customized physical fitness and healthcare system.
Ijkema, R.; Langelaan, M.; van de Steeg, L.; Wagner, C.
Objective: To gain insight into which factors impede, and which facilitate, the implementation of a complex multi-component improvement initiative in hospitalized older patients. Design: A qualitative study based on semi-structured interviews. The three dimensions of Pettigrew and Whipp's
Duerink, D.O.; Farida, H.; Nagelkerke, N.J.; Wahyono, H.; Keuter, M.; Lestari, E.S.; Hadi, U.; Broek, P.J.J.A. van den
Standard precautions can prevent transmission of micro-organisms. This study investigated hand hygiene, handling of needles and use of personal protective equipment in an Indonesian teaching hospital, and performed a multi-faceted intervention study to improve compliance. An intervention was
Lindhard, Søren; Wandahl, Søren
Last Planner System has through the sounding process increased the reliability of the schedule. The sound activities are moved to a buffer and afterwards selected to the Weekly Work Plans to match capacity. Therefore, in order to maximise productivity it is essential to ensure that the sounding p...... be introduced to absorb the effect. This is achieved by introducing slack at the critical path and supplementing it with buffers of “time” flexible activities....
Luczynski, Kevin C; Hanley, Gregory P
Several studies have shown that children prefer contingent reinforcement (CR) rather than yoked noncontingent reinforcement (NCR) when continuous reinforcement is programmed in the CR schedule. Preference has not, however, been evaluated for practical schedules that involve CR. In Study 1, we assessed 5 children's preference for obtaining social interaction via a multiple schedule (periods of fixed-ratio 1 reinforcement alternating with periods of extinction), a briefly signaled delayed reinforcement schedule, and an NCR schedule. The multiple schedule promoted the most efficient level of responding. In general, children chose to experience the multiple schedule and avoided the delay and NCR schedules, indicating that they preferred multiple schedules as the means to arrange practical schedules of social interaction. In Study 2, we evaluated potential controlling variables that influenced 1 child's preference for the multiple schedule and found that the strong positive contingency was the primary variable. © Society for the Experimental Analysis of Behavior.
David A. Williams
Full Text Available Background: With new resident duty-hour regulations, resident work schedules have progressively transitioned towards shift-based systems, sometimes resulting in increased team fragmentation. We hypothesized that exposure to shift-based schedules and subsequent team fragmentation would negatively affect medical student experiences during their third-year internal medicine clerkship. Design: As part of a larger national study on duty-hour reform, 67 of 150 eligible third-year medical students completed surveys about career choice, teaching and supervision, assessment, patient care, well-being, and attractiveness of a career in internal medicine after completing their internal medicine clerkship. Students who rotated to hospitals with shift-based systems were compared to those who did not. Non-demographic variables used a five-point Likert scale. Chi-squared and Fisher's exact tests were used to assess the relationships between exposure to shift-based schedules and student responses. Questions with univariate p≤0.1 were included in multivariable logistic regression models. Results: Thirty-six students (54% were exposed to shift-based schedules. Students exposed to shift-based schedules were less likely to perceive that their attendings were committed to teaching (odds ratio [OR] 0.35, 95% confidence interval [CI]: 0.13–0.90, p=0.01 or perceive that residents had sufficient exposure to assess their performance (OR 0.29, 95% CI: 0.09–0.91, p=0.03. However, those students were more likely to feel their interns were able to observe them at the bedside (OR 1.89, 95% CI: 1.08–3.13, p=0.02 and had sufficient exposure to assess their performance (OR 3.00, 95% CI: 1.01–8.86, p=0.05. Conclusions: These findings suggest that shift-based schedules designed in response to duty-hour reform may have important broader implications for the teaching environment.
Williams, David A; Kogan, Jennifer R; Hauer, Karen E; Yamashita, Traci; Aagaard, Eva M
With new resident duty-hour regulations, resident work schedules have progressively transitioned towards shift-based systems, sometimes resulting in increased team fragmentation. We hypothesized that exposure to shift-based schedules and subsequent team fragmentation would negatively affect medical student experiences during their third-year internal medicine clerkship. As part of a larger national study on duty-hour reform, 67 of 150 eligible third-year medical students completed surveys about career choice, teaching and supervision, assessment, patient care, well-being, and attractiveness of a career in internal medicine after completing their internal medicine clerkship. Students who rotated to hospitals with shift-based systems were compared to those who did not. Non-demographic variables used a five-point Likert scale. Chi-squared and Fisher's exact tests were used to assess the relationships between exposure to shift-based schedules and student responses. Questions with univariate p ≤ 0.1 were included in multivariable logistic regression models. Thirty-six students (54%) were exposed to shift-based schedules. Students exposed to shift-based schedules were less likely to perceive that their attendings were committed to teaching (odds ratio [OR] 0.35, 95% confidence interval [CI]: 0.13-0.90, p = 0.01) or perceive that residents had sufficient exposure to assess their performance (OR 0.29, 95% CI: 0.09-0.91, p = 0.03). However, those students were more likely to feel their interns were able to observe them at the bedside (OR 1.89, 95% CI: 1.08-3.13, p = 0.02) and had sufficient exposure to assess their performance (OR 3.00, 95% CI: 1.01-8.86, p = 0.05). These findings suggest that shift-based schedules designed in response to duty-hour reform may have important broader implications for the teaching environment.
Paprocka, I.; Kempa, W. M.; Grabowik, C.; Kalinowski, K.; Krenczyk, D.
In the paper a survey of predictive and reactive scheduling methods is done in order to evaluate how the ability of prediction of reliability characteristics influences over robustness criteria. The most important reliability characteristics are: Mean Time to Failure, Mean Time of Repair. Survey analysis is done for a job shop scheduling problem. The paper answers the question: what method generates robust schedules in the case of a bottleneck failure occurrence before, at the beginning of planned maintenance actions or after planned maintenance actions? Efficiency of predictive schedules is evaluated using criteria: makespan, total tardiness, flow time, idle time. Efficiency of reactive schedules is evaluated using: solution robustness criterion and quality robustness criterion. This paper is the continuation of the research conducted in the paper , where the survey of predictive and reactive scheduling methods is done only for small size scheduling problems.
X. Zhang (Xiandong)
textabstractScheduling is essential when activities need to be allocated to scarce resources over time. Motivated by the problem of scheduling barges along container terminals in the Port of Rotterdam, this thesis designs and analyzes algorithms for various on-line and off-line scheduling problems
Biefeld, Eric W.; Cooper, Lynne P.
Artificial-intelligence software that automates scheduling developed in Operations Mission Planner (OMP) research project. Software used in both generation of new schedules and modification of existing schedules in view of changes in tasks and/or available resources. Approach based on iterative refinement. Although project focused upon scheduling of operations of scientific instruments and other equipment aboard spacecraft, also applicable to such terrestrial problems as scheduling production in factory.
Warfare, Naval Sea Systems Command Acquisition Cycle Time : Defining the Problem David Tate, Institute for Defense Analyses Schedule Analytics Jennifer...research was comprised of the following high- level steps : Identify and review primary data sources 1...research. However, detailed reviews of the OMB IT Dashboard data revealed that schedule data is highly aggregated. Program start date and program end date
Full Text Available Purpose: A decomposition heuristics based on multi-bottleneck machines for large-scale job shop scheduling problems (JSP is proposed.Design/methodology/approach: In the algorithm, a number of sub-problems are constructed by iteratively decomposing the large-scale JSP according to the process route of each job. And then the solution of the large-scale JSP can be obtained by iteratively solving the sub-problems. In order to improve the sub-problems' solving efficiency and the solution quality, a detection method for multi-bottleneck machines based on critical path is proposed. Therewith the unscheduled operations can be decomposed into bottleneck operations and non-bottleneck operations. According to the principle of “Bottleneck leads the performance of the whole manufacturing system” in TOC (Theory Of Constraints, the bottleneck operations are scheduled by genetic algorithm for high solution quality, and the non-bottleneck operations are scheduled by dispatching rules for the improvement of the solving efficiency.Findings: In the process of the sub-problems' construction, partial operations in the previous scheduled sub-problem are divided into the successive sub-problem for re-optimization. This strategy can improve the solution quality of the algorithm. In the process of solving the sub-problems, the strategy that evaluating the chromosome's fitness by predicting the global scheduling objective value can improve the solution quality.Research limitations/implications: In this research, there are some assumptions which reduce the complexity of the large-scale scheduling problem. They are as follows: The processing route of each job is predetermined, and the processing time of each operation is fixed. There is no machine breakdown, and no preemption of the operations is allowed. The assumptions should be considered if the algorithm is used in the actual job shop.Originality/value: The research provides an efficient scheduling method for the
Izosimov, Viacheslav; Pop, Paul; Eles, Petru
In this article, we propose a strategy for the synthesis of fault-tolerant schedules and for the mapping of fault-tolerant applications. Our techniques handle transparency/performance trade-offs and use the faultoccurrence information to reduce the overhead due to fault tolerance. Processes...... and messages are statically scheduled, and we use process reexecution for recovering from multiple transient faults. We propose a finegrained transparent recovery, where the property of transparency can be selectively applied to processes and messages. Transparency hides the recovery actions in a selected part...... of the application so that they do not affect the schedule of other processes and messages. While leading to longer schedules, transparent recovery has the advantage of both improved debuggability and less memory needed to store the faulttolerant schedules....
Kim, Sungjae; Kim, Jinhyun
The purpose of this study was to propose optimal hospitalization fees for nurse staffing levels and to improve the current nursing fee policy. A break-even analysis was used to evaluate the impact of a nursing fee policy on hospital's financial performance. Variables considered included the number of beds, bed occupancy rate, annual total patient days, hospitalization fees for nurse staffing levels, the initial annual nurses' salary, and the ratio of overhead costs to nursing labor costs. Data were collected as secondary data from annual reports of the Hospital Nursing Association and national health insurance. The hospitalization fees according to nurse staffing levels in general hospitals are required to sustain or decrease in grades 1, 2, 3, 4, and 7, and increase in grades 5 and 6. It is suggested that the range between grade 2 and 3 be sustained at the current level, the range between grade 4 and 5 be widen or merged into one, and the range between grade 6 and 7 be divided into several grades. Readjusting hospitalization fees for nurse staffing level will improve nurse-patient ratio and enhance the quality of nursing care in hospitals. Follow-up studies including tertiary hospitals and small hospitals are recommended.
Hoogeveen, H.; Skutella, M.; Woeginger, Gerhard
We consider the problem of preemptively scheduling a set of n jobs on m (identical, uniformly related, or unrelated) parallel machines. The scheduler may reject a subset of the jobs and thereby incur job-dependent penalties for each rejected job, and he must construct a schedule for the remaining
Hoogeveen, J.A.; Skutella, M.; Woeginger, G.J.; Paterson, M.
We consider the problem of preemptively scheduling a set of n jobs on m (identical, uniformly related, or unrelated) parallel machines. The scheduler may reject a subset of the jobs and thereby incur job-dependent penalties for each rejected job, and he must construct a schedule for the remaining
Crespo Fernández, Inma; Soldevila, Núria; Carmona, Gloria; Sala, Maria Rosa; Godoy, Pere; Domínguez, Angela; Group of Catalonia, the Pertussis Surveillance
Pertussis is a vaccine-preventable disease that generates a large number of cases and hospitalizations. In Catalonia, the vaccination schedule includes three doses of vaccine at 2, 4 and 6 mo and two booster doses at 18 mo and 4–6 y. In 2002, DTPw was replaced by DTPa. The aim of this study was to determine how the vaccination status affects pertussis hospitalizations. Cases were obtained from the epidemiological surveillance system of the Generalitat of Catalonia from 2003 to 2009. Hospitalization, immunization status and type of vaccine received in reported cases were analyzed. OR and 95% confidence intervals (CI) were calculated. To control the effect of age (cases were reported. Cases below vaccination age (cases were hospitalized: 137 (51.7%) had no vaccine administrated, 104 (39.2%) were correctly vaccinated according to age and 24 (9.1%) were poorly vaccinated. Correct vaccination protected against hospitalization (ORMH: 0.33; 95%CI: 0.23–0.47). Of hospitalized cases, 38 (14.3%) had received DTPw and 91 (34.2%) DTPa. Both vaccines were effective in avoiding hospitalization, and comparison showed no differences (ORMH: 0.73; 95%CI: 0.46–1.14). We highlight the importance of a correct follow-up immunization schedule in reducing the number of cases and hospitalizations. PMID:23302866
García-Huete, M Eloisa; Sebastián-Viana, Tomás; Lema-Lorenzo, Isabel; Granados-Martín, Mónica; Buitrago-Lobo, Nuria; Heredia-Reina, M del Pilar; Merino-Ruiz, Margarita; Ventosa-Hernández, Esther; Gutiérrez-Fernández, Carmen; Mota-Boada, M Luisa
To evaluate the evolution of falls with the implemented measures to improve the attention of patients at risk and to reduce the number of falls. To know the characteristics of patients who have suffered fall-related injuries. All the falls registered between 2008 and 2013 have been analyzed to determine the evolution of these and to describe the implemented measures through the electronic clinical history at University Hospital of Fuenlabrada. The incidence of falls in hospitalized patients has been estimated and the evolution with the chi square test has been studied. The frequencies of the characteristics of patients who fall has been presented: age, length of stay, performed activity, patient companion, mobility level, state of consciousness. 445 registered falls happened. 2009 is the year with the highest number of falls, 86 patients fell of a total of 15,819 discharged patients (0.55%). The statistic drops until 2013, where 55 patients fell out of 15,052 discharged patients (0.37%). This difference was not statistically significant. The deployment of an assessment about fall risk at admission has helped to identify individualized risk factors. Furthermore, the awareness and alerts to the nursing staff have helped to consider fall prevention as a rutinary procedure, hence appropriate measures can be implemented on the most vulnerable patients. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.
Full Text Available Aiming at the problem of ant colony algorithm for solving Job一shop scheduling problem. Considering the complexity of the algorithm that uses disjunctive graph to describe the relationship between workpiece processing. To solve the problem of optimal solution，a generalized ant colony algorithm is proposed. Under the premise of considering constrained relationship between equipment and process，the pheromone update mechanism is applied to solve Job-shop scheduling problem，so as to improve the quality of the solution. In order to improve the search efficiency，according to the state transition rules of ant colony algorithm，this paper makes a detailed study on the selection and improvement of the parameters in the algorithm，and designs the pheromone update strategy. Experimental results show that a generalized ant colony algorithm is more feasible and more effective. Compared with other algorithms in the literature，the results prove that the algorithm improves in computing the optimal solution and convergence speed.
Paez, Kathryn; Schur, Claudia; Zhao, Lan; Lucado, Jennifer
This study assessed the perceptions and actions of rural hospital nurse executives with regard to patient safety and quality improvement (QI). A national sample of rural hospital nurse executives (n = 300) completed a survey measuring 4 domains related to patient safety and QI: (a) patient "Safety Culture," (b) adequacy of QI "Resources," (c) "Barriers" related to QI, and (d) "Nurse Leader Engagement" in activities supporting QI. Perceptions of Safety Culture were strong but 47% of the Resources needed to carry out QI were inadequate, 29% of Barriers were moderate to major, and 25% of Nurse Leader Engagement activities were performed infrequently. Nurse Leader Engagement in quality-related activities was less frequent among nurses in isolated and small rural town hospitals compared with large rural city hospitals. To further QI, rural nurse executives may need to use their communications and actions to raise the visibility of QI.
Kortbeek, Nikky; Zonderland, Maartje E.; Braaksma, Aleida; Vliegen, Ingrid M. H.; Boucherie, Richard J.; Litvak, Nelly; Hans, Erwin W.
We present a methodology to design appointment systems for outpatient clinics and diagnostic facilities that offer both walk-in and scheduled service. The developed blueprint for the appointment schedule prescribes the number of appointments to plan per day and the moment on the day to schedule the
Kortbeek, Nikky; Zonderland, Maartje Elisabeth; Boucherie, Richardus J.; Litvak, Nelli; Hans, Elias W.
We present a methodology to design appointment systems for outpatient clinics and diagnostic facilities that offer both walk-in and scheduled service. The developed blueprint for the appointment schedule prescribes the number of appointments to plan per day and the moment on the day to schedule the
Iles, E. J.; McCallum, L.; Lovell, J. E. J.; McCallum, J. N.
As we move into the next era of geodetic VLBI, the scheduling process is one focus for improvement in terms of increased flexibility and the ability to react with changing conditions. A range of simulations were conducted to ascertain the impact of scheduling on geodetic results such as Earth Orientation Parameters (EOPs) and station coordinates. The potential capabilities of new automated scheduling modes were also simulated, using the so-called 'dynamic scheduling' technique. The primary aim was to improve efficiency for both cost and time without losing geodetic precision, particularly to maximise the uses of the Australian AuScope VLBI array. We show that short breaks in observation will not significantly degrade the results of a typical 24 h experiment, whereas simply shortening observing time degrades precision exponentially. We also confirm the new automated, dynamic scheduling mode is capable of producing the same standard of result as a traditional schedule, with close to real-time flexibility. Further, it is possible to use the dynamic scheduler to augment the 3 station Australian AuScope array and thereby attain EOPs of the current global precision with only intermittent contribution from 2 additional stations. We thus confirm automated, dynamic scheduling bears great potential for flexibility and automation in line with aims for future continuous VLBI operations.
A pre-intervention situation analysis was conducted to assess Hospital Waste Management (HWM) practices, solutions were proffered for the observed inadequacies and advocacy was made to Hospital administration for which a number of interventional measures were instituted. A post interventional survey was conducted ...
Gao, Xingbo; Bassiouni, Mostafa A.; Li, Guifang
In this paper we introduce a new preemptive scheduling technique for next generation optical burst-switched networks considering the impact of cascaded wavelength conversions. It has been shown that when optical bursts are transmitted all optically from source to destination, each wavelength conversion performed along the lightpath may cause certain signal-to-noise deterioration. If the distortion of the signal quality becomes significant enough, the receiver would not be able to recover the original data. Accordingly, subject to this practical impediment, we improve a recently proposed fair channel scheduling algorithm to deal with the fairness problem and aim at burst loss reduction simultaneously in optical burst switching. In our scheme, the dynamic priority associated with each burst is based on a constraint threshold and the number of already conducted wavelength conversions among other factors for this burst. When contention occurs, a new arriving superior burst may preempt another scheduled one according to their priorities. Extensive simulation results have shown that the proposed scheme further improves fairness and achieves burst loss reduction as well.
Full Text Available The Internet of Things (IoT is expected to foster the development of 5G wireless networks and requires the efficient support for a large number of simultaneous short message communications. To address these challenges, some existing works utilize new waveform and multiuser superposition transmission schemes to improve the capacity of IoT communication. In this paper, we will investigate the spatial degree of freedom of IoT devices based on their distribution, then extend the multiuser shared access (MUSA which is one of the typical MUST schemes to spatial domain, and propose two novel schemes, that is, the preconfigured access scheme and the joint spatial and code domain scheduling scheme, to enhance IoT communication. The results indicate that the proposed schemes can reduce the collision rate dramatically during the IoT random access procedure and improve the performance of IoT communication obviously. Based on the simulation results, it is also shown that the proposed scheduling scheme can achieve the similar performance to the corresponding brute-force scheduling but with lower complexity.
Muhamad Badri, Huda; Deros, Baba Md; Syahri, M.; Saleh, Chairul; Fitria, Aninda
The learning curve shows the relationship between time and the cumulative number of units produced which using the mathematical description on the performance of workers in performing repetitive works. The problems of this study is level differences in the labors performance before and after the break which affects the company's production scheduling. The study was conducted in the garment industry, which the aims is to predict the company production scheduling using the learning curve and forgetting curve. By implementing the learning curve and forgetting curve, this paper contributes in improving the labors performance that is in line with the increase in maximum output 3 hours productive before the break are 15 unit product with learning curve percentage in the company is 93.24%. Meanwhile, the forgetting curve improving maximum output 3 hours productive after the break are 11 unit product with the percentage of forgetting curve in the company is 92.96%. Then, the obtained 26 units product on the productive hours one working day is used as the basic for production scheduling.
Full Text Available This paper discusses integrated model of batch production scheduling and machine maintenance scheduling. Batch production scheduling uses minimize total actual flow time criteria and machine maintenance scheduling uses the probability of machine failure based on Weibull distribution. The model assumed no nonconforming parts in a planning horizon. The model shows an increase in the number of the batch (length of production run up to a certain limit will minimize the total actual flow time. Meanwhile, an increase in the length of production run will implicate an increase in the number of PM. An example was given to show how the model and algorithm work.
Rossi, P Justin; Opri, Enrico; Shute, Jonathan B; Molina, Rene; Bowers, Dawn; Ward, Herbert; Foote, Kelly D; Gunduz, Aysegul; Okun, Michael S
Personalized, scheduled deep brain stimulation in Tourette syndrome (TS) may permit clinically meaningful tic reduction while reducing side effects and increasing battery life. Here, we evaluate scheduled DBS applied to TS at two-year follow-up. Five patients underwent bilateral centromedian thalamic (CM) region DBS. A cranially contained constant-current device delivering stimulation on a scheduled duty cycle, as opposed to the standard continuous DBS paradigm was utilized. Baseline vs. 24-month outcomes were collected and analyzed, and a responder analysis was performed. A 40% improvement in the Modified Rush Tic Rating Scale (MRTRS) total score or Yale Global Tic Severity Scale (YGTSS) total score defined a full responder. Three of the 4 patients followed to 24 months reached full responder criteria and had a mean stimulation time of 1.85 h per day. One patient lost to follow-up evaluated at the last time point (month 18) was a non-responder. Patients exhibited improvements in MRTRS score beyond the improvements previously reported for the 6 month endpoint; on average, MRTRS total score was 15.6% better at 24 months than at 6 months and YGTSS total score was 14.8% better. Combining the patients into a single cohort revealed significant improvements in the MRTRS total score (-7.6 [5.64]; p = 0.02). Electrical stimulation of the centromedian thalamic region in a scheduled paradigm was effective in suppressing tics, particularly phonic tics. Full responders were able to achieve the positive DBS effect with a mean of 2.3 ± 0.9 (SEM) hours of DBS per day. Copyright © 2016 Elsevier Ltd. All rights reserved.
Oosting, E.; Jans, M.P.; Dronkers, J.J.; Naber, R.H.; Dronkers-Landman, C.M.; Appelman-De Vries, S.M.; Meeteren, N.L. van
Preoperative home-based physical therapy versus usual care to improve functional health of frail older adults scheduled for elective total hip arthroplasty: a pilot randomized controlled trial. Objective: To investigate the feasibility and preliminary effectiveness of a home-based intensive exercise
Kalisch, Beatrice J; Lee, Hyunhwa
This study aimed to explore whether and how staff characteristics, staffing, and scheduling variables are associated with the level of teamwork in nursing staff on acute care hospital patient units. This was a cross-sectional study with a sample of 1,758 nursing staff members from two different hospitals on 38 patient care units who completed the Nursing Teamwork Survey in 2008. This study focused on nursing teams who are stationed on a particular patient care unit (as opposed to visitors to the units). The return rate was 56.9%. The sample was made up of 77.4% nurses (registered nurses and licensed practical nurses), 11.9% assistive personnel, and 7.9% unit secretaries. Teamwork varied by unit and service type, with the highest scores occurring in pediatrics and maternity and the lowest scores on the medical-surgical and emergency units. Staff with less than 6 months of experience, those working 8- or 10-hour shifts (as opposed to 12 hours or a combination of 8 and 12 hours), part-time staff (as opposed to full time), and those working on night shift had higher teamwork scores. The higher teamwork scores were also associated with no or little overtime. The higher perception of the adequacy of staffing and the fewer patients cared for on a previous shift, the higher the teamwork scores. There is a relationship between selected staff characteristics, aspects of work schedules, staffing, and teamwork. Nursing staff want to work where teamwork is high, and perceptions of good staffing lead to higher teamwork. Higher teamwork scores correlated with those who worked less overtime.
Yu, Tsung-Hsien; Chung, Kuo-Piao
Quality improvement (QI) methods have been fashionable in hospitals for decades. Previous studies have discussed the relationships between the implementation of QI methods and various external and internal factors, but there has been no examination to date of whether the neighbourhood effect influences such implementation. The aim of this study was to use a multilevel model to investigate whether and how the neighbourhood effect influences the implementation of QI methods in the hospital setting in Taiwan. This is a retrospective questionnaire-based survey. All medical centres, regional hospitals and district teaching hospitals in Taiwan. Directors or persons in charge of implementing QI methods in hospitals. None. The breadth and depth of QI method implementation. Seventy-two of the 139 hospitals contacted returned the questionnaire, yielding a 52% response rate. The breadth and depth of QI method implementation increased over the 10-year study period, particularly between 2004 and 2006. The breadth and depth of the QI methods implemented in the participating hospitals were significantly associated with the average breadth and depth of those implemented by their competitors in the same medical area during the previous period. In addition, time was positively associated with the breadth and depth of QI method implementation. In summary, the findings of this study show that hospitals' QI implementation status is influenced by that of their neighbours. Hence, the neighbourhood effect is an important factor in understanding hospital behaviour. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.
Luo, Qifang; Zhou, Yongquan; Xie, Jian; Ma, Mingzhi; Li, Liangliang
A discrete bat algorithm (DBA) is proposed for optimal permutation flow shop scheduling problem (PFSP). Firstly, the discrete bat algorithm is constructed based on the idea of basic bat algorithm, which divide whole scheduling problem into many subscheduling problems and then NEH heuristic be introduced to solve subscheduling problem. Secondly, some subsequences are operated with certain probability in the pulse emission and loudness phases. An intensive virtual population neighborhood search is integrated into the discrete bat algorithm to further improve the performance. Finally, the experimental results show the suitability and efficiency of the present discrete bat algorithm for optimal permutation flow shop scheduling problem. PMID:25243220
Luo, Qifang; Zhou, Yongquan; Xie, Jian; Ma, Mingzhi; Li, Liangliang
A discrete bat algorithm (DBA) is proposed for optimal permutation flow shop scheduling problem (PFSP). Firstly, the discrete bat algorithm is constructed based on the idea of basic bat algorithm, which divide whole scheduling problem into many subscheduling problems and then NEH heuristic be introduced to solve subscheduling problem. Secondly, some subsequences are operated with certain probability in the pulse emission and loudness phases. An intensive virtual population neighborhood search is integrated into the discrete bat algorithm to further improve the performance. Finally, the experimental results show the suitability and efficiency of the present discrete bat algorithm for optimal permutation flow shop scheduling problem.
Altmeyer, Sebastian; Gebhard, Gernot
Hard real-time systems induce strict constraints on the timing of the task set. Validation of these timing constraints is thus a major challenge during the design of such a system. Whereas the derivation of timing guarantees must already be considered complex if tasks are running to completion, it gets even more complex if tasks are scheduled preemptively -- especially due to caches, deployed to improve the average performance. In this paper we propose a new method to compu...
Desombre, T; Eccles, G
This article looks to review recent practice undertaken within the UK hotel sector to improve customer service, and suggests ideals that could be implemented within National Health (NHS) Trust hospitals. At a time of increasing competition, hotel firms are using service enhancement as a means to gain competitive advantage, and therefore developing a range of techniques to measure levels of service quality improvement. With continued change in the health service, where greater focus now lies with patient satisfaction, so there is a requirement for managers to adapt techniques presently being offered in other service industries to improve levels of customer service and ensure patients are targeted to define their levels of satisfaction.
Allison, J.E.; Segall, P.; Smith, R.R.
Successful preparation and implementation of an outage schedule and completion of scheduled and emergent work within an identified critical path time frame is a result of careful coordination by Operations, Work Control, Maintenance, Engineering, Planning and Administration and others. At the Fast Flux Test Facility (FFTF) careful planning has been responsible for meeting all scheduled outage critical paths
Indusree, J. R.; Prabadevi, B.
Process scheduling is a very important functionality of Operating system. The main-known process-scheduling algorithms are First Come First Serve (FCFS) algorithm, Round Robin (RR) algorithm, Priority scheduling algorithm and Shortest Job First (SJF) algorithm. Compared to its peers, Round Robin (RR) algorithm has the advantage that it gives fair share of CPU to the processes which are already in the ready-queue. The effectiveness of the RR algorithm greatly depends on chosen time quantum value. Through this research paper, we are proposing an enhanced algorithm called Enhanced Round Robin with Burst-time based Time Quantum (ERRBTQ) process scheduling algorithm which calculates time quantum as per the burst-time of processes already in ready queue. The experimental results and analysis of ERRBTQ algorithm clearly indicates the improved performance when compared with conventional RR and its variants.
Tian, Yunna; Li, Dongni; Zheng, Dan; Jia, Yunde
Intercell scheduling problems arise as a result of intercell transfers in cellular manufacturing systems. Flexible intercell routes are considered in this article, and a coalition-based scheduling (CBS) approach using distributed multi-agent negotiation is developed. Taking advantage of the extended vision of the coalition agents, the global optimization is improved and the communication cost is reduced. The objective of the addressed problem is to minimize mean tardiness. Computational results show that, compared with the widely used combinatorial rules, CBS provides better performance not only in minimizing the objective, i.e. mean tardiness, but also in minimizing auxiliary measures such as maximum completion time, mean flow time and the ratio of tardy parts. Moreover, CBS is better than the existing intercell scheduling approach for the same problem with respect to the solution quality and computational costs.
Jull, Andrew; McCall, Elaine; Chappell, Matt; Tobin, Sam
To describe a surveillance approach for monitoring the effect of improvement initiatives on hospital-acquired pressure injuries and findings arising from that surveillance. Random sampling of patients on the same day of each successive month from a campus of child and adult hospitals using a standard audit tool to identify presence of hospital-acquired pressure injury. Where multiple pressure injuries were present, the most severe grade injury contributed to prevalence. Statistical process control charts were used to monitor monthly performance and Maximum Likelihood Estimation to determine timing of step change. 8274 patients were assessed over 3 years from an eligible population of 32,259 hospitalised patients. 517 patients had hospital-acquired pressure injuries giving an overall prevalence of 6.2% (95% CI 5.7-6.8%). Annual prevalence was 8.4% (95% CI 7.4-9.5%) in the first year, falling to 5.6% (95% CI 4.7-6.4%) in the second year and 4.8% (95% CI 4.0-5.6%) in the third year. A step change was signalled with mean prevalence up to July 2013 being 7.9% (95% CI 7.1-8.8%) and mean prevalence thereafter 4.8% (95% CI 4.2-5.4%). Hospital-acquired pressure injuries were found in all age ranges, but were more frequent in children up to 14 years (17.4%) and those aged 75 years or older (38.7%). Monthly random sampling of patients within clinical units can be used to monitor performance improvement. This approach represents a rational alternative to cross-sectional prevalence surveys especially if the focus is on performance improvement. Copyright © 2016 Elsevier Ltd. All rights reserved.
Edgerton, James R; Herbert, Morley A; Hamman, Baron L; Ring, W Steves
Readmission rates after cardiac surgery are being used as a quality indicator; they are also being collected by Medicare and are tied to reimbursement. Accurate knowledge of readmission rates may be difficult to achieve because patients may be readmitted to different hospitals. In our area, 81 hospitals share administrative claims data; 28 of these hospitals (from 5 different hospital systems) do cardiac surgery and share Society of Thoracic Surgeons (STS) clinical data. We used these 2 sources to compare the readmissions data for accuracy. A total of 45,539 STS records from January 2008 to December 2016 were matched with the hospital billing data records. Using the index visit as the start date, the billing records were queried for any subsequent in-patient visits for that patient. The billing records included date of readmission and hospital of readmission data and were compared with the data captured in the STS record. We found 1153 (2.5%) patients who had STS records that were marked "No" or "missing," but there were billing records that showed a readmission. The reported STS readmission rate of 4796 (10.5%) underreported the readmission rate by 2.5 actual percentage points. The true rate should have been 13.0%. Actual readmission rate was 23.8% higher than reported by the clinical database. Approximately 36% of readmissions were to a hospital that was a part of a different hospital system. It is important to know accurate readmission rates for quality improvement processes and institutional financial planning. Matching patient records to an administrative database showed that the clinical database may fail to capture many readmissions. Combining data with an administrative database can enhance accuracy of reporting. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
Full Text Available Proliferation of acute lymphoblastic leukemic cells is nutritionally dependent on the external supply of asparagine. l-asparaginase, an enzyme hydrolyzing l-asparagine in blood, is used for treatment of acute lymphoblastic leukemic and other related blood cancers. Although previous studies demonstrated that l-asparaginase suppresses the proliferation of cultured solid tumor cells, it remains unclear whether this enzyme prevents the growth of solid tumors in vivo. In this study, we demonstrated the importance of optimizing dosing schedules for the anti-tumor activity of l-asparaginase in 4T1 breast tumor-bearing mice. Cultures of several types of murine solid tumor cells were dependent on the external supply of asparagine. Among them, we selected murine 4T1 breast cancer cells and implanted them into BALB/c female mice kept under standardized light/dark cycle conditions. The growth of 4T1 tumor cells implanted in mice was significantly suppressed by intravenous administration of l-asparaginase during the light phase, whereas its administration during the dark phase failed to show significant anti-tumor activity. Decreases in plasma asparagine levels due to the administration of l-asparaginase were closely related to the dosing time-dependency of its anti-tumor effects. These results suggest that the anti-tumor efficacy of l-asparaginase in breast tumor-bearing mice is improved by optimizing the dosing schedule. Keywords: l-asparaginase, Asparagine, Solid tumor, Chrono-pharmacotherapy
Shiromizu, Shoya; Kusunose, Naoki; Matsunaga, Naoya; Koyanagi, Satoru; Ohdo, Shigehiro
Proliferation of acute lymphoblastic leukemic cells is nutritionally dependent on the external supply of asparagine. l-asparaginase, an enzyme hydrolyzing l-asparagine in blood, is used for treatment of acute lymphoblastic leukemic and other related blood cancers. Although previous studies demonstrated that l-asparaginase suppresses the proliferation of cultured solid tumor cells, it remains unclear whether this enzyme prevents the growth of solid tumors in vivo. In this study, we demonstrated the importance of optimizing dosing schedules for the anti-tumor activity of l-asparaginase in 4T1 breast tumor-bearing mice. Cultures of several types of murine solid tumor cells were dependent on the external supply of asparagine. Among them, we selected murine 4T1 breast cancer cells and implanted them into BALB/c female mice kept under standardized light/dark cycle conditions. The growth of 4T1 tumor cells implanted in mice was significantly suppressed by intravenous administration of l-asparaginase during the light phase, whereas its administration during the dark phase failed to show significant anti-tumor activity. Decreases in plasma asparagine levels due to the administration of l-asparaginase were closely related to the dosing time-dependency of its anti-tumor effects. These results suggest that the anti-tumor efficacy of l-asparaginase in breast tumor-bearing mice is improved by optimizing the dosing schedule. Copyright © 2018 The Authors. Production and hosting by Elsevier B.V. All rights reserved.
Dückers, Michel L.A.; Stegeman, Inge; Spreeuwenberg, Peter; Wagner, Cordula; Sanders, Karin; Groenewegen, Peter P.
Objectives: The success of a Dutch program to disseminate quality improvement projects depends on the participation of physicians working in program hospitals. The leadership of hospital executives (CEOs) is considered an important explanation. This study aims to determine whether the relation,
Dückers, M.L.A.; Stegeman, I.; Spreeuwenberg, P.; Wagner, C.; Sanders, K.; Groenewegen, P.P.
Objectives: The success of a Dutch program to disseminate quality improvement projects depends on the participation of physicians working in program hospitals. The leadership of hospital executives (CEOs) is considered an important explanation. This study aims to determine whether the relation,
Duckers, M.L.A.; Stegeman, I.; Spreeuwenberg, P.; Wagner, C.; Sanders, K.; Groenewegen, P.P.
OBJECTIVES: The success of a Dutch program to disseminate quality improvement projects depends on the participation of physicians working in program hospitals. The leadership of hospital executives (CEOs) is considered an important explanation. This study aims to determine whether the relation,
Dückers, M.L.A.; Stegeman, I.; Spreeuwenberg, P.; Wagner, C.; Sanders, K.; Groenewegen, P.P.
Objectives: The success of a Dutch program to disseminate quality improvement projects depends on the participation of physicians working in program hospitals. The leadership of hospital executives (CEOs) is considered an important explanation. This study aims to determine whether the relation,
Full Text Available This work was aimed to improve the water management for agriculture by applying efficient crop schedules in Vilcabamba and similar areas of the high jungle, which can satisfy most of the water requirements with rainfed agriculture to maximize the crops yield. For this purpose, two field practices were carried out during the dry (September 2012 and wet season (February 2013 to measure rivers and canals flows with the velocity/area method; 19 soil samples were collected on-site and analyzed, presenting prevalent sandy loam and loam textures. Cropwat program was used to estimate crop water requirements and scheme irrigation requirements, resulting in a maximum flow capacity of 1.72 l s-1 in May, during the dry season. The flow capacity can be satisfied, since small ditches convey approximately 2 to 6 l s-1 on the same season. The research findings indicate that rainfed farming can be practised, yet an initial pre-irrigation needs to be applied, for crops should not be water stressed. However, if soil is not pre-irrigated the production can be affected, with vegetables and potato crop yields being reduced by 4.7% and 1.4% respectively. To minimize these effects, both crops are suggested to be sowed one month later, adapting their growth period to the rainy season.
Almorsy, Lamia; Khalifa, Mohamed
Access time refers to the interval between requesting and actual outpatient appointment. It reflects healthcare accessibility and has a great influence on patient treatment and satisfaction. King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia studied the accessibility to outpatient services in order to develop useful strategies and recommendations for improvement. Utilized, unutilized and no-show appointments were analyzed. It is crucial to manage no-shows and short notice appointment cancellations by preparing a waiting list for those patients who can be called in to an appointment on the same day using an open access policy. An overlapping appointment scheduling model can be useful to minimize patient waiting time and doctor idle time in addition to the sensible use of appointment overbooking that can significantly improve productivity.
PROCESSING CLASS V SYSTEM .... .......... . A BIBLIOGRAPHY ....... ........... . . . .. . ii ’I. INTRODUCTIO9 Development of the Problem Convinced that...of the most difficult administrativo tasks that a modern hospital must face, and proposed using a combination of a master posting sheet and a...deal with scheduling problems.9 This particular process also incorporates the two-room system doscribed earlier, and the author admits that this
Padula, William V; Mishra, Manish K; Weaver, Christopher D; Yilmaz, Taygan; Splaine, Mark E
To demonstrate complementary results of regression and statistical process control (SPC) chart analyses for hospital-acquired pressure ulcers (HAPUs), and identify possible links between changes and opportunities for improvement between hospital microsystems and macrosystems. Ordinary least squares and panel data regression of retrospective hospital billing data, and SPC charts of prospective patient records for a US tertiary-care facility (2004-2007). A prospective cohort of hospital inpatients at risk for HAPUs was the study population. There were 337 HAPU incidences hospital wide among 43 844 inpatients. A probit regression model predicted the correlation of age, gender and length of stay on HAPU incidence (pseudo R(2)=0.096). Panel data analysis determined that for each additional day in the hospital, there was a 0.28% increase in the likelihood of HAPU incidence. A p-chart of HAPU incidence showed a mean incidence rate of 1.17% remaining in statistical control. A t-chart showed the average time between events for the last 25 HAPUs was 13.25 days. There was one 57-day period between two incidences during the observation period. A p-chart addressing Braden scale assessments showed that 40.5% of all patients were risk stratified for HAPUs upon admission. SPC charts complement standard regression analysis. SPC amplifies patient outcomes at the microsystem level and is useful for guiding quality improvement. Macrosystems should monitor effective quality improvement initiatives in microsystems and aid the spread of successful initiatives to other microsystems, followed by system-wide analysis with regression. Although HAPU incidence in this study is below the national mean, there is still room to improve HAPU incidence in this hospital setting since 0% incidence is theoretically achievable. Further assessment of pressure ulcer incidence could illustrate improvement in the quality of care and prevent HAPUs.
Army Engineering and Support Center, Huntsville, Price Reasonableness Determinations for Federal Supply Schedule Orders for Supplies Need...0207.000) │ i Results in Brief U.S. Army Engineering and Support Center, Huntsville, Price Reasonableness Determinations for Federal Supply Schedule...officers made determinations of fair and reasonable pricing for General Services Administration Federal supply schedule orders awarded for purchases
Amelia, Dwirani; Suhowatsky, Stephanie; Baharuddin, Mohammad; Tholandi, Maya; Hyre, Anne; Sethi, Reena
Clinical governance is a concept used to improve management, accountability and the provision of quality healthcare. An approach to strengthen clinical governance as a means to improve the quality of maternal and newborn care in Indonesia was developed by the Expanding Maternal and Neonatal Survival (EMAS) Program. This case study presents findings and lessons learned from EMAS program experience in 22 hospitals where peer-to-peer mentoring supported staff in strengthening clinical governance from 2012-2015. Efforts resulted in improved hospital preparedness and significantly increased the odds of facility-level coverage for three evidence-based maternal and newborn healthcare interventions.
Pinedo, Michael L
This new edition of the well-established text Scheduling: Theory, Algorithms, and Systems provides an up-to-date coverage of important theoretical models in the scheduling literature as well as important scheduling problems that appear in the real world. The accompanying website includes supplementary material in the form of slide-shows from industry as well as movies that show actual implementations of scheduling systems. The main structure of the book, as per previous editions, consists of three parts. The first part focuses on deterministic scheduling and the related combinatorial problems. The second part covers probabilistic scheduling models; in this part it is assumed that processing times and other problem data are random and not known in advance. The third part deals with scheduling in practice; it covers heuristics that are popular with practitioners and discusses system design and implementation issues. All three parts of this new edition have been revamped, streamlined, and extended. The reference...
Stoica, Ion; Abdel-Wahab, Hussein; Pothen, Alex
We describe a scheduler based on the microeconomic paradigm for scheduling on-line a set of parallel jobs in a multiprocessor system. In addition to the classical objectives of increasing the system throughput and reducing the response time, we consider fairness in allocating system resources among the users, and providing the user with control over the relative performances of his jobs. We associate with every user a savings account in which he receives money at a constant rate. When a user wants to run a job, he creates an expense account for that job to which he transfers money from his savings account. The job uses the funds in its expense account to obtain the system resources it needs for execution. The share of the system resources allocated to the user is directly related to the rate at which the user receives money; the rate at which the user transfers money into a job expense account controls the job's performance. We prove that starvation is not possible in our model. Simulation results show that our scheduler improves both system and user performances in comparison with two different variable partitioning policies. It is also shown to be effective in guaranteeing fairness and providing control over the performance of jobs.
Niemann, Hans Henrik; Stoustrup, Jakob