Operations Research, Systems Engineering and Industrial Engineering Commons^™

Eagle Medical Tray Denesting & Debris Removal Process, Nicholas Allen Ungefug, Noah Chavez, Susana Shu-Lin Okhuysen, Michael Augustine Pennington

Industrial and Manufacturing Engineering

Eagle Medical Incorporated is a contract medical device packaging and sterilization company. The company purchases thermoformed medical packaging trays, which maintain the sterility of medical devices, from various manufacturers. To ensure packaging quality and to prevent cleanroom contamination, Eagle Medical inspects and sterilizes each blister tray that they order. This process is an essential non-value-added activity that creates a bottleneck. Cleanroom employees must stop packaging medical devices and attend to the processing of blister trays and packaging solutions. The blister trays arrive at Eagle’s facility in nested stacks. Vibration and movement during shipping further compresses the stacks, which makes separation …

Inpatient Discharge-By-Noon: Are Fewer Better Than All?, Nicholas Ballester, Pratik J. Parikh, Kara Combs, Jordan S. Peck

Journal of Maine Medical Center

Introduction: To address boarding in hospital emergency departments, discharge-by-noon could free up inpatient beds earlier in the day. However, discharging all patients by noon can heavily burden inpatient units and may not be feasible. In this study, we determine the number of discharges after which the benefits of an additional discharge-by-noon diminish.

Methods: We conducted a simulation analysis to quantify how occupancy rate, mean daily number of discharges, and peak discharge time impact upstream boarding time in an inpatient neurology unit at Maine Medical Center. Using a day-of-discharge simulation model with one year of retrospective data, we assessed configurations approximating …

Lean Six Sigma As An Enabler For Healthcare Operational Excellence In Covid-19, Olivia Mcdermott Dr, Antony Jiju

International Conference on Lean Six Sigma

1. Purpose -This paper aims to present the results of a qualitative research interview study on the utilization and importance of Lean Six Sigma methods in the Healthcare sector in COVID-19 and in pandemics in general.
2. Design/methodology/approach -a qualitative interview approach was utilised by interviewing leading Lean Six Sigma academics and practitioners who are expert in and have experience in Lean Six Sigma.
3. Findings – Lean Six Sigma methods are proven and can be utilised in pandemic situations to improve efficiency and resilience in the healthcare system and readiness for pandemics.
4. Research limitations/implications - One limitation of this research was that …

The Discrete-Event Modeling Of Administrative Claims (Demac) System: Dynamically Modeling The U.S. Healthcare Delivery System With Medicare Claims Data To Improve End-Of-Life Care, Rachael Chacko

Dartmouth College Undergraduate Theses

The shift of the U.S. healthcare delivery system from the treatment of acute conditions to chronic diseases requires a new method of healthcare system analysis to properly assess end- of-life (EOL) quality throughout the country. In this paper, we propose the Discrete-Event Modeling of Administrative Claims (DEMAC) system, which relies on a hetero-functional graph theory and discrete event-driven framework to dynamically model EOL care on multiple levels. The heat map visualizations produced by the DEMAC system enable the elucidation of not only patient-specific EOL care but also broader treatment patterns among providers and hospitals. As a whole, the DEMAC system …

The Probability Of Success-Through Fault Tree Analytical Binomial Result, Tyleka Riddle

Night Flight Journal

Prestigious Appeal Rule of Thumb (Ear Drum Plugs)

In truant fashion, with proven accidental probabilistic perception for proposed cued facial expression recognition and voice commands without filtering. The estimated cost analysis for design and development generated from the enhanced project in the word "no”: Additionally, an audio noise effect size (ES) for desired level of comprehensive sensory receptors in sound reference to noisy party syndrome. Sytoss, (2019) "Resulting in a cocktail party theory for chalkboard distinction and conversation with applied facial recognition. As well as, the enhanced project management tool, EPMT, to provide output and input determination for higher-level acoustic …

A Core Reference Hierarchical Primitive Ontology For Electronic Medical Records Semantics Interoperability, Ziniya Zahedi

Engineering Management & Systems Engineering Theses & Dissertations

Currently, electronic medical records (EMR) cannot be exchanged among hospitals, clinics, laboratories, pharmacies, and insurance providers or made available to patients outside of local networks. Hospital, laboratory, pharmacy, and insurance provider legacy databases can share medical data within a respective network and limited data with patients. The lack of interoperability has its roots in the historical development of electronic medical records. Two issues contribute to interoperability failure. The first is that legacy medical record databases and expert systems were designed with semantics that support only internal information exchange. The second is ontological commitment to the semantics of a particular knowledge …

Systemic Risk Management Plan For Electronic Medical Records (Emr): Why And How?, Ziniya Zahedi, Faisal Mahmud, Cesar Pinto

Engineering Management & Systems Engineering Faculty Publications

Electronic patient data use and handling are critical issues in terms of privacy, confidentiality, security, and the Health Insurance Portability and Accountability Act (HIPAA) regulations. The risks associated with electronic patient data are not limited to identity theft but rather include a person’s social, economic, and psychological well-being. However, there have not been many studies that have focused on the associated risk factors that could lead to these situations. This paper identifies those risks related to electronic patient data breaches by means of a grounded theory approach and develops a systemic risk management plan that enables engineering managers and risk …

Data-Driven Surgical Duration Prediction Model For Surgery Scheduling: A Case-Study For A Practice-Feasible Model In A Public Hospital, Kar Way Tan, Francis Ngoc Hoang Long Nguyen, Boon Yew Ang, Jerald Gan, Sean Shao Wei Lam

Research Collection School Of Computing and Information Systems

Hospitals have been trying to improve the utilization of operating rooms as it affects patient satisfaction, surgery throughput, revenues and costs. Surgical prediction model which uses post-surgery data often requires high-dimensional data and contains key predictors such as surgical team factors which may not be available during the surgical listing process. Our study considers a two-step data-mining model which provides a practical, feasible and parsimonious surgical duration prediction. Our model first leverages on domain knowledge to provide estimate of the first surgeon rank (a key predicting attribute) which is unavailable during the listing process, then uses this predicted attribute and …

Managing Healthcare Data Assets As A Complex Adaptive System, Katie Clifton

Systems Science Friday Noon Seminar Series

A major project is underway to develop a shared platform for data and analytics in a highly federated healthcare delivery organization. In the status quo data environment, analysts have integrated information from various domains — medical records, claims, membership — to produce a multitude of reports and analysis. Duplicative, mis-aligned, and siloed datasets were created as an unintended consequence.

One objective of the project is to produce outcomes (reports, analysis) that are more standardized and efficient than the status quo without sacrificing adaptability. Standards and practices are being intentionally developed as a mechanism for this emerging system to achieve more …

A Game-Theoretic Approach To Share The Costs Of Cooperating Healthcare Networks, Jay M. Lightfoot

Journal of International Technology and Information Management

The growing demand for healthcare services combined with the disarray in the health insurance market in the United States has created a situation where rival health networks are aggressively competing by building duplicate health facilities and providing redundant services in localized geographic regions. Unfortunately, this strategy can reduce the quality of patient care and decrease profits (Kaissi & Charland, 2013). A solution to this problem is for health networks to cooperate and share healthcare equipment, facilities, and personnel. Toward that end, this paper presents a game-theoretic method that can share these costs in a fair, efficient, and repeatable manner.

Evaluation Of A Scientifically Developed Anesthesiology Handoff Protocol, Kristen Lise Welsh Webster

Doctoral Dissertations and Master's Theses

Communication failures have been cited as the leading cause of avoidable adverse events in healthcare. Specifically, within handoffs, these communication failures can cause error in the transfer of patient information. A multitude of factors can affect the transmission of patient information between providers including transactive memory, power distance, and conversational noise; however, literature suggests that the use of handoff protocols assist in improving communication and efficiency during handoffs. Studies regarding handoffs have typically centered on the content or delivery of the information during the handoff. To date, none have targeted the underlying mechanisms of the communication and their effects on …

Exploring The Association Between Patient Waiting Time, No-Shows And Overbooking Strategy To Improve Efficiency In Health Care, Cam Tu M. Nguyen

Industrial Engineering Undergraduate Honors Theses

Many primary care clinics are using overbooking as a strategy to mitigate the negative impacts on operations and performance caused by patient nonattendance of appointments, also known as “no-shows”. However, overbooking tends to increase patient waiting time and worker overtime. It is also acknowledged that patient waiting time is associated with no-show behavior, yet there is a lack of observational study to quantify the relationship. The overall goal of this research is to explore the relationships between patient waiting time, no-show behavior and overbooking strategy in terms of clinic performance. Arena® simulation software is used to create a discrete-event simulation …

Healthcare Utilization Awareness And Labor Monitoring Methodology: A Theoretical I.M.S.E. Approach To Risk Minimization And Human Metrics Capturing In The Nursing Workforce, Luis Reyes

Open Access Theses & Dissertations

The healthcare industry is so complex and dynamic that the development of any tool designed to promote positive patient outcomes nearly requires the developer to be an actual healthcare practitioner. Many healthcare tools exists that initially give the perception that there will be no future requirements that may hinder the tools' integrity, but more often than not, the unexpected occurs. The future is one unpredictable element of life that most engineers wish they could capture with optimal precision. I.M.S.E. (Industrial, Manufacturing and Systems Engineering) applications do not assist with fortune telling, but they do assist with creating robust tools designed …

Impact Of A Localized Lean Six Sigma Implementation On Overall Patient Safety And Process Efficiency, Luvianca Gil, Pilar Pazos, Mamadou Seck, Rolando Delaguila

Engineering Management & Systems Engineering Faculty Publications

Continuous quality improvement tools have caught the attention of the Health Care Industry as a solution to process efficiency, patient safety and cost reduction. This research explores the impact of a Lean Six Sigma (LSS) process improvement initiative in overall process efficiency and patient safety in two Labor and Delivery (L+D) units of two large hospital providers. This study focuses on the application of modeling and simulation methodology to investigate the influence of a localized process improvement intervention on the overall L+D unit output, by considering patient flow, system capacity and unit performance. The simulation models capacity profiles and patient …

Simulation Of 48-Hour Queue Dynamics For A Semi-Private Hospital Ward Considering Blocked Beds, Wei Chen

Masters Theses

This thesis study evaluates access to care at an internal medicine unit with solely semi-private rooms at Baystate Medical Center (BMC). Patients are divided into two types: Type I patient consumes one bed; Type II patient occupies two beds or an entire semi-private room as a private space for clinical reasons, resulting in one empty but unavailable (blocked) bed per Type II patient. Because little data is available on blocked beds and Type II patients, unit-level hospital bed planning studies that consider blocked beds have been lacking. This thesis study bridges that gap by building a single-stream and a two-stream …

Retaining Behavioral Healthcare Employees Of The Millennial Generation, David W. Gomel

Walden Dissertations and Doctoral Studies

As a result of the passage of the Affordable Care Act, the behavioral healthcare field is experiencing an increased demand for services. This increase is based on the availability of healthcare coverage to an estimated 13.4 million previously uninsured individuals. To meet this demand for treatment, the workforce of behavioral health therapists must grow. The largest generation entering the workforce, the Millennial Generation - those born after 1980 - is believed to lack commitment to their employers, frequently vacating their positions for the next best offer. The purpose of this case study was to determine factors that both affect retention …

Risk Based Optimization For Improving Emergency Medical Systems, Sandhya Saisubramanian, Pradeep Varakantham, Hoong Chuin Lau

Research Collection School Of Computing and Information Systems

In emergency medical systems, arriving at the incident location a few seconds early can save a human life. Thus, this paper is motivated by the need to reduce the response time – time taken to arrive at the incident location after receiving the emergency call – of Emergency Response Vehicles, ERVs (ex: ambulances, fire rescue vehicles) for as many requests as possible. We expect to achieve this primarily by positioning the "right" number of ERVs at the "right" places and at the "right" times. Given the exponentially large action space (with respect to number of ERVs and their placement) and …

Comparing Data Envelopment Analysis (Dea) And An Integrated Approach Of Dea And Malmquist Index (Dea-Mi) In Evaluation Of Hospitals Performances, Amin Yazdani Kachoei, Mohammad Mahdi Mozaffari, Amin Vafadarnikjoo, Mahdi Saeedpoor

Amin Vafadarnikjoo

Productivity in hospitals where are major centres for health and medical services has always been emphasised, on the other hand considering development of countries, various methods are presented to measure this factor. It should be noted that not using the scientific measurement methods and indexes correctly will end up misleading and generalising productivity and will lead to poor compliance with scientific principles, wasting resources and failing to achieve productivity in both enterprise and the whole economic system. The purpose of this paper is to compare two approaches; data envelopment analysis (DEA) and the hybrid of DEA and Malmquist index in …

Designing A Sustainable And Transferable Inventory Management System For Small Healthcare Facilities, Shree Frazier

Open Access Theses

Managing the costs of supplies within healthcare facilities has been a task that has plagued the health industry for many years. Many facilities are accustomed to using a par system approach. This involves bringing an inventory item to an amount sufficient for daily operation. This method often requires daily inspection by a healthcare worker, which reduces his/her time spent performing value added tasks. Employees at small healthcare facilities have multiple responsibilities, therefore they cannot afford to spend much time on inventory management. A proposed approach is the Kanban method, which allows for strict monitoring of inventory items without the need …

Robust System For Infection Control - An Industrial Systems Engineering Approach, Sundaravel Vinay Swarup Achudhan

Department of Mechanical and Materials Engineering: Dissertations, Theses, and Student Research

Health care delivery in the United States needs improvement. Each year about 98,000 people die as a result of medical errors and the United States is outranked by a number of developed countries in life expectancy, mortality and comorbidity. Healthcare quality is determined based on the quality of the service provided to the patient during their visit. Apart from the traditional problem solving design and development tools used to improve healthcare quality, The National Academy of Engineering and the Institute of Medicine recommend systems engineering principle and systems engineering tools to be used in health care to improve the industry. …

Modeling And Optimization Of Care Transitions, Yuming Mo

Open Access Theses

More than 145 million people live with at least one chronic condition, and almost half of them have multiple conditions. As a result, many managed care and integrated delivery systems have taken a great interest in alleviating the many deficiencies in managing the current care system that spans across various care delivery settings. In addition, many Americans have to rely on some social health insurance plan to cover her care expenses. As a result, these patients often may not been sufficiently cured but have to be transitioned to less expensive but less medically intensive facilities, due to the increasing pressure …

Predictive Analytics For Outpatient Appointments, Nang Laik Ma, Khataniar Seemanta, Dan Wu, Serene Seng Ying Ng

Research Collection School Of Computing and Information Systems

Healthcare is a very important industry where analytics has been applied successfully to generate insights about patients, identify bottleneck and to improve the business efficiency. In this paper, we aim to look at the patient appointment process as the hospital is experiencing high volume of ?no shows. ?No shows have a high impact on longer appointment lead time for patients, poor patient satisfaction and loss of revenue for hospital. We use data analytics to identify pattern of ?no shows, develop a statistical model to predict the probability of ?no shows and finally operationalizing the model to embed the analytics solution …

Dynamic Queue Management For Hospital Emergency Room Services, Kar Way Tan

Dissertations and Theses Collection (Open Access)

The emergency room (ER) – or emergency department (ED) – is often seen as a place with long waiting times and a lack of doctors to serve the patients. However, it is one of the most important departments in a hospital, and must efficiently serve patients with critical medical needs. In the existing literature, addressing the issue of long waiting times in an ED often takes the form of single-faceted queue-management strategies that are either from a demand perspective or from a supply perspective. From the demand perspective, there is work on queue design such as priority queues, or queue …

Master Physician Scheduling Problem, Aldy Gunawan, Hoong Chuin Lau

Research Collection School Of Computing and Information Systems

We study a real-world problem arising from the operations of a hospital service provider, which we term the master physician scheduling problem. It is a planning problem of assigning physicians’ full range of day-to-day duties (including surgery, clinics, scopes, calls, administration) to the defined time slots/shifts over a time horizon, incorporating a large number of constraints and complex physician preferences. The goals are to satisfy as many physicians’ preferences and duty requirements as possible while ensuring optimum usage of available resources. We propose mathematical programming models that represent different variants of this problem. The models were tested on a real …

Urgent Aeromedical Evacuation Network Capacity Planning, Scott C. Finkbeiner

Theses and Dissertations

Aeromedical Evacuation (AE) has been steadily utilized during Operation Iraqi Freedom and Operation Enduring Freedom. AE is a global enterprise. The current structure of AE is facing changes as forces scale down from operations in Iraq and Afghanistan. AE will, however, continue to be important in its domestic use in the continental USA (CONUS). Current practice is to pull aircraft (e.g. C-17, C-130 or KC-135) from their normal operations to meet Urgent and Priority patient needs when local alternatives are infeasible. An alternative to the current system would be having a centralized "bed-down" location for AE operations that would house …

Rfid Technology Selection And Economic Justification For Healthcare Asset Tracking, Tyler Robert Peabody, Tali Freed

Master's Theses

Although Radio Frequency Identification (RFID) and Real-Time Location System (RTLS) technologies for inventory tracking have been growing in popularity, the healthcare industry has been reluctant to adopt these technologies. One of the primary reasons for this lack of enthusiasm has been the risk associated with electromagnetic interference between RFID/RTLS systems and medical equipment functionality. The other reason has been the substantial cost and complexity of implementing RFID/RTLS in healthcare organizations. In this study, we show that there are several ways to safely install RFID/RTLS systems to improve the inventory management processes of hospitals and clinics. We then analyze the inventory …

Using Computer Simulation To Study Hospital Admission And Discharge Processes, Edwin S. Kim

Masters Theses 1911 - February 2014

Hospitals around the country are struggling to provide timely access to inpatient beds. We use discrete event simulation to study the inpatient admission and discharge processes in US hospitals. Demand for inpatient beds comes from two sources: the Emergency Department (ED) and elective surgeries (NonED). Bed request and discharge rates vary from hour to hour; furthermore, weekday demand is different from weekend demand. We use empirically collected data from national and local (Massachusetts) sources on different-sized community and referral hospitals, demand rates for ED and NonED patients, patient length of stay (LOS), and bed turnover times to calibrate our discrete …

Shared Leadership In Six Sigma Teams From The North Shore-Lij Health System, Brian J. Galli

Engineering Management & Systems Engineering Theses & Dissertations

The main goal of the research was to identify the relationships that the internal research team environment and external coaching variables had with the degree of shared leadership in the context of Six Sigma teams from the North Shore LIJ Health System. Furthermore, the research ascertained the relationships that these variables had with two performance metrics: a team's ability to complete project deliverables and satisfy customer's requirements. This research also sought to understand additional factors that affected the five variables.

The research found that while shared leadership did not positively change as a team progressed through the phases of the …

The Factors Behind A Successful Implementation Of Electronic Health Records Systems, Anjee Gorkhali

Engineering Management & Systems Engineering Theses & Dissertations

This research explores the role that budget for Information System (IS) and technical expertise of healthcare service provider staff play on the successful leap from a partial to exhaustive implementation of Electronic Health Records (EHR) Systems. Technical expertise in Information Systems might not be easily measurable directly, but there are a number of indicators that could be used as a proxy, such as: Information System (IS) Department Budget, number of IS staff and the extent of technical trainings provided by the IS department to the clinical staff. This research study hypothesizes that quality technical trainings conducted by an IS department …

A Primary Care Workload Production Model For Estimating Relative Value Unit Output, Rachel G. Murphy

Theses and Dissertations

Health care costs have grown to unsustainable levels nationally and within the Department of Defense. Military health care costs have historically been difficult to isolate, causing budget cuts to be the vehicle for cost control. Maximum efficiency, therefore, is the goal in order to show improvement. With the Air Force’s new preventive health plan, they aim to drive a long-term posture for cost reduction through prevention. This research effort aimed to develop a tool to assist in future efforts to understand and improve efficiency in workload output, and whether a relationship exists between patient workload demand and the per-encounter variables …