Operations Research, Systems Engineering and Industrial Engineering Commons^™

Effects Of Three Dry Powder Inhalers On Deposition Of Aerosolized Medicine In The Human Oral-Pharyngeal-Laryngeal Regions, Mohammed Ali

Technology Faculty Publications and Presentations

The dry powder inhaler (DPI) is a popular, effective and convenient drug delivery device for inhalation therapy to treat asthma. However, a large quantity (approximately 54%) of inhaled aerosols deposit in the oropharyngeal region. Deposition in this region is undesirable because it provides minimum therapeutic benefits and has adverse localized or systemic side effects. This study reports a method of examining electrostatic charge effects on deposition of three DPI aerosols (Spiriva^™ Handihaler, Advair Diskus^™, and Pulmicort^™ Turbohaler) in a cadaver-based cast of the human oral-pharyngeal-laryngeal (OPL) regions. Experimental aerosols were generated from the three commercially available …

Modeling And Optimization Of Non-Profit Hospital Call Centers With Service Blending, Yanli Zhao

Wayne State University Dissertations

This dissertation focuses on the operations problems in non-profit hospital call centers with inbound and outbound calls service blending.

First, the routing policy for inbound and outbound calls is considered. The objective is to improve the system utilization under constraints of service quality and operators' quantity. A collection of practical staffing assignment methods, separating and mixing staffing policy are evaluated. Erlang C queuing model is used to decide the minimum number of operators required by inbound calls. Theoretical analysis and numerical experiments illustrate that through dynamically assigning the inbound and outbound calls to operators under optimal threshold policy, mixing staffing …

Patient Populations, Clinical Associations, And System Efficiency In Healthcare Delivery System, Yazhuo Liu

USF Tampa Graduate Theses and Dissertations

The efforts to improve health care delivery usually involve studies and analysis of patient populations and healthcare systems. In this dissertation, I present the research conducted in the following areas: identifying patient groups, improving treatments for specific conditions by using statistical as well as data mining techniques, and developing new operation research models to increase system efficiency from the health institutes’ perspective. The results provide better understanding of high risk patient groups, more accuracy in detecting disease’ correlations and practical scheduling tools that consider uncertain operation durations and real-life constraints.

Predictive Analytics For Disease Condition Of Patients In Emergency Department, Azade Tabaie

Wayne State University Theses

Emergency Departments (EDs) in hospitals are experiencing severe crowding and prolonged patient waiting times. The reported crowding in hospitals shows patients in hospital hallways, long waiting times and full occupancy of ED beds. ED crowding has several potential unfavorable effects including patients and staff frustration, lower patient satisfaction and poor health outcomes. The primary motivations behind this study are shortening the patients’ waiting time and improving patient satisfaction and level of care.

The very initial interaction between clinicians and a patient is recorded on nurse triage notes which contain details of the reason for patient’s visit including specific symptoms and …

A Decision Support Simulation Model For Bed Management In Healthcare, Raja A. Baru

Masters Theses

"In order to provide access to care in a timely manner, it is necessary to effectively manage the allocation of limited resources such as beds. Bed management is key to the effective delivery of high-quality and low-cost healthcare. An efficient utilization of beds requires a detailed understanding of the hospital's operational behavior. It is necessary to understand the behavior of a hospital in order to make necessary adjustments to its resources, and policies, which can improve patient's access to care. The aim of this research was to develop a discrete event simulation to assist in planning and staff scheduling decisions. …

A Comparison Of Combined Overlap Block Fuzzy Cognitive Maps (Cobfcm) And Combined Overlap Block Neutrosophic Cognitive Map (Cobncm) In Finding The Hidden Patterns And Indeterminacies In Psychological Causal Models: Case Study Of Adhd, Hojjatollah Farahani, Florentin Smarandache, Lihshing Leigh Wang

Branch Mathematics and Statistics Faculty and Staff Publications

In spite of researchers’ concerns to find causalities, reviewing the literature of psychological studies one may argue that the classical statistical methods applied in order to find causalities are unable to find uncertainty and indeterminacies of the relationships between concepts.

In this paper, we introduce two methods to find effective solutions by identifying “hidden” patterns in the patients’ cognitive maps. Combined Overlap Block Fuzzy Cognitive Map (COBFCM) and Combined Overlap Block Neutrosophic Map (COBNCM) are effective when the number of concepts can be grouped and are large in numbers. In the first section, we introduce COBFCM, COBNCM, their applications, and …

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 …

Clinical Significance Of Response Shift In A Spine Interventional Clinical Trial, Robin Carlson

Walden Dissertations and Doctoral Studies

The effectiveness of treatments for degenerative spine conditions, where the primary symptom is back pain, is typically determined using patient-reported quality of life (QoL) measures. However, patients may adjust their internal standards when scoring QoL based on factors other than their health. This response shift phenomenon could confound the interpretation of study data and impact effectiveness conclusions. In the current study, response shift was examined using structural equation modeling (SEM) and previously collected clinical trial data comparing 2 minimally invasive medical devices in lumbar spinal stenosis patients through 1 year postintervention. In subject QoL results, reprioritization shift between 3 months …

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 …

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 …

Hippi Care Hospital: Towards Proactive Business Processes In Emergency Room Services, Kar Way Tan, Venky Shankaraman

Research Collection School Of Computing and Information Systems

It was 2.35 am on a Saturday morning. Wiki Lim, process specialist from the Process Innovation Centre (PIC) of Hippi Care Hospital (HCH), desperately doodling on her notepad for ideas to improve service delivery at HCH’s Emergency Department (ED). HCH has committed to the public that its ED would meet the service quality criterion of serving 90% of A3 and A4 patients, non-emergency patients with moderate to mild symptoms, within 90 minutes of their arrival at the ED. The ED was not able to meet this performance goal and Dr. Edward Kim, the head of the ED at HCH, had …

Pharmacists' And Patients' Perceptions Of Role Of Pharmacist In Discharge Process, Ravi Teja Vempati

All Theses

The objective of this study was to identify the perceptions of both patients and pharmacists about the pharmacist's role in the hospital discharge process. In order to do this, observations were conducted with the patients and interviews were conducted with both patients and pharmacists. During the interviews, both the patients and pharmacists were asked about the pharmacist's role in the hospital discharge process. The interviews were qualitatively analyzed using the in vivo technique. Four high-level themes emerged from this study: Current role of a pharmacist in the hospital, Ideal role of a pharmacist in the discharge process, Pharmacists' perceptions of …

Large-Scale Solution Approaches For Healthcare And Supply Chain Scheduling, Ridvan Gedik

Graduate Theses and Dissertations

This research proposes novel solution techniques for two real world problems. We first consider a patient scheduling problem in a proton therapy facility with deterministic patient arrivals. In order to assess the impacts of several operational constraints, we propose single and multi-criteria linear programming models. In addition, we ensure that the strategic patient mix restrictions predetermined by the decision makers are also enforced within the planning horizon. We study the mathematical structures of the single criteria model with strict patient mix restrictions and derive analytical equations for the optimal solutions under several operational restrictions. These efforts lead to a set …

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 …

Assessing The Impact Of Electronic Health Record Systems Implementation On Hospital Patient Perceptions Of Care, Katherine Sofia Palacio Salgar

Engineering Management & Systems Engineering Theses & Dissertations

The delivery of health care services has been impacted by advances in Knowledge Management Information Systems (KMIS) and Information Technology (IT). The literature reveals that Electronic Health Records Systems (EHRs) are a comprehensive KMIS. There is a wide recognition in the body of knowledge that demonstrates the potential of EHRs to transform all aspects of health care services and, in consequence, the performance of Health Care Delivery Organizations (HCDO). Authors of published research also agree that there is a need for more empirical contributions that demonstrate the impact of EHRs upon HCDO. It is argued that in most cases, studies …

Statistical And Prognostic Modeling Of Clinical Outcomes With Complex Physiologic Data, Monica A. Puertas

USF Tampa Graduate Theses and Dissertations

Laboratory tests are a primary resource for diagnosing patient diseases. However, physicians often make decisions based on a single laboratory result and have a limited perspective of the role of commonly-measured parameters in enhancing the diagnostic process. By providing a dynamic patient profile, the diagnosis could be more accurate and timely, allowing physicians to anticipate changes in the recovery trajectory and intervene more effectively.

The assessment and monitoring of the circulatory system is essential for patients in intensive care units (ICU). One component of this system is the platelet count, which is used in assessing blood clotting. However, platelet counts …

Antiviral Resistance And Dynamic Treatment And Chemoprophylaxis Of Pandemic Influenza, Sandro Paz

USF Tampa Graduate Theses and Dissertations

Public health data show the tremendous economic and societal impact of pandemic influenza in the past. Currently, the welfare of society is threatened by the lack of planning to ensure an adequate response to a pandemic. This preparation is difficult because the characteristics of the virus that would cause the pandemic are unknown, but primarily because the response requires tools to support decision-making based on scientific methods. The response to the next pandemic influenza will likely include extensive use of antiviral drugs, which will create an unprecedented selective pressure for the emergence of antiviral resistant strains. Nevertheless, the literature has …

Injury Prevention With Physical Therapy, Karen Kott, Margaret F. Lemaster

Rehabilitation Sciences Faculty Publications

(First paragraph) Ergonomics is the study of human performance (positioning and movement) and workplace design, such as equipment, ambience, and placement. The purpose of ergonomics is to maximize productivity by increasing safety, improving work quality, reducing operator fatigue and discomfort, and decreasing the risk of work -related musculoskeletal disorders (MSDs).^1-3

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 …

Improving Patient Length-Of-Stay In Emergency Department Through Dynamic Queue Management, Kar Way Tan, Hoong Chuin Lau, Francis Chun Yue Lee

Research Collection School Of Computing and Information Systems

Addressing issue of crowding in an Emergency Department (ED) typically takes the form of process engineering or single-faceted queue management strategies such as demand restriction, queue prioritization or staffing the ED. This work provides an integrated framework to manage queue dynamically from both demand and supply perspectives. More precisely, we introduce intelligent dynamic patient prioritization strategies to manage the demand concurrently with dynamic resource adjustment policies to manage supply. Our framework allows decision-makers to select both the demand-side and supply-side strategies to suit the needs of their ED. We verify through a simulation that such a framework improves the patients' …

Predicting Hospital Patients' Admission To Reduce Emergency Department Boarding, Mohammadmahdi Moqri

Graduate Masters Theses

Emergency Department (ED) boarding - the inability to transfer emergency patients to inpatient beds- is a key factor contributing to ED overcrowding. This paper presents a novel approach to improving hospital operational efficiency and, therefore, to decreasing ED boarding. Using the historic data of 15,000 patients, admission results and patient information are correlated in order to identify important admission predictor factors. For example, the type of radiology exams prescribed by the ED physician is identified as among the most important predictors of admission. Based on these factors, a real-time prediction model is developed which is able to correctly predict the …

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 …

Adequate Ventilation: How Is It Defined And Does It Adequately Warn Consumers?, Christopher Blankenship

Theses, Dissertations and Capstones

The purpose of this research was to clarify and define the term “adequate ventilation.” Upon looking at regulations, court cases, and other elements, it is clear that the term is inadequate to inform consumers and does not instruct consumers on how to achieve proper ventilation. To find out if consumers understand this, random persons were asked to define it. The answers were given a numerical value to show the knowledge trend. The outcome showed that most people do not understand how to achieve proper ventilation. Conclusion: Diagrams showing how to set up a room with ventilation and new instructions are …

The Role Of Is Infrastructure And Organizational Context On Implementation Of Electronic Health Records Systems, Pilar Pazos, Anjee Gorkhali, Rolando Delaguila

Engineering Management & Systems Engineering Faculty Publications

This research explores the role that Information System (IS) infrastructure and organizational context play on the implementation of Electronic Health Records (EHR) Systems. A number of indicators can be used as a proxy for IS infrastructure such as: Information System (IS) Department Budget allocation, percentage of full time IS staff and the number of technical trainings provided by the IS department to the clinical staff. Data was obtained from the Healthcare Information and Management Systems Society (HIMSS) database, a non-for profit organization that evaluates the use of information technology in the health care industry. This paper reports on the development …

A Methodology For Scheduling Operating Rooms Under Uncertainty, Marbelly Paola Davila

USF Tampa Graduate Theses and Dissertations

An operating room (OR) is considered to be one of the most costly functional areas within hospitals as well as its major profit center. It is known that managing an OR department is a challenging task, which requires the integration of many actors (e.g., patients, surgeons, nurses, technicians) who may have conflicting interests and priorities.

Considering these aspects, this dissertation focuses on developing a simulation based methodology for scheduling operating rooms under uncertainty, which reflects the complexity, uncertainty and variability associated with surgery.

We split the process of scheduling ORs under uncertainty into two main components. First, we designed a …

A Mathematical Modeling Framework For Phlebotomist Scheduling And Blood Draw Assignments In Laboratory Medicine, Laquanda T. Leaven

Dissertations

Laboratory services in healthcare delivery systems play a vital role in inpatient care. Studies have shown that laboratory data affects approximately 65% of the most critical decisions on admission, discharge, and medication. Laboratory testing accounts for approximately 10% of hospital billing. Reducing laboratory costs would contribute to reducing total healthcare cost, which is one of the major goals for the U.S. healthcare delivery system. This research focuses on improving the performance of the hospital laboratory in a large hospital system. The intention of this study is to identify and then optimize the most critical stage to improve the entire laboratory …