In April 2008, the Ontario government announced its top two healthcare priorities for the next 4 years, one of which is reducing wait time in emergency rooms. To study the wait time in emergency rooms or any other departments in a hospital, one must investigate resource planning, scheduling, and utilization within the hospital. This thesis provides hospitals with a set of simulation and optimization tools to help identify areas of improvement, particularly when there are a number of alternatives under consideration. A simulation tool (a Monte Carlo simulation model) estimates patient demand for beds in a hospital during a typical week. Two optimization tools (an integer programming mathematical model and a heuristics model) demonstrate opportunities for smoothing the patient demand for beds by adjusting the operating room schedule.

In April 2008, the Ontario government announced its top two healthcare priorities for the next 4 years, one of which is reducing wait time in emergency rooms. To study the wait time in emergency rooms or any other departments in a hospital, one must investigate resource planning, scheduling, and utilization within the hospital. This thesis provides hospitals with a set of simulation and optimization tools to help identify areas of improvement, particularly when there are a number of alternatives under consideration. A simulation tool (a Monte Carlo simulation model) estimates patient demand for beds in a hospital during a typical week. Two optimization tools (an integer programming mathematical model and a heuristics model) demonstrate opportunities for smoothing the patient demand for beds by adjusting the operating room schedule.

Com a longevidade, os indivíduos desenvolvem doenças crônicas e degenerativas, aumentando o número de internações hospitalares e, consequentemente, o tempo de internação. Para a gestão eficaz, é fundamental que o cuidado seja integrado. Assim, os objetivos deste estudo foram: analisar a utilização do Interdisciplinary Method Instrument (Método INTERMED) durante a internação e pós-alta hospitalar; enumerar os aspectos biopsicossociais e o sistema de saúde de pessoas idosas hospitalizadas; identificar a presença de reinternação; correlacionar os escores do INTERMED com as variáveis tempo de permanência hospitalar e reinternação. Para isso, foram utilizadas informações de banco de dados de 180 pessoas idosas internadas em hospital filantrópico do município de São Paulo, como os sociodemográficos, tempo de permanência hospitalar, número de reinternações, Método INTERMED e Escala de Mayo. Houve predomínio de participantes do sexo masculino com média de idade de 72,1 anos, casados (80,5%), e diferença significativa entre os grupos para idade, estado civil, tempo de permanência, escore do INTERMED, encaminhado ao serviço de psicologia e social, o uso de antimicrobiano e solicitação de home care. O escore do domínio biológico foi o de maior valor (p=0,479), porém não houve diferenças significativas entre os escores do INTERMED e reinternação. Nas análises de curva ROC, a área sob a curva foi de 0,426, com ponto de corte de 10/15 pontos e com sensibilidade de 0,714 e especificidade de 0,316, indicando ponto de corte ideal para o INTERMED para predição de Mayo>= 10 é 15 pontos. Os resultados têm que ser encarados como sua aplicação ampliada a diferentes populações e melhor avaliado sob a perspectiva de implicação no processo de trabalho diário da equipe interprofissional. No entanto, visualiza-se vantagens na operacionalização do modelo biopsicossocial, visando a integralidade do cuidado e a influência na gestão da clínica de idosos internados em instituição hospitalar. Espera-se que este estudo possa contribuir para melhoria da gestão clínica, buscando a integralidade do cuidado e aprimorar o processo de trabalho da equipe interprofissional / With longevity, individuals develop chronic and degenerative diseases, increasing the number of hospital admissions and consequently the length of hospital stay. For effective management, it is critical that care be integrated. Thus, the objectives of this study were: to analyze the use of the Interdisciplinary Method Instrument during hospitalization and after hospital discharge; to enumerate the biopsychosocial and health system aspects of hospitalized elderly people; identify the presence of readmission; to correlate the INTERMED scores with the variables length of hospital stay and readmission. For this, we used information from a database of 180 elderly people hospitalized in a philanthropic hospital in the city of São Paulo. Data were: sociodemographic, length of hospital stay, number of readmissions, INTERMED Method and May Scale. There was a predominance of male participants, mean age of 72.1 years, married. There was a significant difference between groups for age, marital status, length of stay, INTERMED score, referral to psychology and social service, antimicrobial use and Home Care request. The biological domain score was the highest value. There were no significant differences between the INTERMED scores and re-hospitalization. The results have to be considered as preliminary, that their application has to be extended to different populations and better evaluated from the perspective of their implication in the daily work process of the interprofessional team. However, it is possible to visualize advantages in the operationalization of the biopsychosocial model aiming at the integrality of the care and its influence in the management of the clinic of elderly hospitalized in a hospital institution. It is hoped that this study may contribute to the improvement of clinical management aiming at the integrality of care and to improve the work process of the interprofessional team

Background: Swedish hospitals face intensified challenges due to elevated demands from patients, demographic changes and cost constraints. Furthermore, patient safety is negatively affected by the relatively high rate of health care associated infections (HAIs). Thus, enforced preventive measures have to be undertaken to improve medical institutions’ ability to provide a qualitative and safe health care. Hence, logistics and technology solutions are gaining presence in modern day medical institutions in order to deliver improved health care.  Purpose: The purpose of this study is to explore how a central automatic bed disinfection system could be implemented at a hospital, and investigate if this would improve the patient safety by minimiz-ing the health care associated infections while enhancing the working environment for health professionals.  Method: This study takes the form of an exploratory single case study through the investigation of a Swedish hospital. Qualitative data was compiled through semi-structured interviews and observations, which were analyzed inductively.  Conclusion: The findings reveal that introducing a central automatic bed disinfection system may improve patient safety and the working environment for health care personnel. Additionally, more consistent hygiene standards and improved cleaning quality result in an augmented minimization of bacteria, which as a consequence reduces transmissions of HAIs. Through the implementation of an automatic bed disinfection system, the cleaning capacity is increased, thus the supply of beds becomes more responsive, which indirectly affects the patient flow. By developing a sound logistics system through a flow perspective, a more effective bed management at the hospital is enabled, which optimizes the patient throughput. Moreover, cost efficiencies may be obtained through a more efficient qualitative health care.

The Swedish health care system plays a vital role in satisfying the citizens’ demands for quality health care services. To deliver the right services in time in a hospital, an efficient admission plan is required, but this can be difficult to achieve. The Department of Pulmonary Medicine at the University Hospital in Linköping needs a better admission plan for their patients. In the department, the patient demand does not match the capacity, which leads to overcrowding at the ward. The aim of this thesis is to improve the admission plan of patients for the ward at the Department of Pulmonary Medicine by using discrete event simulation. To fulfil the aim, a simulation study is performed to understand how the system is working, where the problems emerged and how to prevent overcrowding. Different experiments are performed to check what could improve the admission plan at the ward. The results from this study shows that an improvement of the admission plan could be reached by better cooperation between involved units, improved documentation at the Department, a queue system of patients based on medical priorities and changed number of care beds. These solutions can prevent overcrowding and deliver health care services in time.

This diploma thesis is focused on information systems in the field of hospital and nursing-care bed management and contactless vital signals monitoring. The aim of this thesis is to provide the basic overview of information systems used in health care facilities, to introduce both the LINis and Vitalmonitor systems, to analyse the effectiveness of their implementation as well as to prepare their financing models. The introductory section defines the area of health information systems. It covers the whole system spectrum from the strategic to the less important ones. This definition determines the environment for the new systems. The analysis of the largest suppliers within the Czech Republic is also included in this section. The second part deals with the LINis system and Vitalmonitor system, their basic functionality, structure and integration. The most important is the third section which contains the analysis of the effects resulting from the standard information system extension. The Effects of the LINis system and Vitalmonitor system are assessed according to the level of patient care, staff performance, value added for different types of medical facilities and financing models.

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2017-03-17T17:32:50Z No. of bitstreams: 1 Corina Maria Mattos.pdf: 1949702 bytes, checksum: 1adf7f70ac89c35fa4e0953b59985d1a (MD5) / Made available in DSpace on 2017-03-17T17:32:50Z (GMT). No. of bitstreams: 1 Corina Maria Mattos.pdf: 1949702 bytes, checksum: 1adf7f70ac89c35fa4e0953b59985d1a (MD5) Previous issue date: 2016 / Mestrado Profissional em Enfermagem Assistencial / Pesquisa cujo objeto de investigação é a aplicação da ferramenta Kanban no processo de internação na clínica médica pediátrica de uma unidade hospitalar pública municipal. Tem por objetivo geral: elaborar o planejamento de aplicação da ferramenta Kanban para o processo de internação hospitalar de uma unidade pública pediátrica. Objetivos específicos: buscar evidências sobre a utilização da ferramenta Kanban na área da saúde; aplicar a ferramenta Kanban no processo de internação hospitalar na unidade pública pediátrica; adaptar a ferramenta para a especificidade do processo de internação hospitalar na unidade pública pediátrica em estudo. Trata-se de uma pesquisa participante, descritiva, com abordagem qualitativa, sobre a adaptação e aplicação de uma ferramenta administrativa de gestão denominada Kanban. Os resultados apontam que a introdução de uma ferramenta administrativa inovadora, em um serviço de saúde em unidade pública, requer a escolha objetiva de gestores locais que possuam poder de liderança e comando, tenham flexibilidade, sejam agregadores e conheçam profundamente sua equipe, sendo características essenciais para realização de um planejamento do plano de aplicação do Kanban como ferramenta de gestão na rotina diária dos profissionais da clínica médica pediátrica. Conclui-se ser essencial a adesão da equipe multiprofissional à aplicação da ferramenta no processo de hospitalização, havendo participação ativa dos setores chaves da unidade e apoio integral da direção. Neste processo, o vínculo criado entre o pesquisador e os participantes favorece a troca de conhecimento referente à situação investigada, de forma que, em conjunto, desenvolvam atitudes para solucionar interferências e encontrar a melhor forma de implantação e aplicação da ferramenta em sua rotina diária, de modo participativo. O Kanban aplicado à clínica médica pediátrica demonstra ir além da gestão de leitos, ele facilita a tomada de decisão sobre um tratamento ou diagnóstico instaurado, reduz o tempo de permanência da criança na unidade, subsidia a diminuição dos custos e possibilita a criação de indicadores específicos para área pediátrica / A study approaching the application of the Kanban tool in the process of hospitalization in the pediatric medical department of a municipal public hospital unit. Its main goal is to elaborate the planning of application of the Kanban tool for the hospitalization process of a pediatric public unit. It also presents the following specific goals: to seek evidence about the use of the Kanban tool in the health area; to apply the Kanban tool in the hospitalization process in the pediatric public unit; to adapt the tool to the specificity of the hospitalization process in the pediatric public unit under study. This is a participatory, descriptive study with a qualitative approach about the adaptation and application of an administrative management tool known as Kanban. The results indicate that the introduction of an innovative administrative tool in a public health service requires the objective choice for local managers who have leadership and command power, are aggregators, flexible and have a deep knowledge of their team, since these are essential characteristics to project the Kanban application plan as a management tool in the daily activities of pediatric medical clinic professionals. We concluded that the adhesion of the multiprofessional team to the application of the tool in the hospitalization process is essential, with active participation of the key sectors of the unit and integral support of the management. In this process, the link created between the researcher and the participants favors the exchange of knowledge regarding the investigated situation, so they can develop actions to solve interferences and find the best way to implement and apply the tool in their daily activities together. The Kanban tool, when applied to the pediatric medical clinic, is capable of reaching beyond bedside management, it also facilitates decision making on an established treatment or diagnosis, reduces the patients’ time in the unit, helps in the reduction of costs and allows the creation of specific indicators for pediatric area

Healthcare systems, driven by increased demand due to growth in chronic diseases and population, suffer from lack of staffing and facility resources. Many major hospitals have long waiting lists and have subsequently pushed their production close to maximum capacity due to the high demand for services. The consequences are lack of overview of the operations and lack of coordination between healthcare staff, which leads to treatment delays. Surgery planning or scheduling is an important part of production planning in hospitals, which is considered highly complex due to high variability and many decisions variables that need to be considered. Those responsible for surgery planning are often considered to lack the right tools to support them in evaluating the many different decision factors.   Simulation is a technology within the field of operations research which has been applied to aid with surgery planning problems and to look for process improvements. Many studies however use a simplified approach to the surgery planning, due to the complexities of the planning problem. Studies have further argued that surgery planning fails to consider downstream resources and the negative effects it has on utilization of those resources. This thesis is based on a case study at one of Sweden’s major hospitals and aims to explore how simulation could become a decision support to help with surgery planning and identifying what process improvements such a tool could be aimed at. The surgery planning decision making process is first analyzed using a hierarchical framework for hospitals’ production planning. The results were that the decision making process regarding patient flows needs to be improved by taking both a top-down and bottom-up strategy for better information flow and coordination. The study further concludes that improved coordination and information sharing are important factors to improve patient flow through the hospital, which could be supported by the usage of Discrete Event Simulation for decision making. The ideal decision support tool is however considered the simulation tool embedded with an online system to support bed management decisions which could increase patient throughput. Such a tool could help to decrease the demand for the hospital’s beds by discharging patients quicker. In addition, it could support the bottom-up strategy for coordination, while implementing a multi-method or hybrid simulation could further support the top-down part of the strategy.

Submitted by Silvana Teresinha Dornelles Studzinski (sstudzinski) on 2016-11-03T11:54:04Z No. of bitstreams: 1 Murillo da Silveira Grübler_.pdf: 3027339 bytes, checksum: 2fdb175c76ab90e275bf8ba04792e452 (MD5) / Made available in DSpace on 2016-11-03T11:54:04Z (GMT). No. of bitstreams: 1 Murillo da Silveira Grübler_.pdf: 3027339 bytes, checksum: 2fdb175c76ab90e275bf8ba04792e452 (MD5) Previous issue date: 2016-08-19 / CNPQ – Conselho Nacional de Desenvolvimento Científico e Tecnológico / O Gerenciamento de Leitos é uma importante área de planejamento e controle hospitalar. Sua função é garantir o equilíbrio entre os pacientes que chegam através do setor de emergência, os eletivos que possuem algum tratamento agendado e aqueles que saem do hospital. Dessa forma, esse gerenciamento possibilita manter alta a taxa de ocupação dos quartos, mas sem realmente lotá-los, além de prever qualquer situação não planejada. A gestão eficaz de leitos hospitalares como recurso sempre foi um desafio para os gestores. Nas décadas de 80 e 90, por exemplo, milhares de pacientes tiveram operações canceladas em virtude de razões não médicas. Como há necessidade de um melhor controle do fluxo, a área de Gerenciamento de Leitos começou, então, a receber mais atenção acadêmica e também políticas nacionais para a sua gestão. O processo de admissão e posicionamento de enfermos, a partir do Gerenciamento de Leitos, vem se desenvolvendo nos últimos anos através de diversas técnicas de pesquisa operacional, tais como simulação, teoria de filas, análise estatística, entre outras. Devido às constantes incertezas vividas pelos hospitais atualmente, o uso do modelo cognitivo Ciência de Situação em pesquisas científicas na área da saúde vem crescendo cada vez mais. A Ciência de Situação é uma área de estudo que busca compreender o contexto dos ambientes e projetar ações futura. Em suma, é uma técnica que vai além do tradicional processamento de informações, visto que procura explicar o comportamento humano na operação de sistemas complexos. Nessa assertiva, este trabalho tem como objetivo utilizar a Ciência de Situação na área de Gerenciamento de Leitos, usando um modelo híbrido que une a técnica de Rede Neural Artificial Multilayer Perceptron com a Teoria do Valor Multiatributo para tomada de decisão, auxiliando gestores no processo de atribuição de pacientes em leitos adequados ao seu tratamento. Através da implementação de um protótipo baseado neste modelo híbrido de apoio à decisão, nomeado de IMBEDS, foram avaliados 50 pacientes em um total de 266 leitos gerenciados pela Central de Leitos, no Hospital Mãe de Deus, localizado em Porto Alegre. O resultado final dos testes foi de 93,5% de similaridade entre o leito apto apresentado pelo modelo e o processo real de alocação dos enfermos. / The Bed Management is an important area of planning and control hospital. It’s function is to ensure the balance between the patients who come through the emergency department, elective that have some scheduled treatment and those leaving the hospital. Thus, the Bed Management enables the hospital keep high occupancy rate of rooms, but without fill all the beds, in addition to providing any unplanned situation. Effective management of hospital beds as a resource has always been a challenge for managers. In the 80s and 90s, for example, thousands of patients have operations canceled due to non-medical reasons. As there is need for better control of the flow, Bed Management area then began to receive more academic attention and also policies national for the Bed Management. The process of admission and positioning the patients, from the management of beds, has been developing in recent years through of operational research, such as simulation, queuing theory, statistical analysis, among others. Due to the uncertainties experienced by hospitals nowadays, the use of model Situation Awareness in research in the health field is growing increasingly. Situation Awareness is a field of study that seeks to understand the context of the environment and designing future actions. In short, it is a technique that goes beyond the traditional information processing, as it seeks to explain human behavior in the operation of complex systems. In this statement, this work aims to use the Situation Awareness in Bed Management area, using a hybrid model that combines the technique Artificial Neural Network Multilayer Perceptron with the Multi-Attribute Value Theory for decision making, assisting managers in process of patient's allocation to the bed suitable in his treatment. Through the implementation of a prototype based on this hybrid model of decision support, named of IMBEDS, were evaluated 50 patients in a total of 266 beds managed by Beds Center, in the Hospital Mãe de Deus, located in Porto Alegre. The final result of the tests was 93.5% similarity between the bed apt selected by the model and the allocation process of the patients.