1,720,979 research outputs found
A framework for operational modelling of hospital resources
No full textThe provision of hospital resources, such as beds, operating theatres and nurses, is a matter of considerable public and political concern and has been the subject of widespread debate. The political element of healthcare emphasises the need for objective methods and tools to inform the debate and provide a better foundation for decision-making. There is considerable scope for operational models to be widely used for this purpose. An appreciation of the dynamics governing a hospital system, and the flow of patients through it, point towards the need for sophisticated capacity models reflecting the complexity, uncertainty, variability and limited resources. Working alongside managers and clinicians from participating hospitals, this paper proposes a generic framework for modelling of hospital resources in the light of perceived user-needs and real-life hospital processes. The proposed framework incorporates the need for patient classification techniques to be adopted, which forms a key differentiator between this approach and other attempts to produce practical capacity planning and management tools. Statistically and clinically meaningful patient groupings may then be fed into developed simulation models and individual patients from each group passed through the particular hospital system of concern. The effectiveness of the framework is demonstrated through the development and use of an integrated hospital capacity tool
Classification trees: a possible method for maternity risk grouping
No full textPregnancy, although being one of the most natural processes in our evolution, still remains subject to numerous complications and potential high risk. Complications at birth, such as the need for a caesarean section or the use of forceps, are not uncommon. An early warning of possible complications would greatly benefit both medical professionals and the expectant mother. Classification tree analysis uses selected independent variables to group pregnant women according to a dependent variable in a way that reduces variation. In this study, data on 3,902 births were analysed to create risk groups for a number of complications, including the risk of a non-spontaneous delivery (a complicated birth) and premature delivery. From an overall risk of 23% of a non-spontaneous delivery, the classification tree was able to find statistically significant risk groups ranging from 7% to 65%. The resulting classification rules have been incorporated into a developed database tool to help quantify associated risks and act as an early warning system of possible complications to individual pregnant women
Can you model growth of trust? A study of the sustainability of a rural community health centre in North India
Full text linkTrust in the service provided by any health facility is of vital importance to its sustainability, whether it is a community clinic in a rural area of a developing country or an international telemedicine service. Community health centres can be used as a means of delivering highly accessible, low-cost health service in the developing world. A major strategic issue for planners of such centres is the expected level of uptake of services throughout a region and its effect on sustainability of any facility. In this study of a clinic in rural north India, Monte Carlo simulation is used in modelling the spatio-temporal spread of usage of the service. Trust in the provider is built both through word-of-mouth contacts and previous development activities: our study contributes to the literature with a practical application of trust modelling
Modelling for the planning and management of bed capacities in hospitals
No full textThe internal dynamics of a hospital represent a complex non-linear structure. Planning and management of bed capacities must be evaluated within an environment of uncertainty, variability and limited resources. A common approach is to plan and manage capacities based on simple deterministic spreadsheet calculations. This paper demonstrates that these calculations typically do not provide the appropriate information and result in underestimating true bed requirements. More sophisticated, flexible and necessarily detailed capacity models are needed. The development and use of such a simulation model is presented in this paper. The modelling work, in-conjunction with a major UK NHS Trust, considers various types of patient flows, at the individual patient-level, and resulting bed needs over time. The consequence of changes in capacity planning policies and management of existing capacities can be readily examined. The work has highlighted the need for evaluating hospital bed capacities in light of both bed occupancies and refused admission rates. The relationship between occupancy and refusals is complex and often overlooked by hospital managers
On the challenges of healthcare modelling and a proposed project life-cycle for successful implementation
No full textOR methods and tools are being increasingly applied within the health services domain to support objective decision-making for the effective and efficient provision of resources. Healthcare modelling, however, is beset with many challenges and this paper examines a number of issues that define the primary challenges faced by the modeller in this field. It is fair to say that their resolution determines the likely success or failure of healthcare modelling in general. Working with a number of participating health service organizations, a proposed framework towards successful implementation has evolved and is presented in this pape
Locational analysis: highlights of growth to maturity
No full textLocational analysis has grown to maturity over the last decades, from its earliest roots, to fruitfulness in a wide-ranging number of strands that join with other disciplines and applications such as environmental planning and supply chain management. We chart the progress of location theory in three stages: a period of early contributions, when a number of seminal geometrical and geographical problems were studied; a “coming of age” with the development of defining or classical problems that have proved fundamental to much later research and a third period of new models and new application
An analysis of the academic literature on simulation and modelling in healthcare
No full textThis article describes a multi-dimensional approach to the classification of the research literature on simulation and modelling in health care. The aim of the study was to analyse the relative frequency of use of a range of operational research modelling approaches in health care, along with the specific domains of application and the level of implementation. Given the vast scale of the health care modelling literature, a novel review methodology was adopted, similar in concept to the approach of stratified sampling. The results provide new insights into the level of activity across many areas of application, highlighting important relationships and pointing to key areas of omission and neglect in the literature. In addition, the approach presented in this article provides a systematic and generic methodology that can be extended to other application domains as well as other types of information source in health-care modelling.<br/
Improving the cost-effectiveness of Chlamydia screening with targeted screening strategies
No full textChlamydia is the most common sexually transmitted infection in the UK and constitutes a major public health problem. The UK Department of Health is phasing in a National Chlamydia Screening Programme (NCSP) but there is concern that blanket screening of the entire at risk population will simply add extra burden to the already overstretched health economy. This paper demonstrates that certain high-risk sub-groups within the general population are critical in the infection dynamics. Improved targeting of these high-risk populations achieves greater cost-effectiveness. Statistical risk-group clustering techniques have been used to identify indicators that are strong predictors in determining high-risk status while geomapping techniques visually display prevalence geographically across the region, thus identifying high prevalence postcode clusters and informing public health planners where to target intervention and screening strategies. A System Dynamics simulation model has been used to capture the infection dynamics and measure the cost-effectiveness of the intervention strategies. The model incorporates risk-group behaviour as identified by the above geomapping and statistical analysis components of the research. The combined use of computer simulation, statistical analysis and geomapping methodologies has provided a unique holistic view of the problem
Combining discrete-event simulation and system dynamics in a healthcare setting: a composite model for Chlamydia infection
No full textThis paper presents a composite model in which two simulation approaches, discrete-event simulation (DES) and system dynamics (SD), are used together to address a major healthcare problem, the sexually transmitted infection Chlamydia. The paper continues an on-going discussion in the literature about the potential benefits of linking DES and SD. Previous researchers have argued that DES and SD are complementary approaches and many real-world problems would benefit from combining both methods. In this paper, a DES model of the hospital outpatient clinic which treats Chlamydia patients is combined with an SD model of the infection process in the community. These two models were developed in commercial software and linked in an automated fashion via an Excel interface. To our knowledge this is the first time such a composite model has been used in a healthcare setting. The model shows how the prevalence of Chlamydia at a community level affects (and is affected by) operational level decisions made in the hospital outpatient department. We discuss the additional benefits provided by the composite model over and above the benefits gained from the two individual model
Geographical simulation modelling for the regional planning of oral and maxillofacial surgery across London
No full textOral and maxillofacial surgery (OMFS) is a recognized surgical specialty, with its foundations in dentistry. The current configuration of OMFS services across London has evolved over time and reflects historical rather than contemporary patterns of care. The creation of a London Health Region in 1998 provided the opportunity for rational planning of hospital services to serve the resident population of London (7.2 million) and beyond, with recent change focusing on London's five sectors that are represented within this planning model. A detailed geographical simulation model has been developed and has enabled planners to consider a number of OMFS service configurations and evaluate their impact on providers, variations in caseload, travelling distances and times for patients, and thus inform consultation over change. The research confirms that any in-patient service rationalization which concentrates care in one designated hub (main centre) per sector, involves a significant increase in caseload for the designated hub. Average travelling distances and times for in-patient admissions also increase significantly. However, it does suggest that current commissioned provision of day surgery patterns may not be well aligned to the geographical distribution of need for services, resulting in many patients travelling further than necessary for day surgery treatment. These may be overcome by sending patients to their local centre, which may be out with their sector of residence
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