Projects
THE BED SIZING PROBLEM IN AN INTENSIVE CARE UNIT (ICU)
Defining the problem
Intensive Care Units form a key component of hospital services for patients in need of critical care. Such a high level of care involves the use of hi-tech equipment and large numbers of medical professionals, making the cost per bed in the ICU far higher than in the rest of the hospital. This converts ICU bed allocation into a difficult sizing problem, where the lack of a bed means a poorer patient prognosis, while an excess of free beds unnecessarily increases the cost of the service, which has fixed costs regardless of the bed occupancy level.
The aim of this project is to build a valid, credible simulation model that will convince healthcare managers of its usefulness as an analysis tool for dealing with the ICU bed sizing problem.
ANALYSIS OF PATIENT DISCHARGE CRITERIA USED BY DOCTORS IN AN INTENSIVE CARE UNIT (ICU). A NORMATIVE APPROACH
Defining the problem
Previous research (the ICU bed-sizing Project) shone light on the importance of doctors’ bed allocation/triage decisions and the lack of mathematical models to support them and this project seeks a deeper analysis of the issue. A normative approach is used in working towards a mathematical optimization formulation of the problem leading to solutions that will inform efficient hospital bed management policies: the requirement being that they should enable minimization both of the number of patients prematurely discharged and of those turned away due to resource saturation. In addition, we investigate ways of transforming the mathematical solutions (in terms of service rates) into easily comprehensible and applicable bed allocation criteria for medical professionals.
CONSTRUCTION OF AN INTERACTIVE ICU MANAGEMENT SIMULATOR
Defining the problem
As a result of growing demand and the increase in treatment costs due to developing technology, increasing importance is being given to developing computer programs specifically designed for the purposes of hospital management and healthcare service management in general. Efficient management of (typically) scarce healthcare resources is crucial to achieving a positive impact on the health of (almost) all patients. At medical school, doctors learn to cure illnesses and treat patients on an individual basis, but, when resources are limited, the allocation of resources to one patient might diminish those needed by others. This problem of resource allocation, which reaches its extreme in the ICU setting, might be termed “the dilemma of the last bed”; the dilemma being which patient ought to be allocated the last bed in an ICU? Should it be one who has already been admitted to hospital or one who is yet to arrive but whose need may be greater? This means that the health unit needs to be understood from a global perspective and thus requires global decision-making. This enables predictions to be made as to the outcome of one or another set of decisions affecting the population as a whole and ensures selection of the most appropriate. The question that remains, however, is how these management skills are to be acquired. The proposal in this research project is to develop an IT tool that will help to explain the decision making process in an ICU with a view to improving the way it is managed.
MONITORIZACIÓN DEL ESTRÉS DE LOS MÉDICOS. APLICACIÓN AL SERVICIO DE URGENCIAS HOSPITALARIAS (SUH)
Defining the problem
The very hig
h level of stress under which emergency unit doctors work their shifts can have a negative impact both on the quality of care received by the patient and on doctors’ own health. The problem is sometimes aggravated by a poorly distributed workload leading to an undue increase in stress. The purpose of this research is to develop methodology to enable the quantification in real time of the amount of stress typically endured by doctors in emergency units over the course of a working day. The resulting stress measures will be useful when it comes to devising patient-physician assignment criteria to reduce stress without compromising (and, indeed, possibly improving) patient care quality indicators (which are largely based on waiting times). This stress function must consider the three main stress-inducing components identified by doctors: workload, time pressures while seeing patients and uncertainty. By workload, they mean the number and type of patients assigned to the doctor at a given moment; by time pressure, the limit on the duration of the first consultation with the patient, which depends on the severity of his/her condition; and by uncertainty, the unknown details of the tasks that will be required to attend to patients still awaiting triage or those awaiting diagnostic/complementary tests.
IMPROVING PATIENT FLOW THROUGH THE EMERGENCY DEPARTMENT
Defining the problem
The increasing demand placed on hospital emergency servicies (HES) regularly leads to service collapse. However, any service improvement requires additional resources (which, under current economic conditions, are unlikely to match growing demand), some means of controlling demand (hard to achieve, given the nature of the service) or better resource management. In this project, we explore alternatives for patient-flow management that might improve emergency service efficiency. Patients arriving at the HES are triaged in order to assess the severity of their condition and immediately assigned to a physician who will be responsible for their care throughout their stay. In most cases, patients are assigned to doctors by simple rota, under the premise that this is a fair means of sharing the workload. There are, however, other assignment strategies which can lead to better outcomes not only for the patient but also for the staff workload distribution.
IMPROVING PATIENT FLOW IN A HOSPITAL EMERGENCY DEPARTMENT. WAITING ROOM MANAGEMENT
Defining the problem
After triage, emergency patients are assigned to a physician for the first consultation, after which this same physician decides which patient will be seen next. This means taking into account the patient’s severity and what stage of care he/she has reached (waiting for a first consultation or for a second consultation pending the results of diagnostic tests ordered at the first consultation). The order in which patients are seen is not easily decided, because routine application of simple priority-based criteria can lead to excessive waiting times for some types of patient and even to system congestion. In this study, we investigate patient-in-process selection criteria using a multi-objective approach including compulsory maximum waiting times for first consultation (based on patient severity), minimization of patient stay in A&E and minimization of congestion.
PHYSICIAN SHIFT ASSIGNMENT IN A HOSPITAL EMERGENCY DEPARTMENT
Defining the problem
Hospital Emergency Services (HES) are open 24 hours a day, 365 days a year. Doctors therefore have to work a variety of different shifts: day or night, work day or holiday, different numbers of hours, in different placements and with different task assignments, etc. They are also affected by having to comply with ergonomic requirements relating to rest periods after certain types of shift. In this situation, it is difficult, especially in view of the fact that not all doctors have the same number of working hours, to achieve a fair and equitable annual shift assignment among all staff members.
RESEARCH INTO THE BENEFITS OF ENDOTRACHEAL INTUBATION IN PATIENTS WITH POLYTRAUMA RECEIVING ATTENTION IN AN OUT-OF-HOSPITAL EMERGENCY SETTING
Defining the problem
Observation shows that the intubation of patients with polytrauma in out-of-hospital emergency settings is practised less often in Spain than in reference countries such as Germany and France. The technique, which is not risk-free, is used at the doctor’s discretion. The potential impact of intubation on the probability of survival is being studied with a view to its inclusion in the emergency protocol should the evidence show that it would increase the patient’s chances of survival.