PATIENT FLOW: REDUCING DELAY IN HEALTHCARE DELIVERY

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PATIENT FLOW:

REDUCING DELAY IN HEALTHCARE

DELIVERY

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Recent titles in the INTERNATIONAL SERIES IN

OPERATIONS RESEARCH & MANAGEMENT SCIENCE

Frederick S. Hillier, Series Editor, Stanford University Maros/ COMPUTATIONAL TECHNIQUES OF THE SIMPLEX METHOD

Harrison, Lee & Neale/ THE PRACTICE OF SUPPLY CHAIN MANAGEMENT: Where Theory and Application Converge

Shanthikumar, Yao & Zijm/ STOCHASTIC MODELING AND OPTIMIZATION OF MANUFACTURING SYSTEMS AND SUPPLY CHAINS

Nabrzyski, Schopf & W?glarz/ GRID RESOURCE MANAGEMENT: State of the Art and Future Trends

Thissen & Herder/ CRITICAL INFRASTRUCTURES: State of the Art in Research and Application Carlsson, Fedrizzi, & Fuller/ FUZZY LOGIC IN MANAGEMENT

Soyer, Mazzuchi & Singpurwalla/ MATHEMATICAL RELIABILITY: An Expository Perspective Chakravarty & Eliashberg/ MANAGING BUSINESS INTERFACES: Marketing, Engineering, and

Manufacturing Perspectives

Talluri & van Ryzin/ THE THEORY AND PRACTICE OF REVENUE MANAGEMENT

Kavadias & hochiPROJECT SELECTION UNDER UNCERTAINTY: Dynamically Allocating Resources to Maximize Value

Brandeau, Sainfort & Pierskalla/ OPERATIONS RESEARCH AND HEALTH CARE: A Handbook of Methods and Applications

Cooper, Seiford & Zhu/ HANDBOOK OF DATA ENVELOPMENT ANALYSIS: Models and Methods

Luenberger/ LINEAR AND NONLINEAR PROGRAMMING, 2'"^ Ed

Sherbrooke/ OPTIMAL INVENTORY MODELING OF SYSTEMS: Multi-Echelon Techniques, Second Edition

Chu, Leung, Hui & Cheung/ 4th PARTY CYBER LOGISTICS FOR AIR CARGO

Simchi-Levi, Wu & Shen/ HANDBOOK OF QUANTITATIVE SUPPLY CHAIN ANALYSIS:

Modeling in the E-Business Era

Gass & Assad/ AN ANNOTATED TIMELINE OF OPERATIONS RESEARCH: An Informal History Greenberg/ TUTORIALS ON EMERGING METHODOLOGIES AND APPLICATIONS IN

OPERATIONS RESEARCH

Weber/ UNCERTAINTY IN THE ELECTRIC POWER INDUSTRY: Methods and Models for Decision Support

Figueira, Greco & Ehrgott/ MULTIPLE CRITERIA DECISION ANALYSIS: State of the Art Surveys

Reveliotis/ REAL-TIME MANAGEMENT OF RESOURCE ALLOCATIONS SYSTEMS: A Discrete Event Systems Approach

Kail & Mayer/ STOCHASTIC LINEAR PROGRAMMING: Models, Theory, and Computation Sethi, Yan & Zhang/ INVENTORY AND SUPPLY CHAIN MANAGEMENT WITH FORECAST

UPDATES

Cox/ QUANTITATIVE HEALTH RISK ANALYSIS METHODS: Modeling the Human Health Impacts of Antibiotics Used in Food Animals

Ching & Ng/ MARKOV CHAINS: Models, Algorithms and Applications Li & Sun/NONLINEAR INTEGER PROGRAMMING

Kaliszewski/ SOFT COMPUTING FOR COMPLEX MULTIPLE CRITERIA DECISION MAKING Bouyssou et al/ EVALUATION AND DECISION MODELS WITH MULTIPLE CRITERIA:

Stepping stones for the analyst

Blecker & Friedrich/ MASS CUSTOMIZATION: Challenges and Solutions

Appa, Pitsoulis & Williams/ HANDBOOK ON MODELLING FOR DISCRETE OPTIMIZATION Herrmann/ HANDBOOK OF PRODUCTION SCHEDULING

Axsater/ INVENTORY CONTROL, 2'"^ Ed

* A list of the early publications in the series is at the end of the book *

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PATIENT FLOW:

REDUCING DELAY IN HEALTHCARE DELIVERY

Edited by

Randolph W. Hall

Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, California 90089-0193

^ Spri inger

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Randolph W. Hall, (Editor) University of Southern California Los Angeles, CA, USA

Library of Congress Control Number: 2006924378

ISBN-10: 0-387-33635-4 (HB) ISBN-10: 0-387-33636-2 (e-book) ISBN-13: 978-0387-33635-0 (HB) ISBN-13: 978-0387-33636-7 (e-book) Printed on acid-free paper.

All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science + Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now know or hereafter developed is forbidden.

The use in this publication of trade names, trademarks, service marks and similar terms, even if the are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights.

Printed in the United States of America.

9 8 7 6 5 4 3 2 springer.com

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Contributing Authors vii

Preface xi Acknowledgments xiii

1. Modeling Patient Flows Through the Healthcare System 1 RANDOLPH HALL, DAVID BELSON, PAVAN MURALI AND

MAGED DESSOUKY

2. Hospitals And Clinical Facilities, Processes And Design For

Patient Flow 45 MICHAEL WILLIAMS

3. Access to Surgery and Medical Consequences of Delays 79 BORIS SOBOLEV, ADRIAN LEVY AND LISA KURAMOTO

4. Breakthrough Demand-Capacity Management Strategies to Improve

Hospital Flow, Safety, and Satisfaction 101 LINDA KOSNIK

5. Managing Patient Appointments in Primary Care 123

SERGEI SAVIN

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vi Contents 6. Waiting Lists for Surgery 151

EMILIO

C E R D A ,

LAURA DE PABLOS, MARIA V. RODRIGUEZ- URIA

7. Personnel Staffing and Scheduling 189 MICHAEL WARNER

8. Discrete-Event Simulation Of Health Care Systems 211 SHELDON H. JACOBSON, SHANE N. HALL AND JAMES R.

SWISHER

9. Forecasting Demand for Regional Healthcare 253 PETER CONGDON

10. Queueing Analysis in Healthcare 281 LINDA GREEN

11. Rapid Distribution of Medical Supplies 309 MAGED DESSOUKY, FERNANDO ORDONEZ, HONGZHONG

JIA, AND ZHIHONG SHEN

12. Using a Diagnostic to Focus Hospital Flow Improvement Strategies 339 ROGER RESAR

13. Continuum of Care Program 357 MARK LINDSAY

14. A Logistics Approach for Hospital Process Improvement 393 JAN VISSERS

15. Managing a Patient Flow Improvement Project 429 DAVID BELSON

Biographies 453

Index 457

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Contributing Authors

David Belson

Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, California

Emilio Cerda

University Complutense of Madrid, Spain

Peter Congdon

Department of Geography, Queen Mary and Westfield College, Londdon

Maged Dessouky

Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, California

Linda Green

Graduate School of Business, Columbia University, New York

Randolph Hall

Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, California

Shane N. Hall

Department of Mechanical and Industrial Engineering, University of

Illinois at Urbana-Champaign, Urbana, Illinois

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Vlll

Sheldon Jacobson

Department of Mechanical and Industrial Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois

Hongzhong Jia

Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, California

Linda Kosnik

Overlook Hosptial, Summit, New Jersey

Lisa Kuramoto

Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia

Adrian Levy

Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, British Columbia

Mark Lindsay

Mayo Health System, Eau Claire, Wisconsin

Pavan Murali

Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, California

Fernando Ordoiiez

Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, California

Laura de Pablos

University Complutense of Madrid, Spain

Roger Resar

Institute for Healthcare Improvement, Boston

Maria V. Rodriguez University of Oviedo, Spain Sergei Savin

Graduate School of Business, Columbia University, New York

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IX

Zhihong Shen

Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, California

Boris Sobolev

Department of Health Care and Epidemiology, the University of British Columbia, British Columbia

James R. Swisher

Mary Washington Hospital, Fredericksburg, Virginia Jan Vissers

Institute for Health Policy and Management, Erasmus University Medical Centre, Rotterdam, Netherlands

Michael Warner

AtStaff, Inc., Durham, North Carolina Michael Williams

The Abaris Group, Walnut Creek, California

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Preface

Over the last 100 years, quality of life and human longevity have improved in most of the industrialized world as a result of advances in human health. We have benefited from reduced exposure to disease (through such measures as vaccinations and improved water quality), and developed treatments that reduce the consequences of disease once exposed.

Nevertheless, humans continue to suffer because they do not have access to appropriate healthcare, or because healthcare is delivered in a manner that is confusing or inefficient. The gap between the science and the practice of healthcare is large.

This book is dedicated to improving healthcare through reducing the delays experienced by patients. One aspect of this goal is to improve the flow of patients, so that they do not experience unnecessary waits as they flow through a healthcare system. Another aspect is ensuring that services are closely synchronized with patterns of patient demand. Still another aspect is ensuring that ancillary services, such as housekeeping and transportation, are fully coordinate with direct patient care. Past experience shows that effective management of healthcare delays can produce dramatic improvements in medical outcomes, patient satisfaction, and access to service, while also reducing the cost of healthcare.

Within the 15 chapters of this book, readers will be exposed to a set of

techniques and strategies that can be used by clinicians and administrators to

substantially reduce delays in healthcare delivery. This is the first book to

have reduction in patient delay as its sole focus, and this book provides the

foundation by which hospitals can implement change. Reflecting the highly

interdisciplinary nature of this book, the chapters have been written by

doctors, nurses, industrial engineers, system engineers and geographers.

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xii PATIENT FLOWS: REDUCING DELAYS IN HEALTHCARE DELIVERY

These perspectives provide the comprehensive view needed to address the problem of patient delay.

The book begins in Chapters 1 to 4 by examining healthcare as an integrated system. Chapters 1 and 2 provide hands-on methods for developing process models, using these models to identify and remove bottienecks, and developing facility plans. Chapter 3 examines medical outcomes that result from waits for surgeries. Chapter 4 presents a set of breakthrough strategies that use real-time monitoring systems for continuous improvement.

Chapters 5 to 11 present techniques and methods that can be immediately implemented to improve healthcare operations. Chapter 5 focuses on the patient appointment system, particularly through the approach of advanced access, which makes appointments more immediately available to patients.

Chapter 6 concentrates on management of waiting lists for surgeries and the allocation of available capacity to meet patient demands. Chapter 7 offers techniques for scheduling staff to match patterns in patient demand, and thus reducing predictable delays. The literature on simulation modeling, which is widely used for both healthcare design and process improvement, is surveyed in Chapter 8. Chapter 9 provides methods for forecasting demand for healthcare on a region-wide basis. Last in this group. Chapter 10 presents queueing theory as a general method for modeling waits in healthcare.

The last section of the book concentrates on achieving change. Chapter 11 focuses on the rapid delivery of medication in the event of a catastrophic event, such as a pandemic on terrorist attack. Chapter 12 provides a diagnostic for assessing the state of a hospital and using the state assessment to select improvement strategies. Chapter 13 demonstrates the importance of optimizing care as patients transition from one care setting to the next with an emphasis on clinical outcomes and the business case. Chapter 14 shows how to evaluate the overall portfolio of patient diagnostic groups to guide system changes. Lastiy, Chapter 15 provides project management tools to guide the execution of patient flow projects.