Reducing 'Patient Turnaround Time' at an Emergency Department

"Patient Turnaround Time" (or PTAT) is the time that elapses between the arrival and discharge of patients from the Emergency Department (ED). Minimization of the 'patient turnaround time' has several advantages, namely, faster service to patients, improved customer satisfaction and higher potential to generate revenue for the hospital. The goal of this research endeavor was to minimize the PTAT at one of the prominent EDs in Broome County, which is located within the Wilson Memorial Regional Medical Center (WMRMC).

Industrial Engineering concepts and methods were used to streamline key activities and develop new strategies intended to maximize the efficiency of the ED. This involved the use of quantitative and qualitative techniques to identify means for more efficient utilization of space, time, and resources without compromising the quality of patient care. Computer simulation models representing the ED were developed in order to evaluate the various 'what-if' scenarios. The recommendations provided to the ED could result in saving 10-30% of the time from the overall PTAT. Consequently, the ED would have the capacity to treat more than 10% additional patients per year. Further, the proposed recommendations based on this study would neither require additional capital investment nor an increase in the number of personnel.

Subsequent to the above study, another effort to further reduce the PTAT was initiated. The objective of this research effort was to assess the impact of the Rapid Care (Fast Track) strategy on the PTAT and the wait time for bed allocation. Simulation was used to explore different options for the implementation of Rapid Care strategy. The 'best scenario' was then implemented at the ED area. Statistical analysis was conducted to quantify the impact of Rapid Care on PTAT and the wait time for bed allocation. The reduction in PTAT was observed to be approximately 15%, and the wait time for the bed allocation decreased by approximately 38%, which were identical to the results from the simulation study. Consequently, the ED would have the capacity to serve an estimated 3000 additional patients per year. It was observed that Rapid Care appeared to be an effective methodology to provide care to the patients with less severe ailments. Larger reductions in the PTATs and wait times are expected once the system operations reach a steady state.

Enhancing the Utilization of Multiple Suites of Operating Rooms

Operating rooms (ORs) are a major source of revenue for hospitals. They also account for a proportionate share of the expenses incurred by the hospitals. ORs in a hospital are at the convergence of numerous complex processes and high cost labor. The 'optimum' utilization of the available resources in ORs is critical; therefore, the efficient scheduling of ORs assumes prominence. This research endeavor comprised of a detailed investigation and development of solutions to maximize the utilization of ORs at two hospitals, Wilson Memorial Regional Medical Center (WMRMC) and Binghamton General Hospital (BGH), Binghamton, NY. Concurrently, maintenance/improvement of the customer satisfaction was also a focus.

The principal objective of this research endeavor was (i) to investigate the issues that relate to the effective utilization of the OR suites at two hospitals and (ii) enhance the utilization of the OR suites, without any negative impact on the current surgical practices and emergency scheduling practices. Before modifying a system, a thorough understanding should be garnered to identify the factors that affect the objective. Detailed process mapping of the two OR suites was conducted and a baseline of the two OR suites was developed. Data from the existing hospital database was validated through observations and statistical tests. Simulation models were developed incorporating an 'optimal' level of granularity and detail to accurately reflect the existing scenarios. After verification and validation of the simulation models, alternative schedules that were developed through brainstorming sessions with the concerned experts were modeled. These alternative schedules were judged through predetermined performance measures.

A phased implementation plan for the gradual incorporation of the 'best alternative' schedules was presented to the hospitals. The proposed solutions would double the utilization of the ORs while concurrently making available at least 50 hours of operating time per week for additional surgeries. In conclusion, the implementation of the proposed solutions would offer substantial cost benefits in terms of time savings and additional opportunities.

The Impact of the Implementation of the Picture Archiving and Communication System (PACS) at Radiology Services

Ancillary departments, which include radiology services, are among the important factors that affect the efficiency of patient care in a hospital. Recently, healthcare organizations have been increasingly implementing systems that record and store the medical information of patients, such as radiology images and reports, in digital formats. The intent of such systems is to minimize the inefficiencies associated with the traditional film-based methodology. This transition is expected to improve the speed and quality of clinical care by enabling real-time availability of imaging data from various locations. However, several other organization-wide changes are required to be implemented in order to truly harvest the benefits from the digital systems.

This research focused on identifying appropriate modifications to the existing workflow at the radiology services of Wilson Memorial Regional Medical Center (WMRMC) while transitioning from a film-based image archiving system to a digital system. The ultimate goal was to maximize patient throughput and minimize report generation time in the radiology department. Process mapping and time study were used to identify the original flow of operations. Various quantitative techniques were considered in order to solve the problem under consideration. Simulation was used as a proactive tool to evaluate the different scenarios that were expected to 'optimize' the response variables, namely the patient throughput and the report generation time.

An initial study analyzed the modifications to the workflow prior to the implementation of a mini Picture Archiving and Communication System (PACS) at the Computed Tomography (CT) scan suite. This 'pilot' study used simulation to present and validate several other key suggestions, including the increase of the number of radiologists onsite that read CT scan images, the reallocation of machine resources, and the addition of a patient holding area. The proposed modifications would reduce report generation times by approximately 60% and increase in patient throughput by up to 40%.

Following the success of the above research effort, the PACS initiative was expanded to include the ultrasound, vascular lab, nuclear medicine, general radiology and diagnostic imaging modalities. Using a similar simulation-based approach, the impact on patient throughput and report generation times were again studied. Significant improvements were observed, and many alternative scenarios were analyzed - ranging from modified technologist schedules to the dedication of a resident cardiologist for stress tests at nuclear medicine.

Strategic Considerations for the Implementation of a Forms Management System

Most organizations are in the process of transitioning to a system by which their documents are filed and managed electronically, a deviation from the traditional strategies. Businesses have realized that historical filing systems are not affordable, as their competitors embrace the future. Numerous research efforts have shown that electronic document management frees time, office space and increases an organization's efficiency, if implemented appropriately.

Hospitals are a prime example for the implementation of an electronic document management system. Healthcare providers have seen an exponential growth in the number of patients served. As a result, the storage of documents was an increasing problem. The resources required for initiating, maintaining, tracking, and retrieving medical records has become a significant overhead expense as well. In addition, there was an increasing demand by administrators, physicians, nurses and billing clerks to have patient data at their fingertips. This calls for transferring the patients' medical records to an electronic imaging system.

Wilson Memorial Regional Medical Center (WMRMC) is in the process of implementing a system-wide forms management system. The objective of this research is to assist the Health Information Management (HIM) team for the efficient and effective implementation of the forms management system. The responsibilities include developing a review tool for the successful selection of vendors and helping to develop an implementation plan. This research would focus on using the Industrial Engineering tools such as workflow analysis and simulation modeling to analyze the current processes to identify the potential improvements.

Use of Simulation Modeling in Planning of an Ambulatory Surgery Center

Ambulatory Surgery is one of the fastest growing areas in the healthcare industry. Over four thousand Ambulatory Surgery Centers (ASCs) are in currently operation across the United States, and the number is estimated to be growing at 7.1% per year. An ASC is a facility where surgeries are performed which do not require inpatient admission. Typically, patients arrive to the ASC facility on the same day of the surgery and then are discharged after their recovery. With the introduction of ASCs, hospitals have experienced an increasing shift of cases from the Hospital Outpatient Department (HOPD) to the 'Freestanding' ASC. The United Health Services Hospitals (UHSHs) are involved in a joint venture with a local group of surgeons to implement an ASC at Binghamton General Hospital. This venture would help the hospital to avoid losing cases to any other prospective freestanding ASC in the community.

The objective of this research is to aid in the implementation of the ASC. The initial focus would be to estimate the demand for ambulatory surgery in the community. Simulation modeling would subsequently be used to determine the number of resources required to efficiently and effectively operate the new center. The various clinical pathways and administrative workflows would be developed. Industrial Engineering tools such as simulation modeling, process mapping and artificial intelligence (using neural networks) will be employed to achieve the objective.