Matching Items (6)
- All Subjects: Industrial Engineering
- All Subjects: Hospitals
Harm during hospitalizations for heart failure: adverse events as a reliability measure of hospital policies and procedures
For more than twenty years, clinical researchers have been publishing data regarding incidence and risk of adverse events (AEs) incurred during hospitalizations. Hospitals have standard operating policies and procedures (SOPP) to protect patients from AE. The AE specifics (rates, SOPP failures, timing and risk factors) during heart failure (HF) hospitalizations are unknown. There were 1,722 patients discharged with a primary diagnosis of HF from an academic hospital between January 2005 and December 2007. Three hundred eighty-one patients experienced 566 AEs, classified into four categories: medication (43.9%), infection (18.9%), patient care (26.3%), or procedural (10.9%). Three distinct analyses were performed: 1) patient's perspective of SOPP reliability including cumulative distribution and hazard functions of time to AEs; 2) Cox proportional hazards model to determine independent patient-specific risk factors for AEs; and 3) hospital administration's perspective of SOPP reliability through three years of the study including cumulative distribution and hazard functions of time between AEs and moving range statistical process control (SPC) charts for days between failures of each type. This is the first study, to our knowledge, to consider reliability of SOPP from both the patient's and hospital administration's perspective. AE rates in hospitalized patients are similar to other recently published reports and did not improve during the study period. Operations research methodologies will be necessary to improve reliability of care delivered to hospitalized patients.
The development of a validated clinically meaningful endpoint for the evaluation of tear film stability as a measure of ocular surface protection for use in the diagnosis and evaluation of dry eye disease
This dissertation presents methods for the evaluation of ocular surface protection during natural blink function. The evaluation of ocular surface protection is especially important in the diagnosis of dry eye and the evaluation of dry eye severity in clinical trials. Dry eye is a highly prevalent disease affecting vast numbers (between 11% and 22%) of an aging population. There is only one approved therapy with limited efficacy, which results in a huge unmet need. The reason so few drugs have reached approval is a lack of a recognized therapeutic pathway with reproducible endpoints. While the interplay between blink function and ocular surface protection has long been recognized, all currently used evaluation techniques have addressed blink function in isolation from tear film stability, the gold standard of which is Tear Film Break-Up Time (TFBUT). In the first part of this research a manual technique of calculating ocular surface protection during natural blink function through the use of video analysis is developed and evaluated for it's ability to differentiate between dry eye and normal subjects, the results are compared with that of TFBUT. In the second part of this research the technique is improved in precision and automated through the use of video analysis algorithms. This software, called the OPI 2.0 System, is evaluated for accuracy and precision, and comparisons are made between the OPI 2.0 System and other currently recognized dry eye diagnostic techniques (e.g. TFBUT). In the third part of this research the OPI 2.0 System is deployed for use in the evaluation of subjects before, immediately after and 30 minutes after exposure to a controlled adverse environment (CAE), once again the results are compared and contrasted against commonly used dry eye endpoints. The results demonstrate that the evaluation of ocular surface protection using the OPI 2.0 System offers superior accuracy to the current standard, TFBUT.
Surgical instrument reprocessing in a hospital setting analyzed with statistical process control and data mining techniques
In a healthcare setting, the Sterile Processing Department (SPD) provides ancillary services to the Operating Room (OR), Emergency Room, Labor & Delivery, and off-site clinics. SPD's function is to reprocess reusable surgical instruments and return them to their home departments. The management of surgical instruments and medical devices can impact patient safety and hospital revenue. Any time instrumentation or devices are not available or are not fit for use, patient safety and revenue can be negatively impacted. One step of the instrument reprocessing cycle is sterilization. Steam sterilization is the sterilization method used for the majority of surgical instruments and is preferred to immediate use steam sterilization (IUSS) because terminally sterilized items can be stored until needed. IUSS Items must be used promptly and cannot be stored for later use. IUSS is intended for emergency situations and not as regular course of action. Unfortunately, IUSS is used to compensate for inadequate inventory levels, scheduling conflicts, and miscommunications. If IUSS is viewed as an adverse event, then monitoring IUSS incidences can help healthcare organizations meet patient safety goals and financial goals along with aiding in process improvement efforts. This work recommends statistical process control methods to IUSS incidents and illustrates the use of control charts for IUSS occurrences through a case study and analysis of the control charts for data from a health care provider. Furthermore, this work considers the application of data mining methods to IUSS occurrences and presents a representative example of data mining to the IUSS occurrences. This extends the application of statistical process control and data mining in healthcare applications.
An analytical approach to lean six sigma deployment strategies: project identification and prioritization
The ever-changing economic landscape has forced many companies to re-examine their supply chains. Global resourcing and outsourcing of processes has been a strategy many organizations have adopted to reduce cost and to increase their global footprint. This has, however, resulted in increased process complexity and reduced customer satisfaction. In order to meet and exceed customer expectations, many companies are forced to improve quality and on-time delivery, and have looked towards Lean Six Sigma as an approach to enable process improvement. The Lean Six Sigma literature is rich in deployment strategies; however, there is a general lack of a mathematical approach to deploy Lean Six Sigma in a global enterprise. This includes both project identification and prioritization. The research presented here is two-fold. Firstly, a process characterization framework is presented to evaluate processes based on eight characteristics. An unsupervised learning technique, using clustering algorithms, is then utilized to group processes that are Lean Six Sigma conducive. The approach helps Lean Six Sigma deployment champions to identify key areas within the business to focus a Lean Six Sigma deployment. A case study is presented and 33% of the processes were found to be Lean Six Sigma conducive. Secondly, having identified parts of the business that are lean Six Sigma conducive, the next steps are to formulate and prioritize a portfolio of projects. Very often the deployment champion is faced with the decision of selecting a portfolio of Lean Six Sigma projects that meet multiple objectives which could include: maximizing productivity, customer satisfaction or return on investment, while meeting certain budgetary constraints. A multi-period 0-1 knapsack problem is presented that maximizes the expected net savings of the Lean Six Sigma portfolio over the life cycle of the deployment. Finally, a case study is presented that demonstrates the application of the model in a large multinational company. Traditionally, Lean Six Sigma found its roots in manufacturing. The research presented in this dissertation also emphasizes the applicability of the methodology to the non-manufacturing space. Additionally, a comparison is conducted between manufacturing and non-manufacturing processes to highlight the challenges in deploying the methodology in both spaces.
Buildings (approximately half commercial and half residential) consume over 70% of the electricity among all the consumption units in the United States. Buildings are also responsible for approximately 40% of CO2 emissions, which is more than any other industry sectors. As a result, the initiative smart building which aims to not only manage electrical consumption in an efficient way but also reduce the damaging effect of greenhouse gases on the environment has been launched. Another important technology being promoted by government agencies is the smart grid which manages energy usage across a wide range of buildings in an effort to reduce cost and increase reliability and transparency. As a great amount of efforts have been devoted to these two initiatives by either exploring the smart grid designs or developing technologies for smart buildings, the research studying how the smart buildings and smart grid coordinate thus more efficiently use the energy is currently lacking. In this dissertation, a "system-of-system" approach is employed to develop an integrated building model which consists a number of buildings (building cluster) interacting with smart grid. The buildings can function as both energy consumption unit as well as energy generation/storage unit. Memetic Algorithm (MA) and Particle Swarm Optimization (PSO) based decision framework are developed for building operation decisions. In addition, Particle Filter (PF) is explored as a mean for fusing online sensor and meter data so adaptive decision could be made in responding to dynamic environment. The dissertation is divided into three inter-connected research components. First, an integrated building energy model including building consumption, storage, generation sub-systems for the building cluster is developed. Then a bi-level Memetic Algorithm (MA) based decentralized decision framework is developed to identify the Pareto optimal operation strategies for the building cluster. The Pareto solutions not only enable multiple dimensional tradeoff analysis, but also provide valuable insight for determining pricing mechanisms and power grid capacity. Secondly, a multi-objective PSO based decision framework is developed to reduce the computational effort of the MA based decision framework without scarifying accuracy. With the improved performance, the decision time scale could be refined to make it capable for hourly operation decisions. Finally, by integrating the multi-objective PSO based decision framework with PF, an adaptive framework is developed for adaptive operation decisions for smart building cluster. The adaptive framework not only enables me to develop a high fidelity decision model but also enables the building cluster to respond to the dynamics and uncertainties inherent in the system.
The current Enterprise Requirements and Acquisition Model (ERAM), a discrete event simulation of the major tasks and decisions within the DoD acquisition system, identifies several what-if intervention strategies to improve program completion time. However, processes that contribute to the program acquisition completion time were not explicitly identified in the simulation study. This research seeks to determine the acquisition processes that contribute significantly to total simulated program time in the acquisition system for all programs reaching Milestone C. Specifically, this research examines the effect of increased scope management, technology maturity, and decreased variation and mean process times in post-Design Readiness Review contractor activities by performing additional simulation analyses. Potential policies are formulated from the results to further improve program acquisition completion time.