Matching Items (4)
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- All Subjects: Health Care Management
- Creators: Wu, Teresa
Description
Overcrowding of Emergency Departments (EDs) put the safety of patients at risk. Decision makers implement Ambulance Diversion (AD) as a way to relieve congestion and ensure timely treatment delivery. However, ineffective design of AD policies reduces the accessibility to emergency care and adverse events may arise. The objective of this dissertation is to propose methods to design and analyze effective AD policies that consider performance measures that are related to patient safety. First, a simulation-based methodology is proposed to evaluate the mean performance and variability of single-factor AD policies in a single hospital environment considering the trade-off between average waiting time and percentage of time spent on diversion. Regression equations are proposed to obtain parameters of AD policies that yield desired performance level. The results suggest that policies based on the total number of patients waiting are more consistent and provide a high precision in predicting policy performance. Then, a Markov Decision Process model is proposed to obtain the optimal AD policy assuming that information to start treatment in a neighboring hospital is available. The model is designed to minimize the average tardiness per patient in the long run. Tardiness is defined as the time that patients have to wait beyond a safety time threshold to start receiving treatment. Theoretical and computational analyses show that there exists an optimal policy that is of threshold type, and diversion can be a good alternative to decrease tardiness when ambulance patients cause excessive congestion in the ED. Furthermore, implementation of AD policies in a simulation model that accounts for several relaxations of the assumptions suggests that the model provides consistent policies under multiple scenarios. Finally, a genetic algorithm is combined with simulation to design effective policies for multiple hospitals simultaneously. The model has the objective of minimizing the time that patients spend in non-value added activities, including transportation, waiting and boarding in the ED. Moreover, the AD policies are combined with simple ambulance destination policies to create ambulance flow control mechanisms. Results show that effective ambulance management can significantly reduce the time that patients have to wait to receive appropriate level of care.
ContributorsRamirez Nafarrate, Adrian (Author) / Fowler, John W. (Thesis advisor) / Wu, Teresa (Thesis advisor) / Gel, Esma S. (Committee member) / Limon, Jorge (Committee member) / Arizona State University (Publisher)
Created2011
Description
Optimization of surgical operations is a challenging managerial problem for surgical suite directors. This dissertation presents modeling and solution techniques for operating room (OR) planning and scheduling problems. First, several sequencing and patient appointment time setting heuristics are proposed for scheduling an Outpatient Procedure Center. A discrete event simulation model is used to evaluate how scheduling heuristics perform with respect to the competing criteria of expected patient waiting time and expected surgical suite overtime for a single day compared to current practice. Next, a bi-criteria Genetic Algorithm is used to determine if better solutions can be obtained for this single day scheduling problem. The efficacy of the bi-criteria Genetic Algorithm, when surgeries are allowed to be moved to other days, is investigated. Numerical experiments based on real data from a large health care provider are presented. The analysis provides insight into the best scheduling heuristics, and the tradeoff between patient and health care provider based criteria. Second, a multi-stage stochastic mixed integer programming formulation for the allocation of surgeries to ORs over a finite planning horizon is studied. The demand for surgery and surgical duration are random variables. The objective is to minimize two competing criteria: expected surgery cancellations and OR overtime. A decomposition method, Progressive Hedging, is implemented to find near optimal surgery plans. Finally, properties of the model are discussed and methods are proposed to improve the performance of the algorithm based on the special structure of the model. It is found simple rules can improve schedules used in practice. Sequencing surgeries from the longest to shortest mean duration causes high expected overtime, and should be avoided, while sequencing from the shortest to longest mean duration performed quite well in our experiments. Expending greater computational effort with more sophisticated optimization methods does not lead to substantial improvements. However, controlling daily procedure mix may achieve substantial improvements in performance. A novel stochastic programming model for a dynamic surgery planning problem is proposed in the dissertation. The efficacy of the progressive hedging algorithm is investigated. It is found there is a significant correlation between the performance of the algorithm and type and number of scenario bundles in a problem instance. The computational time spent to solve scenario subproblems is among the most significant factors that impact the performance of the algorithm. The quality of the solutions can be improved by detecting and preventing cyclical behaviors.
ContributorsGul, Serhat (Author) / Fowler, John W. (Thesis advisor) / Denton, Brian T. (Thesis advisor) / Wu, Teresa (Committee member) / Zhang, Muhong (Committee member) / Arizona State University (Publisher)
Created2010
Description
Surgery is one of the most important functions in a hospital with respect to operational cost, patient flow, and resource utilization. Planning and scheduling the Operating Room (OR) is important for hospitals to improve efficiency and achieve high quality of service. At the same time, it is a complex task due to the conflicting objectives and the uncertain nature of surgeries. In this dissertation, three different methodologies are developed to address OR planning and scheduling problem. First, a simulation-based framework is constructed to analyze the factors that affect the utilization of a catheterization lab and provide decision support for improving the efficiency of operations in a hospital with different priorities of patients. Both operational costs and patient satisfaction metrics are considered. Detailed parametric analysis is performed to provide generic recommendations. Overall it is found the 75th percentile of process duration is always on the efficient frontier and is a good compromise of both objectives. Next, the general OR planning and scheduling problem is formulated with a mixed integer program. The objectives include reducing staff overtime, OR idle time and patient waiting time, as well as satisfying surgeon preferences and regulating patient flow from OR to the Post Anesthesia Care Unit (PACU). Exact solutions are obtained using real data. Heuristics and a random keys genetic algorithm (RKGA) are used in the scheduling phase and compared with the optimal solutions. Interacting effects between planning and scheduling are also investigated. Lastly, a multi-objective simulation optimization approach is developed, which relaxes the deterministic assumption in the second study by integrating an optimization module of a RKGA implementation of the Non-dominated Sorting Genetic Algorithm II (NSGA-II) to search for Pareto optimal solutions, and a simulation module to evaluate the performance of a given schedule. It is experimentally shown to be an effective technique for finding Pareto optimal solutions.
ContributorsLi, Qing (Author) / Fowler, John W (Thesis advisor) / Mohan, Srimathy (Thesis advisor) / Gopalakrishnan, Mohan (Committee member) / Askin, Ronald G. (Committee member) / Wu, Teresa (Committee member) / Arizona State University (Publisher)
Created2010
Description
The use of Red Blood Cells (RBCs) is a pillar of modern health care. Annually, the lives of hundreds of thousands of patients are saved through ready access to safe, fresh, blood-type compatible RBCs. Worldwide, hospitals have the common goal to better utilize available blood units by maximizing patients served and reducing blood wastage. Managing blood is challenging because blood is perishable, its supply is stochastic and its demand pattern is highly uncertain. Additionally, RBCs are typed and patient compatibility is required.
This research focuses on improving blood inventory management at the hospital level. It explores the importance of hospital characteristics, such as demand rate and blood-type distribution in supply and demand, for improving RBC inventory management. Available inventory models make simplifying assumptions; they tend to be general and do not utilize available data that could improve blood delivery. This dissertation develops useful and realistic models that incorporate data characterizing the hospital inventory position, distribution of blood types of donors and the population being served.
The dissertation contributions can be grouped into three areas. First, simulations are used to characterize the benefits of demand forecasting. In addition to forecast accuracy, it shows that characteristics such as forecast horizon, the age of replenishment units, and the percentage of demand that is forecastable influence the benefits resulting from demand variability reduction.
Second, it develops Markov decision models for improved allocation policies under emergency conditions, where only the units on the shelf are available for dispensing. In this situation the RBC perishability has no impact due to the short timeline for decision making. Improved location-specific policies are demonstrated via simulation models for two emergency event types: mass casualty events and pandemic influenza.
Third, improved allocation policies under normal conditions are found using Markov decision models that incorporate temporal dynamics. In this case, hospitals receive replenishment and units age and outdate. The models are solved using Approximate Dynamic Programming with model-free approximate policy iteration, using machine learning algorithms to approximate value or policy functions. These are the first stock- and age-dependent allocation policies that engage substitution between blood type groups to improve inventory performance.
This research focuses on improving blood inventory management at the hospital level. It explores the importance of hospital characteristics, such as demand rate and blood-type distribution in supply and demand, for improving RBC inventory management. Available inventory models make simplifying assumptions; they tend to be general and do not utilize available data that could improve blood delivery. This dissertation develops useful and realistic models that incorporate data characterizing the hospital inventory position, distribution of blood types of donors and the population being served.
The dissertation contributions can be grouped into three areas. First, simulations are used to characterize the benefits of demand forecasting. In addition to forecast accuracy, it shows that characteristics such as forecast horizon, the age of replenishment units, and the percentage of demand that is forecastable influence the benefits resulting from demand variability reduction.
Second, it develops Markov decision models for improved allocation policies under emergency conditions, where only the units on the shelf are available for dispensing. In this situation the RBC perishability has no impact due to the short timeline for decision making. Improved location-specific policies are demonstrated via simulation models for two emergency event types: mass casualty events and pandemic influenza.
Third, improved allocation policies under normal conditions are found using Markov decision models that incorporate temporal dynamics. In this case, hospitals receive replenishment and units age and outdate. The models are solved using Approximate Dynamic Programming with model-free approximate policy iteration, using machine learning algorithms to approximate value or policy functions. These are the first stock- and age-dependent allocation policies that engage substitution between blood type groups to improve inventory performance.
ContributorsDumkrieger, Gina (Author) / Mirchandani, Pitu B. (Thesis advisor) / Fowler, John (Committee member) / Wu, Teresa (Committee member) / Ju, Feng (Committee member) / Arizona State University (Publisher)
Created2020