Predicting the Future: Using Simulation Modeling to Forecast Patient Flow on General Medicine Units
Predicting the Future: Using Simulation Modeling to Forecast Patient Flow on General Medicine Units
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预测未来：使用仿真模型预测普通医学科室的患者流量
DOI：
10.12788/jhm.3081
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发表时间：
2019
影响因子：
2.6
通讯作者：
A. Dow
中科院分区：
文献类型：
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作者：
Vimal K Mishra;S. Tu;J. Heim;H. Masters;Lindsey Hall;Ralph R Clark;A. Dow
背景医院是复杂的适应性系统，其中多个组件，如患者，从业者，设施和技术相互作用。需要一种仔细的方法来优化这个复杂的系统，因为任何变化都可能导致意想不到的有害影响。其中一种方法是离散事件模拟，在这种情况下，假设情景允许研究人员预测拟议的变化对系统的影响。然而，研究说明应用模拟在优化普通内科（GIM）团队住院手术是缺乏的。方法利用住院和出院的管理数据、时间运动研究的数据和专家对工作流程的意见构建仿真模型。然后，四个变化的影响-调整医疗团队与护理单位，增加一个住院医生团队，增加一个护理单位，并增加了护理单位和住院医生团队更高的入院量-对关键医院运营指标进行建模。结果：将医疗团队与护理单位相结合改善了团队指标，但将患者转移到不一致的团队。增加一个住院医生团队没有什么好处，但增加一个护理单位改善了系统指标。增加一个住院医生团队和一个护理单位都需要保持业务指标与增加的病人数量。结论：使用模拟模型，我们提供了四种可能的战略变化对GIM住院单位，供应商和患者吞吐量的影响数据。这种分析可能是一种值得的投资，可以用来研究战略决策，并做出更好的选择，减少意外后果。
BACKGROUND Hospitals are complex adaptive systems within which multiple components such as patients, practitioners, facilities, and technology interact. A careful approach to optimization of this complex system is needed because any change can result in unexpected deleterious effects. One such approach is discrete event simulation, in which what-if scenarios allow researchers to predict the impact of a proposed change on the system. However, studies illustrating the application of simulation in optimization of general internal medicine (GIM) team inpatient operations are lacking. METHODS Administrative data about admissions and discharges, data from a time-motion study, and expert opinion on workflow were used to construct the simulation model. Then, the impact of four changes – aligning medical teams with nursing units, adding a hospitalist team, adding a nursing unit, and adding both a nursing unit and hospitalist team with higher admission volume – were modeled on key hospital operational metrics. RESULTS Aligning medical teams with nursing units improved team metrics for aligned teams but shifted patients to unaligned teams. Adding a hospitalist team had little benefit, but adding a nursing unit improved system metrics. Both adding a hospitalist team and a nursing unit would be required to maintain operational metrics with increased patient volume. CONCLUSION Using simulation modeling, we provided data on the implications of four possible strategic changes on GIM inpatient units, providers, and patient throughput. Such analyses may be a worthwhile investment to study strategic decisions and make better choices with fewer unintended consequences.
DOI：
10.1089/tmj.2009.0148
发表时间：
2010-06-01
期刊：
TELEMEDICINE JOURNAL AND E-HEALTH
影响因子：
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作者：
Cady, Rhonda;Finkelstein, Stanley;Harrington, Kathleen
通讯作者：
Harrington, Kathleen