using information and technology in the measurement.pptVIP

Using information and technology in the measurement and evaluation … of healthcare processes? ? Michael W. Carter Health Care Resource Modelling Group Mechanical and Industrial Engineering University of Toronto e-mail: carter@mie.utoronto.ca Outline Brief intro to Operations Research A few applications: ED Simulation Cardiac Bed Planning Strategic Planning I.S. vs O.R. vs Statistical Analysis Brief Intro to O.R. Started during WWII in UK Quantitative analysis: math, physics, stats Canadians involved from the start Optimisation in Health Care Two main criteria: Minimize Cost per visit/episode? average annual cost? Maximize Quality for the particular episode? quality of life? Have you ever counted them? Nuclear Medicine at William Ostler Endocrinology at the Cleveland Clinc Medical Imaging at a large hospital OR Scheduling Delays Downtown acute care hospital OR suite Address issues causing delays in turnaround ORSOS data: two main factors lack of recovery room beds cleaners unavailable “Simple” solution Hospital Patient Simulation 1989: Nursing Crisis in Ontario Ont. Min. of Health Five Hospitals Linda O’Brien-Pallas Linda McGillis-Hall (Nursing) plus John Blake (IE Dalhousie) 1995: Efficient Use of Resources! “What if?” Simulation tool However, some of the results were “simple” Data Challenges The CIHI discharge report - a mixed blessing Takes two years to get reliable data! Multiple surgeries Stakeholder buy-in and politics CHEO: Emergency Room Children’s Hospital of Eastern Ontario: Ottawa 1993 Paediatric Teaching Hospital 50,000 patient visits per year in the ER CHEO: Waiting Times (1993) CHEO: Emergency Room 20 % of patients wait over two hours Eleven suggestions by staff Simulation used to evaluate scenarios Fast track clinic New Casualty Officer Staggered start times Data Challenges We had high level data (arrival time, prelim diagnosis, ED LOS, triage level, disposition, etc.) We had zero data about the processes or durations … hard to collect data i