André Baumgart

Using Computer Simulation in Operating Room Management: Impacts on Process Engineering and Performance

Operating rooms are regarded as the most costly hospital facilities. Due to rising costs and decreasing reimbursements, it is necessary to optimize the efficiency of the operating room suite. In this context several strategies have been proposed that optimize patient throughput by redesigning perioperative processes. The successful deployment of effective practices for continuous process improvements in operating rooms can require that operating room management sets targets and monitors improvements throughout all phases of process engineering. Simulation can be used to study the effects of process improvements through novel facilities, technologies and/or strategies. In this paper, we propose a conceptual framework to use computer simulations in different stages of business process management (BPM) lifecycle for operating room management. Additionally, we conduct simulation studies in different stages of the BPM lifecycle. The results of our studies provide evidence that simulation can provide effective decision support to drive performance in operating rooms in several phases of the BPM lifecycle

Status quo and current trends of operating room management in Germany.

Purpose of review Ongoing healthcare reforms in Germany have required strenuous efforts to adapt hospital and operating room organizations to the needs of patients, new technological developments, and social and economic demands. This review addresses the major developments in German operating room management research and current practice. Recent findings The introduction of the diagnosis-related group system in 2003 has changed the incentive structure of German hospitals to redesign their operating room units. The role of operating room managers has been gradually changing in hospitals in response to the change in the reimbursement system. Operating room managers are today specifically qualified and increasingly externally hired staff. They are more and more empowered with authority to plan and control operating rooms as profit centers. For measuring performance, common perioperative performance indicators are still scarcely implemented in German hospitals. In 2008, a concerted time glossary was established to enable consistent monitoring of operating room performance with generally accepted process indicators. These key performance indicators are a consistent way to make a procedure or case – and also the effectiveness of the operating room management – more transparent. Summary In the presence of increasing financial pressure, a hospitals executives need to empower an independent operating room management function to achieve the hospitals economic goals. Operating room managers need to adopt evidence-based methods also from other scientific fields, for example management science and information technology, to further sustain operating room performance.

How work context affects operating room processes: using data mining and computer simulation to analyze facility and process design.

The complexity of the operating room (OR) requires that both structural (eg, department layout) and behavioral (eg, staff interactions) patterns of work be considered when developing quality improvement strategies. In our study, we investigated how these contextual factors influence outpatient OR processes and the quality of care delivered. The study setting was a German university-affiliated hospital performing approximately 6000 outpatient surgeries annually. During the 3-year-study period, the hospital significantly changed its outpatient OR facility layout from a decentralized (ie, ORs in adjacent areas of the building) to a centralized (ie, ORs in immediate vicinity of each other) design. To study the impact of the facility change on OR processes, we used a mixed methods approach, including process analysis, process modeling, and social network analysis of staff interactions. The change in facility layout was seen to influence OR processes in ways that could substantially affect patient outcomes. For example, we found a potential for more errors during handovers in the new centralized design due to greater interdependency between tasks and staff. Utilization of the mixed methods approach in our analysis, as compared with that of a single assessment method, enabled a deeper understanding of the OR work context and its influence on outpatient OR processes.

Comparing different holonomic mobile robots

This paper presents a comparison between three different holonomic mobile robots. The first has three caster wheels with wheel angular velocities actuation and carries the name C3P. The second is omni-directional wheeled mobile robot and the third is a special holonomic robot configuration developed by ETH named Ramsis II. Inverse kinematic and forward dynamic models are presented for each robot for the simulation process. The simulation results illustrate the performance of each robot in comparison to the others. The comparison is done with respect to three main aspects; 1) the mobility, 2)the total energy consumed by each robot in a finite interval of time, and 3) the hardware complexity. A cost functional is obtained to demonstrate the comparison, and a criteria is developed to measure the hardware complexity of each robot. The weight sum method enables the cost functional to show the importance of each aspect and to distinguish between the lowest cost platform with respect to each aspect importance.

An extended Petri net for modeling workflow with critical sections

This work presents an extended workflow Petri net which synchronizes activity flow in the critical sections of the process. A critical section is a non empty set of tasks that cannot serve more than one activity at a time. The structure of the proposed net is introduced and a theorem is proposed and proved for the properties of separability and serializability. A fully detailed model for the operation theater in a hospital is presented using the proposed theoretical structure to control concurrency between activities in the critical sections

Separate Medication Preparation Rooms Reduce Interruptions and Medication Errors in the Hospital Setting: A Prospective Observational Study

BACKGROUND Interruptions and errors during the medication process are common, but published literature shows no evidence supporting whether separate medication rooms are an effective single intervention in reducing interruptions and errors during medication preparation in hospitals. We tested the hypothesis that the rate of interruptions and reported medication errors would decrease as a result of the introduction of separate medication rooms. AIM Our aim was to evaluate the effect of separate medication rooms on interruptions during medication preparation and on self-reported medication error rates. METHODS We performed a preintervention and postintervention study using direct structured observation of nurses during medication preparation and daily structured medication error self-reporting of nurses by questionnaires in 2 wards at a major teaching hospital in Switzerland. RESULTS A volunteer sample of 42 nurses was observed preparing 1498 medications for 366 patients over 17 hours preintervention and postintervention on both wards. During 122 days, nurses completed 694 reporting sheets containing 208 medication errors. After the introduction of the separate medication room, the mean interruption rate decreased significantly from 51.8 to 30 interruptions per hour (P < 0.01), and the interruption-free preparation time increased significantly from 1.4 to 2.5 minutes (P < 0.05). Overall, the mean medication error rate per day was also significantly reduced after implementation of the separate medication room from 1.3 to 0.9 errors per day (P < 0.05). CONCLUSIONS The present study showed the positive effect of a hospital-based intervention; after the introduction of the separate medication room, the interruption and medication error rates decreased significantly.

Mobile semantic data exchange in ad hoc networks using distributed profiles

Collecting relevant information from a heterogeneous set of data resources is a challenging problem. Moreover, the storage and search for semantic data is even more complex in mobile environments. In this paper we present an approach how to collect semantic information by underlying profile settings. We define several profile types and levels where the users interests are stored. Information retrieval is then executed according to the profile settings. Distributed profiles for mobile semantic data exchange can personalize the exchanged information in business settings. This leads to effective data transmission with regard to the mobile (device) context and the business environment, the user is exposed to. Our realization of a prototype confirms the effective semantic data exchange. The evaluation of dynamic profile settings in ad hoc network scenarios verifies our approach experimentally.

A Profile-Based Peer-to-Peer RSS Information Distribution

Really simple syndication (RSS) is an XML dialect that is widely used to distribute personalized information. From the users perspective, RSS seems to be the ideal news reader technology because the RSS feeds notifies the user of information updates. In this paper we propose a profile-based peer-to-peer RSS information distribution for mobile devices using RSS feeds. We show how peers connect with each other and explain the mapping of user keywords with existing RSS feeds on other peers effectively. We have implemented a prototypical application and introduce the most important features

Robust flexible real-time monitoring of workflow processes

Business processes show unpredictable and unstable behavior. This requires workflow systems to support monitoring functions with the ability to flexibly and robustly adapt to the changing activities of the workflow at runtime. In this paper flexible distributed realtime workflow monitoring is realized by a layered architecture. The architecture consists of: (1) middleware components supporting real-time and fault-tolerant monitoring and (2) different controllers for controlling workflows and performance data, view models for the specification of the graphical user interface and quality of service (QoS) requirements. A software system was implemented as a client-server application in Java using real-time and fault-tolerant CORBA middleware components. The prototype shows that the separation of process models, data models and view models can lead to flexible monitoring of workflows in real-time and thus guarantees robust and valuable information about business processes at runtime.

Towards flexible distributed real-time monitoring and managing of workflows

The unpredictability of business processes requires workflow systems to support monitoring functions with the ability to flexibly adapt to the changing environment, in which the activities of the workflow are distributed and the status of the process has to be presented in real-time fashion. In this context flexibility refers to the following main requirements: (a) adaptation to changes of the different dimensions of the workflow (process flows, resources and specific cases) (b) context awareness of the monitoring systems such that the graphical user interface displays information depending on the situation of the different workflow entities. Previous approaches to workflow monitoring focused on automated routing, distributed monitoring or various repetitive requests to the workflow system. These approaches did neither consider real-time data exchange from user interface clients to the server nor the separation of the process logic from the representational logic of the graphical user interface. In this paper flexible distributed real-time workflow monitoring is realized by: (1) middleware components supporting real-time monitoring; (2) different controllers for controlling workflows definitions, the specification of the graphical user interface and the data that is managed by the user interfaces. The prototypical software system was implemented as a client-server application in Java using a real-time CORBA middleware component. The server component manages the registration of the user interface clients and controls the data exchange with the workflow management system. The definition of the user interface view, the process data and the managed data is stored in XML files and transferred as XML streams between the software components. The prototypical implementation shows that the separation of process models, data models and view models can lead to flexible monitoring and managing of workflows in real-time and thus guarantee valuable information of business processes at runtime