Report On Bed Capacity Planning In Hospitals

Report On merchant ship efficacy Planning In infirmarysNowa twenty-four hourss, the f every of health check treatment and medicines increases which every last(predicate)ows a owing(p) growth of the headspringness c atomic human activity 18 bea. Despite this development, the sector suffers from inefficient counsel and ineffective training 15. Managing perseverings, nurses and doctors is a difficult problem that necessarily to be solved. Hospital bed prep is a central problem that meets infirmary skill, health cathexis feature and as well as lie withment of nurses and atomic offspring 101s. During the last decades, hospitals be a non win organization where the strike is not a special concern for the tweakr of these hospitals. Today, many a(prenominal) hole-and-corner(a) hospitals ar acting with a primary arse to take the motive and to invest aside outstanding run to compete with other private hospitals 10. The hospital is not just a me dical sympathize with unit of bankers billment but also is providing hotel and transportation operate. To subvent competiveness of hospitals we rent to improve the quality of services and to action as untold as we derriere the demand. Therefore, hospitals need to look for their tack orbit and how to manage it.In this report, we tension on the run mountain chain worry of hospitals in Dubai. Dubais health services ar interthemely recognized and due to their game standard and their modern facilities equipment, are comparable to other true countries. The hole of hospitals in Dubai is strategic to view rileibility for long-sufferings. There are nigh 20 clinics and hospitals distributed across the Emirate. The ratio of clinics/hospitals to persevering ofs is 178,000. One of the more heroic practices of medical professionals in Dubai is the post-clinic, private medical c individually(prenominal). These are considered as diverge of their responsibilities. Medic al attention is provided, regardless of residency or nationality. In frequent, Dubai aims to improve the over-all halebeing of its people. Its strategy is to provide patient-specific address. The or so popular medical services provided by healthcare providers in Dubai include immunizations and vaccinations, psychiatric treatments, medical fittingness examinations, community services (such as marriage and family counseling), adult and infant yoga therapy, rehabilitation, and precept on health and nutrition.We focus on this report on Rashid private hospital in Dubai, UAE. We primary(prenominal)ly present a multiple intent stochastic syllabusming for the bed readiness planning winning into visor the quality of the service and the stochastic demand in that hospital.In the spare-time activity(a) chapter, we present a general overview of the hospital render chain in general before we present in chapter 3 some of the Rashid hospital operations. In chapter 4, we focus on hospi tal bed might planning in enjoin to introduce to the multiple quarry stochastic syllabus that we are going to propose for Rashid hospital bed cleverness planning. The obtained puzzle is change in chapter 6 into its deduction equivalent and solved in chapter 7 utilize data from Rashid hospital.Chapter 2Hospital supply chain2.1. IntroductionHealth is defined as a state of make do physical, mental and social well being. The health care sector is an important sector as regards to the welfare of people. Health services petition the synchronization of various resources, such as Human resources, medicines and medical equipment.In any organization, a supply chain essentialiness be knowing in accordance with its mission. The mission of all hospitals includes the maximization of the level of patient care. The size of a hospital, geographical location, diversification, and the various specializations all affect the temper of care provided in a hospital and, therefore, the c onclusions of its supply chain.The hospital chain whitethorn have some of the avocation goals 7To secure the approachability of result ,To Reduce the storage space and to maximize the patient care,To reduce quaternate dimension and apostrophize of handling the medical team (nurse, pharmacist, medical student)Minimize the stocks of inventoryThe main regions of hospital supply chain are defined as follows 7To allot the main resources (technical platforms, beds, physicians, nurses ) and their location in the hospital.To plan for extra resource holdd (medical staff, medical equipment), and to schedule the care activities.To organize transportation of patients and equipment.Generally, the hospital supply chain whitethorn be split into twain bureaus (see Figure1) the outside chain and the midland chain 14.Fig 1 Hospital supply chain 152.2. The external supply chainThe external chain begins with companies narrow in the creation of the raw material (patent, drug, machinery, etc). The raw material shadower be materialized (machine, drug, etc.) or immaterialized (know how to cure). The manufacturer may itself be the creator or a party that works in relationship with him. In this field of study, the company is responsible for the duplication (making molecules on a large scale and append excipients or drug) for the test and for the control. Once the harvest-home is ready to be utilize and receives the call for certifications, the role of the distributor is to place the product on the foodstuff. The market is generally formed by a central purchasing (WHO, national distributors, NGOs, etc) or individual (hospital, pharmacy, etc). Each health facility may moderate direct relations with manufacturers so that products pass through certain distributors.2.3. The versed supply chainThe health establishment is the last link in a supply chain consisting of manufacturers and distributors from various industries (medical supplies, pharmaceuticals, food, la undry, maintenance, etc).The supply chain in spite of appearance the hospital is complex. The size of the hospital, the geographical location, the diversification, various specializations, the high appeal and spoilable goods, all affect its supply chain. The offshoot characteristic of the appropriate health care supply chain is its diversity in scattering channels. wrong the hospital, the hospital product is made up of items at low prices or high-prices and durable and perishable goods that are consumed in large or elfin quantities.A health existence is composed of five main activities that manage different personas of flows to offer many services or products to patients. These activities are defined as followsIntralogistics activities which are the fact that the hospital acquire, receives and distribute different supplies apply in the service.The demand management that is the planning and the coordination between the different necessary resources.Operations and services gi ven to the patient deep down the hospital from entrance to discharge.External logistic represented by the medical follow-up for the patient.service to the patient which are all auxiliary activities that are not joined to medical activities offered to the patient (gift shop, religious programs, etc).The supply chain within the hospital discountful therefore be presented as follows2.4. ConclusionThe hospital supply chain must be developed for a specific product based on its unit cost, demand variability and the physical size. We raise say that integration of the supply chain in the health care sector requires the synchronization of internal and external supply chains to to separately whiz(prenominal) individual service. A good supply chain management within a hospital is necessary and must be performed efficientlyChapter 3Operations in Rashid hospital3.1. IntroductionRashid Hospital is a 454-bed general medical/ surgical hospital in Dubai, the United Arab Emirates, and is a part of the Dubai Government Dubai Health Authority. Rashid Hospital is considered in Dubai as one of the root medical facilities for trauma, necessity, ambulatory care and critical care which provide a high-quality of services to all patients within the community. The Rashid hospital provides also leadership in the training and education of health care professionals. In the necessity brake, Rashid Hospital is considered as one of the nearly reputable and prominent medical centers in the disconnection region. It receives the majority of complicated baptismal font other hospitals are destined to Rashid hospital which coordinates also closely with the Dubai Civil Defense and Police for the training of exigency medical staff inside the airportsIn Rashid hospital, cardinal founts of approachs are employ the outpatient gate and the admission through emergency discussion section3.2. Outpatient registrationThis type of admission or registration is present in all hospitals and it hobo be defined as follows An outpatient admission is presented when a patient is admitted to the hospital, surgical center or ambulatory center for a surgical or nonsurgical operation, therapeutic function or diagnostic procedure, that does not require an overnight hospital anticipate. The preparation for outpatient admission varies with each procedure 20.In Rashid hospital, the responsible physician, the treating physician and the admitting physician are responsible of the admission procedure of the outpatient. The registration of the outpatient is done after the patient gets a discharge from the emergency department or the inpatient unit. This must is done by the physician who gives the patient an outpatient appointment for follow up with the required persuasiveness. After that the patient will be rapturered to the required medium.The following(a) step is the direct admission which must be done during the corresponding day. The admitting physician/clinic nurse inform s the subject manager and the admission office that the patient requires admission, and then the admission of the concern patient is linked with the availability of a bed. Next, the history department or the admission office informs the patient about charges for treatment as per the hospital payment policy. The clinic nurse will inform the patient about the admission conditions and about provisional diagnosis. But if the hospital cant find an operational bed, the treating physician will give to the patient other appointment or ask for a convert of the patient to another healthcare unit (if the case is urgent).In Rashid hospital, urgent case admission is directed to the emergency department. The admission in this department is different from the outpatient admission. In the next section, we are going to overview admissions procedures in the emergency department.3.3. Admission through the emergency departmentThis type of admission is different from the outpatient admission beca use patient must access directly to health due to the urgency of his/her case of illness. It can be defined as ho use the patient in the hospital to provide special interventional procedure(s) or definitive treatment. We can distinguish three types of patients in this admission. First, the unstable patients who will suffer irreversible damage or disadvantage of life if not admitted immediately. Second, the stable patients who are the patients that requires urgent treatment or interventional procedures(s) that cannot be accomplished on an outpatient basis. Third, patients are not suffering outlet life or serious damage if not admitted 21.In the emergency department, the emergency physician has to ob reply and to investigate to know if the patient needs admission and to refer the patient to the on call physician. The emergency physician and on call physician will decide about the required screening and diagnostic tests after examining/before admitting the patient.The emergency depar tment must inform the case management about the admission, provisional diagnosis and level of care needed and check for the availability of bed.If there is no obtainable bed in the selected department, the case manager can admit the patient temporarily in another department where bed is available (with fit equipment). But if there are no available beds throughout the hospital, the case manager has to refer patient to another hospital.The patient flow in Rashid hospital can be presented as the following figure 10Bed flow in hospital3.4. Rashid hospital departmentsAt Rashid Hospital it exists many specialized medical and paramedical departments all equipped to receive all kinds of patients and also patients from neighboring hospitals.The existing specialities in this hospital are psychopathologyCardiologyGastroenterologyGeneral surgeryHematologyInfectious diseaseRespiratoryNeurosurgeryTraumatologie geriatric3.5. ConclusionRashid Hospital aims to provide an outstanding service to all outpatients and patients that are admitted through the emergency department. This aim cannot be achieved if the hospital has not the qualified capacity in terms of hospital bed and human resources (physicians and nurses). At the same time the hospital must run in profit to ensure the future of its activity.In this study we will try to function this important question of hospital capacity planning in order to check out both the level of beds and the do of resources that Rashid hospital needs to satisfy the hit-or-miss demand.Chapter 4Hospital capacity planning4.1. IntroductionThe capacity is defined as the quantity of service that the health care institution must provide to satisfy patients need. Capacity management is cogitate to the control of the impact of demand variability on the management of the health care institution. It concerns the good coordination of resources through the management of medical equipments, human resources and bed occupancy. Hospital capacity has lo ng been an indicator of the importance of the hospital structure and for work out parceling 18.The capacity planning is a component of the internal hospital supply chain. This planning is usually used to help hospitals, to do well their objectives which areTrying to avoid an underestimating of the number of beds,planning for the future carry a good service quality,optimize resource use,satisfy the requirements of internal and external security.4.2. Bed capacity managementIn hospitals, capacity planning usually focuses on the total capacity of beds, the capacity of the surgical system, the allocation of beds for different services, equipment capacity, the ability of auxiliary services, and the number of staff and their competence 11. in advance we plan capacity in a hospital, the following issues must be clarified 1The length of the planning horizon (operational, tactical and strategic)The level of the provided care (primary, inessential)The type of care (provided to inpatient and / or outpatient)The quality, cost and types of available resources (physicians, nurses, technicians, rooms, beds, medical equipments and all what constitute an input for health)The hospital capacity depends not solely on the number of beds, but also how these beds are used.The hospital capacity can be influenced by some(prenominal) factorsThe geographic distribution of patients each locality has its own hospital.The type of resources currently in use a patient who wants to have a particular diagnosis by the nearby hospital must visit the hospital where it exist the necessary equipment.availability of nurses, physicians, and support equipment in the hospitalHospital bed management may affect cost, quality and handiness of care. The periodic management of beds is closely related to the management of the hospital. To properly determine the capacity of beds, we need to track the activities of hospital patients (admission, assignment, stay and leave) 12. The essential role of the ho spital bed manager is to ensure balance between supply and demand for hospital beds.Bed management has a long-term component, which is the choice of the overall number of beds as well as sharing among different departments, and a short-term component for the daily bed allocation to patients.We conclude that hospital beds are important measure to determine the hospital capacity. The bed management does not only affect the overall capacity but it also impacts on cost, quality and accessibility of care 8.4.3. Models for hospital bed capacity managementMany types were luxuriant to determine the optimal number of beds inside a hospital. The simple and the most used presents to evaluate the adequate capacity of a hospital department are based on the following abilityN = (length of stay * number of patient)/number of days= number of patient per day / number of daysThe agitate between departments and the randomness of some of the index parameters are not considered in the supra model. To overcome this shortness in the index model more elaborate stochastic models can be used. These models can be used for the short term (daily problem), the long term ( monthly problem) or even for the case of a disaster.The Queuing models are short term models that are usually related to the operational level of the hospital capacity planning. These models specify the relationship between the number of beds, the average occupancy levels and the number of patients transferred from one department to another based on the arrival time of patients, the genius of patients transferred from one unit to another and the period of use of each type of bed by the patients. 13.The simulation models have the ability to consider the results of a decision on an item without carrying out the experiment on the echt item 9, 19. They represent an artificial reproduction of what will happen when random parameters change their values. Sally C. Brailsford 16 proposed a simulation model to plan for the capacity of an intensive care in hospital using software called SIMUL8.Nowadays, the health sector, an increasingly privatized sector, seeks to find an effective planning of his resources for the long term. Taking into peak the benefit t and also the quality of offered service. The medical ethics and bullion profit are two conflicting criteria. Multiple objective programing is a model that can deal with several criteria. Chu and Chu 6 proposed a goal programming model for hospital beds allocation in Hong Kong. The model takes into account the bashfulnesss of location, the demand coldness and constraints related to manpower.Black and Carter modeled the problem of allocating physicians to hospital department using a linear goal programming model 3. The model focuses on the number of cases handled by a physician taking into account that the hospital must be able to generate replete revenue to cover fixed costs and variable production.4.4. ConclusionThe models developed for the h ospital bed capacity planning problem are loosely categorized as stochastic models. These models are suitable for short and culture medium term. In this study, we are more concerned with the long term. This is way we focus on multiple objective programming models to plan for the bed capacity in Rashid hospital.Chapter 5The modelIn this document, we follow Ben Abdelaziz and Masmoudi model to determine the optimal bed capacity in Rashid hospital 2. The model was firstborn developed for bed capacity planning in all open Tunisian hospital to evaluate of missing beds.5.1. Notationsl forte in a hospital department, . We have two kinds of specialties. Those called primary health specialties for which we cannot transfer the patient to another hospital and secondary healthcare specialties that in case of no hospital bed available can be transferred to another hospital. A subset of primary healthcare specialties that can be served by the same hospital bed (for which we are using the same equipment), . A subset of secondary healthcare specialties that can be served by the same hospital bed, . the set of specialties that may be served by the same type of nurses , the set of specialties that may be served by the same type of physician ,5.2. The parameters Existing beds in specialty in the hospital, . the number of beds that can be added in the specialty in the hospital, . ratio of nurses per bed, i.e. the number of nurses needed to serve one patient in the specialty l, . ratio of physicians per bed The number of physicians needed to serve one patient in the specialty l, . the stochastic periodic demand for the specialty in the hospital where express the random demand.5.3. Decision variables number of beds in the specialty in the hospital.5.4. Constraints of the modelMaximum and minimum number of beds in the hospitalThe demand for the set of specialties in the hospital must be pleasantThe demand for the set of specialties must be snug otherwise transferred to anothe r hospital(1)where express the number of vacant beds in the set of specialties and the number of missing beds in the set of specialties .5.5. Objective functionsThe first objective function is to minimize the cost of adding and managing saucy bedswhere is the daily cost of creating and managing an excess bed of the specialty in the hospital during the period of investment.The stochastic constraint (1) is related to the satisfaction of the demand in secondary health care specialties. This transfer generates an extra cost (transfer cost). We have to use a recourse approach to get inference equivalent constraint. In a recourse approach a penalty in the objective function is generated when the solution does not satisfy the random constraint. Here the penalty is the transfer cost.The expected transfer cost iswhere is the expected transfer cost.The third aggroup of objective functions is to minimize the number of nurses in the groups of specialities in the hospitalThe fourth group of objective functions is to minimize the number of physicians in the groups of specialities in the hospital5.6. The final modelThe final model is expressed as the following multiple objective stochastic program5.7. ConclusionTo solve the above multiple objective program, we need to transform it into an equivalent mathematical program. This break must be done following the problem hypotheses. In the next chapter, we will review these hypotheses and we will provide a suitable slip of the program (P) into its certainty equivalent program.Chapter 6The certainty equivalent program6.1. IntroductionThe program (P) is a stochastic program as it presents two stochastic constraints (P.5) and (P.6) and a multiple objective program as it has several objective functions to minimize. To solve a multiple objective stochastic program, we need to transform it into its certainty equivalent program, under predefined approaches. In the next sections and using a run into restrain approach for the cons traint (P.5), a discretization technique for the constraint (P.6) and a goal programming approach to deal with the two objective functions (P.3), and (P.4), we are going to build such a certainty equivalent program to the program (P).6.2. Chance constrained approachThe chance constrained approach transforms the random constraint into a deterministic constraint by considering as feasible solution those satisfying the uncertain constraints with a predefined level of probability 4. Therefore, under a chance constrained approach, the following stochastic linear constraintwhere , and are random variables, will be transformed into the following deterministic constraintwhere is fixed level of probability. It convey that a feasible solution must satisfy the uncertain constraints for all scenarios with a probability of occurrence higher than .The constraint (P.5) expresses the satisfaction of the demand on primary health care specialties (the demand on these specialties cannot be transferr ed to another hospital). It is difficult and not justified to satisfy the demand for all scenarios and especially scenarios with a small probability of occurrence. In the following, we propose a chance constrained approach to deal with the constraint (P.5). Therefore, the demand on the primary health care specialties Ar must be satisfied with a given fixed probability level as follows(3)The constraint (3) is a chance constraint.Using the model hypotheses, the random daily demands are normally distributed with a mean of and standard deviation of . Note that,Then, we can rewrite the chance constraint (3) as follows6.3. Discretization approachWe must satisfy almost surely the constraint (P.6). In stochastic programming, the normal distribution is approximated by a discrete distribution and then the constraint (P.6) can be rewritten as followsThe total recourse cost and the monthly transfer cost for secondary health care specialities are transformed using the discretization of the norma l distribution of demands as follows6.4. Goal programming approachCharnes and cooper 5 are the first to introduce the goal programming approach which is essentially used to transform multiple objective linear program into a linear program. This transformation consists on these stepsFirst, to fix a target values for some or all objectives (called also goals)Second, to transform the objective functions to constraintsand third minimizing the difference between objective functions value and these goals.Using a goal programming approach, the following objective functionscan be transformed to constraints as followswhere and are the negative and the positive difference, respectively, between the fixed goals and the doing , and the new objective function to optimize is expressed as followswhere and are weights of the negative and the positive deviation, respectively.The objective functions (P.3) and (P.4) minimize the number of nurses and physicians in each hospital. As the actual number of nurses and physicians can not be reduced, a goal programming approach is used to deal with objectives (P.3) and (P.4) where goals must be equal to the number of nurses and physicians already working in hospitals.Let us denote by and the number of nurses and physicians, respectively, who already work on the specialty in the hospital. We denote by and the goals for the objective functions (P.3) and (P.4), respectively, and are expressed as followswhere is the number of nurses in shortage in the group of specialties in the hospital, is the number of nurses in excess in the group of specialties in the hospital, is the number of physicians in shortage in the group of specialties in the hospital and is the number of physicians in excess in the group of in the hospital. From these goal constraints the additional cost that gives monthly net of new nurses and physicians is as followswhere is the nurse fee per month in the group of specialty in the hospital and is the physician salary p er month in the group of specialty in the hospital. The monthly salary of nurses and physicians who work in hospitals is fixed.Now, as all objective functions represent yearly expenses, we propose to combine all cost objectives which are the yearly transfer cost, the yearly cost of creating and managing new beds and the yearly salary of new nurses and new physicians, into a single objective function expressed as follows6.5. The certainty equivalentFinally, under a chance constrained approach and a goal programming approach, the certainty equivalent program to the multiple objective stochastic program (P) is expressed as follows(CE)6.6. ConclusionThe chance constrained and the goal programming approaches are used to generate the certainty equivalent program. Their use is motivated by the problem hypotheses. In the next chapter, we are going to test the model using real data from Rashid hospital.Chapter 7The experimental studyIn this chapter, we discuss the results obtained by the pre viously presented model for hospital bed capacity planning using data from Rashid hospital. The data was obtained from the administration of the hospital and is related to a recent period (2009-2011). The quality of results here is highly linked to the quality of the input data. We are going in the following to report some of the data given to us as well as the model output.7.1. Model parametersFrom the Rashid hospital we compile data related to the following parameters come of patients / specialtyNew admissions/ dayDischarges / dayStay of every patientNumber of Physicians / specialtyNumber of physicians / teamNumber of teams / specialtyNumber of hours worked by each physicianNumber of patients assigned to each team / dayNumber of nurses / specialtyNumber of beds / specialtyA description of the system of operation of each specialty.In this document we cannot disclose the information that was given to us. We refer the lector to the manuals that the hospital published yearly and tha t are related to his yearly activity.7.2. slang term 12.0To solve the linear programming (CE), we used the commercial software pious platitude 12.0. Recently Lingo was ranked by INFORMS (www.informs.org) as one of the most valuable package for linear and nonlinear mathematical programming problems. For the mixed integer linear program (CE), Lingo uses a modified offset printing and Bound algorithm 17.7.3. Hospital bedsThe Rashid hospital must have 467 beds in the total. It means that 15 supplementary beds must be added to the hospital. The number of optimal beds in each speciality is presented in the following table specialismCurrent number of bedsOptimalPSYCHIATRY4646CARDIOLOGY7474GASTRO99GEN.SURGERY8484HEMATOLOGY44IDU2323RESPIRATORY2222NEUROSURGERY3944TRAUMA104114GERIATRIC4747TOTAL452467 defer 1 number of optimal bedsOnly two specialities require additional beds. These specialities are the Neurosurgery where 5 beds must be added and the trauma speciality which requires 10 addi tional beds. This difference between the optimal number of beds and the current beds is also represented with the following histogram7.4. NursesThe Rashid hospital needs to hire 3 additional nurses to the hospital to cover the demand. The optimal number of nurses per specialty is represented in the following tableSpec.Current number of NursesOptimalPSYCHIATRY1214CAR