simulation modeling of pre and post procedure beds …€¦ · purpose of modeling • identify...
TRANSCRIPT
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SIMULATION MODELING OF PRE AND POST PROCEDURE BEDS FOR THE INTERVENTIONAL
PLATFORM SSM SAINT LOUIS UNIVERSITY HOSPITAL
Frank Zilm,D.Arch, FAIA, FACHA Chester Dean Director of the Institute for Health and Wellness Design The University of Kansas
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Presentation Agenda
• Overview of Interventional Platform • Visioning future process • Development of model • Output/evaluation • Questions
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SSM St. Louis University Hospital Renewal Project
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Planning Approach
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Traditional Model
Patient Waiting/
Prep
Inpatient Hold
O.R.’s
Patient Waiting/Prep/
Recovery
Endoscopy
Staff Work areas/
Support
Staff Support
O.R.’s O.R.’s
O.R.’s O.R.’s O.R.’s
O.R.’s
O.R.’s
Recovery/ Phase II
Central Sterile
Admin/ Lockers
Surgery Suite
Intervent. Imaging
Staff Support
Patient Wait./Prep/
Rec.
Cath/EP
Staff Support
Patient Wait./Prep/
Rec.
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Interventional Suite
Patient/Family Waiting
Inpatient Hold
Intervent. Room
Endoscopy
Staff Work areas/
Support
Cath/EP
O.R.’s O.R.’s O.R.’s
O.R.’s
O.R.’s
Recovery/ Prep
Phase II/Phase III
Admin/ Lockers
Surgery Suite
O.R.’s
O.R.’s
Future Growth
Central Sterile
Intervent. Room
O.R.’s
O.R.’s
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Second Floor Composite Plan
University Medical Center at Princeton
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Space Program
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SSM St. Louis University Hospital Renewal Project
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Interventional Platform Concept
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Purpose of Modeling
• Identify proposed patient flows for services using the Interventional Platform (IP)
• Estimate bed requirements based on simulation models of proposed demand and flow. Components include:
• PACU • Prep/Phase II • Phase III (recliner area) • Short stay (<23 hour observation)
• Test the sensitivity of the model results to key operational assumptions
• Recommend adjustments, if needed, to the IP space program
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George Box, Professor Emeritus, University of Wisconsin
“Essentially all models are wrong, but some are useful”
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Process
• Meetings with staff from affected services to explain project goals and data needs.
• Development of anticipated flow steps for major patient types.
• Established prototype schedule for patients. • Modeling of proposed system. • Testing of sensitivity of model results. • Review with staff. • Recommendations of adjustments to space program.
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Examples of patient flows
• 18 types of patient procedures were identified for surgery, cardiology, interventional radiology and endoscopy.
Example of patient flow diagrams
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Prototype schedules • Prototype schedules were developed for each patient
group
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Prototype schedules
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The Model
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Model Development • Arrivals and patient flow for each group were translated
into a Simul8 model.
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Model Development
• As a patient moves through the Interventional Platform requests are made for the type of beds needed.
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Model Development
• Variability was built into most steps in patient process. Normal or uniform distributions were typical distributions
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Model Development
• Total demand by all patients for each type of bed was recorded.
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Initial Results
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Initial Results
Prep/Phase II PACU Phase III Short Stay
Current Program 56 20 16 10
Model Max Estimate 40 11 14 16
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Key Model Issues/Questions
• Model assumes no holding in IP for inpatient bed availability
• Prep/Phase II assumes complete sharing of beds, no holding of beds by a service line
• Current model assumes most inpatients are held in prep area prior to procedure rather than PACU
• Mix of surgery patients has six rooms used by long case time procedures, reducing peak demand on PACU beds
• Only 30% of short duration surgery patients are routed to PACU
• Turn around times for bed space are assumed in patient LOS
• Does this reflect worst case demand?
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70% of Surgery Short Cases to PACU
Prep/Phase II PACU Phase III Short Stay
Current Program 56 20 16 10
Model Max Estimate 41 13 13 16
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70% of Surgery Short & All Long Cases to PACU
Prep/Phase II PACU Phase III Short Stay
Current Program 56 20 16 10
Model Max Estimate 41 14 13 16
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Add 5 minutes for clean up/turn
Prep/Phase II PACU Phase III Short Stay
Current Program 56 20 16 10
Model Max Estimate 44 12 13 14
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Recommendations
• Shift 6 beds from Prep/Phase II beds to short stay, shell 6 Prep beds. (44 initial Prep/Phase II rooms, 16 Short Stay)
• Shell 4 beds in PACU for future growth or adjustments for final operational strategies. (16 initial PACU beds, 4 shell)
• Reduce Phase III to 14 stations
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