Elia Eleni G, Ge Shirley, Bergersen Lisa, Thiagarajan Ravi R, Thornton Jason, Sleeper Lynn A, Fynn-Thompson Francis, Mathieu Derek, Alexander Peta M A
Department of Cardiology, Boston Children's Hospital, Boston, MA, United States.
Department of Pediatrics, Harvard Medical School, Boston, MA, United States.
Front Health Serv. 2022 Feb 10;1:787358. doi: 10.3389/frhs.2021.787358. eCollection 2021.
Elective surgeries are primarily scheduled according to surgeon availability with less consideration of patients' postoperative cardiac intensive care unit (CICU) length of stay. Furthermore, the CICU census can exhibit a high rate of variation in which the CICU is operating at over-capacity, resulting in admission delays and cancellations; or under-capacity, resulting in underutilized labor and overhead expenditures.
To identify strategies to reduce variation in CICU occupancy levels and avoid late patient surgery cancellation.
Monte Carlo simulation study of the daily and weekly CICU census at Boston Children's Hospital Heart Center. Data on all surgical admissions to and discharges from the CICU at Boston Children's Hospital between September 1, 2009 and November 2019 were included to obtain the distribution of length of stay for the simulation study. The available data allows us to model realistic length of stay samples that include short and extended lengths of stay.
Annual number of patient surgical cancellations and change in average daily census.
We demonstrate that the models of strategic scheduling would result in up to 57% reduction in patient surgical cancellations, increase the historically low Monday census and decrease the historically higher late-mid-week (Wednesday and Thursday) censuses in our center.
Use of strategic scheduling may improve surgical capacity and reduce the number of annual cancellations. The reduction of peaks and valleys in the weekly census corresponds to a reduction of underutilization and overutilization of the system.
择期手术主要根据外科医生的可用时间安排，较少考虑患者术后在心脏重症监护病房（CICU）的住院时长。此外，CICU的每日住院人数可能会出现很大波动，导致CICU处于超容量运行状态，造成入院延迟和手术取消；或者处于容量不足状态，导致劳动力和间接费用未得到充分利用。
确定减少CICU占用水平波动并避免患者手术延迟取消的策略。
对波士顿儿童医院心脏中心CICU的每日和每周住院人数进行蒙特卡洛模拟研究。纳入了2009年9月1日至2019年11月期间波士顿儿童医院CICU所有手术入院和出院的数据，以获取模拟研究的住院时长分布。现有数据使我们能够对包括短期和长期住院时长的实际住院时长样本进行建模。
患者手术取消的年度数量以及平均每日住院人数的变化。
我们证明，战略排班模型将使患者手术取消数量最多减少57%，提高我们中心历来较低的周一住院人数，并降低历来较高的周中晚些时候（周三和周四）的住院人数。
采用战略排班可能会提高手术能力并减少年度取消手术的数量。每周住院人数的峰谷减少对应着系统未充分利用和过度利用情况的减少。
