Standardizing admission and discharge processes to improve patient flow: A cross sectional study

Background: The aim of this study was to evaluate how hospital capacity was managed focusing on standardizing the admission and discharge processes. Methods: This study was set in a 900-bed university affiliated hospital of the National Health Service, near Barcelona (Spain). This is a cross-sectional study of a set of interventions which were gradually implemented between April and December 2008. Mainly, they were focused on standardizing the admission and discharge processes to improve patient flow. Primary administrative data was obtained from the 2007 and 2009 Hospital Database. Main outcome measures were median length of stay, percentage of planned discharges, number of surgery cancellations and median number of delayed emergency admissions at 8:00 am. For statistical bivariate analysis, we used a Chi-squared for linear trend for qualitative variables and a Wilcoxon signed ranks test and a Mann–Whitney test for non-normal continuous variables. Results: The median patients’ global length of stay was 8.56 days in 2007 and 7.93 days in 2009 (p<0.051). The percentage of patients admitted the same day as surgery increased from 64.87% in 2007 to 86.01% in 2009 (p<0.05). The number of cancelled interventions due to lack of beds was 216 patients in 2007 and 42 patients in 2009. The median number of planned discharges went from 43.05% in 2007 to 86.01% in 2009 (p<0.01). The median number of emergency patients waiting for an in-hospital bed at 8:00 am was 5 patients in 2007 and 3 patients in 2009 (p<0.01). Conclusions: In conclusion, standardization of admission and discharge processes are largely in our control. There is a significant opportunity to create important benefits for increasing bed capacity and hospital throughput.

Aplicació del Value Stream Map (VSM) en un sistema de producció de feltres insonoritzants per a l'automòbil

Actualment en el sector industrial, les organitzacions tenen el repte d'optimitzar els seus sistemes productius per a millorar en quant a preu, qualitat i nivell de servei i poder adaptar-se a les exigències dels clients (excel·lència productiva). El present anàlisi, es basa en l'optimització d'una cadena de producció de feltres insonoritzants per a l'automòbil a través de l'eliminació de les pèrdues existents (operacions que no aporten valor afegit al producte final). Per dur-ho a terme, la metodologia emprada és el Value Stream Map (VSM). El VSM és una tècnica desenvolupada sota el model de gestió de la producció Lean Manufacturing, molt visual i entenedora, permet visualitzar i entendre l'estat actual d'un procés. Aquesta, abarca a tota la organització, i te per objectiu recolzar-la en el procés de redisseny dels seus entorns productius per assolir un estat futur millor que possibiliti obtenir resultats en un periode curt de temps. L'objectiu principal de l'estudi, és aplicar l'eina VSM com a mètode per a l'eliminació de les mudes o malbarataments que impedeix la consecució d'una cadena Lean amb el cas concret d'un sistema productiu de feltres insonoritzants. En la primera part del projecte s'introdueix al lector en la teoria del pensament Lean (quins principis té i quins són els objectius) com a marc teòric. Aquí es detalla el procediment, així com les característiques per a la correcta elaboració del VSM actual, per al seu corresponent anàlisi i per a la seva representació del estat futur. En una segona part del projecte, s'exposen les etapes que constitueixen la cadena de producció d'estudi i es duu a terme l'elaboració del Value Stream Map, on es posen de manifest les ineficiències del flux que conformen la línia de producció. Per últim s'analitzen els fluxes, s'identifiquen les pèrdues de la cadena, i a partir d'aquests, es dissenyen i es proposen projectes i accions que permitin establir línies d'actuació per a un millor estat futur. L'estudi ha permés demostrar la validesa del VSM com a eina per a facilitar la consecució i assoliment de millores en la productivitat, competitivitat i rendibilitat dels diferents processos de l'organització en la línia de fabricació de feltres insonoritzats.

Aplicación de la metodología “policy deployment” planificación estratégica a un departamento de suministro de materiales para aerogeneradores para reducir inventarios

Debido a la necesidad de diferenciarse y hacer frente a la competencia, las empresas han apostado por desarrollar operaciones que den valor al cliente, por eso muchas de ellas han visto en las herramientas lean la oportunidad para mejorar sus operaciones. Esta mejora implica la reducción de dinero, personas, equipos grandes, inventario y espacio, con dos objetivos: eliminar despilfarro y reducir la variabilidad. Para conseguir los objetivos estratégicos de la empresa es imprescindible qué éstos estén alineados con los planes de la gerencia a nivel medio y a su vez con el trabajo realizado por los empleados para asegurar que cada persona está alineada en la misma dirección y al mismo tiempo. Ésta es la filosofía de la planificación estratégica. Por ello uno de los objetivos de este proyecto será el desarrollar una herramienta que facilite la exposición de los objetivos de la empresa y la comunicación de los mismos a todos los niveles de la organización para a partir de ellos y tomando como referencia la necesidad de reducir inventarios en la cadena de suministro se realizará un estudio de la producción de un componente de control del aerogenerador para conseguir nivelarla y reducir su inventario de producto terminado. Los objetivos particulares en este apartado serán reducir el inventario en un 28%, nivelar la producción reduciendo la variabilidad del 31% al 24%, mantener un stock máximo de 24 unidades garantizando el suministro ante una demanda variable, incrementar la rotación del inventario en un 10% y establecer un plan de acción para reducir el lead time entre un 40-50%. Todo ello será posible gracias a la realización del mapa de valor presente y futuro para eliminar desperdicios y crear un flujo continuo y el cálculo de un supermercado que mantenga el stock en un nivel óptimo.

Evaluación y optimización de los servicios de un taller de mantenimiento mediante el software de simulación ARENA

Debido a la necesidad de diferenciarse y hacer frente a la competencia, las empresas han apostado por desarrollar operaciones que den valor al cliente, por eso muchas de ellas han visto en las herramientas lean la oportunidad para mejorar sus operaciones. Esta mejora implica la reducción de dinero, personas, equipos grandes, inventario y espacio, con dos objetivos: eliminar despilfarro y reducir la variabilidad. Para conseguir los objetivos estratégicos de la empresa es imprescindible qué éstos estén alineados con los planes de la gerencia a nivel medio y a su vez con el trabajo realizado por los empleados para asegurar que cada persona está alineada en la misma dirección y al mismo tiempo. Ésta es la filosofía de la planificación estratégica. Por ello uno de los objetivos de este proyecto será el desarrollar una herramienta que facilite la exposición de los objetivos de la empresa y la comunicación de los mismos a todos los niveles de la organización para a partir de ellos y tomando como referencia la necesidad de reducir inventarios en la cadena de suministro se realizará un estudio de la producción de un componente de control del aerogenerador para conseguir nivelarla y reducir su inventario de producto terminado. Los objetivos particulares en este apartado serán reducir el inventario en un 28%, nivelar la producción reduciendo la variabilidad del 31% al 24%, mantener un stock máximo de 24 unidades garantizando el suministro ante una demanda variable, incrementar la rotación del inventario en un 10% y establecer un plan de acción para reducir el lead time entre un 40-50%. Todo ello será posible gracias a la realización del mapa de valor presente y futuro para eliminar desperdicios y crear un flujo continuo y el cálculo de un supermercado que mantenga el stock en un nivel óptimo.

Spreading due to heterogeneity in two-phase flow

Postprint (published version)

Orchestration signals in the classroom: managing the jigsaw collaborative learning flow

The orchestration of collaborative learning processes in face-to-facephysical settings, such as classrooms, requires teachers to coordinate students indicating them who belong to each group, which collaboration areas areassigned to each group, and how they should distribute the resources or roles within the group. In this paper we present an Orchestration Signal system,composed of wearable Personal Signal devices and an Orchestration Signal manager. Teachers can configure color signals in the manager so that they are transmitted to the wearable devices to indicate different orchestration aspects.In particular, the paper describes how the system has been used to carry out a Jigsaw collaborative learning flow in a classroom where students received signals indicating which documents they should read, in which group they were and in which area of the classroom they were expected to collaborate. The evaluation results show that the proposed system facilitates a dynamic, visual and flexible orchestration.

Standardizing admission and discharge processes to improve patient flow: A cross sectional study

Background: The aim of this study was to evaluate how hospital capacity was managed focusing on standardizing the admission and discharge processes. Methods: This study was set in a 900-bed university affiliated hospital of the National Health Service, near Barcelona (Spain). This is a cross-sectional study of a set of interventions which were gradually implemented between April and December 2008. Mainly, they were focused on standardizing the admission and discharge processes to improve patient flow. Primary administrative data was obtained from the 2007 and 2009 Hospital Database. Main outcome measures were median length of stay, percentage of planned discharges, number of surgery cancellations and median number of delayed emergency admissions at 8:00¿am. For statistical bivariate analysis, we used a Chi-squared for linear trend for qualitative variables and a Wilcoxon signed ranks test and a Mann¿Whitney test for non-normal continuous variables. Results:The median patients' global length of stay was 8.56 days in 2007 and 7.93 days in 2009 (p<0.051). The percentage of patients admitted the same day as surgery increased from 64.87% in 2007 to 86.01% in 2009 (p<0.05). The number of cancelled interventions due to lack of beds was 216 patients in 2007 and 42 patients in 2009. The median number of planned discharges went from 43.05% in 2007 to 86.01% in 2009 (p<0.01). The median number of emergency patients waiting for an in-hospital bed at 8:00¿am was 5 patients in 2007 and 3 patients in 2009 (p<0.01). Conclusions: In conclusion, standardization of admission and discharge processes are largely in our control. There is a significant opportunity to create important benefits for increasing bed capacity and hospital throughput.

Fluid dynamical prediction of changed v1-flow at energies available at the CERN Large Hadron Collider

Substantial collective flow is observed in collisions between lead nuclei at Large Hadron Collider (LHC) as evidenced by the azimuthal correlations in the transverse momentum distributions of the produced particles. Our calculations indicate that the global v1-flow, which at RHIC peaked at negative rapidities (named third flow component or antiflow), now at LHC is going to turn toward forward rapidities (to the same side and direction as the projectile residue). Potentially this can provide a sensitive barometer to estimate the pressure and transport properties of the quark-gluon plasma. Our calculations also take into account the initial state center-of-mass rapidity fluctuations, and demonstrate that these are crucial for v1 simulations. In order to better study the transverse momentum flow dependence we suggest a new"symmetrized" vS1(pt) function, and we also propose a new method to disentangle global v1 flow from the contribution generated by the random fluctuations in the initial state. This will enhance the possibilities of studying the collective Global v1 flow both at the STAR Beam Energy Scan program and at LHC.

Diffusion in stationary flow from mesoscopic nonequilibrium thermodynamics

We analyze the diffusion of a Brownian particle in a fluid under stationary flow. By using the scheme of nonequilibrium thermodynamics in phase space, we obtain the Fokker-Planck equation that is compared with others derived from the kinetic theory and projector operator techniques. This equation exhibits violation of the fluctuation-dissipation theorem. By implementing the hydrodynamic regime described by the first moments of the nonequilibrium distribution, we find relaxation equations for the diffusion current and pressure tensor, allowing us to arrive at a complete description of the system in the inertial and diffusion regimes. The simplicity and generality of the method we propose makes it applicable to more complex situations, often encountered in problems of soft-condensed matter, in which not only one but more degrees of freedom are coupled to a nonequilibrium bath.

A hybrid algorithm combining metaheuristic with Monte Carlo simulation for solving the Stochastic Flow Shop problem

In this paper, a hybrid simulation-based algorithm is proposed for the StochasticFlow Shop Problem. The main idea of the methodology is to transform the stochastic problem into a deterministic problem and then apply simulation to the latter. In order to achieve this goal, we rely on Monte Carlo Simulation and an adapted version of a deterministic heuristic. This approach aims to provide flexibility and simplicity due to the fact that it is not constrained by any previous assumption and relies in well-tested heuristics.

A hybrid algorithm combining metaheuristic with Monte Carlo simulation for solving the Stochastic Flow Shop problem

In this paper, a hybrid simulation-based algorithm is proposed for the StochasticFlow Shop Problem. The main idea of the methodology is to transform the stochastic problem into a deterministic problem and then apply simulation to the latter. In order to achieve this goal, we rely on Monte Carlo Simulation and an adapted version of a deterministic heuristic. This approach aims to provide flexibility and simplicity due to the fact that it is not constrained by any previous assumption and relies in well-tested heuristics.

Trust region versus line search for computing the optical flow

We consider the numerical treatment of the optical flow problem by evaluating the performance of the trust region method versus the line search method. To the best of our knowledge, the trust region method is studied here for the first time for variational optical flow computation. Four different optical flow models are used to test the performance of the proposed algorithm combining linear and nonlinear data terms with quadratic and TV regularization. We show that trust region often performs better than line search; especially in the presence of non-linearity and non-convexity in the model.

Programación de la producción en un sistema flow shop híbrido sin esperas y tiempos de preparación dependientes de la secuencia.

Se estudia la programación de la producción en sistemas flow shop híbrido con tiempos depreparación dependientes de la secuencia de piezas a fabricar. Las piezas pueden pertenecer adiferentes familias y las máquinas requerirán un tiempo de preparación cada vez que se debacambiar de familia. Se han desarrollado procedimientos heurísticos para el caso monocriterio enel que el objetivo buscado en la programación de la producción es la minimización del retrasomedio, equivalente a minimizar la suma de retrasos de las piezas, y para el caso bicriterio en elque se tendrá en cuenta tanto la minimización de una función objetivo formada por la sumaponderada del retraso medio más la suma de los tiempos medios de proceso. Además se hanadaptado los métodos implementados para trabajar bajo la restricción nowait.

Using the optical flow to implement a relative virtual mouse controlled by head movements

The following paper introduces the work conducted to create a relative virtual mouse based on the interpretation of head movements and face gesture through a low cost camera and the optical flow of the images. This virtual device is designed specifically as an alternative non-contact pointer for people with mobility impairments in the upper extremities and reduced head control. The proposed virtual device was compared with a conventional mouse, a touchpad and a digital joystick. Validation results show performances close to a digital joystick but far away from a conventional mouse.

Flow resistance equations for mountain rivers

Three models of flow resistance (a Keulegan-type logarithmic law and two models developed for large-scale roughness conditions: the full logarithmic law and a model based on an inflectional velocity profile) were calibrated, validated and compared using an extensive database (N = 1,533) from rivers and flumes, representative of a wide hydraulic and geomorphologic range in the field of gravel-bed and mountain channels. It is preferable to apply the model based on an inflectional velocity profile in the relative submergence (y/d90) interval between 0.5 and 15, while the full logarithmic law is preferable for values below 0.5. For high relative submergence, above 15, either the logarithmic law or the full logarithmic law can be applied. The models fitted to the coarser percentiles are preferable to those fitted to the median diameter, owing to the higher explanatory power achieved by setting a model, the smaller difference in the goodness-of-fit between the different models and the lower influence of the origin of the data (river or flume).