Quality Control in the Healthcare Industry: An Analysis of Surgery Turnover Times

For virtually all hospitals, utilization rates are a critical managerial indicator of efficiency and are determined in part by turnover time. Turnover time is defined as the time elapsed between surgeries, during which the operating room is cleaned and preparedfor the next surgery. Lengthier turnover times result in lower utilization rates, thereby hindering hospitals’ ability to maximize the numbers of patients that can be attended to. In this thesis, we analyze operating room data from a two year period provided byEvangelical Community Hospital in Lewisburg, Pennsylvania, to understand the variability of the turnover process. From the recorded data provided, we derive our best estimation of turnover time. Recognizing the importance of being able to properly modelturnover times in order to improve the accuracy of scheduling, we seek to fit distributions to the set of turnover times. We find that log-normal and log-logistic distributions are well-suited to turnover times, although further research must validate this finding. Wepropose that the choice of distribution depends on the hospital and, as a result, a hospital must choose whether to use the log-normal or the log-logistic distribution. Next, we use statistical tests to identify variables that may potentially influence turnover time. We find that there does not appear to be a correlation between surgerytime and turnover time across doctors. However, there are statistically significant differences between the mean turnover times across doctors. The final component of our research entails analyzing and explaining the benefits of introducing control charts as a quality control mechanism for monitoring turnover times in hospitals. Although widely instituted in other industries, control charts are notwidely adopted in healthcare environments, despite their potential benefits. A major component of our work is the development of control charts to monitor the stability of turnover times. These charts can be easily instituted in hospitals to reduce the variabilityof turnover times. Overall, our analysis uses operations research techniques to analyze turnover times and identify manners for improvement in lowering the mean turnover time and thevariability in turnover times. We provide valuable insight into a component of the surgery process that has received little attention, but can significantly affect utilization rates in hospitals. Most critically, an ability to more accurately predict turnover timesand a better understanding of the sources of variability can result in improved scheduling and heightened hospital staff and patient satisfaction. We hope that our findings can apply to many other hospital settings.

The Effects of Hibernation on Immunological Functions in Female Big Brown Bats (Eptesicus fuscus)

The emerging disease White-Nose Syndrome in hibernating bat populations across the United States has increased the need to understand the physiological benefits and consequences of hibernation and the effects on immunological responsiveness. Hibernation has been well-documented in many mammalian species, yet few studies have examined hibernation immunology in bats, particularly with respect to normal immunological patterns. In order to characterize the levels of circulating leukocytes and plasma immunoglobulins in euthermic and hibernating female big brown bats (Eptesicus fuscus), blood smear differential leukocyte counts and total immunoglobulin assays were performed for each group using blood samples from the active and hibernation seasons. Hibernation patterns – torpor and arousals from torpor – were determined by placing temperature-sensitive dataloggers on the backs of bats assigned to the hibernating group during the hibernation season. Data indicate that the ratio of circulating neutrophils to lymphocytes is lower in bats assigned to the euthermic group during the hibernation season than in bats assigned to the hibernation group during the hibernation period, but that relative immunoglobulin levels do not differ during the hibernation season, regardless of whether bats were active or hibernating. Neither bats assigned to the hibernation group nor bats assigned to the euthermic group demonstrate a significant change in the ratio of circulating neutrophils and lymphocytes between their active and hibernating seasons. Bats assigned to the hibernation group were also observed to arouse from torpor somewhat synchronously. These results suggest that innate and adaptive cell levels are maintained, at best, in hibernating bats that are not immunologically challenged and that bats that remain euthermic during the hibernation season are able to continually regulate their levels of neutrophils and lymphocytes and therefore their innate and adaptive immune system responses.