Browsing by Subject "healthcare"
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Item Application of Lean Principles to Neurosurgical Procedures: The Case of Lumbar Spinal Fusion Surgery, a Literature Review and Pilot Series(Oxford, 2018) Liu, Jesse J.; Raskin, Jeffrey S.; Hardaway, Fran; Holste, Katherine; Brown, Sarah; Raslan, Ahmed M.; Neurological Surgery, School of MedicineBACKGROUND Delivery of higher value healthcare is an ultimate government and public goal. Improving efficiency by standardization of surgical steps can improve patient outcomes, reduce costs, and lead to higher value healthcare. Lean principles and methodology have improved timeliness in perioperative medicine; however, process mapping of surgery itself has not been performed. OBJECTIVE To apply Plan/Do/Study/Act (PDSA) cycles methodology to lumbar posterior instrumented fusion (PIF) using lean principles to create a standard work flow, identify waste, remove intraoperative variability, and examine feasibility among pilot cases. METHODS Process maps for 5 PIF procedures were created by a PDSA cycle from 1 faculty neurosurgeon at 1 institution. Plan, modularize PIF into basic components; Do, map and time components; Study, analyze results; and Act, identify waste. Waste inventories, spaghetti diagrams, and chartings of time spent per step were created. Procedural steps were broadly defined in order to compare steps despite the variability in PIF and were analyzed with box and whisker plots to evaluate variability. RESULTS Temporal variabilities in duration of decompression vs closure and hardware vs closure were significantly different (P = .003). Variability in procedural step duration was smallest for closure and largest for exposure. Wastes including waiting and instrument defects accounted for 15% and 66% of all waste, respectively. CONCLUSION This pilot series demonstrates that lean principles can standardize surgical workflows and identify waste. Though time and labor intensive, lean principles and PDSA methodology can be applied to operative steps, not just the perioperative period.Item Bibliometric analysis of publications on healthcare disparities among sexual and gender minorities: an exploratory study(2020-10-01) Ramirez, Mirian; Craven, Hannah J.Academic and scientific literature related to healthcare disparities among sexual and gender minorities has increased significantly over the past decade. For this study, a bibliometric analysis will be applied to examine the characteristics, as well as the growth and authorship patterns of worldwide research output, addressing issues related to barriers and disparities of the availability or access to medical services for the LGBTQ population. For this exploratory study, we used the Web of Science database, one of the most widely multidisciplinary databases, that provides the analytical tools for bibliometric calculations. For this analysis, we conducted a bibliographic search on the topic of healthcare disparities in order to collect the representative documents about the topic and to identify authors, document types, year of publications, sources, main thematic areas, most productive institutions, languages and most productive countries of research output. We used an open-source Bibliometrix/Biblioshiny R-package to conduct quantitative analysis. This approach aims to inform the development and trends of research outputs to understand what this research is focusing on, identify research productivity and topic trends.Item Coordination of Autonomous Healthcare Entities: Emergency Response to Multiple Casualty Incidents(Wiley, 2017) Mills, Alex F.; Helm, Jonathan E.; Jola-Sanchez, Andres F.; Tatikonda, Mohan V.; Courtney, Bobby A.; Kelley School of Business – IndianapolisIn recent years, many urban areas have established healthcare coalitions (HCCs) composed of autonomous (and often competing) hospitals, with the goal of improving emergency preparedness and response. We study the role of such coalitions in the specific context of response to multiple-casualty incidents in an urban setting, where on-scene responders must determine how to send casualties to medical facilities. A key function in incident response is multi-agency coordination. When this coordination is provided by an HCC, responders can use richer information about hospital capacities to decide where to send casualties. Using bed availability data from an urban area and a suburban area in the United States, we analyze the response capability of healthcare infrastructures under different levels of coordination, and we develop a stress test to identify areas of weakness. We find that improved coordination efforts should focus on decision support using information about inpatient resources, especially in urban areas with high inter-hospital variability in resource availability. We also find that coordination has the largest benefit in small incidents. This benefit is a new value proposition for HCCs, which were originally formed to improve preparedness for large disasters.Item Daily Situational Brief, December 1, 2014(MESH Coalition, 12/01/14) MESH CoalitionItem Daily Situational Brief, December 10, 2014(MESH Coalition, 12/10/14) MESH CoalitionItem Daily Situational Brief, December 17, 2014(MESH Coalition, 12/17/14) MESH CoalitionItem Daily Situational Brief, December 2, 2014(MESH Coalition, 12/02/14) MESH CoalitionItem Daily Situational Brief, December 3, 2014(MESH Coalition, 12/03/14) MESH CoalitionItem Daily Situational Brief, December 4, 2014(MESH Coalition, 12/04/14) MESH CoalitionItem Daily Situational Brief, December 8, 2014(MESH Coalition, 12/08/14) MESH Coalition