using discrete event simulation to improve diagnostic imaging resource utilization pheba philip...
TRANSCRIPT
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Using Discrete Event Simulation to Improve Diagnostic Imaging Resource Utilization
Pheba PhilipAshley Robinson
June 2014
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MD Anderson & the Breast Diagnostic Center
Problem & Aim Statement
Simulation Preparation
Building the Simulation
Initial Results
Next Steps
Challenges
Outline
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Background on MD Anderson
Located in Houston, TX
Found in 1941
20,000 Employees (1,600 faculty)
650 inpatient beds
1.3 M outpatient visits
Provided care to 120,000 patients in 2013
Ranked Number 1 in cancer care by U.S. News and World Report
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Background Breast Diagnostic Imaging
Sub-specialty of the Department of Diagnostic Radiology
Biopsies performed and Images taken of the breast to identify cancer
Over 54,000 procedure performed
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Why use Simulation?
• Understanding of complex systems
• Identification of constraints in the system (patient flow, staff utilization, resource management)
• Testing & experimentation
• Visual tool to enhance communication
• FlexSim Healthcare used for the simulation model
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Problem & Aim Statement
Patients are experiencing long wait times and resources are under utilized in the breast diagnostic center.
The aim is to build a simulation model that identifies opportunities to reduce patient wait time and better utilize resources by April 2014.
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SIMULATION PREPARATION
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Simulation Preparation
Identify the Scope
1. Wait time of patients with appointments in Mammo and US
2. Utilization of labor and equipment
3. Scheduling of patients, radiologist, and techs
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Center Information
• Two Modalities: Diagnostic Mammo & Ultrasound (US)
• 9 US Techs / 9 Mammo Techs
• 3 US Radiologist / 2 Diagnostic Mammo Radiologist
• 2 Diagnostic Assistants
• 3 RNs
• 8 Breast US Rooms/ 8 Diagnostic Mammo Rooms
Simulation Preparation
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Four Patient Flow Charts
• Diagnostic Mammo
• Ultrasound
• Diagnostic to Mammo
• Stereotactic
Simulation Preparation
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Simulation Preparation
Process Flow
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Simulation Preparation
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Activities captured for
• Electronic Data Validation
• Simulation
Simulation Preparation
Data Collection
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34% 42% 24%
Baseline 63.4 (min)
Data Collection
Simulation Preparation
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Data Collection
Simulation Preparation
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BUILDING THE SIMULATION
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Building the Simulation
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Building the Simulation
Insert the schedule of all labor resources
represented in the model
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Building the Simulation
Wait Area
Entrance & ExitRadiologist Reading Room
Diagnostic Mammo
Ultrasound
Diagnostic Mammo
Patient Path
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Building the Simulation
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Building the Simulation
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Initial Results
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Next Steps
• Validate simulation results
• Recommend changes based on simulation output
• Create new simulation with recommended changes
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Before you begin…
• What are you simulating?
• Are you simulating something you can’t change?
• Are you attempting to simulate EVERYTHING? EEK!
• Validate, Validate, VALIDATE
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Supplementary
MD Anderson Volume of Clinical Activity2
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SupplementaryModality Description
X-rays Common method of sending beams to
be absorbed through the body to
creating images
Magnetic Resonance Imaging (MRI) Accurate test that uses a magnetic field
to make computer images of the body’s
soft tissue, large blood vessels and
major organs
Computed Tomography (CT) Scan Test that uses radiographic beams to
make detailed computerized pictures
taken with a special X-ray machine;
more precise than a standard X-ray
Mammography An x-ray image specifically of the
breast for both screening and
diagnostic purposes
Nuclear medicine Specialized technology that uses
radioactive materials
(radiopharmaceuticals) in diagnosis
and therapy
Positron Emission Tomography (PET) Similar to a CT Scan, but patient takes
a small dose of radioactive sugar which
provides information about tissue
function
Ultrasound High-frequency sound waves
transmitted into the body and
converted into a computerized image to
determine if a suspicious lump is solid
or fluid.
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SupplementaryUltrasound Procedures Mammography Procedures
Ultrasound Guided Needle Biopsy Mammography, Ductography
/Galactography, SIN S&I or Multiple
Ultrasound Pre-op Needle
Localization
Unilateral Digital Screen Mammogram
and/or with TOMO
US, Breast with Fine Needle
Aspiration
Unilat Digital Screen Mammogram
with implant and/or with TOMO
US, Radiation Seed 76942 Digital Screening Mammogram and/or
with TOMO
Intra-operative Ultrasound Digital Screening mammogram with
implants and/or with TOMO
Ultrasound Breast Unilateral Digital Bilateral Diag Mammogram
and/or with TOMO
Ultrasound Breast Bilateral Digital Unilateral Diag Mammogram
and/or with TOMO
Ultrasound Chest Mammogram Guide For Needle
Placement
Ultrasound, Extremity Limited Mammogram guided Seed
Localization
Molecular Breast Imaging
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- Key Stats- LOS- Average Wait Times- Volumes- Operating Hours (closing time)- Evaluation- Modality concerns- Bottlenecks?- Space Sufficient?- Utilization- What-If Scenarios
Projected Demand
DI Processes & Service Times
Facility Layout
Simulation Model
Supplementary