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Publications (129)
Background and objectives
Understanding factors affecting the timing of critical clinical events in ALS progression.
Methods
We captured ALS progression based on the timing of critical events (tollgates), by augmenting 6366 patients’ data from the PRO-ACT database with tollgate-passed information using classification. Time trajectories of passing...
Objective
To report the first steps of a project to automate and optimize scheduling of multidisciplinary consultations for patients with longstanding dizziness utilizing artificial intelligence.
Study Design
Retrospective case review.
Setting
Quaternary referral center.
Methods
A previsit self‐report questionnaire was developed to query patient...
For a large portion of mental health patients, the Emergency Department is the first point of contact when in crisis and in need of urgent acute care. Unfortunately, those who have already received an admission disposition may wait hours or days after before being placed in a psychiatric inpatient (IP) care unit. Known as ED boarding, one primary c...
Recent use of noninvasive and continuous hemoglobin (SpHb) concentration monitor has emerged as an alternative to invasive laboratory-based hematological analysis. Unlike delayed laboratory based measures of hemoglobin (HgB), SpHb monitors can provide real-time information about the HgB levels. Real-time SpHb measurements will offer healthcare prov...
We present a novel framework to characterize the probability that an offered appointment with k‐days' access delay will be booked and subsequently attended by a patient. We refer to this probability as the “probability of realization” of an offered appointment, and demonstrate how empirical characterizations of this measure can be used to identify...
Background
We aimed to determine if patient symptoms and computed tomography enterography (CTE) and magnetic resonance enterography (MRE) imaging findings can be used to predict near-term risk of surgery in patients with small bowel Crohn’s disease (CD).
Methods
CD patients with small bowel strictures undergoing serial CTE or MRE were retrospectiv...
Uncontrolled hemorrhage is a leading cause of preventable death among patients with trauma. Early recognition of hemorrhage can aid in the decision to administer blood transfusion and improve patient outcomes. To provide real-time measurement and continuous monitoring of hemoglobin concentration, the non-invasive and continuous hemoglobin (SpHb) me...
Clinicians and staff who work in intense hospital settings such as the emergency department (ED) are under an extended amount of mental and physical pressure every day. They may spend hours in active physical pressure to serve patients with severe injuries or stay in front of a computer to review patients' clinical history and update the patients'...
We introduce DeepABM, a framework for agent-based modeling that leverages geometric message passing of graph neural networks for simulating action and interactions over large agent populations. Using DeepABM allows scaling simulations to large agent populations in real-time and running them efficiently on GPU architectures. To demonstrate the effec...
Background
The progression of many degenerative diseases is tracked periodically using scales evaluating functionality in daily activities. Although estimating the timing of critical events (i.e., disease tollgates) during degenerative disease progression is desirable, the necessary data may not be readily available in scale records. Further, analy...
Background
Hospitals face the challenge of managing demand for limited computed tomography (CT) resources from multiple patient types while ensuring timely access.
Methods
A discrete event simulation model was created to evaluate CT access time for emergency department (ED) patients at a large academic medical center with six unique CT machines th...
Patient no-shows and cancellations are a significant problem to healthcare clinics, as they compromise a clinic's efficiency. Therefore, it is important to account for both no-shows and cancellations into the design of appointment systems. To provide additional empirical evidence on no-show and cancellation behaviour, we assess outpatient clinic da...
Hypertrophic Cardiomyopathy (HCM) is the most common genetic heart disease in the US and is known to cause sudden death (SCD) in young adults. While significant advancements have been made in HCM diagnosis and management, there is a need to identify HCM cases from electronic health record (EHR) data to develop automated tools based on natural langu...
Objectives
To estimate population health outcomes under delayedsecond dose versus standard schedule SARS-CoV-2 mRNA vaccination.
Design
Agent-based modeling on a simulated population of 100,000 based on a real-world US county. The simulation runs were replicated 10 times. To test the robustness of these findings, simulations were performed under d...
The ability of a Real Time Location System (RTLS) to provide correct information in a clinical environment is an important consideration in evaluating the effectiveness of the technology. While past efforts describe how well the technology performed in a lab environment, the performance of such technology has not been specifically defined or evalua...
Purpose:To introduce a new optimization algorithm that improves DVH results and is designed for the type of heterogeneous dose distributions that occur in brachytherapy.Methods:The new optimization algorithm is based on a prior mathematical approach that uses mean doses of the DVH metric tails. The prior mean dose approach is referred to as conditi...
(Abstracted from Obstet Gynecol 2020;135:761–769)
Between 2007 and 2010, the rate of total vaginal hysterectomy (TVH) in the United States among commercially insured patients undergoing hysterectomy decreased from 21.7% to 19.8% and by 2013 decreased to 11.5%. Between 2007 and 2010, use of robotic-assisted hysterectomy increased from 0.5% to 9.5%.
Increasing workload is one of the main problems that surgical practices face. This increase is not only due to the increasing demand volume but also due to increasing case complexity. This raises the question on how to measure and predict the complexity to address this issue. Predicting surgical duration is critical to parametrize surgical complexi...
Background
Emergency department (ED) operations leaders are under increasing pressure to make care delivery more efficient. Publicly reported ED efficiency metrics are traditionally patient centred and do not show situational or facility-based improvement opportunities. We propose the consideration of a novel metric, the ‘Number of Unnecessary Wait...
Hospital emergency department (ED) operations are affected when critically ill or injured patients arrive. Such events often lead to the initiation of specific protocols, referred to as Resuscitation-team Activation (RA), in the ED of a large academic medical center where this study was conducted. RA events lead to the diversion of resources from o...
Purpose
A Pareto Navigation and Visualization (PNaV) tool is presented for interactively constructing a high-dose-rate (HDR) brachytherapy treatment plan by navigating and visualizing the multidimensional Pareto surface. PNaV aims to improve treatment planning time and quality and is generalizable to any number of dose–volume histogram (DVH) and co...
Real-time location systems (RTLS) such as radio frequency identification (RFID) have been shown to improve safety, save cost, and increase patient satisfaction in a healthcare setting especially in the emergency department (ED). Hospital administrators have realized the potential of these applications for improved workflow and operations and are po...
This study focuses on interruptions in an inpatient pharmacy setting and the impact of CPOE implementation on the types, frequency, and duration of interruptions. A cross-sectional observation study of pharmacy employees in an inpatient pharmacy was conducted. The independent variables included day of week, time of day, job position of the person i...
Objective:
To evaluate the rate of vaginal hysterectomy and outcomes after initiation of a prospective decision-tree algorithm to determine the optimal surgical route of hysterectomy.
Methods:
A prospective algorithm to determine optimal route of hysterectomy was developed, which uses the following factors: history of laparotomy, uterine size, a...
Objective:
To assess the impact of a triage system of emergency department (ED) referrals for outpatient cardiology appointments.
Patient and methods:
We implemented a triage system of ED referrals for outpatient cardiology appointments among patients with a cardiovascular chief complaint deemed safe to leave the ED but needing outpatient follow...
Objective:
Chief complaint (CC) is among the earliest health information recorded at the beginning of a patient's visit to an emergency department (ED). We propose a heuristic methodology for automatically mapping the free-text data into a structured list of CCs.
Methods:
A comprehensive structured list categorizing CCs was developed by experien...
Objective.:
The Dizziness Handicap Inventory (DHI) is a 25-item self-report questionnaire developed to measure the disabling and handicapping impact of dizziness. The present investigation was conducted in an effort to re-assess the factor structure of the DHI.
Study design.:
Retrospective study.
Setting.:
Tertiary care center.
Patients.:
Su...
Real-time location systems (RTLS) has found extensive application in the healthcare setting, that is shown to improve safety, save cost, and increase patient satisfaction. More specifically, some studies have shown the efficacy of RTLS leading to an improved workflow in the emergency department. However, due to substantial implementation costs of s...
Background:
Patients who present to emergency departments (EDs) for evaluation but are noted to have left without being seen (LWBS) are potentially at great risk. Governmental agencies, such as the Centers for Medicare and Medicaid, as well as hospitals and health organizations, are examining the factors which drive LWBS, including accurately quan...
Strategic allocation of limited operating room (OR) capacity to surgeons is crucial for the coordination of surgical work flow, including planning of consultation and surgery days, and staff assignment to perioperative teams. However, it is a challenging problem in practice, since the capacity allocation needs to be cyclic for schedule predictabili...
Objective
To capture ALS progression in arm, leg, speech, swallowing, and breathing segments using a disease-specific staging system, namely tollgate-based ALS staging system (TASS), where tollgates refer to a set of critical clinical events including having slight weakness in arms, needing a wheelchair, needing a feeding tube, etc.
Methods
We com...
Visualizing process metrics can help identify targets for improvement initiatives. Dashboards and scorecards are tools to visualize important metrics in an easily interpretable manner. We describe the development of two visualization systems: a dashboard to provide real-time situational awareness to frontline coordinators, and a scorecard to displa...
Objectives:
This study was conducted to describe patients at risk for prolonged time alone in the emergency department (ED) and to determine the relationship between clinical outcomes, specifically 30-day hospitalization, and patient alone time (PAT) in the ED.
Methods:
An observational cohort design was used to evaluate PAT and patient characte...
This paper focuses on building a statistical monitoring scheme for service systems that experience time-varying arrivals of customers and have time-varying service rates. There is lack of research in the systematic statistical monitoring of large-scale service systems, which is critical for maintaining a high quality of service. Motivated by the em...
Residents and scribes in an Emergency Department (ED) work closely with an attending physician. Residents care for patients under the supervision of the attending physician, whereas scribes assist physicians with documentation contemporaneously with the patient encounter. Optimal allocation of these roles to shifts is crucial to improve patient car...
Background:
Constrained optimization methods are already widely used in health care to solve problems that represent traditional applications of operations research methods, such as choosing the optimal location for new facilities or making the most efficient use of operating room capacity.
Objectives:
In this paper we illustrate the potential u...
Objective
The aim of this study was to assess the role of frozen section (FS) in identifying an absence of lymph nodes during sentinel lymph node (SLN) biopsy for apparent early-stage endometrial cancer (EC).
Methods
Consecutive apparent early-stage EC patients who had SLNs removed after cervical injection with indocyanine green (ICG) from 1 June...
Objective:
The propose of this article is to develop a method for improving the accuracy of SpHb monitors, which are non-invasive hemoglobin monitoring tools, leading to better critical care protocols in trauma care.
Methods:
The proposed method is based on fitting smooth spline functions to SpHb measurements collected over a time window and the...
The primary objective of this study was to investigate the impact of interrupting nurses on mental workload in emergency departments by using a Natural Goals Operators Methods and Selection rules Language (NGOMSL) simulation model. The model advanced our understanding of how interrupting nurses influenced their mental workload. A time study was con...
Objective
Psychiatric patient boarding in emergency department (ED) is a severe and growing problem. In July 2013, Minnesota implemented a law requiring jailed persons committed to state psychiatric facilities be transferred within 48-h of commitment. This study aims to quantify the effect of this law on a large ED's psychiatric patient flow.
Meth...
Common approaches to emergency department (ED) staffing are to optimize shifts based on historical patient volume or arrival patterns. The former is problematic because historical patient volumes are based on the volumes during existing shifts. Therefore, optimizing shifts based on these volumes can replicate the inefficiencies in these shifts. The...
Background:
It is unclear how workflow interruptions impact emergency physicians at the point of care.
Objectives:
Our study aimed to evaluate interruption characteristics experienced by academic emergency physicians.
Methods:
This prospective, observational study collected interruptions during attending physician shifts. An interruption is de...
Background:
Contact tracing is the systematic method of identifying individuals potentially exposed to infectious diseases. Electronic medical record (EMR) use for contact tracing is time-consuming and may miss exposed individuals. Real-time location systems (RTLSs) may improve contact identification. Therefore, the relative effectiveness of these...
Despite the important role of emergency department (ED) performance measurement, commonly used metrics remain disaggregated and are not standardized. The objectives of this study are 1) to develop an aggregated performance measure that enables benchmarking EDs with respect to technical and scale efficiencies and 2) to investigate significant exogen...
Emergency Department (ED) is a complex care delivery environment in a hospital that provides time sensitive urgent and lifesaving care [1]. Emergency medicine is an unscheduled practice and therefore providers experience extreme fluctuations in their workload. ED crowding is a major concern that affects the efficacy of the ED workflow, which often...
Providing health services with the greatest possible value to patients and society given the constraints imposed by patient characteristics, health care system characteristics, budgets, and so forth relies heavily on the design of structures and processes. Such problems are complex and require a rigorous and systematic approach to identify the best...
Emergency Department (ED) represents a highly chaotic environment with a big responsibility to provide critical care to patients on a rapid fashion for life saving service. The operating capacity of ED is often challenged with overcrowding especially with patients at non-emergency situation using it as point of access for primary care. Application...
This work analyzes strategies for better allocation of surgeon resources in an elective surgical practice. Among the metrics considered to evaluate the assignment of tasks are OR-to-Clinic ratio per provider, OR-to-Clinic ratio per day, patient access to clinic, and patient access to surgery. In addition, a simulation model is used to evaluate the...
Occupational fatigue is an important challenge in improving health and safety in healthcare systems. A secondary analysis of cross-sectional data from a survey sample comprised of 340 hospital nurses was conducted to explore the relationships between components of the nursing work system (person, tasks, tools and technology, environment, organizati...
Background:
Reliable prediction of operative duration is essential for improving patient and care team satisfaction, optimizing resource utilization and reducing cost. Current operative scheduling systems are unreliable and contribute to costly over- and underestimation of operative time. We hypothesized that the inclusion of patient-specific fact...
Providing timely access to surgery is crucial for patients with high acuity diseases like cancer. We present a methodological framework to make efficient use of scarce resources including surgeons, operating rooms, and clinic appointment slots with a goal of coordinating clinic and surgery appointments so that patients with different acuity levels...
Objective:
To evaluate practice change after initiation of a robotic surgery program using a clinical algorithm to determine the optimal surgical approach to benign hysterectomy.
Methods:
A retrospective postrobot cohort of benign hysterectomies (2009-2013) was identified and the expected surgical route was determined from an algorithm using vag...
Natural Goals Operators Methods and Selection Rules Language (NGOMSL) model of the clinical process in an Emergency Department (ED) was developed using Micro Saint Sharp. This model advanced our understanding of a care provider's cognitive behavior in a dynamic ED environment. It also revealed the understanding of proximal workflow in the ED and th...
Introduction: An increasing number of behavioral health (BH) patients are presenting to the
emergency department (ED) while BH resources continue to decline. This situation may lead to more
external transfers to find care.
Methods: This is a retrospective cohort study of consecutive patients presenting to a tertiary
care academic ED from February 1...
Radio Frequency Identification Device (RFID) technology use in health care services has been shown to save lives, prevents errors, save costs and increases security. Implementation of RFID technology has been challenged with high implementation costs, substantial gap between technology implementation costs and the RFID-enabled benefits, lack of com...
Acute Kidney Injury (AKI) occurs in at least 5 % of hospitalized patients and can result in 40–70 % morbidity and mortality. Even following recovery, many subjects may experience progressive deterioration of renal function. The heterogeneous etiology and pathophysiology of AKI complicates its diagnosis and medical management and can add to poor pat...