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Math in the hospital? Boosting efficiency at Lucile Packard Children’s Hospital Stanford

A mathematician and his team used computational methods to improve efficiency at outpatient infusion center at Lucile Packard Children's Hospital Stanford.

In 2015, Lucile Packard Children's Hospital Stanford hired mathematician David Scheinker, PhD, director of Systems Utilization Research For Stanford Medicine. Hospital leaders wanted his help optimizing efficiency -- and the experience of patients and staff -- using the magic of math, statistics and computational analysis.

A story in the new issue of Stanford Medicine magazine describes their collaboration, including an in-depth look at how Scheinker and his colleagues worked to streamline scheduling at the Bass Center for Childhood Cancer and Blood Diseases.

The center, where patients come by appointment for hours-long chemotherapy infusion, was using only 40% of its capacity. Scheinker, former graduate student Allison Esho, PhD, and others on their team started by creating computer simulations to identify ways to increase usage. Based on the simulations, it became clear that the center could take on more patients than it was currently supporting, including patients receiving other types of infusions elsewhere in the hospital.

This revelation surprised some who worked at the center. As patient care manager Merian van Eijk, MSN, RN, says in the article:

'My perception was that we were always busy, but the reality was that it was in a very inefficient way,' she said. 'I thought, 'OK, we're going to do this, because we need to take care of these patients.'

Working with the center's executive administrative director Angie Kopetsky and other hospital staff, Sheinker and Esho found that relatively few beds were used in early morning and early evening hours, as patients could dictate their arrival times and many wanted the same slots. The article describes how they sought a solution:

With guidance from Kopetsky and other hospital staff, Scheinker and Esho designed simulations to test various alternative scheduling plans as well as options for increasing the clinic's hours of operation, including adding Saturday hours. The simulations accounted for such constraints as the duration and frequency of infusion appointments, whether the patient's doctor needed to be on hand, and whether the patient needed lab tests before treatment.

Based on the simulation results, the center added Saturday hours, and the hospital's schedulers changed how they allotted appointments, encouraging patients to opt for early or later time slots. As a result, the center is able to accommodate more patients who had been receiving infusions at the hospital's short stay unit, freeing beds in that high-demand area for other patients.

As the article reports, "the center is now using 64% of its bed space, with fewer spikes in population in the middle of the day and a better ability to accommodate same-day add-ons of patients with urgent needs."

To smooth the transition, Van Eijk and others coordinated with staff members and reached out to affected patients and families.

For their part, Scheinker and his team have worked on several projects for the children's hospital -- including surgical scheduling and optimizing data from patients' wearable devices -- and they continue to offer assistance in multiple areas, now also focusing on Stanford Health Care.

In the magazine story, Scheinker shared his hope that hospitals in general will embrace systemic changes once they recognize the role of technology in modern medicine:

'Health care is notorious for how long it takes to adopt new things, especially if they require people to change their workflows,' he said. Yet current electronic health records make possible the redesigns and improvements that other industries have shown can lead to transparency, efficiency, fewer errors, fewer delays and overall higher quality, Scheinker said.

Illustration by Harry Campbell

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