SlideShare una empresa de Scribd logo
1 de 27
Descargar para leer sin conexión
USA BUFFER  IN THE HEALTHCARE IS STUDIED BY VARIOUS  AUTHORS (PRACTIONEERS AND ACADEMICS) FROM DIFFERENT COUNTRIES. THE GOAL IS TO REDUCE LONG TIME DELAY (REDUCE QUEING) IN THE HEALTHCARE INDUSTRY (THUS  REDUCING DEATH RATIO DUE TO HOSPITAL DIVERSTION STATUS ). RELEVANT LESSONS LEARNED WOULD SERVED AS  A MODEL WORLDWIDE MYSELF,  I AM INTERESTING WITH THIS STUDIES AS FINDING FOR AN APPROPRIATE MODEL TO RAPIDE RESPONSE AS A MEAN OF OVERALL FLOOD RISK REDUCTION AND THE COUPLING/GAP BETWEEN FORCASTED COSTS OF ADAPTION STRATEGIES AND MITIGATIONS WITH WEATHER AND HYDROLOGY FORECASTS. IN THE PROJECT WAER I DEVELOPPED POSTERIOR TO THE MBA PROJECT WAER (POST WAER PROJECT). THE SEASIDE FRONT - ALSO, I CALLED IT SEAFRONT,  WHICH IS AT THE JUNCTION BETWEEN 2 MEDIA  -MEDIUM 1: SEA WATER AND MEDIUM 2: THE LAND- IT IS SIMILAR TO A BUFFER. THEREFORE MY BUFFER MODEL FOR COST ASSESSMENT IN ANTICIPATORY MANAGEMENT OF WATER HAZARDS WITH FORECASTED WEATHER IS TECHNICALLY ABOUT LEAD-TIME REDUCTIONS. THE KNOWLEDGE OF THE BUFFER CHARACTERISTICS CAN IMPACT THE FUTURE OF THE REGION RESCUE ORGANIZATION WITH LESS RESSOURCE ALLOCATIONS.  I HAVE BUILD MY PROCESS ON A REAL EVENT WITH THE MEDIA ATTENTION BASED ON THE XYNTHIA FLOOD IN VENDEE. GS RADJOU 5/07/2010
So, I have developed a model looking like the US Healthcare buffer  or it just a business buffer model applied to flood zones where Hi (with i= 0, 1 and 2)are  water elevation chareteristics of the buffer.  For example: H1, lower volume of water with sea tide is the lower limit of the tide  H2= average water volume, which is an indicator for surge water height, and all buildings and infrastructures are build to the best of our knowledge to this surge  water elevations.  It is a prerequisite of flood defence systems in landlocked countries and the policy  goal for helping the post recovery operations. -when H2 moves to H3, which is  the critical value for inundating dangerously the flood prone regions-. These heights are monitored permanently of twice a day on a daily basis. Hi (H1, H2 and H3) are made by WMO through satellite detections or gauging  stations and help to measure the cost of intervention in case of flood by anticipation with the coupling of weather forecast estimates. This buffer is a basic process with no unknown (policy 1).The model is a metaphore of an hospital model of the study where numbers of patients are replaced by  Water heights of tides. Also, the community souls are known from council townhall  registration office) If we know Hi (heights), which is predictable because of the forecasts and monitors  -recorded twice per day-, we can assess the best policy in nearly real time for cost management of inundated regions and diagnostic a solution either in anticipatory  management through the predictions or in emergency planning from observing data.
BUFFER IS A BUZZWORD ITCAN BE FOUND IN ALL INDUSTRIES A TOOL FOR HOLDING PRODCUTION OF GOODS AND AVOID DISRUPTION OF THE SUPPLY CHAIN. CUSTOMER NEEDS ARE DELIVERED ON TIME EITHER THROUGH THE JUST IN TIME PRODUCTION THEY BUY ON ORDER AND THE FIRM SUPPLIES ON ORDER AND/OR THROUGH FORCASTED DEMAND. BUFFERS ARE HOLDINGS IN « C » language: reduce the number of system calls at the (small) expense of having a section of memory to store larger dat for read or write. Find also, in chemistry when a acidic solution is neutelize by a basic solution PH cannot varies in the Buffer zone Also, in economics, after the World War 2 germany calls foreign labors to buffer the lack of national labors. So, the buffer concept as seen as a stock keeper concept is regulate by a condition which is the variation of the stock value around a mean value and within value limits that are dfined by the resplenishment policy. Etc. In the case, I try to find (re-discover form the authors cited in the slide show  the model (or seveval models), which could help to model interface between medium between water (during a flood) and the land. If I manage to find this appropriate model, I could link it to flood forecast). This would be my flood buffer. So at could organize the ressources and assess the costs for emergency, preparadness in flood treatment and post recovery operation. Knowing the quantity of water is the pond is like a black box GS RADJOU
Cause: Holding Patients in Emergency Room Impact on triage to bed time Buffer: 5 patients/room Triage rduction : 24% -> 22% Prototyping a model ------> implementing worldwide? Test: discret event simulation for patient safety Diversion status Hospital Full New diversion status due to intial diversion status Higher Mortality rate for the diverted Source: Cowan and Trzeciak 2005; McCaig and Burt 2004, Andrulis et Al. 1991 Systemic Pb, Schneider et al. 2001 Ressource stress and waiting time GS RADJOU ambulance
Perceived situation : More patients than staffed treatment beds and waiting time exceed reasonable periods Types of patients: - patients waiting for ED -patients under monitors in non treatment area -patient waiting for transfer to inpatient unit (IU) Issue:  criteria for diversion status (very nebulous -Derlet, Richards and Kravitz 2001; Jones et al.2006; Hoot et al 2007) Crowding conditions (conditional   indicators have been selected by Kolb, Lee and Peck 2007),  if: 1- 100% if beds in ER fully occupied 2-queuing length >50% of ER Beds ( Note : By the way, I remember I read in Vocable magazine comparing 2 health systems in North America. The Canadian Social security is free for all but there are long delays when queuing for a therapy at the hospital.  When somebody need a treatment it is faster to cross the US/Canadian border for the health services , but of course, it is a paying service) GS RADJOU
Influencing factors for patient flows: PATIENT FLOWS INFLUX THROUGHOUPUT OUTFLUX Sources Products Old Patients  increased in numbers More emergency medical needs Emergency Department Source: Mcaig and Burt 2004; Cowan and Trezeciak 2005
Time to enter : influx time (Ti) Time spend in the emergency department:  throughput time (Ts) Time to go out: outflux time (To) T i T o Ts' Ts'' Ts' is the real time spent for the cure Ts' = Ts'' - (Ti+To) Uncertainties on throughput times ISSUE ABOUT ACCESS TO HEALTH IS TIME.  (TIME UNCERTAINTY) (Ts'' – Ts')
PROJECT CONCEPTS FLOOD CONCEPT BUFFER CONCEPT RIPARIAN  CONCEPT HYDROGRAPH
UNCERTAINTY ON THROUGHPUT TIMES INFLUENCE SOURCES T s Infrastructure layout (issue with walking distance) Communication Promotion TRIAGE REGISTRATION Note : In Project, I have suspected that  promotion is th main factor of water poisoning. In fact what the service should make is to study the 4Ps marketing rule. I have illustrated with the example of the Canadian Health that price has nothing to make for buying a health service. There is also, a second dimension in Health service which is the time to supply these service and people are willing to pay for time. Also, communication promotion is a driver of speed of changes. Bertoty 2007 Subash 2004 (under research) Miro et al 2003
TESTS FOR LOW ACUITY CASES WITH FAST TRACK ELECTONIC SYSTEMS (Garcia 1995; Peck et al . 2008) PATIENT OUTFLOWS Note:  the use of electronic Speed-up the patient out flow for low acuity cases. The hospital are like supermarkets With fast tills or with selfpaying automated machined where the customer process himself the provisions Traditional medical treatment versus electonical treatment of patient are competing and reduce the throughtput time for low acuity cases
OVERCROWDING CONDITIONS (Qualitative and quantitative) Emergency Department (ED) Sources: Schull et al 2003 Foster et al 2003 Rathlev et al 2007 US GAO 2003
ED IU INFLOW OUTFLOW 1RST BACKLOG INVESTIGATION RESULTS Source: Kolb, Lee and Peck (2007) Normally, the backlog should serve the investigation in determined in which step of the process between ED and IU, the Patient congestion (time delays and queueing is important° AND IF backlog is F (IU) -> it is the bottleneck Back log = F (IU) ED : Emergency Department ER : Emergency Room IU : Inpatient Unit
Problem of time delay of Patient Is located between ER and IU The slowest service gives the speed for all the department Which is unfair for patient waiting to be treated -> goal would be to find a solution at this level if the hospital want to avoid diversion status and reduce deaths My qualitative Solution: « Pseudo Bison futé »: -No diversion cause of deads -Forecast IU frequentation -improve IU  -buy new machines -trained staff -motivation -health policy -treatment can be diverted in the ED itself by rorganizing the service either people or influences
CROWDING MEASURES AND UNCERTAINTIES ON MEASURES SPEED UP  PATIENT  IU-INFLOW  HOW? WHEN? WHO? IU-INFLOW  =  ED-OUTFLOW Yancer et al 2007 Solutions Uncertainty Author names Principles UTILIZATION OF IU AS WAITNG ROOM INSTEAD OF ED. FALSE DECONGESTION VERSUS REAL DECONGESTION Greene 2007 How to improve is unclear (who, what, why, when, where, how, characteristics, frequency, etc. GOOD TO REDUCE CROWDING Richardson, Dick, Schneider 2007
CONCEPTUAL MODEL OF US HEALTHCARE (KOLB 2008) ACQUISITION OF KNOWLEDGE: 1°  OBSERVING THE ENVIRONMENT  (US HOSPITAL SUBURBAN AREA, ONE MILE FROM THE HIGHWAY) 2°  DATA GATHERING  ABOUT: Beds => 24 adult ER beds =>  8 pediatric ER beds, and =>  4 fast-track beds Rooms: => 2 X ray  rooms,  => 3 triage rooms, and  => 2  registration rooms. (Unvisible details) =>  interview staffs + mangers helps to understand ED process in theory and  practice and, which aspect is needed for the simulation (modelling)
Branching points BASIC MODEL (ED-IU SYSTEM)
DETAILED MODEL Influx  channels Front start Front end Fast track Adult ER IU Diagnostic Pediatric ER Greeter Waiting area Triage room
DETAILED MODEL OF THE AUTHORS
COMPUTERIZED MODEL
APLLIED SCENARIO TO XANTHIA FLOOD RISK REDUCTION BASIC MODEL
H° Average sea tide H ¹ Surge tide Surge water Inundated land H ² Disaster tide GS RADJOU SCENARIO BUFFER  XANTHIA
PROJECT GLOBAL  ARCHITECTURE (Requirement and specifications)
LEVEL ONE FLOATING SCREEN (like a wrap in standy) WASTE SCREEN WATER INFILTRATIONS WATER ELIMINATION  DRAINAGE CONTROL DEBORDEMENT 2ND  PROTECTION WITH PLANTED TREES ELEVATED  TOWER MODEL ONE (for the new urbanism) -the dock and the elevated building- The dock side WALL  (Optional) Or stands to support the floating screen when in deployment CANAL OR TUNNEL Water stock zone Impervious surfaces ( or saturated soil create the flood zone) Protection levels from flood  (flood wall) Buildings, shelters,  dry feets GS RADJOU Global architecture
MODEL TWO: LEAVE WATER TO ITS OWN EXPANSION  =  NO WALL, NO SCREEN BUT... RIVER FLOWS INUNDATION Monitoring stations Flood zone Pool for  Evacuation drainage FLOOD ZONE RIVER LAND DEMARCATION LINE
CONFIGURATION CHANGES
22 m 60 m 32 m PROJECT SKETCH VARIATION SIMILAR BARCELONA SEA FRONT (LE PASSEIG COLOM ET LE MOLL DE LA FUSTA)  [1] SEA TREE ZONE TREE ZONE ELEVATION HOUSE CANAL  TUNNEL [1]  Exact detailed of the seafront drawning in L »urbanisme  végétal, Institut pour le dévelopment forestier, Caroline Stefulesco, Collection Mission du Paysage  GS RADJOU Adaptation strategy   No screen, no wall,only  planting trees and elevation house in flood prone region b
SEA FRONT CONFIGURATION VARIATION [2] For details of the Front sea Archachon Le Parc Pereire, see page 194 of the book L'urbanisme végétale, Caroline stefulesco SEA LAND (TREE ZONE)

Más contenido relacionado

Destacado

Snsのメリットとは
SnsのメリットとはSnsのメリットとは
Snsのメリットとはuchidakatsuya
 
Trabajo de tic (conte)
Trabajo de tic (conte)Trabajo de tic (conte)
Trabajo de tic (conte)lautaro
 
Bastiat inhebrew
Bastiat inhebrewBastiat inhebrew
Bastiat inhebrewAnochi.com.
 
2011 Volvo of English Creek XC90 Egg Harbor Township NJ
2011 Volvo of English Creek XC90 Egg Harbor Township NJ2011 Volvo of English Creek XC90 Egg Harbor Township NJ
2011 Volvo of English Creek XC90 Egg Harbor Township NJVolvo of English Creek
 
The Effects of SEO on Website Visitation
The Effects of SEO on Website VisitationThe Effects of SEO on Website Visitation
The Effects of SEO on Website VisitationAliah Thomas
 
2010 Chevy Malibu Hybrid in El Paso, TX
2010 Chevy Malibu Hybrid in El Paso, TX2010 Chevy Malibu Hybrid in El Paso, TX
2010 Chevy Malibu Hybrid in El Paso, TXViva Chevrolet
 
AYN RAND Translations
AYN RAND TranslationsAYN RAND Translations
AYN RAND TranslationsAnochi.com.
 
Fortune 100 Procurement Practices: What every company needs to know about pro...
Fortune 100 Procurement Practices: What every company needs to know about pro...Fortune 100 Procurement Practices: What every company needs to know about pro...
Fortune 100 Procurement Practices: What every company needs to know about pro...Michaelle Gocko
 
You're on google+, now what?
You're on google+, now what?You're on google+, now what?
You're on google+, now what?Ray Hiltz
 
Overcome regulatory data retention challenges
Overcome regulatory data retention challengesOvercome regulatory data retention challenges
Overcome regulatory data retention challengesBryant Bell
 
1949-2015 בחירות
 1949-2015 בחירות 1949-2015 בחירות
1949-2015 בחירותAnochi.com.
 

Destacado (20)

2 feed black box to forecast hazard Analysis Critical Control Points
2 feed black box to forecast hazard Analysis Critical Control Points2 feed black box to forecast hazard Analysis Critical Control Points
2 feed black box to forecast hazard Analysis Critical Control Points
 
Snsのメリットとは
SnsのメリットとはSnsのメリットとは
Snsのメリットとは
 
Trabajo de tic (conte)
Trabajo de tic (conte)Trabajo de tic (conte)
Trabajo de tic (conte)
 
Water Outlook 2030
Water Outlook 2030Water Outlook 2030
Water Outlook 2030
 
Sakutei ki
Sakutei kiSakutei ki
Sakutei ki
 
Bastiat inhebrew
Bastiat inhebrewBastiat inhebrew
Bastiat inhebrew
 
2011 Volvo of English Creek XC90 Egg Harbor Township NJ
2011 Volvo of English Creek XC90 Egg Harbor Township NJ2011 Volvo of English Creek XC90 Egg Harbor Township NJ
2011 Volvo of English Creek XC90 Egg Harbor Township NJ
 
The Effects of SEO on Website Visitation
The Effects of SEO on Website VisitationThe Effects of SEO on Website Visitation
The Effects of SEO on Website Visitation
 
2010 Chevy Malibu Hybrid in El Paso, TX
2010 Chevy Malibu Hybrid in El Paso, TX2010 Chevy Malibu Hybrid in El Paso, TX
2010 Chevy Malibu Hybrid in El Paso, TX
 
Mobile Marketing 101
Mobile Marketing 101Mobile Marketing 101
Mobile Marketing 101
 
AYN RAND Translations
AYN RAND TranslationsAYN RAND Translations
AYN RAND Translations
 
Fortune 100 Procurement Practices: What every company needs to know about pro...
Fortune 100 Procurement Practices: What every company needs to know about pro...Fortune 100 Procurement Practices: What every company needs to know about pro...
Fortune 100 Procurement Practices: What every company needs to know about pro...
 
You're on google+, now what?
You're on google+, now what?You're on google+, now what?
You're on google+, now what?
 
Green cities elevated tower tank tree
Green cities elevated tower tank treeGreen cities elevated tower tank tree
Green cities elevated tower tank tree
 
Overcome regulatory data retention challenges
Overcome regulatory data retention challengesOvercome regulatory data retention challenges
Overcome regulatory data retention challenges
 
Company meeting aimee
Company meeting aimeeCompany meeting aimee
Company meeting aimee
 
Sean f commercev2
Sean f commercev2Sean f commercev2
Sean f commercev2
 
Waer through the lens of the ifm help desk and the investment
Waer through the lens of the ifm help desk and the investmentWaer through the lens of the ifm help desk and the investment
Waer through the lens of the ifm help desk and the investment
 
1949-2015 בחירות
 1949-2015 בחירות 1949-2015 בחירות
1949-2015 בחירות
 
09082010 gramina banks to mdgs
09082010 gramina banks to mdgs09082010 gramina banks to mdgs
09082010 gramina banks to mdgs
 

Similar a Buffer concept in the us health care

A New Real Time Clinical Decision Support System Using Machine Learning for C...
A New Real Time Clinical Decision Support System Using Machine Learning for C...A New Real Time Clinical Decision Support System Using Machine Learning for C...
A New Real Time Clinical Decision Support System Using Machine Learning for C...IRJET Journal
 
Proposed actions to improve waiting times at the emergency room
Proposed actions to improve waiting times at the emergency roomProposed actions to improve waiting times at the emergency room
Proposed actions to improve waiting times at the emergency roomXiomara Arias Fernandez
 
Presentationversino41520162halfpastmidnightfinalversion
Presentationversino41520162halfpastmidnightfinalversionPresentationversino41520162halfpastmidnightfinalversion
Presentationversino41520162halfpastmidnightfinalversionJames Nichols
 
Ed overcrowding
Ed overcrowdingEd overcrowding
Ed overcrowdingEM OMSB
 
Resuscitation from Severe Sepsis: do we need care bundles?
Resuscitation from Severe Sepsis: do we need care bundles?Resuscitation from Severe Sepsis: do we need care bundles?
Resuscitation from Severe Sepsis: do we need care bundles?International Fluid Academy
 
approaching infection outbreak in picu
approaching infection outbreak in picuapproaching infection outbreak in picu
approaching infection outbreak in picuFarhan Shaikh
 
16. #ifad219 report of fluid day spain (colomina)
16. #ifad219 report of fluid day spain (colomina)16. #ifad219 report of fluid day spain (colomina)
16. #ifad219 report of fluid day spain (colomina)International Fluid Academy
 
Large Language Models, No-Code, and Responsible AI - Trends in Applied NLP in...
Large Language Models, No-Code, and Responsible AI - Trends in Applied NLP in...Large Language Models, No-Code, and Responsible AI - Trends in Applied NLP in...
Large Language Models, No-Code, and Responsible AI - Trends in Applied NLP in...David Talby
 
accurate monitoring of intravascular fluid volume
accurate monitoring of intravascular fluid volumeaccurate monitoring of intravascular fluid volume
accurate monitoring of intravascular fluid volumePhilip Binkley MD, MPH
 
Atls; Advanced Trauma Life Support
Atls; Advanced Trauma Life SupportAtls; Advanced Trauma Life Support
Atls; Advanced Trauma Life SupportFaisalRawagah1
 
Synopsis Project 1
Synopsis Project 1Synopsis Project 1
Synopsis Project 1Neha Bhilare
 
Preoperative leukocytosis as predictor of intraabdominal injury in penetratin...
Preoperative leukocytosis as predictor of intraabdominal injury in penetratin...Preoperative leukocytosis as predictor of intraabdominal injury in penetratin...
Preoperative leukocytosis as predictor of intraabdominal injury in penetratin...Juan de Dios Díaz Rosales
 

Similar a Buffer concept in the us health care (20)

A New Real Time Clinical Decision Support System Using Machine Learning for C...
A New Real Time Clinical Decision Support System Using Machine Learning for C...A New Real Time Clinical Decision Support System Using Machine Learning for C...
A New Real Time Clinical Decision Support System Using Machine Learning for C...
 
Proposed actions to improve waiting times at the emergency room
Proposed actions to improve waiting times at the emergency roomProposed actions to improve waiting times at the emergency room
Proposed actions to improve waiting times at the emergency room
 
Presentationversino41520162halfpastmidnightfinalversion
Presentationversino41520162halfpastmidnightfinalversionPresentationversino41520162halfpastmidnightfinalversion
Presentationversino41520162halfpastmidnightfinalversion
 
Alternate Care Facility: Developing Medical Surge Capability in King County
Alternate Care Facility:  Developing Medical Surge Capability in King County Alternate Care Facility:  Developing Medical Surge Capability in King County
Alternate Care Facility: Developing Medical Surge Capability in King County
 
Ed overcrowding
Ed overcrowdingEd overcrowding
Ed overcrowding
 
Resuscitation from Severe Sepsis: do we need care bundles?
Resuscitation from Severe Sepsis: do we need care bundles?Resuscitation from Severe Sepsis: do we need care bundles?
Resuscitation from Severe Sepsis: do we need care bundles?
 
approaching infection outbreak in picu
approaching infection outbreak in picuapproaching infection outbreak in picu
approaching infection outbreak in picu
 
16. #ifad219 report of fluid day spain (colomina)
16. #ifad219 report of fluid day spain (colomina)16. #ifad219 report of fluid day spain (colomina)
16. #ifad219 report of fluid day spain (colomina)
 
Large Language Models, No-Code, and Responsible AI - Trends in Applied NLP in...
Large Language Models, No-Code, and Responsible AI - Trends in Applied NLP in...Large Language Models, No-Code, and Responsible AI - Trends in Applied NLP in...
Large Language Models, No-Code, and Responsible AI - Trends in Applied NLP in...
 
American Journal of Anesthesia & Clinical Research
American Journal of Anesthesia & Clinical ResearchAmerican Journal of Anesthesia & Clinical Research
American Journal of Anesthesia & Clinical Research
 
accurate monitoring of intravascular fluid volume
accurate monitoring of intravascular fluid volumeaccurate monitoring of intravascular fluid volume
accurate monitoring of intravascular fluid volume
 
Presentacion
PresentacionPresentacion
Presentacion
 
Atls; Advanced Trauma Life Support
Atls; Advanced Trauma Life SupportAtls; Advanced Trauma Life Support
Atls; Advanced Trauma Life Support
 
Presentacion
PresentacionPresentacion
Presentacion
 
A stitch in time saves nine
A stitch in time saves nineA stitch in time saves nine
A stitch in time saves nine
 
Synopsis Project 1
Synopsis Project 1Synopsis Project 1
Synopsis Project 1
 
Trauma
TraumaTrauma
Trauma
 
Acute Kidney Injury Essay
Acute Kidney Injury EssayAcute Kidney Injury Essay
Acute Kidney Injury Essay
 
Damage control resuscitation. history theory and technique
Damage control resuscitation.  history theory and techniqueDamage control resuscitation.  history theory and technique
Damage control resuscitation. history theory and technique
 
Preoperative leukocytosis as predictor of intraabdominal injury in penetratin...
Preoperative leukocytosis as predictor of intraabdominal injury in penetratin...Preoperative leukocytosis as predictor of intraabdominal injury in penetratin...
Preoperative leukocytosis as predictor of intraabdominal injury in penetratin...
 

Más de Business Innovation Research Development

Indicator of universal wage in post 2015 millennium development goals (MDGs) ...
Indicator of universal wage in post 2015 millennium development goals (MDGs) ...Indicator of universal wage in post 2015 millennium development goals (MDGs) ...
Indicator of universal wage in post 2015 millennium development goals (MDGs) ...Business Innovation Research Development
 
Prototyping Cash transfer in India for pro poor economic growth and empowerment
Prototyping Cash transfer in India for pro poor economic growth and empowermentPrototyping Cash transfer in India for pro poor economic growth and empowerment
Prototyping Cash transfer in India for pro poor economic growth and empowermentBusiness Innovation Research Development
 

Más de Business Innovation Research Development (20)

2013 UTTARAKHAND DISASTER IN HIMALAYA AND THE GIANT FLOOD IN MOUNTAIN
2013 UTTARAKHAND DISASTER IN HIMALAYA AND THE GIANT FLOOD IN MOUNTAIN2013 UTTARAKHAND DISASTER IN HIMALAYA AND THE GIANT FLOOD IN MOUNTAIN
2013 UTTARAKHAND DISASTER IN HIMALAYA AND THE GIANT FLOOD IN MOUNTAIN
 
Indicator of universal wage in post 2015 millennium development goals (MDGs) ...
Indicator of universal wage in post 2015 millennium development goals (MDGs) ...Indicator of universal wage in post 2015 millennium development goals (MDGs) ...
Indicator of universal wage in post 2015 millennium development goals (MDGs) ...
 
Prototyping Cash transfer in India for pro poor economic growth and empowerment
Prototyping Cash transfer in India for pro poor economic growth and empowermentPrototyping Cash transfer in India for pro poor economic growth and empowerment
Prototyping Cash transfer in India for pro poor economic growth and empowerment
 
Use of af vs in gao strategy
Use of af vs in gao strategyUse of af vs in gao strategy
Use of af vs in gao strategy
 
Uncc 2013 2 nd scientific conferencebonn dldd-
Uncc 2013 2 nd scientific conferencebonn  dldd-Uncc 2013 2 nd scientific conferencebonn  dldd-
Uncc 2013 2 nd scientific conferencebonn dldd-
 
Why a dam building is profitable
Why a dam building is profitableWhy a dam building is profitable
Why a dam building is profitable
 
Electrical car- sustainable development -carbon foot print - innovation
Electrical car- sustainable development -carbon foot print - innovationElectrical car- sustainable development -carbon foot print - innovation
Electrical car- sustainable development -carbon foot print - innovation
 
3 d simulation for the ravine sediment accumulation
3 d simulation for the ravine sediment accumulation3 d simulation for the ravine sediment accumulation
3 d simulation for the ravine sediment accumulation
 
Technology transfer versus environment leadership
Technology transfer versus environment leadershipTechnology transfer versus environment leadership
Technology transfer versus environment leadership
 
Costs of oil impacts and equilibrium of oil price
Costs of oil impacts and equilibrium of oil priceCosts of oil impacts and equilibrium of oil price
Costs of oil impacts and equilibrium of oil price
 
Mutecos 2 airbus innovation industry project excellence
Mutecos 2  airbus innovation industry project excellenceMutecos 2  airbus innovation industry project excellence
Mutecos 2 airbus innovation industry project excellence
 
Appplied art in tsunami coastal early warning system and preparedness
Appplied art in tsunami coastal early warning system and preparednessAppplied art in tsunami coastal early warning system and preparedness
Appplied art in tsunami coastal early warning system and preparedness
 
Islands as witness of changes in the quaternary
Islands as witness of changes in the quaternaryIslands as witness of changes in the quaternary
Islands as witness of changes in the quaternary
 
10272010 rfid network as early warning system (gs radjou)
10272010 rfid network as early warning system (gs radjou)10272010 rfid network as early warning system (gs radjou)
10272010 rfid network as early warning system (gs radjou)
 
Technology pole against tsunamis
Technology pole against tsunamisTechnology pole against tsunamis
Technology pole against tsunamis
 
09082010 gramina banks to mdgs
09082010 gramina banks to mdgs09082010 gramina banks to mdgs
09082010 gramina banks to mdgs
 
10102010 basic hazard management
10102010 basic hazard management10102010 basic hazard management
10102010 basic hazard management
 
09262010 micro leadtimes and influence on the quality of work
09262010 micro leadtimes and influence on the quality of work09262010 micro leadtimes and influence on the quality of work
09262010 micro leadtimes and influence on the quality of work
 
0910 s010 new flood screen protection
0910 s010 new flood screen protection0910 s010 new flood screen protection
0910 s010 new flood screen protection
 
0910 s010 new flood screen protection
0910 s010 new flood screen protection0910 s010 new flood screen protection
0910 s010 new flood screen protection
 

Último

Education and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptxEducation and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptxraviapr7
 
Clinical Pharmacy Introduction to Clinical Pharmacy, Concept of clinical pptx
Clinical Pharmacy  Introduction to Clinical Pharmacy, Concept of clinical pptxClinical Pharmacy  Introduction to Clinical Pharmacy, Concept of clinical pptx
Clinical Pharmacy Introduction to Clinical Pharmacy, Concept of clinical pptxraviapr7
 
General views of Histopathology and step
General views of Histopathology and stepGeneral views of Histopathology and step
General views of Histopathology and stepobaje godwin sunday
 
The basics of sentences session 10pptx.pptx
The basics of sentences session 10pptx.pptxThe basics of sentences session 10pptx.pptx
The basics of sentences session 10pptx.pptxheathfieldcps1
 
CapTechU Doctoral Presentation -March 2024 slides.pptx
CapTechU Doctoral Presentation -March 2024 slides.pptxCapTechU Doctoral Presentation -March 2024 slides.pptx
CapTechU Doctoral Presentation -March 2024 slides.pptxCapitolTechU
 
3.21.24 The Origins of Black Power.pptx
3.21.24  The Origins of Black Power.pptx3.21.24  The Origins of Black Power.pptx
3.21.24 The Origins of Black Power.pptxmary850239
 
Patient Counselling. Definition of patient counseling; steps involved in pati...
Patient Counselling. Definition of patient counseling; steps involved in pati...Patient Counselling. Definition of patient counseling; steps involved in pati...
Patient Counselling. Definition of patient counseling; steps involved in pati...raviapr7
 
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdf
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdfMaximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdf
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdfTechSoup
 
The Stolen Bacillus by Herbert George Wells
The Stolen Bacillus by Herbert George WellsThe Stolen Bacillus by Herbert George Wells
The Stolen Bacillus by Herbert George WellsEugene Lysak
 
5 charts on South Africa as a source country for international student recrui...
5 charts on South Africa as a source country for international student recrui...5 charts on South Africa as a source country for international student recrui...
5 charts on South Africa as a source country for international student recrui...CaraSkikne1
 
Patterns of Written Texts Across Disciplines.pptx
Patterns of Written Texts Across Disciplines.pptxPatterns of Written Texts Across Disciplines.pptx
Patterns of Written Texts Across Disciplines.pptxMYDA ANGELICA SUAN
 
Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.EnglishCEIPdeSigeiro
 
Philosophy of Education and Educational Philosophy
Philosophy of Education  and Educational PhilosophyPhilosophy of Education  and Educational Philosophy
Philosophy of Education and Educational PhilosophyShuvankar Madhu
 
DUST OF SNOW_BY ROBERT FROST_EDITED BY_ TANMOY MISHRA
DUST OF SNOW_BY ROBERT FROST_EDITED BY_ TANMOY MISHRADUST OF SNOW_BY ROBERT FROST_EDITED BY_ TANMOY MISHRA
DUST OF SNOW_BY ROBERT FROST_EDITED BY_ TANMOY MISHRATanmoy Mishra
 
Practical Research 1 Lesson 9 Scope and delimitation.pptx
Practical Research 1 Lesson 9 Scope and delimitation.pptxPractical Research 1 Lesson 9 Scope and delimitation.pptx
Practical Research 1 Lesson 9 Scope and delimitation.pptxKatherine Villaluna
 
How to Make a Field read-only in Odoo 17
How to Make a Field read-only in Odoo 17How to Make a Field read-only in Odoo 17
How to Make a Field read-only in Odoo 17Celine George
 
Prescribed medication order and communication skills.pptx
Prescribed medication order and communication skills.pptxPrescribed medication order and communication skills.pptx
Prescribed medication order and communication skills.pptxraviapr7
 

Último (20)

Education and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptxEducation and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptx
 
Clinical Pharmacy Introduction to Clinical Pharmacy, Concept of clinical pptx
Clinical Pharmacy  Introduction to Clinical Pharmacy, Concept of clinical pptxClinical Pharmacy  Introduction to Clinical Pharmacy, Concept of clinical pptx
Clinical Pharmacy Introduction to Clinical Pharmacy, Concept of clinical pptx
 
General views of Histopathology and step
General views of Histopathology and stepGeneral views of Histopathology and step
General views of Histopathology and step
 
The basics of sentences session 10pptx.pptx
The basics of sentences session 10pptx.pptxThe basics of sentences session 10pptx.pptx
The basics of sentences session 10pptx.pptx
 
CapTechU Doctoral Presentation -March 2024 slides.pptx
CapTechU Doctoral Presentation -March 2024 slides.pptxCapTechU Doctoral Presentation -March 2024 slides.pptx
CapTechU Doctoral Presentation -March 2024 slides.pptx
 
3.21.24 The Origins of Black Power.pptx
3.21.24  The Origins of Black Power.pptx3.21.24  The Origins of Black Power.pptx
3.21.24 The Origins of Black Power.pptx
 
Finals of Kant get Marx 2.0 : a general politics quiz
Finals of Kant get Marx 2.0 : a general politics quizFinals of Kant get Marx 2.0 : a general politics quiz
Finals of Kant get Marx 2.0 : a general politics quiz
 
Patient Counselling. Definition of patient counseling; steps involved in pati...
Patient Counselling. Definition of patient counseling; steps involved in pati...Patient Counselling. Definition of patient counseling; steps involved in pati...
Patient Counselling. Definition of patient counseling; steps involved in pati...
 
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdf
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdfMaximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdf
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdf
 
The Stolen Bacillus by Herbert George Wells
The Stolen Bacillus by Herbert George WellsThe Stolen Bacillus by Herbert George Wells
The Stolen Bacillus by Herbert George Wells
 
5 charts on South Africa as a source country for international student recrui...
5 charts on South Africa as a source country for international student recrui...5 charts on South Africa as a source country for international student recrui...
5 charts on South Africa as a source country for international student recrui...
 
Patterns of Written Texts Across Disciplines.pptx
Patterns of Written Texts Across Disciplines.pptxPatterns of Written Texts Across Disciplines.pptx
Patterns of Written Texts Across Disciplines.pptx
 
Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.
 
Philosophy of Education and Educational Philosophy
Philosophy of Education  and Educational PhilosophyPhilosophy of Education  and Educational Philosophy
Philosophy of Education and Educational Philosophy
 
DUST OF SNOW_BY ROBERT FROST_EDITED BY_ TANMOY MISHRA
DUST OF SNOW_BY ROBERT FROST_EDITED BY_ TANMOY MISHRADUST OF SNOW_BY ROBERT FROST_EDITED BY_ TANMOY MISHRA
DUST OF SNOW_BY ROBERT FROST_EDITED BY_ TANMOY MISHRA
 
Practical Research 1 Lesson 9 Scope and delimitation.pptx
Practical Research 1 Lesson 9 Scope and delimitation.pptxPractical Research 1 Lesson 9 Scope and delimitation.pptx
Practical Research 1 Lesson 9 Scope and delimitation.pptx
 
Personal Resilience in Project Management 2 - TV Edit 1a.pdf
Personal Resilience in Project Management 2 - TV Edit 1a.pdfPersonal Resilience in Project Management 2 - TV Edit 1a.pdf
Personal Resilience in Project Management 2 - TV Edit 1a.pdf
 
Prelims of Kant get Marx 2.0: a general politics quiz
Prelims of Kant get Marx 2.0: a general politics quizPrelims of Kant get Marx 2.0: a general politics quiz
Prelims of Kant get Marx 2.0: a general politics quiz
 
How to Make a Field read-only in Odoo 17
How to Make a Field read-only in Odoo 17How to Make a Field read-only in Odoo 17
How to Make a Field read-only in Odoo 17
 
Prescribed medication order and communication skills.pptx
Prescribed medication order and communication skills.pptxPrescribed medication order and communication skills.pptx
Prescribed medication order and communication skills.pptx
 

Buffer concept in the us health care

  • 1. USA BUFFER IN THE HEALTHCARE IS STUDIED BY VARIOUS AUTHORS (PRACTIONEERS AND ACADEMICS) FROM DIFFERENT COUNTRIES. THE GOAL IS TO REDUCE LONG TIME DELAY (REDUCE QUEING) IN THE HEALTHCARE INDUSTRY (THUS REDUCING DEATH RATIO DUE TO HOSPITAL DIVERSTION STATUS ). RELEVANT LESSONS LEARNED WOULD SERVED AS A MODEL WORLDWIDE MYSELF, I AM INTERESTING WITH THIS STUDIES AS FINDING FOR AN APPROPRIATE MODEL TO RAPIDE RESPONSE AS A MEAN OF OVERALL FLOOD RISK REDUCTION AND THE COUPLING/GAP BETWEEN FORCASTED COSTS OF ADAPTION STRATEGIES AND MITIGATIONS WITH WEATHER AND HYDROLOGY FORECASTS. IN THE PROJECT WAER I DEVELOPPED POSTERIOR TO THE MBA PROJECT WAER (POST WAER PROJECT). THE SEASIDE FRONT - ALSO, I CALLED IT SEAFRONT, WHICH IS AT THE JUNCTION BETWEEN 2 MEDIA -MEDIUM 1: SEA WATER AND MEDIUM 2: THE LAND- IT IS SIMILAR TO A BUFFER. THEREFORE MY BUFFER MODEL FOR COST ASSESSMENT IN ANTICIPATORY MANAGEMENT OF WATER HAZARDS WITH FORECASTED WEATHER IS TECHNICALLY ABOUT LEAD-TIME REDUCTIONS. THE KNOWLEDGE OF THE BUFFER CHARACTERISTICS CAN IMPACT THE FUTURE OF THE REGION RESCUE ORGANIZATION WITH LESS RESSOURCE ALLOCATIONS. I HAVE BUILD MY PROCESS ON A REAL EVENT WITH THE MEDIA ATTENTION BASED ON THE XYNTHIA FLOOD IN VENDEE. GS RADJOU 5/07/2010
  • 2. So, I have developed a model looking like the US Healthcare buffer or it just a business buffer model applied to flood zones where Hi (with i= 0, 1 and 2)are water elevation chareteristics of the buffer. For example: H1, lower volume of water with sea tide is the lower limit of the tide H2= average water volume, which is an indicator for surge water height, and all buildings and infrastructures are build to the best of our knowledge to this surge water elevations. It is a prerequisite of flood defence systems in landlocked countries and the policy goal for helping the post recovery operations. -when H2 moves to H3, which is the critical value for inundating dangerously the flood prone regions-. These heights are monitored permanently of twice a day on a daily basis. Hi (H1, H2 and H3) are made by WMO through satellite detections or gauging stations and help to measure the cost of intervention in case of flood by anticipation with the coupling of weather forecast estimates. This buffer is a basic process with no unknown (policy 1).The model is a metaphore of an hospital model of the study where numbers of patients are replaced by Water heights of tides. Also, the community souls are known from council townhall registration office) If we know Hi (heights), which is predictable because of the forecasts and monitors -recorded twice per day-, we can assess the best policy in nearly real time for cost management of inundated regions and diagnostic a solution either in anticipatory management through the predictions or in emergency planning from observing data.
  • 3. BUFFER IS A BUZZWORD ITCAN BE FOUND IN ALL INDUSTRIES A TOOL FOR HOLDING PRODCUTION OF GOODS AND AVOID DISRUPTION OF THE SUPPLY CHAIN. CUSTOMER NEEDS ARE DELIVERED ON TIME EITHER THROUGH THE JUST IN TIME PRODUCTION THEY BUY ON ORDER AND THE FIRM SUPPLIES ON ORDER AND/OR THROUGH FORCASTED DEMAND. BUFFERS ARE HOLDINGS IN « C » language: reduce the number of system calls at the (small) expense of having a section of memory to store larger dat for read or write. Find also, in chemistry when a acidic solution is neutelize by a basic solution PH cannot varies in the Buffer zone Also, in economics, after the World War 2 germany calls foreign labors to buffer the lack of national labors. So, the buffer concept as seen as a stock keeper concept is regulate by a condition which is the variation of the stock value around a mean value and within value limits that are dfined by the resplenishment policy. Etc. In the case, I try to find (re-discover form the authors cited in the slide show the model (or seveval models), which could help to model interface between medium between water (during a flood) and the land. If I manage to find this appropriate model, I could link it to flood forecast). This would be my flood buffer. So at could organize the ressources and assess the costs for emergency, preparadness in flood treatment and post recovery operation. Knowing the quantity of water is the pond is like a black box GS RADJOU
  • 4. Cause: Holding Patients in Emergency Room Impact on triage to bed time Buffer: 5 patients/room Triage rduction : 24% -> 22% Prototyping a model ------> implementing worldwide? Test: discret event simulation for patient safety Diversion status Hospital Full New diversion status due to intial diversion status Higher Mortality rate for the diverted Source: Cowan and Trzeciak 2005; McCaig and Burt 2004, Andrulis et Al. 1991 Systemic Pb, Schneider et al. 2001 Ressource stress and waiting time GS RADJOU ambulance
  • 5. Perceived situation : More patients than staffed treatment beds and waiting time exceed reasonable periods Types of patients: - patients waiting for ED -patients under monitors in non treatment area -patient waiting for transfer to inpatient unit (IU) Issue: criteria for diversion status (very nebulous -Derlet, Richards and Kravitz 2001; Jones et al.2006; Hoot et al 2007) Crowding conditions (conditional indicators have been selected by Kolb, Lee and Peck 2007), if: 1- 100% if beds in ER fully occupied 2-queuing length >50% of ER Beds ( Note : By the way, I remember I read in Vocable magazine comparing 2 health systems in North America. The Canadian Social security is free for all but there are long delays when queuing for a therapy at the hospital. When somebody need a treatment it is faster to cross the US/Canadian border for the health services , but of course, it is a paying service) GS RADJOU
  • 6. Influencing factors for patient flows: PATIENT FLOWS INFLUX THROUGHOUPUT OUTFLUX Sources Products Old Patients increased in numbers More emergency medical needs Emergency Department Source: Mcaig and Burt 2004; Cowan and Trezeciak 2005
  • 7. Time to enter : influx time (Ti) Time spend in the emergency department: throughput time (Ts) Time to go out: outflux time (To) T i T o Ts' Ts'' Ts' is the real time spent for the cure Ts' = Ts'' - (Ti+To) Uncertainties on throughput times ISSUE ABOUT ACCESS TO HEALTH IS TIME. (TIME UNCERTAINTY) (Ts'' – Ts')
  • 8. PROJECT CONCEPTS FLOOD CONCEPT BUFFER CONCEPT RIPARIAN CONCEPT HYDROGRAPH
  • 9. UNCERTAINTY ON THROUGHPUT TIMES INFLUENCE SOURCES T s Infrastructure layout (issue with walking distance) Communication Promotion TRIAGE REGISTRATION Note : In Project, I have suspected that promotion is th main factor of water poisoning. In fact what the service should make is to study the 4Ps marketing rule. I have illustrated with the example of the Canadian Health that price has nothing to make for buying a health service. There is also, a second dimension in Health service which is the time to supply these service and people are willing to pay for time. Also, communication promotion is a driver of speed of changes. Bertoty 2007 Subash 2004 (under research) Miro et al 2003
  • 10. TESTS FOR LOW ACUITY CASES WITH FAST TRACK ELECTONIC SYSTEMS (Garcia 1995; Peck et al . 2008) PATIENT OUTFLOWS Note: the use of electronic Speed-up the patient out flow for low acuity cases. The hospital are like supermarkets With fast tills or with selfpaying automated machined where the customer process himself the provisions Traditional medical treatment versus electonical treatment of patient are competing and reduce the throughtput time for low acuity cases
  • 11. OVERCROWDING CONDITIONS (Qualitative and quantitative) Emergency Department (ED) Sources: Schull et al 2003 Foster et al 2003 Rathlev et al 2007 US GAO 2003
  • 12. ED IU INFLOW OUTFLOW 1RST BACKLOG INVESTIGATION RESULTS Source: Kolb, Lee and Peck (2007) Normally, the backlog should serve the investigation in determined in which step of the process between ED and IU, the Patient congestion (time delays and queueing is important° AND IF backlog is F (IU) -> it is the bottleneck Back log = F (IU) ED : Emergency Department ER : Emergency Room IU : Inpatient Unit
  • 13. Problem of time delay of Patient Is located between ER and IU The slowest service gives the speed for all the department Which is unfair for patient waiting to be treated -> goal would be to find a solution at this level if the hospital want to avoid diversion status and reduce deaths My qualitative Solution: « Pseudo Bison futé »: -No diversion cause of deads -Forecast IU frequentation -improve IU -buy new machines -trained staff -motivation -health policy -treatment can be diverted in the ED itself by rorganizing the service either people or influences
  • 14. CROWDING MEASURES AND UNCERTAINTIES ON MEASURES SPEED UP PATIENT IU-INFLOW HOW? WHEN? WHO? IU-INFLOW = ED-OUTFLOW Yancer et al 2007 Solutions Uncertainty Author names Principles UTILIZATION OF IU AS WAITNG ROOM INSTEAD OF ED. FALSE DECONGESTION VERSUS REAL DECONGESTION Greene 2007 How to improve is unclear (who, what, why, when, where, how, characteristics, frequency, etc. GOOD TO REDUCE CROWDING Richardson, Dick, Schneider 2007
  • 15. CONCEPTUAL MODEL OF US HEALTHCARE (KOLB 2008) ACQUISITION OF KNOWLEDGE: 1° OBSERVING THE ENVIRONMENT (US HOSPITAL SUBURBAN AREA, ONE MILE FROM THE HIGHWAY) 2° DATA GATHERING ABOUT: Beds => 24 adult ER beds => 8 pediatric ER beds, and => 4 fast-track beds Rooms: => 2 X ray rooms, => 3 triage rooms, and => 2 registration rooms. (Unvisible details) => interview staffs + mangers helps to understand ED process in theory and practice and, which aspect is needed for the simulation (modelling)
  • 16. Branching points BASIC MODEL (ED-IU SYSTEM)
  • 17. DETAILED MODEL Influx channels Front start Front end Fast track Adult ER IU Diagnostic Pediatric ER Greeter Waiting area Triage room
  • 18. DETAILED MODEL OF THE AUTHORS
  • 20. APLLIED SCENARIO TO XANTHIA FLOOD RISK REDUCTION BASIC MODEL
  • 21. H° Average sea tide H ¹ Surge tide Surge water Inundated land H ² Disaster tide GS RADJOU SCENARIO BUFFER XANTHIA
  • 22. PROJECT GLOBAL ARCHITECTURE (Requirement and specifications)
  • 23. LEVEL ONE FLOATING SCREEN (like a wrap in standy) WASTE SCREEN WATER INFILTRATIONS WATER ELIMINATION DRAINAGE CONTROL DEBORDEMENT 2ND PROTECTION WITH PLANTED TREES ELEVATED TOWER MODEL ONE (for the new urbanism) -the dock and the elevated building- The dock side WALL (Optional) Or stands to support the floating screen when in deployment CANAL OR TUNNEL Water stock zone Impervious surfaces ( or saturated soil create the flood zone) Protection levels from flood (flood wall) Buildings, shelters, dry feets GS RADJOU Global architecture
  • 24. MODEL TWO: LEAVE WATER TO ITS OWN EXPANSION = NO WALL, NO SCREEN BUT... RIVER FLOWS INUNDATION Monitoring stations Flood zone Pool for Evacuation drainage FLOOD ZONE RIVER LAND DEMARCATION LINE
  • 26. 22 m 60 m 32 m PROJECT SKETCH VARIATION SIMILAR BARCELONA SEA FRONT (LE PASSEIG COLOM ET LE MOLL DE LA FUSTA) [1] SEA TREE ZONE TREE ZONE ELEVATION HOUSE CANAL TUNNEL [1] Exact detailed of the seafront drawning in L »urbanisme végétal, Institut pour le dévelopment forestier, Caroline Stefulesco, Collection Mission du Paysage GS RADJOU Adaptation strategy No screen, no wall,only planting trees and elevation house in flood prone region b
  • 27. SEA FRONT CONFIGURATION VARIATION [2] For details of the Front sea Archachon Le Parc Pereire, see page 194 of the book L'urbanisme végétale, Caroline stefulesco SEA LAND (TREE ZONE)