Dataset Information

Where is my infusion pump? Harnessing network dynamics for improved hospital equipment fleet management.

ABSTRACT:

Objective

Timely availability of intravenous infusion pumps is critical for high-quality care delivery. Pumps are shared among hospital units, often without central management of their distribution. This study seeks to characterize unit-to-unit pump sharing and its impact on shortages, and to evaluate a system-control tool that balances inventory across all care areas, enabling increased availability of pumps.

Materials and methods

A retrospective study of 3832 pumps moving in a network of 5292 radiofrequency and infrared sensors from January to November 2017 at The Johns Hopkins Hospital in Baltimore, Maryland. We used network analysis to determine whether pump inventory in one unit was associated with inventory fluctuations in others. We used a quasi-experimental design and segmented regressions to evaluate the effect of the system-control tool on enabling safe inventory levels in all care areas.

Results

We found 93 care areas connected through 67,111 pump transactions and 4 discernible clusters of pump sharing. Up to 17% (95% confidence interval, 7%-27%) of a unit's pump inventory was explained by the inventory of other units within its cluster. The network analysis supported design and deployment of a hospital-wide inventory balancing system, which resulted in a 44% (95% confidence interval, 36%-53%) increase in the number of care areas above safe inventory levels.

Conclusions

Network phenomena are essential inputs to hospital equipment fleet management. Consequently, benefits of improved inventory management in strategic unit(s) are capable of spreading safer inventory levels throughout the hospital.

SUBMITTER: Martinez DA

PROVIDER: S-EPMC7647311 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:Current pain therapeutics offer inadequate relief to patients with chronic pain. A growing literature supports that pro-inflammatory cytokine signaling between immune, glial, and neural cells is integral to the development of pathological pain. Modulation of these communications may hold the key to improved pain management. In this review we first offer an overview of the relationships between pro-inflammatory cytokine and chemokine signaling and pathological pain, with a focus on the actions of cytokines and chemokines in communication between glia (astrocytes and microglia), immune cells (macrophages and T cells), and neurons. These interactions will be discussed in relation to both peripheral and central nervous system locations. Several novel non-neuronal drug targets for controlling pain are emerging as highly promising, including non-viral IL-10 gene therapy, which offer the potential for substantial pain relief through localized modulation of targeted cytokine pathways. Preclinical investigation of the mechanisms underlying the success of IL-10 gene therapy revealed the unexpected discovery of the powerful anti-nociceptive anti-inflammatory properties of D-mannose, an adjuvant in the non-viral gene therapeutic formulation. This review will include gene therapeutic approaches showing the most promise in controlling pro-inflammatory signaling via increased expression of anti-inflammatory cytokines like interleukin-10 (IL-10) or IL-4, or by directly limiting the bioavailability of specific pro-inflammatory cytokines, as with tumor necrosis factor (TNF) by the TNF soluble receptor (TNFSR). Approaches that increase endogenous anti-inflammatory signaling may offer additional opportunities for pain therapeutic development in patients not candidates for gene therapy. Promising novel avenues discussed here include the disruption of lymphocyte function-associated antigen (LFA-1) activity, antagonism at the cannabinoid 2 receptor (CB2R), and toll-like receptor 4 (TLR4) antagonism. Given the partial efficacy of current drugs, new strategies to manipulate neuroimmune and cytokine interactions hold considerable promise.

Project description:Cars have a high share of global transport-related CO2 emissions. To model the market diffusion of new energy carriers and powertrains like electric vehicles, fleet turnover models are commonly used. A decisive influence factor for the substitution dynamics of such transformations is the survival rate of the national car fleet of a country. It represents the likelihood of a car reaching a certain lifespan. Due to a lack of data, current methods to estimate such survival probabilities neglect the imports and exports of used cars. Existing studies are limited to countries with a predominant market of new cars, compared to low numbers of imported and exported used cars. In this study, we resolve this marked simplification and propose a new method to estimate survival probabilities for countries with a high number of imported and exported used cars. Empirical data on the car stock, on inflows of new and used cars, and on outflows of exported and scrapped cars are gathered from 71 national statistics offices. Survival rates of the car fleets of 31 European countries are derived, for which we find a pronounced regional variability. Average lifespans of cars vary from 8.0 to 35.1 years, with a mean of 18.1 years in Western and 28.4 years in Eastern European countries, revealing the high impact of cross-border flows of cars. The study also shows that survival rate estimates can be improved significantly even in the absence of reliable data if a combination of a Weibull and a Gaussian distribution is used. It is likely that the predictive power of existing models (regarding the future environmental impact of car fleets) could be improved significantly if these findings were considered accordingly. The findings of this study can directly be included in fleet turnover and policy assessment models. They also enable the analysis of economic and environmental spillover effects from the imports and exports of used cars between countries. Supplementary Information The online version contains supplementary material available at (10.1186/s12544-020-00464-0).

Project description:In this article, we present GE Healthcare's design philosophy and implementation of X-ray imaging systems with dose management for pediatric patients, as embodied in its current radiography and fluoroscopy and interventional cardiovascular X-ray product offerings. First, we present a basic framework of image quality and dose in the context of a cost-benefit trade-off, with the development of the concept of imaging dose efficiency. A set of key metrics of image quality and dose efficiency is presented, including X-ray source efficiency, detector quantum efficiency (DQE), detector dynamic range, and temporal response, with an explanation of the clinical relevance of each. Second, we present design methods for automatically selecting optimal X-ray technique parameters (kVp, mA, pulse width, and spectral filtration) in real time for various clinical applications. These methods are based on an optimization scheme where patient skin dose is minimized for a target desired image contrast-to-noise ratio. Operator display of skin dose and Dose-Area Product (DAP) is covered, as well. Third, system controls and predefined protocols available to the operator are explained in the context of dose management and the need to meet varying clinical procedure imaging demands. For example, fluoroscopic dose rate is adjustable over a range of 20:1 to adapt to different procedure requirements. Fourth, we discuss the impact of image processing techniques upon dose minimization. In particular, two such techniques, dynamic range compression through adaptive multiband spectral filtering and fluoroscopic noise reduction, are explored in some detail. Fifth, we review a list of system dose-reduction features, including automatic spectral filtration, virtual collimation, variable-rate pulsed fluoroscopic, grid and no-grid techniques, and fluoroscopic loop replay with store. In addition, we describe a new feature that automatically minimizes the patient-to-detector distance, along with an estimate of its dose reduction potential. Finally, two recently developed imaging techniques and their potential effect on dose utilization are discussed. Specifically, we discuss the dose benefits of rotational angiography and low frame rate imaging with advanced image processing in lieu of higher-dose digital subtraction.