Cildoz Esquíroz, Marta
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Cildoz Esquíroz
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Marta
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Estadística, Informática y Matemáticas
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Publication Open Access Accumulating priority queues versus pure priority queues for managing patients in emergency departments(Elsevier, 2019) Cildoz Esquíroz, Marta; Ibarra, Amaia; Mallor Giménez, Fermín; Institute of Smart Cities - ISCImproving the quality of healthcare in emergency departments (EDs) is at the forefront of many hospital managers’ efforts, as they strive to plan and implement better patient flow strategies. In this paper, a new approach to manage the patient flow in EDs after triage is proposed. The new queue discipline, named accumulative priority queue with finite horizon and denoted by APQ-h, is an extension of the accumulative priority queue (APQ) discipline that considers not only the acuity level of patients and their waiting time but also the stage of the healthcare treatment. APQ disciplines have been studied in the literature from a queueing theory point of view, which requires assumptions rarely found in real EDs, such as homogeneity in the patient arrival pattern and only one service stage. The APQ-h discipline accumulates priority from the point of waiting for the first physician consultation until the moment the waiting time exceeds the upper time limit set to access the physician after the patient's arrival. A recent study shows that a management strategy of this type is applied in practice in several Canadian EDs. The main aim of this paper is to explore the implementation of APQ-h managing policies in a real ED. For this purpose, a simulation model replicating a real ED is developed. This simulation model is also used to obtain the optimal APQ type polices through a simulation-based optimization method that solves a multi-objective and stochastic optimization problem. Arrival to provider time and total waiting time in the ED are considered to be the key ED performance indicators. An extensive computational analysis shows the flexibility of the APQ-h and APQ discipline and their superiority over other pure priority disciplines in a real setting and in a variety of ED scenarios. In addition, no superiority over the APQ discipline is demonstrated. © 2019 The AuthorsPublication Open Access Coping with stress in emergency department physicians through improved patient-flow management(Elsevier, 2020) Cildoz Esquíroz, Marta; Ibarra, Amaia; Mallor Giménez, Fermín; Estatistika, Informatika eta Matematika; Institute of Smart Cities - ISC; Estadística, Informática y MatemáticasThis paper provides a method for the real-time monitoring of job stress in emergency department (ED) physicians. It is implemented in a Decision Support System (DSS) designed for patient-to-physician assignment after triage. Our concept of job stress includes not only the workload but also time pressure and uncertainty. A job stress function is estimated based on the consensus views of ED physicians obtained through a novel methodology involving stress factor analysis, questionnaire design, and the statistical analysis of expert opinions. The resulting stress score enables the assessment of job stress using workload data from the ED physicians’ whiteboard. These data can be used for the real-time measurement and monitoring of ED physician job stress in a stochastic and dynamic environment, which is the main novelty of this method as compared to previous workload and stress measurement proposals. A further advantage of this methodology is that it is general enough to be adapted to physician job stress monitoring in any ED. The use of the DSS for ED patient-flow management reduces job stress and spreads it more evenly among the whole team of physicians, while also improving other important ED performance measures such as arrival-to-provider time and the percentage of compliance with patient waiting time targets. A case study illustrates the application of the methodology for the construction of a stress-score, the monitoring of physician stress levels, and ED patient-flow management.Publication Open Access I Congreso Salud, Desastres y Desarrollo Sostenible: libro congreso(2022) Azcárate Camio, Cristina; Cildoz Esquíroz, Marta; Frías Paredes, Laura; Ibarra, Amaia; Galbete Jiménez, Arkaitz; García de Vicuña Bilbao, Daniel; Gastón Romeo, Martín; Moler Cuiral, José Antonio; Mallor Giménez, Fermín; Jean Louis, Clint; Institute of Smart Cities - ISCEl congreso se plantea como un foro de encuentro de investigadores del área de Investigación Operativa con interés en aplicaciones a la salud, los desastres y el desarrollo sostenible, y los profesionales de la toma de decisiones concernientes a los ámbitos anteriores. Este encuentro promueve el intercambio de conocimiento y experiencias entre Universidad y Servicios de Salud para afrontar retos asociados al acceso de la población a unos servicios de salud de calidad y a la gestión del riesgo creciente de desastres naturales o provocados por el ser humano. El envejecimiento de la población y el desarrollo tecnológico plantean nuevos entornos para la provisión de los servicios de salud, en los que su correcta planificación y gestión debe contribuir a garantizar su eficiencia y sostenibilidad. El creciente impacto en términos de vidas humanas y daños económicos causados por desastres naturales y no naturales, como incendios, inundaciones, terremotos, fugas industriales, pandemias, etc. precisa de su comprensión para desarrollar estrategias de prevención y elaborar planes efectivos de respuesta.Publication Open Access Necesidad de un enfoque holístico y cuantitativo para el diagnóstico y mejora de los servicios de urgencia hospitalarios(Gobierno de Navarra, 2018) Mallor Giménez, Fermín; Cildoz Esquíroz, Marta; Ibarra, Amaia; Institute of Smart Cities - ISCCarta al editor a raíz del artículo ‘Una propuesta de modelo fisiológico de servicio de urgencias hospitalario. Principios de funcionamiento, tipificación de la saturación y pautas para el rediseño’ y réplica de los autores del mismo.