Publication Date
2016
Document Type
Dissertation
Committee Members
Frank Ciarallo (Committee Member), Jennie Gallimore (Committee Member), Nan Kong (Committee Member), Mary McCarthy (Committee Member), Parikh Prakik (Advisor)
Degree Name
Doctor of Philosophy (PhD)
Abstract
The efficacy of nurses is impacted by their availability to their patients and the occurrence of both beneficial and detrimental interruptions. Using system engineering tools, this work addresses open challenges in (i) methods for effective matching of nurse availability to non-stationary stochastic demand, (ii) differentiation of beneficial and detrimental interruptions, and (iii) modeling of nurses’ work with interruptions to provide an objective method of testing interruption interventions. First, we propose both qualitative and quantitative approaches to evaluate and then model the impact of resource scheduling on patient wait time in a Level I trauma center for a highly specialized nurse, the advanced practice provider (APP). Our findings revealed mismatches during evenings and weekends, which prompted the trauma manager to implement a schedule similar to one proposed by our model. This schedule reduced the patent wait time by over 73% at the cost of a 10.5% increase in APP hours. Applying a simulation-optimization approach, we obtained near-optimal schedules that reduced the wait time to over 78% with no increase in APP hours. Second, we proposed a novel patient-centered framework for classifying observed interruptions as detrimental or beneficial. We utilize a mixed-method approach that involved analysis of data collected via direct observation, surveys, and analysis of retrospective data for hands-free devices. With comfort and time as performance measures, we show that beneficial interruptions include those returning the nurse’s focus to the patient, and detrimental interruptions those breaking the delivery of steady treatment or attention to the patient. Finally, using this differentiation, we provide a model of nurse’s workflow with interruptions that captures the underlying stochastic, non-stationary nature of interruptions and their onset through actual observation of trauma center nurses. This model provides a deeper understanding of how interruptions develop from sources with unmet needs, and leads to an objective model based on discrete event simulation for testing interventions. Findings include the dynamics of interruption deferment on other activities, the need for focused interruption interventions rather than across-the-board strategies, and the ratio of beneficial to detrimental interruptions as a novel measure of nurses’ work that may be a useful measure in comparing interventions.
Page Count
114
Department or Program
Ph.D. in Engineering
Year Degree Awarded
2016
Copyright
Copyright 2016, some rights reserved. My ETD may be copied and distributed only for non-commercial purposes and may not be modified. All use must give me credit as the original author.
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
