Theses and Dissertations at Montana State University (MSU)
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Item A mental workload based patient scheduling model for an oncology clinic(Montana State University - Bozeman, College of Engineering, 2016) Huggins Davila, Anali Glamary; Chairperson, Graduate Committee: David ClaudioThe healthcare systems in the United States have faced competing challenges such as reducing costs and improving outcomes. Currently, the United States healthcare system is considered the most expensive in the world; 53% per capita more than the second-highest country. This study was focused on increasing resource productivity and efficiency in the healthcare system specifically at Bozeman Deaconess Cancer Center (BDCC) taking into consideration mental workload. The demand of the center has increased in approximately 16% each year since 2011. The BDCC strategic objectives are to improve the distribution and supply of resources, to maximize service coverage, to minimize waiting time of patients, and maximize service capacity. This research measured and validated mental workload in the infusion area of BDCC using two perceptual tools, NASA-TLX and SWAT, as well physiological responses. The purpose is to balance patient appointment and increase resource utilization. This study took into consideration the balance of human resource workload as a main part of the proposed model rather than only a mathematical solution balancing the capacity of the human resources without overloading them. A mathematical model was be developed and tested through a discrete event simulation to validate and explore the feasibility of the scheduling polices. In conclusion this thesis was able to successfully build a patient scheduling model considering nurses workload. It was proved that the model balanced patient appointments through the day by leveling the workload of nurses and pharmacists. Sensitivity analysis showed that the patient demand of the center could be increased up to 40% in some instances without negatively impacting patient service. This research is one of the first of its kind to include mental workload as a mathematical constraint in a scheduling model.Item Definition of alarm fatigue and its influence on staff performance(Montana State University - Bozeman, College of Engineering, 2014) Deb, Shuchisnigdha; Chairperson, Graduate Committee: David ClaudioAn alarm is a warning of an approaching situation which requires a response. This study considered the influences of alarms in the clinical health environment. The Emergency Care Research Institute considered alarm hazard as the number one health technology hazard for the years 2012 through 2014. The Joint Commission set a standard for all hospitals in the US to assess alarm fatigue in their monitoring process and to develop a systematic, coordinated approach to clinical alarm system management. In order to comply with this requirement, a working definition of alarm fatigue is necessary. To the very best of our knowledge, there have been no studies proposing a quantitative definition of alarm fatigue, a way to measure it, or exploring the influence of alarm fatigue on performance deterioration. This observational study undertook the objective of defining alarm fatigue and its role on performance deterioration in a quantitative way. A survey using a questionnaire proposed by the American College of Clinical Engineering Healthcare Technology Foundation was conducted before the observations to assess the attitude of nurses toward the existing alarm monitoring system at the hospital where the research took place. An extensive literature review and Hierarchical Task Analyses were conducted in order to reveal all the possible influencing factors behind alarm fatigue. From these, alarm fatigue was defined and measured in terms of mental workload and three types of affect: boredom, apathy, and distrust. A conceptual model was developed considering the significance of working conditions and staff individuality on alarm fatigue and, consequently, alarm fatigue on staff performance. Staff performance was measured in terms of response (yes/no), response time and number of ignored alarms. Several analytical approaches were performed to find association between alarm fatigue and staff performance. The results show that, in general, performance deterioration is actually influenced by a combination of alarm fatigue with working conditions and staff individuality. In the case of nurses and response time, alarm fatigue plays no role, only working conditions and staff individuality. These findings suggest that the role of alarm fatigue as a health hazard in the clinical environment should be reevaluated.