Mary Washington Hospital

About: Mary Washington Hospital is a healthcare organization based out in Fredericksburg, Virginia, United States. It is known for research contribution in the topics: Population & Health care. The organization has 47 authors who have published 54 publications receiving 2389 citations.

A survey of simulation optimization techniques and procedures

Abstract: Discrete event simulation optimization is a problem of significant interest to practitioners interested in extracting useful information about an actual (or yet to be designed) system that can be modeled using discrete event simulation. This paper presents a brief survey of the literature on discrete event simulation optimization over the past decade (1988 to the present). Swisher et al. (2000) provides a more comprehensive review of this topic while Jacobson and Schruben (1989) covers the literature preceding 1988. Optimization of both discrete and continuous input parameters are examined. The continuous input parameter case is separated into gradient and non-gradient based optimization procedures. The discrete input parameter case differentiates techniques appropriate for small and for large numbers of feasible input parameter values.

Discrete-event simulation of health care systems

Abstract: Over the past forty years, health care organizations have faced ever-increasing pressures to deliver quality care while facing rising costs, lower reimbursements, and new regulatory demands. Discrete-event simulation has become a popular and effective decision-making tool for the optimal allocation of scarce health care resources to improve patient flow, while minimizing health care delivery costs and increasing patient satisfaction. The proliferation of increasingly sophisticated discrete-event simulation software packages has resulted in a large number of new application opportunities, including more complex implementations. In addition, combined optimization and simulation tools allow decision-makers to quickly determine optimal system configurations, even for complex integrated facilities. This chapter provides an overview of discrete-event simulation modeling applications to health care clinics and integrated health care systems (e.g. hospitals, outpatient clinics, emergency departments, and pharmacies) over the past forty years.

Influence of triple-lumen central venous catheters coated with chlorhexidine and silver sulfadiazine on the incidence of catheter-related bacteremia

Abstract: Objective To evaluate the efficacy of triple-lumen central venous catheters coated with a combination product of chlorhexidine and silver sulfadiazine (CSS) in reducing the incidence of local catheter infection and catheter-related bacteremia. Design Randomized, controlled trial. Setting The surgical intensive care units in a university hospital. Patients All patients who needed central venous catheterization were randomized to receive either an uncoated triple-lumen catheter (n=157) or a catheter coated with CSS (n=151). Main Outcome Measure Catheters were removed when no longer needed or suspected as a cause of infection. The tip and a 5-cm segment of the intradermal portion of the catheter were cultured semiquantitatively. Blood cultures were obtained when clinically indicated. The remaining segment of catheters coated with CSS were cut and incubated on an agar plate with strains of Staphylococcus aureus and Enterococcus . Zone of inhibition was determined 24 hours later. Data were analyzed by survival and logistic multivariate regression methods. Results Catheters coated with CSS were effective in reducing the rate of significant bacterial growth on either the tip or intradermal segment (40%) compared with control catheters (52%; P =.04). However, there was no difference in the incidence of catheter-related bacteremia (3.8% [uncoated] vs 3.3% [coated]; P =.81). In vitro activity of catheters with CSS against S aureus was evident up to 25 days but activity against Enterococcus dissipated more quickly over time and was absent by day 4. The most common colonizing organisms were coagulase-negative staphylococcus and enterococcus. Variables that were associated with a significant amount of growth on the tip or intradermal segment were a duration of catheterization of longer than 7 days, jugular insertion site, and the absence of a CSS coating. The use of a guidewire when the catheter was removed was associated with a lower risk of significant bacterial growth. Conclusions The use of CSS reduces the incidence of significant bacterial growth on either the tip or intradermal segments of coated triple-lumen catheters but has no effect on the incidence of catheter-related bacteremia. In this patient population, catheters coated with CSS provide no additional benefit over uncoated catheters.