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A simulation tool for better management of retinal services
摘要： Background: Advances in the management of retinal diseases have been fast-paced as new treatments become available, resulting in increasing numbers of patients receiving treatment in hospital retinal services. These patients require frequent and long-term follow-up and repeated treatments, resulting in increased pressure on clinical workloads. Due to limited clinic capacity, many National Health Service (NHS) clinics are failing to maintain recommended follow-up intervals for patients receiving care. As such, clear and robust, long term retinal service models are required to assess and respond to the needs of local populations, both currently and in the future. Methods: A discrete event simulation (DES) tool was developed to facilitate the improvement of retinal services by identifying efficiencies and cost savings within the pathway of care. For a mid-size hospital in England serving a population of over 500,000, we used 36 months of patient level data in conjunction with statistical forecasting and simulation to predict the impact of making changes within the service. Results: A simulation of increased demand and a potential solution of the ‘Treat and Extend’ (T&E) regimen which is reported to result in better outcomes, in combination with virtual clinics which improve quality, effectiveness and productivity and thus increase capacity is presented. Without the virtual clinic, where T&E is implemented along with the current service, we notice a sharp increase in the number of follow-ups, number of Anti-VEGF injections, and utilisation of resources. In the case of combining T&E with virtual clinics, there is a negligible (almost 0%) impact on utilisation of resources. Conclusions: Expansion of services to accommodate increasing number of patients seen and treated in retinal services is feasible with service re-organisation. It is inevitable that some form of initial investment is required to implement service expansion through T&E and virtual clinics. However, modelling with DES indicates that such investment is outweighed by cost reductions in the long term as more patients receive optimal treatment and retain vision with better outcomes. The model also shows that the service will experience an average of 10% increase in surplus capacity.
关键词： Virtual clinics,Retinal services,Discrete event simulation,Treat and extend,Patient flow modelling
更新于2025-09-11 14:15:04
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[IEEE 2018 IEEE 14th International Conference on Automation Science and Engineering (CASE) - Munich, Germany (2018.8.20-2018.8.24)] 2018 IEEE 14th International Conference on Automation Science and Engineering (CASE) - Simulation-based Performance Assessment of Tool Requalification Strategies in Wafer Fabs
摘要： In this paper, we discuss requalification strategies for stepper tools in semiconductor wafer fabrication facilities (wafer fabs). Before processing lots on steppers, the steppers have to be qualified. A mathematical programming formulation is used periodically to determine appropriate qualification plans. These plans will be implemented at the shop-floor. Dur-ing consecutive planning epochs, certain already established qualifications of steppers can be canceled, for instance, due to stepper breakdowns. We study the performance of several re-qualification strategies in this situation. Therefore, we use a discrete-event simulation framework that allows for applying the mathematical programming formulation in a rolling hori-zon manner and for performing the requalification strategies while the production is executed in the simulation. We demon-strate by designed simulation experiments that some of the pro-posed strategies perform well with respect to throughput and cycle time while requiring only a low additional qualification effort.
关键词： semiconductor wafer fabrication,mathematical programming,discrete-event simulation,requalification strategies,stepper tools
更新于2025-09-04 15:30:14