MATERIAL PLANNING AT OPERATING ROOMS: DESIGN OF A NEW APPOINTMENT SYSTEM USING BILL OF OPERATION CASE (BOC) AND AN APPLICATION

Yıl 2020, Cilt: 15 Sayı: 1, 335 - 349, 24.06.2020

Adem Tüzemen , Şevkinaz Gümüşoğlu

Öz

In the health sector, patients' satisfaction has started to gain an increasing importance. Hospital administrations should plan the activities carried out to minimize costs and financial losses in the most appropriate way. Surgical operations, which are the most important cost point of hospitals, have a critical importance in these plans.

The critical factor in an effective surgical operation is the effective and efficient use of hospital resources. Planning of operations involves strategic, tactical, and managerial planning problems. All these problems need to be optimized. The planning of the operating theaters covers a process from determining the date of admission to the date of surgery and subsequent hospitalization. In planning the operations, the physical capacities of the hospitals, operating rooms, surgeons, materials and equipment, bed capacity for each patient and intensive care units should be considered as a whole. Otherwise, there will be an increase in some cost items such as wasted time costs, costs resulting from the patient's treatment period, intervention costs, costs arising from operating room capacity usage, patient waiting times and other hospitals / doctors.

The purpose of this study; To rearrange the operation-based materials used in the operating rooms, to design the operating system operation recipes (AOR) with a modular and flexible structure that will provide effective inventory management and to establish the information infrastructure of an alternative appointment system.

The study includes an alternative bill to the surgery dates and appointment systems of all operator doctors in an exemplary university hospital. In this context, firstly, the Department of Obstetrics and Gynecology was selected for pilot practice, and the appointment systems of operator doctors working in this department were arranged, and then the material needs were determined according to the type of surgeries to be performed. Considering the improvements at this stage, a generalized system design has been created in which the department, doctor and surgery needs are considered to create operation recipes.

As a methodology, Using the historical data, the minimum - maximum material requirements were determined for each surgery, and Operating Operations Recipes (AOR) were prepared using the modular product trees in the light of the information obtained. The method of the study was also discussed with the chief physician and the work to be done was transferred, and after the project was accepted and their support was received, a formal assignment letter was prepared. Then, firstly, the problems of material management in the operating theater of the relevant university hospital were examined. In this examination, in order to determine how the system works and to understand the solutions, continuous observations were made for three months in the operating room depot; Interviews were conducted with warehouse employees, responsible nurses, duty nurses, support staff, operating room secretaries and other staff. To record the use of the material during on-site observations, photographs, video shots and audio recordings were made in some of the interviews.

The main reason for conducting this research is that the main reason for choosing the material management topic as the research is that although there is a large amount of money allocated to materials in both public and private sector hospitals, managers do not have sufficient knowledge about modern material management techniques and material management services are not carried out effectively. Since the Ministry of Health cannot fully and accurately determine how much resources hospitals use for medical supplies and medicines, they cannot make the necessary and appropriate decisions in policy making, planning and orientation studies in this field. It is necessary to establish a management information system that will allow the ministry and hospital managers to make the right decisions and to take corrective actions on time. With the establishment of such a system, when the needs are determined, since the correct data regarding the materials and drugs used by all units in the past can be reached on time, what material they have in their hands, and how the previous year's usage can be tracked, excessive need notification will be eliminated, and excessive demands of the units can be questioned immediately. The operating room will be made more specialized with the management information system. Thus, the amount of payment determined by each state and covered by the state can be determined almost certainly.

Effective order management will ensure that large quantities of materials purchased in bulk do not have inherited problems. Since the developed system performs instantaneous inventory control, no new order will be placed until the use of the amounts held. Based on the MRP logic, the amount of orders to be placed can also be determined depending on the consumption rate of the system. In this way, the administrations will both strengthen their hands in bulk purchases and will not keep inventories in the warehouse in quantities that may be inherited.

Thanks to the AOR model and the appointment system that operates on this model, it will be possible to prevent the problem of inheritance by monitoring the material to be produced, who wants, when and what it wants (purchase request) and why it is not used. In material distribution activities, all warehouse entrances and exits will be recorded in databases on time. The cost of the material, which is missing in the counts and cannot be used due to the expiration of the expiry date, may be invoiced to the responsible person if necessary. In addition, the necessary lists given to the purchasing unit and the people or units that cause the expiration of the expiry of the drug or materials by purchasing more than the need can be determined and necessary action can be taken about the relevant people.

AMELİYATHANELERDE MALZEME PLANLAMASI: AMELİYATHANE OPERASYON REÇETESİ (AOR) İLE YENİ RANDEVU SİSTEMİNİN TASARIMI VE BİR UYGULAMA

Öz

Sağlιk sektöründe özellikle hastalarιn memnuniyeti gittikçe artarak daha fazla önem kazanmaya başlamιştιr. Hastane yönetimleri bir yandan maliyetlerini ve finansal zararlarι en aza indirmek isterken diğer bir yandan da hasta memnuniyetini en yükseğe çιkarmayι istemektedirler. Ameliyatlar hastanelerde en önemli maliyet kalemlerinden biridir. Bir ameliyatιn efektif olmasιnda kritik olan unsur hastane kaynaklarιnιn etkin ve verimli kullanιlmasιdιr. Ameliyatlarιn planlanmasι, stratejik, taktiksel ve yönetimsel planlama problemlerini içerir. Bu çalιşmanın amacı; modüler ve esnek yapιya sahip bir ürün ağacι olan ameliyathane operasyon reçetelerini (AOR) tasarlayιp yeni bir yönetim bilişim sistemi geliştirerek, kullanιcιlara randevu sistemi ile cerrahi operasyonlarda kullanιlan malzemelerin planlanmasının ve tedarikinin sezgisel yöntemlerle değil gerçek verilerle yapιlabileceğini göstermektir. Önerilen bütünleşik bilişim sistemi ile ilgili uygulama çalιşmalarι Ege Bölgesi’nde hizmet veren bir üniversite hastanesinde gerçekleştirilmiştir. Geliştirilen sistemde AOR’ler, ameliyatlarda görev alan operatör doktorlarιn, kişisel tercih ve yeteneklerine göre seçim yapabileceği birleşik bir yapι şeklinde tasarlanmιş ve geliştirilen randevu sistemine aktarιlmιştιr. Bu sistem de hastanenin mevcut yönetim bilişim sistemine entegre edilerek, AOR’lerin uygulamaya geçmesi desteklenmektedir.

Anahtar Kelimeler

Ameliyathane Operasyon Reçetesi, Ameliyathane Randevu Sistemi, Hastane Bilişim Sistemi

Kaynakça

• Ak, B. (2009). Türkiye’de Sağlık Bilişimi, Bir Kişisel Değerlendirme ve Uluslararası Bir Başarı Öyküsü: Corttex. Akademik Bilişim’09 - XI. Akademik Bilişim Konferansı Bildirileri (Ss. 333-341), Harran Üniversitesi. Şanlıurfa. 11-13 Şubat 2009.
• Austin, C. J., Trimm, J. M., ve Sobczak, P. M. (1995). Information Systems And Strategic Management. Health Care Management Review, 20(3), 26-33.
• Beaulieu, M., Duhamel, C. ve Philippe, R. (2003). A Logistics Approach To Reorganizing An Operating Room. CHAINE Research Group, HEC Montréal. 1-10.
• Braa, J., Hanseth, O., Mohammed, W., Heywood, A. ve Shaw, V. (2007). Developing Health Information Systems In Developing Countries: The Flexible Standards Strategy. Mis Quarterly. 381-402.
• Cardoen, B., Demeulemeester, E. ve Beliën, J. (2011). Operating Room Planning And Scheduling Problems: A Classification Scheme. International Journal Of Health Management And Information. 1-21.
• Çakmakçı, M., (2001). Hastane İnfeksiyonları ve Hastane Tasarımı: Ameliyathanelerin Planlanması. Hastane İnfeksiyonları Dergisi. 5(3): 172-177.
• Çetinkaya Şardan, Y. (2005). Ameliyathanenin Yapılanması Nasıl Olmalıdır? 4. Ulusal Sterilizasyon Dezenfeksiyon Kongresi. 5-9.
• Effken, J. A. (2002). Different Lenses, Improved Outcomes: A New Approach To The Analysis And Design Of Healthcare Information Systems. International Journal Of Medical Informatics. 65(1): 59-74.
• Epstein, R. H., ve Dexter, F. (2000). Economic Analysis Of Linking Operating Room Scheduling And Hospital Material Management İnformation Systems For Just-In-Time İnventory Control. Anesthesia & Analgesia, 91(2), 337-343.
• Fera, M. ve Macchiaroli, R. (2010). A Proposal For A New Management Framework For Health Care Organizations. Simulation And Optimization.
• Fetter, R. B., Thompson, J. D. ve Mills, R. E. (1976). A System For Cost And Reimbursement Control In Hospitals. The Yale Journal Of Biology And Medicine, 49 (2), 123-136.
• Heeks, R. (2005). Health Information Systems: Failure, Success And Improvisation. International Journal Of Medical Informatics. 75(2): 125-137.
• Isık, O., Ve Akbolat, M. (2010). Bilgi Teknolojileri ve Hastane Bilgi Sistemleri Kullanımı: Saglık Çalısanları Üzerine Bir Arastırma [The Use Of İnformation Technology And Hospital İnformation Systems: A Study On Health Employees]. Information World, 11, 365-389.
• Kuhn, K. A. ve Giuse, D. A. (2001). From Hospital Information Systems To Health Information Systems. Methods Of Information İn Medicine, Schattauer Gmbh. 40(4): 275-287.
• Kuperman, G. J., Spurr, C., Flammini, S., Bates, D. ve Glaser, J. (2000). A Clinical Information Systems Strategy For A Large Integrated Delivery Network. Inproceedings Of The AMIA Symposium. Ss.438-442. American Medical Informatics Association.
• Lenz, R., Dring, Elstner, T., Phys, D., Siegele, H., Kuhn, K. A. ve Med. (2002). A Practical Approach To Process Support İn Health Information Systems. Journal Of The American Medical Informatics Association. 9(6):571-585.
• Macario, A., Vitez, T. S., Dunn, B. ve Mcdonald, T. (1995). Where Are The Costs İn Perioperative Care? Analysis Of Hospital Costs And Charges For Inpatient Surgical Care. American Society Of Anesthesiologists, Inc. 83(6): 1138-1144.
• Magerlein, J.M. ve Martin, J.B. (1978). Surgical Demand Scheduling: A Review. Health Services Research. 13(4): 418-433.
• Riley, R. ve Manias, E. (2006). Governing Time In Operating Rooms. Journal Of Clinical Nursing. 15(5): 546-553.
• Rodoplu, D. (2008). Bilgi Teknolojileri Uygulamalarına Karşı Çalışan Direnci; Hastane Bilgi Sistemi Üzerinde Bir Uygulama. Review Of Social, Economic & Business Studies. 9(10): 409-438.
• Soysal, M. ve Diğerleri (1993). Hastanelerde Bilgisayar Kullanımı. Ankara: Milli Prodüktivite Merkezi Yayınları.
• Wasserman, A. I. (1977). Minicomputers May-Maximize Data Processing. Hospitals. 51(20): 119-128.
• Yılmaz, A. ve Aloğlu E. (2002). Hastane Bilgi Sistemleri. 5. Ulusal Sağlık Kuruluşları Ve Hastane Yönetimi Sempozyum Kitabı. Eskişehir: 16-19 Ekim, 331-339.