🏥 Ayyukan kulawa mai tsanani na asibiti Samfurin kai-tsaye
Kai ne ke haɗa sashen kulawa mai tsanani na asibiti: gadajen ICU 20 da za su iya ƙaruwa zuwa 30, ma'aikatan jinya da ke kula da su, da tankin ruwan oxygen da ke ciyar da kowane gado. Wannan na'urar koyon aiki ne — ba ya kwatanta shawarwarin asibiti.
Abin da za ka koya
Dalilin da yasa sassan da suka kusa cika ke ƙarewa da gadaje ba zato ba tsammani (layi, ba matsakaita ba).
Yadda asibitoci ke tsara oxygen: kwararar kowane mara lafiya, iyakokin vaporizer da sa'o'in tanki.
Waɗanne hanyoyi ne shugaban ayyuka ke da su a lokacin hauhawa: gadaje, ma'aikata, kwararar sallama da wadata.
Na'urar koyi
Lokaci 0 h
🛏Mara lafiya a gadon ICU
·Gado mara kowa mai ma'aikata
✕Gado ba ma'aikata
•Jira a ED
Sarrafawa
Kowace ma'aikaciyar jinya na iya kula da gadajen kulawa mai tsanani biyu a wannan samfurin. Jadawali yana da 10; kowace ma'aikaciyar jinya sama da haka ƙarin lokaci ce ko ta hukuma (agency) kuma ana ragewa daga kasafin ma'aikata.
Har zuwa ƙarin gadaje 10 — suna da amfani ne kawai idan akwai ma'aikatan jinya da za su kula da su.
Mayar da marasa lafiya masu murmurewa zuwa sassan da ba su da tsanani da wuri (zama ya gajarta da 25 %).
Likitoci suna nufin ƙasan kewayon da aka rubuta; an kwatanta shi ne kawai a matsayin 20 % ƙarancin buƙata.
Sa'o'i tsakanin isar da ruwan oxygen da aka tsara; kowace isarwa tana cika tankin 3,000 L gaba ɗaya. Mai kawowa yana buƙatar sanarwa ta 24 h, don haka ɗan gajeren tazara ba zai taɓa kawo babbar mota ta gaba da wuri fiye da haka ba.
Iskar ajiya, matsakaicin 150 L/min — tana ƙara wa tanki, ba za ta iya maye gurbinsa ba. Rukunin silinda biyu kawai cike ke wurin.
Daga wani mai kawowa: kaya ɗaya na har 3,000 L na ruwan oxygen, yana isa 18 h bayan odar. A lokacin ƙaranci ɗaya kawai za su iya bayarwa.
Alamomi
Cikar ICU
75%
daidai
Marasa lafiya da ke jira a ED
0
daidai
Ƙarancin oxygen
0L/min
daidai
Lokacin da ya rage a tankin oxygen
145h
daidai
Buƙatar oxygen
290 L/min
Marasa lafiyar ICU
15
Jira mafi tsawo don gadon ICU
0 h
Sa'o'in ma'aikatan jinya na ƙarin lokaci / hukuma
0 h
Marasa lafiya ga kowace ma'aikaciyar jinya
1.5
Ruwan oxygen a tanki
3000 L
Ajiyar silinda
0 m³
Yanayi
Yanayin rikici
Mataki 1 · Hauhawar cutar numfashi
Sashen ya kusa cika lokacin da raƙuman cutar numfashi suka ƙara zuwan marasa lafiya masu tsanani fiye da ninki biyu na kwana ɗaya, kuma da yawa daga cikinsu suna da rashin lafiya mai tsanani. Ka kai kowane mara lafiya gadon ICU a kan lokaci ba tare da gudanar da tsarin oxygen fiye da iyakarsa ba — kuma cikin kasafin ma'aikata na hauhawar.
Matsakaicin jiran ED ≤ mara lafiya 1
Babu mara lafiya da ke jira 6 h ko fiye don gadon ICU
Babu ƙarancin oxygen a kowane lokaci
Ba fiye da marasa lafiya 2 ga kowace ma'aikaciyar jinya ba
Tanki ya ragu zuwa sulusi, kuma isar da ta yau da kullum za ta zo gobe. Sai mai kawowa ya kira: wannan isarwa za ta yi jinkirin kwanaki. Ka tabbatar kowane mara lafiya yana da wadata har ta isa — ba a buƙatar ƙarin ma'aikata a wannan karon.
Babu ƙarancin oxygen a kowane lokaci
Tanki ba ya taɓa ƙarewa
Babu sa'o'in ma'aikatan jinya na ƙarin lokaci / hukuma
Mataki 3 · Vaporizer a iyakarsa
Sashen ya kusa cika da marasa lafiya masu tsanani sosai lokacin da raƙuman marasa lafiya masu tsanani suka iso — kusan ɗaya a awa na rabin yini. Kowannensu yana buƙatar kwararar oxygen mai yawa, kuma vaporizer zai iya bayarwa 600 L/min kawai. Ka riƙe kwararar ka kuma ka tsabtace hanyoyi, cikin kasafin ma'aikata.
Kowace alaƙa da na'urar koyi ke amfani da ita, tare da tushenta. Ƙayyadaddun ƙimomin da aka yi wa alama a matsayin zato daidaitawa ne na misali.
Marasa lafiya masu tsanani suna zuwa ba da tsari ba kuma suna zama na lokaci mara tsari (exponential, matsakaici 72 h).
arrivals ~ Poisson(λ·Δt); P(discharge in Δt) = 1 − e^(−Δt/LOS), LOS = 72 h[4][2]Zato: tsawon zama, adadin gadaje da ma'aikatan jinya, kasafin ma'aikata, girman tanki, vaporizer da silinda, da sharuɗɗan mai kawowa na gaggawa ƙimomi ne na misali don matsakaicin asibiti.
Cikar gadaje da layi: da zuwa ba tare da tsari ba, jinkiri yana ƙaruwa sosai tun kafin sashe ya cika 100 %.
occupancy = patients / open beds; queueing delay rises steeply as occupancy → 100 %[2][3]
Ana ƙidaya gado ne kawai idan yana da ma'aikata.
staffed beds = min(open beds, 2 × nurses)[4]Zato: tsawon zama, adadin gadaje da ma'aikatan jinya, kasafin ma'aikata, girman tanki, vaporizer da silinda, da sharuɗɗan mai kawowa na gaggawa ƙimomi ne na misali don matsakaicin asibiti.
Kuɗin ma'aikata: kowace sa'ar ma'aikaciyar jinya sama da aikin jadawali ƙarin lokaci ce ko ta hukuma. Gadajen ƙari suna buƙatar waɗannan ma'aikatan jinya, don haka su ke ɗaukar kuɗin.
overtime/agency nurse-hours = Σ max(0, nurses − 10) · ΔtZato: tsawon zama, adadin gadaje da ma'aikatan jinya, kasafin ma'aikata, girman tanki, vaporizer da silinda, da sharuɗɗan mai kawowa na gaggawa ƙimomi ne na misali don matsakaicin asibiti.
Jira mafi tsawo a sashen gaggawa don gadon ICU. A wani babban binciken rajista, marasa lafiya masu tsanani da suka jira 6 h ko fiye suna da yawan mutuwa mafi girma.
longest ED wait = now − time the first waiting patient arrived (first come, first served); ≥ 6 h counts as a delayed transfer[6]
Buƙatar oxygen daga kwararar tsarawa ta WHO ga kowane mara lafiya.
demand = Σ flow(patient): severe 10 L/min, critical 30 L/min[1]
Vaporizer yana iyakance yawan iskar da tanki zai iya bayarwa a kowane minti; silinda suna ƙara kaɗan.
delivered = min(demand, vaporizer 600 L/min, tank) + cylinders (≤150 L/min)[1]Zato: tsawon zama, adadin gadaje da ma'aikatan jinya, kasafin ma'aikata, girman tanki, vaporizer da silinda, da sharuɗɗan mai kawowa na gaggawa ƙimomi ne na misali don matsakaicin asibiti.
Ruwan oxygen yana faɗaɗa kusan sau 843 zuwa iska a 15 °C da 1 atm (861 da ake yawan ambato ƙimar 21 °C ce); sa'o'in tanki suna fitowa daga amfani na yanzu.
gas litres (15 °C, 1 atm) = liquid litres × 843; tank hours = gas / (use × 60)[5]
Sauran ƙayyadaddun ƙimomin aiki da samfurin ke amfani da su.
20 base beds + up to 10 surge · 10 rostered nurses · 40 % critical at baseline · tank 3,000 L liquid, deliveries fill it to capacity; a new interval moves the next truck no closer than 24 h · vaporizer 600 L/min · 2 cylinder banks on site, 120 m³ each at ≤150 L/min · one emergency load of up to 3,000 L, 18 h after the order · step-down push shortens stay by 25 %Zato: tsawon zama, adadin gadaje da ma'aikatan jinya, kasafin ma'aikata, girman tanki, vaporizer da silinda, da sharuɗɗan mai kawowa na gaggawa ƙimomi ne na misali don matsakaicin asibiti.
Daidaita oxygen a hankali a matsayin abin buƙata.
demand × 0.8 when conservative titration is applied[7]Zato: tanadin 20 % na misali ne. Manufofin oxygen shawara ce ta likita ga kowane mara lafiya; wannan na'urar koyi tana nuna tasirin wadata ne kawai.
Rashin tsari: mai samar da mulberry32 mai iri; rarrabawar da aka yi amfani da su — uniform, exponential (inverse CDF), normal (Box–Muller), Poisson (Knuth). Ana nuna iri kuma ana iya raba shi.