WorldWideScience

Sample records for department ed services

  1. Psychiatric service users' experiences of emergency departments

    DEFF Research Database (Denmark)

    Carstensen, Kathrine; Lou, Stina; Jensen, Lotte Groth

    2017-01-01

    Background: There is increased clinical and political attention towards integrating general and psychiatric emergency departments (ED). However, research into psychiatric service users’ experiences regarding general EDs is limited. Aim: To identify and summarize current, qualitative evidence rega...... the discomfort. Overall, the results of this review speak in favour of integrated EDs where service users’ needs are more likely to be recognized and accommodated....

  2. Characterising non-urgent users of the emergency department (ED): A retrospective analysis of routine ED data.

    Science.gov (United States)

    O'Keeffe, Colin; Mason, Suzanne; Jacques, Richard; Nicholl, Jon

    2018-01-01

    The pressures of patient demand on emergency departments (EDs) continue to be reported worldwide, with an associated negative impact on ED crowding and waiting times. It has also been reported that a proportion of attendances to EDs in different international systems could be managed in settings such as primary care. This study used routine ED data to define, measure and profile non-urgent ED attendances that were suitable for management in alternative, non-emergency settings. We undertook a retrospective analysis of three years of Hospital Episode and Statistics Accident Emergency (HES A&E) data for one large region in England, United Kingdom (April 1st 2011 to March 31st 2014). Data was collected on all adult (>16 years) ED attendances from each of the 19 EDs in the region. A validated process based definition of non-urgent attendance was refined for this study and applied to the data. Using summary statistics non-urgent attenders were examined by variables hypothesised to influence them as follows: age at arrival, time of day and day of week and mode of arrival. Odds ratios were calculated to compare non-urgent attenders between groups. There were 3,667,601 first time attendances to EDs, of which 554,564 were defined as non-urgent (15.1%). Non-urgent attendances were significantly more likely to present out of hours than in hours (OR = 1.19, 95% CI: 1.18 to 1.20, Paged 16-44) compared to those aged 45-64 (odds ratio: 1.42, 95% CI: 1.41 to 1.43, Puse the ED to obtain healthcare that could be provided in a less urgent setting and also more likely to do this out of hours. Alternative services are required to manage non-urgent demand, currently being borne by the ED and the ambulance service, particularly in out of hours.

  3. Moments of disaster response in the emergency department (ED).

    Science.gov (United States)

    Hammad, Karen S; Arbon, Paul; Gebbie, Kristine; Hutton, Alison

    2017-11-01

    We experience our lives as a series of memorable moments, some good and some bad. Undoubtedly, the experience of participating in disaster response, is likely to stand out as a memorable moment in a nurses' career. This presentation will describe five distinct moments of nursing in the emergency department (ED) during a disaster response. A Hermeneutic Phenomenological approach informed by van Manen underpins the research process. Thirteen nurses from different countries around the world participated in interviews about their experience of working in the ED during a disaster. Thematic analysis resulted in five moments of disaster response which are common to the collective participant experience. The 5 themes emerge as Notification (as a nurse finds out that the ED will be receiving casualties), Waiting (waiting for the patients to arrive to the ED), Patient Arrival (the arrival of the first patients to the ED), Caring for patients (caring for people affected by the disaster) and Reflection (the moment the disaster response comes to an end). This paper provides an in-depth insight into the experience of nursing in the ED during a disaster response which can help generate awareness and inform future disaster preparedness of emergency nurses. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  4. Emergency Department (ED, ED Observation, Day Hospital, and Hospital Admissions for Adults with Sickle Cell Disease

    Directory of Open Access Journals (Sweden)

    Susan Silva

    2018-02-01

    Full Text Available Introduction: Use of alternative venues to manage uncomplicated vaso-occlusive crisis (VOC, such as a day hospital (DH or ED observation unit, for patients with sickle cell anemia, may significantly reduce admission rates, which may subsequently reduce 30-day readmission rates. Methods: In the context of a two-institution quality improvement project to implement best practices for management of patients with sickle cell disease (SCD VOC, we prospectively compared acute care encounters for utilization of 1 emergency department (ED; 2 ED observation unit; 3 DH, and 4 hospital admission, of two different patient cohorts with SCD presenting to our two study sites. Using a representative sample of patients from each institution, we also tabulated SCD patient visits or admissions to outside hospitals within 20 miles of the patients’ home institutions. Results: Over 30 months 427 patients (297 at Site 1 and 130 at Site 2 initiated 4,740 institutional visits, totaling 6,627 different acute care encounters, including combinations of encounters. The range of encounters varied from a low of 0 (203 of 500 patients [40.6%] at Site 1; 65 of 195 patients [33.3%] at Site 2, and a high of 152 (5/month acute care encounters for one patient at Site 2. Patients at Site 2 were more likely to be admitted to the hospital during the study period (88.4% vs. 74.4%, p=0.0011 and have an ED visit (96.9% vs. 85.5%, p=0.0002. DH was used more frequently at Site 1 (1.207 encounters for 297 patients at Site 1, vs. 199 encounters for 130 patients at Site 2, and ED observation was used at Site 1 only. Thirty-five percent of patients visited hospitals outside their home academic center. Conclusion: In this 30-month assessment of two sickle cell cohorts, healthcare utilization varied dramatically between individual patients. One cohort had more hospital admissions and ED encounters, while the other cohort had more day hospital encounters and used a sickle cell disease

  5. Characterising non-urgent users of the emergency department (ED: A retrospective analysis of routine ED data.

    Directory of Open Access Journals (Sweden)

    Colin O'Keeffe

    Full Text Available The pressures of patient demand on emergency departments (EDs continue to be reported worldwide, with an associated negative impact on ED crowding and waiting times. It has also been reported that a proportion of attendances to EDs in different international systems could be managed in settings such as primary care. This study used routine ED data to define, measure and profile non-urgent ED attendances that were suitable for management in alternative, non-emergency settings.We undertook a retrospective analysis of three years of Hospital Episode and Statistics Accident Emergency (HES A&E data for one large region in England, United Kingdom (April 1st 2011 to March 31st 2014. Data was collected on all adult (>16 years ED attendances from each of the 19 EDs in the region. A validated process based definition of non-urgent attendance was refined for this study and applied to the data. Using summary statistics non-urgent attenders were examined by variables hypothesised to influence them as follows: age at arrival, time of day and day of week and mode of arrival. Odds ratios were calculated to compare non-urgent attenders between groups.There were 3,667,601 first time attendances to EDs, of which 554,564 were defined as non-urgent (15.1%. Non-urgent attendances were significantly more likely to present out of hours than in hours (OR = 1.19, 95% CI: 1.18 to 1.20, P<0.001. The odds of a non-urgent attendance were significantly higher for younger patients (aged 16-44 compared to those aged 45-64 (odds ratio: 1.42, 95% CI: 1.41 to 1.43, P<0.001 and the over 65's (odds ratio: 3.81, 95% CI: 3.78 to 3.85, P<0.001. Younger patients were significantly more likely to attend non-urgently out of hours compared to the 45-64's (OR = 1.24, 95% CI: 1.22 to 1.25, P<0.001 and the 65+'s (OR = 1.38, 95% CI: 1.35 to 1.40, P<0.001. 110,605/554,564 (19.9% of the non-urgent attendances arrived by ambulance, increasing significantly out of hours versus in hours (OR = 2

  6. Scientific Services Department

    International Nuclear Information System (INIS)

    SSD in the South Western Region employs more than 200 people, of which 90% are scientists or engineers. Their purpose is to understand and clarify the extensive technical issues which arise during the operation of many different types of plant spread over a wide area of Southern England and South Wales. Priority is given to work in terms of its potential value to the Board. This brochure illustrates some aspects of the work of SSD. Based at Regional Headquarters in Bristol, the Department undertakes 'on site' inspection followed by more thorough laboratory examinations for the diagnosis of faults, and carries out selected research activities. Most of this effort is directed towards the three nuclear sites and four large conventional power stations in the Region. (author)

  7. ED services: the impact of caring behaviors on patient loyalty.

    Science.gov (United States)

    Liu, Sandra S; Franz, David; Allen, Monette; Chang, En-Chung; Janowiak, Dana; Mayne, Patricia; White, Ruth

    2010-09-01

    This article describes an observational study of caring behaviors in the emergency departments of 4 Ascension Health hospitals and the impact of these behaviors on patient loyalty to the associated hospital. These hospitals were diverse in size and geography, representing 3 large urban community hospitals in metropolitan areas and 1 in a midsized city. Research assistants from Purdue University (West Lafayette, IN) conducted observations at the first study site and validated survey instruments. The Purdue research assistants trained contracted observers at the subsequent study sites. The research assistants conducted observational studies of caregivers in the emergency departments at 4 study sites using convenience sampling of patients. Caring behaviors were rated from 0 (did not occur) to 5 (high intensity). The observation included additional information, for example, caregiver roles, timing, and type of visit. Observed and unobserved patients completed exit surveys that recorded patient responses to the likelihood-to-recommend (loyalty) questions, patient perceptions of care, and demographic information. Common themes across all study sites emerged, including (1) the area that patients considered most important to an ED experience (prompt attention to their needs upon arrival to the emergency department); (2) the area that patients rated as least positive in their actual ED experience (prompt attention to their needs upon arrival to the emergency department); (3) caring behaviors that significantly affected patient loyalty (eg, making sure that the patient is aware of care-related details, working with a caring touch, and making the treatment procedure clearly understood by the patient); and (4) the impact of wait time to see a caregiver on patient loyalty. A number of correlations between caring behaviors and patient loyalty were statistically significant (P loyalty but that occurred least frequently. The study showed through factor analysis that some caring

  8. Mental Health and Drivers of Need in Emergent and Non-Emergent Emergency Department (ED) Use: Do Living Location and Non-Emergent Care Sources Matter?

    Science.gov (United States)

    McManus, Moira C; Cramer, Robert J; Boshier, Maureen; Akpinar-Elci, Muge; Van Lunen, Bonnie

    2018-01-13

    Emergency department (ED) utilization has increased due to factors such as admissions for mental health conditions, including suicide and self-harm. We investigate direct and moderating influences on non-emergent ED utilization through the Behavioral Model of Health Services Use. Through logistic regression, we examined correlates of ED use via 2014 New York State Department of Health Statewide Planning and Research Cooperative System outpatient data. Consistent with the primary hypothesis, mental health admissions were associated with emergent use across models, with only a slight decrease in effect size in rural living locations. Concerning moderating effects, Spanish/Hispanic origin was associated with increased likelihood for emergent ED use in the rural living location model, and non-emergent ED use for the no non-emergent source model. 'Other' ethnic origin increased the likelihood of emergent ED use for rural living location and no non-emergent source models. The findings reveal 'need', including mental health admissions, as the largest driver for ED use. This may be due to mental healthcare access, or patients with mental health emergencies being transported via first responders to the ED, as in the case of suicide, self-harm, manic episodes or psychotic episodes. Further educating ED staff on this patient population through gatekeeper training may ensure patients receive the best treatment and aid in driving access to mental healthcare delivery changes.

  9. 77 FR 27263 - Computer Matching Between the Selective Service System and the Department of Education

    Science.gov (United States)

    2012-05-09

    ... SELECTIVE SERVICE SYSTEM Computer Matching Between the Selective Service System and the Department of Education AGENCY: Selective Service System. Action: Notice. In accordance with the Privacy Act of... of Participating Agencies The Selective Service System (SSS) and the Department of Education (ED). 2...

  10. Interprofessional collaboration between general physicians and emergency department services in Belgium: a qualitative study

    OpenAIRE

    Karam, Marlène; Tricas, Sandra Maria; Darras, Elisabeth; Macq, Jean

    2016-01-01

    Introduction: The use of emergency department (ED) services has known a significant rise in the past decade. Organizational factors, such as the models of after-hours primary medical care services, and the shortage of general practitioners (GPs) could explain this phenomena. But also demographic and societal elements combined with the problem of patient’s ‘inappropriate visits to the ED. In order to ensure continuity of care for patients, collaboration between GPs and EDs becomes increasingly...

  11. oneED: Embedding a mindfulness-based wellness programme into an emergency department.

    Science.gov (United States)

    Braganza, Shahina; Young, Jessica; Sweeny, Amy; Brazil, Victoria

    2018-03-30

    ED staff are subject to many stressors, but there are few descriptions of collective approaches to enhancing wellness in this setting. We aim to describe a programme developed to address these issues at department level, to report the feasibility and sustainability of the programme, and its impact on staff. The oneED programme was developed and delivered in a tertiary ED. The programme included a 1 day mindfulness workshop, followed by ongoing mindfulness activities embedded in clinical areas over the subsequent 12 months. A mixed-methods evaluation of the programme was conducted, which included quantitative validated psychological tools to measure anxiety, depression and emotional exhaustion, and pragmatic evaluation using surveys of participants and iterative appreciative inquiry. Eighty staff members attended the mindfulness workshop; 66 from ED. Following the workshop, understanding and frequency of mindfulness practice increased significantly in 47% of participants. Free-text survey results demonstrated that staff found the programme to be acceptable (80% survey participants) and of perceived value to themselves (50%) and the ED (60%). Appreciative inquiry led to modification of the programme: the 4 min pause is now conducted weekly rather than daily, the pause consists of a variety of activities, and group activities are made more overtly optional. A departmental wellness programme embedding mindfulness practice is feasible and sustainable. Potential for success is enhanced by an approach that is open to modification according to each institution's culture. © 2018 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  12. Suicide Prevention in an Emergency Department Population: The ED-SAFE Study.

    Science.gov (United States)

    Miller, Ivan W; Camargo, Carlos A; Arias, Sarah A; Sullivan, Ashley F; Allen, Michael H; Goldstein, Amy B; Manton, Anne P; Espinola, Janice A; Jones, Richard; Hasegawa, Kohei; Boudreaux, Edwin D

    2017-06-01

    Suicide is a leading cause of deaths in the United States. Although the emergency department (ED) is an opportune setting for initiating suicide prevention efforts, ED-initiated suicide prevention interventions remain underdeveloped. To determine whether an ED-initiated intervention reduces subsequent suicidal behavior. This multicenter study of 8 EDs in the United States enrolled adults with a recent suicide attempt or ideation and was composed of 3 sequential phases: (1) a treatment as usual (TAU) phase from August 2010 to December 2011, (2) a universal screening (screening) phase from September 2011 to December 2012, and (3) a universal screening plus intervention (intervention) phase from July 2012 to November 2013. Screening consisted of universal suicide risk screening. The intervention phase consisted of universal screening plus an intervention, which included secondary suicide risk screening by the ED physician, discharge resources, and post-ED telephone calls focused on reducing suicide risk. The primary outcome was suicide attempts (nonfatal and fatal) over the 52-week follow-up period. The proportion and total number of attempts were analyzed. A total of 1376 participants were recruited, including 769 females (55.9%) with a median (interquartile range) age of 37 (26-47) years. A total of 288 participants (20.9%) made at least 1 suicide attempt, and there were 548 total suicide attempts among participants. There were no significant differences in risk reduction between the TAU and screening phases (23% vs 22%, respectively). However, compared with the TAU phase, patients in the intervention phase showed a 5% absolute reduction in suicide attempt risk (23% vs 18%), with a relative risk reduction of 20%. Participants in the intervention phase had 30% fewer total suicide attempts than participants in the TAU phase. Negative binomial regression analysis indicated that the participants in the intervention phase had significantly fewer total suicide attempts

  13. Medical assistance in the management of nuclear power plant accidents. Guide for: medical personnel of emergency preparedness services, doctors of emergency departments, doctors for out-patient or in-patient treatment. 2. rev. ed.

    International Nuclear Information System (INIS)

    Gumprecht, D.; Haehnel, S.

    1995-01-01

    The guide explains the medical tasks and activities in the context of the emergency preparedness programmes and provisions established by the Laender. The medical expert for radiation injuries is a particularly important function in the radiologial accident management services. The provisions for medical care have been determined on the basis of knowledge drawn among other sources from the German Nuclear Power Plant Risk Study, Phase B. In addition, the guide's provisions are based on international knowledge about the consequences of enhanced radiation exposure, and the medical tasks and the required organisational infrastructure have been determined accordingly. A further source of reference for planning the activities are the data accumulated during emergency preparedness training activities in the various Laender. (orig./MG). 3 figs., 5 tabs [de

  14. Emergency Department Telepsychiatry Service Model for a Rural Regional Health System: The First Steps.

    Science.gov (United States)

    Meyer, James D; McKean, Alastair J S; Blegen, Rebecca N; Demaerschalk, Bart M

    2018-05-09

    Emergency departments (EDs) have recognized an increasing number of patients presenting with mental health (MH) concerns. This trend imposes greater demands upon EDs already operating at capacity. Many ED providers do not feel they are optimally prepared to provide the necessary MH care. One consideration in response to this dilemma is to use advanced telemedicine technology for psychiatric consultation. We examined a rural- and community-based health system operating 21 EDs, none of which has direct access to psychiatric consultation. Dedicated beds to MH range from zero (in EDs with only 3 beds) to 6 (in an ED with 38 beds). We conducted a needs assessment of this health system. This included a survey of emergency room providers with a 67% response rate and site visits to directly observe patient flow and communication with ED staff. A visioning workshop provided input from ED staff. Data were also obtained, which reflected ED admissions for the year 2015. The data provide a summary of provider concerns, a summary of MH presentations and diagnosis, and age groupings. The data also provide a time when most MH concerns present to the ED. Based upon these results, a proposed model for delivering comprehensive regional emergency telepsychiatry and behavioral health services is proposed. Emergency telepsychiatry services may be a tenable solution for addressing the shortage of psychiatric consultation to EDs in light of increasing demand for MH treatment in the ED.

  15. Comprehensive services delivery and emergency department use among chronically homeless adults.

    Science.gov (United States)

    Moore, David T; Rosenheck, Robert A

    2017-05-01

    Homeless adults use emergency department (ED) services more frequently than other adults, but the relationships between homelessness, health status, outpatient service use, and ED utilization are poorly understood. Data from the Collaborative Initiative to Help End Chronic Homelessness (CICH) were used to compare ED use among chronically homeless adults receiving comprehensive housing, case management, mental health, addiction, and primary care services through CICH at 5 U.S. sites (n = 274) and ED use among comparison group clients receiving generally available community services (n = 116) at the same sites. Multiple imputation was used to account for missing data and differential rates of attrition between the cohorts. Longitudinal models were constructed to compare ED use between the 2 groups during the first year after initiation of CICH services. A mediation analysis was performed to determine the relative contributions of being housed, the receipt of outpatient services, and health status to group differences in ED utilization. Participants receiving CICH services were significantly less likely to report ED use (odds ratio = 0.78, 95% confidence interval [0.65, 0.93]) in the year after program entry. Decreased ED use was primarily mediated by decreased homelessness-not by increased access to other services or health status. This suggests that becoming housed is a key driver of reduced ED utilization and that efforts to provide housing for homeless adults may result in significantly decreased ED use. Further research is needed to determine the long-term effects of housing on health status and to develop services to improve health outcomes. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  16. Barriers and Facilitators to Implementing the HEADS-ED: A Rapid Screening Tool for Pediatric Patients in Emergency Departments.

    Science.gov (United States)

    MacWilliams, Kate; Curran, Janet; Racek, Jakub; Cloutier, Paula; Cappelli, Mario

    2017-12-01

    This study sought to identify barriers and facilitators to the implementation of the HEADS-ED, a screening tool appropriate for use in the emergency department (ED) that facilitates standardized assessments, discharge planning, charting, and linking pediatric mental health patients to appropriate community resources. A qualitative theory-based design was used to identify barriers and facilitators to implementing the HEADS-ED tool. Focus groups were conducted with participants recruited from 6 different ED settings across 2 provinces (Ontario and Nova Scotia). The Theoretical Domains Framework was used as a conceptual framework to guide data collection and to identify themes from focus group discussions. The following themes spanning 12 domains were identified as reflective of participants' beliefs about the barriers and facilitators to implementing the HEADS-ED tool: knowledge, skills, beliefs about capabilities, social professional role and identity, optimism, beliefs about consequences, reinforcement, environmental context and resources, social influences, emotion, behavioral regulation and memory, and attention and decision process. The HEADS-ED has the potential to address the need for better discharge planning, complete charting, and standardized assessments for the increasing population of pediatric mental health patients who present to EDs. This study has identified potential barriers and facilitators, which should be considered when developing an implementation plan for adopting the HEADS-ED tool into practice within EDs.

  17. Improving Motivation in the Service Department

    OpenAIRE

    Sosingot-Sundström, Sevarine

    2015-01-01

    The objective of this study is to improve motivation of the employees in the Service Department. What motivates employees in this century beyond the normal norms of job security and money. The study is based on improving the motivation of the Service Department of Company X. This research was based on the service’s department low score in motivation after the results of the 2012 annual staff survey. The research aims to find out the cause(s) for the low motivation and also find a solution tha...

  18. Evaluating Service Quality in Universities: A Service Department Perspective

    Science.gov (United States)

    Smith, Gareth; Smith, Alison; Clarke, Alison

    2007-01-01

    Purpose: The purpose of the study is to report on an in-depth exploration of service quality in an Information Technology service department in a Higher Education Institute (HEI) and to evaluate the instrument used. Design/methodology/approach: The study surveys customers using the SERVQUAL instrument, which is one of the most widely used and…

  19. Solving the worldwide emergency department crowding problem - what can we learn from an Israeli ED?

    Science.gov (United States)

    Pines, Jesse M; Bernstein, Steven L

    2015-01-01

    ED crowding is a prevalent and important issue facing hospitals in Israel and around the world, including North and South America, Europe, Australia, Asia and Africa. ED crowding is associated with poorer quality of care and poorer health outcomes, along with extended waits for care. Crowding is caused by a periodic mismatch between the supply of ED and hospital resources and the demand for patient care. In a recent article in the Israel Journal of Health Policy Research, Bashkin et al. present an Ishikawa diagram describing several factors related to longer length of stay (LOS), and higher levels of ED crowding, including management, process, environmental, human factors, and resource issues. Several solutions exist to reduce ED crowding, which involve addressing several of the issues identified by Bashkin et al. This includes reducing the demand for and variation in care, and better matching the supply of resources to demands in care in real time. However, what is needed to reduce crowding is an institutional imperative from senior leadership, implemented by engaged ED and hospital leadership with multi-disciplinary cross-unit collaboration, sufficient resources to implement effective interventions, access to data, and a sustained commitment over time. This may move the culture of a hospital to facilitate improved flow within and across units and ultimately improve quality and safety over the long-term.

  20. Restructuring a State Nutrition Education and Obesity Prevention Program: Implications of a Local Health Department Model for SNAP-Ed.

    Science.gov (United States)

    Wu, Helen W; Backman, Desiree; Kizer, Kenneth W

    The US Department of Agriculture Supplemental Nutrition Assistance Program-Education (SNAP-Ed) funds state programs to improve nutrition and physical activity in low-income populations through its Nutrition Education and Obesity Prevention grants. States vary in how they manage and structure these programs. California substantially restructured its program in 2012 to universally position local health departments (LHDs) as the programmatic lead in all jurisdictions. This study sought to determine whether California's reorganization aligned with desirable attributes of decentralized public management. This study conducted 40 in person, semistructured interviews with 57 local, state, and federal SNAP-Ed stakeholders between October 2014 and March 2015. Local respondents represented 15 counties in all 7 of California's SNAP-Ed regions. We identified 3 common themes that outlined advantages or disadvantages of local public management, and we further defined subthemes within: (1) coordination and communication (within local jurisdictions, across regions, between local and state), (2) efficiency (administrative, fiscal, program), and (3) quality (innovation, skills). We conducted qualitative content analysis to evaluate how respondents characterized the California experience for each theme, identifying positive and negative experiences. California's LHD model offers some distinct advantages, but the model does not exhibit all the advantages of decentralized public management. Strategic planning, partnerships, subcontracting, and fiscal oversight are closer to communities than previously. However, administrative burden remains high and LHDs are limited in their ability to customize programs on the basis of community needs because of state and federal constraints. California's use of a universal LHD model for SNAP-Ed is novel. Recent federal SNAP-Ed changes present an opportunity for other states to consider this structure. Employing small-scale approaches initially (eg

  1. A reengineering success story: process improvement in emergency department x-ray cycle time, leading to breakthrough performance in the ED ambulatory care (Fast Track) process.

    Science.gov (United States)

    Espinosa, J A; Treiber, P M; Kosnik, L

    1997-01-01

    This article describes the journey of a multidisciplinary reengineering team, which worked to reduce a critical, high-leverage process in an emergency department setting. The process selected was emergency department radiology services. This process was selected on a rational basis. The team knew tht 60 percent of our emergency department patients were truly ambulatory, and that most could be seen in a "fast track" process as part of our emergency department's core mission. However, we knew from customer satisfaction data, that patients would like to be "in and out" of emergency department Fast Track in less than an hour. Over half of our Fast Track patients require x-rays. For most, this was their sole reason for seeking emergency care. Our state, at the start of the project, included an average x-ray cycle time of over 60 minutes. The associated Fast-Track cycle time was over 90 minutes median. It was clear to the emergency department leadership, as well as to members of the Fast-Track management team, that a cycle time of 30 minutes or less for x-ray service was needed as a necessary condition to an hour or less Fast Track cycle time. It was also felt that a more rapid x-ray cycle time would allow for more rapid turn over of ED rooms, leading to a virtual greater capacity to the ED. It was hoped that this would lead to a reduction in the time from arrival to treatment by the emergency physician for all patients.

  2. Evaluation of service quality of hospital outpatient department services.

    Science.gov (United States)

    Chakravarty, Abhijit

    2011-07-01

    It has become essential for hospital managers to understand and measure consumer perspectives and service quality gaps, so that any perceived gap in delivery of service is identified and suitably addressed. A study was conducted at a peripheral service hospital to ascertain any service gap between consumer expectations and perceptions in respect of the hospital outpatient department (OPD) services. A cross-sectional study was conducted using SERVQUAL as the survey instrument, the instrument being validated for use in the hospital environment. Consumer ratings across 22 items of the survey instrument were collected in paired expectation and perception scores and then service quality gaps were identified and statistically analysed. Service quality gaps were identified to exist across all the five dimensions of the survey instrument, with statistically significant gaps across the dimensions of 'tangibles' and 'responsiveness.' The quality gaps were further validated by a total unweighted SERVQUAL score of (-) 1.63. The study concludes that significant service quality gaps existed in the delivery of the hospital OPD services, which need to be addressed by focused improvement efforts by the hospital management.

  3. Child, Caregiver, and Family Characteristics Associated with Emergency Department Use by Children Who Remain at Home after a Child Protective Services Investigation

    Science.gov (United States)

    Schneiderman, Janet U.; Hurlburt, Michael S.; Leslie, Laurel K.; Zhang, Jinjin; Horwitz, Sarah McCue

    2012-01-01

    Objectives: To examine emergency department (ED) use among children involved with child protective services (CPS) in the US but who remain at home, and to determine if ED use is related to child, caregiver and family characteristics as well as receipt of CPS services. Method: We analyzed data on 4,001 children in the National Survey of Child and…

  4. A Consultation Phone Service for Patients With Total Joint Arthroplasty May Reduce Unnecessary Emergency Department Visits.

    Science.gov (United States)

    Hällfors, Eerik; Saku, Sami A; Mäkinen, Tatu J; Madanat, Rami

    2018-03-01

    Different measures for reducing costs after total joint arthroplasty (TJA) have gained attention lately. At our institution, a free-of-charge consultation phone service was initiated that targeted patients with TJA. This service aimed at reducing unnecessary emergency department (ED) visits and, thus, potentially improving the cost-effectiveness of TJAs. To our knowledge, a similar consultation service had not been described previously. We aimed at examining the rates and reasons for early postdischarge phone calls and evaluating the efficacy of this consultation service. During a 2-month period, we gathered information on every call received by the consultation phone service from patients with TJAs within 90 days of the index TJA procedure. Patients were followed for 2 weeks after making a call to detect major complications and self-initiated ED visits. Data were collected from electronic medical charts regarding age, gender, type of surgery, date of discharge, and length of hospital stay. We analyzed 288 phone calls. Calls were mostly related to medication (41%), wound complications (17%), and mobilization issues (15%). Most calls were resolved in the phone consultation. Few patients (13%) required further evaluation in the ED. The consultation service failed to detect the need for an ED visit in 2 cases (0.7%) that required further care. The consultation phone service clearly benefitted patients with TJAs. The service reduced the number of unnecessary ED visits and functioned well in detecting patients who required further care. Most postoperative concerns were related to prescribed medications, wound complications, and mobilization issues. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. 77 FR 5012 - Environmental Protection Agency, Department of Health and Human Services and Department of...

    Science.gov (United States)

    2012-02-01

    ..., Department of Health and Human Services and Department of Agriculture; Memorandum of Understanding Regarding... Memorandum of Understanding (MOU). The MOU will support and encourage cooperation and communication between... Department of Human Services (HHS) and the U.S. Department of Agriculture (USDA). HHS's Centers for Disease...

  6. 77 FR 43369 - Lexisnexis, a Subsidiary of Reed Elsevier Customer Service Department and Fulfillment Department...

    Science.gov (United States)

    2012-07-24

    ..., a Subsidiary of Reed Elsevier Customer Service Department and Fulfillment Department, Including On... Including Remote Workers in New York Reporting to Miamisburg, OH; Lexisnexis, a Subsidiary of Reed Elsevier... subsidiary of Reed Elsevier, Inc., Customer Service Department and Fulfillment Department, including on-site...

  7. Emergency department boarding and adverse hospitalization outcomes among patients admitted to a general medical service.

    Science.gov (United States)

    Lord, Kito; Parwani, Vivek; Ulrich, Andrew; Finn, Emily B; Rothenberg, Craig; Emerson, Beth; Rosenberg, Alana; Venkatesh, Arjun K

    2018-03-20

    Overcrowding in the emergency department (ED) has been associated with patient harm, yet little is known about the association between ED boarding and adverse hospitalization outcomes. We sought to examine the association between ED boarding and three common adverse hospitalization outcomes: rapid response team activation (RRT), escalation in care, and mortality. We conducted an observational analysis of consecutive patient encounters admitted from the ED to the general medical service between February 2013 and June 2015. This study was conducted in an urban, academic hospital with an annual adult ED census over 90,000. We defined boarding as patients with greater than 4h from ED bed order to ED departure to hospital ward. The primary outcome was a composite of adverse outcomes in the first 24h of admission, including RRT activation, care escalation to intensive care, or in-hospital mortality. A total of 31,426 patient encounters were included of which 3978 (12.7%) boarded in the ED for 4h or more. Adverse outcomes occurred in 1.92% of all encounters. Comparing boarded vs. non-boarded patients, 41 (1.03%) vs. 244 (0.90%) patients experienced a RRT activation, 53 (1.33%) vs. 387 (1.42%) experienced a care escalation, and 1 (0.03%) vs.12 (0.04%) experienced unanticipated in-hospital death, within 24h of ED admission. In unadjusted analysis, there was no difference in the composite outcome between boarding and non-boarding patients (1.91% vs. 1.91%, p=0.994). Regression analysis adjusted for patient demographics, acuity, and comorbidities also showed no association between boarding and the primary outcome. A sensitivity analysis showed an association between ED boarding and the composite outcome inclusive of the entire inpatient hospital stay (5.8% vs. 4.7%, p=0.003). Within the first 24h of hospital admission to a general medicine service, adverse hospitalization outcomes are rare and not associated with ED boarding. Copyright © 2018 Elsevier Inc. All rights

  8. Telehealth-Enabled Emergency Medical Services Program Reduces Ambulance Transport to Urban Emergency Departments

    OpenAIRE

    Langabeer, James R.; Gonzalez, Michael; Alqusairi, Diaa; Champagne-Langabeer, Tiffany; Jackson, Adria; Mikhail, Jennifer; Persse, David

    2016-01-01

    Introduction Emergency medical services (EMS) agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED), affecting the entire emergency care system’s capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. T...

  9. Telehealth-Enabled Emergency Medical Services Program Reduces Ambulance Transport to Urban Emergency Departments.

    Science.gov (United States)

    Langabeer, James R; Gonzalez, Michael; Alqusairi, Diaa; Champagne-Langabeer, Tiffany; Jackson, Adria; Mikhail, Jennifer; Persse, David

    2016-11-01

    Emergency medical services (EMS) agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED), affecting the entire emergency care system's capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. This research describes the development and comparative effectiveness of one large urban program. The Houston Fire Department initiated the Emergency Telehealth and Navigation (ETHAN) program in 2014. ETHAN combines telehealth, social services, and alternative transportation to navigate primary care-related patients away from the ED where possible. Using a case-control study design, we describe the program and compare differences in effectiveness measures relative to the control group. During the first 12 months, 5,570 patients participated in the telehealth-enabled program, which were compared against the same size control group. We found a 56% absolute reduction in ambulance transports to the ED with the intervention compared to the control group (18% vs. 74%, P models are effective at reducing unnecessary ED ambulance transports and increasing EMS unit productivity. This provides support for broader EMS mobile integrated health programs in other regions.

  10. NPP Engineering and Servicing / Design Analysis Department

    International Nuclear Information System (INIS)

    Sik, J.

    2006-01-01

    The article provides an overview of the activities of the SKODA JS's Design Analysis Department performed recently in the fields of reactor physics, shielding physics, thermal hydraulics and mechanical structure stresses and life analysis. (orig.)

  11. Records management and service delivery: the case of Department ...

    African Journals Online (AJOL)

    Ngulup

    The principal records management unit within the Department of Corporate Services ... ies services (15), Finance and Accounting (3); however, only 59 participated in it. Data col- ...... records and public-sector financial management.

  12. Customer service in appliance sales departments of selected ...

    African Journals Online (AJOL)

    Customer service in appliance sales departments of selected prominent retail outlets: store manager, ... A single measurement of customers' perception of service quality in various stores however suggested ... AJOL African Journals Online.

  13. Increasing off-service resident productivity while on their emergency department rotation using shift cards.

    Science.gov (United States)

    Chakravarthy, Bharath; Posadas, Emerson; Ibrahim, Deena; McArthur, Kurt; Osborn, Megan; Hoonpongsimanont, Wirachin; Wong, Andrew; Lotfipour, Shahram

    2015-04-01

    Differences in productivity between off-service residents rotating in the emergency department (ED) and their emergency medicine (EM) resident counterparts have never been directly quantified. We sought to quantify the difference between off-service residents rotating in the ED and their EM resident counterparts. We also sought to find whether shift cards could be used to increase the productivity of off-service residents rotating in the ED. This is a prospective cohort study conducted at an urban, tertiary, Level I trauma center. We implemented the use of shift cards for off-service residents during their EM rotation. Completion of the shift card involved recording patients seen and their dispositions, procedures done, and documenting a learned bedside teaching point from their shift that day. Productivity was measured in terms of patients seen per hour (PPH) and relative value units per hour (RVU/h). Off-service residents showed a productivity of 0.529 PPH (95% confidence interval [CI] 0.493-0.566) and 1.40 RVU/h (95% CI 1.28-1.53) prior to implementation of shift cards. With the introduction of shift cards, productivity increased to 0.623 PPH (95% CI 0.584-0.663, p = 0.001) and 1.77 RVU/h (95% CI 1.64-1.91, p = 0.001). In comparison, first year EM resident productivity was 0.970 PPH (95% CI 0.918-1.02) and 3.01 RVU/h (95% CI 2.83-3.19). Shift cards can be used to foster motivation for off-service residents rotating in the ED, and is a simple and cost-effective method to improve system-based practices and utilization of resources. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Efficacy of hospital in the home services providing care for patients admitted from emergency departments: an integrative review.

    Science.gov (United States)

    Varney, Jane; Weiland, Tracey J; Jelinek, George

    2014-06-01

    Increases in emergency department (ED) demand may compromise patient outcomes, leading not only to overcrowding in the ED, increased ED waiting times and increased ED length of stay, but also compromising patient safety; the risk of adverse events is known to rise in the presence of overcrowding. Hospital in the home (HiTH) services may offer one means of reducing ED demand. This integrative review sought to assess the efficacy of admission-avoidance HiTH services that admit patients directly from the ED. Papers published between 1995 and 2013 were identified through searches of Medline, CINAHL and Google. English-language studies that assessed the efficacy of a HiTH service and that recruited at least one-third of the participants directly from the ED were included in the review. A HiTH service was considered one that provided health professional support to patients at home for a time-limited period, thus avoiding the need for hospitalization. Twenty-two articles met the inclusion criteria for this review. The interventions were diverse in terms of the clinical interventions delivered, the range and intensity of health professional input and the conditions treated. The studies included in the review found no effect on clinical outcomes, rates of adverse events or complications, although patient satisfaction and costs were consistently and favourably affected by HiTH treatment. Given evidence suggesting that HiTH services which recruit patients directly from the ED contribute to cost-savings, greater patient satisfaction and safety and efficacy outcomes that are at least equivalent to those associated with hospital-based care, the expansion of such programmes might therefore be considered a priority for policy makers.

  15. Lung-Protective Ventilation Initiated in the Emergency Department (LOV-ED): A Quasi-Experimental, Before-After Trial.

    Science.gov (United States)

    Fuller, Brian M; Ferguson, Ian T; Mohr, Nicholas M; Drewry, Anne M; Palmer, Christopher; Wessman, Brian T; Ablordeppey, Enyo; Keeperman, Jacob; Stephens, Robert J; Briscoe, Cristopher C; Kolomiets, Angelina A; Hotchkiss, Richard S; Kollef, Marin H

    2017-09-01

    We evaluated the efficacy of an emergency department (ED)-based lung-protective mechanical ventilation protocol for the prevention of pulmonary complications. This was a quasi-experimental, before-after study that consisted of a preintervention period, a run-in period of approximately 6 months, and a prospective intervention period. The intervention was a multifaceted ED-based mechanical ventilator protocol targeting lung-protective tidal volume, appropriate setting of positive end-expiratory pressure, rapid oxygen weaning, and head-of-bed elevation. A propensity score-matched analysis was used to evaluate the primary outcome, which was the composite incidence of acute respiratory distress syndrome and ventilator-associated conditions. A total of 1,192 patients in the preintervention group and 513 patients in the intervention group were included. Lung-protective ventilation increased by 48.4% in the intervention group. In the propensity score-matched analysis (n=490 in each group), the primary outcome occurred in 71 patients (14.5%) in the preintervention group compared with 36 patients (7.4%) in the intervention group (adjusted odds ratio 0.47; 95% confidence interval [CI] 0.31 to 0.71). There was an increase in ventilator-free days (mean difference 3.7; 95% CI 2.3 to 5.1), ICU-free days (mean difference 2.4; 95% CI 1.0 to 3.7), and hospital-free days (mean difference 2.4; 95% CI 1.2 to 3.6) associated with the intervention. The mortality rate was 34.1% in the preintervention group and 19.6% in the intervention group (adjusted odds ratio 0.47; 95% CI 0.35 to 0.63). Implementing a mechanical ventilator protocol in the ED is feasible and is associated with significant improvements in the delivery of safe mechanical ventilation and clinical outcome. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  16. Designing services for frequent attenders to the emergency department: a characterisation of this population to inform service design.

    Science.gov (United States)

    Jacob, Rebecca; Wong, Mai Luen; Hayhurst, Catherine; Watson, Peter; Morrison, Cecily

    2016-08-01

    Frequent attendance to the emergency department (ED) is a growing public health concern. Designing services for frequent attenders poses challenges, given the heterogeneous nature of this group. This was a two-part observational study identifying frequent attenders from ED records. The first stage studied trends and developed personas with emphasis on differentiating moderate frequent attenders (attending between 5 and 20 times per year) and extreme frequent attenders (attending more than 20 times). Stage 2 included a case note review of 100 consecutive frequent attenders. Results showed an increase in frequent attendance from 2.59% to 4.12% over 8 years. Moderate frequent attenders accounted for 97%. Of the 100 frequent attenders studied, 45% had medically unexplained symptoms (MUS), associated with younger age (p0.05). In conclusion, the ED is a useful hub for identifying frequent attenders with MUS, particularly among moderate frequent attenders; service design for this group should consider a 'whole-systems approach' with integration between primary and secondary care, including specialist liaison psychiatry services where appropriate. © 2016 Royal College of Physicians.

  17. Alaska Department of Health and Social Services

    Science.gov (United States)

    marijuana means for Alaska and you. Careline: 1-877-266-HELP (4357) Alaska's Tobacco Quitline Learn the Twitter Find us on Facebook Quicklinks Alaska Opioid Policy Task Force "Spice" Synthetic Marijuana Health Information Alaska State Plan for Senior Services, FY 2016-FY 2019 Get health insurance at

  18. Administrative Services Division - Alaska Department of Law

    Science.gov (United States)

    accounting practices and procedures. JoAnn Pelayo Finance Officer Email: joann.pelayo@alaska.gov Tel: (907 @alaska.gov Tel: (907) 465-3674 Fiscal and Accounting Provide centralized fiscal and accounting functions for , inter-departmental payments for core services, payroll accounting adjustments and oversight, and grant

  19. Telehealth-Enabled Emergency Medical Services Program Reduces Ambulance Transport to Urban Emergency Departments

    Directory of Open Access Journals (Sweden)

    James Robert Langabeer

    2016-11-01

    Full Text Available Introduction Emergency medical services (EMS agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED, affecting the entire emergency care system’s capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. This research describes the development and comparative effectiveness of one large urban program. Methods The Houston Fire Department initiated the Emergency Telehealth and Navigation (ETHAN program in 2014. ETHAN combines telehealth, social services, and alternative transportation to navigate primary care-related patients away from the ED where possible. Using a case-control study design, we describe the program and compare differences in effectiveness measures relative to the control group. Results During the first 12 months, 5,570 patients participated in the telehealth-enabled program, which were compared against the same size control group. We found a 56% absolute reduction in ambulance transports to the ED with the intervention compared to the control group (18% vs. 74%, P<.001. EMS productivity (median time from EMS notification to unit back in service was 44 minutes faster for the ETHAN group (39 vs. 83 minutes, median. There were no statistically significant differences in mortality or patient satisfaction. Conclusion We found that mobile technology-driven delivery models are effective at reducing unnecessary ED ambulance transports and increasing EMS unit productivity. This provides support for broader EMS mobile integrated health programs in other regions.

  20. Detection and correction of prescription errors by an emergency department pharmacy service.

    Science.gov (United States)

    Stasiak, Philip; Afilalo, Marc; Castelino, Tanya; Xue, Xiaoqing; Colacone, Antoinette; Soucy, Nathalie; Dankoff, Jerrald

    2014-05-01

    Emergency departments (EDs) are recognized as a high-risk setting for prescription errors. Pharmacist involvement may be important in reviewing prescriptions to identify and correct errors. The objectives of this study were to describe the frequency and type of prescription errors detected by pharmacists in EDs, determine the proportion of errors that could be corrected, and identify factors associated with prescription errors. This prospective observational study was conducted in a tertiary care teaching ED on 25 consecutive weekdays. Pharmacists reviewed all documented prescriptions and flagged and corrected errors for patients in the ED. We collected information on patient demographics, details on prescription errors, and the pharmacists' recommendations. A total of 3,136 ED prescriptions were reviewed. The proportion of prescriptions in which a pharmacist identified an error was 3.2% (99 of 3,136; 95% confidence interval [CI] 2.5-3.8). The types of identified errors were wrong dose (28 of 99, 28.3%), incomplete prescription (27 of 99, 27.3%), wrong frequency (15 of 99, 15.2%), wrong drug (11 of 99, 11.1%), wrong route (1 of 99, 1.0%), and other (17 of 99, 17.2%). The pharmacy service intervened and corrected 78 (78 of 99, 78.8%) errors. Factors associated with prescription errors were patient age over 65 (odds ratio [OR] 2.34; 95% CI 1.32-4.13), prescriptions with more than one medication (OR 5.03; 95% CI 2.54-9.96), and those written by emergency medicine residents compared to attending emergency physicians (OR 2.21, 95% CI 1.18-4.14). Pharmacists in a tertiary ED are able to correct the majority of prescriptions in which they find errors. Errors are more likely to be identified in prescriptions written for older patients, those containing multiple medication orders, and those prescribed by emergency residents.

  1. Assessing the physical service setting: a look at emergency departments.

    Science.gov (United States)

    Steinke, Claudia

    2015-01-01

    To determine the attributes of the physical setting that are important for developing a positive service climate within emergency departments and to validate a measure for assessing physical service design. The design of the physical setting is an important and contributing factor for creating a service climate in organizations. Service climate is defined as employee perceptions of the practices, procedures, and behaviors that get rewarded, supported, and expected with regard to customer service and customer service quality. There has been research conducted which identifies antecedents within organization that promotes a positive service climate which in turn creates service-oriented behaviors by employees toward clients. The antecedent of the physical setting and its impact on perceptions of service climate has been less commonly explored. Using the concept of the physical service setting (which may be defined as aspects of the physical, built environment that facilitate the delivery of quality service), attributes of the physical setting and their relationship with service climate were explored by means of a quantitative paper survey distributed to emergency nurses (n = 180) throughout a province in Canada. The results highlight the validity and reliability of six scales measuring the physical setting and its relation to service. Respondents gave low ratings to the physical setting of their departments, in addition to low ratings of service climate. Respondents feel that the design of the physical setting in the emergency departments where they work is not conducive to providing quality service to clients. Certain attributes of the physical setting were found to be significant in influencing perceptions of service climate, hence service quality, within the emergency department setting. © The Author(s) 2015.

  2. Extending the liaison psychiatry service in a large hospital in the UK: a before and after evaluation of the economic impact and patient care following ED attendances for self-harm

    NARCIS (Netherlands)

    Opmeer, Brent C.; Hollingworth, William; Marques, Elsa M. R.; Margelyte, Ruta; Gunnell, David

    2017-01-01

    Objectives To evaluate the impact of an expansion of liaison psychiatry services (LPS) on patient management, outcomes and treatment costs for emergency department (ED) attendances for self-harm. Design Retrospective before and after cohort study using routinely collected Self-Harm Surveillance

  3. Emergency Department Sickle Cell Assessment of Needs and Strengths (ED-SCANS), a Focus Group and Decision Support Tool Development Project

    Science.gov (United States)

    Tanabe, Paula; Reddin, Christopher; Thornton, Victoria L.; Todd, Knox H.; Wun, Ted; Lyons, John S.

    2010-01-01

    Objectives A decision support tool may guide emergency clinicians in recognizing assessment, analgesic and overall management, and health service delivery needs for patients with sickle cell disease (SCD) in the emergency department (ED). We aimed to identify data and process elements important in making decisions regarding evaluation and management of adult patients in the ED with painful episodes of sickle cell disease. Methods Qualitative methods using a series of focus groups and grounded theory were used. Eligible participants included adult clients with SCD, and emergency physicians and nurses with a minimum of one year of experience providing care to patients with SCD in the ED. Patients were recruited in conjunction with annual SCD meetings, and providers included clinicians who were and were not affiliated with sickle cell centers. Groups were conducted until saturation was reached, and included a total of two patient groups, three physician groups, and two nurse groups. Focus groups were held in New York, Durham, Chicago, New Orleans, and Denver. Clinician participants were asked the following three questions to guide the discussion: 1) what information would be important to know about patients with SCD in the ED setting to effectively care for them and help you identify patient analgesic, treatment, and referral needs? 2) what treatment decisions would you make with this information? and 3) what characteristics would a decision support tool need to have to make it meaningful and useful? Client participants were asked the same questions with re-wording to reflect what they believed providers should know to provide the best care, and what they should do with the information. All focus groups were audio taped and transcribed. The constant comparative method was used to analyze the data. Two coders independently coded participant responses and identified focal themes based on the key questions. An investigator and assistant independently reviewed the

  4. [Outpatient care in emergency departments and primary care services : A descriptive analysis of secondary data in a rural hospital].

    Science.gov (United States)

    Seeger, I; Rupp, P; Naziyok, T; Rölker-Denker, L; Röhrig, R; Hein, A

    2017-09-01

    The use of emergency departments in German hospitals has been increasing in recent years. Emergency care provided by primary care services ("Bereitschaftsdienstpraxis") or a hospital emergency departments (EDs) is the subject of current discussions. The purpose of this study was to determine the reasons that outpatients with lower treatment urgency consult the ED. Further, the effects of the cooperation between primary care services and the ED will be examined. The study was an exploratory secondary data analysis of data from the hospital information system and a quality management survey of a basic and standard care clinic in a rural area. All patients classified as 4 and 5 according to the emergency severity index (ESI), both four weeks before and after the primary care services and ED visit, were included in the study. During the two survey periods, a total of 1565 outpatient cases were treated, of which 962 cases (61%) were triaged ESI 4 or 5. Of these patients, 324 were surveyed (34%). Overall, 276 cases (85%) visited the ED without contacting a physician beforehand, 161 of the cases (50%) reported an emergency as the reason. In 126 cases (39%) the symptoms lasted more than one day. One-third of all outpatient admissions (537 cases, 34%) visited the ED during the opening hours of the general practitioner. More than 80% of the surviving cases visited the ED without physician contact beforehand. The most common reason for attending the ED was, "It is an emergency." The targeted control of the patients by integrating the primary care service into the ED does not lead to an increased number of cases in the primary care service, but to a subjective relief of the ED staff.

  5. Department of Agriculture, Food Safety and Inspection Service

    Science.gov (United States)

    ... Standard Forms FSIS United States Department of Agriculture Food Safety and Inspection Service About FSIS District Offices Careers Contact Us Ask ... Reports Fact Sheets Food Defense and Emergency Response Food Safety Education FSIS ... Assistance Contact Centers Cooperative Agreements Email Subscription ...

  6. Enabling Healthcare IT Governance: Human Task Management Service for Administering Emergency Department's Resources for Efficient Patient Flow.

    Science.gov (United States)

    Rodriguez, Salvador; Aziz, Ayesha; Chatwin, Chris

    2014-01-01

    The use of Health Information Technology (HIT) to improve healthcare service delivery is constantly increasing due to research advances in medical science and information systems. Having a fully automated process solution for a Healthcare Organization (HCO) requires a combination of organizational strategies along with a selection of technologies that facilitate the goal of improving clinical outcomes. HCOs, requires dynamic management of care capability to realize the full potential of HIT. Business Process Management (BPM) is being increasingly adopted to streamline the healthcare service delivery and management processes. Emergency Departments (EDs) provide a case in point, which require multidisciplinary resources and services to deliver effective clinical outcomes. Managed care involves the coordination of a range of services in an ED. Although fully automated processes in emergency care provide a cutting edge example of service delivery, there are many situations that require human interactions with the computerized systems; e.g. Medication Approvals, care transfer, acute patient care. This requires a coordination mechanism for all the resources, computer and human, to work side by side to provide the best care. To ensure evidence-based medical practice in ED, we have designed a Human Task Management service to model the process of coordination of ED resources based on the UK's NICE Clinical guideline for managing the care of acutely ill patients. This functionality is implemented using Java Business process Management (jBPM).

  7. Assessing STD Partner Services in State and Local Health Departments.

    Science.gov (United States)

    Cuffe, Kendra M; Leichliter, Jami S; Gift, Thomas L

    2018-02-07

    State and local health department STD programs provide several partner services to reduce disease transmission. Budget cuts and temporary staff reassignments for public health emergencies may affect the provision of partner services. Determining the impact of staffing reductions on STD rates and public health response should be further assessed.

  8. Lung-protective ventilation initiated in the emergency department (LOV-ED): a study protocol for a quasi-experimental, before-after trial aimed at reducing pulmonary complications.

    Science.gov (United States)

    Fuller, Brian M; Ferguson, Ian; Mohr, Nicholas M; Stephens, Robert J; Briscoe, Cristopher C; Kolomiets, Angelina A; Hotchkiss, Richard S; Kollef, Marin H

    2016-04-11

    In critically ill patients, acute respiratory distress syndrome (ARDS) and ventilator-associated conditions (VACs) are associated with increased mortality, survivor morbidity and healthcare resource utilisation. Studies conclusively demonstrate that initial ventilator settings in patients with ARDS, and at risk for it, impact outcome. No studies have been conducted in the emergency department (ED) to determine if lung-protective ventilation in patients at risk for ARDS can reduce its incidence. Since the ED is the entry point to the intensive care unit for hundreds of thousands of mechanically ventilated patients annually in the USA, this represents a knowledge gap in this arena. A lung-protective ventilation strategy was instituted in our ED in 2014. It aims to address the parameters in need of quality improvement, as demonstrated by our previous research: (1) prevention of volutrauma; (2) appropriate positive end-expiratory pressure setting; (3) prevention of hyperoxia; and (4) aspiration precautions. The lung-protective ventilation initiated in the emergency department (LOV-ED) trial is a single-centre, quasi-experimental before-after study testing the hypothesis that lung-protective ventilation, initiated in the ED, is associated with reduced pulmonary complications. An intervention cohort of 513 mechanically ventilated adult ED patients will be compared with over 1000 preintervention control patients. The primary outcome is a composite outcome of pulmonary complications after admission (ARDS and VACs). Multivariable logistic regression with propensity score adjustment will test the hypothesis that ED lung-protective ventilation decreases the incidence of pulmonary complications. Approval of the study was obtained prior to data collection on the first patient. As the study is a before-after observational study, examining the effect of treatment changes over time, it is being conducted with waiver of informed consent. This work will be disseminated by

  9. Challenges to effective crisis management: using information and communication technologies to coordinate emergency medical services and emergency department teams.

    Science.gov (United States)

    Reddy, Madhu C; Paul, Sharoda A; Abraham, Joanna; McNeese, Michael; DeFlitch, Christopher; Yen, John

    2009-04-01

    The purpose of this study is to identify the major challenges to coordination between emergency department (ED) teams and emergency medical services (EMS) teams. We conducted a series of focus groups involving both ED and EMS team members using a crisis scenario as the basis of the focus group discussion. We also collected organizational workflow data. We identified three major challenges to coordination between ED and EMS teams including ineffectiveness of current information and communication technologies, lack of common ground, and breakdowns in information flow. The three challenges highlight the importance of designing systems from socio-technical perspective. In particular, these inter-team coordination systems must support socio-technical issues such as awareness, context, and workflow between the two teams.

  10. Demand for Emergency Services Trends in New South Wales Years 2010-2014 (DESTINY): Age and Clinical Factors Associated with Ambulance Transportation to Emergency Departments.

    Science.gov (United States)

    Dinh, Michael M; Muecke, Sandy; Berendsen Russell, Saartje; Chalkley, Dane; Bein, Kendall J; Muscatello, David; Nagaraj, Guruprasad; Paoloni, Richard; Ivers, Rebecca

    2016-01-01

    The study aimed to analyze ambulance transportations to Emergency Departments (EDs) in New South Wales (NSW) and to identify temporal changes in demographics, acuity, and clinical diagnoses. This was a retrospective analysis of a population based registry of ED presentations in New South Wales. The NSW Emergency Department data collection (EDCC) collects patient level data on presentations to designated EDs across NSW. Patients that presented to EDs by ambulance between January 2010 and December 2014 were included. Patients dead on arrival, transferred from another hospital, or planned ED presentations were excluded. A total of 10.8 million ED attendances were identified of which 2.6 million (23%) were transported to ED by ambulance. The crude rate of ambulance transportations to EDs across all ages increased by 3.0% per annum over the five years with the highest rate observed in those 85 years and over (620.5 presentations per 1,000 population). There was an increase in the proportion of category 1 and 2 (life-threatening or potentially life-threatening) cases from 18.1% to 24.0%. Demand for ambulance services appears to be driven by older patients presenting with higher acuity problems. Alternative models of acute care for elderly patients need to be planned and implemented to address these changes.

  11. Modelling a radiology department service using a VDL integrated approach.

    Science.gov (United States)

    Guglielmino, Maria Gabriella; Celano, Giovanni; Costa, Antonio; Fichera, Sergio

    2009-01-01

    The healthcare industry is facing several challenges such as the reduction of costs and quality improvement of the provided services. Engineering studies could be very useful in supporting organizational and management processes. Healthcare service efficiency depends on a strong collaboration between clinical and engineering experts, especially when it comes to analyzing the system and its constraints in detail and subsequently, when it comes to deciding on the reengineering of some key activities. The purpose of this paper is to propose a case study showing how a mix of representation tools allow a manager of a radiology department to solve some human and technological resource re-organizational issues, which have to be faced due to the introduction of a new technology and a new portfolio of services. In order to simulate the activities within the radiology department and examine the relationship between human and technological resources, different visual diagrammatic language (VDL) techniques have been implemented to get knowledge about the heterogeneous factors related to the healthcare service delivery. In particular, flow charts, IDEFO diagrams and Petri nets have been integrated each other with success as a modelisation tools. The simulation study performed through the application of the aforementioned VDL techniques suggests the opportunity of re-organizing the nurse activities within the radiology department. The re-organization of a healthcare service and in particular of a radiology department by means of joint flow charts, IDEF0 diagrams and Petri nets is a poorly investigated topic in literature. This paper demonstrates how flow charts and IDEF0 can help people working within the department to understand the weak points of their organization and constitute an efficient base of knowledge for the implementation of a Petri net aimed at improving the departmental performance.

  12. IT Service Departments Struggle to Adopt a Service-Oriented Philosophy

    OpenAIRE

    Aileen Cater-Steel

    2009-01-01

    Many IT service departments are adopting IT service management best practice frameworks such as the IT Infrastructure Library (ITIL) to improve the quality of service to customers. This study reports on recent surveys and case studies of organizations which have embarked on IT service management improvement. It highlights specific difficulties experienced by organizations. Six factors were found to be critical in achieving an effective service-oriented philosophy. The factors are support from...

  13. Effects of a dedicated regional psychiatric emergency service on boarding of psychiatric patients in area emergency departments.

    Science.gov (United States)

    Zeller, Scott; Calma, Nicole; Stone, Ashley

    2014-02-01

    Mental health patients boarding for long hours, even days, in United States emergency departments (EDs) awaiting transfer for psychiatric services has become a considerable and widespread problem. Past studies have shown average boarding times ranging from 6.8 hours to 34 hours. Most proposed solutions to this issue have focused solely on increasing available inpatient psychiatric hospital beds, rather than considering alternative emergency care designs that could provide prompt access to treatment and might reduce the need for many hospitalizations. One suggested option has been the "regional dedicated emergency psychiatric facility," which serves to evaluate and treat all mental health patients for a given area, and can accept direct transfers from other EDs. This study sought to assess the effects of a regional dedicated emergency psychiatric facility design known at the "Alameda Model" on boarding times and hospitalization rates for psychiatric patients in area EDs. Over a 30-day period beginning in January 2013, 5 community hospitals in Alameda County, California, tracked all ED patients on involuntary mental health holds to determine boarding time, defined as the difference between when they were deemed stable for psychiatric disposition and the time they were discharged from the ED for transfer to the regional psychiatric emergency service. Patients were also followed to determine the percentage admitted to inpatient psychiatric units after evaluation and treatment in the psychiatric emergency service. In a total sample of 144 patients, the average boarding time was approximately 1 hour and 48 minutes. Only 24.8% were admitted for inpatient psychiatric hospitalization from the psychiatric emergency service. The results of this study indicate that the Alameda Model of transferring patients from general hospital EDs to a regional psychiatric emergency service reduced the length of boarding times for patients awaiting psychiatric care by over 80% versus

  14. Nighttime assaults: using a national emergency department monitoring system to predict occurrence, target prevention and plan services

    Directory of Open Access Journals (Sweden)

    Bellis Mark A

    2012-09-01

    Full Text Available Abstract Background Emergency department (ED data have the potential to provide critical intelligence on when violence is most likely to occur and the characteristics of those who suffer the greatest health impacts. We use a national experimental ED monitoring system to examine how it could target violence prevention interventions towards at risk communities and optimise acute responses to calendar, holiday and other celebration-related changes in nighttime assaults. Methods A cross-sectional examination of nighttime assault presentations (6.01 pm to 6.00 am; n = 330,172 over a three-year period (31st March 2008 to 30th March 2011 to English EDs analysing changes by weekday, month, holidays, major sporting events, and demographics of those presenting. Results Males are at greater risk of assault presentation (adjusted odds ratio [AOR] 3.14, 95% confidence intervals [CIs] 3.11-3.16; P 2 = 0.918; P  Conclusions To date, the role of ED data has focused on helping target nightlife police activity. Its utility is much greater; capable of targeting and evaluating multi-agency life course approaches to violence prevention and optimising frontline resources. National ED data are critical for fully engaging health services in the prevention of violence.

  15. Pain management trend of vaso-occulsive crisis (VOC) at a community hospital emergency department (ED) for patients with sickle cell disease.

    Science.gov (United States)

    Inoue, Susumu; Khan, Isra'a; Mushtaq, Rao; Sanikommu, Srinivasa Reddy; Mbeumo, Carline; LaChance, Jenny; Roebuck, Michael

    2016-01-01

    Pain management at the emergency department (ED) for vaso-occulsive crisis (VOC) for patients with sickle cell disease has not been optimum, with a long delay in giving the initial analgesic. We conducted a retrospective survey over a 7-year period to determine our ED's timing in giving pain medication to patients with VOC as a quality improvement project. We compared different periods, children vs adults, and the influence of gender in the analgesic administration timing. This is a retrospective chart review of three different periods: (1) years 2007-2008, (2) years 2011-2012, and (3) year 2013. We extracted relevant information from ED records. Data were analyzed using Student t test, chi-square analysis, and the Kruskal-Wallis test. There was a progressive improvement in the time interval to the 1st analgesic over these three periods. Children received analgesics more quickly than adults in all periods. Male adult patients received pain medication faster than female adult patients, although initial pain scores were higher in female than in male patients. Progressively fewer pediatric patients utilized ED over these three periods, but no difference for adult patients was observed. The proportion of pediatric patients admitted to the hospital increased with each period. The progressive decrease in both the number of patients and the number of visits to the ED by children suggested that the collective number of VOC in children has decreased, possibly secondary to the dissemination of hydroxyurea use. We failed to observe the same trend in adult patients. The need for IV access, and ordering laboratory tests or imaging studies tends to delay analgesic administration. Delay in administration of the first analgesic was more pronounced for female adult patients than male adult patients in spite of their higher pain score. Health care providers working in ED should make conscious efforts to respect pain in women as well as pain in men. Though not proven from this study

  16. Service quality of hospital outpatient departments: patients' perspective.

    Science.gov (United States)

    Zarei, Ehsan

    2015-01-01

    Assessment of patient perceptions of health service quality as an important element in quality assessments has attracted much attention in recent years. The purpose of this paper is to assess the service quality of hospital outpatient departments affiliated to Shahid Beheshti University of Medical Sciences from the patients' perspective. This cross-sectional study was conducted in 2014 in Tehran, Iran. The study samples included 500 patients who were selected by multi-stage random sampling from four hospitals. The data collection instrument was a questionnaire consisting of 50 items, and the validity and reliability of the questionnaire were confirmed. For data analysis, exploratory and confirmatory factor analysis, Friedman test, and descriptive statistics were used through LISREL 8.54 and SPSS 18 applications. Eight significant factors were extracted for outpatient service quality, which explained about 67 per cent of the total variance. Physician consultation, information provided to the patient, and the physical environment of the clinic were the three determining factors of the quality of outpatient services. The highest and lowest perceptions were related to physician consultation and perceived waiting time dimension, respectively. The mean score of patients' perception of outpatient service quality was 3.89 (±0.60). About 59.5 per cent of patients assessed the quality of outpatient services as good, 38.2 per cent as moderate, and 2.3 per cent as poor. Practical implications - The instrument developed for this study is valid and reliable, and it can help hospital managers to identify the areas needing improvement and correction. According to the findings of this study, the majority of patients had a positive experience with outpatient departments of teaching hospitals, and the services provided in these centres were of adequate quality, based on patient assessments.

  17. Hospital-Based Emergency Department Visits With Dental Conditions: Impact of the Medicaid Reimbursement Fee for Dental Services in New York State, 2009-2013.

    Science.gov (United States)

    Rampa, Sankeerth; Wilson, Fernando A; Wang, Hongmei; Wehbi, Nizar K; Smith, Lynette; Allareddy, Veerasathpurush

    2018-06-01

    Hospital-based emergency department (ED) visits for dental problems have been on the rise. The objectives of this study are to provide estimates of hospital-based ED visits with dental conditions in New York State and to examine the impact of Medicaid reimbursement fee for dental services on the utilization of EDs with dental conditions. New York State Emergency Department Database for the year 2009-2013 and Health Resources and Services Administration's Area Health Resource File were used. All ED visits with diagnosis for dental conditions were selected for analysis. The present study found a total of 325,354 ED visits with dental conditions. The mean age of patient was 32.4 years. A majority of ED visits were made by those aged 25-44 years (49%). Whites comprised 52.1% of ED visits. Proportion of Medicaid increased from 22% (in 2009) to 41.3% (in 2013). For Medicaid patients, the mean ED charges and aggregated ED charges were $811.4 and $88.1 million, respectively. Eleven counties had fewer than 4 dentists per 10,000 population in New York State. High-risk groups identified from the study are those aged 25-44 years, uninsured, covered by Medicaid and private insurance, and residing in low-income areas. The study highlights the need for increased Medicaid reimbursement for dentists and improves access to preventive dental care especially for the vulnerable groups. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Nuclear medicine. The management of patients coming out of a nuclear medicine department - Radiation protection sheet ED 4242

    International Nuclear Information System (INIS)

    2006-03-01

    This sheet aims at providing elements for the preparation of the management of a patient by a department or unit other than a nuclear medicine department after this patient has been submitted to an examination or treatment involving the use of radionuclides in unsealed sources, as this exposure may result in an internal or external exposure risk for the personnel, other persons and relatives. It briefly describes the modalities of performance of nuclear medicine act, the modalities of information of patients and of their relatives, indicates instructions to departments hosting the patient (instruction regarding the patient and wastes), and instructions for pregnant or breast feeding women

  19. 75 FR 62424 - EDS, an HP Company (Re-Branded as HP-Enterprise Services) Including On-Site Workers From: Abel...

    Science.gov (United States)

    2010-10-08

    ...-Branded as HP--Enterprise Services) Including On-Site Workers From: Abel Personnel Inc., Advantage Tech... February 4, 2010, applicable to workers of EDS, an HP Company (Re- branded as HP--Enterprise Services...-branded as HP-- Enterprise Services). These employees provided various activities related to the supply of...

  20. Oiling the gate: a mobile application to improve the admissions process from the emergency department to an academic community hospital inpatient medicine service.

    Science.gov (United States)

    Fung, Russell; Hyde, Jensen Hart; Davis, Mike

    2018-01-01

    The process of admitting patients from the emergency department (ED) to an academic internal medicine (AIM) service in a community teaching hospital is one fraught with variability and disorder. This results in an inconsistent volume of patients admitted to academic versus private hospitalist services and results in frustration of both ED and AIM clinicians. We postulated that implementation of a mobile application (app) would improve provider satisfaction and increase admissions to the academic service. The app was designed and implemented to be easily accessible to ED physicians, regularly updated by academic residents on call, and a real-time source of the number of open AIM admission spots. We found a significant improvement in ED and AIM provider satisfaction with the admission process. There was also a significant increase in admissions to the AIM service after implementation of the app. We submit that the implementation of a mobile app is a viable, cost-efficient, and effective method to streamline the admission process from the ED to AIM services at community-based hospitals.

  1. When high pressure, system constraints, and a social justice mission collide: A socio-structural analysis of emergency department social work services.

    Science.gov (United States)

    Moore, Megan; Cristofalo, Margaret; Dotolo, Danae; Torres, Nicole; Lahdya, Alexandra; Ho, Leyna; Vogel, Mia; Forrester, Mollie; Conley, Bonnie; Fouts, Susan

    2017-04-01

    The emergency department (ED) can be a critical intervention point for many patients with multifaceted needs. Social workers have long been part of interdisciplinary ED teams. This study aimed to contribute to the limited understanding of social worker-patient interactions and factors influencing social work services in this setting. This paper reports a qualitative content analysis of social work medical record notes (N = 1509) of services provided to trauma patients in an urban, public, level 1 trauma center and an in-depth analysis of semi-structured interviews with ED social workers (N = 10). Eight major social work roles were identified: investigator, gatekeeper, resource broker, care coordinator, problem solver, crisis manager, advocate, discharge planner. Analyses revealed a complex interplay between ED social work services and multi-layered contexts. Using a social-ecological framework, we identified the interactions between micro or individual level factors, mezzo or local system level factors and macro environmental and systemic factors that play a role in ED interactions and patient services. Macro-level contextual influences were socio-structural forces including socioeconomic barriers to health, social hierarchies that reflected power differentials between providers and patients, and distrust or bias. Mezzo-level forces were limited resources, lack of healthcare system coordination, a challenging hierarchy within the medical model and the pressure to discharge patients quickly. Micro-level factors included characteristics of patients and social workers, complexity of patient stressors, empathic strain, lack of closure and compassion. All of these forces were at play in patient-social worker interactions and impacted service provision. Social workers were at times able to successfully navigate these forces, yet at other times these challenges were insurmountable. A conceptual model of ED social work and the influences on the patient-social worker

  2. The Frederic Joliot hospital department; Le service hospitalier Frederic Joliot

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1999-02-01

    The Service Hospitalier Frederic Joliot (SHFJ) of the CEA, has got a scientific and a medical mission: to develop techniques allowing the functional study of human organs. The paper presents the main activities of this department: the positron emission tomography to visualize in real time markers in the organism in neurology and cardiology, researches on epilepsy to localize the epileptic centre, the nuclear medicine in cardiology with the use of the gamma photon emission tomography and the radiopharmacology to visualize the drugs effects in the organism. (A.L.B.)

  3. [Services portfolio of a department of endocrinology and clinical nutrition].

    Science.gov (United States)

    Vicente Delgado, Almudena; Gómez Enterría, Pilar; Tinahones Madueño, Francisco

    2011-03-01

    Endocrinology and Clinical Nutrition are branches of Medicine that deal with the study of physiology of body glands and hormones and their disorders, intermediate metabolism of nutrients, enteral and parenteral nutrition, promotion of health by prevention of diet-related diseases, and appropriate use of the diagnostic, therapeutic, and preventive tools related to these disciplines. Development of Endocrinology and Clinical Nutrition support services requires accurate definition and management of a number of complex resources, both human and material, as well as adequate planning of the care provided. It is therefore essential to know the services portfolio of an ideal Department of Endocrinology and Clinical Nutrition because this is a useful, valid and necessary tool to optimize the available resources, to increase efficiency, and to improve the quality of care. Copyright © 2010 SEEN. Published by Elsevier Espana. All rights reserved.

  4. Does providing prescription information or services improve medication adherence among patients discharged from the emergency department? A randomized controlled trial.

    Science.gov (United States)

    McCarthy, Melissa L; Ding, Ru; Roderer, Nancy K; Steinwachs, Donald M; Ortmann, Melinda J; Pham, Julius Cong; Bessman, Edward S; Kelen, Gabor D; Atha, Walter; Retezar, Rodica; Bessman, Sara C; Zeger, Scott L

    2013-09-01

    We determine whether prescription information or services improve the medication adherence of emergency department (ED) patients. Adult patients treated at one of 3 EDs between November 2010 and September 2011 and prescribed an antibiotic, central nervous system, gastrointestinal, cardiac, or respiratory drug at discharge were eligible. Subjects were randomly assigned to usual care or one of 3 prescription information or services intervention groups: (1) practical services to reduce barriers to prescription filling (practical prescription information or services); (2) consumer drug information from MedlinePlus (MedlinePlus prescription information or services); or (3) both services and information (combination prescription information or services). Self-reported medication adherence, measured by primary adherence (prescription filling) and persistence (receiving medicine as prescribed) rates, was determined during a telephone interview 1 week postdischarge. Of the 3,940 subjects enrolled and randomly allocated to treatment, 86% (N=3,386) completed the follow-up interview. Overall, primary adherence was 88% and persistence was 48%. Across the sites, primary adherence and persistence did not differ significantly between usual care and the prescription information or services groups. However, at site C, subjects who received the practical prescription information or services (odds ratio [OR]=2.4; 95% confidence interval [CI] 1.4 to 4.3) or combination prescription information or services (OR=1.8; 95% CI 1.1 to 3.1) were more likely to fill their prescription compared with usual care. Among subjects prescribed a drug that treats an underlying condition, subjects who received the practical prescription information or services were more likely to fill their prescription (OR=1.8; 95% CI 1.0 to 3.1) compared with subjects who received usual care. Prescription filling and receiving medications as prescribed was not meaningfully improved by offering patients patient

  5. The evaluation of tertiary institution service quality using HiEdQUAL ...

    African Journals Online (AJOL)

    One of the most important decisions that affect the future of young students is a decision as regards a Tertiary Institution of choice. In making such a decision, a number of factors are required which include service quality. Service quality consists of different attributes and many of them are intangible and difficult to measure, ...

  6. District heating service connections. Technical recommendations. 4. ed. Hausanschluesse an Fernwaermenetze. Technische Richtlinien

    Energy Technology Data Exchange (ETDEWEB)

    1986-01-01

    The fourth edition of the 'Technical regulations - district heating service connections' constitutes a completely revised version answering to the considerable developments and changes the house service sector experienced between 1975 and 1985. Analyses and practical experiences have proved to show that precision thermostats which, depending on the mode of lines and layout of the service system allow to spare central temperature control systems, still have a decisive influence on the design of district heating service stations. The revised chapter on steam line service connections focuses on problems concerning the metering of condensates and the connection of secondary water heating networks to steam lines. The reader finds an updated selection of diagrams as well as a revised appendix listing the AGFW codes of practice and recommendations, relevant DIN standards and relevant VDE/VDI recommendations.

  7. ASN takes position in the in-service follow-up programs of primary and secondary loops of EdF's nuclear power plants

    International Nuclear Information System (INIS)

    2002-01-01

    This decision from the French authority of nuclear safety (ASN) aims at fixing the conditions to be respected by Electricite de France (EdF) during its in-service follow-up programs for the monitoring and preventive maintenance of the primary and secondary cooling loops of EdF's PWR reactors. The components and the particular points to be controlled are listed in appendixes. (J.S.)

  8. HCUP Nationwide Emergency Department Database (NEDS) Restricted Access File

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Nationwide Emergency Department Sample (NEDS) was created to enable analyses of emergency department (ED) utilization patterns and support public health...

  9. Evaluation of emergency department nursing services and patient satisfaction of services.

    Science.gov (United States)

    Mollaoğlu, Mukadder; Çelik, Pelin

    2016-10-01

    To identify nursing services and assess patient satisfaction in patients who present to the emergency department. Emergency nursing care is a significant determinant of patient satisfaction. Patient satisfaction is often regarded as a reliable indicator of the quality of services provided in the emergency department. This is a descriptive study. Eighty-four patients who presented to the university emergency department were included in the study. The study data were collected by the Patient Information Form and the Satisfaction Level Form. Emergency nursing services, including history taking, assessing vital signs, preparing the patient for an emergency intervention, oxygen therapy, drug delivery and blood-serum infusion were shown to be more commonly provided compared with other services such as counselling the patients and the relatives about their care or delivering educational and psychosocial services. However, 78·6% of the patients were satisfied with their nursing services. The highest satisfaction rates were observed in the following sub-dimensions of the Satisfaction Level Form: availability of the nurse (82·1%), behaviour of the nurse towards the patient (78·6%) and the frequency of nursing rounds (77·4%). The most common practices performed by nurses in the emergency department were physical nursing services. Patient satisfaction was mostly associated with the availability of nurses when they were needed. Our results suggest that in addition to the physical care, patients should also receive education and psychosocial care in the emergency department. We believe that this study will contribute to the awareness and understanding of principles and concepts of emergency nursing, extend the limits of nursing knowledge and abilities, and improve and maintain the quality of clinical nursing education and practice to train specialist nurses with high levels of understanding in ethical, intellectual, administrative, investigative and professional issues.

  10. Datový sklad v prostředí Amazon Web Services

    OpenAIRE

    Kuželka, Kryštof

    2015-01-01

    The primary objective of this work is to investigate the potential of utilizing Hadoop and Amazon Redshift in the Amazon Web Services ("AWS") cloud, in order to design and implement a data warehouse, the efficacy of which will be tested afterwards. Contributions of this work include: documenting the technologies in the AWS cloud in Czech, demonstration of the design and performance tests of the data warehouse and the ETL part. Another considerable benefit is the added value to the company for...

  11. Emergency department admissions are more profitable than non-emergency department admissions.

    Science.gov (United States)

    Henneman, Philip L; Lemanski, Michael; Smithline, Howard A; Tomaszewski, Andrew; Mayforth, Janice A

    2009-02-01

    We compare the contribution margin per case per hospital day of emergency department (ED) admissions with non-ED admissions in a single hospital, a 600-bed, academic, tertiary referral, Level I trauma center with an annual ED census of 100,000. This was a retrospective comparison of the contribution margin per case per day for ED and non-ED inpatient admissions for fiscal years 2003, 2004, and 2005 (October 1 through September 30). Contribution margin is defined as net revenue minus total direct costs; it is then expressed per case per hospital day. Service lines are a set of linked patient care services. Observation admissions and outpatient services are not included. Resident expenses (eg, salary and benefits) and revenue (ie, Medicare payment of indirect medical expenses and direct medical expenses) are not included. Overhead expenses are not included (eg, building maintenance, utilities, information services support, administrative services). For fiscal year 2003 through fiscal year 2005, there were 51,213 ED and 57,004 non-ED inpatient admissions. Median contribution margin per day for ED admissions was higher than for non-ED admissions: ED admissions $769 (interquartile range $265 to $1,493) and non-ED admissions $595 (interquartile range $178 to $1,274). Median contribution margin per day varied by site of admissions, by diagnosis-related group, by service line, and by insurance type. In summary, ED admissions in our institution generate a higher contribution margin per day than non-ED admissions.

  12. 78 FR 13743 - Department of State FY11 Service Contract Inventory

    Science.gov (United States)

    2013-02-28

    ... DEPARTMENT OF STATE [Public Notice 8207] Department of State FY11 Service Contract Inventory... Contract Inventory. SUMMARY: The Department of State has publically released its Service Contract Inventory... Act, Public Law 111-117, requires Department of State, and other civilian agencies, to submit an...

  13. Assessing the Idaho Transportation Department's customer service performance.

    Science.gov (United States)

    2011-10-23

    This report assesses customer satisfaction with the Idaho Transportation Department. It also compares and contrasts the results of customer satisfaction surveys conducted for the Idaho Transportation Department with the results from other state trans...

  14. Clinical Profile and Sex Differences in Brazilian Children and Adolescents Receiving Psychiatric Services in the Emergency Department.

    Science.gov (United States)

    Tonezer, Jordana; Muller, Thomaz; Rocha, Gibsi Possapp; Recondo, Rogéria; Nogueira, Eduardo Lopes; Spanemberg, Lucas

    2015-06-27

    We present a survey of sex differences and socio-demographic and clinical variables in children and adolescents receiving a psychiatric consultation service in an emergency department (ED). This observational, retrospective, and cross-sectional study included all records of patients (age, services in an ED in a 4-year period (January 2010 to December 2013). Two hundred fifty-nine records of children and adolescents were located. The mean age of the participants was 14.19 years, and most subjects were female (59.5%) and had private health insurance (83.7%). Most participants (87.4%) were accompanied by their parents. The main complaints were suicide attempts (21.8%) and psychomotor agitation/aggressiveness (21.8%). Unipolar depression (37.8%) and adjustment, reactive, and anxiety disorders (13.7%) were the most prevalent diagnoses. Most patients received an indication of psychiatric hospitalization (51.7%). Females had more suicide attempts than males (28.3% vs 12.4%) and less psychomotor agitation/aggressiveness than males (15.5% vs 31.4%). Females also exhibited more unipolar depression (47.6% vs 23.5%), fewer psychotic disorders (4.2% vs 16.3%), and substance use/misuse (1.4% vs 13.3%) than males. Males needed more psychiatric medication during evaluation (37.9% vs 19.2%). This survey of the profile of pediatric patients evaluated by a psychiatric service in an ED in Brazil was the first of its kind. The large percentage of patients referred for hospitalization highlights the importance of specialized psychiatry care for this age group in this facility, which is a common entry point for mental health care.

  15. Fertilizing ROSES through the STEM: Interdisciplinary Modules as Pre-service Research Experiences for Secondary STEM Educators (IMPRESS-Ed)

    Science.gov (United States)

    Kavic, Michael; Wiita, P. J.; Benoit, M.; Magee, N.

    2013-01-01

    IMPRESS-Ed is a program designed to provide authentic summer research experiences in the space, earth, and atmospheric sciences for pre-service K-12 educators at Long Island University (LIU) and The College of New Jersey (TCNJ). In 2011 and 2012, the program involved five students and took place over eight weeks with recruitment occurring during the preceding academic year. The program was divided into two modules: A common core module and an individual mentored research experience. The common module consisted of three units focusing on data-driven pedagogical approaches in astrophysics, tectonophysics, and atmospheric science, respectively. The common module also featured training sessions in observational astronomy, and use of a 3D geowall and state of the art planetarium. Participants in the program are also offered the opportunity to utilize the available TCNJ facilities with their future students. The individual mentored research module matched student interests with potential projects. All five students demonstrated strong gains in earth and space science literacy compared to a baseline measurement. Each student also reported gaining confidence to incorporate data and research-driven instruction in the space and earth sciences into the K-12 STEM classroom setting. All five research projects were also quite successful: several of the students plan to continue research during the academic year and two students are presenting research findings as first authors here at AAS. Other research results are likely to be presented at this year's American Geophysical Union meeting.

  16. 76 FR 9399 - Department of State FY10 Service Contract Inventory

    Science.gov (United States)

    2011-02-17

    ... DEPARTMENT OF STATE [Public Notice 7321] Department of State FY10 Service Contract Inventory... Contract Inventory. SUMMARY: The Department of State has publically released its Service Contract Inventory for FY10. Section 743 of Division C of the FY 2010 Consolidated Appropriations Act, Public Law 111-117...

  17. 77 FR 5614 - Department of State FY11 Service Contract Inventory

    Science.gov (United States)

    2012-02-03

    ... DEPARTMENT OF STATE [Public Notice 7785] Department of State FY11 Service Contract Inventory... Contract Inventory. SUMMARY: The Department of State has publically released its Service Contract Inventory.../ . Section 743 of Division C of the FY 2010 Consolidated Appropriations Act, Public Law 111-117, requires...

  18. Health Services Utilization Patterns Associated with Emergency Department Closure

    DEFF Research Database (Denmark)

    Hansen, Kristian Schultz; Enemark, Ulrika; Foldspang, Anders

    2011-01-01

    , 1997-2003. Data were extracted from administrative registries including information on individual use of emergency services and other hospital care, contact with GPs and socioeconomic background. Health services' use by the Morsø population was measured before reduction in emergency room opening hours...... of substitute health services. By contrast, Morsø women compared to the rest of Viborg county reduced their use of GP services in terms of face-to-face visits (β = -0.08, P = 0.020), telephone consultations (β = -0.11, P = 0.007), home visits (β = -0.48, P = 0.009), and their inpatient hospital utilization (β...... = -0.12, P = 0.022) during the period when emergeny services were only available in the daytime. CONCLUSIONS: Emergency services at neighbouring hospitals (40 kilometres distance) were able to compensate, in part, for the decreased local emergency service provision. Concurrent changes in health care...

  19. Utilización por cuenta propia de los Servicios de Urgencias Hospitalarias: razones que dan las personas con problemas de salud de baja complejidad para utilizar estos servicios Non-Urgent and Non-Referred Patients Presenting to the Emergency Department (ED: Understanding the Reasons of the Non Urgent Patients to Visit the ED

    Directory of Open Access Journals (Sweden)

    Manuel Espinel Vallejo

    2011-09-01

    ó acudir a urgencias porque no mejoró con el tratamiento que le prescribió el MC (71% y porque no estaba satisfecho con el tratamiento y quería una segunda opinión (39%. El 70% consideró que su problema de salud no era grave pero pensaba que sí era merecedor de atención urgente o rápida. El 63% expresó alta preocupación por su problema. El 63% consideró que el actual problema de salud no podía ser resuelto por su MC en caso de ser atendido en ese momento. Finalmente el 50% consideró que el SUH tenía más capacidad para resolver los problemas de salud que el CS. Conclusión: La mejor eficacia y efectividad, en términos de uso y gestión de recursos técnicos y del tiempo para resolver el problema de salud, y la comodidad, en términos de horarios, disponibilidad y accesibilidad, parecen ser las principales razones por las cuales las personas con problemas de salud de baja complejidad utilizan por cuenta propia los SUH. La preocupación, más que la gravedad, parece movilizar activamente la búsqueda de solución al problema de salud de manera rápida y urgente. Estas razones parecen estar condicionadas en la experiencia institucional previa con el CS.

    Objectives: The objectives of this study are: 1 To understand the reasons of non-urgent non-referred patients to use the Emergency Department (ED, 2 To understand the “urgency” and “concern” perceptions of non-urgent non-referring patients. 3 To determinate the associated factors with the use the ED for non-urgent non-referred patients. Methods: Design: Descriptive cross-sectional study. Setting: Emergency Department (ED of “Infanta Cristina” General Hospital, Parla, Madrid, Spain. Patients: non-referred non-urgent adult patients were selected by Emergency Department Triage system in levels IV and V, on weekdays between 10:00 and 22:00 hours, from April 26 to July 30, 2010, to be surveyed using a structured face

  20. 76 FR 8402 - Public Availability of the Department of Veterans Affairs FY 2010 Service Contract Inventory

    Science.gov (United States)

    2011-02-14

    ... DEPARTMENT OF VETERANS AFFAIRS Public Availability of the Department of Veterans Affairs FY 2010 Service Contract Inventory AGENCY: Department of Veterans Affairs. ACTION: Notice of public availability... Consolidated Appropriations Act of 2010 (Pub. L. 111-117), Department of Veterans Affairs (VA) is publishing...

  1. Customer service in appliance sales departments of selected ...

    African Journals Online (AJOL)

    Store managers firstly judged tangible evidence of the service offering in their own stores; consumers' perception of the service quality (N=296) in retail stores was subsequently investigated immediately after closure of a sales deal; and salespeople's recommendations (based on their personal experience) to augment the ...

  2. Records management and service delivery: the case of Department ...

    African Journals Online (AJOL)

    This article explores the role of records management in the delivery of public service in ... to the Corporate Services Division at the Ministry of Health headquarters. ... delays in access and use of records; lack of a elaborate electronic records ...

  3. Informing the design of clinical decision support services for evaluation of children with minor blunt head trauma in the emergency department: a sociotechnical analysis.

    Science.gov (United States)

    Sheehan, Barbara; Nigrovic, Lise E; Dayan, Peter S; Kuppermann, Nathan; Ballard, Dustin W; Alessandrini, Evaline; Bajaj, Lalit; Goldberg, Howard; Hoffman, Jeffrey; Offerman, Steven R; Mark, Dustin G; Swietlik, Marguerite; Tham, Eric; Tzimenatos, Leah; Vinson, David R; Jones, Grant S; Bakken, Suzanne

    2013-10-01

    Integration of clinical decision support services (CDSS) into electronic health records (EHRs) may be integral to widespread dissemination and use of clinical prediction rules in the emergency department (ED). However, the best way to design such services to maximize their usefulness in such a complex setting is poorly understood. We conducted a multi-site cross-sectional qualitative study whose aim was to describe the sociotechnical environment in the ED to inform the design of a CDSS intervention to implement the Pediatric Emergency Care Applied Research Network (PECARN) clinical prediction rules for children with minor blunt head trauma. Informed by a sociotechnical model consisting of eight dimensions, we conducted focus groups, individual interviews and workflow observations in 11 EDs, of which 5 were located in academic medical centers and 6 were in community hospitals. A total of 126 ED clinicians, information technology specialists, and administrators participated. We clustered data into 19 categories of sociotechnical factors through a process of thematic analysis and subsequently organized the categories into a sociotechnical matrix consisting of three high-level sociotechnical dimensions (workflow and communication, organizational factors, human factors) and three themes (interdisciplinary assessment processes, clinical practices related to prediction rules, EHR as a decision support tool). Design challenges that emerged from the analysis included the need to use structured data fields to support data capture and re-use while maintaining efficient care processes, supporting interdisciplinary communication, and facilitating family-clinician interaction for decision-making. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. ABC estimation of unit costs for emergency department services.

    Science.gov (United States)

    Holmes, R L; Schroeder, R E

    1996-04-01

    Rapid evolution of the health care industry forces managers to make cost-effective decisions. Typical hospital cost accounting systems do not provide emergency department managers with the information needed, but emergency department settings are so complex and dynamic as to make the more accurate activity-based costing (ABC) system prohibitively expensive. Through judicious use of the available traditional cost accounting information and simple computer spreadsheets. managers may approximate the decision-guiding information that would result from the much more costly and time-consuming implementation of ABC.

  5. 76 FR 79221 - Penske Logistics, LLC, Customer Service Department General Motors and Tier Finished Goods...

    Science.gov (United States)

    2011-12-21

    ..., Customer Service Department General Motors and Tier Finished Goods/Finished Goods Division; a Subsidiary of... Manpower El Paso, TX; Amended Certification Regarding Eligibility To Apply for Worker Adjustment Assistance... should read Penske Logistics, LLC, Customer Service Department, General Motors and Tier Finished Goods...

  6. 78 FR 977 - Public Availability of the Department of Transportation FY 2012 Service Contract Inventory

    Science.gov (United States)

    2013-01-07

    ... Service Contract Inventory AGENCY: Department of Transportation. ACTION: Notice of Public Availability of FY 2012 Service Contract Inventories. SUMMARY: In accordance with Section 743 of Division C of the Consolidated Appropriations Act of 2010, Public Law 111-117, Department of Transportation is publishing this...

  7. 31 CFR 223.22 - Fees for services of the Treasury Department.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Fees for services of the Treasury Department. 223.22 Section 223.22 Money and Finance: Treasury Regulations Relating to Money and Finance... BUSINESS WITH THE UNITED STATES § 223.22 Fees for services of the Treasury Department. (a) Fees shall be...

  8. Fertilizing ROSES through the STEM: Interdisciplinary Modules as Pre-service Research Experiences for Secondary STEM Educators (IMPRESS-Ed)

    Science.gov (United States)

    Magee, N. B.; Kavic, M.; Benoit, M. H.; Wiita, P.

    2011-12-01

    IMPRESS-Ed is a program designed to provide authentic summer research experiences in the space, earth, and atmospheric sciences for pre-service K-12 educators at The College of New Jersey (TCNJ). In 2011, the program involved five students and took place over eight weeks with recruitment occurring during the preceding academic year. The program was divided into two modules: A common core module and an individual mentored research experience. The common module consisted of three units focusing on data-driven pedagogical approaches in astrophysics, tectonophysics, and atmospheric science, respectively. The common module also featured training sessions in observational astronomy, and use of a 3D geowall and state of the art planetarium. Participants in the program are also offered the opportunity to utilize the available TCNJ facilities with their future students. Given that a large number of graduates from the TCNJ take positions in local New Jersey schools, the opportunity to make use of these facilities at a future time would be of great significance to them and their future students. The individual mentored research module matched student interests with potential projects. Research led by M.H. Benoit analyzed gravity data from the NASA-GRACE mission to find lithospheric density contrasts beneath the eastern US. A student working with N.B. Magee used data from NASA satellites CALIPSO, CloudSat, and AQUA-MODIS to study the dynamics of convective cloud tops. Research projects led by M. Kavic performed simulations to investigate the possibility of detecting superconducting cosmic strings using radio observations and also designed and constructed a radio interferometer based on the NASA's Radio-Jove program. P. Wiita supervised a research project studying star-forming regions of active galaxies through analysis of images from NASA's Hubble Space Telescope and GALEX. The research program was also incorporated into the framework of the TCNJ Mentored Undergraduate Summer

  9. Modeling factors influencing the demand for emergency department services in ontario: a comparison of methods

    OpenAIRE

    Meaney Christopher; Moineddin Rahim; Agha Mohammad; Zagorski Brandon; Glazier Richard Henry

    2011-01-01

    Abstract Background Emergency departments are medical treatment facilities, designed to provide episodic care to patients suffering from acute injuries and illnesses as well as patients who are experiencing sporadic flare-ups of underlying chronic medical conditions which require immediate attention. Supply and demand for emergency department services varies across geographic regions and time. Some persons do not rely on the service at all whereas; others use the service on repeated occasions...

  10. 78 FR 70584 - ATOS IT Solutions & Services, Inc., Billing and Collections Department, Including Workers Whose...

    Science.gov (United States)

    2013-11-26

    ...) Wages are Reported Through Siemens IT Solutions and Services, Mason, Ohio; Amended Certification... Solutions & Services, Inc., Billing and Collections Department, Mason, Ohio. The workers are engaged in... workers separated from employment at the Mason, Ohio location of ATOS IT Solutions & Services, Inc...

  11. Unscheduled-return-visits after an emergency department (ED) attendance and clinical link between both visits in patients aged 75 years and over: a prospective observational study.

    Science.gov (United States)

    Pereira, Laurent; Choquet, Christophe; Perozziello, Anne; Wargon, Mathias; Juillien, Gaelle; Colosi, Luisa; Hellmann, Romain; Ranaivoson, Michel; Casalino, Enrique

    2015-01-01

    Predictors of unscheduled return visits (URV), best time-frame to evaluate URV rate and clinical relationship between both visits have not yet been determined for the elderly following an ED visit. We conducted a prospective-observational study including 11,521 patients aged ≥75-years and discharged from ED (5,368 patients (53.5%)) or hospitalized after ED visit (6,153 patients). Logistic Regression and time-to-failure analyses including Cox proportional model were performed. Mean time to URV was 17 days; 72-hour, 30-day and 90-day URV rates were 1.8%, 6.1% and 10% respectively. Multivariate analysis indicates that care-pathway and final disposition decisions were significantly associated with a 30-day URV. Thus, we evaluated predictors of 30-day URV rates among non-admitted and hospitalized patient groups. By using the Cox model we found that, for non-admitted patients, triage acuity and diagnostic category and, for hospitalized patients, that visit time (day, night) and diagnostic categories were significant predictors (prisk of URV, and that some diagnostic categories are also related for non-admitted and hospitalized subjects alike. Our study also demonstrates that the best time frame to evaluate the URV rate after an ED visit is 30 days, because this is the time period during which most URVs and cases with close clinical relationships between two visits are concentrated. Our results suggest that URV can be used as an indicator or quality.

  12. Department

    African Journals Online (AJOL)

    USER

    2016-09-20

    Sep 20, 2016 ... Department of Biological and Environmental Sciences, Kibabii University. Abstract. This study ... Key Words: Climate Change, Regional Circulation Model, PRECIS, Bungoma County ... by different computer models is much.

  13. Reciprocal Allocation Method in Service Departments. The Case of a Production Enterprise

    Science.gov (United States)

    Papaj, Ewelina

    2017-12-01

    The main aim of this article is to indicate the role of reciprocal allocation method in the process of costs calculation. In the environment of nowadays companies, often taking very complex organisational forms, the existence of service departments becomes of great importance. Although, as far as management accounting processes are concerned, which lead to identifying the product cost, the service departments' costs come out to be of minor importance. This article means to prove that the service departments' costs and their reliable settlement are a desirable source of information about the products. This work consists of two parts. First of them features theoretical considerations and a critical analysis of subject literature. In the latter part, the service departments' costs calculation will be presented, basing on reciprocal services in a production enterprise from chemical industry.

  14. Services Supply Chain in the Department of Defense: A Comparison of Acquisition Management Practices in the Army, Navy, and Air Force

    Science.gov (United States)

    2010-08-23

    characteristics also lead to differences in the marketing of services ( Lovelock , 1992; Hutt & Speh, 1998). Given these differences in the production and...Press. Lovelock , C. H. (1992). Are services really different? In C. H. Lovelock (Ed.), Managing services (2nd ed., pp. 1-8). Englewood Cliffs, NJ

  15. EDS becoms CERN Openlab contributor

    CERN Multimedia

    2007-01-01

    "EDS announced that it has become an official contributor to CERN openlab. The purpose of the joint project beteween CERN and EDS is to carry out research and development in the field of monitoring, management and operation of grid services." (1 page)

  16. PUBLIC COMMENT ON THE DEPARTMENT OF HEALTH AND HUMAN SERVICES 2018 FEDERAL PHYSICAL ACITIVTY GUIDELINES

    Science.gov (United States)

    Title: Public Comment on Department of Health and Human Services (DHHS) 2018 Physical Activity Guidelines Author: Wayne E. Cascio, Director, Environmental Public Health Division, US EPA Abstract: In the 2008 Physical Activity Guidelines, the effects of air pollution and advers...

  17. A System Architecture and Migration Plan for the Student Services Department of the Marine Corps Institute

    National Research Council Canada - National Science Library

    Evers

    1997-01-01

    ... to a client server based, open information system for the Marine Corps Institute (MCI). The primary objective of this thesis is to develop the technology architecture required to support the information systems of the Student Services Department (SSD...

  18. Kepuasan Kerja Karyawan Food And Beverage Service Department di Hotel Grand Tjokro Pekanbaru

    OpenAIRE

    Lestari, Delia Putri; Ibrahim, Mariaty

    2016-01-01

    The purpose of this research is how employee satisfaction Food and Beverage Service Department in work and how efforts to improve employee job satisfaction Food and Beverage Service Department in Grand Tjokro Hotel.This research was used descriptive quantitatif method to describe the issues. The sample used in this research was 7 people. Quesionnaires, interviews, and observations were used to collect the research data.The results of this research indicate that based on the research results o...

  19. Change of offices for HR Department - disrupted service during the last week of February 2013

    CERN Multimedia

    2013-01-01

    HR Department would like to inform that, due to office renovation work, a number of HR Services currently located on the ground, first and second floors of Building 5 will move to temporary offices as from late February.   The removals will take place from Friday 22 until Tuesday 26 February 2013 inclusive and during this period, telephone and e-mail contact may be disrupted. The following services will be relocated to: Building 510  – ground floor (until mid-June) Head of Department and Deputy Office of the Head of HR Department Group Leaders and Partners Diversity Office HR Legal Section Building 652 – Prefab/Algeco (until September) Human Resources Advisors and assistants Staff Recruitment Service Fellows & Apprentices Service Students & Associates Service Temporary office numbers will be available in the CERN phonebook. Any emergencies during the removals may be addressed to Lynda.Leroux@cern.ch Thank you in advance for your understanding. HR Head O...

  20. 75 FR 47631 - Swets Information Services, Operations Department, Information Technology Group, Marketing Group...

    Science.gov (United States)

    2010-08-06

    ... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-73,668] Swets Information Services, Operations Department, Information Technology Group, Marketing Group, Finance Group, Runnemede..., Information Technology (IT) Group, Marketing Group and the Finance Group into one entity instead of...

  1. The Suffolk County Department of Social Services Performance Study. An Executive Summary.

    Science.gov (United States)

    Spottheim, David; Wilson, George R.

    The logic and methodology applied in a management science approach to performance and staff utilization in the Client Benefits (CBA) and Community Service (CSA) divisions of the Suffolk County (New York) Department of Social Services (SCDSS) are described. Using a blend of classical organization theory and management science techniques, the CBA…

  2. Rates of TBI-related Emergency Department Visits, Hospitalizations, and Deaths - United States, 2001 – 2010

    Data.gov (United States)

    U.S. Department of Health & Human Services — In general, total combined rates for traumatic brain injury (TBI)-related emergency department (ED) visits, hospitalizations and deaths have increased over the past...

  3. EXCEPTIONAL CLOSURE OF VARIOUS HR DEPARTEMENT SERVICES ON 20 AND 21 SEPTEMBER 2007

    CERN Document Server

    HR Department

    2007-01-01

    Due to a group training event, the following services will be exceptionally closed on Thursday 20 and Friday 21 September 2007 : installation service (removals, cars, diplomatic privileges), school fees, Personnel Records Office (including attestations), French visas; duty travel, leave, reinstallation indemnity, unemployment benefit, tax information and social affairs. The French and Swiss cards service will remain open as usual, from 8:30 to 12:30. Thank you for your understanding. HR Department HR-SPS Group

  4. EXCEPTIONAL CLOSURE OF VARIOUS HR DEPARTMENT SERVICES ON 20 AND 21 SEPTEMBER 2007

    CERN Document Server

    *Beyond was established as CIC Productions to produce the television series Beyond 2000 for the Seven Network in Australia,

    2007-01-01

    Due to a group training event, the following services will be exceptionally closed on Thursday 20 and Friday 21 September 2007: installation service (removals, cars, diplomatic privileges), school fees, Personnel Records Office (including attestations), French visas; duty travel, leave, reinstallation indemnity, unemployment benefit, tax information and social affairs. The French and Swiss cards service will remain open as usual, from 8:30 to 12:30. Thank you for your understanding. HR Department HR-SPS Group

  5. DynCorp Tricities Services, Inc. Hanford fire department FY 1998 annual work plan

    International Nuclear Information System (INIS)

    Good, D.E.

    1997-01-01

    The mission of the Hanford Fire Department (HFD) is to support the safe and timely cleanup of the Hanford site by providing fire suppression, fire prevention, emergency rescue, emergency medical service, and hazardous materials response; and to be capable of dealing with and terminating emergency situations which could threaten the operations, employees, or interest of the U.S. Department of Energy operated Hanford site. This includes response to surrounding fire departments/districts under mutual aid and state mobilization agreements and fire fighting, hazardous materials, and ambulance support to Washington Public Power Supply System (Supply System) and various commercial entities operating on site through Requests for Service from DOE-RL. This fire department also provides site fire marshal overview authority, fire system testing and maintenance, respiratory protection services, building tours and inspections, ignitable and reactive waste site inspections, prefire planning, and employee fire prevention education. This plan provides a program overview, program baselines, and schedule baseline

  6. 75 FR 23254 - Office of Special Education and Rehabilitative Services; Overview Information; Training and...

    Science.gov (United States)

    2010-05-03

    ... DEPARTMENT OF EDUCATION Office of Special Education and Rehabilitative Services; Overview... special education, early intervention services, transition services, and related services; (iii... Special Education Programs' (OSEP) technical assistance and dissemination centers ( http://www.ed.gov...

  7. Ambient versus traditional environment in pediatric emergency department.

    Science.gov (United States)

    Robinson, Patricia S; Green, Jeanette

    2015-01-01

    We sought to examine the effect of exposure to an ambient environment in a pediatric emergency department. We hypothesized that passive distraction from ambient lighting in an emergency department would lead to reduction in patient pain and anxiety and increased caregiver satisfaction with services. Passive distraction has been associated with lower anxiety and pain in patients and affects perception of wait time. A pediatric ED was designed that optimized passive distraction techniques using colorful ambient lighting. Participants were nonrandomly assigned to either an ambient ED environment or a traditional ED environment. Entry and exit questionnaires assessed caregiver expectations and experiences. Pain ratings were obtained with age-appropriate scales, and wait times were recorded. A total of 70 participants were assessed across conditions, that is, 40 in the ambient ED group and 30 in the traditional ED group. Caregivers in the traditional ED group expected a longer wait, had higher anxiety pretreatment, and felt more scared than those in the ambient ED group. Caregivers in the ambient ED group felt more included in the care of their child and rated quality of care higher than caregivers in the traditional ED group. Pain ratings and administrations of pain medication were lower in the ambient ED group. Mean scores for the ambient ED group were in the expected direction on several items measuring satisfaction with ED experiences. Results were suggestive of less stress in caregivers, less pain in patients, and higher satisfaction levels in the ambient ED group. © The Author(s) 2015.

  8. Pre-Emergency-Department Care-Seeking Patterns Are Associated with the Severity of Presenting Condition for Emergency Department Visit and Subsequent Adverse Events: A Timeframe Episode Analysis

    OpenAIRE

    Chan, Chien-Lung; Lin, Wender; Yang, Nan-Ping; Lai, K. Robert; Huang, Hsin-Tsung

    2015-01-01

    Background Many patients treated in Emergency Department (ED) visits can be treated at primary or urgent care sectors, despite the fact that a number of ED visitors seek other forms of care prior to an ED visit. However, little is known regarding how the pre-ED activity episodes affect ED visits. Objectives We investigated whether care-seeking patterns involve the use of health care services of various types prior to ED visits and examined the associations of these patterns with the severity ...

  9. Comparative emergency department resource utilisation across age groups.

    Science.gov (United States)

    Burkett, Ellen; Martin-Khan, Melinda G; Gray, Leonard C

    2017-12-11

    Objectives The aim of the present study was to assess comparative emergency department (ED) resource utilisation across age groups. Methods A retrospective analysis of data collected in the National Non-admitted Patient Emergency Department Care Database was undertaken to assess comparative ED resource utilisation across six age groups (0-14, 15-35, 36-64, 65-74, 75-84 and ≥85 years) with previously used surrogate markers of ED resource utilisation. Results Older people had significantly higher resource utilisation for their individual ED episodes of care than younger people, with the effect increasing with advancing age. Conclusion With ED care of older people demonstrated to be more resource intensive than care for younger people, the projected increase in older person presentations anticipated with population aging will have a magnified effect on ED services. These predicted changes in demand for ED care will only be able to be optimally managed if Australian health policy, ED funding instruments and ED models of care are adjusted to take into account the specific care and resource needs of older people. What is known about the topic? Current Australian ED funding models do not adjust for patient age. Several regional studies have suggested higher resource utilisation of ED patients aged ≥65 years. Anticipated rapid population aging mandates that contribution of age to ED visit resource utilisation be further explored. What does this paper add? The present study of national Australian ED presentations compared ED resource utilisation across age groups using surrogate markers of ED cost. Older people were found to have significantly higher resource utilisation in the ED, with the effect increasing further with advancing age. What are the implications for practitioners? The higher resource utilisation of older people in the ED warrants a review of current ED funding models to ensure that they will continue to meet the needs of an aging population.

  10. Modeling factors influencing the demand for emergency department services in ontario: a comparison of methods

    Directory of Open Access Journals (Sweden)

    Meaney Christopher

    2011-08-01

    Full Text Available Abstract Background Emergency departments are medical treatment facilities, designed to provide episodic care to patients suffering from acute injuries and illnesses as well as patients who are experiencing sporadic flare-ups of underlying chronic medical conditions which require immediate attention. Supply and demand for emergency department services varies across geographic regions and time. Some persons do not rely on the service at all whereas; others use the service on repeated occasions. Issues regarding increased wait times for services and crowding illustrate the need to investigate which factors are associated with increased frequency of emergency department utilization. The evidence from this study can help inform policy makers on the appropriate mix of supply and demand targeted health care policies necessary to ensure that patients receive appropriate health care delivery in an efficient and cost-effective manner. The purpose of this report is to assess those factors resulting in increased demand for emergency department services in Ontario. We assess how utilization rates vary according to the severity of patient presentation in the emergency department. We are specifically interested in the impact that access to primary care physicians has on the demand for emergency department services. Additionally, we wish to investigate these trends using a series of novel regression models for count outcomes which have yet to be employed in the domain of emergency medical research. Methods Data regarding the frequency of emergency department visits for the respondents of Canadian Community Health Survey (CCHS during our study interval (2003-2005 are obtained from the National Ambulatory Care Reporting System (NACRS. Patients' emergency department utilizations were linked with information from the Canadian Community Health Survey (CCHS which provides individual level medical, socio-demographic, psychological and behavioral information for

  11. Modeling factors influencing the demand for emergency department services in Ontario: a comparison of methods.

    Science.gov (United States)

    Moineddin, Rahim; Meaney, Christopher; Agha, Mohammad; Zagorski, Brandon; Glazier, Richard Henry

    2011-08-19

    Emergency departments are medical treatment facilities, designed to provide episodic care to patients suffering from acute injuries and illnesses as well as patients who are experiencing sporadic flare-ups of underlying chronic medical conditions which require immediate attention. Supply and demand for emergency department services varies across geographic regions and time. Some persons do not rely on the service at all whereas; others use the service on repeated occasions. Issues regarding increased wait times for services and crowding illustrate the need to investigate which factors are associated with increased frequency of emergency department utilization. The evidence from this study can help inform policy makers on the appropriate mix of supply and demand targeted health care policies necessary to ensure that patients receive appropriate health care delivery in an efficient and cost-effective manner. The purpose of this report is to assess those factors resulting in increased demand for emergency department services in Ontario. We assess how utilization rates vary according to the severity of patient presentation in the emergency department. We are specifically interested in the impact that access to primary care physicians has on the demand for emergency department services. Additionally, we wish to investigate these trends using a series of novel regression models for count outcomes which have yet to be employed in the domain of emergency medical research. Data regarding the frequency of emergency department visits for the respondents of Canadian Community Health Survey (CCHS) during our study interval (2003-2005) are obtained from the National Ambulatory Care Reporting System (NACRS). Patients' emergency department utilizations were linked with information from the Canadian Community Health Survey (CCHS) which provides individual level medical, socio-demographic, psychological and behavioral information for investigating predictors of increased emergency

  12. Assessing Healthcare Utilization for Influenza-like Illness at an Emergency Department and a Student Health Service during the 2009–2010 H1N1 Pandemic

    Directory of Open Access Journals (Sweden)

    Ruchi Bhandari

    2013-01-01

    Full Text Available Estimates of healthcare utilization during an influenza pandemic are needed in order to plan for the allocation of staff and resources. The aim of this study was to assess the number, age, and arrival time of patients with influenza-like-illness (ILI, and associations between their symptoms during the 2009–2010 H1N1 pandemic. We conducted a cross-sectional analysis of electronic health records from the student health service (SHS and an emergency department (ED in Morgantown, West Virginia, between January 2009 and December 2010. During the 2009–2010 H1N1 pandemic, patient arrivals at SHS and ED varied over the week. SHS patients arrived early in the week and primarily in the afternoon. ED patient arrivals were more evenly distributed, with busier evenings and weekends. Those with fever were more likely to experience cough, sore throat, vomiting/nausea, chills, congestion, headache, and body-ache. These results can assist health professionals in preparing for an influenza pandemic.

  13. The perceived impact of an emergency department immediate reporting service: An exploratory survey

    International Nuclear Information System (INIS)

    Snaith, Beverly; Hardy, Maryann

    2013-01-01

    Background: Immediate reporting, commonly referred to as a ‘hot reporting’, has been advocated as a method of effectively supporting clinical decision making. However, its implementation nationally has been limited with poor understanding of its value in practice. Method: A cross sectional attitudinal survey was distributed to emergency department clinicians (medical and nursing staff) and radiographers to explore perceptions of an immediate reporting service in terms of its influence on professional role and autonomy, patient care and service quality. Results: A total of 87 (n = 87/155; 56.1%) completed questionnaires were returned. The findings suggest that significant support for immediate reporting exists. Immediate reporting is believed to improve service quality, reduce clinical errors and provide opportunity for image interpretation skills development. However, responses were not consistent across clinical professions and staff grades. Conclusion: The immediate reporting of emergency department images is perceived to benefit patient, emergency department clinicians and hospital organisation

  14. PENGUKURAN KUALITAS LAYANAN DENGAN HIGHER EDUCATION PERFORMANCE (HEdPERF DAN HIGHER EDUCATION SERVICE QUALITY (HiEdQUAL

    Directory of Open Access Journals (Sweden)

    Ika Widya Ardhyani

    2017-06-01

    Full Text Available Kualitas layanan merupakan kunci sukses dalam pemasaran dan bisnis strategi. Peningkatan kualitas layanan terhadap perguruan tinggi merupakan hal yang perlu mendapatkan prioritas, karena kualitas layanan berhubungan erat dengan peningkatan keuntungan kompetitif. UMAHA merupakan universitas swasta di Sidoarjo. Sejak didirikan tahun 1998 hingga 2015 animo masyarakat terhadap UMAHA terus mengalami peningkatan hal ini ditunjukkan dengan semakin meningkatnya jumlah mahasiswa yang mendaftar. Namun disisi lain masih terjadi keluhan-keluhan terhadap pelayanan akademik. Berdasarkan hal tersebut, maka pengukuran kualitas layanan pendidikan yang akurat sangat penting dilakukan untuk mendapatkan gambaran yang lebih baik dan menjadi pedoman dalam melakukan suatu perbaikan. Item-item dalam penelitian ini diadaptasi dari instrumen HEdPERF dan HiEdQUAL. Pengukuran kualitas layanan dalam penelitian ini akan dilakukan dengan responden dosen, staf administrasi dan mahasiswa sebagai pelanggan perguruan tinggi. Kuesioner digunakan untuk memperoleh data, berupa harapan dan persepsi. Teknik pengambilan sampel yang digunakan dalam penelitian ini adalah cluster sampling. Data yang diperoleh dianalisis dengan menggunakan uji validitas dan uji reliabilitas. Kualitas layanan akan di ukur dengan menggunakan model diskonfirmasi SERVQUAL, yang mendefinisikan kualitas dalam hal perbedaan yang muncul antara harapan pelanggan dan persepsi layanan yang sebenarnya. Hasil perhitungan skor SERVQUAL untuk ketiga responden, menunjukkan masing-masing item belum dapat memenuhi harapan pelanggan. Hal ini ditunjukkan dengan hasil perhitungan semua item yang bernilai negatif.

  15. Staggered work shifts : a way to downsize and restructure an emergency department workforce yet maintain current operational performance

    NARCIS (Netherlands)

    Jabali, O.; Sinreich, D.

    2007-01-01

    Starting from the last decade of the twentieth century, most hospital Emergency Department (ED) budgets did not keep up with the demand for ED services made by growing populations and aging societies. Since labor consumes over 50% of the total monies invested in EDs and other healthcare systems, any

  16. Services Supply Chain in the Department of Defense: Comparison and Analysis of Acquisition Management in the Army, Navy, and Air Force

    Science.gov (United States)

    2010-05-01

    the marketing of services ( Lovelock , 1992; Hutt & Spec, 1998). Given these differences in the production and marketing of services as opposed to...8(1), 45-57. Hutt, M.D., & Speh, T.W. (1998). Business marketing (6th ed.). New York: Dryden Press. Lovelock , C.H. (1992). Are services really...different? In C.H. Lovelock (Ed.), Managing services (2nd ed.) (pp. 1-8). Englewood Cliffs, NJ: Prentice-Hall. Metters, R., King-Metters, K., & Pullman

  17. Determining relevant financial statement ratios in Department of Defense service component general fund financial statements

    OpenAIRE

    Koetter, Nicholas J.; Krause, Daniel J.; Liptak, Carl S.

    2014-01-01

    Approved for public release; distribution is unlimited Department of Defense (DOD) service components are dedicating significant financial and human resources toward achieving unqualified opinions on audits of their financial statements. The DOD has endeavored to produce auditable financial statements as mandated in the Chief Financial Officers Act of 1990. In December of 2013, the United States Marine Corps became the first service component to achieve an unqualified audit opinion on its ...

  18. The Emergency Department: Challenges and Opportunities for Suicide Prevention.

    Science.gov (United States)

    Asarnow, Joan Rosenbaum; Babeva, Kalina; Horstmann, Elizabeth

    2017-10-01

    Emergency departments (EDs) can offer life-saving suicide prevention care. This article focuses on the ED and emergency services as service delivery sites for suicide prevention. Characteristics of EDs, models of emergency care, ED screening and brief intervention models, and practice guidelines and parameters are reviewed. A care process model for youths at risk for suicide and self-harm is presented, with guidance for clinicians based on the scientific evidence. Strengthening emergency infrastructure and integrating effective suicide prevention strategies derived from scientific research are critical for advancing suicide prevention objectives. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Depth contours for NOS Chart 11013, 39th Ed., 1992-04-25 for South Florida, Cuba, and the Bahamas in GIS vector form (NODC Accession 0000459)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — GIS line coverage of depth contours (bathymetry) for the area shown in National Ocean Service (NOS) chart 11013, 39th Ed., 25 Apr 1992. Area covers South Florida,...

  20. Using Excel's Solver Function to Facilitate Reciprocal Service Department Cost Allocations

    Science.gov (United States)

    Leese, Wallace R.

    2013-01-01

    The reciprocal method of service department cost allocation requires linear equations to be solved simultaneously. These computations are often so complex as to cause the abandonment of the reciprocal method in favor of the less sophisticated and theoretically incorrect direct or step-down methods. This article illustrates how Excel's Solver…

  1. 76 FR 4725 - Apria Healthcare Customer Service Department; Fourteen Locations in Missouri Cameron, Cape...

    Science.gov (United States)

    2011-01-26

    ... services to India. The amended notice applicable to TA-W-73,676 is hereby issued as follows: ``All workers... and Clinton, MO; Amended Certification Regarding Eligibility To Apply for Worker Adjustment Assistance... Department of Labor issued a Certification of Eligibility to Apply for Worker Adjustment Assistance on August...

  2. Developing a multidisciplinary approach within the ED towards domestic violence presentations.

    Science.gov (United States)

    Basu, Subhashis; Ratcliffe, Giles

    2014-03-01

    To improve the detection and quality of care of patients who attend the emergency department (ED) with confirmed or suspected domestic abuse (DA). A quality improvement report on the design, implementation and evaluation of a specialised service and structured training programme to detect and manage DA presentations within an emergency medicine department. The study was set in the ED at the Northern General Hospital, Sheffield, UK. Key measures for improvement included introducing a service within the ED to help staff manage DA and coordinate responses; improve staff confidence in detecting DA; develop a structured and consistent process by which to manage DA presentations. An Independent Domestic Violence Advocate service was introduced into the department in July 2011 through a multiagency agreement. A structured training and education programme was delivered to ED staff. A 'communications form' was developed for DA risk assessment and case management. The process was reviewed quarterly. One hundred and seventy-two referrals were made to the service (121 distinct clients) over a 12-month period. Staff reported greater confidence in detecting DA, and community partners highlighted the role the service had in improving DA detection and care quality within the city. Strong leadership and prioritising the issue within the department has facilitated the development of the process and contributed substantially to its success. Support from community partners has been invaluable in tailoring the service and education programme to the needs of staff and patients within the department.

  3. Energy contracting. Energy-related services and decentral energy supply. 2. ed.; Energie-Contracting. Energiedienstleistungen und dezentrale Energieversorgung

    Energy Technology Data Exchange (ETDEWEB)

    Hack, Martin

    2012-11-01

    According to the author, the intended German energy turnaround cannot be achieved solely on the basis of power from renewables and by constructing new passive buildings. Also required are decentral energy services if the energy saving and efficiency goals are to be achieved. In spite of many variations, the basic structure of these is the following: A contractor providing energy services does not only supply energy but also carries the risk and responsibility for efficient supply. This will relieve energy users, whether industrial or trade enterprises, public administration or home owners from this task; also, this integrated approach will open up undeveloped efficiency potentials. The book discusses current legal issues in a clear and practice-oriented manner and also provides a check list for energy contracting and an exemplary contract. (orig./RHM)

  4. 77 FR 14600 - Public Availability of the Department of Veterans Affairs Fiscal Year (FY) 2011 Service Contract...

    Science.gov (United States)

    2012-03-12

    ... DEPARTMENT OF VETERANS AFFAIRS Public Availability of the Department of Veterans Affairs Fiscal Year (FY) 2011 Service Contract Inventory AGENCY: Department of Veterans Affairs. ACTION: Notice of... Affairs (VA) is publishing this notice to advise the public of the availability of the FY 2011 Service...

  5. Product-line administration: a framework for redefining medical record department services.

    Science.gov (United States)

    Postal, S N

    1990-06-01

    Product-line administration is a viable approach for managing medical records services in an environment that demands high quantity and quality service levels. Product-line administration directs medical record department team members to look outside of the department and seek input from the customers it is intended to serve. The feedback received may be alarming at first, as the current state of products usually reveals a true lack of customer input. As the planning, defining, managing, and marketing phases are implemented, the road will not be easy and rewards will be slow to come. Product-line administration does not provide quick fixes, but it does provide long-term problem resolution as products are refined and new products developed to meet customer needs and expectations. In addition to better meeting the needs of the department's external customers, the department's internal customers' needs and expectations will be addressed. The participative management approach will help nurture each team member's creativity. The team members will have the opportunity to reach their full potential while reaping the rewards and benefits of providing products and services that meet the needs and expectations of all department customers. The future of the health care industry promises more changes as the country moves toward some form of prospective payment in the ambulatory setting. Reactive management and the constant struggle to catch up can no longer be accepted as a management approach. It is imperative that the medical record department be viewed as a business with product lines composed of quality products. The planning, defining, managing, and marketing components of product-line administration afford responsiveness to the current situation and the development of quality products that will ensure that medical record departments are prepared for the future.

  6. Are trends in billing for high-intensity emergency care explained by changes in services provided in the emergency department? An observational study among US Medicare beneficiaries

    Science.gov (United States)

    Burke, Laura G; Wild, Robert C; Orav, E John; Hsia, Renee Y

    2018-01-01

    Objective There has been concern that an increase in billing for high-intensity emergency care is due to changes in coding practices facilitated by electronic health records. We sought to characterise the trends in billing for high-intensity emergency care among Medicare beneficiaries and to examine the degree to which trends in high-intensity billing are explained by changes in patient characteristics and services provided in the emergency department (ED). Design, setting and participants Observational study using traditional Medicare claims to identify ED visits at non-federal acute care hospitals for elderly beneficiaries in 2006, 2009 and 2012. Outcomes measures Billing intensity was defined by emergency physician evaluation and management (E&M) codes. We tested for overall trends in high-intensity billing (E&M codes 99285, 99291 and 99292) and in services provided over time using linear regression models, adjusting for patient characteristics. Additionally, we tested for time trends in rates of admission to the hospital and to the intensive care unit (ICU). Next, we classified outpatient visits into 39 diagnosis categories and analysed the change in proportion of high-intensity visits versus the change in number of services. Finally, we quantified the extent to which trends in high-intensity billing are explained by changes in patient demographics and services provided in the ED using multivariable modelling. Results High-intensity visits grew from 45.8% of 671 103 visits in 2006 to 57.8% of 629 010 visits in 2012 (2.0% absolute increase per year; 95% CI 1.97% to 2.03%) as did the mean number of services provided for admitted (1.28 to 1.41; +0.02 increase in procedures per year; 95% CI 0.018 to 0.021) and discharged ED patients (7.1 to 8.6; +0.25 increase in services per year; 95% CI 0.245 to 0.255). There was a reduction in hospital admission rate from 40.1% to 35.9% (−0.68% per year; 95% CI −0.71% to −0.65%; Pbilled as high intensity

  7. Where Do Freestanding Emergency Departments Choose to Locate? A National Inventory and Geographic Analysis in Three States.

    Science.gov (United States)

    Schuur, Jeremiah D; Baker, Olesya; Freshman, Jaclyn; Wilson, Michael; Cutler, David M

    2017-04-01

    We determine the number and location of freestanding emergency departments (EDs) across the United States and determine the population characteristics of areas where freestanding EDs are located. We conducted a systematic inventory of US freestanding EDs. For the 3 states with the highest number of freestanding EDs, we linked demographic, insurance, and health services data, using the 5-digit ZIP code corresponding to the freestanding ED's location. To create a comparison nonfreestanding ED group, we matched 187 freestanding EDs to 1,048 nonfreestanding ED ZIP codes on land and population within state. We compared differences in demographic, insurance, and health services factors between matched ZIP codes with and without freestanding EDs, using univariate regressions with weights. We identified 360 freestanding EDs located in 30 states; 54.2% of freestanding EDs were hospital satellites, 36.6% were independent, and 9.2% were not classifiable. The 3 states with the highest number of freestanding EDs accounted for 66% of all freestanding EDs: Texas (181), Ohio (34), and Colorado (24). Across all 3 states, freestanding EDs were located in ZIP codes that had higher incomes and a lower proportion of the population with Medicaid. In Texas and Ohio, freestanding EDs were located in ZIP codes with a higher proportion of the population with private insurance. In Texas, freestanding EDs were located in ZIP codes that had fewer Hispanics, had a greater number of hospital-based EDs and physician offices, and had more physician visits and medical spending per year than ZIP codes without a freestanding ED. In Ohio, freestanding EDs were located in ZIP codes with fewer hospital-based EDs. In Texas, Ohio, and Colorado, freestanding EDs were located in areas with a better payer mix. The location of freestanding EDs in relation to other health care facilities and use and spending on health care varied between states. Copyright © 2016 American College of Emergency Physicians

  8. Use of emergency department services by women victims of violence in Lazio region, Italy.

    Science.gov (United States)

    Farchi, Sara; Polo, Arianna; Asole, Simona; Ruggieri, Maria Pia; Di Lallo, Domenico

    2013-07-19

    Violence against women is a significant health problem and a hidden phenomenon, in Italy that about 31% of the women have been victims of violence once in life. Aims of this study are to describe characteristics of women victims of violence (VV) attending the EDs in the Lazio region in 2008 and to illustrate the frequency and characteristics of previous ED visits. Using the Emergency Information System, visits of women, (15-49 years), in the 60 EDs, for a violent trauma have been analysed. For each VV identified, we considered the last episode and searched for ED attendances in a six year period (2003-08) in order to identify other visits. We performed descriptive analyses of socio-demographic and clinical factors of VV and we analyzed the impact previous ED visits. We compared ED utilization of women VV with a random sample of women with the same age distribution who gave birth in 2008. In 2008, 7,725 ED attendances of women VV were found (1.1% of the ED visits) corresponding to 6,936 women (prevalence = 52.0x10,000). The mean number of ED visits for each woman in five years was 5.0 (1-190). Prevalent diagnoses were contusions (45.8%), neurotic disorders (5.4%) complications of medical care (6.3%). The women were young, approximately 70% were residents in Rome or the surrounding areas. Foreign women were three times more likely to visit the ED for intentional injuries than were Italian women (114.1 vs 44.4 per 10.000). This study shows high prevalence of violence against women in Lazio region, Italy. Most of the women have been visited by the ED several times before the violent episode, often with traumas. ED medical and nursing staff should be prepared and trained to successfully manage victims of violence.

  9. Executive Selection in Government Agencies: An Analysis of the Department of the Navy and Immigration and Naturalization Services Senior Executive Service Selection Processes

    National Research Council Canada - National Science Library

    Jordan, Mark

    2001-01-01

    .... The Senior Executive Service (SES) selection process for the Department of the Navy (DON) is analyzed and compared to the SES selection process used by the Immigration and Naturalization Service...

  10. 42 CFR 59.7 - What criteria will the Department of Health and Human Services use to decide which family...

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false What criteria will the Department of Health and Human Services use to decide which family planning services projects to fund and in what amount? 59.7... FOR FAMILY PLANNING SERVICES Project Grants for Family Planning Services § 59.7 What criteria will the...

  11. Program collaboration and service integration activities among HIV programs in 59 U.S. health departments.

    Science.gov (United States)

    Fitz Harris, Lauren F; Toledo, Lauren; Dunbar, Erica; Aquino, Gustavo A; Nesheim, Steven R

    2014-01-01

    We identified the level and type of program collaboration and service integration (PCSI) among HIV prevention programs in 59 CDC-funded health department jurisdictions. Annual progress reports (APRs) completed by all 59 health departments funded by CDC for HIV prevention activities were reviewed for collaborative and integrated activities reported by HIV programs for calendar year 2009. We identified associations between PCSI activities and funding, AIDS diagnosis rate, and organizational integration. HIV programs collaborated with other health department programs through data-related activities, provider training, and providing funding for sexually transmitted disease (STD) activities in 24 (41%), 31 (53%), and 16 (27%) jurisdictions, respectively. Of the 59 jurisdictions, 57 (97%) reported integrated HIV and STD testing at the same venue, 39 (66%) reported integrated HIV and tuberculosis testing, and 26 (44%) reported integrated HIV and viral hepatitis testing. Forty-five (76%) jurisdictions reported providing integrated education/outreach activities for HIV and at least one other disease. Twenty-six (44%) jurisdictions reported integrated partner services among HIV and STD programs. Overall, the level of PCSI activities was not associated with HIV funding, AIDS diagnoses, or organizational integration. HIV programs in health departments collaborate primarily with STD programs. Key PCSI activities include integrated testing, integrated education/outreach, and training. Future assessments are needed to evaluate PCSI activities and to identify the level of collaboration and integration among prevention programs.

  12. Services Acquisition in the Department of Defense: Analysis of Operational and Performance Data to Identify Drivers of Success

    Science.gov (United States)

    2015-03-24

    improving the disclosure of CPARS program office Audit results (Black et al., 2014, pp. 48–49). Acquisition Research Program Graduate School of...improving the disclosure of CPARS program office audit results (Black et al., 2014, pp. 44–49). Recommendations Based on our conclusions, we identified...Fitzsimmons, J. A., & Fitzsimmons, M. J. (2006). Service management: Operations, strategy, and information technology (5th ed.). New York, NY: McGraw -Hill

  13. Hand-held ultrasound serving three EDs.

    Science.gov (United States)

    2007-02-01

    Having a portable ultrasound available to your ED will enable you to perform scans during the nighttime hours, instead of having patients wait for several hours until the radiology department opens. Additional time can be saved by having a technologist read the scans, which frees your ED physicians for other duties. Having ED docs contact the technologist directly, rather than going through a resident, also saves valuable time. Arriving at a diagnosis more quickly provides a boost to patient safety.

  14. 78 FR 72703 - Notice of Inventory Completion: U.S. Department of the Interior, National Park Service...

    Science.gov (United States)

    2013-12-03

    ... of an inventory of human remains and associated funerary objects under the control of Canyonlands....R50000] Notice of Inventory Completion: U.S. Department of the Interior, National Park Service.... Department of the Interior, National Park Service, Canyonlands National Park, has completed an inventory of...

  15. 76 FR 66940 - Privacy Act of 1974; Department of Homeland Security/United States Secret Service-004 Protection...

    Science.gov (United States)

    2011-10-28

    ... DEPARTMENT OF HOMELAND SECURITY Office of the Secretary [Docket No. DHS-2011-0083] Privacy Act of 1974; Department of Homeland Security/United States Secret Service--004 Protection Information System... Security (DHS)/United States Secret Service (USSS)-004 System name: DHS/USSS-004 Protection Information...

  16. 20 CFR 1010.210 - In which Department job training programs do covered persons receive priority of service?

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false In which Department job training programs do... job training programs do covered persons receive priority of service? (a) Priority of service applies to every qualified job training program funded, in whole or in part, by the Department, including: (1...

  17. Utility of Procalcitonin (PCT and Mid regional pro-Adrenomedullin (MR-proADM in risk stratification of critically ill febrile patients in Emergency Department (ED. A comparison with APACHE II score

    Directory of Open Access Journals (Sweden)

    Travaglino Francesco

    2012-08-01

    Full Text Available Abstract Background The aim of our study was to evaluate the prognostic value of MR-proADM and PCT levels in febrile patients in the ED in comparison with a disease severity index score, the APACHE II score. We also evaluated the ability of MR-proADM and PCT to predict hospitalization. Methods This was an observational, multicentric study. We enrolled 128 patients referred to the ED with high fever and a suspicion of severe infection such as sepsis, lower respiratory tract infections, urinary tract infections, gastrointestinal infections, soft tissue infections, central nervous system infections, or osteomyelitis. The APACHE II score was calculated for each patient. Results MR-proADM median values in controls were 0.5 nmol/l as compared with 0.85 nmol/l in patients (P P . MR-proADM and PCT levels were significantly increased in accordance with the Apache II quartiles (P  respectively. In the respiratory infections, urinary infections, and sepsis-septic shock groups we found a correlation between the Apache II and MR-proADM respectively and MR-proADM and PCT respectively. We evaluated the ability of MR-proADM and PCT to predict hospitalization in patients admitted to our emergency departments complaining of fever. MR-proADM alone had an AUC of 0.694, while PCT alone had an AUC of 0.763. The combined use of PCT and MR-proADM instead showed an AUC of 0.79. Conclusions The present study highlights the way in which MR-proADM and PCT may be helpful to the febrile patient’s care in the ED. Our data support the prognostic role of MR-proADM and PCT in that setting, as demonstrated by the correlation with the APACHE II score. The combined use of the two biomarkers can predict a subsequent hospitalization of febrile patients. The rational use of these two molecules could lead to several advantages, such as faster diagnosis, more accurate risk stratification, and optimization of the treatment, with consequent benefit to the patient and

  18. Linking departmental priorities to knowledge management: the experiences of Santa Cruz County's Human Services Department.

    Science.gov (United States)

    Lindberg, Arley

    2012-01-01

    Federal welfare reform, local service collaborations, and the evolution of statewide information systems inspired agency interest in evidence-informed practice and knowledge sharing systems. Four agency leaders, including the Director, Deputy Director, Director of Planning and Evaluation, and Staff Development Program Manager championed the development of a learning organization based on knowledge management throughout the agency. Internal department restructuring helped to strengthen the Planning and Evaluation, Staff Development, and Personnel units, which have become central to supporting knowledge sharing activities. The Four Pillars of Knowledge framework was designed to capture agency directions in relationship to future knowledge management goals. Featuring People, Practice, Technology and Budget, the framework links the agency's services, mission and goals to the process of becoming a learning organization. Built through an iterative process, the framework was created by observing existing activities in each department rather than being designed from the top down. Knowledge management can help the department to fulfill its mission despite reduced resources. Copyright © Taylor & Francis Group, LLC

  19. The Impact of "ED" on Educational Research.

    Science.gov (United States)

    Florio, David H.

    1980-01-01

    The purposes, structure, and component parts of the newly formed Department of Education (ED) organizations from which educational research programs will be administered are discussed. As the climate surrounding ED changes, opportunities to take advantage of the elevated status of research will be presented. (Author/RL)

  20. Assessment of client satisfaction on emergency department services in Hawassa University Referral Hospital, Hawassa, Southern Ethiopia.

    Science.gov (United States)

    Worku, Mesfin; Loha, Eskindir

    2017-06-27

    Satisfaction refers to a state of pleasure or contentment with an action, event or service, especially one that was previously desired. Regarding to client, satisfaction is the level of happiness that clients experience having used a service. It therefore reflects the gap between the expected service and the experience of the service, from the client's point of view. Information was unavailable regarding the level of satisfaction of patients towards emergency health care servicesat Hawassa University Referral Hospital thatserve a huge catchment area; and this study addressed this gap. Cross-sectional study was conducted from March 13 to May 15/2014. Systematic sampling method was used to enroll study participants. The data was collected by trained data collectors using pre-structured questionnaire. A total 407 clients were enrolled under this study with respondent rate of 96.9%. Nearly two third of study participants were male, 270 (66.3%). 86.7% of study participants were satisfied by services provided in Emergency Out Patient Department (OPD). The percentage of study satisfaction with physical examination by Doctor, nursing, laboratory and pharmacy services were 95.6%, 89.9%, 84.7% and 67.6%, respectively. Only 31.9% were satisfied with availability of drugs in the pharmacy. Regarding to staff courtesy, 91.7% of study participants were satisfied by the manner shown by the staffs working in Emergency OPD. The vast majority of the participants (97%) were satisfied with the courtesy of Medical laboratory personnel and the least satisfaction (79.4%) was recorded for security guards. This study showed low level of patient satisfaction in pharmacy services specifically due to unavailability of drugs due to lack of sustained supply of drugs.

  1. An Evaluation of the Cybersecurity Policies for the United States Health & Human Services Department: Criteria, Regulations, and Improvements

    OpenAIRE

    Derek Mohammed; Ronda Mariani

    2014-01-01

    This paper examines the criteria necessary for the evaluation of the cybersecurity policies for the United States Health and Human Services Department of the Federal Government. The overall purpose of cybersecurity policies and procedures is supported through compliance with Federal mandated regulation and standards, which serve to protect the organizational services and goals of the United States Health and Human Services Department, and to promote the best possible security practices in the...

  2. Leave management for promoting organisational efficiency in the Department of Correctional Services and the Department of Home Affairs : Pretoria region / Mathews Tibane Moleki

    OpenAIRE

    Moleki, Mathews Tibane

    2014-01-01

    The framework of this study is based on the reforms of human resource leave management in the field of public administration for the South African public sector. The researcher’s interest lies in the increasing complexity of leave management development pertaining to policy-making, administrative processes and efficiency in the South African public sector. This study aimed to assess leave management at the Department of Correctional Services (DCS) and the Department of Home Affairs (DHA). The...

  3. The impact of a temporary ice-rink on an emergency department service.

    LENUS (Irish Health Repository)

    Clarke, Heather J

    2012-02-03

    BACKGROUND: A temporary ice-rink opened close to Cork city for 6 weeks from 30 November 2003. During this time, a number of patients presented to the local emergency departments with ice-skating-related injuries. We documented these injuries. METHODS: All patients presenting to emergency departments in Cork city with ice-skating-related complaints were included. Information on age and sex, mechanism of injury, diagnosis, follow-up\\/disposition and ambulance service utilization was recorded. RESULTS: One hundred and twenty-five ice-rink-related attendances were reported at Cork emergency departments, representing 1.25% of total attendances. One hundred and twenty-three patients presented with skating-related injuries and two with medical complaints occurring at the ice-rink: 70.8% were female patients and 29.2% were male patients. In the 4-14-year age group, however, 48.5% were girls and 51.5% were boys. Most injuries were directly due to falls; 5.6% were due to skate blades. The commonest site of injury was the upper limb. Fractures and dislocations accounted for 53.9% of injuries, with 20.5% of these requiring orthopaedic admission. Lacerations and digital injuries accounted for 7.1%, with 11% of these required admission for surgery. One minor head injury was reported. 38.1% had soft tissue injuries. Fifteen patients were transported by ambulance. These attendances represented a minimum overall cost of 77,510 euro to the local health service. CONCLUSIONS: A temporary ice-rink had a significant impact on local emergency departments. Currently, there is no specific legislation in Ireland relating to public health and safety in ice-rinks. We recommend consultation with local public bodies before opening such facilities, and appropriate regulation.

  4. 76 FR 66937 - Privacy Act of 1974; Department of Homeland Security/United States Secret Service-003 Non...

    Science.gov (United States)

    2011-10-28

    ... 1974; Department of Homeland Security/United States Secret Service--003 Non-Criminal Investigation... Security/United States Secret Service--003 Non-Criminal Investigation Information System.'' As a result of... Secret Service, 245 Murray Lane SW., Building T-5, Washington, DC 20223. For privacy issues please...

  5. 49 CFR 40.403 - Must a service agent notify its clients when the Department issues a PIE?

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 1 2010-10-01 2010-10-01 false Must a service agent notify its clients when the... Must a service agent notify its clients when the Department issues a PIE? (a) As a service agent, if... clients, in writing, about the issuance, scope, duration, and effect of the PIE. You may meet this...

  6. Ed overcrowding – matematic models for integrated solutions and decisions

    OpenAIRE

    ROTARU, LUCIANA TEODORA; BĂNICIOIU - COVEI, MIHAI

    2017-01-01

    Dear Editor In Chief, We are writing to You in line with an very interesting point of view regarding the Emergency Department (ED) development. The paper titled Improving Emergency Department Capacity Efficiency, published in your Journal 2016; 12(1): 52- 57, as an original articles, spotlight solution for ED crowding. So we are proposing a mathematics models for reciprocal accommodation of patients flows to the response capacity of the ED. ED overcrowding ...

  7. The 1991 Department of the Army Service Response Force exercise: Procedural Guide SRFX-91

    Energy Technology Data Exchange (ETDEWEB)

    Madore, M.A.; Thomson, R.S.; Haffenden, R.A.; Baldwin, T.E.; Meleski, S.A.

    1991-09-01

    This procedural guide was written to assist the US Army in planning for a chemical emergency exercise at Tooele Army Depot in Utah. The roles of various members of the emergency response community are described for various accident scenarios, and the relationships between the various responders are identified. For the June 1991 exercise at Tooele, the emergency response community includes the command structure at Tooele Army Depot; the US Army Service Response Force and other Department of Defense agencies; emergency response personnel from Tooele, Salt Lake, and Utah counties and municipal governments; the Utah Comprehensive Emergency Management Agency and other state agencies; and various federal agencies.

  8. Inform@ed space

    DEFF Research Database (Denmark)

    Bjerrum, Peter; Olsen, Kasper Nefer

    2001-01-01

    Inform@ed space Sensorial Perception And Computer Enchancement - bidrag til Nordisk Arkitekturforskningsforenings IT-konference, AAA april 2001.......Inform@ed space Sensorial Perception And Computer Enchancement - bidrag til Nordisk Arkitekturforskningsforenings IT-konference, AAA april 2001....

  9. SPA (Solus per Aqua) service industry: An entrepeneurship opportunity to beauty education department

    Science.gov (United States)

    Marwiyah, Apriyani, Delta

    2018-03-01

    Beauty industry grows vastly in the scope of regional, national, or international. Beauty industry includes Spa service. It becomes one of the choices where the urban citizen can use it to release their stress and relax their mind. This business grows as the development of technology. Spa industry should be able to provide the best service for physical and mental therapy, it will make the user of the service can be freed from their business and stress in the respective time to be healthies, more beautiful, and able to do their activity maximally. Spa treatment consists of hair creambath, facial treatment, manicure-pedicure, scrub treatment, foot spa, aromatherapy, and body treatment with traditional cosmetics which are easy to get in Indonesia. Beauty education is one of the programs in Home Economics Department of Engineering Faculty of UNNES. This program was established to produce graduates in beauty fields as Vocational High School teachers with bachelor (S1) qualification. The graduates suppose to be excellent, professional, skillful, and care to the environment, culture, and social condition around them. It prepares them as teachers of beauty (in formal and non- formal education). Besides, it also prepared them to have professional competence in production fields of beauty service with adaptive, creative, and innovative which can be entrepreneurs who are able to create job vacancies for others. Beauty education used KKNI- based curriculum, which is oriented to Industry and Working Fields with UNNES' Conservation basis. It provided the students a chance to practive their knowledge in working internship program, study field trip, and teaching practice program. The industry of Spa service provides a big chance to become an entrepreneur, create a working field, and help the government reduce unemployment number, whether from beauty education graduates or from vocational high school students

  10. Collaborating across the Departments of Veterans Affairs and Defense to integrate mental health and chaplaincy services.

    Science.gov (United States)

    Nieuwsma, Jason A; Jackson, George L; DeKraai, Mark B; Bulling, Denise J; Cantrell, William C; Rhodes, Jeffrey E; Bates, Mark J; Ethridge, Keith; Lane, Marian E; Tenhula, Wendy N; Batten, Sonja V; Meador, Keith G

    2014-12-01

    Recognizing that clergy and spiritual care providers are a key part of mental health care systems, the Department of Veterans Affairs (VA) and Department of Defense (DoD) jointly examined chaplains' current and potential roles in caring for veterans and service members with mental health needs. Our aim was to evaluate the intersection of chaplain and mental health care practices in VA and DoD in order to determine if improvement is needed, and if so, to develop actionable recommendations as indicated by evaluation findings. A 38-member multidisciplinary task group partnered with researchers in designing, implementing, and interpreting a mixed methods study that included: 1) a quantitative survey of VA and DoD chaplains; and 2) qualitative interviews with mental health providers and chaplains. Quantitative: the survey included all full-time VA chaplains and all active duty military chaplains (n = 2,163 completed of 3,464 invited; 62 % response rate). Qualitative: a total of 291 interviews were conducted with mental health providers and chaplains during site visits to 33 VA and DoD facilities. Quantitative: the online survey assessed intersections between chaplaincy and mental health care and took an average of 37 min to complete. Qualitative: the interviews assessed current integration of mental health and chaplain services and took an average of 1 h to complete. When included on interdisciplinary mental health care teams, chaplains feel understood and valued (82.8-100 % of chaplains indicated this, depending on the team). However, findings from the survey and site visits suggest that integration of services is often lacking and can be improved. Closely coordinating with a multidisciplinary task group in conducting a mixed method evaluation of chaplain-mental health integration in VA and DoD helped to ensure that researchers assessed relevant domains and that findings could be rapidly translated into actionable recommendations.

  11. Emergency Department Utilization in the Texas Medicaid...

    Data.gov (United States)

    U.S. Department of Health & Human Services — There were 44,246 individuals enrolled in TexKat in 2005. Roughly 13 percent of these enrollees had at least one ED visit during the sample period, with one quarter...

  12. An Evaluation of the Cybersecurity Policies for the United States Health & Human Services Department: Criteria, Regulations, and Improvements

    Directory of Open Access Journals (Sweden)

    Derek Mohammed

    2014-04-01

    Full Text Available This paper examines the criteria necessary for the evaluation of the cybersecurity policies for the United States Health and Human Services Department of the Federal Government. The overall purpose of cybersecurity policies and procedures is supported through compliance with Federal mandated regulation and standards, which serve to protect the organizational services and goals of the United States Health and Human Services Department, and to promote the best possible security practices in the protection of information systems from unauthorized actors and cyber-threats. The criteria of the cybersecurity evaluation is identified and analyzed for quality, strengths, weaknesses, and future applicability. Topics within the criteria include organizational operation, regulations and industrial standards compliance, service delivery to national customers, and the prevention and mitigation of IT system and security failure. This analysis determines the strengths and weaknesses, and makes recommendations for revising the cybersecurity policies within the United States Health and Human Services Department.

  13. United States Department of Health and Human Services Biodosimetry and radiological/nuclear medical countermeasure programs

    International Nuclear Information System (INIS)

    Homer, Mary J.; Raulli, Robert; Esker, John; Moyer, Brian; Wathen, Lynne; DiCarlo-Cohen, Andrea L.; Maidment, Bert W.; Rios, Carmen; Macchiarini, Francesca; Hrdina, Chad; Prasanna, Pataje G.

    2016-01-01

    The United States Department of Health and Human Services (HHS) is fully committed to the development of medical countermeasures to address national security threats from chemical, biological, radiological, and nuclear agents. Through the Public Health Emergency Medical Countermeasures Enterprise, HHS has launched and managed a multi-agency, comprehensive effort to develop and operationalize medical countermeasures. Within HHS, development of medical countermeasures includes the National Institutes of Health (NIH), (led by the National Institute of Allergy and Infectious Diseases), the Office of the Assistant Secretary of Preparedness and Response/Biomedical Advanced Research and Development Authority (BARDA); with the Division of Medical Countermeasure Strategy and Requirements, the Centers for Disease Control and Prevention, and the Food and Drug Administration as primary partners in this endeavor. This paper describes various programs and coordinating efforts of BARDA and NIH for the development of medical countermeasures for radiological and nuclear threats. (authors)

  14. An Investigation of Social Factors Affecting on Personnel Job Satisfaction of Remedial Service Insurance Department

    Directory of Open Access Journals (Sweden)

    Sayyed Yaser Ebrahimian Jolodar

    2012-01-01

    Full Text Available Because of the paramount importance of job satisfaction and due to its main consequences such as reduction of work absence and resignation, personnel promotion and society‟s health, and more importantly, its role in achievement of organization goals, this study aimed at investigating the effects of six social factors including personnel‟s belief, salary and benefits, participation in organizational decision-making, sense of job security, interaction with colleagues and meeting the basic needs of personnel on job satisfaction. The statistical population of this study was the personnel of Remedial Service Insurance Department in Sari and the questionnaire was distributed among them. The results showed that there is a significant and positive correlation among all these factors and they have meaningful effects on personnel job satisfaction based on multiple regression analysis. Furthermore, findings revealed that personnel‟s belief about their job has the most effects on job satisfaction.

  15. The haven of the self-service store: A study of the fruit and vegetable department's influence on chain equity

    DEFF Research Database (Denmark)

    Bech-Larsen, Tino

    -equity, by the creation of stronger relations and positive shopping experiences. In this respect a number of measures, as fx service management and direct marketing programmes, have been instigated. Most of these developments have concentrated on the peripheral spheres of the purchase decision situation. A more recent...... perception of the fruit & vegetable department can lead to an increased chain-equity and c) the factors in the fruit & vegetable department that determine the perception of this department....

  16. Services Provided to Military Dependents Who Are "Mentally Gifted" in the US Department of Defense (DoDEA) Schools

    Science.gov (United States)

    Bugaj, Stephen J.

    2013-01-01

    The US Department of Defense Education Activity (DoDEA) is a federal agency that provides educational services to military dependents in 12 foreign countries, seven states, Cuba, and Puerto Rico. Perhaps due to its restricted audience, the general public has limited knowledge of DoDEA services; moreover, empirical information about these services…

  17. 75 FR 44280 - Notice of Intent to Repatriate Cultural Items: U.S. Department of Agriculture, Forest Service...

    Science.gov (United States)

    2010-07-28

    ... DEPARTMENT OF THE INTERIOR National Park Service Notice of Intent to Repatriate Cultural Items: U... Museum of Natural History, New York City, NY AGENCY: National Park Service, Interior. ACTION: Notice..., ethnographic materials, technology and architecture indicate that the prehistoric peoples of the upper Verde...

  18. 76 FR 43718 - Notice of Inventory Completion: U.S. Department of Agriculture, Forest Service, Gila National...

    Science.gov (United States)

    2011-07-21

    ... Reservation, New Mexico (hereinafter referred to as ``The Tribes''). History and Description of the Remains... History, Chicago, IL AGENCY: National Park Service, Interior. ACTION: Notice. SUMMARY: The U.S. Department of Agriculture, Forest Service, Gila National Forest and the Field Museum of Natural History have...

  19. 76 FR 7232 - Notice of Inventory Completion: U.S. Department of the Interior, National Park Service, Dinosaur...

    Science.gov (United States)

    2011-02-09

    .... Department of the Interior, National Park Service, Dinosaur National Monument, Dinosaur, CO AGENCY: National... Service, Dinosaur National Monument, Dinosaur, CO, has completed an inventory of human remains and... Indian tribe that believes itself to be culturally affiliated with the human remains may contact Dinosaur...

  20. Investments for medical equipment in a mother and child health hospital: correlation with level of services/departments.

    Science.gov (United States)

    Trevisanuto, Daniele; Raggi, Roberto; Bavuusuren, Bayasgalantai; Tudevdorj, Erkhembaatar; Doglioni, Nicoletta; Zanardo, Vincenzo

    2011-02-01

    To assess whether investments for medical equipments assigned by a team of experts to a mother and child health hospital located in Mongolia were correlated with structural, organizational, and educational level of its services/departments. A score was used for evaluating the level of each service/department. It was based on a 'structural area' and an 'organizational and educational area'. Destination of funds was determined by a team of experts in collaboration with the head of the service/department. Thirty-three of 36 services/departments (91.6%) were evaluated. A total sum of 4,432,140 Euros to invest in medical equipment was estimated. Assigned investments were inversely correlated with the total (structural plus organizational and educational area) score (n = 33; r =  -0.59; p = 0.0002), and the specific scores for structural area (n = 33; r = -0.46; p = 0.005) and organizational and educational area (n = 33; r =  -0.56; p = 0.0006). A large part of the funds for medical equipment was destined to services/departments with low organizational and educational conditions, limiting the potential effect of the aid meanwhile supporting the most in need departments. Educational efforts and monitoring of specific long-term indicators are mandatory.

  1. Effect of Job Specialization on the Hospital Stay and Job Satisfaction of ED Nurses.

    Science.gov (United States)

    Shamsi, Vahid; Mahmoudi, Hosein; Sirati Nir, Masoud; Babatabar Darzi, Hosein

    2016-02-01

    In recent decades, the increasing crowdedness of the emergency departments has posed various problems for patients and healthcare systems worldwide. These problems include prolonged hospital stay, patient dissatisfaction and nurse burnout or job dissatisfaction. The aim of this study was to investigate the effect of emergency department (ED) nurses' job specialization on their job satisfaction and the length of patient stay in the ED. This before-after quasi-experimental study was conducted from April to May 2014 at the Baqiyatallah Hospital, Tehran, Iran. Initially, 35 patients were recruited as controls and the length of their stay in the ED was measured in minutes via a chronometer; Moreover, nurses' job satisfaction was evaluated using the Mohrman-Cooke-Mohrman job satisfaction scale. Then, a job specialization intervention was developed based on the stabilization model. After that, 35 new patients were recruited to the treatment group and received specialized care services. Accordingly, the length of their stay in the ED was measured. Moreover, the same nurses' job satisfaction was re-evaluated after the study. The study intervention lasted one month. Data were analyzed using the SPSS software version 20 and statistical tests such as the Kolmogrov-Smirnov, the paired and the independent t, and chi-square tests. There was a significant difference between the two groups of patients concerning the length of their stay in the ED (P nurses had greater job satisfaction after the study (P job specialization intervention can improve nurses' satisfaction and relieve the crowdedness of the EDs.

  2. Applicability of the modified Emergency Department Work Index (mEDWIN) at a Dutch Emergency Department

    NARCIS (Netherlands)

    Brouns, S.; van der Schuit, K.C.H.; Stassen, P.; Lambooij, S.L.E.; Dieleman, Jeanne P.; Vanderfeesten, I.T.P.; Haak, H.

    2017-01-01

    Background Emergency department (ED) crowding leads to prolonged emergency department length of stay (ED-LOS) and adverse patient outcomes. No uniform definition of ED crowding exists. Several scores have been developed to quantify ED crowding; the best known is the Emergency Department Work Index

  3. Pre-emergency-department care-seeking patterns are associated with the severity of presenting condition for emergency department visit and subsequent adverse events: a timeframe episode analysis.

    Directory of Open Access Journals (Sweden)

    Chien-Lung Chan

    Full Text Available Many patients treated in Emergency Department (ED visits can be treated at primary or urgent care sectors, despite the fact that a number of ED visitors seek other forms of care prior to an ED visit. However, little is known regarding how the pre-ED activity episodes affect ED visits.We investigated whether care-seeking patterns involve the use of health care services of various types prior to ED visits and examined the associations of these patterns with the severity of the presenting condition for the ED visit (EDVS and subsequent events.This retrospective observational study used administrative data on beneficiaries of the universal health care insurance program in Taiwan. The service type, treatment capacity, and relative diagnosis were used to classify pre-ED visits into 8 care types. Frequent pattern analysis was used to identify sequential care-seeking patterns and to classify 667,183 eligible pre-ED episodes into patterns. Generalized linear models were developed using generalized estimating equations to examine the associations of these patterns with EDVS and subsequent events.The results revealed 17 care-seeking patterns. The EDVS and likelihood of subsequent events significantly differed among patterns. The ED severity index of patterns differ from patterns seeking directly ED care (coefficients ranged from -0.05 to 0.13, and the odds-ratios for the likelihood of subsequent ED visits and hospitalization ranged from 1.18 to 1.86 and 1.16 to 2.84, respectively.The pre-ED care-seeking patterns differ in severity of presenting condition and subsequent events that may represent different causes of ED visit. Future health policy maker may adopt different intervention strategies for targeted population to reduce unnecessary ED visit effectively.

  4. Pre-emergency-department care-seeking patterns are associated with the severity of presenting condition for emergency department visit and subsequent adverse events: a timeframe episode analysis.

    Science.gov (United States)

    Chan, Chien-Lung; Lin, Wender; Yang, Nan-Ping; Lai, K Robert; Huang, Hsin-Tsung

    2015-01-01

    Many patients treated in Emergency Department (ED) visits can be treated at primary or urgent care sectors, despite the fact that a number of ED visitors seek other forms of care prior to an ED visit. However, little is known regarding how the pre-ED activity episodes affect ED visits. We investigated whether care-seeking patterns involve the use of health care services of various types prior to ED visits and examined the associations of these patterns with the severity of the presenting condition for the ED visit (EDVS) and subsequent events. This retrospective observational study used administrative data on beneficiaries of the universal health care insurance program in Taiwan. The service type, treatment capacity, and relative diagnosis were used to classify pre-ED visits into 8 care types. Frequent pattern analysis was used to identify sequential care-seeking patterns and to classify 667,183 eligible pre-ED episodes into patterns. Generalized linear models were developed using generalized estimating equations to examine the associations of these patterns with EDVS and subsequent events. The results revealed 17 care-seeking patterns. The EDVS and likelihood of subsequent events significantly differed among patterns. The ED severity index of patterns differ from patterns seeking directly ED care (coefficients ranged from -0.05 to 0.13), and the odds-ratios for the likelihood of subsequent ED visits and hospitalization ranged from 1.18 to 1.86 and 1.16 to 2.84, respectively. The pre-ED care-seeking patterns differ in severity of presenting condition and subsequent events that may represent different causes of ED visit. Future health policy maker may adopt different intervention strategies for targeted population to reduce unnecessary ED visit effectively.

  5. HIV Services Provided by STD Programs in State and Local Health Departments - United States, 2013-2014.

    Science.gov (United States)

    Cuffe, Kendra M; Esie, Precious; Leichliter, Jami S; Gift, Thomas L

    2017-04-07

    The incidence of human immunodeficiency virus (HIV) infection in the United States is higher among persons with other sexually transmitted diseases (STDs), and the incidence of other STDs is increased among persons with HIV infection (1). Because infection with an STD increases the risk for HIV acquisition and transmission (1-4), successfully treating STDs might help reduce the spread of HIV among persons at high risk (1-4). Because health department STD programs provide services to populations who are at risk for HIV, ensuring service integration and coordination could potentially reduce the incidence of STDs and HIV. Program integration refers to the combining of STD and HIV prevention programs through structural, service, or policy-related changes such as combining funding streams, performing STD and HIV case matching, or integrating staff members (5). Some STD programs in U.S. health departments are partially or fully integrated with an HIV program (STD/HIV program), whereas other STD programs are completely separate. To assess the extent of provision of HIV services by state and local health department STD programs, CDC analyzed data from a sample of 311 local health departments and 56 state and directly funded city health departments derived from a national survey of STD programs. CDC found variation in the provision of HIV services by STD programs at the state and local levels. Overall, 73.1% of state health departments and 16.1% of local health departments matched STD case report data with HIV data to analyze possible syndemics (co-occurring epidemics that exacerbate the negative health effects of any of the diseases) and overlaps. Similarly, 94.1% of state health departments and 46.7% of local health departments performed site visits to HIV care providers to provide STD information or public health updates. One fourth of state health departments and 39.4% of local health departments provided HIV testing in nonclinical settings (field testing) for STD

  6. Services quality in emergency department of Nemazee Hospital: Using SERVQUAL model

    Directory of Open Access Journals (Sweden)

    Maryam Gholami

    2016-10-01

    Full Text Available Introduction: Patient satisfaction is crucial to the long-run success in health care center. With regard to the highest patients’ referral to the emergency department and the existing challenges due to the patient’s need to urgent care, we aimed to evaluate health care services quality in this unit to find out whether the patients have different expectations from health care providers and if they perceive some dimensions of care more important than others. Method: The SERVQUAL scale method was used in this cross-sectional study on 100 patients in June 2015. Patient satisfaction questionnaire based on SERVQUAL model was evaluated with high content validity and the reliability was 0.97 and 0.81. The data collected were analyzed using SPSS, version 20.0 (IBM, USA. Statistical analyses included descriptive statistics, paired and independence sample t-test and ANOVA at the significance level 0.05. Results:The results showed that the quality gap in all dimensions was significant (P<0.001. The largest quality gap was related to responsiveness (-1.08 and the lowest belonged to assurance (-0.8. Demographic characteristics were analyzed and the number of referrals was significant in tangibility and assurance dimensions (P = 0.04; also, in all cases the patients’ expectations (total Mean=4.35 were higher than their perception (total Mean = 3.295. Conclusion: In order to improve emergency services, it is recommended that the hospital management should provide appropriate facilities, reduce waiting time, increase in attention to ordering system based on the patients’ condition, and improve the behavior of health care personnel to patient is placed on the agenda of hospital management.

  7. ED breast cases and other breast emergencies.

    Science.gov (United States)

    Khadem, Nasim; Reddy, Sravanthi; Lee, Sandy; Larsen, Linda; Walker, Daphne

    2016-02-01

    Patients with pathologic processes of the breast commonly present in the Emergency Department (ED). Familiarity with the imaging and management of the most common entities is essential for the radiologist. Additionally, it is important to understand the limitations of ED imaging and management in the acute setting and to recognize when referrals to a specialty breast center are necessary. The goal of this article is to review the clinical presentations, pathophysiology, imaging, and management of emergency breast cases and common breast pathology seen in the ED.

  8. Interpersonal influence among public health leaders in the United States department of health and human services.

    Science.gov (United States)

    Harris, Jenine K; Carothers, Bobbi J; Wald, Lana M; Shelton, Sarah C; Leischow, Scott J

    2012-02-17

    In public health, interpersonal influence has been identified as an important factor in the spread of health information, and in understanding and changing health behaviors. However, little is known about influence in public health leadership. Influence is important in leadership settings, where public health professionals contribute to national policy and practice agendas. Drawing on social theory and recent advances in statistical network modeling, we examined influence in a network of tobacco control leaders at the United States Department of Health and Human Services (DHHS). Fifty-four tobacco control leaders across all 11 agencies in the DHHS were identified; 49 (91%) responded to a web-based survey. Participants were asked about communication with other tobacco control leaders, who influenced their work, and general job characteristics. Exponential random graph modeling was used to develop a network model of influence accounting for characteristics of individuals, their relationships, and global network structures. Higher job ranks, more experience in tobacco control, and more time devoted to tobacco control each week increased the likelihood of influence nomination, as did more frequent communication between network members. Being in the same agency and working the same number of hours per week were positively associated with mutual influence nominations. Controlling for these characteristics, the network also exhibited patterns associated with influential clusters of network members. Findings from this unique study provide a perspective on influence within a government agency that both helps to understand decision-making and also can serve to inform organizational efforts that allow for more effective structuring of leadership.

  9. Radionuclide traceability for U.S. Department of Energy Environmental Management Radioanalytical Services

    International Nuclear Information System (INIS)

    Morton, J.S.; McIntyre, T.I.

    2001-01-01

    In 1999, the Department of Energy Office of Environmental Management (DOE-EM) National Analytical Management Program (NAMP) established a Radiological Traceability Program (RTP) as a new initiative for the radioanalytical activities related to the environmental programs conducted throughout the DOE complex. The National Analytical Management Program entered into an interagency agreement with the National Institute of Standards and Technology (NIST) to establish traceability to the national standard for DOE-EM radioanalytical activities through the NIST/reference laboratory concept as described in ANSI N42.23-1996. Using the criteria established by the RTP, NAMP named two DOE-EM laboratories as reference or secondary laboratories and established a program with NIST that demonstrated the concept of traceability. In order to gain and maintain traceability to NIST, each reference laboratory must meet the performance criteria as defined by the RTP and NAMP. Traceability to NIST is tiered down to each radioanalytical laboratory (monitor or service) that successfully participates in the performance-evaluation programs offered by the reference laboratories. Essential to the RTP is the demonstration that the reference laboratories can produce performance-testing (PT) materials of high quality as well as analyze/verify the radionuclide concentration to the required accuracy and precision. Elements of the RTP and the program requirements of NIST and the reference laboratories are presented. (author)

  10. Minor injury attendance times to the ED.

    LENUS (Irish Health Repository)

    Conlon, Ciaran

    2009-07-01

    The Health Service Executive (HSE) highlights the need for effective patient throughput and management, whilst providing appropriate staffing and therapeutic interventions. It acknowledges that patient need is integral to the development of a nurse led service and advocates planning staffing levels to reflect arrival times of patients. An observational study of all patients who presented to the emergency department in July 2005 and February 2006 was undertaken (n=7768). The study identified 1577 patients suitable for treatment by the Advanced Nurse Practitioner (ANP) in these two months, which represents 20% of all patient attendances to the ED in this time period. A data collection tool was devised collectively by the ANPs to identify appropriate patients. The findings of the study revealed that 73% of patients suitable for the ANP service presented between the hours of 0800 and 2000, of which 54% attended between 0800 and 1600 h. Sunday emerged as the busiest day in July 2005 whereas Monday was found to be the busiest day in February 2006. Friday was found to be consistently busy for both months.

  11. Needs assessment for fire department services and resources for the Los Alamos National Laboratory, Los Alamos, New Mexico. Final report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-11-15

    This report has been developed in response to a request from the Los Alamos National Laboratory (LANL) to evaluate the need for fire department services so as to enable the Laboratory to plan effective fire protection and thereby: meet LANL`s regulatory and contractual obligations; interface with the Department of Energy (DOE) and other agencies on matters relating to fire and emergency services; and ensure appropriate protection of the community and environment. This study is an outgrowth of the 1993 Fire Department Needs Assessment (prepared for DOE) but is developed from the LANL perspective. Input has been received from cognizant and responsible representatives at LANL, DOE, Los Alamos County (LAC) and the Los Alamos Fire Department (LAFD).

  12. Airport level of service: A model according to departing passengers’ perceptions at a small-sized airport

    Directory of Open Access Journals (Sweden)

    Max Well Elias Gonçalves

    2017-04-01

    Full Text Available Purpose: This study proposes a conceptual model of level of service evaluation to a small-sized airport with a focus on departing passengers. Design/Methodology: The variables selected to compose the model were chosen according to their adequacy to departing passengers and the airport’s characteristics. A survey was conducted, and, posteriorly, exploratory factor analysis was used in order to verify the adequacy of the conceptual model proposed and also to improve it according to the results obtained. Findings: The results show that the level of service of the airport is composed of three dimensions: airport characteristics, passenger processing, and prices. The relative importance of the dimensions according to their contribution to the composition of the airport’s overall level of service was also determined. Originality/value: The paper combines theoretical and practical findings in a model for level of service evaluation to a small-sized airport from an air transportation management perspective.

  13. Comparing Emergency Department Use Among Medicaid and Commercial Patients Using All-Payer All-Claims Data.

    Science.gov (United States)

    Kim, Hyunjee; McConnell, K John; Sun, Benjamin C

    2017-08-01

    The high rate of emergency department (ED) use by Medicaid patients is not fully understood. The objective of this paper is (1) to provide context for ED service use by comparing Medicaid and commercial patients' differences across ED and non-ED health service use, and (2) to assess the extent to which Medicaid-commercial differences in ED use can be explained by observable factors in administrative data. Statistical decomposition methods were applied to ED, mental health, and inpatient care using 2011-2013 Medicaid and commercial insurance claims from the Oregon All Payer All Claims database. Demographics, comorbidities, health services use, and neighborhood characteristics accounted for 44% of the Medicaid-commercial difference in ED use, compared to 83% for mental health care and 75% for inpatient care. This suggests that relative to mental health and inpatient care, a large portion of ED use cannot be explained by administrative data. Models that further accounted for patient access to different primary care physicians explained an additional 8% of the Medicaid-commercial difference in ED use, suggesting that the quality of primary care may influence ED use. The remaining unexplained difference suggests that appropriately reducing ED use remains a credible target for policy makers, although success may require knowledge about patients' perceptions and behaviors as well as social determinants of health.

  14. Perceived Case Management Needs and Service Preferences of Frequent Emergency Department Users: Lessons Learned in a Large Urban Centre.

    Science.gov (United States)

    Kahan, Deborah; Poremski, Daniel; Wise-Harris, Deborah; Pauly, Daniel; Leszcz, Molyn; Wasylenki, Donald; Stergiopoulos, Vicky

    2016-01-01

    This study aimed to explore the service needs and preferences of frequent emergency department users with mental health and addictions concerns who participated in a brief intensive case management intervention. We conducted semi-structured individual interviews with 20 frequent emergency department users with mental health and addictions challenges, 13 service providers involved in the delivery of a brief case management intervention, and a focus group with intervention case managers. Thematic analysis was used to explore perceived service user profiles, service needs and preferences of care. Service users experienced complex health and social needs and social isolation, while exhibiting resilience and the desire to contribute. They described multiple instances of stigmatization in interactions with healthcare professionals. Components of the brief intensive case management intervention perceived to be helpful included system navigation, advocacy, intermediation, and practical needs assistance. Frequent service users valued relational responsiveness, a non-judgmental stance, and a recovery orientation in case managers. Interventions for frequent service users in mental health may be enhanced by focusing on the engagement of formal and informal social supports, practical needs assistance, system navigation, advocacy and intermediation, and attention to the recovery goals of service users.

  15. Perceived Case Management Needs and Service Preferences of Frequent Emergency Department Users: Lessons Learned in a Large Urban Centre.

    Directory of Open Access Journals (Sweden)

    Deborah Kahan

    Full Text Available This study aimed to explore the service needs and preferences of frequent emergency department users with mental health and addictions concerns who participated in a brief intensive case management intervention.We conducted semi-structured individual interviews with 20 frequent emergency department users with mental health and addictions challenges, 13 service providers involved in the delivery of a brief case management intervention, and a focus group with intervention case managers. Thematic analysis was used to explore perceived service user profiles, service needs and preferences of care.Service users experienced complex health and social needs and social isolation, while exhibiting resilience and the desire to contribute. They described multiple instances of stigmatization in interactions with healthcare professionals. Components of the brief intensive case management intervention perceived to be helpful included system navigation, advocacy, intermediation, and practical needs assistance. Frequent service users valued relational responsiveness, a non-judgmental stance, and a recovery orientation in case managers.Interventions for frequent service users in mental health may be enhanced by focusing on the engagement of formal and informal social supports, practical needs assistance, system navigation, advocacy and intermediation, and attention to the recovery goals of service users.

  16. Early detection of abnormal patient arrivals at hospital emergency department

    KAUST Repository

    Harrou, Fouzi; Sun, Ying; Kadri, Farid; Chaabane, Sondes; Tahon, Christian

    2015-01-01

    Overcrowding is one of the most crucial issues confronting emergency departments (EDs) throughout the world. Efficient management of patient flows for ED services has become an urgent issue for most hospital administrations. Handling and detection of abnormal situations is a key challenge in EDs. Thus, the early detection of abnormal patient arrivals at EDs plays an important role from the point of view of improving management of the inspected EDs. It allows the EDs mangers to prepare for high levels of care activities, to optimize the internal resources and to predict enough hospitalization capacity in downstream care services. This study reports the development of statistical method for enhancing detection of abnormal daily patient arrivals at the ED, which able to provide early alert mechanisms in the event of abnormal situations. The autoregressive moving average (ARMA)-based exponentially weighted moving average (EWMA) anomaly detection scheme proposed was successfully applied to the practical data collected from the database of the pediatric emergency department (PED) at Lille regional hospital center, France.

  17. Early detection of abnormal patient arrivals at hospital emergency department

    KAUST Repository

    Harrou, Fouzi

    2015-10-21

    Overcrowding is one of the most crucial issues confronting emergency departments (EDs) throughout the world. Efficient management of patient flows for ED services has become an urgent issue for most hospital administrations. Handling and detection of abnormal situations is a key challenge in EDs. Thus, the early detection of abnormal patient arrivals at EDs plays an important role from the point of view of improving management of the inspected EDs. It allows the EDs mangers to prepare for high levels of care activities, to optimize the internal resources and to predict enough hospitalization capacity in downstream care services. This study reports the development of statistical method for enhancing detection of abnormal daily patient arrivals at the ED, which able to provide early alert mechanisms in the event of abnormal situations. The autoregressive moving average (ARMA)-based exponentially weighted moving average (EWMA) anomaly detection scheme proposed was successfully applied to the practical data collected from the database of the pediatric emergency department (PED) at Lille regional hospital center, France.

  18. TechEdSat

    Data.gov (United States)

    National Aeronautics and Space Administration — TechEdSat is a 1U CubeSat built by San Jose State University in partnership with NASA Ames Research Center and AAC Microtec. Its mission is to evaluate Space...

  19. Interpersonal influence among public health leaders in the United States Department of Health and Human Services

    Directory of Open Access Journals (Sweden)

    Jenine K. Harris

    2012-02-01

    Full Text Available Background. In public health, interpersonal influence has been identified as an important factor in the spread of health information, and in understanding and changing health behaviors. However, little is known about influence in public health leadership. Influence is important in leadership settings, where public health professionals contribute to national policy and practice agendas. Drawing on social theory and recent advances in statistical network modeling, we examined influence in a network of tobacco control leaders at the United States Department of Health and Human Services (DHHS. Design and Methods. Fifty-four tobacco control leaders across all 11 agencies in the DHHS were identified; 49 (91% responded to a web-based survey. Participants were asked about communication with other tobacco control leaders, who influenced their work, and general job characteristics. Exponential random graph modeling was used to develop a network model of influence accounting for characteristics of individuals, their relationships, and global network structures. Results. Higher job ranks, more experience in tobacco control, and more time devoted to tobacco control each week increased the likelihood of influence nomination, as did more frequent communication between network members. Being in the same agency and working the same number of hours per week were positively associated with mutual influence nominations. Controlling for these characteristics, the network also exhibited patterns associated with influential clusters of network members. Conclusions. Findings from this unique study provide a perspective on influence within a government agency that both helps to understand decision-making and also can serve to inform organizational efforts that allow for more effective structuring of leadership.

  20. How Much Time Do Unhospitalized Patients Applying for Emergency Services Stay in Emergency Department

    Directory of Open Access Journals (Sweden)

    Mansur Kürsad Erkuran

    2013-12-01

    Full Text Available INTRODUCTION: The patients applying to a emergency service may stay longer than necessary for diagnosis, monitoring and treatment. This can be due to the inadequacy of the treatment performed in emergency department or to the absence of the required unit in the hospital. In this study, we analyzed the waiting period of the patients who have not been hospitalized. METHODS: The patients applying to Bolu İzzet Baysal Public Hospital Emergency Unit between 24.11.2009 and 25.08.2011 have been studied regarding their application date, the season, and their waiting period in the emergency unit. The data have been analyzed using the statistics software Package for the Social Sciences (SPSS, Inc., Chicago, IL, version 17.0 for Windows. The chi-square χ2 test has been used for the determination of the percentage distribution and significance and p<0,05 has been considered significant. RESULTS: 4215 patients applying to Bolu İzzet Baysal Public Hospital Emergency Unit between 24.11.2009 and 25.08.2011 and monitored without hospitalization have been studied. The patients mainly presented during spring (p<0.05. The application occurred more often between 20.00 PM – 23.59 PM (p<0.005. The mean duration of the accept-standby of the patients in emergency unit was 09±12 (minimum 0 minute, maximum 130 minutes. The patients waited 0,26 ±70 minutes in emergency unit examination (minimum 0 minute, maximum 1292 minutes. The total waiting time in emergency unit was 52 ±100 minutes (minimum 10, maximum 1435 minutes. DISCUSSION AND CONCLUSION: In this study, we observed that the duration of the hospitalization in emergency unit is longer than the ideal duration.

  1. Managing the Service Supply Chain in the Department of Defense: Opportunities and Challenges

    National Research Council Canada - National Science Library

    Apte, Uday; Ferrer, Geraldo; Lewis, Ira; Rendon, Rene

    2006-01-01

    ...% of total DoD procurement dollars) on services. In recent years, the DoD has spent more on services than on supplies, equipment and goods, even considering the high value of weapon systems and large military items...

  2. 77 FR 24990 - Public Availability of the Department of Labor FY 2011 Service Contract Inventory

    Science.gov (United States)

    2012-04-26

    ... INFORMATION CONTACT: Questions regarding the service contract inventory should be directed to Gladys M. Bailey in the DOL/ Office of Acquisition Management Services on (202) 693-7244 or bailey.gladys@dol.gov...

  3. Department of Defense Use of Commercial Cloud Computing Capabilities and Services

    Science.gov (United States)

    2015-11-01

    models (Infrastructure as a Service (IaaS), Platform as a Service (PaaS), and Software as a Service ( SaaS )), and four deployment models (Public...NIST defines three main models for cloud computing: IaaS, PaaS, and SaaS . These models help differentiate the implementation responsibilities that fall...and SaaS . 3. Public, Private, Community, and Hybrid Clouds Cloud services come in different forms, depending on the customer’s specific needs

  4. Customer Service Analysis : Case: Sky Club Department of Yeti Airlines, Nepal

    OpenAIRE

    Chiluwal, Debendra

    2014-01-01

    In recent year, competition in business field is significantly growing and an organization cannot focus only on price but also they have to focus on customer service and satisfaction level. The objective of this thesis is to find out the level of customer service experience and satisfaction and provide suggestions for the future development. Customer service and customer satisfaction are relates to each other. Therefore, good customer service can get high level of customer satisfaction. A hig...

  5. 75 FR 45606 - Department of Commerce Measuring and Enhancing Services Trade Data Conference

    Science.gov (United States)

    2010-08-03

    ... decision-making, policy planning, and is relevant for trade agreements in support of increased US services... business and public policy decision-making. DOC will accept registrations on a first-come-first-served... services, accounting for intangible assets, and accuracy of service price indices. The target audience for...

  6. An Evaluation of Service Quality in Higher Education: Marmara and Nigde Omer Halisdemir Universities' Department of Education Students

    Science.gov (United States)

    Ada, Sefer; Baysal, Z. Nurdan; Erkan, Senem Seda Sahenk

    2017-01-01

    The purpose of this research is to evaluate the quality service in higher education in Marmara and Nigde Omer Halisdemir Universities' department of education students. This study was prepared using a screening model from quantitative research methods. The sample of this research comprised 886 university students attending the higher education…

  7. 76 FR 76032 - Schedule of Fees for Consular Services, Department of State and Overseas Embassies and Consulates

    Science.gov (United States)

    2011-12-06

    ... proposed changes to the Schedule of Fees for Consular Services (Schedule) for nonimmigrant visa and border... (Machine-Readable Visas or MRVs) and adult Border Crossing Cards (BCCs). The rule also provides new tiers... these visas under the current cost structure. The Department endeavors to recover the cost of providing...

  8. 78 FR 78380 - Notice of Inventory Completion: U.S. Department of the Interior, National Park Service, Fort...

    Science.gov (United States)

    2013-12-26

    ... completion of an inventory of human remains under the control of Fort Bowie National Historic Site, Bowie, AZ....R50000] Notice of Inventory Completion: U.S. Department of the Interior, National Park Service, Fort... completed an inventory of human remains, in consultation with the appropriate Indian tribes or Native...

  9. 78 FR 78378 - Notice of Inventory Completion: U.S. Department of the Interior, National Park Service, Grant...

    Science.gov (United States)

    2013-12-26

    ... Repatriation Act (NAGPRA), 25 U.S.C. 3003, of the completion of an inventory of human remains under the control....R50000] Notice of Inventory Completion: U.S. Department of the Interior, National Park Service, Grant... Historic Site has completed an inventory of human remains, in consultation with the appropriate Indian...

  10. Assessment of Service Members Knowledge and Trust of the Department of Veterans Affairs

    Science.gov (United States)

    2015-06-12

    www.va.gov/health/aboutVHA.asp. 24 Veterans Benefits Administration, “About VBA ,” last updated December 18, 2014, accessed May 10, 2015, http...Department of Veterans Affairs, 2014. Veterans Benefits Administration. “About VBA .” Last updated December 18, 2014. Accessed May 10, 2015. http...OIF Operation Iraqi Freedom VA Department of Veterans Affairs VA OIG Department of Veterans Affairs Office of Inspector General VBA Veterans Benefits

  11. 75 FR 64710 - Availability of the Fiscal Year 2009 Department of Defense Services Contracts Inventory

    Science.gov (United States)

    2010-10-20

    ... DEPARTMENT OF DEFENSE Office of the Secretary Availability of the Fiscal Year 2009 Department of... National Defense Authorization Act for Fiscal Year 2008 (NDAA 08) section 807, the Office of the Director, Defense Procurement and Acquisition Policy, Office of Program Acquisition and Strategic Sourcing (DPAP...

  12. The Long-Term Cost to the UK NHS and Social Services of Different Durations of IV Thiamine (Vitamin B1) for Chronic Alcohol Misusers with Symptoms of Wernicke's Encephalopathy Presenting at the Emergency Department.

    Science.gov (United States)

    Wilson, Edward C F; Stanley, George; Mirza, Zulfiquar

    2016-04-01

    Wernicke's encephalopathy (WE) is an acute neuropsychiatric condition caused by depleted intracellular thiamine, most commonly arising in chronic alcohol misusers, who may present to emergency departments (EDs) for a variety of reasons. Guidelines recommend a minimum 5-day course of intravenous (IV) thiamine in at-risk patients unless WE can be excluded. To estimate the cost impact on the UK public sector (NHS and social services) of a 5-day course of IV thiamine, vs a 2- and 10-day course, in harmful or dependent drinkers presenting to EDs. A Markov chain model compared expected prognosis of patients under alternative admission strategies over 35 years. Model inputs were derived from a prospective cohort study, expert opinion via structured elicitation and NHS costing databases. Costs (2012/2013 price year) were discounted at 3.5 %. Increasing treatment from 2 to 5 days increased acute care costs but reduced the probability of disease progression and thus reduced the expected net costs by GBP87,000 per patient (95 % confidence interval GBP19,300 to GBP172,300) over 35 years. Increasing length of stay to optimize IV thiamine replacement will place additional strain on acute care but has potential UK public sector cost savings. Social services and the NHS should explore collaborations to realise both the health benefits to patients and savings to the public purse.

  13. Millennials in the Fire Service: The Effectiveness of Fire Service Recruiting, Testing, and Retention

    Science.gov (United States)

    2017-12-01

    Administration/US-fire-department-profile. 50 Taro Yamane, Statistics : An Introductory Analysis, 2nd ed. (New York: Harper and Rowe, 1967), 886. 15...241096018-Is-there-a-better-approach-for-fire-department-testing/. Yamane, Taro. Statistics : An Introductory Analysis, 2nd ed. New York: Harper and...Fire Protection Association, January 2016), 21, http://www.nfpa.org/News-and-Research/Fire- statistics - and-reports/Fire- statistics /The-fire-service

  14. PREFACE: EDS2010 Preface

    Science.gov (United States)

    Heggie, Malcolm I.

    2011-03-01

    The biennial international conference on Extended Defects in Semiconductors started in 1978 with a meeting in Hünfeld, Germany. Subsequent meetings rotated between Poland, France, Great Britain, Germany, Russia and Italy, culminating in EDS2004 in Chernogolovka, EDS2006 in Halle and EDS2008 in Poitiers. EDS2010 was held at the University of Sussex at Brighton, UK from September 19th to 24th. An extension of the tabulation of this history, which first appeared on the EDS2006 website, is given in the attached PDF. It is with sadness that we note one of the founders of the series, Prof. Dr Helmut Alexander, passed away on 3 December 2009 and we were proud to dedicate EDS2010 to his memory. It has become a tradition to make an award in his name, and this year it was made to Ivan Isacov for his poster "Electrical levels of dislocation networks in p- and n-type silicon". A short and warm celebration of Prof. Dr Alexander's life by his friends and colleagues, Prof. Drs Helmut Gottschalk, Eicke Weber and Wolfgang Schröter, is included in this volume. The conference was a forum for the state-of-the-art of investigation and modelling of extended defects in semiconductors. Scientists from universities, research institutes and industry made contributions to a deeper understanding of extended defects, their interaction with point defects and their role in the development of semiconductor technology. The remit of the conference included extended defects, nanostructures, nanoparticles, quantum dots and interfaces within semiconducting materials ranging from narrow to wide band gaps, including graphene-derived materials and diamond. Scientific interests range from defect geometry, electronic structure, dynamics, spectroscopy, microscopy, reactions and chemistry to introduction mechanisms, such as implantation and strained layers and the operation of devices such as integrated circuits, heterostructures, and solar cells. The organisers were confronted with a long period between

  15. Commercial Methodologies for Acquiring Consulting Services: Can Department of Defense Contracting Activities Follow Suit?

    National Research Council Canada - National Science Library

    Clarke, Will

    2001-01-01

    .... The objective of this thesis is to ascertain the best pre-award commercial practices for acquiring CS and draw conclusions and make recommendations for employing these proven methods in future Department of Defense (DoD) procurements...

  16. Critical care in the emergency department.

    LENUS (Irish Health Repository)

    O'Connor, Gabrielle

    2012-02-01

    BACKGROUND: The volume and duration of stay of the critically ill in the emergency department (ED) is increasing and is affected by factors including case-mix, overcrowding, lack of available and staffed intensive care beds and an ageing population. The purpose of this study was to describe the clinical activity associated with these high-acuity patients and to quantify resource utilization by this patient group. METHODS: The study was a retrospective review of ED notes from all patients referred directly to the intensive care team over a 6-month period from April to September 2004. We applied a workload measurement tool, Therapeutic Intervention Scoring System (TISS)-28, which has been validated as a surrogate marker of nursing resource input in the intensive care setting. A nurse is considered capable of delivering nursing activities equal to 46 TISS-28 points in each 8-h shift. RESULTS: The median score from our 69 patients was 19 points per patient. Applying TISS-28 methodology, we estimated that 3 h 13 min nursing time would be spent on a single critically ill ED patient, with a TISS score of 19. This is an indicator of the high levels of personnel resources required for these patients in the ED. ED-validated models to quantify nursing and medical staff resources used across the spectrum of ED care is needed, so that staffing resources can be planned and allocated to match service demands.

  17. Impact of an ABCDE team triage process combined with public guidance on the division of work in an emergency department.

    Science.gov (United States)

    Kantonen, Jarmo; Lloyd, Robert; Mattila, Juho; Kauppila, Timo; Menezes, Ricardo

    2015-06-01

    To study the effects of applying an emergency department (ED) triage system, combined with extensive publicity in local media about the "right" use of emergency services, on the division of work between ED nurses and general practitioners (GPs). An observational and quasi-experimental study based on before-after comparisons. Implementation of the ABCDE triage system in a Finnish combined ED where secondary care is adjacent, and in a traditional primary care ED where secondary care is located elsewhere. GPs and nurses from two different primary care EDs. Numbers of monthly visits to different professional groups before and after intervention in the studied primary care EDs and numbers of monthly visits to doctors in the local secondary care ED. The beginning of the triage process increased temporarily the number of independent consultations and patient record entries by ED nurses in both types of studied primary care EDs and reduced the number of patient visits to a doctor compared with previous years but had no effect on doctor visits in the adjacent secondary care ED. No further decrease in the number of nurse or GP visits was observed by inhibiting the entrance of non-urgent patients. The ABCDE triage system combined with public guidance may reduce non-urgent patient visits to doctors in different kinds of primary care EDs without increasing visits in the secondary care ED. However, the additional work to implement the ABCDE system is mainly directed to nurses, which may pose a challenge for staffing.

  18. Quality assurance plan: Prepared for the state of Florida, Department of Health and rehabilitative Services, Office of Laboratory Services, Water Certification Program

    International Nuclear Information System (INIS)

    1992-02-01

    This quality assurance plan is for use in ongoing operations in the General Electric Neutron Devices Department. General Electric operates the Department of Energy (DOE) facility in Largo, Florida. All work covered by this quality assurance plan is in support of the operations of the wastewater pretreatment facility operated by GENDD at the DOE facility in Largo, Florida. As a Florida State certified laboratory we will follow Health and Rehabilitation Services (HRS) or HRS approved standard methods, successfully participate in HRS or HRS approved performance evaluation studies, and will maintain Quality Assurance Documentation as outlined in this plan or its subsequent revisions

  19. Relationships among providing maternal, child, and adolescent health services; implementing various financial strategy responses; and performance of local health departments.

    Science.gov (United States)

    Issel, L Michele; Olorunsaiye, Comfort; Snebold, Laura; Handler, Arden

    2015-04-01

    We explored the relationships between local health department (LHD) structure, capacity, and macro-context variables and performance of essential public health services (EPHS). In 2012, we assessed a stratified, random sample of 195 LHDs that provided data via an online survey regarding performance of EPHS, the services provided or contracted out, the financial strategies used in response to budgetary pressures, and the extent of collaborations. We performed weighted analyses that included analysis of variance, pairwise correlations by jurisdiction population size, and linear regressions. On average, LHDs provided approximately 13 (36%) of 35 possible services either directly or by contract. Rather than cut services or externally consolidating, LHDs took steps to generate more revenue and maximize capacity. Higher LHD performance of EPHS was significantly associated with delivering more services, initiating more financial strategies, and engaging in collaboration, after adjusting for the effects of the Affordable Care Act and jurisdiction size. During changing economic and health care environments, we found that strong structural capacity enhanced local health department EPHS performance for maternal, child, and adolescent health.

  20. Erectile Dysfunction (ED)

    Science.gov (United States)

    ... Talking to Your Kids About VirginityTalking to Your Kids About Sex Home Diseases and Conditions Erectile Dysfunction (ED) Condition ... Well-Being Mental Health Sex and Birth Control Sex and Sexuality Birth Control ... and Toddlers Kids and Teens Pregnancy and Childbirth Women Men Seniors ...

  1. Managing the Service Supply Chain in Department of Defense: Implications for the Program Management Infrastructure

    National Research Council Canada - National Science Library

    Rendon, Rene G; Apte, Uday

    2007-01-01

    .... In fact, in recent years, the DoD has spent more on services than on supplies, equipment and goods, even considering the high value of weapon systems and large military items (Camm, Blickstein & Venzor, 2004...

  2. A Model of a Tacit Knowledge Transformation for the Service Department in a Manufacturing Company: A Case Study

    Directory of Open Access Journals (Sweden)

    Dudek Adam

    2016-01-01

    Full Text Available This article elaborates on the development of a dedicated model of a tacit knowledge transformation for the service department in a manufacturing company. The four main components of the tacit knowledge transformation process are formulated: (1 tacit knowledge source identification, (2 tacit knowledge acquisition, (3 tacit knowledge determination and formalization, and (4 knowledge classification. The proposed model is illustrated by examples on the use of the methods: automatic recognition of speech, natural language processing, and automatic object recognition in the tacit knowledge transformation process in order to obtain a formalized procedure for the service department in a manufacturing company. This is followed by a discussion of the results of the research experiments.

  3. Communication and Work Development as a Change Management Tool in the In-flight Customer Service Department : Case Finnair

    OpenAIRE

    Hölttä, Katri

    2011-01-01

    The challenges and changes in the air transport sector have increased the need for radical changes also in the airlines organizations. Finnair has chosen to be a quality airline to focus on operations into customer-orientation and delivering improved customer experience to its customers. The objective of this thesis is to find development suggestions to the In-flight customer service department how to develop communication and work development to be used as a change management tool. The study...

  4. Application of Analytical Hierarchy Process Approach for Service Quality Evaluation in Radiology Departments: A Cross-Sectional Study.

    Science.gov (United States)

    Alimohammadzadeh, Khalil; Bahadori, Mohammadkarim; Hassani, Fariba

    2016-01-01

    Radiology department as a service provider organization requires realization of quality concept concerning service provisioning knowledge, satisfaction and all issues relating to the customer as well as quality assurance and improvement issues. At present, radiology departments in hospitals are regarded as income generating units and they should continuously seek performance improvement so that they can survive in the changing and competitive environment of the health care sector. The aim of this study was to propose a method for ranking of radiology departments in selected hospitals of Tehran city using analytical hierarchical process (AHP) and quality evaluation of their service in 2015. This study was an applied and cross-sectional study, carried out in radiology departments of 6 Tehran educational hospitals in 2015. The hospitals were selected using non-probability and purposeful method. Data gathering was performed using customized joint commission international (JCI) standards. Expert Choice 10.0 software was used for data analysis. AHP method was used for prioritization. "Management and empowerment of human resources'' (weight = 0.465) and "requirements and facilities" (weight = 0.139) were of highest and lowest significance respectively in the overall ranking of the hospitals. MS (weight = 0.316), MD (weight = 0.259), AT (weight = 0.14), TS (weight = 0.108), MO (weight = 0.095), and LH (0.082) achieved the first to sixth rankings respectively. The use of AHP method can be promising for fostering the evaluation method and subsequently promotion of the efficiency and effectiveness of the radiology departments. The present model can fill in the gap in the accreditation system of the country's hospitals in respect with ranking and comparing them considering the significance and value of each individual criteria and standard. Accordingly, it can predict an integration of qualitative and quantitative criteria involved and thereby take a decisive step towards

  5. Application of Analytical Hierarchy Process Approach for Service Quality Evaluation in Radiology Departments: A Cross-Sectional Study

    International Nuclear Information System (INIS)

    Alimohammadzadeh, Khalil; Bahadori, Mohammadkarim; Hassani, Fariba

    2016-01-01

    Radiology department as a service provider organization requires realization of quality concept concerning service provisioning knowledge, satisfaction and all issues relating to the customer as well as quality assurance and improvement issues. At present, radiology departments in hospitals are regarded as income generating units and they should continuously seek performance improvement so that they can survive in the changing and competitive environment of the health care sector. The aim of this study was to propose a method for ranking of radiology departments in selected hospitals of Tehran city using analytical hierarchical process (AHP) and quality evaluation of their service in 2015. This study was an applied and cross-sectional study, carried out in radiology departments of 6 Tehran educational hospitals in 2015. The hospitals were selected using non-probability and purposeful method. Data gathering was performed using customized joint commission international (JCI) standards. Expert Choice 10.0 software was used for data analysis. AHP method was used for prioritization. “Management and empowerment of human resources’’ (weight = 0.465) and “requirements and facilities” (weight = 0.139) were of highest and lowest significance respectively in the overall ranking of the hospitals. MS (weight = 0.316), MD (weight = 0.259), AT (weight = 0.14), TS (weight = 0.108), MO (weight = 0.095), and LH (0.082) achieved the first to sixth rankings respectively. The use of AHP method can be promising for fostering the evaluation method and subsequently promotion of the efficiency and effectiveness of the radiology departments. The present model can fill in the gap in the accreditation system of the country’s hospitals in respect with ranking and comparing them considering the significance and value of each individual criteria and standard. Accordingly, it can predict an integration of qualitative and quantitative criteria involved and thereby take a decisive step

  6. A proposed simulation optimization model framework for emergency department problems in public hospital

    Science.gov (United States)

    Ibrahim, Ireen Munira; Liong, Choong-Yeun; Bakar, Sakhinah Abu; Ahmad, Norazura; Najmuddin, Ahmad Farid

    2015-12-01

    The Emergency Department (ED) is a very complex system with limited resources to support increase in demand. ED services are considered as good quality if they can meet the patient's expectation. Long waiting times and length of stay is always the main problem faced by the management. The management of ED should give greater emphasis on their capacity of resources in order to increase the quality of services, which conforms to patient satisfaction. This paper is a review of work in progress of a study being conducted in a government hospital in Selangor, Malaysia. This paper proposed a simulation optimization model framework which is used to study ED operations and problems as well as to find an optimal solution to the problems. The integration of simulation and optimization is hoped can assist management in decision making process regarding their resource capacity planning in order to improve current and future ED operations.

  7. Role of Department of Defense Policies in Identifying Traumatic Brain Injuries Among Deployed US Service Members, 2001-2016.

    Science.gov (United States)

    Agimi, Yll; Regasa, Lemma Ebssa; Ivins, Brian; Malik, Saafan; Helmick, Katherine; Marion, Donald

    2018-05-01

    To examine the role of Department of Defense policies in identifying theater-sustained traumatic brain injuries (TBIs). We conducted a retrospective study of 48 172 US military service members who sustained their first lifetime TBIs between 2001 and 2016 while deployed to Afghanistan or Iraq. We used multivariable negative binomial models to examine the changes in TBI incidence rates following the introduction of Department of Defense policies. Two Army policies encouraging TBI reporting were associated with an increase of 251% and 97% in TBIs identified following their implementation, respectively. Among airmen, the introduction of TBI-specific screening questions to the Post-Deployment Health Assessment was associated with a 78% increase in reported TBIs. The 2010 Department of Defense Directive Type Memorandum 09-033 was associated with another increase of 80% in the likelihood of being identified with a TBI among soldiers, a 51% increase among sailors, and a 124% increase among Marines. Department of Defense and service-specific policies introduced between 2006 and 2013 significantly increased the number of battlefield TBIs identified, successfully improving the longstanding problem of underreporting of TBIs.

  8. Using Google Flu Trends data in forecasting influenza-like-illness related ED visits in Omaha, Nebraska.

    Science.gov (United States)

    Araz, Ozgur M; Bentley, Dan; Muelleman, Robert L

    2014-09-01

    Emergency department (ED) visits increase during the influenza seasons. It is essential to identify statistically significant correlates in order to develop an accurate forecasting model for ED visits. Forecasting influenza-like-illness (ILI)-related ED visits can significantly help in developing robust resource management strategies at the EDs. We first performed correlation analyses to understand temporal correlations between several predictors of ILI-related ED visits. We used the data available for Douglas County, the biggest county in Nebraska, for Omaha, the biggest city in the state, and for a major hospital in Omaha. The data set included total and positive influenza test results from the hospital (ie, Antigen rapid (Ag) and Respiratory Syncytial Virus Infection (RSV) tests); an Internet-based influenza surveillance system data, that is, Google Flu Trends, for both Nebraska and Omaha; total ED visits in Douglas County attributable to ILI; and ILI surveillance network data for Douglas County and Nebraska as the predictors and data for the hospital's ILI-related ED visits as the dependent variable. We used Seasonal Autoregressive Integrated Moving Average and Holt Winters methods with3 linear regression models to forecast ILI-related ED visits at the hospital and evaluated model performances by comparing the root means square errors (RMSEs). Because of strong positive correlations with ILI-related ED visits between 2008 and 2012, we validated the use of Google Flu Trends data as a predictor in an ED influenza surveillance tool. Of the 5 forecasting models we have tested, linear regression models performed significantly better when Google Flu Trends data were included as a predictor. Regression models including Google Flu Trends data as a predictor variable have lower RMSE, and the lowest is achieved when all other variables are also included in the model in our forecasting experiments for the first 5 weeks of 2013 (with RMSE = 57.61). Google Flu Trends data

  9. Systematic review of frequent users of emergency departments in non-US hospitals: state of the art.

    Science.gov (United States)

    van Tiel, Sofie; Rood, Pleunie P M; Bertoli-Avella, Aida M; Erasmus, Vicky; Haagsma, Juanita; van Beeck, Ed; Patka, Peter; Polinder, Suzanne

    2015-10-01

    This review focuses on frequent users (FUs) of the emergency department (ED). Elucidation of the characteristics of frequent ED users will help to improve healthcare services. A systematic review of the literature (from 1999 onwards) on frequent ED users in non-US hospitals was performed. Twenty-two studies were included. FUs are responsible for a wide variety of 1-31% of ED visits depending on the FU definition used. They have a mean age between 40 and 50 years and are older than nonfrequent users. Chronic physical and mental diseases seem to be the main reasons for frequent ED visits. In terms of social characteristics, lacking a partner is more frequently reported among FUs in some studies. The absence of a universal definition for FUs complicates the determination of the burden on emergency healthcare services. FUs are a heterogeneous group of patients with genuine medical needs and high consumption of other healthcare services.

  10. Frequent use of emergency departments by older people: a comparative cohort study of characteristics and outcomes.

    Science.gov (United States)

    Street, Maryann; Berry, Debra; Considine, Julie

    2018-04-12

    To characterise older people who frequently use emergency departments (EDs) and compare patient outcomes with older non-frequent ED attenders. Retrospective comparative cohort study. Logistic regression modelling of patient characteristics and health service usage, comparing older frequent ED attenders (≥4 ED attendances in 12 months) to non-frequent ED attenders. Three Australian public hospital EDs, with a total of 143 327 emergency attendances in the 12 months. People aged ≥65 years attending the ED in financial year 2013/2014. The primary outcome was frequent ED use; secondary outcomes were ED length of stay, discharge destination from ED, hospital length of stay, re-presentation within 48 h, hospital readmission within 30 days and in-hospital mortality. Five percent of older people were frequent attenders (n = 1046/21 073), accounting for 16.9% (n = 5469/32 282) of all attendances by older people. Frequent ED attenders were more likely to be male, aged 75-84 years, arrive by ambulance and have a diagnosis relating to chronic illness. Frequent attenders stayed 0.4 h longer in ED (P < 0.001), were more likely to be admitted to hospital (69.2% vs 67.2%; P = 0.004), and had a 1 day longer hospital stay (P < 0.001). In-hospital mortality for older frequent ED attenders was double that of non-frequent attenders (7.0% vs 3.2%, P < 0.001) over 12 months. Older frequent ED attenders had more chronic disease and care needs requiring hospital admission than non-frequent attenders. A new approach to care planning and coordination is recommended, to optimise the patient journey and improve outcomes.

  11. 76 FR 32358 - Meeting of the Defense Department Advisory Committee on Women in the Services (DACOWITS)

    Science.gov (United States)

    2011-06-06

    ... give the Committee a briefing on the results of their Workplace and Gender Relations survey... restrict the service of female members and the plans for a new Working Group on women's issues. The meeting... FY11 NDAA. --Receive briefing from Defense Manpower Data Center on survey results on 2010 workplace and...

  12. A missed primary care appointment correlates with a subsequent emergency department visit among children with asthma.

    Science.gov (United States)

    McGovern, Colleen Marie; Redmond, Margaret; Arcoleo, Kimberly; Stukus, David R

    2017-11-01

    Since the Affordable Care Act's implementation, emergency department (ED) visits have increased. Poor asthma control increases the risk of acute exacerbations and preventable ED visits. The Centers for Medicare and Medicaid Services support the reduction of preventable ED visits to reduce healthcare spending. Implementation of interventions to avoid preventable ED visits has become a priority for many healthcare systems yet little data exist examining children's missed asthma management primary care (PC) appointments and subsequent ED visits. Longitudinal, retrospective review at a children's hospital was conducted for children with diagnosed asthma (ICD-9 493.xx), ages 2-18 years, scheduled for a PC visit between January 1, 2010, and June 30, 2012 (N = 3895). Records were cross-referenced with all asthma-related ED visits from January 1, 2010 to December 31, 2012. Logistic regression with maximum likelihood estimation was conducted. None of the children who completed a PC appointment experienced an ED visit in the subsequent 6 months whereas 2.7% of those with missed PC appointments had an ED visit (χ 2 = 64.28, p asthma as one mechanism for preventing ED visits was demonstrated. Interventions targeting missed visits could decrease asthma-related morbidity, preventable ED visits, and healthcare costs.

  13. Application of ESE Data and Tools to Air Quality Management: Services for Helping the Air Quality Community use ESE Data (SHAirED)

    Science.gov (United States)

    Falke, Stefan; Husar, Rudolf

    2011-01-01

    The goal of this REASoN applications and technology project is to deliver and use Earth Science Enterprise (ESE) data and tools in support of air quality management. Its scope falls within the domain of air quality management and aims to develop a federated air quality information sharing network that includes data from NASA, EPA, US States and others. Project goals were achieved through a access of satellite and ground observation data, web services information technology, interoperability standards, and air quality community collaboration. In contributing to a network of NASA ESE data in support of particulate air quality management, the project will develop access to distributed data, build Web infrastructure, and create tools for data processing and analysis. The key technologies used in the project include emerging web services for developing self describing and modular data access and processing tools, and service oriented architecture for chaining web services together to assemble customized air quality management applications. The technology and tools required for this project were developed within DataFed.net, a shared infrastructure that supports collaborative atmospheric data sharing and processing web services. Much of the collaboration was facilitated through community interactions through the Federation of Earth Science Information Partners (ESIP) Air Quality Workgroup. The main activities during the project that successfully advanced DataFed, enabled air quality applications and established community-oriented infrastructures were: develop access to distributed data (surface and satellite), build Web infrastructure to support data access, processing and analysis create tools for data processing and analysis foster air quality community collaboration and interoperability.

  14. Ectodermal dysplasia (ED) syndrome.

    Science.gov (United States)

    Chee, Siew-Yin; Wanga, Chung-Hsing; Lina, Wei-De; Tsaia, Fuu-Jen

    2014-01-01

    Ectodermal dysplasia (ED) syndrome comprises a large, heterogeneous group of inherited disorders that are defined by primary defects in the development of 2 or more tissues derived from the embryonic ectoderm. The tissues primarily involved are the skin and its appendages (including hair follicles, eccrine glands, sebaceous glands, nails) and teeth. The clinical features include sparse hair, abnormal or missing teeth, and an inability to sweat due to lack of sweat glands. One such case report of ectodermal dysplasia is presented here.

  15. Competitive Wrestling-related Injuries in School Aged Athletes in U.S. Emergency Departments

    OpenAIRE

    Myers, Richard J.; Linakis, Seth W.; Mello, Michael J.; Linakis, James G.

    2010-01-01

    Objective: To describe the characteristics of wrestling injuries occurring in male athletes aged 7-17 treated in United States (U.S.) emergency departments (ED) from 2000-2006, and to compare injury patterns between younger & older youth wrestlers. Methods: A stratified probability sample of U.S. hospitals providing emergency services in the National Electronic Injury Surveillance System was used for 2000-2006. ED visits for injuries sustained in organized wrestling were analyzed for...

  16. VARIOUS SPEECH SEQUENCES OF ENGLISH DEPARTMENT STUDENTS IN DOING REQUEST VIA SHORT MESSAGE SERVICE

    Directory of Open Access Journals (Sweden)

    Ike Revita

    2015-09-01

    Full Text Available Interaction, if not wisely considered, may be very risky. The unwise utterances may lead to misunderstanding. When this happens, pragmatic failure is of great possibility occur. This writing is aimed at describing the some variations of speech seqeunces in doing request and the reasons of using each variation. The data are the request uttered by English Department students Andalas University to their friends, their lecturer and vice versa at the campus. Data are collected by observational method, interviewing and note-taking technique. To analyze the data, pragmatic and referential identity method is used. The result of analysis is naratively and descriptively presented. Having been related to the concept of speech act of request (Revita, 2008 and context (Yule, 1986, it is found that there are four variations of speech sequence when English Department students do request. They are (a (1 1 in 1; (b 2 in 1; (c 3 in 1; and (d multi acts in 1. The choice of these variations is basically based on several reasons, namely (i social; (iipsychological; (iii cultural ; and (iv religious aspect.

  17. Identification of Emergency Department Visits in Medicare Administrative Claims: Approaches and Implications.

    Science.gov (United States)

    Venkatesh, Arjun K; Mei, Hao; Kocher, Keith E; Granovsky, Michael; Obermeyer, Ziad; Spatz, Erica S; Rothenberg, Craig; Krumholz, Harlan M; Lin, Zhenqui

    2017-04-01

    Administrative claims data sets are often used for emergency care research and policy investigations of healthcare resource utilization, acute care practices, and evaluation of quality improvement interventions. Despite the high profile of emergency department (ED) visits in analyses using administrative claims, little work has evaluated the degree to which existing definitions based on claims data accurately captures conventionally defined hospital-based ED services. We sought to construct an operational definition for ED visitation using a comprehensive Medicare data set and to compare this definition to existing operational definitions used by researchers and policymakers. We examined four operational definitions of an ED visit commonly used by researchers and policymakers using a 20% sample of the 2012 Medicare Chronic Condition Warehouse (CCW) data set. The CCW data set included all Part A (hospital) and Part B (hospital outpatient, physician) claims for a nationally representative sample of continuously enrolled Medicare fee-for-services beneficiaries. Three definitions were based on published research or existing quality metrics including: 1) provider claims-based definition, 2) facility claims-based definition, and 3) CMS Research Data Assistance Center (ResDAC) definition. In addition, we developed a fourth operational definition (Yale definition) that sought to incorporate additional coding rules for identifying ED visits. We report levels of agreement and disagreement among the four definitions. Of 10,717,786 beneficiaries included in the sample data set, 22% had evidence of ED use during the study year under any of the ED visit definitions. The definition using provider claims identified a total of 4,199,148 ED visits, the facility definition 4,795,057 visits, the ResDAC definition 5,278,980 ED visits, and the Yale definition 5,192,235 ED visits. The Yale definition identified a statistically different (p < 0.05) collection of ED visits than all other

  18. Using the Integration of Discrete Event and Agent-Based Simulation to Enhance Outpatient Service Quality in an Orthopedic Department

    Directory of Open Access Journals (Sweden)

    Cholada Kittipittayakorn

    2016-01-01

    Full Text Available Many hospitals are currently paying more attention to patient satisfaction since it is an important service quality index. Many Asian countries’ healthcare systems have a mixed-type registration, accepting both walk-in patients and scheduled patients. This complex registration system causes a long patient waiting time in outpatient clinics. Different approaches have been proposed to reduce the waiting time. This study uses the integration of discrete event simulation (DES and agent-based simulation (ABS to improve patient waiting time and is the first attempt to apply this approach to solve this key problem faced by orthopedic departments. From the data collected, patient behaviors are modeled and incorporated into a massive agent-based simulation. The proposed approach is an aid for analyzing and modifying orthopedic department processes, allows us to consider far more details, and provides more reliable results. After applying the proposed approach, the total waiting time of the orthopedic department fell from 1246.39 minutes to 847.21 minutes. Thus, using the correct simulation model significantly reduces patient waiting time in an orthopedic department.

  19. Using the Integration of Discrete Event and Agent-Based Simulation to Enhance Outpatient Service Quality in an Orthopedic Department.

    Science.gov (United States)

    Kittipittayakorn, Cholada; Ying, Kuo-Ching

    2016-01-01

    Many hospitals are currently paying more attention to patient satisfaction since it is an important service quality index. Many Asian countries' healthcare systems have a mixed-type registration, accepting both walk-in patients and scheduled patients. This complex registration system causes a long patient waiting time in outpatient clinics. Different approaches have been proposed to reduce the waiting time. This study uses the integration of discrete event simulation (DES) and agent-based simulation (ABS) to improve patient waiting time and is the first attempt to apply this approach to solve this key problem faced by orthopedic departments. From the data collected, patient behaviors are modeled and incorporated into a massive agent-based simulation. The proposed approach is an aid for analyzing and modifying orthopedic department processes, allows us to consider far more details, and provides more reliable results. After applying the proposed approach, the total waiting time of the orthopedic department fell from 1246.39 minutes to 847.21 minutes. Thus, using the correct simulation model significantly reduces patient waiting time in an orthopedic department.

  20. AVTA Federal Fleet PEV Readiness Data Logging and Characterization Study for Department of Health and Human Services – ASPR

    Energy Technology Data Exchange (ETDEWEB)

    Schey, Steve [Idaho National Lab. (INL), Idaho Falls, ID (United States); Francfort, Jim [Idaho National Lab. (INL), Idaho Falls, ID (United States)

    2015-06-01

    This report focuses on the Department of Health and Human Services, Assistant Secretary for Preparedness and Response fleet to identify daily operational characteristics of select vehicles and report findings on vehicle and mission characterizations to support the successful introduction of PEVs into the agency’s fleet. Individual observations of these selected vehicles provide the basis for recommendations related to electric vehicle adoption and whether a battery electric vehicle or plug-in hybrid electric vehicle (collectively referred to as PEVs) can fulfill the mission requirements.

  1. Is the case-mix of patients who self-present to ED similar to general practice and other acute-care facilities?

    Science.gov (United States)

    Harris, Tim; McDonald, Keith

    2014-12-01

    To benchmark walk-in presentations to emergency departments (ED) with those presenting to other local acute healthcare facilities. A large teaching hospital with an annual ED census of 140, 000 adult patients and surrounding associated acute healthcare providers. A random sample of 384 patients who self-presented to the ED was obtained. Benchmarking data were drawn from two general practices; the Tower Hamlets Community Services walk-in centre (co-located on-site with the ED) and the GP-run out-of-hours service. The case-mix presenting to the ED was characterised by a higher proportion of injuries and chest pain, but fewer simple infections and non-traumatic musculoskeletal conditions as compared to other acute care facilities in our region. Patients with injuries and possible cardiac chest pain were more likely to attend the ED, and those with infection or musculoskeletal problems less likely, as compared with other acute healthcare facilities. The population presenting to the ED is distinct from that presenting to general practice, out-of-hours clinics, or walk-in centres. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  2. Relationships between Personal Traits, Emotional Intelligence, Internal Marketing, Service Management, and Customer Orientation in Korean Outpatient Department Nurses.

    Science.gov (United States)

    Kim, Bogyun; Lee, Jia

    2016-03-01

    Current increase and complexity of medical tests and surgical procedures at outpatient department (OPD) require OPD nurses to have customer orientation focusing on various customers' interests and needs. The purpose of this study was to identify the factors associated with customer orientation in nurses working at OPD of hospitals. The study used a descriptive correlational design with cross-sectional survey. The study settings were four general hospitals in Seoul and its metropolitan area. Data were collected from 138 OPD nurses from general hospitals. Study variables were personal traits, emotional intelligence, internal marketing, service management and customer orientation. Factors associated with customer orientation were identified as conscientiousness from personal traits (β = .37, p marketing from environmental characteristics (β = .21, p = .001). Hospital administrators should support OPD nurses to cultivate sincere and sociable personal traits and emotional intelligence, and to consider employees as internal customers to improve patient-oriented services and satisfaction. Copyright © 2015. Published by Elsevier B.V.

  3. Influences on emergency department length of stay for older people.

    Science.gov (United States)

    Street, Maryann; Mohebbi, Mohammadreza; Berry, Debra; Cross, Anthony; Considine, Julie

    2018-02-14

    The aim of this study was to examine the influences on emergency department (ED) length of stay (LOS) for older people and develop a predictive model for an ED LOS more than 4 h. This retrospective cohort study used organizational data linkage at the patient level from a major Australian health service. The study population was aged 65 years or older, attending an ED during the 2013/2014 financial year. We developed and internally validated a clinical prediction rule. Discriminatory performance of the model was evaluated by receiver operating characteristic (ROC) curve analysis. An integer-based risk score was developed using multivariate logistic regression. The risk score was evaluated using ROC analysis. There were 33 926 ED attendances: 57.5% (n=19 517) had an ED LOS more than 4 h. The area under ROC for age, usual accommodation, triage category, arrival by ambulance, arrival overnight, imaging, laboratory investigations, overcrowding, time to be seen by doctor, ED visits with admission and access block relating to ED LOS more than 4 h was 0.796, indicating good performance. In the validation set, area under ROC was 0.80, P-value was 0.36 and prediction mean square error was 0.18, indicating good calibration. The risk score value attributed to each risk factor ranged from 2 to 68 points. The clinical prediction rule stratified patients into five levels of risk on the basis of the total risk score. Objective identification of older people at intermediate and high risk of an ED LOS more than 4 h early in ED care enables targeted approaches to streamline the patient journey, decrease ED LOS and optimize emergency care for older people.

  4. Reengineering of the business process in the Serbian post's department for express parcel service

    Directory of Open Access Journals (Sweden)

    Lazarević Dragan M.

    2015-01-01

    Full Text Available In this paper the model that solves the problem of exceeding time limit in the system of express parcel shipping in the Post of Serbia is described. The existing principle of the organization of the area serving is explained, as well as the problem of exceeding time limit that appears and leads to the delay of the service to the user. Two approaches for problem solving are suggested. The reengineering of the existing business processes is carried out to some extent through these two approaches, and will be presented by BPMN notation. The first approach is based on the use of the fuzzy set theory, i.e. fuzzy logical systems, while the other one is based on the use of algorithm 'zoning-routing'.

  5. HOspitals and patients WoRking in Unity (HOW R U?): protocol for a prospective feasibility study of telephone peer support to improve older patients' quality of life after emergency department discharge

    OpenAIRE

    Lowthian, Judy A; Lennox, Alyse; Curtis, Andrea; Dale, Jeremy; Browning, Colette; Smit, De Villiers; Wilson, Gillian; O'Brien, Debra; Rosewarne, Cate; Boyd, Lee; Garner, Cath; Cameron, Peter

    2016-01-01

    Introduction Older people presenting to an emergency department (ED) have a higher likelihood of social isolation, loneliness and depression; which are all associated with negative health outcomes and increased health service use, including higher rates of ED attendance. The HOW R U? study aims to ascertain the feasibility and acceptability of a postdischarge telephone support programme for older ED patients following discharge. The intervention, which aims to improve quality of life, will be...

  6. How do patients with chest pain access Emergency Department care?

    Science.gov (United States)

    Van Severen, Evie; Willemsen, Robert; Vandervoort, Pieter; Sabbe, Marc; Dinant, Geert-Jan; Buntinx, Frank

    2017-12-01

    It is important that patients with symptoms of acute coronary syndrome receive appropriate medical care as soon as possible. Little is known about the preadmission actions that patients with chest pain take before arrival at the Emergency Department (ED). This study aimed to describe the actions of patients with chest pain or pressure after onset of symptoms. What is the first action following onset of symptoms? Who is the first lay or professional person to be contacted? Which steps are taken first? How is the patient transported to the hospital? Consecutive patients, arriving at the ED of two large hospitals in Belgium, were asked additional questions during the initial assessment. Overall, 35% of 412 consecutive patients with chest pain admitted to the ED were diagnosed with acute coronary syndrome. A total of 57% contacted a GP between symptom onset and arrival at the ED. Only 32% of the patients were transported to the ED by ambulance, 16% drove themselves and 52% arrived by other means of transport (by family, neighbour, GP, public transport). In Belgium, the GP is still the first professional to be contacted for most patients. Other patients initially rely on their partner, family or friends when symptoms emerge. Too often, patients with chest pain rely on other transport to get to the ED instead of calling the Emergency Medical Services. This study included only patients who ultimately attended the ED.

  7. Radiographer emergency department hot reporting: An assessment of service quality and feasibility

    Energy Technology Data Exchange (ETDEWEB)

    Hardy, Maryann [Division of Radiography, School of Health Studies, University of Bradford, Trinity Road, Bradford, West Yorkshire BD5 0BB (United Kingdom)], E-mail: m.l.hardy1@bradford.ac.uk; Spencer, Nicholas; Snaith, Beverly [Mid Yorkshire Hospitals NHS Trust, Radiology Department, Pinderfields General Hospital, Aberford Road, Wakefield WF1 4DG (United Kingdom)

    2008-11-15

    Purpose: Radiographer reporting has been implemented widely as cold reporting. This study aimed to compare hot and cold reports by the same radiographer to establish whether there was any significant difference in the diagnostic outcome. Method: Three experienced radiographers reported 1618 musculoskeletal trauma cases over a 3 month period. These cases were stratified for age (0-17 years; 18-50 years; 51 years+) and a random sample of 400 cases selected (95% confidence interval, 90% power) for delayed reporting. Both reports were independently compared by 2 experienced film readers. Results: Radiographs and notes on 391 (97.8%; n = 391/400) cases were located (age range 3 months to 97 years) for cold reporting. The diagnostic outcome of the reports was concordant in 357 cases (91.3%; n = 357/391) and discrepant in 34 cases (8.7%; n = 34/391). Logistic regression performed on age stratified discrepancies indicated that paediatric cases had increased odds of receiving discrepant reports (OR = 3.34; p = 0.005; 95% CI [1.44-7.74]). Hot and cold report agreement was high ({kappa} = 0.87). McNemar's test demonstrated no significant difference in the report discrepancies (p = 0.189). Conclusion: No significant difference was demonstrated between the diagnostic outcome of radiographer hot reports, issued whilst working within the trauma radiography department at time of patient attendance, and cold reports.

  8. Radiographer emergency department hot reporting: An assessment of service quality and feasibility

    International Nuclear Information System (INIS)

    Hardy, Maryann; Spencer, Nicholas; Snaith, Beverly

    2008-01-01

    Purpose: Radiographer reporting has been implemented widely as cold reporting. This study aimed to compare hot and cold reports by the same radiographer to establish whether there was any significant difference in the diagnostic outcome. Method: Three experienced radiographers reported 1618 musculoskeletal trauma cases over a 3 month period. These cases were stratified for age (0-17 years; 18-50 years; 51 years+) and a random sample of 400 cases selected (95% confidence interval, 90% power) for delayed reporting. Both reports were independently compared by 2 experienced film readers. Results: Radiographs and notes on 391 (97.8%; n = 391/400) cases were located (age range 3 months to 97 years) for cold reporting. The diagnostic outcome of the reports was concordant in 357 cases (91.3%; n = 357/391) and discrepant in 34 cases (8.7%; n = 34/391). Logistic regression performed on age stratified discrepancies indicated that paediatric cases had increased odds of receiving discrepant reports (OR = 3.34; p = 0.005; 95% CI [1.44-7.74]). Hot and cold report agreement was high (κ = 0.87). McNemar's test demonstrated no significant difference in the report discrepancies (p = 0.189). Conclusion: No significant difference was demonstrated between the diagnostic outcome of radiographer hot reports, issued whilst working within the trauma radiography department at time of patient attendance, and cold reports

  9. Activity-based costing of security services for a Department of Energy nuclear site

    International Nuclear Information System (INIS)

    Togo, D.F.

    1997-01-01

    Department of Energy (DOE) nuclear facilities are being encouraged to reduce costs but the accounting data typically in use by the financial organizations at these laboratories cannot easily be used to determine which security activities offer the best reduction in cost. For example, labor costs have historically been aggregated over various activities, making it difficult to determine the true costs of performing each activity. To illustrate how this problem can be solved, a study was performed applying activity-based costing (ABC) to a hypothetical DOE facility. ABC is a type of cost-accounting developed expressly to determine truer costs of company activities. The hypothetical facility was defined to have features similar to those found across the DOE nuclear complex. ABC traced costs for three major security functions - Protective Force Operations, Material Control and Accountability, and Technical Security - to various activities. Once these costs had been allocated, we compared the cost of three fictitious upgrades: (1) an improvement in training or weapons that allows the protective force to have better capabilities instead of adding more response forces; (2) a change in the frequency of inventories; and (3) a reduction in the annual frequencies of perimeter sensor tests

  10. Geospatial field applications within United States Department of Agriculture, Veterinary Services.

    Science.gov (United States)

    FitzMaurice, Priscilla L; Freier, Jerome E; Geter, Kenneth D

    2007-01-01

    Epidemiologists, veterinary medical officers and animal health technicians within Veterinary Services (VS) are actively utilising global positioning system (GPS) technology to obtain positional data on livestock and poultry operations throughout the United States. Geospatial data, if acquired for monitoring and surveillance purposes, are stored within the VS Generic Database (GDB). If the information is collected in response to an animal disease outbreak, the data are entered into the Emergency Management Response System (EMRS). The Spatial Epidemiology group within the Centers for Epidemiology and Animal Health (CEAH) has established minimum data accuracy standards for geodata acquisition. To ensure that field-collected geographic coordinates meet these minimum standards, field personnel are trained in proper data collection procedures. Positional accuracy is validated with digital atlases, aerial photographs, Web-based parcel maps, or address geocoding. Several geospatial methods and technologies are under investigation for future use within VS. These include the direct transfer of coordinates from GPS receivers to computers, GPS-enabled digital cameras, tablet PCs, and GPS receivers preloaded with custom ArcGIS maps - all with the objective of reducing transcription and data entry errors and improving the ease of data collection in the field.

  11. Financial impact of emergency department ultrasound.

    Science.gov (United States)

    Soremekun, Olanrewaju A; Noble, Vicki E; Liteplo, Andrew S; Brown, David F M; Zane, Richard D

    2009-07-01

    There is limited information on the financial implications of an emergency department ultrasound (ED US) program. The authors sought to perform a fiscal analysis of an integrated ED US program. A retrospective review of billing data was performed for fiscal year (FY) 2007 for an urban academic ED with an ED US program. The ED had an annual census of 80,000 visits and 1,101 ED trauma activations. The ED is a core teaching site for a 4-year emergency medicine (EM) residency, has 35 faculty members, and has 24-hour availability of all radiology services including formal US. ED US is utilized as part of evaluation of all trauma activations and for ED procedures. As actual billing charges and reimbursement rates are institution-specific and proprietary information, relative value units (RVUs) and reimbursement based on the Centers for Medicare & Medicaid Services (CMS) 2007 fee schedule (adjusted for fixed diagnosis-related group [DRG] payments and bad debt) was used to determine revenue generated from ED US. To estimate potential volume, assumptions were made on improvement in documentation rate for diagnostic scans (current documentation rates based on billed volume versus diagnostic studies in diagnostic image database), with no improvements assumed for procedural ED US. Expenses consist of three components-capital costs, training costs, and ongoing operational costs-and were determined by institutional experience. Training costs were considered sunken expenses by this institution and were thus not included in the original return on investment (ROI) calculation, although for this article a second ROI calculation was done with training cost estimates included. For the purposes of analysis, certain key assumptions were made. We utilized a collection rate of 45% and hospitalization rates (used to adjust for fixed DRG payments) of 33% for all diagnostic scans, 100% for vascular access, and 10% for needle placement. An optimal documentation rate of 95% was used to

  12. Department of Energy report on fee for spent nuclear fuel storage and disposal services

    International Nuclear Information System (INIS)

    1980-10-01

    Since the July 1978 publication of an estimated fee for storage and disposal, several changes have occurred in the parameters which impact the spent fuel fee. DOE has mounted a diversified program of geologic investigations that will include locating and characterizing a number of potential repository sites in a variety of different geologic environments with diverse rock types. As a result, the earliest operation date of a geologic repository is now forecast for 1997. Finally, expanded spent fuel storage capabilities at reactors have reduced the projected quantities of fuel to be stored and disposed of. The current estimates for storage and disposal are presented. This fee has been developed from DOE program information on spent fuel storage requirements, facility availability, facility cost estimates, and research and development programs. The discounted cash flow technique has used the most recent estimates of cost of borrowing by the Federal Government. This estimate has also been used in calculating the Federal charge for uranium enrichment services. A prepayment of a percentage of the storage portion of the fee is assumed to be required 5 years before spent fuel delivery. These funds and the anticipated $300 million in US Treasury borrowing authority should be sufficient to finance the acquisition of storage facilities. Similarly, a prepayment of a percentage of the disposal portion would be collected at the same time and would be used to offset disposal research and development expenditures. The balance of the storage and disposal fees will be collected upon spent fuel delivery. If disposal costs are different from what was estimated, there will be a final adjustment of the disposal portion of the fee when the spent fuel is shipped from the AFR for permanent disposal. Based on current spent fuel storage requirements, at least a 30 percent prepayment of the fee will be required

  13. Important historical efforts at emergency department categorization in the United States and implications for regionalization.

    Science.gov (United States)

    Mehrotra, Abhishek; Sklar, David P; Tayal, Vivek S; Kocher, Keith E; Handel, Daniel A; Myles Riner, R

    2010-12-01

    This article is drawn from a report created for the American College of Emergency Physicians (ACEP) Emergency Department (ED) Categorization Task Force and also reflects the proceedings of a breakout session, "Beyond ED Categorization-Matching Networks to Patient Needs," at the 2010 Academic Emergency Medicine consensus conference, "Beyond Regionalization: Integrated Networks of Emergency Care." The authors describe a brief history of the significant national and state efforts at categorization and suggest reasons why many of these efforts failed to persevere or gain wider implementation. The history of efforts to categorize hospital (and ED) emergency services demonstrates recognition of the potential benefits of categorization, but reflects repeated failures to implement full categorization systems or limited excursions into categorization through licensing of EDs or designation of receiving and referral facilities. An understanding of the history of hospital and ED categorization could better inform current efforts to develop categorization schemes and processes. 2010 by the Society for Academic Emergency Medicine.

  14. Overcrowding in emergency departments: A review of strategies to decrease future challenges.

    Science.gov (United States)

    Yarmohammadian, Mohammad H; Rezaei, Fatemeh; Haghshenas, Abbas; Tavakoli, Nahid

    2017-01-01

    Emergency departments (EDs) are the most challenging ward with respect to patient delay. The goal of this study is to present strategies that have proven to reduce delay and overcrowding in EDs. In this review article, initial electronic database search resulted in a total of 1006 articles. Thirty articles were included after reviewing full texts. Inclusion criteria were assessments of real patient flows and implementing strategies inside the hospitals. In this study, we discussed strategies of team triage, point-of-care testing, ideal ED patient journey models, streaming, and fast track. Patients might be directed to different streaming channels depending on clinical status and required practitioners. The most comprehensive strategy is ideal ED patient journey models, in which ten interrelated substrategies are provided. ED leaders should apply strategies that provide a continuous care process without deeply depending on external services.

  15. [Reasons for attending emergency departments. People speak out].

    Science.gov (United States)

    Pasarín, M Isabel; Fernández de Sanmamed, M José; Calafell, Joana; Borrell, Carme; Rodríguez, Dolors; Campasol, Salvador; Torné, Elvira; Torras, M Glòria; Guarga, Alex; Plasència, Antoni

    2006-01-01

    To ascertain why people attend hospital emergency departments (ED) for low complexity health problems. A phenomenological, interactionist, qualitative study was performed. A theoretical sample that selected one urban and one rural area from Catalonia (Spain) was designed. In each setting, persons (n = 36) who had used the ED or a primary care emergency service 1 month before the beginning of the study were chosen. Data were obtained through 8 focus groups. An interpretative content analysis was performed, and emergent categories were constructed through research triangulation. Five categories emerged: symptoms, whether or not self-diagnosis was involved, perception of needs, awareness of the health services available, and the overall context of the person. Symptoms generated feelings of failing health and thus initiated care seeking. Self-diagnosis determined perceived need and the type of care sought. People contrasted their self-perception of need with their own opinion about the health services available. The decision to go to one or other service was made as a result of this contrast, but the individual's family, work, and social situations also played a part. Informants were more familiar with the service provided by the ED than with that provided by primary care. Time consumption also figured heavily in decision making. The presence or absence of self-diagnosis is a determining factor in attendance at EDs. Other factors that influence demand are the level of awareness of the health services available, previous experiences, and the life situation of the individual.

  16. Patients' experience of care and treatment outcome at the Department of Clinical Oral Physiology, Dental Public Service in Stockholm.

    Science.gov (United States)

    Christidis, Nikolaos; Smedberg, Erica; Hägglund, Helene; Hedenberg-Magnusson, Britt

    2010-01-01

    Chronic pain conditions in the craniofacial region are common in the adult population with a prevalence of approximately 10%. They are included in the generic term temporomandibular disorders (TMD) and accompanied by restricted mouth opening capacity, chewing difficulties, headache and neck pain. These pain conditions cause psychological suffering, impaired social relations, and recurrent sick leave, subsequently leading to frequent use of health care, medication and consequently to a decreased quality of life. Approximately 25% of children have signs of TMD and girls are shown to be more affected than boys. These signs increase with age and in the adult population the prevalence is approximately 38-40%, also here with a higher frequency in women than in men. This study comprised 198 patients who answered an anonymous questionnaire after termination of their treatment. The study aimed to investigate the activity at the department of clinical oral physiology at the Folktandvården Eastman Institute in Stockholm, Sweden, regarding the patients and their cause of care-seeking, as well as the patients' subjective experiences of the specialist care and the treatment outcome. As a secondary aim the purpose was to investigate how/if the clinicians at the department of clinical oral physiology reached their intention of being "curious", "considerate" and "accessible". The results from this study show that the majority of the patients (57.1%) were referred from the dental public service in Stockholm. 71.7% of the patients were young women between the ages of 11 and 20. The main causes of care-seeking were temporomandibular joint clickings, followed by limited jaw movement, headache and orofacial pain. Further, an immense majority of the patients (89.9%) were very satisfied with their treatment as well as the treatment outcome. These results indicate that the clinicians at the department reached their intention of being "curious", "considerate"and "accessible", which also

  17. National and Regional Representativeness of Hospital Emergency Department Visit Data in the National Syndromic Surveillance Program, United States, 2014

    Science.gov (United States)

    Coates, Ralph J.; Pérez, Alejandro; Baer, Atar; Zhou, Hong; English, Roseanne; Coletta, Michael; Dey, Achintya

    2016-01-01

    Objective We examined the representativeness of the nonfederal hospital emergency department (ED) visit data in the National Syndromic Surveillance Program (NSSP). Methods We used the 2012 American Hospital Association Annual Survey Database, other databases, and information from state and local health departments participating in the NSSP about which hospitals submitted data to the NSSP in October 2014. We compared ED visits for hospitals submitting 15 data with all ED visits in all 50 states and Washington, DC. Results Approximately 60.4 million of 134.6 million ED visits nationwide (~45%) were reported to have been submitted to the NSSP. ED visits in 5 of 10 regions and the majority of the states were substantially underrepresented in the NSSP. The NSSP ED visits were similar to national ED visits in terms of many of the characteristics of hospitals and their service areas. However, visits in hospitals with the fewest annual ED visits, in rural trauma centers, and in hospitals serving populations with high percentages of Hispanics and Asians were underrepresented. Conclusions NSSP nonfederal hospital ED visit data were representative for many hospital characteristics and in some geographic areas but were not very representative nationally and in many locations. Representativeness could be improved by increasing participation in more states and among specific types of hospitals. PMID:26883318

  18. CriticalEd

    DEFF Research Database (Denmark)

    Kjellberg, Caspar Mølholt; Meredith, David

    2014-01-01

    . Since the comments are not input sequentially, with regard to position, but in arbitrary order, this list must be sorted by copy/pasting the rows into place—an error-prone and time-consuming process. Scholars who produce critical editions typically use off-the-shelf music notation software......The best text method is commonly applied among music scholars engaged in producing critical editions. In this method, a comment list is compiled, consisting of variant readings and editorial emendations. This list is maintained by inserting the comments into a document as the changes are made......, consisting of a Sibelius plug-in, a cross-platform application, called CriticalEd, and a REST-based solution, which handles data storage/retrieval. A prototype has been tested at the Danish Centre for Music Publication, and the results suggest that the system could greatly improve the efficiency...

  19. The emergency department "carousel": an ethnographically-derived model of the dynamics of patient flow.

    Science.gov (United States)

    Nugus, Peter; Forero, Roberto; McCarthy, Sally; McDonnell, Geoff; Travaglia, Joanne; Hilman, Ken; Braithwaite, Jeffrey

    2014-01-01

    Emergency department (ED) overcrowding reduces efficiency and increases the risk of medical error leading to adverse events. Technical solutions and models have done little to redress this. A full year's worth of ethnographic observations of patient flow were undertaken, which involved making hand-written field-notes of the communication and activities of emergency clinicians (doctors and nurses), in two EDs in Sydney, Australia. Observations were complemented by semi-structured interviews. We applied thematic analysis to account for the verbal communication and activity of emergency clinicians in moving patients through the ED. The theoretical model that emerged from the data analysis is the ED "carousel". Emergency clinicians co-construct a moving carousel which we conceptualise visually, and which accounts for the collective agency of ED staff, identified in the findings. The carousel model uniquely integrates diagnosis, treatment and transfer of individual patients with the intellectual labour of leading and coordinating the department. The latter involves managing staff skill mix and the allocation of patients to particular ED sub-departments. The model extends traditional patient flow representations and underlines the importance of valuing ethnographic methods in health services research, in order to foster organisational learning, and generate creative practical and policy alternatives that may, for example, reduce or ameliorate access block and ED overcrowding. Copyright © 2013 Elsevier Ltd. All rights reserved.

  20. Principles of Emergency Department facility design for optimal management of mass-casualty incidents.

    Science.gov (United States)

    Halpern, Pinchas; Goldberg, Scott A; Keng, Jimmy G; Koenig, Kristi L

    2012-04-01

    The Emergency Department (ED) is the triage, stabilization and disposition unit of the hospital during a mass-casualty incident (MCI). With most EDs already functioning at or over capacity, efficient management of an MCI requires optimization of all ED components. While the operational aspects of MCI management have been well described, the architectural/structural principles have not. Further, there are limited reports of the testing of ED design components in actual MCI events. The objective of this study is to outline the important infrastructural design components for optimization of ED response to an MCI, as developed, implemented, and repeatedly tested in one urban medical center. In the authors' experience, the most important aspects of ED design for MCI have included external infrastructure and promoting rapid lockdown of the facility for security purposes; an ambulance bay permitting efficient vehicle flow and casualty discharge; strategic placement of the triage location; patient tracking techniques; planning adequate surge capacity for both patients and staff; sufficient command, control, communications, computers, and information; well-positioned and functional decontamination facilities; adequate, well-located and easily distributed medical supplies; and appropriately built and functioning essential services. Designing the ED to cope well with a large casualty surge during a disaster is not easy, and it may not be feasible for all EDs to implement all the necessary components. However, many of the components of an appropriate infrastructural design add minimal cost to the normal expenditures of building an ED. This study highlights the role of design and infrastructure in MCI preparedness in order to assist planners in improving their ED capabilities. Structural optimization calls for a paradigm shift in the concept of structural and operational ED design, but may be necessary in order to maximize surge capacity, department resilience, and patient and

  1. Simulation modelling of a patient surge in an emergency department under disaster conditions

    Directory of Open Access Journals (Sweden)

    Muhammet Gul

    2015-10-01

    Full Text Available The efficiency of emergency departments (EDs in handling patient surges during disaster times using the available resources is very important. Many EDs require additional resources to overcome the bottlenecks in emergency systems. The assumption is that EDs consider the option of temporary staff dispatching, among other options, in order to respond to an increased demand or even the hiring temporarily non-hospital medical staff. Discrete event simulation (DES, a well-known simulation method and based on the idea of process modeling, is used for establishing ED operations and management related models. In this study, a DES model is developed to investigate and analyze an ED under normal conditions and an ED in a disaster scenario which takes into consideration an increased influx of disaster victims-patients. This will allow early preparedness of emergency departments in terms of physical and human resources. The studied ED is located in an earthquake zone in Istanbul. The report on Istanbul’s disaster preparedness presented by the Japan International Cooperation Agency (JICA and Istanbul Metropolitan Municipality (IMM, asserts that the district where the ED is located is estimated to have the highest injury rate. Based on real case study information, the study aims to suggest a model on pre-planning of ED resources for disasters. The results indicate that in times of a possible disaster, when the percentage of red patient arrivals exceeds 20% of total patient arrivals, the number of red area nurses and the available space for red area patients will be insufficient for the department to operate effectively. A methodological improvement presented a different distribution function that was tested for service time of the treatment areas. The conclusion is that the Weibull distribution function used in service process of injection room fits the model better than the Gamma distribution function.

  2. The effects of workforce-shaping tools on retirement: the case of the Department of Defense civil service.

    Science.gov (United States)

    Asch, Beth J; Haider, Steven J; Zissimopoulos, Julie M

    2009-11-01

    Apriority area for the public health workforce research agenda is the study of the public health labor market and how wages and benefits affect workforce outcomes, including recruiting, retention, and retirement. This study provides an example of such a study for the Department of Defense civil service workforce. We analyze the financial incentives to retire that are specifically embedded in the retirement system and how different workforce-shaping policies would affect these incentives. The study then uses a recently estimated model of the effects of financial incentives on retirement behavior among defense civilians to predict how these workforce-shaping tools would affect retirement behavior. We find that buyouts, retention incentives, and other workforce-shaping tools have a sizable effect on predicted retirement behavior and therefore, could be useful policies to help manage retirement outflows.

  3. Paid sick leave is associated with fewer ED visits among US private sector working adults.

    Science.gov (United States)

    Bhuyan, Soumitra S; Wang, Yang; Bhatt, Jay; Dismuke, S Edward; Carlton, Erik L; Gentry, Dan; LaGrange, Chad; Chang, Cyril F

    2016-05-01

    The United States (US) is the only developed country that does not guarantee short-term or longer-term paid sick leave. This study used a multiyear nationally representative database to examine the association between availability of paid sick leave and frequency of emergency department (ED) use among US private sector employees. We used the National Health Interview Survey data (2012-2014). The final study sample consists of 42,460 US adults between 18 and 64years of age and working in nongovernmental private sector. Our results suggest that availability of paid sick leave is significantly associated with lower likelihood of ED use, for both moderate (1-3 times/year) and repeated users (4 or more times/year). After controlling for confounding factors, respondents with paid sick leave are 14% less likely to be moderate ED users (adjusted odds ratio, 0.86; 95% CI, 0.79-0.93) and 32% less likely to be repeated ED users (adjusted odds ratio, 0.68; 95% CI, 0.50-0.91). Although expansion of health insurance coverage under the Affordable Care Act has not been shown to reduce utilization of high cost health care services such as the ED, our study suggests other factors such as the availability of paid sick leave may do so, by allowing patients to seek care through other more cost-effective mechanisms (eg, primary care providers). To reduce ED utilization, health policymakers should consider alternative reforms including paid sick leave. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Association of emergency department and hospital characteristics with elopements and length of stay.

    Science.gov (United States)

    Handel, Daniel A; Fu, Rongwei; Vu, Eugene; Augustine, James J; Hsia, Renee Y; Shufflebarger, Charles M; Sun, Benjamin

    2014-06-01

    As the Centers for Medicare & Medicaid Services (CMS) core measures in 2013 compare Emergency Department (ED) treatment time intervals, it is important to identify ED and hospital characteristics associated with these metrics to facilitate accurate comparisons. The objective of this study is to assess differences in operational metrics by ED and hospital characteristics. ED-level characteristics included annual ED volume, percentage of patients admitted, percentage of patients presenting by ambulance, and percentage of pediatric patients. Hospital-level characteristics included teaching hospital status, trauma center status, hospital ownership (nonprofit or for-profit), inpatient bed capacity, critical access status, inpatient bed occupancy, and rural vs. urban location area. Data from the ED Benchmarking Alliance from 2004 to 2009 were merged with the American Hospital Association's Annual Survey Database to include hospital characteristics that may impact ED throughput. Overall median length of stay (LOS) and left before treatment is complete (LBTC) were the primary outcome variables, and a linear mixed model was used to assess the association between outcome variables and ED and hospital characteristics, while accounting for correlations among multiple observations within each hospital. All data were at the hospital level on a yearly basis. There were 445 EDs included in the analysis, from 2004 to 2009, with 850 observations over 6 years. Higher-volume EDs were associated with higher rates of LBTC and LOS. For-profit hospitals had lower LBTC and LOS. Higher inpatient bed occupancies were associated with a higher LOS. Increasing admission percentages were positively associated with overall LOS for EDs, but not with rates of LBTC. Higher-volume EDs are associated with higher LBTC and LOS, and for-profit hospitals appear more favorably in these metrics compared with their nonprofit counterparts. It is important to appreciate that hospitals have different baselines

  5. Work conditions, mental workload and patient care quality: a multisource study in the emergency department.

    Science.gov (United States)

    Weigl, Matthias; Müller, Andreas; Holland, Stephan; Wedel, Susanne; Woloshynowych, Maria

    2016-07-01

    Workflow interruptions, multitasking and workload demands are inherent to emergency departments (ED) work systems. Potential effects of ED providers' work on care quality and patient safety have, however, been rarely addressed. We aimed to investigate the prevalence and associations of ED staff's workflow interruptions, multitasking and workload with patient care quality outcomes. We applied a mixed-methods design in a two-step procedure. First, we conducted a time-motion study to observe the rate of interruptions and multitasking activities. Second, during 20-day shifts we assessed ED staff's reports on workflow interruptions, multitasking activities and mental workload. Additionally, we assessed two care quality indicators with standardised questionnaires: first, ED patients' evaluations of perceived care quality; second, patient intrahospital transfers evaluated by ward staff. The study was conducted in a medium-sized community ED (16 600 annual visits). ED personnel's workflow was disrupted on average 5.63 times per hour. 30% of time was spent on multitasking activities. During 20 observations days, data were gathered from 76 ED professionals, 239 patients and 205 patient transfers. After aggregating daywise data and controlling for staffing levels, prospective associations revealed significant negative associations between ED personnel's mental workload and patients' perceived quality of care. Conversely, workflow interruptions were positively associated with patient-related information on discharge and overall quality of transfer. Our investigation indicated that ED staff's capability to cope with demanding work conditions was associated with patient care quality. Our findings contribute to an improved understanding of the complex effects of interruptions and multitasking in the ED environment for creating safe and efficient ED work and care systems. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a

  6. [Proposing a physiological model for Emergency Department. Operating principles, classification of overcrowding and guidelines for redesign].

    Science.gov (United States)

    Herrera Carranza, M; Aguado Correa, F; Padilla Garrido, N; López Camacho, F

    2017-04-30

    The operation of Emergency Departments (ED) is determined by demand, their own organizational structures and the connection to other medical care levels. When these elements are not simultaneous, it hinders patient flow and decreases capacity, making it necessary to employ a systemic approach to the chain of emergency care as a single operational entity. With this theoretical orientation, we suggest a conceptual model similar to the physiological cardiac output, in which the preload is the demand, the contractile or flow pump is the organizational structure, the afterload is the hospital, the pre-ED valve is primary care and outpatient emergencies, and the post-ED valve is the diagnostic support services and the specialist consultants. Based on this theoretical approach we classify the different types of ED overcrowding and systematise its causes and the different waiting lists that it generates, which can help to redesign the service and avoid its saturation.

  7. IT services in a completely digitized radiological department: value and benefit of an in-house departmental IT group

    International Nuclear Information System (INIS)

    Treitl, M.; Wirth, S.; Lucke, A.; Rieger, J.; Pfeifer, K.J.; Reiser, M.; Villain, S.

    2005-01-01

    To analyze the benefit of a departmental IT group in comparison to support by hospital IT groups or system manufacturers in a completely digitized radiological department. The departmental IT group comprises a fulltime IT specialist, two student assistants and four clinical employees participating 1 day/week. For 18 months IT problems were quantified and specified according to urgency, responsibility and affected system by use of an intranet-based reporting system. For each IT service provider the performance and duration of problem solution was evaluated. In 18 months 3,234 IT problems emerged. 88.7% were solved by the departmental IT group. In 474 cases (14.7%) a solution within 2 h was required. The departmental IT group solved 35.8% within 30 min, system manufacturers needed 18 h 38 min in mean. The departmental IT group solved 90.2% of the problems within a time limit. System manufacturers met the limit in 60.1% with a mean duration of 7 days 21 h. In 6.7% of the cases, support by system manufacturers was indispensable. A considerable proportion of IT problems in completely digitized radiological departments can be solved by a departmental IT group, providing a fast and cost-efficient first-level IT support with effective prevention of major breaks in the workflow. In a small number of cases support by system manufacturers remains necessary. (orig.)

  8. Advertising Emergency Department Wait Times

    OpenAIRE

    Weiner, Scott G

    2013-01-01

    Advertising emergency department (ED) wait times has become a common practice in the United States. Proponents of this practice state that it is a powerful marketing strategy that can help steer patients to the ED. Opponents worry about the risk to the public health that arises from a patient with an emergent condition self-triaging to a further hospital, problems with inaccuracy and lack of standard definition of the reported time, and directing lower acuity patients to the higher cost ED se...

  9. COGME 1995 Physician Workforce Funding Recommendations for Department of Health and Human Services' Programs. Council on Graduate Medical Education, 7th Report.

    Science.gov (United States)

    Council on Graduate Medical Education.

    This report presents specific recommendations to the Department of Health and Human Services and Congress from the Council on Graduate Medical Education that address Medicare's direct and indirect graduate medical education (GME) payments and the monies allocated by the Public Health Service that is targeted toward physician education and primary…

  10. Tinnitus and hyperacusis therapy in a UK National Health Service audiology department: Patients’ evaluations of the effectiveness of treatments

    Science.gov (United States)

    Aazh, Hashir; Moore, Brian C. J.; Lammaing, Karen; Cropley, Mark

    2016-01-01

    Abstract Objective: To assess patients’ judgements of the effectiveness of the tinnitus and hyperacusis therapies offered in a specialist UK National Health Service audiology department. Design: Cross-sectional service evaluation questionnaire survey. Patients were asked to rank the effectiveness of the treatment they received on a scale from 1 to 5 (1 = no effect, 5 = very effective). Study sample: The questionnaire was sent to all patients who received treatment between January and March 2014 (n = 200) and 92 questionnaires were returned. Results : The mean score was greatest for counselling (Mean = 4.7, SD = 0.6), followed by education (Mean = 4.5, SD = 0.8), cognitive behavioural therapy - CBT (Mean = 4.4, SD = 0.7), and hearing tests (Mean = 4.4, SD = 0.9). Only 6% of responders rated counselling as 3 or below. In contrast, bedside sound generators, hearing aids, and wideband noise generators were rated as 3 or below by 25%, 36%, and 47% of participants, respectively. Conclusion: The most effective components of the tinnitus and hyperacusis therapy interventions were judged by the patients to be counselling, education, and CBT. PMID:27195947

  11. The Use of Telemental Health to Meet the Mental Health Needs of Women Using Department of Veterans Affairs Services.

    Science.gov (United States)

    Moreau, Jessica L; Cordasco, Kristina M; Young, Alexander S; Oishi, Sabine M; Rose, Danielle E; Canelo, Ismelda; Yano, Elizabeth M; Haskell, Sally G; Hamilton, Alison B

    Women veterans are a growing segment of Department of Veterans Affairs (VA) users with distinct mental health needs and well-documented barriers to care. Telemental health holds much promise for reducing barriers to mental health care. We assessed VA stakeholders' perceptions of telemental health's appropriateness and potential to address the mental health needs of women veteran VA users. We conducted semistructured qualitative interviews with 40 key leadership and clinical stakeholders at VA medical centers and associated outpatient clinics. Transcripts were summarized in a template of key domains developed based on the interview guide, and coded for topics relevant to women's mental health needs and telehealth services. Telemental health was perceived to increase access to mental health care, including same-gender care and access to providers with specialized training, especially for rural women and those with other limiting circumstances. Respondents saw women veterans as being particularly poised to benefit from telemental health, owing to responsibilities associated with childcare, spousal care, and elder caregiving. Interviewees expressed enthusiasm for telemental health's potential and were eager to expand services, including women-only mental health groups. Implementation challenges were also noted. Overall, our stakeholders saw telemental health as a good fit for helping to address the perceived needs of women veterans, especially in addressing the geographical barriers experienced by rural women and those with a limited ability to travel. These findings can help to inform gender-tailored expansion of telemental health within and outside of the VA. Published by Elsevier Inc.

  12. Social workers and unemployment: Factors associated with using employment-promoting practices in Israeli Municipal Departments of Social Services.

    Science.gov (United States)

    Levin, Lia; Sefati, Noga

    2018-04-23

    Unemployment is a harsh social phenomenon with far reaching negative implications. Unemployed individuals often seek assistance from social workers working in Municipal Departments of Social Services around the world. However, little to no research exists on the factors involved in social workers' choice to engage in employment-promoting practices (EPP). The current study aimed to tackle this gap of knowledge, providing initial conclusions about the relationship between social workers' attitudes towards unemployment, their knowledge regarding EPP, the extent to which they perceive their organisations as endorsing EPP and their actual implementation. The main research question dealt with the extent to which each of the examined factors, in itself or in combination with others, would be the best predictor of social workers' utilisation of EPP. The study sample consisted of 163 social workers in Israel with varied experience in working with the unemployed, all working in public sector social services. Structural equation modelling performed on the attained data revealed that knowledge, skills and perceived organisational endorsement of EPP were positively associated with implementation of EPP. Contrary to the hypothesised, attitudes towards unemployment were not associated with the implementation of such practices. At the same time, professional training and seniority were associated with EPP only through the mediation of perceived organisational endorsement. Ultimately, perceived organisational endorsement of EPP emerged as the most influential factor involved in social workers' decision to carry out EPP with their service-users. Consequences of these findings for social work education, supervision, research and policy making are discussed, referring to the local Israeli context as well as its possible international inferences. © 2018 John Wiley & Sons Ltd.

  13. Emergency department performance measures updates: proceedings of the 2014 emergency department benchmarking alliance consensus summit.

    Science.gov (United States)

    Wiler, Jennifer L; Welch, Shari; Pines, Jesse; Schuur, Jeremiah; Jouriles, Nick; Stone-Griffith, Suzanne

    2015-05-01

    The objective was to review and update key definitions and metrics for emergency department (ED) performance and operations. Forty-five emergency medicine leaders convened for the Third Performance Measures and Benchmarking Summit held in Las Vegas, February 21-22, 2014. Prior to arrival, attendees were assigned to workgroups to review, revise, and update the definitions and vocabulary being used to communicate about ED performance and operations. They were provided with the prior definitions of those consensus summits that were published in 2006 and 2010. Other published definitions from key stakeholders in emergency medicine and health care were also reviewed and circulated. At the summit, key terminology and metrics were discussed and debated. Workgroups communicated online, via teleconference, and finally in a face-to-face meeting to reach consensus regarding their recommendations. Recommendations were then posted and open to a 30-day comment period. Participants then reanalyzed the recommendations, and modifications were made based on consensus. A comprehensive dictionary of ED terminology related to ED performance and operation was developed. This article includes definitions of operating characteristics and internal and external factors relevant to the stratification and categorization of EDs. Time stamps, time intervals, and measures of utilization were defined. Definitions of processes and staffing measures are also presented. Definitions were harmonized with performance measures put forth by the Centers for Medicare and Medicaid Services (CMS) for consistency. Standardized definitions are necessary to improve the comparability of EDs nationally for operations research and practice. More importantly, clear precise definitions describing ED operations are needed for incentive-based pay-for-performance models like those developed by CMS. This document provides a common language for front-line practitioners, managers, health policymakers, and researchers.

  14. Forecasting the Emergency Department Patients Flow.

    Science.gov (United States)

    Afilal, Mohamed; Yalaoui, Farouk; Dugardin, Frédéric; Amodeo, Lionel; Laplanche, David; Blua, Philippe

    2016-07-01

    Emergency department (ED) have become the patient's main point of entrance in modern hospitals causing it frequent overcrowding, thus hospital managers are increasingly paying attention to the ED in order to provide better quality service for patients. One of the key elements for a good management strategy is demand forecasting. In this case, forecasting patients flow, which will help decision makers to optimize human (doctors, nurses…) and material(beds, boxs…) resources allocation. The main interest of this research is forecasting daily attendance at an emergency department. The study was conducted on the Emergency Department of Troyes city hospital center, France, in which we propose a new practical ED patients classification that consolidate the CCMU and GEMSA categories into one category and innovative time-series based models to forecast long and short term daily attendance. The models we developed for this case study shows very good performances (up to 91,24 % for the annual Total flow forecast) and robustness to epidemic periods.

  15. Factors associated with ambulatory care sensitive emergency department visits for South Carolina Medicaid members with intellectual disability.

    Science.gov (United States)

    McDermott, S; Royer, J; Mann, J R; Armour, B S

    2018-03-01

    Ambulatory care sensitive conditions (ACSCs) can be seen as failure of access or management in primary care settings. Identifying factors associated with ACSCs for individuals with an Intellectual Disability (ID) provide insight into potential interventions. To assess the association between emergency department (ED) ACSC visits and a number of demographic and health characteristics of South Carolina Medicaid members with ID. A retrospective cohort of adults with ID was followed from 2001 to 2011. Using ICD-9-CM codes, four ID subgroups, totalling 14 650 members, were studied. There were 106 919 ED visits, with 21 214 visits (19.8%) classified as ACSC. Of those, 82.9% were treated and released from EDs with costs averaging $578 per visit. People with mild and unspecified ID averaged greater than one ED visit per member year. Those with Down syndrome and other genetic cause ID had the lowest rates of ED visits but the highest percentage of ACSC ED visits that resulted in inpatient hospitalisation (26.6% vs. an average of 16.8% for other subgroups). When compared with other residential types, those residing at home with no health support services had the highest ED visit rate and were most likely to be discharged back to the community following an ED visit (85.2%). Adults residing in a nursing home had lower rates of ED visits but were most likely to be admitted to the hospital (38.9%) following an ED visit. Epilepsy and convulsions were the leading cause (29.6%) of ACSC ED visits across all subgroups and residential settings. Prevention of ACSC ED visits may be possible by targeting adults with ID who live at home without health support services. © 2017 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

  16. Effects of emergency department expansion on emergency department patient flow.

    Science.gov (United States)

    Mumma, Bryn E; McCue, James Y; Li, Chin-Shang; Holmes, James F

    2014-05-01

    Emergency department (ED) crowding is an increasing problem associated with adverse patient outcomes. ED expansion is one method advocated to reduce ED crowding. The objective of this analysis was to determine the effect of ED expansion on measures of ED crowding. This was a retrospective study using administrative data from two 11-month periods before and after the expansion of an ED from 33 to 53 adult beds in an academic medical center. ED volume, staffing, and hospital admission and occupancy data were obtained either from the electronic health record (EHR) or from administrative records. The primary outcome was the rate of patients who left without being treated (LWBT), and the secondary outcome was total ED boarding time for admitted patients. A multivariable robust linear regression model was used to determine whether ED expansion was associated with the outcome measures. The mean (±SD) daily adult volume was 128 (±14) patients before expansion and 145 (±17) patients after. The percentage of patients who LWBT was unchanged: 9.0% before expansion versus 8.3% after expansion (difference = 0.6%, 95% confidence interval [CI] = -0.16% to 1.4%). Total ED boarding time increased from 160 to 180 hours/day (difference = 20 hours, 95% CI = 8 to 32 hours). After daily ED volume, low-acuity area volume, daily wait time, daily boarding hours, and nurse staffing were adjusted for, the percentage of patients who LWBT was not independently associated with ED expansion (p = 0.053). After ED admissions, ED intensive care unit (ICU) admissions, elective surgical admissions, hospital occupancy rate, ICU occupancy rate, and number of operational ICU beds were adjusted for, the increase in ED boarding hours was independently associated with the ED expansion (p = 0.005). An increase in ED bed capacity was associated with no significant change in the percentage of patients who LWBT, but had an unintended consequence of an increase in ED boarding hours. ED expansion alone does

  17. Emergency Department Frequent Users for Acute Alcohol Intoxication.

    Science.gov (United States)

    Klein, Lauren R; Martel, Marc L; Driver, Brian E; Reing, Mackenzie; Cole, Jon B

    2018-03-01

    A subset of frequent users of emergency services are those who use the emergency department (ED) for acute alcohol intoxication. This population and their ED encounters have not been previously described. This was a retrospective, observational, cohort study of patients presenting to the ED for acute alcohol intoxication between 2012 and 2016. We collected all data from the electronic medical record. Frequent users for alcohol intoxication were defined as those with greater than 20 visits for acute intoxication without additional medical chief complaints in the previous 12 months. We used descriptive statistics to evaluate characteristics of frequent users for alcohol intoxication, as well as their ED encounters. We identified 32,121 patient encounters. Of those, 325 patients were defined as frequent users for alcohol intoxication, comprising 11,370 of the encounters during the study period. The median maximum number of encounters per person for alcohol intoxication in a one-year period was 47 encounters (range 20 to 169). Frequent users were older (47 years vs. 39 years), and more commonly male (86% vs. 71%). Frequent users for alcohol intoxication had higher rates of medical and psychiatric comorbidities including liver disease, chronic kidney disease, ischemic vascular disease, dementia, chronic obstructive pulmonary disease, history of traumatic brain injury, schizophrenia, and bipolar disorder. In this study, we identified a group of ED frequent users who use the ED for acute alcohol intoxication. This population had higher rates of medical and psychiatric comorbidities compared to non-frequent users.

  18. Emergency Department Frequent Users for Acute Alcohol Intoxication

    Directory of Open Access Journals (Sweden)

    Marc L. Martel

    2018-02-01

    Full Text Available Introduction: A subset of frequent users of emergency services are those who use the emergency department (ED for acute alcohol intoxication. This population and their ED encounters have not been previously described. Methods: This was a retrospective, observational, cohort study of patients presenting to the ED for acute alcohol intoxication between 2012 and 2016. We collected all data from the electronic medical record. Frequent users for alcohol intoxication were defined as those with greater than 20 visits for acute intoxication without additional medical chief complaints in the previous 12 months. We used descriptive statistics to evaluate characteristics of frequent users for alcohol intoxication, as well as their ED encounters. Results: We identified 32,121 patient encounters. Of those, 325 patients were defined as frequent users for alcohol intoxication, comprising 11,370 of the encounters during the study period. The median maximum number of encounters per person for alcohol intoxication in a one-year period was 47 encounters (range 20 to 169. Frequent users were older (47 years vs. 39 years, and more commonly male (86% vs. 71%. Frequent users for alcohol intoxication had higher rates of medical and psychiatric comorbidities including liver disease, chronic kidney disease, ischemic vascular disease, dementia, chronic obstructive pulmonary disease, history of traumatic brain injury, schizophrenia, and bipolar disorder. Conclusion: In this study, we identified a group of ED frequent users who use the ED for acute alcohol intoxication. This population had higher rates of medical and psychiatric comorbidities compared to non-frequent users.

  19. Delirium in the Emergency Department and Its Extension into Hospitalization (DELINEATE) Study: Effect on 6-month Function and Cognition.

    Science.gov (United States)

    Han, Jin H; Vasilevskis, Eduard E; Chandrasekhar, Rameela; Liu, Xulei; Schnelle, John F; Dittus, Robert S; Ely, E Wesley

    2017-06-01

    The natural course and clinical significance of delirium in the emergency department (ED) is unclear. We sought to (1) describe the extent to which delirium in the ED persists into hospitalization (ED delirium duration) and (2) determine how ED delirium duration is associated with 6-month functional status and cognition. Prospective cohort study. Tertiary care, academic medical center. ED patients ≥65 years old who were admitted to the hospital. The modified Brief Confusion Assessment Method was used to ascertain delirium in the ED and hospital. Premorbid and 6-month function were determined using the Older American Resources and Services Activities of Daily Living (OARS ADL) questionnaire which ranged from 0 (completely dependent) to 28 (completely dependent). Premorbid and 6-month cognition were determined using the short form Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) which ranged from 1 to 5 (severe dementia). Multiple linear regression was performed to determine if ED delirium duration was associated with 6-month function and cognition adjusted for baseline OARS ADL and IQCODE, and other confounders. A total of 228 older ED patients were enrolled. Of the 105 patients who were delirious in the ED, 81 (77.1%) patients' delirium persisted into hospitalization. For every ED delirium duration day, the 6-month OARS ADL decreased by 0.63 points (95% CI: -1.01 to -0.24), indicating poorer function. For every ED delirium duration day, the 6-month IQCODE increased 0.06 points (95% CI: 0.01-0.10) indicating poorer cognition. Delirium in the ED is not a transient event and frequently persists into hospitalization. Longer ED delirium duration is associated with an incremental worsening of 6-month functional and cognitive outcomes. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  20. Variation in Emergency Department vs Internal Medicine Excess Charges in the United States.

    Science.gov (United States)

    Xu, Tim; Park, Angela; Bai, Ge; Joo, Sarah; Hutfless, Susan M; Mehta, Ambar; Anderson, Gerard F; Makary, Martin A

    2017-08-01

    Uninsured and insured but out-of-network emergency department (ED) patients are often billed hospital chargemaster prices, which exceed amounts typically paid by insurers. To examine the variation in excess charges for services provided by emergency medicine and internal medicine physicians. Retrospective analysis was conducted of professional fee payment claims made by the Centers for Medicare & Medicaid Services for all services provided to Medicare Part B fee-for-service beneficiaries in calendar year 2013. Data analysis was conducted from January 1 to July 31, 2016. Markup ratios for ED and internal medicine professional services, defined as the charges submitted by the hospital divided by the Medicare allowable amount. Our analysis included 12 337 emergency medicine physicians from 2707 hospitals and 57 607 internal medicine physicians from 3669 hospitals in all 50 states. Services provided by emergency medicine physicians had an overall markup ratio of 4.4 (340% excess charges), which was greater than the markup ratio of 2.1 (110% excess charges) for all services performed by internal medicine physicians. Markup ratios for all ED services ranged by hospital from 1.0 to 12.6 (median, 4.2; interquartile range [IQR], 3.3-5.8); markup ratios for all internal medicine services ranged by hospital from 1.0 to 14.1 (median, 2.0; IQR, 1.7-2.5). The median markup ratio by hospital for ED evaluation and management procedure codes varied between 4.0 and 5.0. Among the most common ED services, laceration repair had the highest median markup ratio (7.0); emergency medicine physician review of a head computed tomographic scan had the greatest interhospital variation (range, 1.6-27.7). Across hospitals, markups in the ED were often substantially higher than those in the internal medicine department for the same services. Higher ED markup ratios were associated with hospital for-profit ownership (median, 5.7; IQR, 4.0-7.1), a greater percentage of uninsured patients seen

  1. Violence in the Emergency Department.

    Science.gov (United States)

    Stowell, Keith R; Hughes, Nolan P; Rozel, John S

    2016-12-01

    Violence is common in the emergency department (ED). The ED setting has numerous environmental risk factors for violence, including poor staffing, lack of privacy, overcrowding, and ready availability of nonsecured equipment that can be used as weapons. Strategies can be taken to mitigate the risk of violence toward health care workers, including staff training, changes to the ED layout, appropriate use of security, and policy-level changes. Health care providers in the ED should be familiar with local case law and standards related to the duty to warn third parties when a violent threat is made by a patient. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. EDS operator and control software

    International Nuclear Information System (INIS)

    Ott, L.L.

    1985-04-01

    The Enrichment Diagnostic System (EDS) was developed at Lawrence Livermore National Laboratory (LLNL) to acquire, display and analyze large quantities of transient data for a real-time Advanced Vapor Laser Isotope Separation (AVLIS) experiment. Major topics discussed in this paper are the EDS operator interface (SHELL) program, the data acquisition and analysis scheduling software, and the graphics software. The workstation concept used in EDS, the software used to configure a user's workstation, and the ownership and management of a diagnostic are described. An EDS diagnostic is a combination of hardware and software designed to study specific aspects of the process. Overall system performance is discussed from the standpoint of scheduling techniques, evaluation tools, optimization techniques, and program-to-program communication methods. EDS is based on a data driven design which keeps the need to modify software to a minimum. This design requires a fast and reliable data base management system. A third party data base management product, Berkeley Software System Database, written explicitly for HP1000's, is used for all EDS data bases. All graphics is done with an in-house graphics product, Device Independent Graphics Library (DIGLIB). Examples of devices supported by DIGLIB are: Versatec printer/plotters, Raster Technologies Graphic Display Controllers, and HP terminals (HP264x and HP262x). The benefits derived by using HP hardware and software as well as obstacles imposed by the HP environment are presented in relation to EDS development and implementation

  3. The value of a poison control center in preventing unnecessary ED visits and hospital charges: A multi-year analysis.

    Science.gov (United States)

    Tak, Casey R; Malheiro, Marty C; Bennett, Heather K W; Crouch, Barbara I

    2017-03-01

    The purpose of this study is to determine the economic value of the Utah Poison Control Center (UPCC) by examining its contribution to the reduction of unnecessary emergency department (ED) visits and associated charges across multiple years. A multi-year (2009-2014) analysis of cross-sectional data was performed. Callers were asked what they would do for a poison emergency if the UPCC was not available. Healthcare charges for ED visits averted were calculated according to insurance status using charges obtained from a statewide database. Of the 10,656 survey attempts, 5018 were completed. Over 30,000 cases were managed on-site each year. Using the proportion of callers who noted they would call 911, visit an ED, or call a physician's office, between 20.0 and 24.2 thousand ED visits were potentially prevented each year of the survey. Between $16.6 and $24.4 million dollars in unnecessary healthcare charges were potentially averted annually. Compared to the cost of operation, the service UPCC provides demonstrates economic value by reducing ED visits and associated charges. As the majority of patients have private insurance, the largest benefit falls to private payers. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Availability of Insurance Linkage Programs in U.S. Emergency Departments

    Directory of Open Access Journals (Sweden)

    Mia Kanak

    2014-07-01

    Full Text Available Introduction: As millions of uninsured citizens who use emergency department (ED services are now eligible for health insurance under the Affordable Care Act, the ED is ideally situated to facilitate linkage to insurance. Forty percent of U.S. EDs report having an insurance linkage program. This is the first national study to examine the characteristics of EDs that offer or do not offer these programs. Methods: This was a secondary analysis of data from the National Survey for Preventive Health Services in U.S. EDs conducted in 2008-09. We compared EDs with and without insurance programs across demographic and operational factors using univariate analysis. We then tested our hypotheses using multivariable logistic regression. We also further examined program capacity and priority among the sub-group of EDs with no insurance linkage program. Results: After adjustment, ED-insurance linkage programs were more likely to be located in the West (RR= 2.06, 95% CI = 1.33 – 2.72. The proportion of uninsured patients in an ED, teaching hospital status, and public ownership status were not associated with insurance linkage availability. EDs with linkage programs also offer more preventive services (RR = 1.87, 95% CI = 1.37–2.35 and have greater social worker availability (RR = 1.71, 95% CI = 1.12–2.33 than those who do not. Four of five EDs with a patient mix of ≥25% uninsured and no insurance linkage program reported that they could not offer a program with existing staff and funding. Conclusion: Availability of insurance linkage programs in the ED is not associated with the proportion of uninsured patients served by an ED. Policy or hospital-based interventions to increase insurance linkage should first target the 27% of EDs with high rates of uninsured patients that lack adequate program capacity. Further research on barriers to implementation and cost effectiveness may help to facilitate increased adoption of insurance linkage programs. [West J

  5. Identification of Emergency Department Visits in Medicare Administrative Claims: Approaches and Implications

    Science.gov (United States)

    Venkatesh, Arjun K.; Mei, Hao; Kocher, Keith E.; Granovsky, Michael; Obermeyer, Ziad; Spatz, Erica S.; Rothenberg, Craig; Krumholz, Harlan M.; Lin, Zhenqui

    2018-01-01

    Objectives Administrative claims data sets are often used for emergency care research and policy investigations of healthcare resource utilization, acute care practices, and evaluation of quality improvement interventions. Despite the high profile of emergency department (ED) visits in analyses using administrative claims, little work has evaluated the degree to which existing definitions based on claims data accurately captures conventionally defined hospital-based ED services. We sought to construct an operational definition for ED visitation using a comprehensive Medicare data set and to compare this definition to existing operational definitions used by researchers and policymakers. Methods We examined four operational definitions of an ED visit commonly used by researchers and policymakers using a 20% sample of the 2012 Medicare Chronic Condition Warehouse (CCW) data set. The CCW data set included all Part A (hospital) and Part B (hospital outpatient, physician) claims for a nationally representative sample of continuously enrolled Medicare fee-for-services beneficiaries. Three definitions were based on published research or existing quality metrics including: 1) provider claims–based definition, 2) facility claims–based definition, and 3) CMS Research Data Assistance Center (ResDAC) definition. In addition, we developed a fourth operational definition (Yale definition) that sought to incorporate additional coding rules for identifying ED visits. We report levels of agreement and disagreement among the four definitions. Results Of 10,717,786 beneficiaries included in the sample data set, 22% had evidence of ED use during the study year under any of the ED visit definitions. The definition using provider claims identified a total of 4,199,148 ED visits, the facility definition 4,795,057 visits, the ResDAC definition 5,278,980 ED visits, and the Yale definition 5,192,235 ED visits. The Yale definition identified a statistically different (p services in the

  6. The impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department: a systematic review.

    Science.gov (United States)

    Jennings, Natasha; Clifford, Stuart; Fox, Amanda R; O'Connell, Jane; Gardner, Glenn

    2015-01-01

    To provide the best available evidence to determine the impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department for adult patients. The delivery of quality care in the emergency department is emerging as one of the most important service indicators in health delivery. Increasing service pressures in the emergency department have resulted in the adoption of service innovation models: the most common and rapidly expanding of these is emergency nurse practitioner services. The rapid uptake of emergency nurse practitioner service in Australia has outpaced the capacity to evaluate this service model in terms of outcomes related to safety and quality of patient care. Previous research is now outdated and not commensurate with the changing domain of delivering emergency care with nurse practitioner services. A comprehensive search of four electronic databases from 2006 to 2013 was conducted to identify research evaluating nurse practitioner service impact in the emergency department. English language articles were sought using MEDLINE, CINAHL, Embase and Cochrane and included two previous systematic reviews completed five and seven years ago. A three step approach was used. Following a comprehensive search, two reviewers assessed all identified studies against the inclusion criteria. From the original 1013 studies, 14 papers were retained for critical appraisal on methodological quality by two independent reviewers and data were extracted using standardised tools. Narrative synthesis was conducted to summarise and report the findings as insufficient data was available for meta-analysis of results. This systematic review has shown that emergency nurse practitioner service has a positive impact on quality of care, patient satisfaction and waiting times. There was insufficient evidence to draw conclusions regarding outcomes of a cost benefit analysis. Synthesis of the available research attempts to provide an

  7. Obesity evaluation and treatment: Expert Committee recommendations. The Maternal and Child Health Bureau, Health Resources and Services Administration and the Department of Health and Human Services.

    Science.gov (United States)

    Barlow, S E; Dietz, W H

    1998-09-01

    The development of recommendations for physicians, nurse practitioners, and nutritionists to guide the evaluation and treatment of overweight children and adolescents. The Maternal and Child Health Bureau, Health Resources and Services Administration, the Department of Health and Human Services convened a committee of pediatric obesity experts to develop the recommendations. The Committee recommended that children with a body mass index (BMI) greater than or equal to the 85th percentile with complications of obesity or with a BMI greater than or equal to the 95th percentile, with or without complications, undergo evaluation and possible treatment. Clinicians should be aware of signs of the rare exogenous causes of obesity, including genetic syndromes, endocrinologic diseases, and psychologic disorders. They should screen for complications of obesity, including hypertension, dyslipidemias, orthopedic disorders, sleep disorders, gall bladder disease, and insulin resistance. Conditions that indicate consultation with a pediatric obesity specialist include pseudotumor cerebri, obesity-related sleep disorders, orthopedic problems, massive obesity, and obesity in children younger than 2 years of age. Recommendations for treatment evaluation included an assessment of patient and family readiness to engage in a weight-management program and a focused assessment of diet and physical activity habits. The primary goal of obesity therapy should be healthy eating and activity. The use of weight maintenance versus weight loss to achieve weight goals depends on each patient's age, baseline BMI percentile, and presence of medical complications. The Committee recommended treatment that begins early, involves the family, and institutes permanent changes in a stepwise manner. Parenting skills are the foundation for successful intervention that puts in place gradual, targeted increases in activity and targeted reductions in high-fat, high-calorie foods. Ongoing support for families

  8. Nuclear electricity. 5. ed.

    International Nuclear Information System (INIS)

    Hore-Lacy, I.

    1999-01-01

    This new edition is updated, expanded and in a larger format than its predecessors. Also it is a joint undertaking with Canada, rather than simply an Australian perspective. It has a much expanded chapter on nuclear wastes and reprocessing, as well as more on the advanced reactors which are now coming into service. It also discusses nuclear reactor safety and safeguards issues. A final chapter looks at Australian and Canadian uranium mining

  9. Effectiveness of Comprehensive Geriatric Assessment-Based Intervention to Reduce Frequent Emergency Department Visits: A Report of Four Cases

    Directory of Open Access Journals (Sweden)

    Mei-Chen Liao

    2012-06-01

    Full Text Available A small number of clustered visits by emergency department frequent users (EDFUs may over-consume emergency care resources. We report the effectiveness of comprehensive geriatric assessment (CGA-based multidisciplinary team (MDT care for four EDFUs, in reducing ED visits. Case 1 had visited the ED twice/month due to chest discomfort. Her ED visits were significantly reduced to 0.2 visits/month following CGA-based MDT care. Case 2 had failed back surgery syndrome and bipolar disorder. His ED visit was reduced from 2.8 visits to 0.8 visits/month following CGA-based MDT intervention. Case 3 had chronic obstructive pulmonary disease, heart failure, and urinary incontinence, with a urinary catheter in place. He made 31 ED visits (5.1 visits/month before his lung cancer and depression were discovered by CGA. He died 2 months later. Case 4 made 27 ED visits (2.7 visits/month due to dizziness. His problems of early dementia and neglect were identified by CGA, and he visited the ED only once following MDT intervention. In conclusion, CGA-based MDT intervention successfully reduced ED visits among these EDFUs, but further investigation is needed to evaluate the effectiveness of geriatric services in the ED.

  10. Verbal abuse and physical assault in the emergency department: Rates of violence, perceptions of safety, and attitudes towards security.

    Science.gov (United States)

    Partridge, Bradley; Affleck, Julia

    2017-08-01

    Emergency Department (ED) workers are prone to occupational violence, however the extent and impact of this may not be evenly felt across all roles in the ED. Explore: 1) the rate of verbal abuse and physical assaults experienced by ED staff, 2) perceptions of safety, 3) attitudes towards security officers, and 4) formal reporting of incidents. 330 ED workers were surveyed at four public hospitals in one metropolitan health service district in Queensland, Australia, including 179 nurses, 83 medical staff, 44 administration staff, 14 allied health, and 9 operational. Nurses were more likely to have been physically assaulted in the last six months and were less likely to feel safe. Most ED staff across all roles experienced verbal abuse. Nurses were better than medical staff at reporting instances of occupational violence although overall reporting across all roles was low. Staff who thought that security officers respond to incidents quickly and are a visible presence in the ED were more likely to feel safe in the ED. Workers in the ED, particularly nurses, experience high rates of verbal abuse and physical aggression and there may be a case for having designated security guards in the ED. Copyright © 2017 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

  11. A qualitative systematic review of the reasons for parental attendance at the emergency department with children presenting with minor illness.

    Science.gov (United States)

    Butun, Ahmet; Hemingway, Pippa

    2018-01-01

    Over 5 million children attend the Emergency Department (ED) annually in England with an ever-increasing paediatric emergency caseload echoed globally. Approximately 60% of children present with illness and the majority have non-urgent illness creating burgeoning pressures on children's ED and this crisis resonates globally. To date no qualitative systematic review exists that focuses on the parental reasons for childhood attendance at the ED in this sub-group. To identify parental reasons for attending ED for their children presenting with minor illness. A qualitative systematic review was conducted against inclusion/exclusion criteria. Five electronic databases and key journals were searched in June 2015. 471 studies were identified and following study selection, 4 qualitative studies were included. Nine themes were identified e.g. dissatisfaction with family medical services, perceived advantages of ED and 'child suffering' with novel and insightful sub-themes of 'hereditary anxiety', 'taking it off our hands', ED as a 'magical place'. This novel qualitative systematic review examined parental attendance presenting with childhood minor illness of interest to emergency care reformers and clinicians. ED attendance is complex and multifactorial but parents provide vital insight to ED reformers on parental reasons for ED attendance in this sub-group. Copyright © 2017 Elsevier Ltd. All rights reserved.

  12. Lean Manufacturing Improves Emergency Department Throughput and Patient Satisfaction.

    Science.gov (United States)

    Kane, Marlena; Chui, Kristen; Rimicci, Janet; Callagy, Patrice; Hereford, James; Shen, Sam; Norris, Robert; Pickham, David

    2015-09-01

    A multidisciplinary team led by nursing leadership and physicians developed a plan to meet increasing demand and improve the patient experience in the ED without expanding the department's current resources. The approach included Lean tools and engaged frontline staff and physicians. Applying Lean management principles resulted in quicker service, improved patient satisfaction, increased capacity, and reduced resource utilization. Incorporating continuous daily management is necessary for sustainment of continuous improvement activities.

  13. Regional estimates of ecological services derived from U.S. Department of Agriculture conservation programs in the Mississippi Alluvial Valley

    Science.gov (United States)

    Faulkner, Stephen P.; Baldwin, Michael J.; Barrow, Wylie C.; Waddle, Hardin; Keeland, Bobby D.; Walls, Susan C.; James, Dale; Moorman, Tom

    2010-01-01

    The Mississippi Alluvial Valley (MAV) is the Nation?s largest floodplain and this once predominantly forested ecosystem provided significant habitat for a diverse flora and fauna, sequestered carbon in trees and soil, and stored floodwater, sediments, and nutrients within the floodplain. This landscape has been substantially altered by the conversion of nearly 75% of the riparian forests, predominantly to agricultural cropland, with significant loss and degradation of important ecosystem services. Large-scale efforts have been employed to restore the forest and wetland resources and the U.S. Department of Agriculture (USDA) Wetlands Reserve Program (WRP) and Conservation Reserve Program (CRP) represent some of the most extensive restoration programs in the MAV. The objective of the WRP is to restore and protect the functions and values of wetlands in agricultural landscapes with an emphasis on habitat for migratory birds and wetland-dependent wildlife, protection and improvement of water quality, flood attenuation, ground water recharge, protection of native flora and fauna, and educational and scientific scholarship.

  14. The effectiveness of service delivery initiatives at improving patients' waiting times in clinical radiology departments: a systematic review.

    Science.gov (United States)

    Olisemeke, B; Chen, Y F; Hemming, K; Girling, A

    2014-12-01

    We reviewed the literature for the impact of service delivery initiatives (SDIs) on patients' waiting times within radiology departments. We searched MEDLINE, EMBASE, CINAHL, INSPEC and The Cochrane Library for relevant articles published between 1995 and February, 2013. The Cochrane EPOC risk of bias tool was used to assess the risk of bias on studies that met specified design criteria. Fifty-seven studies met the inclusion criteria. The types of SDI implemented included extended scope practice (ESP, three studies), quality management (12 studies), productivity-enhancing technologies (PETs, 29 studies), multiple interventions (11 studies), outsourcing and pay-for-performance (one study each). The uncontrolled pre- and post-intervention and the post-intervention designs were used in 54 (95%) of the studies. The reporting quality was poor: many of the studies did not test and/or report the statistical significance of their results. The studies were highly heterogeneous, therefore meta-analysis was inappropriate. The following type of SDIs showed promising results: extended scope practice; quality management methodologies including Six Sigma, Lean methodology, and continuous quality improvement; productivity-enhancing technologies including speech recognition reporting, teleradiology and computerised physician order entry systems. We have suggested improved study design and the mapping of the definitions of patient waiting times in radiology to generic timelines as a starting point for moving towards a situation where it becomes less restrictive to compare and/or pool the results of future studies in a meta-analysis.

  15. Realizing what's essential: a case study on integrating electronic journal management into a print-centric technical services department.

    Science.gov (United States)

    Dollar, Daniel M; Gallagher, John; Glover, Janis; Marone, Regina Kenny; Crooker, Cynthia

    2007-04-01

    To support migration from print to electronic resources, the Cushing/Whitney Medical Library at Yale University reorganized its Technical Services Department to focus on managing electronic resources. The library hired consultants to help plan the changes and to present recommendations for integrating electronic resource management into every position. The library task force decided to focus initial efforts on the periodical collection. To free staff time to devote to electronic journals, most of the print subscriptions were switched to online only and new workflows were developed for e-journals. Staff learned new responsibilities such as activating e-journals, maintaining accurate holdings information in the online public access catalog and e-journals database ("electronic shelf reading"), updating the link resolver knowledgebase, and troubleshooting. All of the serials team members now spend significant amounts of time managing e-journals. The serials staff now spends its time managing the materials most important to the library's clientele (e-journals and databases). The team's proactive approach to maintenance work and rapid response to reported problems should improve patrons' experiences using e-journals. The library is taking advantage of new technologies such as an electronic resource management system, and library workflows and procedures will continue to evolve as technology changes.

  16. A multivariate time series approach to forecasting daily attendances at hospital emergency department

    KAUST Repository

    Kadri, Farid; Harrou, Fouzi; Sun, Ying

    2018-01-01

    Efficient management of patient demands in emergency departments (EDs) has recently received increasing attention by most healthcare administrations. Forecasting ED demands greatly helps ED's managers to make suitable decisions by optimally

  17. CME1003Pg023ED

    African Journals Online (AJOL)

    Chantel

    resistance alone or severe defects in ... skeletal muscle and liver, decreased ... weight loss through calorie-restrict- ed diets .... carbohydrate and lipid metabolism.12 ... and a variable effect on low-density ... months of therapy.18 Comparison.

  18. SJP0704Pg001ED

    African Journals Online (AJOL)

    Enrique

    and an updated overview of newer research in this field. It also gives practical ... schizophrenia, manic episodes, major depressive disorder sec- ondary to schizophrenia ..... of Cerebral Disorder. 3rd ed. London: Blackwell Science, 1998. 16.

  19. Francisco Mattos (ed.), industrial

    OpenAIRE

    Gunn, Joshua

    2006-01-01

    An episode of the the U.S. Public Broadcasting Service documentary series P.O.V. titled ‘‘Baby, It’s You’’ (2 June, 1988) captures a glimmer of what is left of that early eighties music-art scene known as ‘‘industrial.’’ In the wake of a newscast detailing new information about the Columbine High School massacre in April, 1999 – a crime initially linked by the press to the ‘‘gothic’’ and «industrial» music consumed by the murderers – the narrator’s voice (Anne Makepeace) invited me to carry t...

  20. The Problem of Women in the Department:  Sex and Gender Discrimination in the 1960s United States Foreign Diplomatic Service

    OpenAIRE

    McKenzie, Beatrice Loftus

    2015-01-01

    Alison Palmer, a United States Foreign Service Officer from 1959 to 1981, brought a gender equity complaint against the U.S. State Department in the late 1960s and then led a class action lawsuit by female officers that lasted until 2010.  Examining the records of Palmer’s grievances against the Department of State reveals linkages between gender, sex, and race in the U.S. Foreign Service.  U.S. Ambassadors to three African nations justified their rejection of her from their staffs by stating...

  1. 2011 Oregon Department of Geology and Mineral Industries (DOGAMI) Lidar: US Forest Service (FS) Newberry Study Area

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Oregon Department of Geology & Mineral Industries (DOGAMI) contracted with Watershed Sciences, Inc. to collect high resolution topographic LiDAR data for...

  2. Radiographic imaging. 4 ed.

    International Nuclear Information System (INIS)

    Chesney, D.N.; Chesney, M.O.

    1981-01-01

    This is a revised edition of the textbook previously entitled 'Radiographic Photography' and accords with the current syllabus of training for the Diploma of the Royal College of Radiographers. The aim is a non-mathematical approach to provide a guide for the student to the knowledge and understanding of the theoretical concepts which affect the quality of radiographic image; materials and practices are also reviewed, particularly in relation to the characteristics of the radiographic image, and to processing equipment and processing areas. The subject is dealt with under the following headings: the photographic process, film materials in x-ray departments, sensitometry, storage of film materials and radiographs, intensifying screens and cassettes, film processing, developing, fixing, rinsing, washing, drying, the processing area and equipment, systems for daylight film handling, the radiographic image, management of the quality, presentation of the radiograph, light images and their recording, fluorography, some special imaging processes, e.g. xerography, copying radiographs. (U.K.)

  3. Pharmaceutical advertising in emergency departments.

    Science.gov (United States)

    Marco, Catherine A

    2004-04-01

    Promotion of prescription drugs represents a growing source of pharmaceutical marketing expenditures. This study was undertaken to identify the frequency of items containing pharmaceutical advertising in clinical emergency departments (EDs). In this observational study, emergency physician on-site investigators quantified a variety of items containing pharmaceutical advertising present at specified representative times and days, in clinical EDs. Measurements were obtained by 65 on-site investigators, representing 22 states. Most EDs in this study were community EDs (87% community and 14% university or university affiliate), and most were in urban settings (50% urban, 38% suburban, and 13% rural). Investigators measured 42 items per ED (mean = 42; median = 31; interquartile range of 14-55) containing pharmaceutical advertising in the clinical area. The most commonly observed items included pens (mean 15 per ED; median 10), product brochures (mean 5; median 3), stethoscope labels (mean 4; median 2), drug samples (mean 3; median 0), books (mean 3.4), mugs (mean 2.4), and published literature (mean 3.1). EDs with a policy restricting pharmaceutical representatives in the ED had significantly fewer items containing pharmaceutical advertising (median 7.5; 95% CI = 0 to 27) than EDs without such a policy (median 35; 95% CI = 27 to 47, p = 0.005, nonparametric Wilcoxon two-sample test). There were no differences in quantities of pharmaceutical advertising for EDs in community compared with university settings (p = 0.5), rural compared with urban settings (p = 0.3), or annual ED volumes (p = 0.9). Numerous items containing pharmaceutical advertising are frequently observed in EDs. Policies restricting pharmaceutical representatives in the ED are associated with reduced pharmaceutical advertising.

  4. Emergency Department Waiting Times (EDWaT): A Patient Flow Management and Quality of Care Rating mHealth Application.

    Science.gov (United States)

    Househ, Mowafa; Yunus, Faisel

    2014-01-01

    Saudi hospital emergency departments (ED) have suffered from long waiting times, which have led to a delay in emergency patient care. The increase in the population of Saudi Arabia is likely to further stretch the healthcare services due to overcrowding leading to decreased healthcare quality, long patient waits, patient dissatisfaction, ambulance diversions, decreased physician productivity, and increased frustration among medical staff. This will ultimately put patients at risk for poor health outcomes. Time is of the essence in emergencies and to get to an ED that has the shortest waiting time can mean life or death for a patient, especially in cases of stroke and myocardial infarction. In this paper, we present our work on the development of a mHealth Application - EDWaT - that will: provide patient flow information to the emergency medical services staff, help in quick routing of patients to the nearest hospital, and provide an opportunity for patients to review and rate the quality of care received at an ED, which will then be forwarded to ED services administrators. The quality ratings will help patients to choose between two EDs with the same waiting time and distance from their location. We anticipate that the use of EDWaT will help improve ED wait times and the quality of care provision in Saudi hospitals EDs.

  5. SARIS Guidelines. 2014 Ed

    International Nuclear Information System (INIS)

    2014-01-01

    The IAEA fundamental safety principles provide the basis for IAEA safety standards and IAEA related programmes. IAEA safety standards reflect an international consensus on what constitutes a high level of safety for protecting people and the environment, and therefore represent what all regulators should achieve. These standards, in particular IAEA Safety Standards Series No. GSR Part 1, Governmental, Legal and Regulatory Framework for Safety, provide the basics for establishing, maintaining and continuously improving the governmental, legal and regulatory framework for safety. Additional IAEA requirements and guidance, such as the IAEA Safety Standards Series No. GSR Part 3 (Interim), Radiation Protection and Safety of Radiation Sources: International Basic Safety Standards, and IAEA Safety Standards Series No. GS-R-3, The Management System for Facilities and Activities, are also used to establish and develop the national infrastructure for safety and for establishing and implementing a management system. Assessment of the regulatory framework for safety with respect to the IAEA safety standards can be made either through an external review or through internal self-assessment. Self-assessment offers a mechanism by which an organization can assess its performance against established standards and models and thereby identify areas for improvement. The IAEA has developed a methodology and tool for Self-assessment of the Regulatory Infrastructure for Safety (SARIS), to assist States in undertaking self-assessment of their national safety framework in accordance with the requirements and recommendations of the IAEA safety standards, and to develop an action plan for improvement. The IAEA self-assessment methodology and the associated tools are fully compatible with the IAEA safety standards and are also used in the preparation for regulatory review missions, such as the Integrated Regulatory Review Service and advisory missions. These guidelines have been developed to

  6. Emergency department characteristics and capabilities in Beijing, China.

    Science.gov (United States)

    Wen, Leana S; Xu, Jun; Steptoe, Anne P; Sullivan, Ashley F; Walline, Joseph H; Yu, Xuezhong; Camargo, Carlos A

    2013-06-01

    Emergency Departments (EDs) are a critical, yet heterogeneous, part of international emergency care. We sought to describe the characteristics, resources, capabilities, and capacity of EDs in Beijing, China. Beijing EDs accessible to the general public 24 h per day/7 days per week were surveyed using the National ED Inventories survey instrument (www.emnet-nedi.org). ED staff were asked about ED characteristics during the calendar year 2008. Thirty-six EDs participated (88% response rate). All were located in hospitals and were independent hospital departments. Participating EDs saw a median of 80,000 patients (interquartile range 40,000-118,508). The vast majority (91%; 95% confidence interval [CI] 78-98%) had a contiguous layout, with medical and surgical care provided in one area. Most EDs (55%) saw only adults; 39% saw both adults and children, and 6% saw only children. Availability of technological and consultant resource in EDs was high. The typical ED length of stay was between 1 and 6 h in 49% of EDs (95% CI 32-67%), whereas in the other half, patients reportedly remained for over 6 h; 36% (95% CI 21-54%) of respondents considered their ED over capacity. Beijing EDs have high volume, long length of stay, and frequent reports of EDs being over capacity. To meet its rapidly growing health needs in urban areas, China should consider improving urban ED capacity and training more Emergency Medicine specialists capable of efficiently staffing its crowded EDs. Copyright © 2013 Elsevier Inc. All rights reserved.

  7. The ED use and non-urgent visits of elderly patients

    OpenAIRE

    Gulacti, Umut; Lok, Ugur; Celik, Murat; Aktas, Nurettin; Polat, Haci

    2016-01-01

    Objective: To evaluate the use of the emergency department (ED) by elderly patients, their non-urgent visits and the prevalence of main disease for ED visits. Methods: This cross-sectional study was conducted on patients aged 65 years and over who visited the ED of a tertiary care university hospital in Turkey between January 2015 and January 2016 retrospectively. Results: A total of 36,369 elderly patients who visited the ED were included in the study. The rate of ED visits by elderly patien...

  8. Regional Energy Deployment System (ReEDS)

    Energy Technology Data Exchange (ETDEWEB)

    Short, W.; Sullivan, P.; Mai, T.; Mowers, M.; Uriarte, C.; Blair, N.; Heimiller, D.; Martinez, A.

    2011-12-01

    The Regional Energy Deployment System (ReEDS) is a deterministic optimization model of the deployment of electric power generation technologies and transmission infrastructure throughout the contiguous United States into the future. The model, developed by the National Renewable Energy Laboratory's Strategic Energy Analysis Center, is designed to analyze the critical energy issues in the electric sector, especially with respect to potential energy policies, such as clean energy and renewable energy standards or carbon restrictions. ReEDS provides a detailed treatment of electricity-generating and electrical storage technologies and specifically addresses a variety of issues related to renewable energy technologies, including accessibility and cost of transmission, regional quality of renewable resources, seasonal and diurnal generation profiles, variability of wind and solar power, and the influence of variability on the reliability of the electrical grid. ReEDS addresses these issues through a highly discretized regional structure, explicit statistical treatment of the variability in wind and solar output over time, and consideration of ancillary services' requirements and costs.

  9. Application of rapid read-out cleaning indicators for improved process control in hospital sterile services departments.

    Science.gov (United States)

    Nugent, P G; Modi, T; McLeod, N; Bock, L J; Smith, C; Poolman, T M; Warburton, R; Meighan, P; Wells, P; Sutton, J M

    2013-05-01

    Heightened awareness of the importance of cleaning has led to an emphasis on automated systems for the decontamination of re-usable medical devices. The authors have previously described an enzymatic indicator system, based on thermostable adenylate kinases (tAK), for quantitative monitoring of automated cleaning processes within hospital sterile services departments (SSDs). To evaluate tAK indicators for routine process monitoring across a range of SSDs with different cleaning chemistries and different automated washer disinfectors (AWDs). tAK indicator devices and alternative industry test indicators were included in five independent cleaning cycles in each of eight different AWDs. Residual tAK post wash was determined by a coupled luciferase assay using a modified hygiene monitoring system. In all cases, with the exception of a single test, the alternative indicators showed that cleaning had been adequate. They were not able to discriminate between the performance of different processes. In contrast, the tAK indicators were able to resolve differences in the performance of processes across the different SSDs. Where the tAK indicators identified cleaning to the limits of detection of the assay, this demonstrated a log10 enzyme removal factor of >5.69. The results suggest that tAK indicators are suitable for providing improved process control for automated cleaning processes, being able to distinguish between wash performance in different hospital settings and between individual process runs. This technology is believed to be a useful addition to routine AWD performance qualification when used as a daily or weekly test. Copyright © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  10. Access to primary care from the perspective of Aboriginal patients at an urban emergency department.

    Science.gov (United States)

    Browne, Annette J; Smye, Victoria L; Rodney, Patricia; Tang, Sannie Y; Mussell, Bill; O'Neil, John

    2011-03-01

    In this article, we discuss findings from an ethnographic study in which we explored experiences of access to primary care services from the perspective of Aboriginal people seeking care at an emergency department (ED) located in a large Canadian city. Data were collected over 20 months of immersion in the ED, and included participant observation and in-depth interviews with 44 patients triaged as stable and nonurgent, most of whom were living in poverty and residing in the inner city. Three themes in the findings are discussed: (a) anticipating providers' assumptions; (b) seeking help for chronic pain; and (c) use of the ED as a reflection of social suffering. Implications of these findings are discussed in relation to the role of the ED as well as the broader primary care sector in responding to the needs of patients affected by poverty, racialization, and other forms of disadvantage.

  11. Improving ED specimen TAT using Lean Six Sigma.

    Science.gov (United States)

    Sanders, Janet H; Karr, Tedd

    2015-01-01

    Lean and Six Sigma are continuous improvement methodologies that have garnered international fame for improving manufacturing and service processes. Increasingly these methodologies are demonstrating their power to also improve healthcare processes. The purpose of this paper is to discuss a case study for the application of Lean and Six Sigma tools in the reduction of turnaround time (TAT) for Emergency Department (ED) specimens. This application of the scientific methodologies uncovered opportunities to improve the entire ED to lab system for the specimens. This case study provides details on the completion of a Lean Six Sigma project in a 1,000 bed tertiary care teaching hospital. Six Sigma's Define, Measure, Analyze, Improve, and Control methodology is very similar to good medical practice: first, relevant information is obtained and assembled; second, a careful and thorough diagnosis is completed; third, a treatment is proposed and implemented; and fourth, checks are made to determine if the treatment was effective. Lean's primary goal is to do more with less work and waste. The Lean methodology was used to identify and eliminate waste through rapid implementation of change. The initial focus of this project was the reduction of turn-around-times for ED specimens. However, the results led to better processes for both the internal and external customers of this and other processes. The project results included: a 50 percent decrease in vials used for testing, a 50 percent decrease in unused or extra specimens, a 90 percent decrease in ED specimens without orders, a 30 percent decrease in complete blood count analysis (CBCA) Median TAT, a 50 percent decrease in CBCA TAT Variation, a 10 percent decrease in Troponin TAT Variation, a 18.2 percent decrease in URPN TAT Variation, and a 2-5 minute decrease in ED registered nurses rainbow draw time. This case study demonstrated how the quantitative power of Six Sigma and the speed of Lean worked in harmony to improve

  12. An Empirical Study of the Management and Oversight of Medical Services Acquisition within the Department of Defense

    Science.gov (United States)

    2009-12-01

    Services Q517 Pharmacology Services Q518 Physical Medicine & Rehabilitation Services Q519 Psychiatry Services Q520 Podiatry Services Q521...755,026 3,571,700 4,744,901 11,550,581 20,770,527 Q520 Podiatry Services 0 0 86,520 130,495 156,928 373,943 Q521 Pulmonary Services 0 0 131,666...1,289,888 1,220,701 2,254,564 3,001,237 8,599,189 Q519 Psychiatry Services 575,836 671,572 1,469,172 6,449,197 6,437,165 15,602,942 Q520 Podiatry

  13. Priorities for emergency department syncope research

    NARCIS (Netherlands)

    Sun, Benjamin C.; Costantino, Giorgio; Barbic, Franca; Bossi, Ilaria; Casazza, Giovanni; Dipaola, Franca; McDermott, Daniel; Quinn, James; Reed, Matthew; Sheldon, Robert S.; Solbiati, Monica; Thiruganasambandamoorthy, Venkatesh; Krahn, Andrew D.; Beach, Daniel; Bodemer, Nicolai; Brignole, Michele; Casagranda, Ivo; Duca, Piergiorgio; Falavigna, Greta; Ippoliti, Roberto; Montano, Nicola; Olshansky, Brian; Raj, Satish R.; Ruwald, Martin H.; Shen, Win-Kuang; Stiell, Ian; Ungar, Andrea; van Dijk, J. Gert; van Dijk, Nynke; Wieling, Wouter; Furlan, Raffaello

    2014-01-01

    There is limited evidence to guide the emergency department (ED) evaluation and management of syncope. The First International Workshop on Syncope Risk Stratification in the Emergency Department identified key research questions and methodological standards essential to advancing the science of

  14. Arthropod genomics research in the United States Department of Agriculture-Agricultural Research Service: Applications of RNA interference and CRISPR gene editing technologies in pest control

    Science.gov (United States)

    The Agricultural Research Service (ARS) is the intramural research agency of the United States Department of Agriculture (USDA) which addresses basic scientific questions and develops applied solutions to a range of agricultural problems, and in doing so protects national food security and supports ...

  15. Out of hours care: a profile analysis of patients attending the emergency department and the general practitioner on call

    Directory of Open Access Journals (Sweden)

    Buylaert Walter

    2010-11-01

    Full Text Available Abstract Background Overuse of emergency departments (ED is of concern in Western society and it is often referred to as 'inappropriate' use. This phenomenon may compromise efficient use of health care personnel, infrastructure and financial resources of the ED. To redirect patients, an extensive knowledge of the experiences and attitudes of patients and their choice behaviour is necessary. The aim of this study is to quantify the patients and socio-economical determinants for choosing the general practitioner (GP on call or the ED. Methods Data collection was conducted simultaneously in 4 large cities in Belgium. All patients who visited EDs or used the services of the GP on call during two weekends in January 2005 were enrolled in the study in a prospective manner. We used semi-structured questionnaires to interview patients from both services. Results 1611 patient contacts were suitable for further analysis. 640 patients visited the GP and 971 went to the ED. Determinants that associated with the choice of the ED are: being male, having visited the ED during the past 12 months at least once, speaking another language than Dutch or French, being of African (sub-Saharan as well as North African nationality and no medical insurance. We also found that young men are more likely to seek help at the ED for minor trauma, compared to women. Conclusions Patients tend to seek help at the service they are acquainted with. Two populations that distinctively seek help at the ED for minor medical problems are people of foreign origin and men suffering minor trauma. Aiming at a redirection of patients, special attention should go to these patients. Informing them about the health services' specific tasks and the needlessness of technical examinations for minor trauma, might be a useful intervention.

  16. Missing the boat: odds for the patients who leave ED without being seen

    Directory of Open Access Journals (Sweden)

    Fayyaz Jabeen

    2013-01-01

    Full Text Available Abstract Background A patient left without being seen is a well-recognized indicator of Emergency Department overcrowding. The aim of this study was to define the characteristics of LWBS patients, their rates and associated factors from a tertiary care hospital of Pakistan. Methods A retrospective patient record review was undertaken. All patients presenting to the Aga Khan University Hospital, Karachi, between April and December of the year 2010, were included in the study. Information was collected on age, sex, presenting complaints, ED capacity, month, time, shift, day of the week, and waiting times in the ED. A basic descriptive analysis was made and the rates of LWBS patients were determined among the patient subgroups. Logistic regression analysis was used to assess the risk factors associated with a patient not being seen in the ED. Results A total of 38,762 patients visited ED during the study period. Among them 5,086 (13% patients left without being seen. Percentage of leaving was highest in the night shift (20%. The percentage was twice as high when the ED was on diversion (19.8% compared to regular periods of operation (9.8%. Mean waiting time before leaving the ED in pediatric patients was 154 minutes while for adults it was 171 minutes. More than 32% of patients had waited for more than 180 minutes before they left without being seen, compared to the patients who were seen in ED. Important predictors for LWBS included; Triage category P4 i.e. walk –in-patients had an OR of 13.62(8.72-21.3, Diversion status, OR 1.49(1.26-1.76, night shift , OR 2.44(1.95-3.05 and Pediatric age, OR 0.57(0.48-0.66. Conclusions Our study elucidates the LWBS population characteristics and identifies the risk factors for this phenomenon. Targeted interventions should be planned and implemented to decrease the waiting time and alternate services should be provided for high-risk patients (for LWBS to minimize their number.

  17. Development of emergency department load relief area--gauging benefits in empirical terms.

    Science.gov (United States)

    Rasheed, Farrukh; Lee, Young Hoon; Kim, Seung Ho; Park, In Cheol

    2012-12-01

    The primary goal of this investigation was to develop a simulation model to evaluate the various internal and external factors affecting patient flow and crowding in the emergency department (ED). In addition, a few recommendations are proposed to reconfigure the patient flow to improve ED capacity while maintaining service quality. In this research, we present a simulation study conducted in the ED at the "S Hospital" located in Seoul. Based on patient flow data and process analysis, a simulation model of patient throughput in the ED has been developed. We evaluated simulations of diverting the specific patient load in the light of our proposed recommendations to a separately managed area named as the ED load relief area (ED-LRA) and analyzing potential effects on overall length of stay (LOS) and waiting time (WT). What-if analyses have been proposed to identify key issues and investigate the improvements as per our proposed recommendations. The simulation results suggest that specific patient load diversion is needed to ensure desired outcomes. With the diversion of specific patient load to ED-LRA, there is a reduction of 40.60% in mean LOS and 42.5% in WT with improved resource utilization. As a result, opening of an ED-LRA is justified. Real-world systems are often too intricate for analytical models and often too expensive to trial with directly. Simulation models allow the modeling of this intricacy and enable experimentation to make inferences about how the actual system might perform. Our simulation study modeled that diverting the specific patient load to ED-LRA produced an improvement in overall ED's LOS and WT.

  18. Good Interdepartmental Relationships: The Foundations of a Solid Emergency Department

    Directory of Open Access Journals (Sweden)

    Frank J. Edwards

    2018-02-01

    Full Text Available “No man is an island” said the English poet, John Donne, and nowhere can that statement be better appreciated than in a modern emergency department (ED. As emergency physicians, we work in the setting of a close knit team involving nurses, technicians, consultants, clerks, security guards and many more. On a macroscopic level as well, the ED itself needs productive relationships with every other department in the hospital. Back when the ED was staffed by physicians-in-training, general practitioners and moonlighting specialists, the care of patients was jealously divided between the long-entrenched traditional specialties. Anesthesiologists handled difficult airways; Surgeons took care of trauma; Radiologists did the ultrasounds and read all the films, and so forth. Emergency medicine—a specialty that encompassed parts of many disciplines—was initially met with skepticism and resistance from the traditional fields.   I have been in practice long enough to remember when anesthesiologists fought against emergency physicians doing RSI and how they tried to stop us from using propofol or ketamine for procedural sedation. Orthopedists wanted to be consulted before we reduced a shoulder. Surgeons got angry if you gave morphine to a belly pain patient. In the early 1990’s at the University of Rochester, my colleague, Dr. Steve White, had to sneak into the ED with his own portable ultrasound device (with its postage stamp sized screen, because to have done so openly would have brought down the wrath of radiologists who believed that ultrasonography belonged to their department alone. These turf battles are mostly a thing of the past, thanks to clinical studies conducted by our specialty that proved what we can and should do. But challenges regarding interdepartmental relationships still remain. In the following discussion we will look at current friction points between the ED and other departments, including radiology, anesthesia, surgery

  19. 75 FR 14111 - Schedule of Fees for Consular Services, Department of State and Overseas Embassies and Consulates

    Science.gov (United States)

    2010-03-24

    ... using business rules that allowed the model to project unit costs for future years. The calculation of...SS), the activity-based costing model that the Department used to determine the fees for consular... , the Department chose to develop and use an activity-based costing (ABC) model to determine the true...

  20. The haven of the self-service store: A study of the fruit and vegetable department's influence on customer attitudes towards food chain stores

    DEFF Research Database (Denmark)

    Bech-Larsen, Tino

    2000-01-01

    of these developments have concentrated on the peripheral spheres of the purchase decision situation. More recently retail managers have concentrated their efforts on the departments believed to be most important to customers' overall shopping experience and attitudes towards the store. So far, academic studies...... self-service stores. With an outset in broad range theories of consumer choice and environmental psychology, this paper discusses a number of reasons why the fruit and vegetable department can be one of the keys to chain differentiation and creation of positive customer attitudes to the store. Also...... the paper describes the results of two empirical studies (a focus group and a survey), which explore customer-perceived quality dimensions of the fruit and vegetable department and the extent to which these dimensions influence customer attitudes towards the department and towards the store in general....

  1. The Effect of Older Age on EMS Use for Transportation to an Emergency Department.

    Science.gov (United States)

    Jones, Courtney M C; Wasserman, Erin B; Li, Timmy; Amidon, Ashley; Abbott, Marissa; Shah, Manish N

    2017-06-01

    Introduction Previous studies have found that older adults are more likely to use Emergency Medical Services (EMS) than younger adults, but the reasons for this remain understudied. Hypothesis/Problem This study aimed to determine if older age is associated with using EMS for transportation to an emergency department (ED) after controlling for confounding variables. A cross-sectional survey study was conducted at a large academic medical center. Data on previous medical history, chief complaint, self-perceived illness severity, demographic information, and mode of arrival to the ED were collected on all subjects. Those who arrived to the ED via EMS also were asked reasons why they opted to call an ambulance for their illness/injury. Descriptive statistics were used to quantify survey responses, and multivariable regression was used to assess the independent effect of age on mode of ED arrival. Data from 1,058 subjects were analyzed, 449 (42%) of whom arrived to the ED via EMS. Compared to adultstransportation to the ED via ambulance; however, this effect is attenuated by number of chronic medical conditions and history of depression. Additional research is needed to account for confounders unmeasured in this study and to elucidate reasons for the increased frequency of EMS use among older adults. Jones CMC , Wasserman EB , Li T , Amidon A , Abbott M , Shah MN . The effect of older age on EMS use for transportation to an emergency department. Prehosp Disaster Med. 2017;32(3):261-268.

  2. Managing the Services Supply Chain in the Department of Defense: An Empirical Study of Current Management Practices

    National Research Council Canada - National Science Library

    Apte, Aruna U; Apte, Uday M; Rendon, Rene G

    2008-01-01

    .... Specifically, we studied the current management practices in such areas as life cycle approach, project management, organization/ management structure, and training provided to services acquisition personnel...

  3. Are we prepared for a growing population? Morbid obesity and its implications in Irish emergency departments.

    LENUS (Irish Health Repository)

    2012-01-31

    Two percent of the Irish population is morbidly obese with this figure expected to rise significantly. This survey aimed to establish the present logistical capacity of Irish emergency departments (EDs) to adequately cater for the bariatric patients. A telephone survey was carried out of 37 health service executive EDs over a 5-day period in October 2008. Questions were posed to the departmental lead nurse regarding facilities (Supplemental digital content 1). No ED had adequate facilities. Two of 37 units questioned had on-site hoists designed to lift patients of more than 170 kg. Four departments had rapid access to mattresses within the hospital and three of these four had access to beds and trolleys for weighing patients. Two percent of the Irish population is morbidly obese with this figure expected to rise significantly to more than 150 kg. One department had access to commodes, chairs, wheelchairs and trolleys from inpatient services. All departments had extra-wide blood pressure cuffs and 12 had a difficult airways trolley. Necessary infrastructure and equipment for bariatric patients is deficient in the majority of Irish EDs.

  4. Designing, Implementing, and Evaluating a Department-Wide Service-Learning Program for English Language Learners in Morocco

    Science.gov (United States)

    Seilstad, Brian

    2014-01-01

    This article describes the theoretical and pedagogical background and results from the first semester of a service-learning program for English learners at a public Moroccan university and the local high school. This study fills a gap in the literature related to service-learning practice and outcomes in Morocco and the Arab world in general. The…

  5. Mitigating Higher Ed Cyber Attacks

    Science.gov (United States)

    Rogers, Gary; Ashford, Tina

    2015-01-01

    In this presentation we will discuss the many and varied cyber attacks that have recently occurred in the higher ed community. We will discuss the perpetrators, the victims, the impact and how these institutions have evolved to meet this threat. Mitigation techniques and defense strategies will be covered as will a discussion of effective security…

  6. 2011 U.S. Department of Agriculture- Natural Resources Conservation Service (USDA-NRCS) Topographic Lidar: North West Connecticut

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Earth Eye collected LiDAR data for approximately 1,703 square kilometers that partially cover the Connecticut counties of Litchfield and Fairfield. The nominal pulse...

  7. 2010 U.S. Department of Agriculture- Natural Resources Conservation Service (USDA-NRCS) Topographic Lidar: Eastern Connecticut

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Earth Eye collected LiDAR data for approximately 4,589 square kilometers that partially cover the Connecticut counties of Hartford, Tolland, Windham, Middlesex and...

  8. The Quebec emergency department guide: A cross-sectional study to evaluate its use, perceived usefulness, and implementation in rural emergency departments.

    Science.gov (United States)

    Fleet, Richard; Hegg-Deloye, Sandrine; Maltais-Giguère, Julie; Légaré, France; Ouimet, Mathieu; Poitras, Julien; Tanguay, Alain; Archambault, Patrick; Levesque, Jean-Frédéric; Simard-Racine, Geneviève; Dupuis, Gilles

    2017-12-07

    The Quebec Emergency Department Management Guide (QEDMG) is a unique document with 78 recommendations designed to improve the organization of emergency departments (EDs) in the province of Quebec. However, no study has examined how this guide is perceived or used by rural health care management. We invited all directors of professional services (DPS), directors of nursing services (DNS), head nurses (HN), and emergency department directors (EDD) working in Quebec's rural hospitals to complete an online survey (144 questions). Simple frequency analyses (percentage [%] and 95% confidence interval) were conducted to establish general familiarity and use of the QEDMG, as well as perceived usefulness and implementation of its recommendations. Seventy-three percent (19/26) of Quebec's rural EDs participated in the study. A total of 82% (62/76) of the targeted stakeholders participated. Sixty-one percent of respondents reported being "moderately or a lot" familiar with the QEDMG, whereas 77% reported "almost never or sometimes" refer to this guide. Physician management (DPS, EDD) were more likely than nursing management (DNS and especially HN) to report "not at all" or "little" familiarity on use of the guide. Finally, 98% of the QEDMG recommendations were considered useful. Although the QEDMG is considered a useful guide for rural EDs, it is not optimally known or used in rural EDs, especially by physician management. Stakeholders should consider these findings before implementing the revised versions of the QEDMG.

  9. Boarding admitted children in the emergency department impacts inpatient outcomes.

    Science.gov (United States)

    Bekmezian, Arpi; Chung, Paul J

    2012-03-01

    This study aimed to assess the relationship between boarding of admitted children in the emergency department (ED) and cost, inpatient length of stay (LOS), mortality, and readmission. This was a retrospective study of 1,792 pediatric inpatients admitted through the ED and discharged from the hospital between February 20, 2007 and June 30, 2008 at a major teaching hospital with an annual ED volume of 40,000 adult and pediatric patients.The main predictor variable was boarding time (time from admission decision to departure for an inpatient bed, in hours). Covariates were patient age, payer group, times of ED and inpatient bed arrival, ED triage acuity, type of inpatient service, intensive care unit admission, surgery, and severity of inpatient illness. The main outcome measures, cost (dollars) and inpatient LOS (hours), were log-transformed and analyzed using linear regressions. Secondary outcomes, mortality and readmission to the hospital within 72 hours of discharge, were analyzed using logistic regression. Mean ED LOS for admitted patients was 9.0 hours. Mean boarding time was 5.1 hours. Mean cost and inpatient LOS were $9893 and 147 hours, respectively. In general, boarding time was associated with cost (P boarding times were associated with greater inpatient LOS especially among patients triaged as low acuity (P = 0.008). In addition, longer boarding times were associated with greater probability of being readmitted among patients on surgical services (P = 0.01). Among low-acuity and surgical patients, longer boarding times were associated with longer inpatient LOS and more readmissions, respectively.

  10. Use of the emergency department for less-urgent care among type 2 diabetics under a disease management program

    Directory of Open Access Journals (Sweden)

    Myers Leann

    2009-12-01

    Full Text Available Abstract Background This study analyzed the likelihood of less-urgent emergency department (ED visits among type 2 diabetic patients receiving care under a diabetes disease management (DM program offered by the Louisiana State University Health Care Services Division (LSU HCSD. Methods All ED and outpatient clinic visits made by 6,412 type 2 diabetic patients from 1999 to 2006 were extracted from the LSU HCSD Disease Management (DM Evaluation Database. Patient ED visits were classified as either urgent or less-urgent, and the likelihood of a less-urgent ED visit was compared with outpatient clinic visits using the Generalized Estimating Equation methodology for binary response to time-dependent variables. Results Patients who adhered to regular clinic visit schedules dictated by the DM program were less likely to use the ED for less urgent care with odds ratio of 0.1585. Insured patients had 1.13 to 1.70 greater odds of a less-urgent ED visit than those who were uninsured. Patients with better-managed glycated hemoglobin (A1c or HbA1c levels were 82 times less likely to use less-urgent ED visits. Furthermore, being older, Caucasian, or a longer participant in the DM program had a modestly lower likelihood of less-urgent ED visits. The patient's Charlson Comorbidity Index (CCI, gender, prior hospitalization, and the admitting facility showed no effect. Conclusion Patients adhering to the DM visit guidelines were less likely to use the ED for less-urgent problems. Maintaining normal A1c levels for their diabetes also has the positive impact to reduce less-urgent ED usages. It suggests that successful DM programs may reduce inappropriate ED use. In contrast to expectations, uninsured patients were less likely to use the ED for less-urgent care. Patients in the DM program with Medicaid coverage were 1.3 times more likely to seek care in the ED for non-emergencies while commercially insured patients were nearly 1.7 times more likely to do so. Further

  11. Improving performance in the ED through laboratory information exchange systems.

    Science.gov (United States)

    Raymond, Louis; Paré, Guy; Maillet, Éric; Ortiz de Guinea, Ana; Trudel, Marie-Claude; Marsan, Josianne

    2018-03-12

    The accessibility of laboratory test results is crucial to the performance of emergency departments and to the safety of patients. This study aims to develop a better understanding of which laboratory information exchange (LIE) systems emergency care physicians (ECPs) are using to consult their patients' laboratory test results and which benefits they derive from such use. A survey of 163 (36%) ECPs in Quebec was conducted in collaboration with the Quebec's Department of Health and Social Services. Descriptive statistics, chi-square tests, cluster analyses, and ANOVAs were conducted. The great majority of respondents indicated that they use several LIE systems including interoperable electronic health record (iEHR) systems, laboratory results viewers (LRVs), and emergency department information systems (EDIS) to consult their patients' laboratory results. Three distinct profiles of LIE users were observed. The extent of LIE usage was found to be primarily determined by the functional design differences between LIE systems available in the EDs. Our findings also indicate that the more widespread LIE usage, the higher the perceived benefits. More specifically, physicians who make extensive use of iEHR systems and LRVs obtain the widest range of benefits in terms of efficiency, quality, and safety of emergency care. Extensive use of LIE systems allows ECPs to better determine and monitor the health status of their patients, verify their diagnostic assumptions, and apply evidence-based practices in laboratory medicine. But for such benefits to be possible, ECPs must be provided with LIE systems that produce accurate, up-to-date, complete, and easy-to-interpret information.

  12. Using Queuing Theory and Simulation Modelling to Reduce Waiting Times in An Iranian Emergency Department.

    Science.gov (United States)

    Haghighinejad, Hourvash Akbari; Kharazmi, Erfan; Hatam, Nahid; Yousefi, Sedigheh; Hesami, Seyed Ali; Danaei, Mina; Askarian, Mehrdad

    2016-01-01

    Hospital emergencies have an essential role in health care systems. In the last decade, developed countries have paid great attention to overcrowding crisis in emergency departments. Simulation analysis of complex models for which conditions will change over time is much more effective than analytical solutions and emergency department (ED) is one of the most complex models for analysis. This study aimed to determine the number of patients who are waiting and waiting time in emergency department services in an Iranian hospital ED and to propose scenarios to reduce its queue and waiting time. This is a cross-sectional study in which simulation software (Arena, version 14) was used. The input information was extracted from the hospital database as well as through sampling. The objective was to evaluate the response variables of waiting time, number waiting and utilization of each server and test the three scenarios to improve them. Running the models for 30 days revealed that a total of 4088 patients left the ED after being served and 1238 patients waited in the queue for admission in the ED bed area at end of the run (actually these patients received services out of their defined capacity). The first scenario result in the number of beds had to be increased from 81 to179 in order that the number waiting of the "bed area" server become almost zero. The second scenario which attempted to limit hospitalization time in the ED bed area to the third quartile of the serving time distribution could decrease the number waiting to 586 patients. Doubling the bed capacity in the emergency department and consequently other resources and capacity appropriately can solve the problem. This includes bed capacity requirement for both critically ill and less critically ill patients. Classification of ED internal sections based on severity of illness instead of medical specialty is another solution.

  13. Using Queuing Theory and Simulation Modelling to Reduce Waiting Times in An Iranian Emergency Department

    Directory of Open Access Journals (Sweden)

    Hourvash Akbari Haghighinejad

    2016-01-01

    Full Text Available Background: Hospital emergencies have an essential role in health care systems. In the last decade, developed countries have paid great attention to overcrowding crisis in emergency departments. Simulation analysis of complex models for which conditions will change over time is much more effective than analytical solutions and emergency department (ED is one of the most complex models for analysis. This study aimed to determine the number of patients who are waiting and waiting time in emergency department services in an Iranian hospital ED and to propose scenarios to reduce its queue and waiting time. Methods: This is a cross-sectional study in which simulation software (Arena, version 14 was used. The input information was extracted from the hospital database as well as through sampling. The objective was to evaluate the response variables of waiting time, number waiting and utilization of each server and test the three scenarios to improve them. Results: Running the models for 30 days revealed that a total of 4088 patients left the ED after being served and 1238 patients waited in the queue for admission in the ED bed area at end of the run (actually these patients received services out of their defined capacity. The first scenario result in the number of beds had to be increased from 81 to179 in order that the number waiting of the “bed area” server become almost zero. The second scenario which attempted to limit hospitalization time in the ED bed area to the third quartile of the serving time distribution could decrease the numberwaiting to 586 patients. Conclusion: Doubling the bed capacity in the emergency department and consequently other resources and capacity appropriately can solve the problem. This includes bed capacity requirement for both critically ill and less critically ill patients. Classification of ED internal sections based on severity of illness instead of medical specialty is another solution.

  14. Correlation of Level of Trauma Activation With Emergency Department Intervention.

    Science.gov (United States)

    Cooper, Michael C; Srivastava, Geetanjali

    2018-06-01

    In-hospital trauma team activation criteria are formulated to identify severely injured patients requiring specialized multidisciplinary care. Efficacy of trauma activation (TA) criteria is commonly measured by emergency department (ED) disposition, injury severity score, and mortality. Necessity of critical ED interventions is another measure that has been proposed to evaluate the appropriateness of TA criteria. Two-year retrospective cohort study of 1715 patients from our trauma registry at a Level 1 pediatric trauma center. We abstracted data on acute interventions, level and criterion of TA, ED disposition, and mortality. We report odds ratio (OR) with 95% confidence intervals (CIs), positive predictive value, and frequency of acute interventions. Trauma activation was initiated for 947 (55%) of the 1715 patients. There were 426 ED interventions performed on 235 patients (14%); 67.8% were in level 1 activations; 17.6% in level 2, and 14.6% in level 3. Highest-level activations were highly associated with need for ED interventions (OR, 16.1; 95% CI, 11.5-22.4). The ORs for requiring an ED intervention were low for lower level activations (OR, 0.4; 95% CI, 0.3-0.5), trauma service consults (OR, 0.3; 95% CI, 0.2-0.4), and certain mechanism-based criteria. The ORs for ED intervention for isolated motor vehicle collision (0.2; 95% CI, 0.1-0.7), isolated all-terrain vehicle rollover (0.4; 95% CI, 0.1-1.7), and suspected spinal cord injury (0.5; 95% CI, 0.1-3.7) were significantly lower than 1. Highest-level activation criteria correlate with high utilization of ED resources and interventions. Lower level activation criteria and trauma service consult criteria are not highly correlated with need for ED interventions. Downgrading isolated motor vehicle collision and all-terrain vehicle rollovers and suspected spinal cord injury to lower level activations could decrease the overtriage rate, and adding age-specific bradycardia as a physiologic criterion could improve our

  15. Forecasting daily patient volumes in the emergency department.

    Science.gov (United States)

    Jones, Spencer S; Thomas, Alun; Evans, R Scott; Welch, Shari J; Haug, Peter J; Snow, Gregory L

    2008-02-01

    Shifts in the supply of and demand for emergency department (ED) resources make the efficient allocation of ED resources increasingly important. Forecasting is a vital activity that guides decision-making in many areas of economic, industrial, and scientific planning, but has gained little traction in the health care industry. There are few studies that explore the use of forecasting methods to predict patient volumes in the ED. The goals of this study are to explore and evaluate the use of several statistical forecasting methods to predict daily ED patient volumes at three diverse hospital EDs and to compare the accuracy of these methods to the accuracy of a previously proposed forecasting method. Daily patient arrivals at three hospital EDs were collected for the period January 1, 2005, through March 31, 2007. The authors evaluated the use of seasonal autoregressive integrated moving average, time series regression, exponential smoothing, and artificial neural network models to forecast daily patient volumes at each facility. Forecasts were made for horizons ranging from 1 to 30 days in advance. The forecast accuracy achieved by the various forecasting methods was compared to the forecast accuracy achieved when using a benchmark forecasting method already available in the emergency medicine literature. All time series methods considered in this analysis provided improved in-sample model goodness of fit. However, post-sample analysis revealed that time series regression models that augment linear regression models by accounting for serial autocorrelation offered only small improvements in terms of post-sample forecast accuracy, relative to multiple linear regression models, while seasonal autoregressive integrated moving average, exponential smoothing, and artificial neural network forecasting models did not provide consistently accurate forecasts of daily ED volumes. This study confirms the widely held belief that daily demand for ED services is characterized by

  16. Managing the Services Supply Chain in the Department of Defense: An Empirical Study of Current Management Practices

    National Research Council Canada - National Science Library

    Apte, Aruna; Apte, Uday; Rendon, Rene G

    2008-01-01

    .... In fact, even considering the high value of weapon systems and large military items purchased in recent years, the DoD has spent more on services than on supplies, equipment and goods (Camm, Blickstein & Venzor, 2004...

  17. Changes in public health preparedness services provided to local health departments by regional offices in North Carolina: a comparison of two cross-sectional studies.

    Science.gov (United States)

    Donovan, Catherine V; Markiewicz, Milissa; Horney, Jennifer A

    2014-05-28

    In 2011, seven decentralized Public Health Regional Surveillance Teams (PHRSTs) were restructured into four centralized Public Health Preparedness and Response (PHP&R) regional offices to realign preparedness priorities and essential services with appropriate infrastructure; field-based staff was reduced, saving approximately $1 million. The objective of this study was to understand the impact that restructuring had on services provided to local health departments (LHDs) throughout North Carolina. A survey to document services that regional offices provide to LHDs in North Carolina was administered by the North Carolina Preparedness and Emergency Response Research Center in 2013. The results were compared to a similar survey from 2009, which identified services provided by regional teams prior to restructuring. Of 69 types of assistance, 14 (20%) were received by 50% or more LHDs in 2012. Compared to 2009, there was a significant decrease in the proportion of LHDs receiving 67% (n = 47) of services. The size of the region served by regional offices was shown to inversely impact the proportion of LHDs receiving services for 25% of services. There was a slight significant decline in perceived quality of the services provided by regional teams in 2012 as comparison to 2009. Following a system-wide review of preparedness in North Carolina, the state's regional teams were reorganized to refine their focus to planning, exercises, and training. Some services, most notably under the functions of epidemiology and surveillance and public health event response, are now provided by other state offices. However, the study results indicate that several services that are still under the domain of the regional offices were received by fewer LHDs in 2012 than 2009. This decrease may be due to the larger number of counties now served by the four regional offices.

  18. The ED use and non-urgent visits of elderly patients.

    Science.gov (United States)

    Gulacti, Umut; Lok, Ugur; Celik, Murat; Aktas, Nurettin; Polat, Haci

    2016-12-01

    To evaluate the use of the emergency department (ED) by elderly patients, their non-urgent visits and the prevalence of main disease for ED visits. This cross-sectional study was conducted on patients aged 65 years and over who visited the ED of a tertiary care university hospital in Turkey between January 2015 and January 2016 retrospectively. A total of 36,369 elderly patients who visited the ED were included in the study. The rate of ED visits by elderly patients was higher than their representation within the general population (p elderly patients visiting polyclinics was 15.8%, the rate of elderly patients visiting the ED was 24.3% (p elderly age groups (p elderly population (17.5%, CI: 17.1-17.9). The proportion of ED visits for non-urgent conditions was 23.4%. Most of the ED visits were during the non-business hours (51.1%), and they were highest in the winter season (25.9%) and in January (10.2%). The hospitalization rate was 9.4%, and 37.9% of hospitalized patients were admitted to intensive care units. The proportion of ED visits by elderly patients was higher than their representation within the general population. Elderly patients often visited the ED instead of a polyclinic. The rate of inappropriate ED use by elderly patients in this hospital was higher than in other countries.

  19. Shock in the emergency department

    DEFF Research Database (Denmark)

    Holler, Jon Gitz; Henriksen, Daniel Pilsgaard; Mikkelsen, Søren

    2016-01-01

    BACKGROUND: The knowledge of the frequency and associated mortality of shock in the emergency department (ED) is limited. The aim of this study was to describe the incidence, all-cause mortality and factors associated with death among patients suffering shock in the ED. METHODS: Population...... failures. Outcomes were annual incidence per 100,000 person-years at risk (pyar), all-cause mortality at 0-7, and 8-90 days and risk factors associated with death. RESULTS: We identified 1646 of 438,191 (0.4 %) ED patients with shock at arrival. Incidence of shock increased from 53.8 to 80.6 cases per 100...

  20. Perceptions of empowerment among ED nurses.

    Science.gov (United States)

    DeVivo, Diane; Quinn Griffin, Mary T; Donahue, Moreen; Fitzpatrick, Joyce J

    2013-11-01

    Nurses' perceptions of empowerment have been linked to a number of variables in the hospital workplace, including job satisfaction, autonomy, and work effectiveness. Yet there have been no previous studies of perceptions of empowerment specifically among emergency department (ED) nurses. Registered nurses (RNs) employed in the EDs of 6 hospitals in a major health care system in the eastern United States were surveyed regarding their perceptions of empowerment. Of the 240 RNs eligible to participate, there were 167 usable surveys. There was a moderate level of empowerment among the RNs who participated, consistent with the level of empowerment reported in several other studies of staff nurses and nurses in other positions. The moderate level of empowerment in this sample may be attributed to the many opportunities for RN involvement in the hospitals within this health care system. Nurse leaders can initiate programs focused on enhancing RN perceptions of empowerment. In addition, there is a need for further research among RNs with different specialty preparation. Copyright © 2013. Published by Mosby, Inc.

  1. A Correlation Study between Student Performance in Food and Beverage Services Course and Internship in F&B Department of Hospitality Business

    OpenAIRE

    Dexter R. Buted; Sevillia S. Felicen; Abigail I. Manzano

    2014-01-01

    One of the biggest challenges hospitality educators face today is determining clear goals and objectives for the curriculum to the constantly changing needs of the industry. It is crucial to close the gap between what is taught to students and what the industry expects from the graduates being hired. This study aimed to assess the relationship between the performance of the students on Food and Beverage Services Course and their internship performance in Food and Beverage department in differ...

  2. Utilization of Failure Mode and Effects Analysis (FMEA Method in Increasing the Revenue of Emergency Department; a Prospective Cohort Study

    Directory of Open Access Journals (Sweden)

    Ali Shahrami

    2013-12-01

    Full Text Available Introduction: The balance between revenue and cost of an organization/system is essential to maintain its survival and quality of services. Emergency departments (ED are one of the most important parts of health care delivery system. Financial discipline of EDs, by increasing the efficiency and profitability, can directly affect the quality of care and subsequently patient satisfaction. Accordingly, the present study attempts to investigate failure mode and effects analysis (FMEA method in identifying the problems leading to the loss of ED revenue and offer solutions to help fix these problems. Methods: This prospective cohort study investigated the financial records of ED patients and evaluated the effective errors in reducing the revenue in ED of Imam Hossein hospital, Tehran, Iran, from October 2007 to November 2009. The whole department was divided based on FMEA into one main system and six subsystems. The study was divided in two phases. In the first phase, the problems leading to the loss in the revenue in each subsystem were identified and weighted to four groups using risk priority number (RPN, and the solutions for fixing them were planned. Then, at the second phase discovered defects in the first phase were fixed according to their priority. Finally, the impact of each solution was compared before and after interventions using the repeated measure ANOVA test. Results: At last, 100 financial records of ED patients were evaluated during the first phase of the study. The average of ED revenue in the six months of the first phase was 73.1±3.65 thousands US dollar/month. 12 types of errors were detected in the predefined subsystems. ED revenue rose from 73.1 to 153.1, 207.06, 240, and 320 thousands US dollar/month after solving of first, second, third, and fourth priority problems, respectively (337.75% increase in two years (p<0.001. 111.0% increase in the ED revenue after solving of first priority problems reveals that they were

  3. Utilization of Failure Mode and Effects Analysis (FMEA Method in Increasing the Revenue of Emergency Department; a Prospective Cohort Study

    Directory of Open Access Journals (Sweden)

    Ali Shahrami

    2015-05-01

    Full Text Available Introduction: The balance between revenue and cost of an organization/system is essential to maintain its survival and quality of services. Emergency departments (ED are one of the most important parts of health care delivery system. Financial discipline of EDs, by increasing the efficiency and profitability, can directly affect the quality of care and subsequently patient satisfaction. Accordingly, the present study attempts to investigate failure mode and effects analysis (FMEA method in identifying the problems leading to the loss of ED revenue and offer solutions to help fix these problems. Methods: This prospective cohort study investigated the financial records of ED patients and evaluated the effective errors in reducing the revenue in ED of Imam Hossein hospital, Tehran, Iran, from October 2007 to November 2009. The whole department was divided based on FMEA into one main system and six subsystems. The study was divided in two phases. In the first phase, the problems leading to the loss in the revenue in each subsystem were identified and weighted to four groups using risk priority number (RPN, and the solutions for fixing them were planned. Then, at the second phase discovered defects in the first phase were fixed according to their priority. Finally, the impact of each solution was compared before and after interventions using the repeated measure ANOVA test. Results: At last, 100 financial records of ED patients were evaluated during the first phase of the study. The average of ED revenue in the six months of the first phase was 73.1±3.65 thousands US dollar/month. 12 types of errors were detected in the predefined subsystems. ED revenue rose from 73.1 to 153.1, 207.06, 240, and 320 thousands US dollar/month after solving of first, second, third, and fourth priority problems, respectively (337.75% increase in two years (p<0.001. 111.0% increase in the ED revenue after solving of first priority problems reveals that they were

  4. Health insurance, neighborhood income, and emergency department usage by Utah children 1996–1998

    Directory of Open Access Journals (Sweden)

    Knight Stacey

    2005-04-01

    Full Text Available Abstract Background It is estimated that approximately half of emergency department (ED usage in the U.S. and other developed countries is for non-urgent conditions and that this usage is related to availability, social, and economic factors. We examined pediatric ED usage in a U.S. state with respect to income, health insurance status, types of medical conditions, and whether introduction of managed care affected utilization by Medicaid children. Methods Emergency department usage rates were calculated from 1996 through 1998 using Utah ED data for children with commercial health insurance, Medicaid, for uninsured children, and by income group estimating neighborhood household income from Zip code of residence. We analyzed usage following the July 1996 transition of Utah Medicaid to managed care. Results Children with Medicaid had approximately 50% greater ED utilization rates than children with commercial health insurance or uninsured children. The majority of usage for Medicaid and uninsured children was for non-traumatic conditions. Only 35% of total ED usage was for non-emergent or non-urgent conditions and this was related to both Medicaid and low household income. Children lacking health insurance were more likely to be discharged against medical advice (OR = 2.36, 95% C.I. 1.88–2.96. There was no reduction in Medicaid ED usage following the transition to managed care. Conclusion Usage of ED services is related to both health insurance status and income. Children lacking health insurance and Medicaid children have excessive usage for conditions which could be treated in a primary care setting. That managed care does not reduce Medicaid ED usage is consistent with findings of other studies.

  5. Epidemiology of Mental Health Attendances at Emergency Departments: Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Helen Barratt

    Full Text Available The characteristics of Emergency Department (ED attendances due to mental or behavioural health disorders need to be described to enable appropriate development of services. We aimed to describe the epidemiology of mental health-related ED attendances within health care systems free at the point of access, including clinical reason for presentation, previous service use, and patient sociodemographic characteristics.Systematic review and meta-analysis of observational studies describing ED attendances by patients with common mental health conditions.18 studies from seven countries met eligibility criteria. Patients attending due to mental or behavioural health disorders accounted for 4% of ED attendances; a third were due to self-harm or suicidal ideation. 58.1% of attendees had a history of psychiatric illness and up to 58% were admitted. The majority of studies were single site and of low quality so results must be interpreted cautiously.Prevalence studies of mental health-related ED attendances are required to enable the development of services to meet specific needs.

  6. Connecting Teachers and Ed-Tech Developers: Lessons from NYC's "Gap App" Program. Technical Appendices

    Science.gov (United States)

    Villavicencio, Adriana; Siman, Nina; Lafayette, Camille; Kang, David

    2016-01-01

    In 2011, with support from a federal Investing in Innovation grant, the NYC Department of Education launched Innovate NYC Schools. The initiative was designed to address two, related challenges to effectively integrating education technology (ed-tech) into classrooms: First, procurement of ed-tech tools is often hampered by a disconnect between…

  7. Connecting Teachers and Ed-Tech Developers: Lessons from NYC's "Gap App" Program. Report

    Science.gov (United States)

    Villavicencio, Adriana; Siman, Nina; Lafayette, Camille; Kang, David

    2016-01-01

    In 2011, with support from a federal Investing in Innovation grant, the NYC Department of Education launched Innovate NYC Schools. The initiative was designed to address two, related challenges to effectively integrating education technology (ed-tech) into classrooms: First, procurement of ed-tech tools is often hampered by a disconnect between…

  8. Joint-Service Integration: An Organizational Culture Study of the United States Department of Defense Voluntary Education System

    Science.gov (United States)

    Benson, Martin K.

    2010-01-01

    The purpose of the descriptive case study with a multiple case framework was to (a) describe the organizational cultures of education programs and leaders in the United States (U.S.) Department of Defense (DoD) voluntary education system on Oahu, Hawaii; (b) determine if an overlapping common organizational culture exists; and (c) assess the…

  9. 75 FR 28188 - Schedule of Fees for Consular Services, Department of State and Overseas Embassies and Consulates

    Science.gov (United States)

    2010-05-20

    ... allow a consular officer to waive the physical appearance of an applicant in the J-1 visa class, but... Department of State visa adjudicator to both determine whether the employment falls under the E-3 program...'' increase for petition-based employment visas, and stated that adjudication of these petition-based visa...

  10. 78 FR 68041 - Memorandum of Understanding Between the Department of Energy and U.S. Fish and Wildlife Service...

    Science.gov (United States)

    2013-11-13

    ... (with Canada, Japan, Mexico, and Russia) for the protection of a shared migratory bird resource. Each of... Agencies to Protect Migratory Birds AGENCY: Office of Health, Safety and Security, Department of Energy... purpose of the MOU is to strengthen migratory bird conservation through enhanced collaboration between DOE...

  11. Analysis of Government Accountability Office and Department of Defense Inspector General Reports and Commercial Sources on Service Contracts

    Science.gov (United States)

    2010-06-01

    Acquisition Research Program BIM Building Information Modeling COR Contracting Officer Representative DoD Department of Defense FPDS...WBS), performance work statements (PWS) and statement of work (SOW), market research, budget and cost estimates, determining contract type, and...contracting within this project. The recurrent best practices in contracting among all sources emphasized planning, defining requirements, market research

  12. 77 FR 18907 - Schedule of Fees for Consular Services, Department of State and Overseas Embassies and Consulates

    Science.gov (United States)

    2012-03-29

    ... to recover the costs of ``allocating visas'' described in section 203(c) of the Immigration and... Statement of Federal Accounting Standards (SFFAS), available at http://www.fasab.gov/pdffiles/sffas-4.pdf... advances in automation making it easier to verify U.S. immigration status. As such, the Department will...

  13. Associations Between Waiting Times, Service Times, and Patient Satisfaction in an Endocrinology Outpatient Department: A Time Study and Questionnaire Survey.

    Science.gov (United States)

    Xie, Zhenzhen; Or, Calvin

    2017-01-01

    The issue of long patient waits has attracted increasing public attention due to the negative effects of waiting on patients' satisfaction with health care. The present study examined the associations between actual waiting time, perceived acceptability of waiting time, actual service time, perceived acceptability of service time, actual visit duration, and the level of patient satisfaction with care. We conducted a cross-sectional time study and questionnaire survey of endocrinology outpatients visiting a major teaching hospital in China. Our results show that actual waiting time was negatively associated with patient satisfaction regarding several aspects of the care they received. Also, patients who were less satisfied with the sociocultural atmosphere and the identity-oriented approach to their care tended to perceive the amounts of time they spent waiting and receiving care as less acceptable. It is not always possible to prevent dissatisfaction with waiting, or to actually reduce waiting times by increasing resources such as increased staffing. However, several improvements in care services can be considered. Our suggestions include providing clearer, more transparent information to keep patients informed about the health care services that they may receive, and the health care professionals who are responsible for those services. We also suggest that care providers are encouraged to continue to show empathy and respect for patients, that patients are provided with private areas where they can talk with health professionals and no one can overhear, and that hospital staff treat the family members or friends who accompany patients in a courteous and friendly way.

  14. Diagnostic errors related to acute abdominal pain in the emergency department.

    Science.gov (United States)

    Medford-Davis, Laura; Park, Elizabeth; Shlamovitz, Gil; Suliburk, James; Meyer, Ashley N D; Singh, Hardeep

    2016-04-01

    Diagnostic errors in the emergency department (ED) are harmful and costly. We reviewed a selected high-risk cohort of patients presenting to the ED with abdominal pain to evaluate for possible diagnostic errors and associated process breakdowns. We conducted a retrospective chart review of ED patients >18 years at an urban academic hospital. A computerised 'trigger' algorithm identified patients possibly at high risk for diagnostic errors to facilitate selective record reviews. The trigger determined patients to be at high risk because they: (1) presented to the ED with abdominal pain, and were discharged home and (2) had a return ED visit within 10 days that led to a hospitalisation. Diagnostic errors were defined as missed opportunities to make a correct or timely diagnosis based on the evidence available during the first ED visit, regardless of patient harm, and included errors that involved both ED and non-ED providers. Errors were determined by two independent record reviewers followed by team consensus in cases of disagreement. Diagnostic errors occurred in 35 of 100 high-risk cases. Over two-thirds had breakdowns involving the patient-provider encounter (most commonly history-taking or ordering additional tests) and/or follow-up and tracking of diagnostic information (most commonly follow-up of abnormal test results). The most frequently missed diagnoses were gallbladder pathology (n=10) and urinary infections (n=5). Diagnostic process breakdowns in ED patients with abdominal pain most commonly involved history-taking, ordering insufficient tests in the patient-provider encounter and problems with follow-up of abnormal test results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  15. Emergency department discharge prescription interventions by emergency medicine pharmacists.

    Science.gov (United States)

    Cesarz, Joseph L; Steffenhagen, Aaron L; Svenson, James; Hamedani, Azita G

    2013-02-01

    We determine the rate and details of interventions associated with emergency medicine pharmacist review of discharge prescriptions for patients discharged from the emergency department (ED). Additionally, we evaluate care providers' satisfaction with such services provided by emergency medicine pharmacists. This was a prospective observational study in the ED of an academic medical center that serves both adult and pediatric patients. Details of emergency medicine pharmacist interventions on discharge prescriptions were compiled with a standardized form. Interventions were categorized as error prevention or optimization of therapy. The staff of the ED was surveyed related to the influence and satisfaction of this new emergency medicine pharmacist-provided service. The 674 discharge prescriptions reviewed by emergency medicine pharmacists during the study period included 602 (89.3%) for adult patients and 72 (10.7%) for pediatric patients. Emergency medicine pharmacists intervened on 68 prescriptions, resulting in an intervention rate of 10.1% (95% confidence interval [CI] 8.0% to 12.7%). The intervention rate was 8.5% (95% CI 6.4% to 11.1%) for adult prescriptions and 23.6% for pediatric prescriptions (95% CI 14.7% to 35.3%) (difference 15.1%; 95% CI 5.1% to 25.2%). There were a similar number of interventions categorized as error prevention and optimization of medication therapy, 37 (54%) and 31 (46%), respectively. More than 95% of survey respondents believed that the new pharmacist services improved patient safety, optimized medication regimens, and improved patient satisfaction. Emergency medicine pharmacist review of discharge prescriptions for discharged ED patients has the potential to significantly improve patient care associated with suboptimal prescriptions and is highly valued by ED care providers. Copyright © 2012. Published by Mosby, Inc.

  16. Predictors of psychiatric boarding in the pediatric emergency department: implications for emergency care.

    Science.gov (United States)

    Wharff, Elizabeth A; Ginnis, Katherine B; Ross, Abigail M; Blood, Emily A

    2011-06-01

    Patients who present to the emergency department (ED) and require psychiatric hospitalization may wait in the ED or be admitted to a medical service because there are no available inpatient psychiatric beds. These patients are psychiatric "boarders." This study describes the extent of the boarder problem in a large, urban pediatric ED, compares characteristics of psychiatrically hospitalized patients with boarders, and compares predictors of boarding in 2 ED patient cohorts. A retrospective cohort study was conducted in 2007-2008. The main outcome measure was placement into a psychiatric facility or boarding. Predictors of boarding in the present analysis were compared with predictors from a similar study conducted in the same ED in 1999-2000. Of 461 ED patient encounters requiring psychiatric admission, 157 (34.1%) boarded. Mean and median boarding duration for the sample were 22.7(SD, 8.08) and 21.18 hours, respectively. Univariate generalized estimating equations demonstrated increased boarding odds for patients carrying Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnoses of autism, mental retardation, and/or developmental delay (P = 0.01), presenting during the weekend (P = 0.03) or presenting during months without school vacation (P = 0.02). Suicidal ideation (SI) significantly predicted boarding status, with increased likelihood of boarding for severe SI (P = 0.02). Age, race, insurance status, and homicidal ideation did not significantly predict boarding in the 2007-2008 patient cohort, although they did in the earlier study. Systemic factors and SI predicted boarding status in both cohorts. Suicidal patients continue to board. Limits within the system, including timing of ED presentation and a dearth of specialized services, still exist, elevating the risk of boarding for some populations. Implications for pediatric ED psychiatric care delivery are discussed.

  17. Distribution and predictors of emergency department charges: the case of a tertiary hospital in Lebanon.

    Science.gov (United States)

    Saleh, Shadi; Mourad, Yara; Dimassi, Hani; Hitti, Eveline

    2016-03-18

    As health care costs continue to increase worldwide, health care systems, and more specifically hospitals are facing continuous pressure to operate more efficiently. One service within the hospital sector whose cost structure has been modestly investigated is the Emergency Department (ED). The study aims to report on the distribution of ED resource use, as expressed in charges, and to determine predictors of/contributors to total ED charges at a major tertiary hospital in Lebanon. The study used data extracted from the ED discharge database for visits between July 31, 2012 and July 31, 2014. Patient visit bills were reported under six major categories: solutions, pharmacy, laboratory, physicians, facility, and radiology. Characteristics of ED visits were summarized according to patient gender, age, acuity score, and disposition. Univariate and multivariate analyses were conducted with total charges as the dependent variable. Findings revealed that the professional fee (40.9 %) followed by facility fee (26.1 %) accounted for the majority of the ED charges. While greater than 80 % of visit charges went to physician and facility fee for low acuity cases, these contributed to only 52 and 54 % of the high acuity presentations where ancillary services and solutions' contribution to the total charges increased. The total charges for males were $14 higher than females; age was a predictor of higher charges with total charges of patients greater than 60 years of age being around $113 higher than ages 0-18 after controlling for all other variables. Understanding the components and determinants of ED charges is essential to developing cost-containment interventions. Institutional modeling of charging patterns can be used to offer price estimates to ED patients who request this information and ultimately help create market competition to drive down costs.

  18. Cabaña ED

    Directory of Open Access Journals (Sweden)

    Lorena Troncoso Valencia

    2018-01-01

    Full Text Available Este proyecto denominado Cabaña Ed, de la arquitecta chilena Lorena Troncoso Valencia, es parte de una serie de obras emplazadas en la comuna de Pinto, Región de Ñuble de Chile. Zona de frondosa vegetación de árboles autóctonos y con fugas visuales hacia la cordillera de los Andes. La Cabaña Ed, donde predomina el uso de la madera, se integra muy sutilmente con ese entorno natural. Cabin ED, by the Chilean architect Lorena Troncoso Valencia, is part of a series of works located in the commune of Pinto, Ñuble Region, Chile. This area is characterized by lush vegetation of native trees and visual towards the Andes leaks. In this project the use of wood predominates, which is subtly integrated with the natural environment. In the edition of REVISTARQUIS 11, another project of the architect, located in that same zone of tourist development was presented.

  19. Ed Watson 1940-2006

    CERN Multimedia

    2006-01-01

    Ed Watson arrived at CERN in March 1973 to work on digital electronics and CAMAC systems under Bob Dobinson, after many years at Rolls Royce in Scotland. He joined the European Muon Collaboration in 1976, where he played a major role in the design, deployment and running of its data acquisition system (DAQ) with David Botterill, Bob Dobinson, and Vicky White. The CAMAC-ROMULUS system was by far the largest and most advanced of its time, and it became a defining standard for DAQ systems for years to come. Ed was deeply involved in the detailed planning of the control rooms and the experiment cabling, as well as sharing the responsibility for the CAMAC readout system. He had a real talent for trouble shooting and played a vital part in supporting the experiment throughout its lifetime. He offered great moral support to the younger members of the collaboration and helped them a great deal with their work. The EMC had a wonderful social life to which Ed was a major contributor - who can forget its barbecues?  In...

  20. Ed Watson - 1940-2006

    CERN Multimedia

    2006-01-01

    Ed Watson passed away suddenly on 1 August in Geneva, he was 66. He leaves his wife and two children. Ed Watson arrived at CERN in March 1973 to work on digital electronics and CAMAC systems under Bob Dobinson, after many years at Rolls Royce in Scotland. He joined the European Muon Collaboration in 1976, where he played a major role in the design, deployment and running of its data acquisition system (DAQ) with David Botterill, Bob Dobinson, and Vicky White. The CAMAC-ROMULUS system was by far the largest and most advanced of its time, and it became a defining standard for DAQ systems for years to come. Ed was deeply involved in the detailed planning of the control rooms and the experiment cabling, as well as sharing the responsibility for the CAMAC readout system. He had a real talent for trouble shooting and played a vital part in supporting the experiment throughout its lifetime. He offered great moral support to the younger members of the collaboration and helped them a great deal with their work. The...

  1. Increased 30-Day Emergency Department Revisits Among Homeless Patients with Mental Health Conditions

    Directory of Open Access Journals (Sweden)

    Chun Nok Lam

    2016-09-01

    Full Text Available Introduction: Patients with mental health conditions frequently use emergency medical services. Many suffer from substance use and homelessness. If they use the emergency department (ED as their primary source of care, potentially preventable frequent ED revisits and hospital readmissions can worsen an already crowded healthcare system. However, the magnitude to which homelessness affects health service utilization among patients with mental health conditions remains unclear in the medical community. This study assessed the impact of homelessness on 30-day ED revisits and hospital readmissions among patients presenting with mental health conditions in an urban, safety-net hospital. Methods: We conducted a secondary analysis of administrative data on all adult ED visits in 2012 in an urban safety-net hospital. Patient demographics, mental health status, homelessness, insurance coverage, level of acuity, and ED disposition per ED visit were analyzed using multilevel modeling to control for multiple visits nested within patients. We performed multivariate logistic regressions to evaluate if homelessness moderated the likelihood of mental health patients’ 30-day ED revisits and hospital readmissions. Results: Study included 139,414 adult ED visits from 92,307 unique patients (43.5±15.1 years, 51.3% male, 68.2% Hispanic/Latino. Nearly 8% of patients presented with mental health conditions, while 4.6% were homeless at any time during the study period. Among patients with mental health conditions, being homeless contributed to an additional 28.0% increase in likelihood (4.28 to 5.48 odds of 30-day ED revisits and 38.2% increase in likelihood (2.04 to 2.82 odds of hospital readmission, compared to non-homeless, non-mental health (NHNM patients as the base category. Adjusted predicted probabilities showed that homeless patients presenting with mental health conditions have a 31.1% chance of returning to the ED within 30-day post discharge and a 3

  2. The Needs Assessment in order to develop the Service of Psychological Lab and Counseling Center, Department of Educational Psychology and Guidance, the Faculty of Education, Mahasarakham University

    Directory of Open Access Journals (Sweden)

    Chaiporn Pongpisanrat

    2017-03-01

    Full Text Available The purpose of this study was to explore the needs assessment in order to develop the service of Psychological Lab and Counseling Center, Department of Educational Psychology and Guidance, the Faculty of Education, Mahasarakham University. This study aimed to compare the realistic service and the desirable service, as well as, to explore the directions to improve the service of Psychological Lab and Counseling Center among the service recipients based on their gender, age range, and field of studies. A total sample of 150 participants were service recipients; college students, lecturers, staff during the first semester academic year 2014 until the first semester academic year 2015. The instruments used included: the Questionnaire on needs assessment of the development of Psychological Lab and Counseling Center, and a focus group discussion. Frequency distribution, percentage, means, standard deviation, and variance were used to analyze the data. The needs assessment results showed as follows: 1 Overall the realistic basis of Psychological Lab and Counseling Center service was in an “above level of needs” while “the highest level of needs” was found in the desirable qualification. After having divided into categories, the result yielded an “above level” on the realistic basis of the counselor characteristics, task planning, and facility arrangement. For the desired qualification, the results showed that the needs on the counselors’ characteristics, task planning, and facility arrangement were identified as at a highest level of needs. 2 No differences were found on the realistic basis needs of the clients, the services provided, gender, and age range of the clients although they responded differently to the questionnaire. The clients who responded to the questionnaire from different field of studies showed the different needs of services provided in the realistic basis significantly at the level of .05 in which the General Sciences

  3. Safe Handling of Snakes in an ED Setting.

    Science.gov (United States)

    Cockrell, Melanie; Swanson, Kristofer; Sanders, April; Prater, Samuel; von Wenckstern, Toni; Mick, JoAnn

    2017-01-01

    Efforts to improve consistency in management of snakes and venomous snake bites in the emergency department (ED) can improve patient and staff safety and outcomes, as well as improve surveillance data accuracy. The emergency department at a large academic medical center identified an opportunity to implement a standardized process for snake disposal and identification to reduce staff risk exposure to snake venom from snakes patients brought with them to the ED. A local snake consultation vendor and zoo Herpetologist assisted with development of a process for snake identification and disposal. All snakes have been identified and securely disposed of using the newly implemented process and no safety incidents have been reported. Other emergency department settings may consider developing a standardized process for snake disposal using listed specialized consultants combined with local resources and suppliers to promote employee and patient safety. Copyright © 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  4. Using Goals, Feedback, Reinforcement, and a Performance Matrix to Improve Customer Service in a Large Department Store

    Science.gov (United States)

    Eikenhout, Nelson; Austin, John

    2005-01-01

    This study employed an ABAC and multiple baseline design to evaluate the effects of (B) feedback and (C) a package of feedback, goalsetting, and reinforcement (supervisor praise and an area-wide celebration as managed through a performance matrix, on a total of 14 various customer service behaviors for a total of 115 employees at a large…

  5. 78 FR 34131 - Notice of Intent To Repatriate Cultural Items: U.S. Department of Agriculture, Forest Service...

    Science.gov (United States)

    2013-06-06

    ..., USDA Forest Service Law Enforcement seized a hide robe from Flora's daughter that had been collected by Flora at the Falls Creek Rock Shelters. Subsequently, in 2009, Bureau of Land Management Law Enforcement..., Cambridge, MA, and by the University of Colorado Museum of Natural History, Boulder, CO. In February 2009...

  6. 78 FR 64265 - Hours of Service of Drivers: U.S. Department of Defense (DOD); Application for Exemption

    Science.gov (United States)

    2013-10-28

    ... break provision of the Agency's hours-of-service (HOS) regulations for commercial motor vehicle (CMV... requirements in Sec. 395.3(a)(3)(ii). SDDC states that it requires continuous attendance and surveillance of... surveillance. Inspecting carrier facilities and corporate headquarters for compliance with DOD and DOT...

  7. 78 FR 48927 - Hours of Service of Drivers: U.S. Department of Defense (DOD); Application for Exemption

    Science.gov (United States)

    2013-08-12

    ... the minimum 30-minute rest break provision of the Agency's hours-of-service (HOS) regulations for... rest break requirements, provided they do not perform any other work during the break. FMCSA requests... reasons for denying or granting the application and, if granted, the name of the person or class of...

  8. 78 FR 70313 - Privacy Act of 1974; Department of Homeland Security U.S. Citizenship and Immigration Services...

    Science.gov (United States)

    2013-11-25

    ... performing or working on a contract, service, grant, cooperative agreement, or other assignment for DOS, when...; Date of Birth; Gender; A-Number; Social Security number; Immigration Status; Date of Arrival in the U.S... disclosure made to such agencies, entities, and persons is reasonably necessary to assist in connection with...

  9. The Students Satisfaction Oriented: Academic Service Improvement Strategy, Department of Aquatic Resources Management, Bogor Agricultural University, Indonesia

    Science.gov (United States)

    Widaryanti; Daryanto, Arief; Fauzi, Anas Miftah

    2016-01-01

    Higher education institutions must have a strategy change management in the increasingly competitive business environment. A continous performance improvement should be made accordingly. This study was conducted with the case of MSP-IPB, to analyze the priority of academic services improvement which were oriented in student satisfaction. This…

  10. The internal audit of clinical areas: a pilot of the internal audit methodology in a health service emergency department.

    Science.gov (United States)

    Brown, Alison; Santilli, Mario; Scott, Belinda

    2015-12-01

    Governing bodies of health services need assurance that major risks to achieving the health service objectives are being controlled. Currently, the main assurance mechanisms generated within the organization are through the review of implementation of policies and procedures and review of clinical audits and quality data. The governing bodies of health services need more robust, objective data to inform their understanding of the control of clinical risks. Internal audit provides a methodological framework that provides independent and objective assurance to the governing body on the control of significant risks. The article describes the pilot of the internal audit methodology in an emergency unit in a health service. An internal auditor was partnered with a clinical expert to assess the application of clinical criteria based on best practice guidelines. The pilot of the internal audit of a clinical area was successful in identifying significant clinical risks that required further management. The application of an internal audit methodology to a clinical area is a promising mechanism to gain robust assurance at the governance level regarding the management of significant clinical risks. This approach needs further exploration and trial in a range of health care settings. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  11. The Library Work Order Processing System: A New Approach to Motivate Employees and to Increase Production in the Technical Service Department of Mercer County Community College Library. Applied Educational Research and Evaluation.

    Science.gov (United States)

    Sim, Yong Sup

    After reviewing the current movement toward job enrichment, a system was designed for the technical services department of the Mercer County Community College Library. The Library Work Order Processing System, as tried between January and March, 1974, was designed to permit each worker more variety of jobs. The technical services department was…

  12. Effect of an emergency department-based electronic system for musculoskeletal consultation on facilitating care for common injuries.

    Science.gov (United States)

    Mears, Simon C; Pantle, Hardin A; Bessman, Edward S; Lifchez, Scott D

    2015-05-01

    Access to musculoskeletal consultation in the emergency department (ED) is a nationwide problem. In addition, consultation from a subspecialist may be delayed or may not be available, which can slow down the ED flow and reduce patient satisfaction. The purpose of this study was to review the 1-year results of a change in the authors' institutional practice to reduce subspecialty consultation for select musculoskeletal problems while still ensuring adequate patient follow-up in orthopedic or plastic surgery clinics for patients not seen by these services in the ED. The authors hypothesized that select injuries could be safely managed in the ED by using an electronic system to ensure appropriate follow-up care. Using Kaizen methodology, a multidisciplinary group (including ED staff, orthopedics, plastic surgery, pediatrics, nursing, radiology, therapy, and administration) met to improve care for select musculoskeletal injuries. A system was agreed on in which ED providers managed select musculoskeletal injuries without subspecialist consultation. Follow-up was organized using an electronic system, which facilitated communication between the ED staff and the secretarial staff of the subspecialist departments. Over a 1-year period, 150 patients were treated using this system. Charts and radiographs were reviewed for missed injuries. Radiographic review revealed 2 missed injuries. One patient had additional back pain and a lumbar spine fracture was found during the subspecialist follow-up visit; it was treated nonoperatively. Another patient appeared to have scapholunate widening on the injury radiograph that was not appreciated in the ED. Of the 150 patients, 51 were seen in follow-up by a subspecialist at the authors' institution. An electronic system to organize follow-up with a subspecialist allowed the ED providers to deliver safe and effective care for simple musculoskeletal injuries. Copyright 2015, SLACK Incorporated.

  13. Time series modelling and forecasting of emergency department overcrowding.

    Science.gov (United States)

    Kadri, Farid; Harrou, Fouzi; Chaabane, Sondès; Tahon, Christian

    2014-09-01

    Efficient management of patient flow (demand) in emergency departments (EDs) has become an urgent issue for many hospital administrations. Today, more and more attention is being paid to hospital management systems to optimally manage patient flow and to improve management strategies, efficiency and safety in such establishments. To this end, EDs require significant human and material resources, but unfortunately these are limited. Within such a framework, the ability to accurately forecast demand in emergency departments has considerable implications for hospitals to improve resource allocation and strategic planning. The aim of this study was to develop models for forecasting daily attendances at the hospital emergency department in Lille, France. The study demonstrates how time-series analysis can be used to forecast, at least in the short term, demand for emergency services in a hospital emergency department. The forecasts were based on daily patient attendances at the paediatric emergency department in Lille regional hospital centre, France, from January 2012 to December 2012. An autoregressive integrated moving average (ARIMA) method was applied separately to each of the two GEMSA categories and total patient attendances. Time-series analysis was shown to provide a useful, readily available tool for forecasting emergency department demand.

  14. ED pharmacist monitoring of provider antibiotic selection aids appropriate treatment for outpatient UTI.

    Science.gov (United States)

    Lingenfelter, Erin; Drapkin, Zachary; Fritz, Kelly; Youngquist, Scott; Madsen, Troy; Fix, Megan

    2016-08-01

    We sought to determine whether an emergency department (ED) pharmacist could aid in the monitoring and correction of inappropriate empiric antibiotic selection for urinary tract infections in an outpatient ED population. Urine cultures with greater than 100 000 CFU/mL bacteria from the University of Utah Emergency Department over 1 year (October 2011-Sept 2012) were identified using our electronic medical record system. Per ED protocol, an ED pharmacist reviews all cultures and performs a chart review of patient symptoms, diagnosis, and discharge antibiotics to determine whether the treatment was appropriate. A retrospective review of this process was performed to identify how often inappropriate treatment was recognized and intervened on by an ED pharmacist. Of the 180 cultures included, a total of 42 (23%) of empiric discharge treatments were considered inappropriate and required intervention. In 35 (83%) of 42 patients, the ED pharmacist was able to contact the patient and make appropriate changes; the remaining 7 patients were unable to be contacted, and no change could be made in their treatment. A chart review of all urine cultures with greater than 100 000 CFU/mL performed by an ED pharmacist helped identify inappropriate treatment in 23% of patients discharged to home with the diagnosis of urinary tract infection. Of these patients who had received inappropriate treatment, an ED pharmacist was able to intervene in 83% of cases. These data highlight the role of ED pharmacists in improving patient care after discharge. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. CORRELATION BETWEEN SERVICE QUALITY AND PATIENT LOYALTY AT OUTPATIENT DEPARTMENT IN SPECIALITY EYE HOSPITAL OF SOUTH SUMATERA PROVINCE

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    Adelina Fitri

    2016-03-01

    Full Text Available Background: The increasing number of hospitals in Indonesia, which is managed by the government and private demand to provide giving the level of care, professionalism and the maximum of competence to reflect the best quality of service. Quality gives special encouragement for company to understand customer expectations which in turn can increase customer satisfaction and create customer loyalty. The objective of the study is analyse correlation between service quality and patient loyalty Method: This study used a survey of analytical methods, with the cross-sectional approach. The samples in this study were patients who were treated in outpatient installation specialty eye hospital South Sumatera Province with total 102 people based on inclusion criteria. The Sampling was taken by proportions random sampling. The data analysis was performed in univariate and bivariate statistical fisher-exact test. The data were presented in p-value, prevalence ratio(PR and 95% confidence intervals (CI. Results: Generally 46.2% respondent who are loyal aged 41-64 years, 32.3% graduate from primary school and 80.6% have distance >5 KM from hospital. From the bivariate analyzes relating to patients loyalty in specialty eye hospital South Sumatera Province are access to services (95% CI 4.3 PR (1.293-14.300 and officer interaction with patients (95% CI 6.786 PR (2.140-21.515, whereas safety (95% CI PR 1.248(0.281-5.540, convenience (95% CI PR 4.136 (1.201-14.246 and waiting times (95% CI PR 1.951 (0.259-14.717 does not have a correlation with patient loyalty. Conclusion: The loyalty of patients in Specialty Eyes Hospital South Sumatera Province have been affected by access to services and officer interaction with the patient.

  16. The impact of an integrated hospital-community medical information system on quality and service utilization in hospital departments.

    Science.gov (United States)

    Nirel, Nurit; Rosen, Bruce; Sharon, Assaf; Blondheim, Orna; Sherf, Michael; Samuel, Hadar; Cohen, Arnon D

    2010-09-01

    In 2005, an innovative system of hospital-community on-line medical records (OFEK) was implemented at Clalit Health Services (CHS). The goals of the study were to examine the extent of OFEK's use and its impact on quality indicators and medical-service utilization in Internal Medicine and General Surgery wards of CHS hospitals. Examining the frequency of OFEK's use with its own track-log data; comparing, "before" and "after", quality indicators and service utilization data in experimental (CHS patients) versus control groups (other patients). OFEK's use increased by tens of percentages each year, Internal Medicine wards showed a significant decrease in the number of laboratory tests and 3 CT tests performed compared with the control group. Wards using OFEK extensively showed a greater decrease in CT tests, in one imaging test, and in the average number of ambulatory hospitalizations. No similar changes were found in General Surgery wards. The study helps evaluate the extent to which OFEK's targets were achieved and contributes to the development of measures to examine the impact of such systems, which can be used to assess a broad range of Health Information Technology (HIT) systems. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

  17. The strengths and weaknesses of the transformational change management process in the South African department of correctional services: A critical analysis

    Directory of Open Access Journals (Sweden)

    Mbongeni A. Mdletye

    2014-12-01

    Full Text Available Change management research has become a critical focus area for change scholars because of the low success rate in change implementation. This exposition of how the transformational change process has been managed at the Department of Correctional Service was meant to show managers, particularly in the said department, that unless managers pay serious attention to certain critical aspects which must form part of the change management process, no real change would be attained. This becomes critical if one considers that there is still a long way to go in the process of transformation to the philosophy of rehbilitation, namely transforming correctional centres to effective institutions of offender rehabilitation. There is currently limited literature on organisational change approaches that are people-oriented. The available literature seems to focus more on the technical aspects (hard issues such as structures, systems and practices in terms of change management at the expense of people issues (soft issues such as the human factors. It has been argued that the neglect of people issues in the management of organisational change processes is responsible for the high failure rate in change implementation. For purposes of contextualising transformational change management within the setting of the Department of Correctional Services, an extensive literature study was undertaken. This was followed by an empirical analysis of data collected through survey questionnaires from correctional officials and offenders respectively. The research established that there were strong and weak points in the DCS transformational change management process from the perspective of both research participants.

  18. Referrer satisfaction as a quality criterion: developing an questionnaire for measuring the quality of services provided by a radiology departement

    International Nuclear Information System (INIS)

    Kubik-Huch, R.A.; Duerselen, L.; Otto, R.; Rexroth, M.; Porst, R.; Szucs, T.

    2005-01-01

    Purpose: To develop a questionnaire for measuring referring physician satisfaction and to conduct a pilot study in which this questionnaire is given to all physicians referring patients to the authors' radiology department. Materials and Methods: After qualitative pre-testing and adjustment of the prototype questionnaire, data were collected using the finalized standardized questionnaire comprising 29 indicators rated on a 4-point ordinal scale mailed with a personalized cover letter to the total referring physician population of a radiology department (n=727). The replies, rated 1-4, were entered into a data entry mask for statistical analysis. Results: The response rate was 33.8%. the indicators with the highest satisfaction rating were the range of examinations offered ('very satisfied': 79.3% mean 3.79), the quality of the technical equipment used for MRI and CT (79.3%, 3.79) and mammography (82.5%, 3.82), and the quality of the images yielded by these procedures (74.5%, 3.73 and 82.2%, 3.83). Dissatisfaction was relatively high with the indicators 'time to receipt of the written report (28.3% 'not very satisfied' or 'not at all satisfied', mean 2.97), 'time to receipt of the X-ray images' (18.2%, 3.07) and 'availability of previous findings' (20.9%, 3.05); satisfaction was higher among external referring physicians (p<0.05). Physicians rated the importance of these three indicators as relatively high ('very important': 62.4%, 54.3% and 49.6%). Other indicators showing a similar level of dissatisfaction were 'car parking availability' (24.1%, 3.01), 'patient waiting time' (27.4%, 2.87) and 'patient environment' (21.2%, 2.99), although these factors were rated as less important ('very important': 33.0%, 33.7% and 40.4%). Conclusion: This questionnaire constitutes a standardized validated instrument for assessing referring physician satisfaction with a radiology department. The data from this pilot study highlight areas for potential improvement. Deployment of

  19. DoD (Department of Defense) Advertising Mix Test. Comparison of Joint-Service with Service-Specific Strategies and Levels of Funding,

    Science.gov (United States)

    1987-07-01

    Change: A Critical Analysis of Theoretical Approaches. New York. Kotler , P. 1975. Marketing for Nonprofit Organizations. Prentice-Han, New Jersey... Kotler , P. and S.J. Levy. 1969. Broadening the Concept of Marketing . Journal of Marketing . (Jan), 19- 33. Kotler , P. and B. Zaltman. 1971. Social...Military Services were confronted with some of the most challenging In total, 72 media markets (i.e., collections of aspects of this experiment. It was

  20. Local Labor Management Relationships as a Vehicle to Advance Reform: Findings from the U.S. Department of Education's Labor Management Conference

    Science.gov (United States)

    Eckert, Jonathan; Houtchens, Bobbi Ciriza; Garcia, Antero; Greer, Nicholas; Khachatryan, Edit; Liou, James; Owens, Steve; Raphael, Leah; Romero, Elaine; Taylor, Katie; Ulmer, Jasmine; VanDusen, Tracey; Yaron, Linda

    2011-01-01

    In February 2011, the U.S. Department of Education (ED)--along with co-sponsors from the American Association of School Administrators, the American Federation of Teachers, the Council of the Great City Schools, the Federal Mediation and Conciliation Service, the National Education Association, and the National School Boards Association--brought…

  1. AdvancED Flex 4

    CERN Document Server

    Tiwari, Shashank; Schulze, Charlie

    2010-01-01

    AdvancED Flex 4 makes advanced Flex 4 concepts and techniques easy. Ajax, RIA, Web 2.0, mashups, mobile applications, the most sophisticated web tools, and the coolest interactive web applications are all covered with practical, visually oriented recipes. * Completely updated for the new tools in Flex 4* Demonstrates how to use Flex 4 to create robust and scalable enterprise-grade Rich Internet Applications.* Teaches you to build high-performance web applications with interactivity that really engages your users.* What you'll learn Practiced beginners and intermediate users of Flex, especially

  2. The ED use and non-urgent visits of elderly patients

    Directory of Open Access Journals (Sweden)

    Umut Gulacti

    2016-12-01

    Full Text Available Objective: To evaluate the use of the emergency department (ED by elderly patients, their non-urgent visits and the prevalence of main disease for ED visits. Methods: This cross-sectional study was conducted on patients aged 65 years and over who visited the ED of a tertiary care university hospital in Turkey between January 2015 and January 2016 retrospectively. Results: A total of 36,369 elderly patients who visited the ED were included in the study. The rate of ED visits by elderly patients was higher than their representation within the general population (p < 0.001. While the rate of elderly patients visiting polyclinics was 15.8%, the rate of elderly patients visiting the ED was 24.3% (p < 0.001. For both genders, the rates of ED visits for patients between 65 and 74 years old was higher than for other elderly age groups (p < 0.001. The prevalence of upper respiratory tract infection (URTI was the highest within the elderly population (17.5%, CI: 17.1–17.9. The proportion of ED visits for non-urgent conditions was 23.4%. Most of the ED visits were during the non-business hours (51.1%, and they were highest in the winter season (25.9% and in January (10.2%. The hospitalization rate was 9.4%, and 37.9% of hospitalized patients were admitted to intensive care units. Conclusion: The proportion of ED visits by elderly patients was higher than their representation within the general population. Elderly patients often visited the ED instead of a polyclinic. The rate of inappropriate ED use by elderly patients in this hospital was higher than in other countries. Keywords: Non-urgent, Prevalence, Visit, Main disease, Elderly patient, Emergency department

  3. Managing pediatric dental trauma in a hospital emergency department.

    Science.gov (United States)

    Mitchell, Jonathan; Sheller, Barbara; Velan, Elizabeth; Caglar, Derya; Scott, Joanna

    2014-01-01

    The purpose of this study was to: (1) examine types of dental trauma presenting to a hospital emergency department (ED); (2) describe the medical services provided to these patients; and (3) quantify time spent during ED encounters for dental trauma emergencies. Records of 265 patients who presented to the ED with dental trauma over a three-year period were reviewed. Demographics, injury types, triage acuity, pain scores, and dental/medical treatment and times were analyzed. Patient demographics and injury types were similar to previous studies. Eighty-two percent of patients received mid-level triage scores; 41 percent of patients had moderate to severe pain. The most frequently provided medical services were administration of analgesics and/or prescriptions (78 percent). The mean times were: 51 minutes waiting for a physician; 55 minutes with dentists; and 176 minutes total time. Higher triage acuity and pain levels resulted in significantly longer wait times for physician assessment. Dental evaluation, including treatment, averaged 32 percent of time spent at the hospital. A dental clinic is the most efficient venue for treating routine dental trauma. Patients in this study spent the majority of time waiting for physicians and receiving nondental services. Most patients required no medical intervention beyond prescriptions commonly used in dental practice.

  4. Working Together to Connect Care: a metropolitan tertiary emergency department and community care program.

    Science.gov (United States)

    Harcourt, Debra; McDonald, Clancy; Cartlidge-Gann, Leonie; Burke, John

    2017-03-02

    Objective Frequent attendance by people to an emergency department (ED) is a global concern. A collaborative partnership between an ED and the primary and community healthcare sectors has the potential to improve care for the person who frequently attends the ED. The aims of the Working Together to Connect Care program are to decrease the number of presentations by providing focused community support and to integrate all healthcare services with the goal of achieving positive, patient-centred and directed outcomes. Methods A retrospective analysis of ED data for 2014 and 2015 was used to ascertain the characteristics of the potential program cohort. The definition used to identify a 'frequent attendee' was more than four presentations to an ED in 1 month. This analysis was used to develop the processes now known as the Working Together to Connect Care program. This program includes participant identification by applying the definition, flagging of potential participants in the ED IT system, case review and referral to community services by ED staff, case conferencing facilitated within the ED and individualised, patient centred case management provided by government and non-government community services. Results Two months after the date of commencement of the Working Together to Connect Care program there are 31 active participants in the program: 10 are on the Mental Health pathway, and one is on the No Consent pathway. On average there are three people recruited to the program every week. The establishment of a new program for supporting frequent attendees of an ED has had its challenges. Identifying systems that support people in their community has been an early positive outcome of this project. Conclusion It is expected that data regarding the number of ED presentations, potential fiscal savings and client outcomes will be available in 2017. What is known about the topic? Frequent attendance at EDs is a global issue and although the number of 'super users' is

  5. Internet Presentation of Departments of Pediatric Surgery in Germany and Their Compliance with Recommended Criteria for Promoting Services and Offering Professional Information for Patients.

    Science.gov (United States)

    Farhat, Naim; Zoeller, Christoph; Petersen, Claus; Ure, Benno

    2016-08-01

    Introduction The presentation of health institutions in the internet is highly variable concerning marketing features and medical information. We aimed to investigate the structure and the kind of information provided on the Web sites of all departments of pediatric surgery in Germany. Furthermore, we aimed to identify the degree to which these Web sites comply with internet marketing recommendations for generating business. Method The Web sites of all pediatric surgery units referred to as departments on the official Web site of the German Society of Pediatric Surgery (GSPS) were assessed. The search engine Google was used by entering the terms "pediatric surgery" and the name of the city. Besides general data eight content characteristics focusing on ranking, accessibility, use of social media, multilingual sites, navigation options, selected images, contact details, and medical information were evaluated according to published recommendations. Results A total of 85 departments of pediatric surgery were included. On Google search results 44 (52%) ranked number one and 34 (40%) of the department's homepages were accessible directly through the homepage link of the GSPS. A link to own digital and/or social media was offered on 11 (13%) homepages. Nine sites were multilingual. The most common navigation bar item was clinical services on 74 (87%) homepages. Overall, 76 (89%) departments presented their doctors and 17 (20%) presented other staff members with images of doctors on 53 (62%) and contact data access from the homepage on 68 (80%) Web sites. On 25 (29%) Web sites information on the medical conditions treated were presented, on 17 (20%) details of treating concepts, and on 4 (5%) numbers of patients with specific conditions treated in the own department per year. Conclusion We conclude that numerous of the investigated online presentations do not comply with recommended criteria for offering professional information for patients and for promoting

  6. Testing the effects of educational toilet posters: a novel way of reducing haemolysis of blood samples within ED.

    Science.gov (United States)

    Corkill, David

    2012-02-01

    Haemolysed blood samples are an unnecessary burden on Emergency Departments (ED) as they increase workloads and drive down efficiencies. Little empirical data exists that demonstrates the effectiveness of educational posters displayed in staff toilet cubicles. This study explored the impact educational toilet posters have on reducing haemolysis rates within the ED. A time series study of the clinical effect of educational toilet posters on reducing haemolysis rates throughout a 12 month period at the Gold Coast Hospital ED was undertaken. The GCH ED is a tertiary emergency service that has approximately 66,000 patient presentations per year. Data was collected prospectively. Analysis was undertaken to investigate the effects on total number of haemolysed samples and those clinically significant samples with a haemolytic index >3. Further investigation explored the specific effects on medical and nursing staff. Analysis undertaken using an independent t-test found that the pre-intervention data demonstrates a medium haemolysis rate of 4.92% (SD=1.04). This is a statistically significantly different (t=3.56, df=50, p=0.001) from the median post intervention data of 3.95% (SD=0.84). The difference of 0.97% (95%CI=0.42, 1.52) represents a 19.72% reduction in clinically significant haemolysed samples over the study period. This study reveals that the use of educational toilet posters had a positive impact on reducing the rates of haemolysed samples collected within the ED. This simple and cost effective educational initiative changed the behaviour of clinical staff. Further investigation is warranted to examine the impact of educational toilet posters on additional clinical scenarios. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

  7. Eight months of emergency services by ambulance (with doctor on board) of the Emergency Department of Prato, Italy.

    Science.gov (United States)

    Olia, P M; Mollica, T V; Querci, A

    2002-11-01

    The aim of the present study was to analyse the types of calls attended by the authors in their ambulance, assigned to one sector of the urban area of Prato. We analysed 1060 consecutive calls carried out by our ambulance; 33 calls (3.1%), cancelled for various reasons, were excluded from statistical analysis. The calls regarded 1027 patients, 549 (53.5%) males and 478 (46.5%) females. 46% of calls concerned non trauma cases, 17% trauma cases and 7.2% transfers between hospitals. Calls in the non trauma group were for dyspnea (16.7%), unconsciousness (16.6%), chest pain (11.8%), cerebrovascular pathology (7.7%), mental disorders (7.1%), abdominal pain (5.1%), use of psychotropic substances (4%) and convulsions (3.2%). Support to patients with terminal cancer accounted for 2.3% of cases, metabolic disorders 2.2%, hypertensive events 2.1%, tachycardia 1.9%, vertigo 1.9%, allergies 1%, obstetric pathology 0.5% and cardiorespiratory resuscitation 2,2%. Thirteen point seven percent were miscellaneous, including poisonings, migraines, haemorrhages and flu syndromes. Trauma cases included road accidents (62.6%), falls (27%), aggression (6.9%), work-related accidents (3.5%). The percentage of trauma cases (17%) was similar to that reported for a Swedish urban area (20%). Cases of cardiorespiratory resuscitation were 1.65% of our calls, compared to 1.73% and 1.8% reported in Northeastern Germany and Taiwan. Although prehospital emergency medical services are organised differently in different countries, our data suggest that emergency medical services in our area have a percentage distribution of case types similar to services in other countries.

  8. PENTINGNYA PERANAN SKILL DAN MENU KNOWLEDGE WAITER/WAITERS TERHADAP KEPUASAN PELANGGAN DI FOOD AND BEVERAGE SERVICE DEPARTEMENT

    Directory of Open Access Journals (Sweden)

    Fitria Earlike AS

    2016-11-01

    Full Text Available The Background of this research from the topic is the lack of waiter/ waitress�s skills and menu knowledge when doing the food and beverage services. The purpose of this research is to know the importance of waiter /waitress�s skills and menu knowledge toward guest satisfaction. Method of the research was descriptive qualitative which was collected data by using interview, observation, documentation, quitionare and study of literature. The rusult shows that guests� satisfaction are decreased and proved by the respondents quitionare result which shows that the guests are not satified with the waiter/ waitress skills and menu knowledge.

  9. Building capacity in VA to provide emergency gynecology services for women.

    Science.gov (United States)

    Cordasco, Kristina M; Huynh, Alexis K; Zephyrin, Laurie; Hamilton, Alison B; Lau-Herzberg, Amy E; Kessler, Chad S; Yano, Elizabeth M

    2015-04-01

    Visits to Veterans Administration (VA) emergency departments (EDs) are increasingly being made by women. A 2011 national inventory of VA emergency services for women revealed that many EDs have gaps in their resources and processes for gynecologic emergency care. To guide VA in addressing these gaps, we sought to understand factors acting as facilitators and/or barriers to improving VA ED capacity for, and quality of, emergency gynecology care. Semistructured interviews with VA emergency and women's health key informants. ED directors/providers (n=14), ED nurse managers (n=13), and Women Veteran Program Managers (n=13) in 13 VA facilities. Leadership, staff, space, demand, funding, policies, and community were noted as important factors influencing VA EDs building capacity and improving emergency gynecologic care for women Veterans. These factors are intertwined and cross multiple organizational levels so that each ED's capacity is a reflection not only of its own factors, but also those of its local medical center and non-VA community context as well as VA regional and national trends and policies. Policies and quality improvement initiatives aimed at building VA's emergency gynecologic services for women need to be multifactorial and aimed at multiple organizational levels. Policies need to be flexible to account for wide variations across EDs and their medical center and community contexts. Approaches that build and encourage local leadership engagement, such as evidence-based quality improvement methodology, are likely to be most effective.

  10. Analysis of Patient Visits and Collections After Opening a Satellite Pediatric Emergency Department.

    Science.gov (United States)

    Nichols, Katherine M; Caperell, Kerry; Cross, Keith; Duncan, Scott; Foster, Ben; Liu, Gil; Pritchard, Hank; Southard, Gary; Shinabery, Ben; Sutton, Brad; Kim, In K

    2018-04-01

    Satellite pediatric emergency departments (PEDs) have emerged as a strategy to increase patient capacity. We sought to determine the impact on patient visits, physician fee collections, and value of emergency department (ED) time at the primary PED after opening a nearby satellite PED. We also illustrate the spatial distribution of patient demographics and overlapping catchment areas for the primary and satellite PEDs using geographical information system. A structured, financial retrospective review was conducted. Aggregate patient demographic data and billing data were collected regarding physician fee charges, collections, and patient visits for both PEDs. All ED visits from January 2009 to December 2013 were analyzed. Geographical information system mapping using ArcGIS mapped ED patient visits. Patient visits at the primary PED were 53,050 in 2009 before the satellite PED opened. The primary PED visits increased after opening the satellite PED to 55,932 in 2013. The satellite PED visits increased to 21,590 in 2013. Collections per visit at the primary PED decreased from $105.13 per visit in 2011 to $86.91 per visit in 2013. Total collections at the satellite PED decreased per visit from $155.41 per visit in 2011 to $128.53 per visit in 2013. After opening a nearby satellite PED, patient visits at the primary PED did not substantially decrease, suggesting that there was a previously unrecognized demand for PED services. The collections per ED visit were greater at the satellite ED, likely due to a higher collection rate.

  11. Utilization of Failure Mode and Effects Analysis (FMEA) Method in Increasing the Revenue of Emergency Department; a Prospective Cohort Study.

    Science.gov (United States)

    Shahrami, Ali; Rahmati, Farhad; Kariman, Hamid; Hashemi, Behrooz; Rahmati, Majid; Baratloo, Alireza; Forouzanfar, Mohammad Mehdi; Safari, Saeed

    2013-01-01

    The balance between revenue and cost of an organization/system is essential to maintain its survival and quality of services. Emergency departments (ED) are one of the most important parts of health care delivery system. Financial discipline of EDs, by increasing the efficiency and profitability, can directly affect the quality of care and subsequently patient satisfaction. Accordingly, the present study attempts to investigate failure mode and effects analysis (FMEA) method in identifying the problems leading to the loss of ED revenue and offer solutions to help fix these problems. This prospective cohort study investigated the financial records of ED patients and evaluated the effective errors in reducing the revenue in ED of Imam Hossein hospital, Tehran, Iran, from October 2007 to November 2009. The whole department was divided into one main system and six subsystems, based on FMEA. The study was divided into two phases. In the first phase, the problems leading to the loss of revenue in each subsystem were identified and weighted into four groups using risk priority number (RPN), and the solutions for fixing them were planned. Then, in the second phase, discovered defects in the first phase were fixed according to their priority. Finally, the impact of each solution was compared before and after intervention using the repeated measure ANOVA test. 100 financial records of ED patients were evaluated during the first phase of the study. The average of ED revenue in the six months of the first phase was 73.1±3.65 thousand US dollars/month. 12 types of errors were detected in the predefined subsystems. ED revenue rose from 73.1 to 153.1, 207.06, 240, and 320 thousand US dollars/month after solving first, second, third, and fourth priority problems, respectively (337.75% increase in two years) (pFMEA could be considered as an efficient model for increasing the revenue of emergency department. According to this model, not recording the services by the nursing unit

  12. Impact of the ABCDE triage in primary care emergency department on the number of patient visits to different parts of the health care system in Espoo City

    Directory of Open Access Journals (Sweden)

    Kantonen Jarmo

    2012-01-01

    Full Text Available Abstract Background Many Finnish emergency departments (ED serve both primary and secondary health care patients and are therefore referred to as combined emergency departments. Primary care doctors are responsible for the initial assessment and treatment. They, thereby, also regulate referral and access to secondary care. Primary health care EDs are easy for the public to access, leading to non-acute patient visits to the emergency department. This has caused increased queues and unnecessary difficulties in providing immediate treatment for urgent patients. The primary aim of this study was to assess whether the flow of patients was changed by implementing the ABCDE-triage system in the EDs of Espoo City, Finland. Methods The numbers of monthly visits to doctors were recorded before and after intervention in Espoo primary care EDs. To study if the implementation of the triage system redirects patients to other health services, the numbers of monthly visits to doctors were also scored in the private health care, the public sector health services of Espoo primary care during office hours and local secondary health care ED (Jorvi hospital. A face-to-face triage system was applied in the primary care EDs as an attempt to provide immediate treatment for the most acute patients. It is based on the letters A (patient sent directly to secondary care, B (to be examined within 10 min, C (to be examined within 1 h, D (to be examined within 2 h and E (no need for immediate treatment for assessing the urgency of patients' treatment needs. The first step was an initial patient assessment by a health care professional (triage nurse. The introduction of this triage system was combined with information to the public on the "correct" use of emergency services. Results After implementation of the ABCDE-triage system the number of patient visits to a primary care doctor decreased by up to 24% (962 visits/month as compared to the three previous years in the EDs

  13. Advertising emergency department wait times.

    Science.gov (United States)

    Weiner, Scott G

    2013-03-01

    Advertising emergency department (ED) wait times has become a common practice in the United States. Proponents of this practice state that it is a powerful marketing strategy that can help steer patients to the ED. Opponents worry about the risk to the public health that arises from a patient with an emergent condition self-triaging to a further hospital, problems with inaccuracy and lack of standard definition of the reported time, and directing lower acuity patients to the higher cost ED setting instead to primary care. Three sample cases demonstrating the pitfalls of advertising ED wait times are discussed. Given the lack of rigorous evidence supporting the practice and potential adverse effects to the public health, caution about its use is advised.

  14. Advertising Emergency Department Wait Times

    Science.gov (United States)

    Weiner, Scott G.

    2013-01-01

    Advertising emergency department (ED) wait times has become a common practice in the United States. Proponents of this practice state that it is a powerful marketing strategy that can help steer patients to the ED. Opponents worry about the risk to the public health that arises from a patient with an emergent condition self-triaging to a further hospital, problems with inaccuracy and lack of standard definition of the reported time, and directing lower acuity patients to the higher cost ED setting instead to primary care. Three sample cases demonstrating the pitfalls of advertising ED wait times are discussed. Given the lack of rigorous evidence supporting the practice and potential adverse effects to the public health, caution about its use is advised. PMID:23599836

  15. Advertising Emergency Department Wait Times

    Directory of Open Access Journals (Sweden)

    Scott G. Weiner

    2013-03-01

    Full Text Available Advertising emergency department (ED wait times has become a common practice in the UnitedStates. Proponents of this practice state that it is a powerful marketing strategy that can help steerpatients to the ED. Opponents worry about the risk to the public health that arises from a patient withan emergent condition self-triaging to a further hospital, problems with inaccuracy and lack of standarddefinition of the reported time, and directing lower acuity patients to the higher cost ED setting insteadto primary care. Three sample cases demonstrating the pitfalls of advertising ED wait times arediscussed. Given the lack of rigorous evidence supporting the practice and potential adverse effects tothe public health, caution about its use is advised

  16. Factors Associated With the Likelihood of Hospitalization Following Emergency Department Visits for Behavioral Health Conditions.

    Science.gov (United States)

    Hamilton, Jane E; Desai, Pratikkumar V; Hoot, Nathan R; Gearing, Robin E; Jeong, Shin; Meyer, Thomas D; Soares, Jair C; Begley, Charles E

    2016-11-01

    Behavioral health-related emergency department (ED) visits have been linked with ED overcrowding, an increased demand on limited resources, and a longer length of stay (LOS) due in part to patients being admitted to the hospital but waiting for an inpatient bed. This study examines factors associated with the likelihood of hospital admission for ED patients with behavioral health conditions at 16 hospital-based EDs in a large urban area in the southern United States. Using Andersen's Behavioral Model of Health Service Use for guidance, the study examined the relationship between predisposing (characteristics of the individual, i.e., age, sex, race/ethnicity), enabling (system or structural factors affecting healthcare access), and need (clinical) factors and the likelihood of hospitalization following ED visits for behavioral health conditions (n = 28,716 ED visits). In the adjusted analysis, a logistic fixed-effects model with blockwise entry was used to estimate the relative importance of predisposing, enabling, and need variables added separately as blocks while controlling for variation in unobserved hospital-specific practices across hospitals and time in years. Significant predisposing factors associated with an increased likelihood of hospitalization following an ED visit included increasing age, while African American race was associated with a lower likelihood of hospitalization. Among enabling factors, arrival by emergency transport and a longer ED LOS were associated with a greater likelihood of hospitalization while being uninsured and the availability of community-based behavioral health services within 5 miles of the ED were associated with lower odds. Among need factors, having a discharge diagnosis of schizophrenia/psychotic spectrum disorder, an affective disorder, a personality disorder, dementia, or an impulse control disorder as well as secondary diagnoses of suicidal ideation and/or suicidal behavior increased the likelihood of hospitalization

  17. Referrer satisfaction as a quality criterion: developing an questionnaire for measuring the quality of services provided by a radiology department

    International Nuclear Information System (INIS)

    Kubik-Huch, R.A.; Duerselen, L.; Otto, R.; Rexroth, M.; Porst, R.; Szucs, T.

    2005-01-01

    Purpose: to develop a questionnaire for measuring referring physician satisfaction and to conduct a pilot study in which this questionnaire is given to all physicians referring patients to the authors' radiology department. Materials and methods: after qualitative pre-testing and adjustment of the prototype questionnaire, data were collected using the finalized standardized questionnaire comprising 29 indicators rated on a 4-point ordinal scale mailed with a personalized cover letter to the total referring physician population of a radiology department (n = 727). The replies, rated 1-4, were entered into a data entry mask for statistical analysis. Results: the response rate was 33.8%. The indicators with the highest satisfaction rating were the range of examinations offered (''very satisfied'': 79.3% mean 3.79), the quality of the technical equipment used for MRI and CT (79.3%, 3.79) and mammography (82.5%, 3.82), and the quality of the images yielded by these procedures (74.5%, 3.73 and 82.2%, 3.83). Dissatisfaction was relatively high with the indicators ''time to receipt of the written report'' (28.3% ''not very satisfied'' or ''not at all satisfied'', mean 2.97), ''time to receipt of the X-ray images'' (18.2%, 3.07) and ''availability of previous findings'' (20.9%, 3.05); satisfaction was higher among external referring physicians (p < 0.05). Physicians rated the importance of these three indicators as relatively high (''very important'': 62.4%, 54.3% and 49.6%). Other indicators showing a similar level of dissatisfaction were ''car parking availability'' (24.1%, 3.01), ''patient waiting time'' (27.4%, 2.87) and ''patient environment'' (21.2%, 2.99), although these factors were rated as less important (''very important'': 33.0%, 33.7% and 40.4%). (orig.)

  18. Real time analysis under EDS

    International Nuclear Information System (INIS)

    Schneberk, D.

    1985-07-01

    This paper describes the analysis component of the Enrichment Diagnostic System (EDS) developed for the Atomic Vapor Laser Isotope Separation Program (AVLIS) at Lawrence Livermore National Laboratory (LLNL). Four different types of analysis are performed on data acquired through EDS: (1) absorption spectroscopy on laser-generated spectral lines, (2) mass spectrometer analysis, (3) general purpose waveform analysis, and (4) separation performance calculations. The information produced from this data includes: measures of particle density and velocity, partial pressures of residual gases, and overall measures of isotope enrichment. The analysis component supports a variety of real-time modeling tasks, a means for broadcasting data to other nodes, and a great degree of flexibility for tailoring computations to the exact needs of the process. A particular data base structure and program flow is common to all types of analysis. Key elements of the analysis component are: (1) a fast access data base which can configure all types of analysis, (2) a selected set of analysis routines, (3) a general purpose data manipulation and graphics package for the results of real time analysis. Each of these components are described with an emphasis upon how each contributes to overall system capability. 3 figs

  19. Radiological dose assessment of Department of Energy Pinellas Plant waste proposed for disposal at Laidlaw Environmental Services of South Carolina, Inc

    International Nuclear Information System (INIS)

    Socolof, M.L.; Lee, D.W.

    1996-05-01

    The U.S. Department of Energy (DOE) Pinellas Plant in Largo, FL is proposing to ship and dispose of hazardous sludge, listed as F006 waste, to the Laidlaw Environmental Services of South Carolina, Inc. (Laidlaw) treatment, storage, and disposal facility in Pinewood, South Carolina. This sludge contains radioactive tritium in concentrations of about 28 pCi/g. The objective of this study is to assess the possible radiological impact to workers at the Laidlaw facility and members of the public due to the handling, processing, and burial of the DOE waste containing tritium

  20. Radiological dose assessment of Department of Energy Pinellas Plant waste proposed for disposal at Laidlaw Environmental Services of South Carolina, Inc.

    Energy Technology Data Exchange (ETDEWEB)

    Socolof, M.L.; Lee, D.W.

    1996-05-01

    The U.S. Department of Energy (DOE) Pinellas Plant in Largo, FL is proposing to ship and dispose of hazardous sludge, listed as F006 waste, to the Laidlaw Environmental Services of South Carolina, Inc. (Laidlaw) treatment, storage, and disposal facility in Pinewood, South Carolina. This sludge contains radioactive tritium in concentrations of about 28 pCi/g. The objective of this study is to assess the possible radiological impact to workers at the Laidlaw facility and members of the public due to the handling, processing, and burial of the DOE waste containing tritium.

  1. Pain management in the emergency department and its relationship to patient satisfaction.

    Science.gov (United States)

    Downey, La Vonne A; Zun, Leslie S

    2010-10-01

    Pain is the most common reason due to which patients come to the emergency department (ED). The purpose of this study was to measure the correlation, if any, between pain reduction and the level of satisfaction in patients who presented to the ED with pain as their chief complaint. This study used a randomly selected group of patients who presented to the ED with pain of 4 or more on the Visual Analogue Pain Scale (VAS) as their chief complaint to a level one adult and pediatric trauma center. Instruments that were used in this study were the VAS, Brief Pain Inventory (BPI), and the Medical Interview Satisfaction Scale (MISS). They were administered to patients by research fellows in the treatment rooms. Statistical analysis included frequencies, descriptive, and linear regression. This study was approved by the Internal Review Board. A total of 159 patients were enrolled in the study. All patients were given some type of treatment for their pain upon arrival to the ED. A logistic regression showed a significant relationship to reduction in pain by 40% or more and customer service questions. A reduction in perceived pain levels does directly relate to several indicators of customer service. Patients who experienced pain relief during their stay in the ED had significant increases in distress relief, rapport with their doctor, and intent to comply with given instructions.

  2. Pain management in the emergency department and its relationship to patient satisfaction

    Directory of Open Access Journals (Sweden)

    Downey La Vonne

    2010-01-01

    Full Text Available Background : Pain is the most common reason due to which patients come to the emergency department (ED. Aim : The purpose of this study was to measure the correlation, if any, between pain reduction and the level of satisfaction in patients who presented to the ED with pain as their chief complaint. Materials and Methods : This study used a randomly selected group of patients who presented to the ED with pain of 4 or more on the Visual Analogue Pain Scale (VAS as their chief complaint to a level one adult and pediatric trauma center. Instruments that were used in this study were the VAS, Brief Pain Inventory (BPI, and the Medical Interview Satisfaction Scale (MISS. They were administered to patients by research fellows in the treatment rooms. Statistical analysis included frequencies, descriptive, and linear regression. This study was approved by the Internal Review Board. Results : A total of 159 patients were enrolled in the study. All patients were given some type of treatment for their pain upon arrival to the ED. A logistic regression showed a significant relationship to reduction in pain by 40% or more and customer service questions. Conclusions : A reduction in perceived pain levels does directly relate to several indicators of customer service. Patients who experienced pain relief during their stay in the ED had significant increases in distress relief, rapport with their doctor, and intent to comply with given instructions.

  3. Recognition difference and improvement direction of the radiological technologists and patient against medical service in department radiology - Inchon area in the object

    International Nuclear Information System (INIS)

    An, Sung Min; Kim, Sung Chul

    2006-01-01

    Satisfaction of the patient against the medical service in department of radiology and it evaluated the different recognition of radiological technologist and patient, and investigates it's improvement direction. It sent the reply the above the which is a usual result in question result of the most that, the receipt process it was complicated in the portion which is insufficient. 'The receipt process is complication', 'waiting time is long' and ' don't radiation protection for patient and guardian'. Also these a facts was recognizing patients and radiological technologist all. And the effort of the radiological technologist is necessary with the method which reduces a recognition difference. The periodical medical service satisfaction investigates and must endeavor in reform measure preparation

  4. Provision of utility support services to the US Department of Energy San Francisco Operations Office. Final technical report

    Energy Technology Data Exchange (ETDEWEB)

    1994-04-01

    The main purpose of this project was to provide to DOE/SAN continuing, follow-up support to realize savings from a number of alternate supply arrangements that had already been and/or were expected to be identified under the original project. This expected continuation of these efforts is demonstrated by certain of the tasks that are spelled out in the Statement of Work. For example: Evaluate and propose alternative options and methods for improving efficiency, reducing cost, and making effective use of the energy supplies and facilities under various conditions of use; Provide engineering and economic analysis and recommendations for utility-related facilities and service issues, such as high voltage discounts, ownership of facilities, etc.; Assist in developing strategy and documentation in support of negotiating utility contracts and modifications thereto. In addition, the follow-on contract provided for monitoring and intervening in rate cases that had particular relevance to the DOE/SAN laboratories.

  5. Quality assurance programs developed and implemented by the US Department of Energy`s Analytical Services Program for environmental restoration and waste management activities

    Energy Technology Data Exchange (ETDEWEB)

    Lillian, D.; Bottrell, D. [Dept. of Energy, Germntown, MD (United States)

    1993-12-31

    The U.S. Department of Energy`s (DOE`s) Office of Environmental Restoration and Waste Management (EM) has been tasked with addressing environmental contamination and waste problems facing the Department. A key element of any environmental restoration or waste management program is environmental data. An effective and efficient sampling and analysis program is required to generate credible environmental data. The bases for DOE`s EM Analytical Services Program (ASP) are contained in the charter and commitments in Secretary of Energy Notice SEN-13-89, EM program policies and requirements, and commitments to Congress and the Office of Inspector General (IG). The Congressional commitment by DOE to develop and implement an ASP was in response to concerns raised by the Chairman of the Congressional Environment, Energy, and Natural Resources Subcommittee, and the Chairman of the Congressional Oversight and Investigations Subcommittee of the Committee on Energy and Commerce, regarding the production of analytical data. The development and implementation of an ASP also satisfies the IG`s audit report recommendations on environmental analytical support, including development and implementation of a national strategy for acquisition of quality sampling and analytical services. These recommendations were endorsed in Departmental positions, which further emphasize the importance of the ASP to EM`s programs. In September 1990, EM formed the Laboratory Management Division (LMD) in the Office of Technology Development to provide the programmatic direction needed to establish and operate an EM-wide ASP program. In January 1992, LMD issued the {open_quotes}Analytical Services Program Five-Year Plan.{close_quotes} This document described LMD`s strategy to ensure the production of timely, cost-effective, and credible environmental data. This presentation describes the overall LMD Analytical Services Program and, specifically, the various QA programs.

  6. Quality assurance programs developed and implemented by the US Department of Energy's Analytical Services Program for environmental restoration and waste management activities

    International Nuclear Information System (INIS)

    Lillian, D.; Bottrell, D.

    1993-01-01

    The U.S. Department of Energy's (DOE's) Office of Environmental Restoration and Waste Management (EM) has been tasked with addressing environmental contamination and waste problems facing the Department. A key element of any environmental restoration or waste management program is environmental data. An effective and efficient sampling and analysis program is required to generate credible environmental data. The bases for DOE's EM Analytical Services Program (ASP) are contained in the charter and commitments in Secretary of Energy Notice SEN-13-89, EM program policies and requirements, and commitments to Congress and the Office of Inspector General (IG). The Congressional commitment by DOE to develop and implement an ASP was in response to concerns raised by the Chairman of the Congressional Environment, Energy, and Natural Resources Subcommittee, and the Chairman of the Congressional Oversight and Investigations Subcommittee of the Committee on Energy and Commerce, regarding the production of analytical data. The development and implementation of an ASP also satisfies the IG's audit report recommendations on environmental analytical support, including development and implementation of a national strategy for acquisition of quality sampling and analytical services. These recommendations were endorsed in Departmental positions, which further emphasize the importance of the ASP to EM's programs. In September 1990, EM formed the Laboratory Management Division (LMD) in the Office of Technology Development to provide the programmatic direction needed to establish and operate an EM-wide ASP program. In January 1992, LMD issued the open-quotes Analytical Services Program Five-Year Plan.close quotes This document described LMD's strategy to ensure the production of timely, cost-effective, and credible environmental data. This presentation describes the overall LMD Analytical Services Program and, specifically, the various QA programs

  7. 8 Different approaches needed to manage ED demand among different age-groups.

    Science.gov (United States)

    Rimmer, Melanie; Ablard, Suzanne; O'Keeffe, Colin; Mason, Suzanne

    2017-12-01

    A variety of interventions have been proposed to manage rising demand for Emergency and Urgent Care, described by an NHS England review as unsustainable in the long term. However it is unlikely that any suggested approach will be equally suitable for the diverse population of ED users.We aimed to understand the patterns of demand amongst different types of patients attending ED. We also sought to understand the intended and unintended effects of demand management initiatives. Our study combined insights from routine data, a survey of ED patients, and qualitative interviews with ED staff. This paper describes the results of our analysis of the interviews. We conducted semi-structured interviews with 25 ED and Urgent Care Centre staff across 7 hospital sites in Yorkshire and Humber between 25 April and 11 July 2016. The interview topic guide asked about 4 broad areas; job role, description of patients and their impact on demand, description of inappropriate attendance, and current/future initiatives to deal with rising demand. Interviews were transcribed verbatim and analysed using framework analysis. We analysed the results to identify groups of patients with different patterns of use of ED services. We also explored ED staff experiences of demand management initiatives, and their suggestions for future initiatives. Although we did not ask specifically about patients' age, our analysis revealed that ED staff categorised attenders as children and young people, working age people, and older people. These groups had different reasons for attendance, different routes to the ED, different rate of non-urgent attendance, and different issues driving demand. Staff also described variation in the time taken to treat patients of different ages, with the oldest and youngest patients described as requiring the most time.There was no consensus amongst staff about the effectiveness of initiatives for managing demand. A strikingly wide variety of initiatives were mentioned

  8. Emergency nurses’ perceptions of emergency department preparedness for an ebola outbreak: a qualitative descriptive study

    OpenAIRE

    Pincha Baduge, Mihirika Surangi De Silva

    2017-01-01

    Introduction: Ebola Virus Disease (EVD) is a highly contagious disease with a high mortality rate. The 2014 outbreak in West Africa grew uncontrollably, and on the 8th August 2014, the World Health Organization (WHO) declared the outbreak as a public health emergency of international concern. Emergency Departments (ED) in Australian health services commenced preparation and vigilance for people presenting with EVD like symptoms, so that any spread of the disease could be prevented. Researc...

  9. Homelessness: patterns of emergency department use and risk factors for re-presentation.

    Science.gov (United States)

    Moore, G; Gerdtz, M F; Hepworth, G; Manias, E

    2011-05-01

    To describe patterns of service use and to predict risk factors for re-presentation to a metropolitan emergency department (ED) among people who are homeless. A retrospective cohort analysis was undertaken over a 24-month period from a principal referral hospital in Melbourne, Australia. All ED visits relating to people classified as homeless were included. A predictive model for risk of re-presentation was developed using logistic regression with random effects. Rates of re-presentation, defined as the total number of visits to the same ED within 28 days of discharge, were measured. The study period was 1 January 2003 to 31 December 2004. The re-presentation rate for homeless people was 47.8% (3199/6689) of ED visits and 45.5% (725/1595) of the patients. The final predictive model included risk factors, which incorporated both hospital and community service use. Those characteristics that resulted in significantly increased odds of re-presentation were leaving hospital at own risk (OR 1.31; 95% CI 1.10 to 1.56), treatment in another hospital (OR 1.45, 95% CI 1.23 to 1.72) and being in receipt of community-based case management (OR 1.31, 95% CI 1.11 to 1.54) or pension (OR 1.34, 95% CI 1.12 to 1.62). The predictive model identified nine risk factors of re-presentation to the ED for people who are homeless. Early identification of these factors among homeless people may alert clinicians to the complexity of issues influencing an individual ED visit. This information can be used at admission and discharge by ensuring that homeless people have access to services commensurate with their health needs. Improved linkage between community and hospital services must be underscored by the capacity to provide safe and secure housing.

  10. A Study on the Relationship between Customer Satisfaction and Employee Service Delivery at Sutera Sanctuary Lodges’s Front Office Department at Kinabalu Park, Kundasang, Sabah, Malaysia

    Directory of Open Access Journals (Sweden)

    Alaska Adrian Kalasa

    2014-01-01

    Full Text Available The purpose of this study is focused on the customer service delivery by staff of front office department of Sutera Sanctuary Lodges, at Kinabalu Park, Kundasang, and Sabah, Malaysia. It will look into the attitude, skills and knowledge of the staff on customer service delivery and its effect on customer satisfaction. There are gaps that were identified from the findings; the front line staff has English language issues. The low rating for knowledge and skills in their work area are a concern. As a three (3 Orchid rated lodges operation the standard and quality should not be compromised. There is a positive relationship of customer satisfaction and employee service delivery. Rating of poor service delivery has been noted in the survey in anticipating guests need with 1% below expectation, Speed and efficiency of check-in process with 1% rated below expectation, welcoming and greeting with 11% below expectation. This includes courtesy, helpfulness of staff and grooming all rated 4% in below expectation.

  11. The association between in-service sexual harassment and post-traumatic stress disorder among Department of Veterans Affairs disability applicants.

    Science.gov (United States)

    Murdoch, Maureen; Polusny, Melissa A; Hodges, James; Cowper, Diane

    2006-02-01

    The goal was to describe the association between post-traumatic stress disorder (PTSD) and in-service sexual harassment in a nationally representative sample of Department of Veterans Affairs PTSD disability applicants. The study was a cross-sectional survey. Of 4,918 eligible veterans, 3,337 (68%) returned surveys. Nonresponse bias appeared to be minimal. After adjustment for other reported traumas, women's reported in-service sexual harassment severity was significantly associated with PTSD symptom severity (p men and for in-service sexual assault among the women. Men showed no association between in-service sexual harassment and PTSD (p = 0.33), although power was low for this test. Sexual harassment significantly contributed to female veterans' PTSD symptoms; its contribution to men's symptoms was unclear. We discuss mechanisms through which sexual harassment might affect PTSD symptom severity, including the possibility that sexual harassment sometimes meets the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, definition of a criterion A stressor.

  12. National Differences in Regional Emergency Department Boarding Times: Are US Emergency Departments Prepared for a Public Health Emergency?

    Science.gov (United States)

    Love, Jennifer S; Karp, David; Delgado, M Kit; Margolis, Gregg; Wiebe, Douglas J; Carr, Brendan G

    2016-08-01

    Boarding admitted patients decreases emergency department (ED) capacity to accommodate daily patient surge. Boarding in regional hospitals may decrease the ability to meet community needs during a public health emergency. This study examined differences in regional patient boarding times across the United States and in regions at risk for public health emergencies. A retrospective cross-sectional analysis was performed by using 2012 ED visit data from the American Hospital Association (AHA) database and 2012 hospital ED boarding data from the Centers for Medicare and Medicaid Services Hospital Compare database. Hospitals were grouped into hospital referral regions (HRRs). The primary outcome was mean ED boarding time per HRR. Spatial hot spot analysis examined boarding time spatial clustering. A total of 3317 of 4671 (71%) hospitals were included in the study cohort. A total of 45 high-boarding-time HRRs clustered along the East/West coasts and 67 low-boarding-time HRRs clustered in the Midwest/Northern Plains regions. A total of 86% of HRRs at risk for a terrorist event had high boarding times and 36% of HRRs with frequent natural disasters had high boarding times. Urban, coastal areas have the longest boarding times and are clustered with other high-boarding-time HRRs. Longer boarding times suggest a heightened level of vulnerability and a need to enhance surge capacity because these regions have difficulty meeting daily emergency care demands and are at increased risk for disasters. (Disaster Med Public Health Preparedness. 2016;10:576-582).

  13. Therapy Dogs in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Nickolas Nahm

    2012-09-01

    Full Text Available Introduction: This study examined acceptance by staff and patients of a therapy dog (TD in the emergency department (ED.Methods: Immediately after TD visits to a University Hospital ED, all available ED staff, patients, and their visitors were invited to complete a survey.Results: Of 125 ‘‘patient’’ and 105 staff responses, most were favorable. Ninety-three percent of patients and 95% of staff agreed that TDs should visit EDs; 87.8% of patients and 92% of staff approved of TDs for both adult and pediatric patients. Fewer than 5% of either patients or staff were afraid of the TDs. Fewer than 10% of patients and staff thought the TDs posed a sanitary risk or interfered with staff work.Conclusion: Both patients and staff approve of TDs in an ED. The benefits of animal-assisted therapy should be further explored in the ED setting.

  14. EDs find physical therapists are an underused asset for musculoskeletal injuries, patient education.

    Science.gov (United States)

    2011-04-01

    Some EDs are finding that the unique skill sets offered by physical therapists (PT) can be an asset to emergency care while also improving the patient experience. Experts say PTs are particularly valuable in the management of musculoskeletal pain and injuries, but they are also being used for wound care, gait training, and balance assessment. ED administrators say consistent, daily coverage is essential to making a PT program successful; otherwise, ED clinicians will neglect to use their services. PTs need to be comfortable with proactively marketing their skills to other ED clinicians who may not be used to having access to this resource. Experts say PT services in the ED can be reimbursed at a level that is consistent with reimbursement in other inpatient and outpatient settings.

  15. A simulation-based training program improves emergency department staff communication.

    Science.gov (United States)

    Sweeney, Lynn A; Warren, Otis; Gardner, Liz; Rojek, Adam; Lindquist, David G

    2014-01-01

    The objectives of this study were to evaluate the effectiveness of Project CLEAR!, a novel simulation-based training program designed to instill Crew Resource Management (CRM) as the communication standard and to create a service-focused environment in the emergency department (ED) by standardizing the patient encounter. A survey-based study compared physicians' and nurses' perceptions of the quality of communication before and after the training program. Surveys were developed to measure ED staff perceptions of the quality of communication between staff members and with patients. Pretraining and posttraining survey results were compared. After the training program, survey scores improved significantly on questions that asked participants to rate the overall communication between staff members and between staff and patients. A simulation-based training program focusing on CRM and standardizing the patient encounter improves communication in the ED, both between staff members and between staff members and patients.

  16. Memorandum from the HR Department and the Legal Service concerning income tax declarations for 2006 in SWITZERLAND

    CERN Document Server

    2007-01-01

    As the Swiss authorities have yet to make known their instructions on how to complete the income tax declaration forms for 2006, members of the CERN personnel who have received or may receive an income tax declaration form must request an extension of the deadline for returning the form to their tax office. Canton of Geneva Declaration forms must be returned by 31 March. An extension to 30 June can be obtained by telephone (stating your tax number) by calling 022 327 49 00 before 31 March. Canton of Vaud Declaration forms must be returned by 15 March. An extension to 15 June can be obtained by telephone (stating your tax number) by calling 021 316 00 00 before 15 March. Canton of Valais Declaration forms must be returned by 31 March. An extension to 31 July can be obtained from the relevant tax office. Please contact the HR Department for further information. Canton of Fribourg Declaration forms must be returned by 31 March. Requests for extensions should be submitted in writing (stating your tax num...

  17. Presentation patterns and outcomes of patients with cancer accessing care in emergency departments in Victoria, Australia.

    Science.gov (United States)

    van der Meer, Dania M; Weiland, Tracey J; Philip, Jennifer; Jelinek, George A; Boughey, Mark; Knott, Jonathan; Marck, Claudia H; Weil, Jennifer L; Lane, Heather P; Dowling, Anthony J; Kelly, Anne-Maree

    2016-03-01

    People with cancer attend emergency departments (EDs) for many reasons. Improved understanding of the specific needs of these patients may assist in optimizing health service delivery. ED presentation and hospital utilization characteristics were explored for people with cancer and compared with those patients without cancer. This descriptive, retrospective, multicentre cohort study used hospital administrative data. Descriptive and inferential statistics were used to summarise and compare ED presentation characteristics amongst cancer and non-cancer groups. Predictive analyses were used to identify ED presentation features predictive of hospital admission for cancer patients. Outcomes of interest were level of acuity, ED and inpatient length of stay, re-presentation rates and admission rates amongst cancer patients and non-cancer patients. ED (529,377) presentations occurred over the 36 months, of which 2.4% (n = 12,489) were cancer-related. Compared with all other attendances, cancer-related attendances had a higher level of acuity, requiring longer management time and length of stay in ED. Re-presentation rates for people with cancer were nearly double those of others (64 vs 33%, p < 0.001), with twice the rate of hospital admission (90 vs 46%, p < 0.001), longer inpatient length of stay (5.6 vs 2.8 days, p < 0.001) and had higher inpatient mortality (7.9 vs 1.0%, p < 0.001). Acuity and arriving by ambulance were significant predictors of hospital admission, with cancer-related attendances having ten times the odds of admission compared to other attendances (OR = 10.4, 95% CI 9.8-11.1). ED presentations by people with cancer represent a more urgent, complex caseload frequently requiring hospital admission when compared to other presentations, suggesting that for optimal cancer care, close collaboration and integration of oncology, palliative care and emergency medicine providers are needed to improve pathways of care.

  18. Tertiary paediatric emergency department use in children and young people with cerebral palsy.

    Science.gov (United States)

    Meehan, Elaine; Reid, Susan M; Williams, Katrina; Freed, Gary L; Babl, Franz E; Sewell, Jillian R; Rawicki, Barry; Reddihough, Dinah S

    2015-10-01

    The aim of this study was to describe the pattern of tertiary paediatric emergency department (ED) use in children and young people with cerebral palsy (CP). A retrospective analysis of ED data routinely collected at the two tertiary paediatric hospitals in Victoria, Australia, cross-matched with the Victorian Cerebral Palsy Register. Data pertaining to the ED presentations of 2183 registered individuals born 1993-2008 were obtained. Between 2008 and 2012, 37% (n = 814) of the CP cohort had 3631 tertiary paediatric ED presentations. Overall, 40% (n = 332) of presenters were residing in inner metropolitan Melbourne; 44% (n = 356) in outer Melbourne; and 13% (n = 108) in regional Victoria. Presenters were more likely than non-presenters to be younger, non-ambulant and have epilepsy. In total, 71% of presentations were triaged as Australasian Triage Scale 1-3 (urgent), and 44% resulted in a hospital admission. Disorders of the respiratory, neurological and gastrointestinal systems, and medical device problems were responsible for 72% of presentations. Many of the tertiary paediatric ED presentations in this group were appropriate based on the high admission rate and the large proportion triaged as urgent. However, there is evidence that some families are bypassing local services and travelling long distances to attend the tertiary paediatric ED, even for less urgent complaints that do not require hospital admission. Alternative pathways of care delivery, and strategies to promote the management of common problems experienced by children and young people with CP in non-paediatric EDs or primary care settings, may go some way towards reducing unnecessary tertiary paediatric ED use in this group. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  19. Operational and financial impact of physician screening in the ED.

    Science.gov (United States)

    Soremekun, Olanrewaju A; Biddinger, Paul D; White, Benjamin A; Sinclair, Julia R; Chang, Yuchiao; Carignan, Sarah B; Brown, David F M

    2012-05-01

    Physician screening is one of many front-end interventions being implemented to improve emergency department (ED) efficiency. We aimed to quantify the operational and financial impact of this intervention at an urban tertiary academic center. We conducted a 2-year before-after analysis of a physician screening system at an urban tertiary academic center with 90 000 annual visits. Financial impact consisted of the ED and inpatient revenue generated from the incremental capacity and the reduction in left without being seen (LWBS) rates. The ED and inpatient margin contribution as well as capital expenditure were based on available published data. We summarized the financial impact using net present value of future cash flows performing sensitivity analysis on the assumptions. Operational outcome measures were ED length of stay and percentage of LWBS. During the first year, we estimate the contribution margin of the screening system to be $2.71 million and the incremental operational cost to be $1.86 million. Estimated capital expenditure for the system was $1 200 000. The NPV of this investment was $2.82 million, and time to break even from the initial investment was 13 months. Operationally, despite a 16.7% increase in patient volume and no decrease in boarding hours, there was a 7.4% decrease in ED length of stay and a reduction in LWBS from 3.3% to 1.8%. In addition to improving operational measures, the implementation of a physician screening program in the ED allowed for an incremental increase in patient care capacity leading to an overall positive financial impact. Copyright © 2012 Elsevier Inc. All rights reserved.

  20. Health-hazard-evaluation report HETA 87-376-2018, US Department of Justice, United States Marshals Service, Washington, DC

    Energy Technology Data Exchange (ETDEWEB)

    Reh, C.M.; Klein, M.K.

    1990-03-01

    In response to a request from the United States Marshals Service (SIC-9221) in Washington, D.C. for assistance in testing the effect of renovations to the ventilation system of their indoor firing range, lead (7439921) exposures were measured during handgun qualifying sessions. Each qualifying session of firing consisted of 60 rounds fired in 10 to 12 minutes. Personal breathing zone air samples were taken from three shooters and the range officer. Lead exposure concentrations measured were 2073, 1786, 172, and 142 micrograms of lead per cubic meter of air (microg/cu m). Eight hour time weighted average concentrations were calculated to be 194, 167, 101, and 13microg/cu m, respectively. The three shooters were therefore overexposed to lead. Bulk sampling of the sand from the bullet trap indicated it to be contaminated, containing 41% lead by weight. The authors concluded that a health hazard existed from exposure to lead. The authors recommended changes to improve the ventilation system. Following modification of the system, tests were again conducted and 11 of the 12 samples taken were below the limits of detection for the method used. The authors conclude that after modification, a hazard did not exist during qualifying sessions. The authors recommend specific measures to protect personnel from exposure to lead.

  1. United States Department of Agriculture-Agricultural Research Service research programs on microbes for management of plant-parasitic nematodes.

    Science.gov (United States)

    Meyer, Susan L F

    2003-01-01

    Restrictions on the use of conventional nematicides have increased the need for new methods of managing plant-parasitic nematodes. Consequently, nematode-antagonistic microbes, and active compounds produced by such organisms, are being explored as potential additions to management practices. Programs in this area at the USDA Agricultural Research Service investigate applied biocontrol agents, naturally occurring beneficial soil microbes and natural compounds. Specific research topics include use of plant growth-promoting rhizobacteria and cultural practices for management of root-knot and ring nematodes, determination of management strategies that enhance activity of naturally occurring Pasteuria species (bacterial obligate parasites of nematodes), studies on interactions between biocontrol bacteria and bacterial-feeding nematodes, and screening of microbes for compounds active against plant-parasitic nematodes. Some studies involve biocontrol agents that are active against nematodes and soil-borne plant-pathogenic fungi, or combinations of beneficial bacteria and fungi, to manage a spectrum of plant diseases or to increase efficacy over a broader range of environmental conditions. Effective methods or agents identified in the research programs are investigated as additions to existing management systems for plant-parasitic nematodes.

  2. [Consultation in a baby clinic of the PMI (mother and infant welfare service): a survey in a French department].

    Science.gov (United States)

    Fanello, Serge; Hassani, Anne; Meunier, Brice; Dagorne, Carole; Parot, Elsa

    2007-01-01

    A dual survey carried out amongst the users and the professionals of PMI showed that proximity, the range of advice available, the exchanges on parenthood, and the assessment of the child's physical and mental progress and of his/her development are the key elements that parents are looking for. It is also noted that the majority of these parents deliberately consult these services. The objectives when consulting vary, going from a model based on the body and physical abilities, found especially in lower and disadvantaged groups, to one emphasising the child's psychological aspect and potential, which is the prerogative of the middle and higher classes. Indeed, although the PMI is particularly aimed at families in difficulties, all the social classes are now represented among the users. The primary role of prevention of PMI means that few parents go there specifically for the treatment of a medical disease. The majority of families maintain a parallel follow-up with another medical professional, usually a general practitioner with whom the PMI has very little contact. Given the decrease in the current medical demography and the governmental directives aimed at improving care in the prenatal period, the prospect of a closer working relationship between these two parties involved in infant welfare would seem to be a way of the future.

  3. The effect of emergency department expansion on emergency department overcrowding.

    Science.gov (United States)

    Han, Jin H; Zhou, Chuan; France, Daniel J; Zhong, Sheng; Jones, Ian; Storrow, Alan B; Aronsky, Dominik

    2007-04-01

    To examine the effects of emergency department (ED) expansion on ambulance diversion at an urban, academic Level 1 trauma center. This was a pre-post study performed using administrative data from the ED and hospital electronic information systems. On April 19, 2005, the adult ED expanded from 28 to 53 licensed beds. Data from a five-month pre-expansion period (November 1, 2004, to March 1, 2005) and a five-month postexpansion period (June 1, 2005, to October 31, 2005) were included for this analysis. ED and waiting room statistics as well as diversion status were obtained. Total ED length of stay (LOS) was defined as the time from patient registration to the time leaving the ED. Admission hold LOS was defined as the time from the inpatient bed request to the time leaving the ED for admitted patients. Mean differences (95% confidence interval [CI]) in total time spent on ambulance diversion per month, diversion episodes per month, and duration per diversion episode were calculated. An accelerated failure time model was performed to test if ED expansion was associated with a reduction in ambulance diversion while adjusting for potential confounders. From pre-expansion to postexpansion, daily patient volume increased but ED occupancy decreased. There was no significant change in the time spent on ambulance diversion per month (mean difference, 10.9 hours; 95% CI = -74.0 to 95.8), ambulance diversion episodes per month (two episodes per month; 95% CI = -4.2 to 8.2), and duration of ambulance diversion per episode (0.3 hours; 95% CI = -4.0 to 3.5). Mean (+/-SD) total LOS increased from 4.6 (+/-1.9) to 5.6(+/-2.3) hours, and mean (+/-SD) admission hold LOS also increased from 3.0 (+/-0.2) to 4.1 (+/-0.2) hours. The proportion of patients who left without being seen was 3.5% and 2.7% (p = 0.06) in the pre-expansion and postexpansion periods, respectively. In the accelerated failure time model, ED expansion did not affect the time to the next ambulance diversion episode

  4. DOC/WSNSO [Department of Commerce/Weather Service Nuclear Support Office] operational support to Federal Radiological Monitoring and Assessment Center

    International Nuclear Information System (INIS)

    Mueller, P.

    1989-01-01

    The National Weather Service (NWS) is an agency of the Department of Commerce. The NWS has hundreds of weather offices throughout the United States. The Weather Service Nuclear Support Office (WSNSO) is a highly specialized unit of NWS that provides direct support to the U.S. Department of Energy's (DOE's) underground nuclear testing program. The WSNSO has been associated with the DOE for >33 yr. As a result of the unique relationship with the DOE, all WSNSO emergency response meteorologists and meteorological technicians are allowed access to classified material. Meteorological phenomena play a significant role during a Federal Radiological Monitoring and Assessment Center (FRMAC) event, and WSNSO meteorologists provide direct support to ARAC. The marriage of state-of-the-art computer systems together with proven technology provides the on-scene WSNSO meteorologist with essentially a portable fully equipped, fully functional, advanced NWS weather station. The WSNSO's emergency response personnel and hardware are at the ready and can be mobilized within 2 h. WSNSO can provide on-scene weather forecasts and critical weather data collection whenever and wherever necessary

  5. CDBG Public Services Activity

    Data.gov (United States)

    Department of Housing and Urban Development — CDBG activity related to public services, including senior services, legal services, youth services, employment training, health services, homebuyer counseling, food...

  6. Impact of presumed service-connected diagnosis on the Department of Veterans Affairs healthcare utilization patterns of Vietnam-Theater Veterans: A cross-sectional study.

    Science.gov (United States)

    Fried, Dennis A; Rajan, Mangala; Tseng, Chin-Lin; Helmer, Drew

    2018-05-01

    During the Vietnam War, the US military sprayed almost 20 million gallons of Agent Orange (AO), an herbicide contaminated with dioxin, over Vietnam. Approximately, 2.7 million US military personnel may have been exposed to AO during their deployment. Ordinarily, veterans who can demonstrate a nexus between a diagnosed condition and military service are eligible for Department of Veterans Affairs (VA) service-connected disability compensation. Vietnam Veterans have had difficulty, however, establishing a nexus between AO exposure and certain medical conditions that developed many years after the war. In response, VA has designated certain conditions as "presumed service connected" for Vietnam Veterans who were present and possibly exposed. Veterans with any of these designated conditions do not have to document AO exposure, making it easier for them to access the VA disability system. The extent to which VA healthcare utilization patterns reflect easier access afforded those with diagnosed presumptive conditions remains unknown. In this cross-sectional study, we hypothesized that Vietnam Veterans with diagnosed presumptive conditions would be heavier users of the VA healthcare system than those without these conditions. In our analysis of 85,699 Vietnam Veterans, we used binary and cumulative logit multivariable regression to assess associations between diagnosed presumptive conditions and VA healthcare utilization in 2013. We found that diagnosed presumptive conditions were associated with higher odds of 5+ VHA primary care visits (OR = 2.01, 95% CI: 1.93-2.07), 5+ specialty care visits (OR = 2.11, 95% CI: 2.04-2.18), emergency department use (OR = 1.22, 95% CI: 1.11-1.34), and hospitalization (OR = 1.23, 95% CI: 1.17-1.29). Consistent with legislative intent, presumptive policies appear to facilitate greater VA system utilization for Vietnam Veterans who may have been exposed to AO.

  7. Impact of presumed service-connected diagnosis on the Department of Veterans Affairs healthcare utilization patterns of Vietnam-Theater Veterans

    Science.gov (United States)

    Fried, Dennis A.; Rajan, Mangala; Tseng, Chin-lin; Helmer, Drew

    2018-01-01

    Abstract During the Vietnam War, the US military sprayed almost 20 million gallons of Agent Orange (AO), an herbicide contaminated with dioxin, over Vietnam. Approximately, 2.7 million US military personnel may have been exposed to AO during their deployment. Ordinarily, veterans who can demonstrate a nexus between a diagnosed condition and military service are eligible for Department of Veterans Affairs (VA) service-connected disability compensation. Vietnam Veterans have had difficulty, however, establishing a nexus between AO exposure and certain medical conditions that developed many years after the war. In response, VA has designated certain conditions as “presumed service connected” for Vietnam Veterans who were present and possibly exposed. Veterans with any of these designated conditions do not have to document AO exposure, making it easier for them to access the VA disability system. The extent to which VA healthcare utilization patterns reflect easier access afforded those with diagnosed presumptive conditions remains unknown. In this cross-sectional study, we hypothesized that Vietnam Veterans with diagnosed presumptive conditions would be heavier users of the VA healthcare system than those without these conditions. In our analysis of 85,699 Vietnam Veterans, we used binary and cumulative logit multivariable regression to assess associations between diagnosed presumptive conditions and VA healthcare utilization in 2013. We found that diagnosed presumptive conditions were associated with higher odds of 5+ VHA primary care visits (OR = 2.01, 95% CI: 1.93–2.07), 5+ specialty care visits (OR = 2.11, 95% CI: 2.04–2.18), emergency department use (OR = 1.22, 95% CI: 1.11–1.34), and hospitalization (OR = 1.23, 95% CI: 1.17–1.29). Consistent with legislative intent, presumptive policies appear to facilitate greater VA system utilization for Vietnam Veterans who may have been exposed to AO. PMID:29742706

  8. New EdF's three challenges

    International Nuclear Information System (INIS)

    Lepetit, V.

    2005-01-01

    The opening of 15% of Electricite de France (EdF) capital to the private sector will allow the first world electric utility to raise 7 billions of euros of cash flow. EdF will have also to face the new European situation: a strained market, several consolidations to come and many competitors to deal with. EdF has to re-launch its production tool and to reinforce its interconnection capacities if it wants to stay the number one of power exports in Europe. The integration of Edison company (Italy) by EdF gives access to new gas capacities but other resources have to be found if EdF wants to enlarge its gas offer. A new concentration era is foreseen in Europe and EdF will have to seize the economic growth opportunities in particular in Europe and China. (J.S.)

  9. Aerial sightings of bowhead whales and other marine mammals by the US Department of the Interior's Minerals Management Service, 1979 - 2006, in the Bering, Chukchi and Beaufort Seas (NODC Accession 0014906)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Minerals Management Service (MMS), previously Bureau of Land Management, has funded fall bowhead whale aerial surveys in this area each year since 1978, using a...

  10. Expanding The INSPIRED COPD Outreach ProgramTM to the emergency department: a feasibility assessment

    Directory of Open Access Journals (Sweden)

    Gillis D

    2017-05-01

    Full Text Available Darcy Gillis,1 Jillian Demmons,1 Graeme Rocker1,2 1Division of Respirology, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, Halifax, NS, Canada; 2Division of Respirology, Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada Background: The Halifax-based INSPIRED COPD Outreach Program™ is a facility-to-community home-based novel clinical initiative that through improved care transitions, self-management, and engagement in advance care planning has demonstrated a significant (60%–80% reduction in health care utilization with substantial cost aversion. By assessing the feasibility of expanding INSPIRED into the emergency department (ED we anticipated extending reach and potential for positive impact of INSPIRED to those with acute exacerbation of chronic obstructive pulmonary disease (AECOPD who avoid hospital admission.Methods: Patients were eligible for the INSPIRED-ED study if >40 years of age, diagnosed with AECOPD and discharged from the ED, willing to be referred, community dwelling with at least one of: previous use of the ED services, admission to Intermediate Care Unit/Intensive Care Unit, or admission to hospital with AECOPD in the past year. We set feasibility objectives for referral rates, completion of action plans, advance care planning participation, and reduction in ED visit frequency.Results: Referral rates were 0.5/week. Among eligible patients (n=174 33 (19% were referred of whom 15 (M=4, F=11 enrolled in INSPIRED-ED. Mean (SD age was 68 (7 years, post-bronchdilator FEV1 44.2 (15.5 % predicted, and Medical Research Council (MRC dyspnea score 3.8 (0.41. We met feasibility objectives for action plan and advance care planning completion. Frequency of subsequent ED visits fell by 54%. Mean (SD Care Transition Measure (CTM-3 improved from 8.6 (2.0 to 11.3 (1.3, P=0.0004, and of 14 patients responding 12 (86% found the program very helpful. An additional 34

  11. A review of factors affecting patient satisfaction with nurse led triage in emergency departments.

    Science.gov (United States)

    Rehman, Salma Abdul; Ali, Parveen Azam

    2016-11-01

    To determine the factors that affect patient satisfaction with nurse-led-triage in EDs using a systematic review. Nurses' involvement in the triage services provided in the Emergency Department has been an integral part of practice for several decades in some countries. Although studies exploring patient satisfaction with nurse-led ED triage exist, no systematic review of this evidence is available. MEDLINE, CINAHL, PsycInfo, EMBASE, the Cochrane Library, Joanna Briggs Library and Google Scholar were searched (January 1980-June 2013). Eighteen studies that met the inclusion criteria were reviewed. Factors that affect patient satisfaction with nurse-led-triage include nurses' abilities to provide patient centred care, communication skills, nurses' caring abilities, concern for the patient and competence in diagnosing and treating the health problem. Other factors include availability and visibility of nurses, provision of appropriate health related information in a jargon-free language, nurses' ability to answer questions, and an ability to provide patients with an opportunity to ask questions. There is continued scope for nurse-led-triage services in the ED. Patients are generally satisfied with the service provided by nurses in EDs and report a willingness to see the same professional again in the future if needed. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. The effect of boarders on emergency department process flow.

    Science.gov (United States)

    Fogarty, Eoin; Saunders, Jean; Cummins, Fergal

    2014-05-01

    Emergency department (ED) overcrowding with boarders and waiting times are a significant concern in many countries. We aim to show the relationship between boarders in the ED and the percentage time to disposition in under 6 h for our ED patients. A review was carried out to show the percentage of patients presenting to the ED compliant with a 6-h standard per day compared to the number of attendances, the number of admissions to the hospital, and the number of boarders in the ED per day. Over the 2-year study period, there was an average 0.37% fall in the ED's rate of compliance per day, with a 6-h standard for each boarder in the ED. Boarding patients in the ED has a negative effect on compliance with our 6-h standard of time to disposition. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Organization structure and the performance of hospital emergency services.

    Science.gov (United States)

    Georgopoulos, B S

    1985-07-01

    A comparative study of 30 hospital emergency departments (EDs) and nearly 1,500 individuals associated with them was conducted. Data were obtained from institutional records, physicians, patients, and other sources. The object was to investigate the relationship between the organization and performance of these health service systems. The study assessed the quality of medical care, the quality of nursing care, and the economic efficiency of hospital EDs. The results show substantial interinstitutional differences in these criteria. They also show a significant relationship between medical and nursing care, but not between the quality of care and economic efficiency. Differences in ED performance are related to medical staffing patterns, medical teaching affiliation, personnel training, scope of emergency services, number of patient visits processed, and hospital size and complexity. Not all of these variables, however, correlate positively with all three criteria of performance, nor are they equally important to each.

  14. Ensamblaje de escarabajos Melolonthidae (Coleoptera: Scarabaeoidea asociados con pasturas en el departamento del Caquetá y su posible relación con la salubridad edáfica Melolonthidae (Coleoptera: Scarabaeoidea assemblage associated to pastures in the Caquetá Department (Colombia and its possible relationship with soil health

    Directory of Open Access Journals (Sweden)

    Luis Carlos Pardo-Locarno

    2011-07-01

    Full Text Available La zona de piedemonte caqueteño (Colombia forma parte de la región amazónica (3600 mm de precipitación anual, 260 m.s.n.m., 26 °C y presenta un ambiente megadiverso y ecológicamente frágil cuyos suelos están siendo afectados de manera creciente por la ganadería de tipo extensivo. En el presente trabajo se hizo un monitoreo de la biología y abundancia de escarabajos edafícolas en fincas ganaderas con pasturas degradadas, localizadas en los municipios de San Vicente del Caguán, El Doncello, Belén de los Andaquíes, Albania y Valparaíso, del departamento del Caquetá. Para el estudio se hicieron muestreos de adultos utilizando trampas de luz y de larvas en cuadrantes de suelo en parcelas de pasturas y relictos de selva durante épocas seca y húmeda. Se registraron 26 especies de Melolonthidae, ensamblaje de diversidad moderada, que incluye 16 nuevos registros para el departamento de Caquetá y dos nuevos registros para el país. Se recolectaron 475 ejemplares de larvas y 11 morfoespecies, cuya distribución y abundancia variaron significativamente según usos del suelo, épocas y localidades. Resalta la poca diversidad beta de la región (11 especies y alfa por municipios (cinco especies, de las cuales solo 33% fueron saprófagas (Cyclocephala, Euetheola, mientras que el resto (Phyllophaga, Plectris, Barybas, Bolax son rizófagas, lo que significa un balance expresivo del deterioro edáfico, presumiblemente causado por la declinación de la materia orgánica y afectación de las condiciones físicas del suelo como consecuencia de la ganadería extensiva. Se sugiere realizar estudios a mayor escala geográfica y reenfocar el uso del suelo hacia sistemas multiestratificados.The Caquetá hillsidezone is a part of the Colombian Amazon region (mean pluvial precipitation 3600 mm; 260 m.a.s.l., 26°C. It shows a mega diverse environment, ecologically fragile as the soils have been increasingly degraded. This research had the purpose of

  15. The Effect of Medicaid Expansion on Utilization in Maryland Emergency Departments.

    Science.gov (United States)

    Klein, Eili Y; Levin, Scott; Toerper, Matthew F; Makowsky, Michael D; Xu, Tim; Cole, Gai; Kelen, Gabor D

    2017-11-01

    A proposed benefit of expanding Medicaid eligibility under the Patient Protection and Affordable Care Act (ACA) was a reduction in emergency department (ED) utilization for primary care needs. Pre-ACA studies found that new Medicaid enrollees increased their ED utilization rates, but the effect on system-level ED visits was less clear. Our objective was to estimate the effect of Medicaid expansion on aggregate and individual-based ED utilization patterns within Maryland. We performed a retrospective cross-sectional study of ED utilization patterns across Maryland, using data from Maryland's Health Services Cost Review Commission. We also analyzed utilization differences between pre-ACA (July 2012 to December 2013) uninsured patients who returned post-ACA (July 2014 to December 2015). The total number of ED visits in Maryland decreased by 36,531 (-1.2%) between the 6 quarters pre-ACA and the 6 quarters post-ACA. Medicaid-covered ED visits increased from 23.3% to 28.9% (159,004 additional visits), whereas uninsured patient visits decreased from 16.3% to 10.4% (181,607 fewer visits). Coverage by other insurance types remained largely stable between periods. We found no significant relationship between Medicaid expansion and changes in ED volume by hospital. For patients uninsured pre-ACA who returned post-ACA, the adjusted visits per person during 6 quarters was 2.38 (95% confidence interval 2.35 to 2.40) for those newly enrolled in Medicaid post-ACA compared with 1.66 (95% confidence interval 1.64 to 1.68) for those remaining uninsured. There was a substantial increase in patients covered by Medicaid in the post-ACA period, but this did not significantly affect total ED volume. Returning patients newly enrolled in Medicaid visited the ED more than their uninsured counterparts; however, this cohort accounted for only a small percentage of total ED visits in Maryland. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights

  16. Emergency Nurses' Perceptions of Providing End-of-Life Care in a Hong Kong Emergency Department: A Qualitative Study.

    Science.gov (United States)

    Tse, Johnson Wai Keung; Hung, Maria Shuk Yu; Pang, Samantha Mei Che

    2016-05-01

    Provision of end-of-life (EOL) care in the emergency department has improved globally in recent years and has a different scope of interventions than traditional emergency medicine. In 2010, a regional hospital established the first ED EOL service in Hong Kong. The aim of this study was to understand emergency nurses' perceptions regarding the provision of EOL care in the emergency department. A qualitative approach was used with purposive sampling of 16 nurses who had experience in providing EOL care. Semi-structured, face-to-face interviews were conducted from May to October, 2014. All the interviews were transcribed verbatim for content analysis. Four themes were identified: (1) doing good for the dying patients, (2) facilitating family engagement and involvement, (3) enhancing personal growth and professionalism, and (4) expressing ambiguity toward resource deployment. Provision of EOL care in the emergency department can enhance patients' last moment of life, facilitate the grief and bereavement process of families, and enhance the professional development of staff in emergency department. It is substantiated that EOL service in the emergency department enriches EOL care in the health care system. Findings from this study integrated the perspectives on ED EOL services from emergency nurses. The integration of EOL service in other emergency departments locally and worldwide is encouraged. Copyright © 2016 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  17. The Department of Veterans Health Administration Office of Nursing Service, "transforming nursing in a national healthcare system: an example of transformation in action".

    Science.gov (United States)

    Wertenberger, Sydney; Chapman, Kathleen M; Wright-Brown, Salena

    2011-01-01

    The Department of Veterans Health Administration Office of Nursing Service has embarked on a multiyear transformational process, an example of which is the development of an organization-wide nursing handbook. The development of this handbook offered the opportunity to improve collaboration, redefine expectations and behavior, as well as prepare for the future of Nursing within the Veterans Health Administration. The lessons learned from this process have revolved around the themes of leadership skills for managing high-level change often in a virtual environment; constant collaboration; that the practice of nursing will continue to evolve on the basis of new evidence, technology, customer expectations, and resources; and that the process to accomplish this goal is powerful.

  18. Development and testing of emergency department patient transfer communication measures.

    Science.gov (United States)

    Klingner, Jill; Moscovice, Ira

    2012-01-01

    Communication problems are a major contributing factor to adverse events in hospitals.(1) The contextual environment in small rural hospitals increases the importance of emergency department (ED) patient transfer communication quality. This study addresses the communication problems through the development and testing of ED quality measurement of interfacility patient transfer communication. Input from existing measures, measurement and health care delivery experts, as well as hospital frontline staff was used to design and modify ED quality measures. Three field tests were conducted to determine the feasibility of data collection and the effectiveness of different training methods and types of partnerships. Measures were evaluated based on their prevalence, ease of data collection, and usefulness for internal and external improvement. It is feasible to collect ED quality measure data. Different data sources, data collection, and data entry methods, training and partners can be used to examine hospital ED quality. There is significant room for improvement in the communication of patient information between health care facilities. Current health care reform efforts highlight the importance of clear communication between organizations held accountable for patient safety and outcomes. The patient transfer communication measures have been tested in a wide range of rural settings and have been vetted nationally. They have been endorsed by the National Quality Forum, are included in the National Quality Measurement Clearinghouse supported by the Agency for Health Care Research and Quality (AHRQ), and are under consideration by the Centers for Medicare and Medicaid Services for future payment determinations beginning in calendar year 2013. © 2011 National Rural Health Association.

  19. Investigating emergency room service quality using lean manufacturing.

    Science.gov (United States)

    Abdelhadi, Abdelhakim

    2015-01-01

    The purpose of this paper is to investigate a lean manufacturing metric called Takt time as a benchmark evaluation measure to evaluate a public hospital's service quality. Lean manufacturing is an established managerial philosophy with a proven track record in industry. A lean metric called Takt time is applied as a measure to compare the relative efficiency between two emergency departments (EDs) belonging to the same public hospital. Outcomes guide managers to improve patient services and increase hospital performances. The patient treatment lead time within the hospital's two EDs (one department serves male and the other female patients) are the study's focus. A lean metric called Takt time is used to find the service's relative efficiency. Findings show that the lean manufacturing metric called Takt time can be used as an effective way to measure service efficiency by analyzing relative efficiency and identifies bottlenecks in different departments providing the same services. The paper presents a new procedure to compare relative efficiency between two EDs. It can be applied to any healthcare facility.

  20. World nuclear directory. 6. ed.

    International Nuclear Information System (INIS)

    Wilson, C.W.J.

    1981-01-01

    The purpose of the directory is to provide a comprehensive, worldwide guide to organizations which conduct, promote, or encourage research into atomic energy. The term research is interpreted fairly generously. The directory is intended to be a reference source useful to scientists and administrators in the nuclear field, to information workers, librarians, journalists, market researchers, and others. It therefore includes nuclear research institutes; government departments; public corporations; industrial firms; electricity generating boards; learned and professional societies; and universities, polytechnics, and other institutes of higher education with nuclear departments. (author)

  1. Emergency Department Crowding: Factors Influencing Flow

    Directory of Open Access Journals (Sweden)

    Arkun, Alp

    2010-02-01

    Full Text Available Background: The objective of this study was to evaluate those factors, both intrinsic and extrinsic to the emergency department (ED that influence two specific components of throughput: “door-to-doctor” time and dwell time.Methods: We used a prospective observational study design to determine the variables that played a significant role in determining ED flow. All adult patients seen or waiting to be seen in the ED were observed at 8pm (Monday-Friday during a three-month period. Variables measured included daily ED volume, patient acuity, staffing, ED occupancy, daily admissions, ED boarder volume, hospital volume, and intensive care unit volume. Both log-rank tests and time-to-wait (survival proportional-hazard regression models were fitted to determine which variables were most significant in predicting “door-to-doctor” and dwell times, with full account of the censoring for some patients.Results: We captured 1,543 patients during our study period, representing 27% of total daily volume. The ED operated at an average of 85% capacity (61-102% with an average of 27% boarding. Median “door-to-doctor” time was 1.8 hours, with the biggest influence being triage category, day of the week, and ED occupancy. Median dwell time was 5.5 hours with similar variable influences.Conclusion: The largest contributors to decreased patient flow through the ED at our institution were triage category, ED occupancy, and day of the week. Although the statistically significant factors influencing patient throughput at our institution involve problems with inflow, an increase in ED occupancy could be due to substantial outflow obstruction and may indicate the necessity for increased capacity both within the ED and hospital. [West J Emerg Med. 2010; 11(1:10-15

  2. Emergency department crowding: factors influencing flow.

    Science.gov (United States)

    Arkun, Alp; Briggs, William M; Patel, Sweha; Datillo, Paris A; Bove, Joseph; Birkhahn, Robert H

    2010-02-01

    THE OBJECTIVE OF THIS STUDY WAS TO EVALUATE THOSE FACTORS, BOTH INTRINSIC AND EXTRINSIC TO THE EMERGENCY DEPARTMENT (ED) THAT INFLUENCE TWO SPECIFIC COMPONENTS OF THROUGHPUT: "door-to-doctor" time and dwell time. We used a prospective observational study design to determine the variables that played a significant role in determining ED flow. All adult patients seen or waiting to be seen in the ED were observed at 8pm (Monday-Friday) during a three-month period. Variables measured included daily ED volume, patient acuity, staffing, ED occupancy, daily admissions, ED boarder volume, hospital volume, and intensive care unit volume. Both log-rank tests and time-to-wait (survival) proportional-hazard regression models were fitted to determine which variables were most significant in predicting "door-to-doctor" and dwell times, with full account of the censoring for some patients. We captured 1,543 patients during our study period, representing 27% of total daily volume. The ED operated at an average of 85% capacity (61-102%) with an average of 27% boarding. Median "door-to-doctor" time was 1.8 hours, with the biggest influence being triage category, day of the week, and ED occupancy. Median dwell time was 5.5 hours with similar variable influences. The largest contributors to decreased patient flow through the ED at our institution were triage category, ED occupancy, and day of the week. Although the statistically significant factors influencing patient throughput at our institution involve problems with inflow, an increase in ED occupancy could be due to substantial outflow obstruction and may indicate the necessity for increased capacity both within the ED and hospital.

  3. California emergency department visit rates for medical conditions increased while visit rates for injuries fell, 2005-11.

    Science.gov (United States)

    Hsia, Renee Y; Nath, Julia B; Baker, Laurence C

    2015-04-01

    The emergency department (ED) is the source of most hospital admissions; provides care for patients with no other point of access to the health care system; receives advanced care referrals from primary care physicians; and provides surveillance data on injuries, infectious diseases, violence, and adverse drug events. Understanding the changes in the profile of disease in the ED can inform emergency services administration and planning and can provide insight into the public's health. We analyzed the trends in the diagnoses seen in California EDs from 2005 to 2011, finding that while the ED visit rate for injuries decreased by 0.7 percent, the rate of ED visits for noninjury diagnoses rose 13.4 percent. We also found a rise in symptom-related diagnoses, such as abdominal pain, along with nervous system disorders, gastrointestinal disease, and mental illness. These trends point out the increasing importance of EDs in providing care for complex medical cases, as well as the changing nature of illness in the population needing immediate medical attention. Project HOPE—The People-to-People Health Foundation, Inc.

  4. Failure Mode and Effect Analysis in Increasing the Revenue of Emergency Department

    Directory of Open Access Journals (Sweden)

    Farhad Rahmati

    2015-02-01

    Full Text Available Introduction: Successful performance of emergency department(ED is one of the important indications of increasing the satisfaction among referees. The insurance of such successful performance is fiscal discipline and avoiding from non-beneficial activities in this department. Therefore, the increasing revenue of emergency department is one of the interested goals of hospital management system. According to above-mentioned, the researchers assessed problems lead to loss the revenue of ED and eliminate them by using failure mode and effects analysis (FMEA.Methods: This was the prospective cohort study performed during 18 months, set in 6 phases. In the first phase, the failures were determined and some solutions suggested to eliminate them. During 2-5 phases, based on the prioritizing the problems, solutions were performed. In the sixth phase, final assessment of the study was done. Finally, the feedback of system’s revenue was evaluated and data analyzed using repeated measure ANOVA.Results: Lack of recording the consuming instrument and attribution of separate codes for emergency services of hospitalized patients were the most important failures that lead to decrease the revenue of ED. Such elimination caused to 75.9% increase in revenue within a month (df = 1.6; F = 84.0; p<0.0001.  Totally, 18 months following the eliminating of failures caused to 328.2% increase in the revenue of ED (df = 15.9; F = 215; p<0.0001.Conclusion: The findings of the present study shows that failure mode and effect analysis, can be used as a safe and effected method to reduce the expenses of ED and increase its revenue.

  5. Changes in insurance status and emergency department visits after the 2008 economic downturn.

    Science.gov (United States)

    Watts, Susan H; David Bryan, E; Tarwater, Patrick M

    2015-01-01

    As the U.S. economy began its downward trend in 2008, many citizens lost their jobs and, ultimately, their employer-sponsored health care insurance. The expectation was that many of the newly uninsured would turn to emergency departments (EDs) for their health care. This study was undertaken to determine, first, if changes in the insurance status of the general population were reflected in the ED insurance payer mix and, second, whether there was evidence of an increased reliance on the ED as a continuing source of health care for any payer group(s). This was a retrospective observational study using public data files from the National Hospital Ambulatory Medical Care Survey for Emergency Departments for years 2006 through 2010 (2008 ± 2 years). Changes in the relative proportions of ED visits funded annually by private insurance, Medicaid, Medicare, and self-pay (uninsured) were analyzed using a logistic model. Poisson regression was used to compare trends in the rates of ED visits for each payer type (i.e., number of ED visits per 100 persons with each insurance type). A linear spline term was used to determine if there was a change in each risk estimate after 2008 compared to the risk estimate before 2008. Before 2008, the odds of an ED visit being funded by private insurance increased by 4% per year (odds ratio [OR] = 1.04, 95% confidence interval [CI] = 0.98 to 1.10; p = 0.15), but after 2008 the odds reversed, decreasing by nearly 10% per year (OR = 0.91, 95% CI = 0.85 to 0.97; p = 0.02). Medicaid-funded visits demonstrated opposite trends with a small decreasing trend of 2% per year before 2008 (OR = 0.98, 95% CI = 0.92 to 1.04; p = 0.52), followed by a significantly increasing trend of 20% per year after 2008 (OR = 1.20, 95% CI = 1.12 to 1.27; p = 0.001). The growth in Medicaid-funded ED visits was attributable to increased numbers of visits by both pediatric (<18 years old) and non-elderly adult (19 to 64 years old) patients. For both Medicaid and private

  6. Characteristics of Emergency Department Visits by Older Versus Younger Homeless Adults in the United States

    Science.gov (United States)

    Steinman, Michael A.

    2013-01-01

    Objectives. We compared the characteristics of emergency department (ED) visits of older versus younger homeless adults. Methods. We analyzed 2005–2009 data from the National Hospital Ambulatory Medical Care Survey, a nationally representative survey of visits to hospitals and EDs, and used sampling weights, strata, and clustering variables to obtain nationally representative estimates. Results. The ED visits of homeless adults aged 50 years and older accounted for 36% of annual visits by homeless patients. Although demographic characteristics of ED visits were similar in older and younger homeless adults, clinical and health services characteristics differed. Older homeless adults had fewer discharge diagnoses related to psychiatric conditions (10% vs 20%; P = .002) and drug abuse (7% vs 15%; P = .003) but more diagnoses related to alcohol abuse (31% vs 23%; P = .03) and were more likely to arrive by ambulance (48% vs 36%; P = .02) and to be admitted to the hospital (20% vs 11%; P = .003). Conclusions. Older homeless adults’ patterns of ED care differ from those of younger homeless adults. Health care systems need to account for these differences to meet the needs of the aging homeless population. PMID:23597348

  7. Quality of coding diagnoses in emergency departments: effects on mapping the public's health.

    Science.gov (United States)

    Aharonson-Daniel, Limor; Schwartz, Dagan; Hornik-Lurie, Tzipi; Halpern, Pinchas

    2014-01-01

    Emergency department (ED) attendees reflect the health of the population served by that hospital and the availability of health care services in the community. To examine the quality and accuracy of diagnoses recorded in the ED to appraise its potential utility as a guage of the population's medical needs. Using the Delphi process, a preliminary list of health indicators generated by an expert focus group was converted to a query to the Ministry of Health's database. In parallel, medical charts were reviewed in four hospitals to compare the handwritten diagnosis in the medical record with that recorded on the standard diagnosis "pick list" coding sheet. Quantity and quality of coding were assessed using explicit criteria. During 2010 a total of 17,761 charts were reviewed; diagnoses were not coded in 42%. The accuracy of existing coding was excellent (mismatch 1%-5%). Database query (2,670,300 visits to 28 hospitals in 2009) demonstrated potential benefits of these data as indicators of regional health needs. The findings suggest that an increase in the provision of community care may reduce ED attendance. Information on ED visits can be used to support health care planning. A "pick list" form with common diagnoses can facilitate quality recording of diagnoses in a busy ED, profiling the population's health needs in order to optimize care. Better compliance with the directive to code diagnosis is desired.

  8. Using the framework of corporate culture in "mergers" to support the development of a cultural basis for integrative medicine - guidance for building an integrative medicine department or service.

    Science.gov (United States)

    Witt, Claudia M; Pérard, Marion; Berman, Brian; Berman, Susan; Birdsall, Timothy C; Defren, Horst; Kümmel, Sherko; Deng, Gary; Dobos, Gustav; Drexler, Atje; Holmberg, Christine; Horneber, Markus; Jütte, Robert; Knutson, Lori; Kummer, Christopher; Volpers, Susanne; Schweiger, David

    2015-01-01

    An increasing number of clinics offer complementary or integrative medicine services; however, clear guidance about how complementary medicine could be successfully and efficiently integrated into conventional health care settings is still lacking. Combining conventional and complementary medicine into integrative medicine can be regarded as a kind of merger. In a merger, two or more organizations - usually companies - are combined into one in order to strengthen the companies financially and strategically. The corporate culture of both merger partners has an important influence on the integration. The aim of this project was to transfer the concept of corporate culture in mergers to the merging of two medical systems. A two-step approach (literature analyses and expert consensus procedure) was used to develop practical guidance for the development of a cultural basis for integrative medicine, based on the framework of corporate culture in "mergers," which could be used to build an integrative medicine department or integrative medicine service. Results include recommendations for general strategic dimensions (definition of the medical model, motivation for integration, clarification of the available resources, development of the integration team, and development of a communication strategy), and recommendations to overcome cultural differences (the clinic environment, the professional language, the professional image, and the implementation of evidence-based medicine). The framework of mergers in corporate culture provides an understanding of the difficulties involved in integrative medicine projects. The specific recommendations provide a good basis for more efficient implementation.

  9. The laws. 4. enlarged ed.

    International Nuclear Information System (INIS)

    1988-01-01

    This issue no. 10 presents the terms and definitions valid in the field of civil defence, and the laws and regulations. There is the law relating to civil defence, of August 9, 1976, the official announcement, and the statement of legislative intent; further, the law relating to an extension of disaster services, together with the general administrative provisions concerning organisation, additional equipment, training of personnel, and financing of disaster services. The issue also presents the general administrative regulation for establishment, support, and management of civil defence, the law concerning construction and provision of shelters for the population, the general administrative regulation concerning local alarm systems and services (Warndienst-VwV) of March 31, 1981, and the act relating to the convention of May 14, 1954, for protection of cultural objects in the event of an armed conflict, (act of April 11, 1967), as well as the text of the convention itself and the protocol. (orig.) [de

  10. Effect of Job Specialization on the Hospital Stay and Job Satisfaction of ED Nurses

    OpenAIRE

    Shamsi; Mahmoudi; Sirati Nir; Babatabar Darzi

    2016-01-01

    Background In recent decades, the increasing crowdedness of the emergency departments has posed various problems for patients and healthcare systems worldwide. These problems include prolonged hospital stay, patient dissatisfaction and nurse burnout or job dissatisfaction. Objectives The aim of this study was to investigate the effect of emergency department (ED) nurses’ job specialization on their job satisfaction and the length ...

  11. Developing World-Class Customer Service at Navy Field Contracting Activities: An Assessment of the FISC San Diego Regional Contracts Department

    National Research Council Canada - National Science Library

    Allen, Robert

    1997-01-01

    .... The thesis defines world-class customer service and then describes various aspects of service quality including the customer's perspective on service, how service is delivered, how to effectively...

  12. Benefit-cost analysis of SBIRT interventions for substance using patients in emergency departments.

    Science.gov (United States)

    Horn, Brady P; Crandall, Cameron; Forcehimes, Alyssa; French, Michael T; Bogenschutz, Michael

    2017-08-01

    Screening, brief intervention, and referral to treatment (SBIRT) has been widely implemented as a method to address substance use disorders in general medical settings, and some evidence suggests that its use is associated with decreased societal costs. In this paper, we investigated the economic impact of SBIRT using data from Screening, Motivational Assessment, Referral, and Treatment in Emergency Departments (SMART-ED), a multisite, randomized controlled trial. Utilizing self-reported information on medical status, health services utilization, employment, and crime, we conduct a benefit-cost analysis. Findings indicate that neither of the SMART-ED interventions resulted in any significant changes to the main economic outcomes, nor had any significant impact on total economic benefit. Thus, while SBIRT interventions for substance abuse in Emergency Departments may be appealing from a clinical perspective, evidence from this economic study suggests resources could be better utilized supporting other health interventions. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Applicability of the modified Emergency Department Work Index (mEDWIN at a Dutch emergency department.

    Directory of Open Access Journals (Sweden)

    Steffie H A Brouns

    Full Text Available Emergency department (ED crowding leads to prolonged emergency department length of stay (ED-LOS and adverse patient outcomes. No uniform definition of ED crowding exists. Several scores have been developed to quantify ED crowding; the best known is the Emergency Department Work Index (EDWIN. Research on the EDWIN is often applied to limited settings and conducted over a short period of time.To explore whether the EDWIN as a measure can track occupancy at a Dutch ED over the course of one year and to identify fluctuations in ED occupancy per hour, day, and month. Secondary objective is to investigate the discriminatory value of the EDWIN in detecting crowding, as compared with the occupancy rate and prolonged ED-LOS.A retrospective cohort study of all ED visits during the period from September 2010 to August 2011 was performed in one hospital in the Netherlands. The EDWIN incorporates the number of patients per triage level, physicians, treatment beds and admitted patients to quantify ED crowding. The EDWIN was adjusted to emergency care in the Netherlands: modified EDWIN (mEDWIN. ED crowding was defined as the 75th percentile of mEDWIN per hour, which was ≥0.28.In total, 28,220 ED visits were included in the analysis. The median mEDWIN per hour was 0.15 (Interquartile range (IQR 0.05-0.28; median mEDWIN per patient was 0.25 (IQR 0.15-0.39. The EDWIN was higher on Wednesday (0.16 than on other days (0.14-0.16, p<0.001, and a peak in both mEDWIN (0.30-0.33 and ED crowding (52.9-63.4% was found between 13:00-18:00 h. A comparison of the mEDWIN with the occupancy rate revealed an area under the curve (AUC of 0.86 (95%CI 0.85-0.87. The AUC of mEDWIN compared with a prolonged ED-LOS (≥4 hours was 0.50 (95%CI 0.40-0.60.The mEDWIN was applicable at a Dutch ED. The mEDWIN was able to identify fluctuations in ED occupancy. In addition, the mEDWIN had high discriminatory power for identification of a busy ED, when compared with the occupancy rate.

  14. Occupational stress in the ED: a systematic literature review.

    Science.gov (United States)

    Basu, Subhashis; Qayyum, Hasan; Mason, Suzanne

    2017-07-01

    Occupational stress is a major modern health and safety challenges. While the ED is known to be a high-pressure environment, the specific organisational stressors which affect ED staff have not been established. We conducted a systematic review of literature examining the sources of organisational stress in the ED, their link to adverse health outcomes and interventions designed to address them. A narrative review of contextual factors that may contribute to occupational stress was also performed. All articles written in English, French or Spanish were eligible for conclusion. Study quality was graded using a modified version of the Newcastle-Ottawa Scale. Twenty-five full-text articles were eligible for inclusion in our systematic review. Most were of moderate quality, with two low-quality and two high-quality studies, respectively. While high demand and low job control were commonly featured, other studies demonstrated the role of insufficient support at work, effort-reward imbalance and organisational injustice in the development of adverse health and occupational outcomes. We found only one intervention in a peer-reviewed journal evaluating a stress reduction programme in ED staff. Our review provides a guide to developing interventions that target the origins of stress in the ED. It suggests that those which reduce demand and increase workers' control over their job, improve managerial support, establish better working relationships and make workers' feel more valued for their efforts could be beneficial. We have detailed examples of successful interventions from other fields which may be applicable to this setting. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  15. Evaluating outcomes of the emergency nurse practitioner role in a major urban emergency department, Melbourne, Australia.

    Science.gov (United States)

    Jennings, Natasha; O'Reilly, Gerard; Lee, Geraldine; Cameron, Peter; Free, Belinda; Bailey, Michael

    2008-04-01

    The aim of this study was to evaluate the impact of the introduction of Emergency Nurse Practitioner Candidates (ENPC) on waiting times and length of stay of patients presenting to a major urban Emergency Department (ED) in Melbourne, Australia. As part of a Victorian state funded initiative to improve patient outcomes, the role of the Emergency Nurse Practitioner has been developed. The integration and implementation of this role, is not only new to the Alfred Emergency and Trauma Centre but to EDs in Melbourne, Australia, with aims of providing holistic and comprehensive care for patients. A retrospective case series of all patients with common ED diagnostic subgroups were included. The ENPC group (n = 572) included all patients managed by the ENPC and the Traditional Model (TM) group (n = 2584) included all patients managed by the traditional medical ED model of care. Outcome measures included waiting times and length of stay. Statistically significant differences were evident between the two groups in waiting times and length of stay in the ED. The overall median waiting time for emergency patients to be seen by the ENPC was less than for the TM group [median (IQR): ENPC 12 (5.5-28) minutes; TM 31 (11.5-76) minutes (Wilcoxon p times for ENPC shifts vs. non-ENPC shifts revealed significant differences [median (IQR): ENPC rostered 24 (9-52) minutes; ENPC not rostered 33 (13-80.5) minutes (Wilcoxon p Melbourne, Australia were associated with significantly reduced waiting times and length of stay for emergency patients. Emergency Nurse Practitioners should be considered as a potential long term strategy to manage increased service demands on EDs. Relevance to clinical practice. This study is the first in Australia with a significant sample size to vigorously compare ENPC waiting times and length of stay outcomes with the TM model of care in the ED. The study suggests that ENPCs can have a favourable impact on patient outcomes with regard to waiting times and length

  16. Factors associated with imaging overuse in the emergency department: A systematic review.

    Science.gov (United States)

    Tung, Monica; Sharma, Ritu; Hinson, Jeremiah S; Nothelle, Stephanie; Pannikottu, Jean; Segal, Jodi B

    2018-02-01

    Emergency departments (ED) are sites of prevalent imaging overuse; however, determinants that drive imaging in this setting are not well-characterized. We systematically reviewed the literature to summarize the determinants of imaging overuse in the ED. We searched MEDLINE® and Embase® from January 1998 to March 2017. Studies were included if they were written in English, contained original data, pertained to a U.S. population, and identified a determinant associated with overuse of imaging in the ED. Twenty relevant studies were included. Fourteen evaluated computerized tomography (CT) scanning in patents presenting to a regional ED who were then transferred to a level 1 trauma center; incomplete transfer of data and poor image quality were the most frequently described reasons for repeat scanning. Unnecessary pre-transfer scanning or repeated scanning after transfer, in multiple studies, was highest among older patients, those with higher Injury Severity Scores (ISS) and those being transferred further. Six studies explored determinants of overused imaging in the ED in varied conditions, with overuse greater in older patients and those having more comorbid diseases. Defensive imaging reportedly influenced physician behavior. Less integration of services across the health system also predisposed to overuse of imaging. The literature is heterogeneous with surprisingly few studies of determinants of imaging in minor head injury or of spine imaging. Older patient age and higher ISS were the most consistently associated with ED imaging overuse. This review highlights the need for precise definitions of overuse of imaging in the ED. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. CME GUEST ED.indd

    African Journals Online (AJOL)

    effects such as those related to heat, cold, floods, storms and solar ultraviolet radiation have been ... reduced availability and quality of water, and food security risks decreasing an individual's ability to cope with existing ... pressure on services and local environmental conditions. Violence and interpersonal crime, already a ...

  18. Oncologic emergencies in a cancer center emergency department and in general emergency departments countywide and nationwide.

    Science.gov (United States)

    Yang, Zhi; Yang, Runxiang; Kwak, Min Ji; Qdaisat, Aiham; Lin, Junzhong; Begley, Charles E; Reyes-Gibby, Cielito C; Yeung, Sai-Ching Jim

    2018-01-01

    Although cancer patients (CPs) are increasingly likely to visit emergency department (ED), no population-based study has compared the characteristics of CPs and non-cancer patients (NCPs) who visit the ED and examined factors associated with hospitalization via the ED. In this study, we (1) compared characteristics and diagnoses between CPs and NCPs who visited the ED in a cancer center or general hospital; (2) compared characteristics and diagnoses between CPs and NCPs who were hospitalized via the ED in a cancer center or general hospital; and (3) investigated important factors associated with such hospitalization. We analyzed patient characteristic and diagnosis [based on International Classification of Diseases-9 (ICD-9) codes] data from the ED of a comprehensive cancer center (MDACC), 24 general EDs in Harris County, Texas (HCED), and the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 1/1/2007-12/31/2009. Approximately 3.4 million ED visits were analyzed: 47,245, 3,248,973, and 104,566 visits for MDACC, HCED, and NHAMCS, respectively, of which 44,143 (93.4%), 44,583 (1.4%), and 632 (0.6%) were CP visits. CPs were older than NCPs and stayed longer in EDs. Lung, gastrointestinal (excluding colorectal), and genitourinary (excluding prostate) cancers were the three most common diagnoses related to ED visits at general EDs. CPs visiting MDACC were more likely than CPs visiting HCED to be privately insured. CPs were more likely than NCPs to be hospitalized. Pneumonia and influenza, fluid and electrolyte disorders, and fever were important predictive factors for CP hospitalization; coronary artery disease, cerebrovascular disease, and heart failure were important factors for NCP hospitalization. CPs consumed more ED resources than NCPs and had a higher hospitalization rate. Given the differences in characteristics and diagnoses between CPs and NCPs, ED physicians must pay special attention to CPs and be familiar with their unique set of oncologic

  19. Does better access to FPs decrease the likelihood of emergency department use?

    Science.gov (United States)

    Mian, Oxana; Pong, Raymond

    2012-01-01

    Abstract Objective To determine whether better access to FP services decreases the likelihood of emergency department (ED) use among the Ontario population. Design Population-based telephone survey. Setting Ontario. Participants A total of 8502 Ontario residents aged 16 years and older. Main outcome measures Emergency department use in the 12 months before the survey. Results Among the general population, having a regular FP was associated with having better access to FPs for immediate care (P FPs for immediate care at least once a year; 63.1% of them had seen FPs without difficulties and were significantly less likely to use EDs than those who did not see FPs or had difficulties accessing physicians when needed (OR = 0.62, P FPs (P FPs for immediate care among the general population. Further research is needed to understand what accounts for a higher likelihood of ED use among those with regular FPs, new immigrants, residents of northern and rural areas of Ontario, and people with low socioeconomic status when actual access and sociodemographic characteristics have been taken into consideration. More important, this study demonstrates a need of distinguishing between potential and actual access to care, as having a regular FP and having timely and effective access to FP care might mean different things and have different effects on ED use. PMID:23152473

  20. Using data to drive emergency department design: a metasynthesis.

    Science.gov (United States)

    Welch, Shari J

    2012-01-01

    There has been an uptick in the field of emergency department (ED) operations research and data gathering, both published and unpublished. This new information has implications for ED design. The specialty suffers from an inability to have these innovations reach frontline practitioners, let alone design professionals and architects. This paper is an attempt to synthesize for design professionals the growing data regarding ED operations. The following sources were used to capture and summarize the research and data collections available regarding ED operations: the Emergency Department Benchmarking Alliance database; a literature search using both PubMed and Google Scholar search engines; and data presented at conferences and proceedings. Critical information that affects ED design strategies is summarized, organized, and presented. Data suggest an optimal size for ED functional units. The now-recognized arrival and census curves for the ED suggest a department that expands and contracts in response to changing census. Operational improvements have been dearly identified and are grouped into three categories: input, throughput, and outflow. Applications of this information are suggested. The sentinel premise of this meta-synthesis is that data derived from improvement work in the area of ED operations has applications for ED design. EDs can optimize their functioning by marrying good processes and operations to good design. This review paper is an attempt to bring this new information to the attention of the multidisciplinary team of architects, designers, and clinicians.

  1. Impact of Superstorm Sandy on Medicare Patients’ Utilization of Hospitals and Emergency Departments

    Directory of Open Access Journals (Sweden)

    Benoit Stryckman

    2017-09-01

    Full Text Available Introduction: National health security requires that healthcare facilities be prepared to provide rapid, effective emergency and trauma care to all patients affected by a catastrophic event. We sought to quantify changes in healthcare utilization patterns for an at-risk Medicare population before, during, and after Superstorm Sandy’s 2012 landfall in New Jersey (NJ. Methods: This study is a retrospective cohort study of Medicare beneficiaries impacted by Superstorm Sandy. We compared hospital emergency department (ED and healthcare facility inpatient utilization in the weeks before and after Superstorm Sandy landfall using a 20% random sample of Medicare fee-for-service beneficiaries continuously enrolled in 2011 and 2012 (N=224,116. Outcome measures were pre-storm discharges (or transfers, average length of stay, service intensity weight, and post-storm ED visits resulting in either discharge or hospital admission. Results: In the pre-storm week, hospital transfers from skilled nursing facilities (SNF increased by 39% and inpatient discharges had a 0.3 day decreased mean length of stay compared to the prior year. In the post-storm week, ED visits increased by 14% statewide; of these additional “surge” patients, 20% were admitted to the hospital. The increase in ED demand was more than double the statewide average in the most highly impacted coastal regions (35% versus 14%. Conclusion: Superstorm Sandy impacted both pre- and post-storm patient movement in New Jersey; post-landfall ED surge was associated with overall storm impact, which was greatest in coastal counties. A significant increase in the number and severity of pre-storm transfer patients, in particular from SNF, as well as in post-storm ED visits and inpatient admissions, draws attention to the importance of collaborative regional approaches to healthcare in large-scale events.

  2. Impact of Superstorm Sandy on Medicare Patients' Utilization of Hospitals and Emergency Departments.

    Science.gov (United States)

    Stryckman, Benoit; Walsh, Lauren; Carr, Brendan G; Hupert, Nathaniel; Lurie, Nicole

    2017-10-01

    National health security requires that healthcare facilities be prepared to provide rapid, effective emergency and trauma care to all patients affected by a catastrophic event. We sought to quantify changes in healthcare utilization patterns for an at-risk Medicare population before, during, and after Superstorm Sandy's 2012 landfall in New Jersey (NJ). This study is a retrospective cohort study of Medicare beneficiaries impacted by Superstorm Sandy. We compared hospital emergency department (ED) and healthcare facility inpatient utilization in the weeks before and after Superstorm Sandy landfall using a 20% random sample of Medicare fee-for-service beneficiaries continuously enrolled in 2011 and 2012 (N=224,116). Outcome measures were pre-storm discharges (or transfers), average length of stay, service intensity weight, and post-storm ED visits resulting in either discharge or hospital admission. In the pre-storm week, hospital transfers from skilled nursing facilities (SNF) increased by 39% and inpatient discharges had a 0.3 day decreased mean length of stay compared to the prior year. In the post-storm week, ED visits increased by 14% statewide; of these additional "surge" patients, 20% were admitted to the hospital. The increase in ED demand was more than double the statewide average in the most highly impacted coastal regions (35% versus 14%). Superstorm Sandy impacted both pre- and post-storm patient movement in New Jersey; post-landfall ED surge was associated with overall storm impact, which was greatest in coastal counties. A significant increase in the number and severity of pre-storm transfer patients, in particular from SNF, as well as in post-storm ED visits and inpatient admissions, draws attention to the importance of collaborative regional approaches to healthcare in large-scale events.

  3. Impact of Superstorm Sandy on Medicare Patients’ Utilization of Hospitals and Emergency Departments

    Science.gov (United States)

    Stryckman, Benoit; Walsh, Lauren; Carr, Brendan G.; Hupert, Nathaniel; Lurie, Nicole

    2017-01-01

    Introduction National health security requires that healthcare facilities be prepared to provide rapid, effective emergency and trauma care to all patients affected by a catastrophic event. We sought to quantify changes in healthcare utilization patterns for an at-risk Medicare population before, during, and after Superstorm Sandy’s 2012 landfall in New Jersey (NJ). Methods This study is a retrospective cohort study of Medicare beneficiaries impacted by Superstorm Sandy. We compared hospital emergency department (ED) and healthcare facility inpatient utilization in the weeks before and after Superstorm Sandy landfall using a 20% random sample of Medicare fee-for-service beneficiaries continuously enrolled in 2011 and 2012 (N=224,116). Outcome measures were pre-storm discharges (or transfers), average length of stay, service intensity weight, and post-storm ED visits resulting in either discharge or hospital admission. Results In the pre-storm week, hospital transfers from skilled nursing facilities (SNF) increased by 39% and inpatient discharges had a 0.3 day decreased mean length of stay compared to the prior year. In the post-storm week, ED visits increased by 14% statewide; of these additional “surge” patients, 20% were admitted to the hospital. The increase in ED demand was more than double the statewide average in the most highly impacted coastal regions (35% versus 14%). Conclusion Superstorm Sandy impacted both pre- and post-storm patient movement in New Jersey; post-landfall ED surge was associated with overall storm impact, which was greatest in coastal counties. A significant increase in the number and severity of pre-storm transfer patients, in particular from SNF, as well as in post-storm ED visits and inpatient admissions, draws attention to the importance of collaborative regional approaches to healthcare in large-scale events. PMID:29085534

  4. Prognostic value of plasma lactate levels in a retrospective cohort presenting at a university hospital emergency department.

    Science.gov (United States)

    van den Nouland, Danith P A; Brouwers, Martijn C G J; Stassen, Patricia M

    2017-01-30

    The prognostic value of lactate in the setting of an emergency department (ED) has not been studied extensively. The goal of this study was to assess 28-day mortality in ED patients in whom lactate was elevated (≥4.0 mmol/L), present in 84% of those with hyperlactatemia, was associated with higher mortality than type B hyperlactatemia (45.8% vs 12.5%, p=0.001). This study demonstrates that the prognostic value of lactate depends largely on the underlying cause and the population in whom lactate has been measured. Prospective studies are required to address the true added value of lactate at the ED. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  5. The association between length of emergency department boarding and mortality.

    Science.gov (United States)

    Singer, Adam J; Thode, Henry C; Viccellio, Peter; Pines, Jesse M

    2011-12-01

    Emergency department (ED) boarding has been associated with several negative patient-oriented outcomes, from worse satisfaction to higher inpatient mortality rates. The current study evaluates the association between length of ED boarding and outcomes. The authors expected that prolonged ED boarding of admitted patients would be associated with higher mortality rates and longer hospital lengths of stay (LOS). This was a retrospective cohort study set at a suburban academic ED with an annual ED census of 90,000 visits. Consecutive patients admitted to the hospital from the ED and discharged between October 2005 and September 2008 were included. An electronic medical record (EMR) system was used to extract patient demographics, ED disposition (discharge, admit to floor), ED and hospital LOS, and in-hospital mortality. Boarding was defined as ED LOS 2 hours or more after decision for admission. Descriptive statistics were used to evaluate the association between length of ED boarding and hospital LOS, subsequent transfer to an intensive care unit (ICU), and mortality controlling for comorbidities. There were 41,256 admissions from the ED. Mortality generally increased with increasing boarding time, from 2.5% in patients boarded less than 2 hours to 4.5% in patients boarding 12 hours or more (p boarding time (p boarded for more than 24 hours. The increases were still apparent after adjustment for comorbid conditions and other factors. Hospital mortality and hospital LOS are associated with length of ED boarding. © 2011 by the Society for Academic Emergency Medicine.

  6. Fire Department Emergency Response

    International Nuclear Information System (INIS)

    Blanchard, A.; Bell, K.; Kelly, J.; Hudson, J.

    1997-09-01

    In 1995 the SRS Fire Department published the initial Operations Basis Document (OBD). This document was one of the first of its kind in the DOE complex and was widely distributed and reviewed. This plan described a multi-mission Fire Department which provided fire, emergency medical, hazardous material spill, and technical rescue services

  7. RESPONSE OF THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES IN PROTECTING CIVILIAN AMERICANS IN JAPAN DURING THE FUKUSHIMA NUCLEAR CRISIS.

    Science.gov (United States)

    Simon, Steven L; Coleman, C Norman; Noska, Michael A; Bowman, Thomas

    2012-05-01

    Following the earthquake and tsunami in northern Japan on 11 March 2011, and the ensuing damage to the Fukushima Daiichi nuclear power plant complex, a request by the U.S. Ambassador to Japan to the U.S. Department of Health and Human Services (DHHS) Assistant Secretary for Preparedness and Response (ASPR) resulted in deployment of a five-person team of subject matter experts to the U.S. Embassy. The primary purpose of the deployment was to provide the U.S. Embassy in Tokyo with guidance on health and medical issues related to potential radiation exposure of U.S. citizens in Japan, including employees of the U.S. Department of State at consulates in Japan and American citizens living in or visiting Japan. At the request of the Government of Japan, the deployed health team also assisted Japanese experts in their public health response to the radiation incident. Over a three-week period in Japan and continuing for weeks after their return to the U.S., the team provided expertise in the areas of medical and radiation oncology, health physics, assessment of radiation dose and cancer risk, particularly to U.S. citizens living in Tokyo and the surrounding areas, food and water contamination and the acceptable limits, countermeasures to exposure such as potassium iodide (KI), the use of KI and an offered donation from the United States, evacuation and re-entry issues, and health/emergency-related communication strategies. This paper describes the various strategies used and observations made by the DHHS team during the first two months after the Fukushima crisis began.

  8. Pharmacist-driven antimicrobial optimization in the emergency department.

    Science.gov (United States)

    Davis, Lucretia C; Covey, Robin B; Weston, Jaye S; Hu, Bee Bee Y; Laine, Gregory A

    2016-03-01

    A pharmacist-driven antimicrobial optimization service in the non-trauma emergency department (ED) of an 864-bed non-profit tertiary care teaching hospital was reviewed to assess its value. Local antimicrobial resistance patterns of urine, wound, stool, and blood cultures were also studied to determine whether or not empiric prescribing practices should be modified. A retrospective electronic chart review was performed for ED patients with positive cultures during two different three-month periods. During Period 1, ED nursing management performed positive culture follow-up. During Period 2, ED clinical pharmacists performed this role. The primary objective was to determine the value of the pharmacist-driven antimicrobial optimization service as measured by the number of clinical interventions made when indicated. The secondary objective was to examine resistance patterns of urine and wound isolates in order to determine if empiric prescribing patterns in the ED should be modified. During Period 1, there were 499 patient visits with subsequent positive cultures. Of those, 76 patients (15%) were discharged home. Nursing management intervened on 21 of 42 (50%) positive cultures that required an intervention; in Period 2, there were 473 patient visits with subsequent positive cultures, and 64 (14%) were discharged home. Pharmacists intervened on 24 of 30 (80%) cultures where an intervention was indicated resulting in a 30% increase in interventions for inappropriate therapy (p = 0.01). A review of the secondary objective revealed a 38% fluoroquinolone resistance rate of E. coli, the most frequently isolated urinary organism. Pharmacist-driven antimicrobial stewardship program resulted in a 30% absolute increase in interventions for inappropriate therapy as compared to the nursing-driven model. This stewardship program has further demonstrated the value of ED pharmacists. Pharmacist interventions should help to ensure that infections are resolved through modification of

  9. Supervision and feedback for junior medical staff in Australian emergency departments: findings from the emergency medicine capacity assessment study

    Directory of Open Access Journals (Sweden)

    Weiland Tracey J

    2010-11-01

    Full Text Available Abstract Background Clinical supervision and feedback are important for the development of competency in junior doctors. This study aimed to determine the adequacy of supervision of junior medical staff in Australian emergency departments (EDs and perceived feedback provided. Methods Semi-structured telephone surveys sought quantitative and qualitative data from ED Directors, Directors of Emergency Medicine Training, registrars and interns in 37 representative Australian hospitals; quantitative data were analysed with SPSS 15.0 and qualitative data subjected to content analysis identifying themes. Results Thirty six of 37 hospitals took part. Of 233 potential interviewees, 95 (40.1% granted interviews including 100% (36/36 of ED Directors, and 96.2% (25/26 of eligible DEMTs, 24% (19/81 of advanced trainee/registrars, and 17% (15/90 of interns. Most participants (61% felt the ED was adequately supervised in general and (64.2% that medical staff were adequately supervised. Consultants and registrars were felt to provide most intern supervision, but this varied depending on shift times, with registrars more likely to provide supervision on night shift and at weekends. Senior ED medical staff (64% and junior staff (79% agreed that interns received adequate clinical supervision. Qualitative analysis revealed that good processes were in place to ensure adequate supervision, but that service demands, particularly related to access block and overcrowding, had detrimental effects on both supervision and feedback. Conclusions Consultants appear to provide the majority of supervision of junior medical staff in Australian EDs. Supervision and feedback are generally felt to be adequate, but are threatened by service demands, particularly related to access block and ED overcrowding.

  10. Emergency Department Crowding: Factors Influencing Flow

    OpenAIRE

    Arkun, Alp; Briggs, William M; Patel, Sweha; Datillo, Paris A; Bove, Joseph; Birkhahn, Robert H

    2010-01-01

    Background: The objective of this study was to evaluate those factors, both intrinsic and extrinsic to the emergency department (ED) that influence two specific components of throughput: “door-to-doctor” time and dwell time. Methods: We used a prospective observational study design to determine the variables that played a significant role in determining ED flow. All adult patients seen or waiting to be seen in the ED were observed at 8pm (Monday-Friday) during a three-month period. V...

  11. Bedding, not boarding. Psychiatric patients boarded in hospital EDs create crisis for patient care and hospital finances.

    Science.gov (United States)

    Kutscher, Beth

    2013-11-18

    As the supply of psychiatric beds dwindles, hospitals are devising innovative ways handle psych patients who come through the emergency department. Some collaborate with other hospitals, use separate pysch EDs or refer patients to residential treatment centers.

  12. Integrating care for frequent users of emergency departments: implementation evaluation of a brief multi-organizational intensive case management intervention.

    Science.gov (United States)

    Kahan, Deborah; Leszcz, Molyn; O'Campo, Patricia; Hwang, Stephen W; Wasylenki, Donald A; Kurdyak, Paul; Wise Harris, Deborah; Gozdzik, Agnes; Stergiopoulos, Vicky

    2016-04-27

    Addressing the needs of frequent users of emergency departments (EDs) is a health system priority in many jurisdictions. This study describes stakeholder perspectives on the implementation of a multi-organizational brief intervention designed to support integration and continuity of care for frequent ED users with mental health and addictions problems, focusing on perceived barriers and facilitators to early implementation in a large urban centre. Coordinating Access to Care from Hospital Emergency Departments (CATCH-ED) is a brief case management intervention bridging hospital, primary and community care for frequent ED users experiencing mental illness and addictions. To examine barriers and facilitators to early implementation of this multi-organizational intervention, between July and October 2012, 47 stakeholders, including direct service providers, managers and administrators participated in 32 semi-structured qualitative interviews and one focus group exploring their experience with the intervention and factors that helped or hindered successful early implementation. Qualitative data were analyzed using thematic analysis. Stakeholders valued the intervention and its potential to support continuity of care for this population. Service delivery system factors, including organizational capacity and a history of collaborative relationships across the healthcare continuum, and support system factors, such as training and supervision, emerged as key facilitators of program implementation. Operational challenges included early low program referral rates, management of a multi-organizational initiative, variable adherence to the model among participating organizations, and scant access to specialty psychiatric resources. Factors contributing to these challenges included lack of dedicated staff in the ED and limited local system capacity to support this population, and insufficient training and technical assistance available to participating organizations. A multi

  13. MicroED data collection and processing

    Energy Technology Data Exchange (ETDEWEB)

    Hattne, Johan; Reyes, Francis E.; Nannenga, Brent L.; Shi, Dan; Cruz, M. Jason de la [Janelia Research Campus, Howard Hughes Medical Institute, Ashburn, VA 20147 (United States); Leslie, Andrew G. W. [Medical Research Council Laboratory of Molecular Biology, Cambridge (United Kingdom); Gonen, Tamir, E-mail: gonent@janelia.hhmi.org [Janelia Research Campus, Howard Hughes Medical Institute, Ashburn, VA 20147 (United States)

    2015-07-01

    The collection and processing of MicroED data are presented. MicroED, a method at the intersection of X-ray crystallography and electron cryo-microscopy, has rapidly progressed by exploiting advances in both fields and has already been successfully employed to determine the atomic structures of several proteins from sub-micron-sized, three-dimensional crystals. A major limiting factor in X-ray crystallography is the requirement for large and well ordered crystals. By permitting electron diffraction patterns to be collected from much smaller crystals, or even single well ordered domains of large crystals composed of several small mosaic blocks, MicroED has the potential to overcome the limiting size requirement and enable structural studies on difficult-to-crystallize samples. This communication details the steps for sample preparation, data collection and reduction necessary to obtain refined, high-resolution, three-dimensional models by MicroED, and presents some of its unique challenges.

  14. Active Intervention Can Decrease Burnout In Ed Nurses.

    Science.gov (United States)

    Wei, Rong; Ji, Hong; Li, Jianxin; Zhang, Liyao

    2017-03-01

    The aim of this study was to evaluate whether active intervention can decrease job burnout and improve performance among ED nurses. This study was carried out in the emergency departments of 3 hospitals randomly selected from 8 comprehensive high-level hospitals in Jinan, China. A total of 102 nurses were enrolled and randomly divided into control and intervention groups. For 6 months, nurses in intervention groups were treated with ordinary treatment plus comprehensive management, whereas nurses in the control group were treated with ordinary management, respectively. Questionnaires were sent and collected at baseline and at the end of the study. The Student t test was used to evaluate the effect of comprehensive management in decreasing burnout. All ED nurses showed symptoms of job burnout at different levels. Our data indicated that comprehensive management significantly decreased emotional exhaustion and depersonalization (P burnout in ED nurses and contribute to relieving work-related stress and may further protect against potential mental health problems. Copyright © 2016 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  15. Utilization of maternal health care services in the department of Matagalpa, Nicaragua Utilización de los servicios de salud materna en el departamento de Matagalpa, Nicaragua

    Directory of Open Access Journals (Sweden)

    Lindsey Ann Lubbock

    2008-08-01

    Full Text Available OBJECTIVES: To better understand the individual and community factors and perceptions that influence women's health care-seeking behaviors during pregnancy in order to increase women's utilization of maternal health services. METHODS: This study investigates the logistical and sociocultural barriers influencing women's utilization of maternal health services through 37 semi-structured in-depth interviews with women from the department of Matagalpa, Nicaragua. RESULTS: Results reveal that delays in seeking health care during pregnancy are influenced not only by poor access to care and economic barriers but also by individual and community knowledge and acceptance of maternal health services. Partner support, previous maternal health care experiences, and the degree of communication with other women and health workers affect women's decisions to seek care. CONLUSIONS: Evidence suggests that in order to improve maternal health outcomes in this region, interventions must be targeted at a hierarchy of levels: individual, household, and community.OBJETIVOS: Mejorar el conocimiento sobre las percepciones y los factores personales y comunitarios que influyen en la búsqueda de atención médica durante el embarazo, con vistas a aumentar la utilización de los servicios de salud materna. MÉTODOS: Mediante 37 entrevistas semiestructuradas en profundidad aplicadas a mujeres del departamento de Matagalpa, Nicaragua, se investigaron las barreras logísticas y socioculturales que influyen en la utilización de los servicios de salud materna. RESULTADOS: Los resultados muestran que sobre la demora en la búsqueda de atención sanitaria durante el embarazo influyeron no solo el escaso acceso y las barreas económicas, sino también el conocimiento individual y comunitario sobre los servicios de salud materna y su grado de aceptación. El apoyo de la pareja, el haber recibido atención médica durante embarazos previos y el grado de comunicación con otras

  16. Bacteraemia in the ED: Are We Meeting Targets?

    LENUS (Irish Health Repository)

    Borhan, N

    2018-03-01

    When sepsis is identified early in the Emergency Department (ED) and its severe form is treated aggressively with the protocolised care bundle of early goal directed therapy (EGDT), improvements in mortality are significant1,2. Surviving sepsis guidelines recommend the administration of effective intravenous antimicrobials within the first hour of recognition of septic shock and severe sepsis without septic shock3. The Mater University Hospital has antimicrobial guidelines to guide empiric prescribing in adult sepsis available on the hospital intranet and on a smartphone app.

  17. The SYVAC standards (ed. 2)

    International Nuclear Information System (INIS)

    Resnick, M.

    1983-04-01

    The Department of the Environment has embarked on a programme to develop computer models to help with assessment of sites suitable for the disposal of nuclear wastes. The first priority is to produce a system, based on the System Variability Analysis Code (SYVAC) obtained from Atomic Energy of Canada Ltd., suitable for assessing radioactive waste disposal in land repositories containing non heat producing wastes from typical UK sources. The requirements of the SYVAC system development were so diverse that each portion of the development was contracted to a different company. Scicon are responsible for software coordination, system integration and user interface. Their present report deals with SYVAC standards: FORTRAN coding; program documentation; testing guidelines; change control. (U.K.)

  18. Characterization of sexual abuse cases valued in the emergency services and outpatient consultation of a first-level hospital institution in the department of Cauca, 2007 - 2015

    Directory of Open Access Journals (Sweden)

    Gloria Cerón Hernández

    2017-08-01

    Full Text Available Introduction: Sexual abuse affects millions of children and adolescents and it impacts on their physical and mental health. Objective: To characterize the cases of sexual abuse valued in the emergency services and external consultation of a hospital institution of first level in the department of Cauca between 2007 and 2015. Materials and methods: A descriptive, retrospective study of victims of sexual abuse attended in external consultation/emergencies was made. Temporal and sociodemographic variables of the victim/aggressor and the context where the event occurred were selected. The analysis was done in Epi Info. Measures of central tendency, dispersion, proportions and reasons were calculated. The relationship between variables was assessed by using the Fischer test. Results: 77% of the victims were women, 23% men, at ages between 2 to 16 years and 100% were students. The act was committed by a single aggressor. Besides, in 93.0% of the cases, the act was perpetrated by acquaintances, of whom 42.9% were family members. Conclusions: Despite the control and regulation measures, the results suggest that sexual abuse takes place at very early ages. The aggressor is almost always a commonly known person with consanguineous bond, which facilitates the perpetuation of the act towards the family nucleus through deceit, blackmail or threat.

  19. The Effects of Management Information System toward Decision Making in Food and Beverage Service Department in X Resorts and Hotels Bandung

    Directory of Open Access Journals (Sweden)

    Agung Gita Subakti

    2015-11-01

    Full Text Available In an organization, decision making hold an important role. That is why a decision made by managers should be a final decision that should be done by their subordinates or those who are related with the organization. In the effort to increase the quality of management information system, a research was held in X Resorts and Hotels Bandung to analyze management information system in the relation to decision making especially in Food and Beverage Service Department and recommendation of how to handle the problem occurred. From the questioner with data analyzing technique of spearman rank gained correlation result 0,84, with determination coefficient 71% which means the management information system has 71% level of influence to decision making, meanwhile the rest of the result (29% shows other factors, which also were related with the decision making other than management information system. To solve with the problem, it is recommended that X Resorts and Hotels decrease the level of information product error in management information used and fasten the delivery of provided information.

  20. [Financial analysis of a department of general surgery in a French hospital. The new "fee-for-service" reimbursement system results in a high deficit for emergency care].

    Science.gov (United States)

    Burdy, G; Dalban-Sillas, B; Leclerc, C; Bonnaventure, F; Roullet Audy, J-C; Frileux, P

    2009-10-01

    The aim of this study was to perform a detailed analysis of income and expense in a department of general surgery in a French hospital under the new system of funding based on a "fee-for-service" principle. All hospital stays of year 2006 were analysed retrospectively. The conditions of admission (elective vs. emergency), the principal diagnosis, and surgical procedures were examined. We determined hospital costs and the reimbursement for every admission. One thousand nine hundred and eighty-five hospitalizations generated an income of 8Meuros with a deficit of 1.3Meuros. The 775 elective admissions generated 50% of the income and 13% of the deficit (178,562euros). Seven hundred and forty-nine emergency admissions generated 45% of the income and 82% of deficit (1.1Meuros). Four hundred and sixty-one admissions for endoscopy generated 5% of the income and 5% of the deficit (67,249euros). Hospital stays of less than two days (the minimum duration of stay for total reimbursement) caused a loss of 122,624euros. Length of hospital stay below the lower limit caused a loss of 42,850euros. Elective surgical activity in digestive surgery can generate a balanced budget provided the length of hospital stay is reduced to the minimum, sometimes to the detriment of patient comfort. Emergency admissions result in a large deficit between cost and reimbursement; this fact may lead hospitals to avoid emergency activity in the future unless appropriate remedial measures are taken.

  1. Emergency department characteristics and capabilities in Bogotá, Colombia.

    Science.gov (United States)

    Bustos, Yury; Castro, Jenny; Wen, Leana S; Sullivan, Ashley F; Chen, Dinah K; Camargo, Carlos A

    2015-12-01

    Emergency departments (EDs) are a critical, yet heterogeneous, part of international emergency care. The National ED Inventories (NEDI) survey has been used in multiple countries as a standardized method to benchmark ED characteristics. We sought to describe the characteristics, resources, capabilities, and capacity of EDs in the densely populated capital city of Bogotá, Colombia. Bogotá EDs accessible to the general public 24/7 were surveyed using the 23-item NEDI survey used in several other countries ( www.emnet-nedi.org ). ED staff were asked about ED characteristics with reference to calendar year 2011. Seventy EDs participated (82 % response). Most EDs (87 %) were located in hospitals, and 83 % were independent hospital departments. The median annual ED visit volume was approximately 50,000 visits. Approximately 90 % (95 % confidence interval (CI) 80-96 %) had a contiguous layout, with medical and surgical care provided in one area. Almost all EDs saw both adults and children (91 %), while 6 % saw only adults and 3 % saw only children. Availability of technological and consultant resources in EDs was variable. Nearly every ED had cardiac monitoring (99 %, 95 % CI 92-100 %), but less than half had a dedicated CT scanner (39 %, 95 % CI 28-52 %). While most EDs were able to treat trauma 24/7 (81 %, 95 % CI 69-89 %), few could manage oncological (22 %, 95 % CI 13-34 %) or dental (3 %, 95 % CI 0-11 %) emergencies 24/7. The typical ED length-of-stay was between 1 and 6 h in 59 % of EDs (95 % CI, 46-70 %), while most others reported that patients remained for >6 h (39 %). Almost half of respondents (46 %, 95 % CI 34-59 %) reported their ED was over capacity. Bogotá EDs have high annual visit volumes and long length-of-stay, and half are over capacity. To meet the emergency care needs of people in Bogotá and other large cities, Colombia should consider improving urban ED capacity and training more emergency medicine specialists capable of efficiently staffing its

  2. Characterizing New England Emergency Departments by Telemedicine Use.

    Science.gov (United States)

    Zachrison, Kori S; Hayden, Emily M; Schwamm, Lee H; Espinola, Janice A; Sullivan, Ashley F; Boggs, Krislyn M; Raja, Ali S; Camargo, Carlos A

    2017-10-01

    Telemedicine connects emergency departments (ED) with resources necessary for patient care; its use has not been characterized nationally, or even regionally. Our primary objective was to describe the prevalence of telemedicine use in New England EDs and the clinical applications of use. Secondarily, we aimed to determine if telemedicine use was associated with consultant availability and to identify ED characteristics associated with telemedicine use. We analyzed data from the National Emergency Department Inventory-New England survey, which assessed basic ED characteristics in 2014. The survey queried directors of every ED (n=195) in the six New England states (excluding federal hospitals and college infirmaries). Descriptive statistics characterized ED telemedicine use; multivariable logistic regression identified independent predictors of use. Of the 169 responding EDs (87% response rate), 82 (49%) reported using telemedicine. Telemedicine EDs were more likely to be rural (18% of users vs. 7% of non-users, p=0.03); less likely to be academic (1% of users vs. 11% of non-users, p=0.01); and less likely to have 24/7 access to neurology (ptelemedicine was more likely in rural EDs (odds ratio [OR] 4.39, 95% confidence interval [CI] 1.30-14.86), and less likely in EDs with 24/7 neurologist availability (OR 0.21, 95% CI [0.09-0.49]), and annual volume Telemedicine is commonly used in New England EDs. In 2014, use was more common among rural EDs and EDs with limited neurology consultant availability. In contrast, telemedicine use was less common among very low-volume EDs.

  3. Department of Defense perspective

    International Nuclear Information System (INIS)

    Devine, R.

    1985-01-01

    This paper examines radiation instrumentation from the Department of Defense perspective. Radiation survey instruments and calibration, or RADIAC, as it is called in the services, while administratively falling under the Assistant Secretary of Defense for Atomic Energy, has generally been managed at a lower level. The Naval Electronics Systems Command and Army Signal Corp are the two principles in the Department of Defense for RADIAC. The actions of the services are coordinated through the tri-service RADIAC working group, which meets about every year and a half. Several points from this organization are highlighted

  4. ED utilization trends in sports-related traumatic brain injury.

    Science.gov (United States)

    Hanson, Holly R; Pomerantz, Wendy J; Gittelman, Mike

    2013-10-01

    Emergency department (ED) visits for sports-related traumatic brain injuries (TBIs) have risen. This study evaluated how the number and severity of admissions have changed as ED visits for sports-related TBIs have increased. A retrospective study of children aged 0 to 19 years at a level 1 trauma center was performed. Patients from 2002 to 2011 with a primary or secondary diagnosis of TBI were identified from the hospital's inpatient and outpatient trauma registries. Frequencies were used to characterize the population, χ(2) analysis was performed to determine differences between groups, and regression analysis looked at relationship between year and injury severity score or length of stay. Sport was responsible for injury in 3878 (15.4%) cases during the study period; 3506 (90.4%) were discharged from the hospital, and 372 (9.6%) were admitted. Seventy-three percent were male patients and 78% Caucasian; mean age was 13 ± 3.5 years. ED visits for sports-related TBIs increased 92% over the study period, yet there was no significant change (χ(2) = 9.8, df = 9, P = .37) in the percentage of children admitted. Mean injury severity score for those admitted decreased from 7.8 to 4.8 (β = -0.46; P = .006); length of stay trended downward (β = -0.05; P = .05). The percentage of children being admitted from the ED with sports-related TBI has not changed over the past 10 years. The severity of admitted sports-related TBI is decreasing. Additional research is needed to correlate these trends with other TBI mechanisms.

  5. Medical identity theft in the emergency department: awareness is crucial.

    Science.gov (United States)

    Mancini, Michelino

    2014-11-01

    Medical identity theft in the emergency department (ED) can harm numerous individuals, and many frontline healthcare providers are unaware of this growing concern. The two cases described began as typical ED encounters until red flags were discovered upon validating the patient's identity. Educating all healthcare personnel within and outside the ED regarding the subtle signs of medical identity theft and implementing institutional policies to identify these criminals will discourage further fraudulent behavior.

  6. Medical Identity Theft in the Emergency Department: Awareness is Crucial

    Science.gov (United States)

    Mancini, Michelino

    2014-01-01

    Medical Identity theft in the emergency department (ED) can harm numerous individuals, and many frontline healthcare providers are unaware of this growing concern. The two cases described began as typical ED encounters until red flags were discovered upon validating the patient’s identity. Educating all healthcare personnel within and outside the ED regarding the subtle signs of medical identity theft and implementing institutional policies to identify these criminals will discourage further fraudulent behavior. PMID:25493150

  7. Emergency Department Use among Adults with Autism Spectrum Disorders (ASD)

    Science.gov (United States)

    Vohra, Rini; Madhavan, Suresh; Sambamoorthi, Usha

    2016-01-01

    A cross-sectional analyses using Nationwide Emergency Department Sample (2006-2011) was conducted to examine the trends, type of ED visits, and mean total ED charges for adults aged 22-64 years with and without ASD (matched 1:3). Around 0.4% ED visits (n = 25,527) were associated with any ASD and rates of such visits more than doubled from 2006 to…

  8. S. 1030: A bill to authorize private sector participation in providing products and services to support Department of Energy defense waste cleanup and modernization missions, introduced in the US Senate, One Hundred Second Congress, First Session, May 9, 1991

    International Nuclear Information System (INIS)

    Anon.

    1991-01-01

    This bill was introduced into the US Senate on May 9, 1991 to authorize private sector participation in providing products and services to support Department of Energy defense waste cleanup and modernization. Congress finds that the management and cleanup of nuclear and hazardous waste and the modernization of Department of Energy facilities must be pursued expeditiously in order to protect the health and safety of the public and workers

  9. Services

    International Nuclear Information System (INIS)

    Hardeman, F.

    1998-01-01

    The objectives of the services section is (1) to offer complete services in health-physics measurements according to international quality standards, (2) to improve continuously these measurement techniques and to follow up international recommendations and legislation concerning the surveillance of workers, (3) to support and advise nuclear and non-nuclear industry on problems of radioactive contamination. Achievements related to gamma spectrometry, whole-body counting, beta and alpha spectrometry, dosimetry, radon measurements, calibration, instrumentation, and neutron activation analysis are described

  10. Older adults who persistently present to the emergency department with severe, non-severe, and indeterminate episode patterns

    Directory of Open Access Journals (Sweden)

    Ohsfeldt Robert L

    2011-10-01

    Full Text Available Abstract Background It is well known that older adults figure prominently in the use of emergency departments (ED across the United States. Previous research has differentiated ED visits by levels of clinical severity and found health status and other individual characteristics distinguished severe from non-severe visits. In this research, we classified older adults into population groups that persistently present with severe, non-severe, or indeterminate patterns of ED episodes. We then contrasted the three groups using a comprehensive set of covariates. Methods Using a unique dataset linking individual characteristics with Medicare claims for calendar years 1991-2007, we identified patterns of ED use among the large, nationally representative AHEAD sample consisting of 5,510 older adults. We then classified one group of older adults who persistently presented to the ED with clinically severe episodes and another group who persistently presented to the ED with non-severe episodes. These two groups were contrasted using logistic regression, and then contrasted against a third group with a persistent pattern of ED episodes with indeterminate levels of severity using multinomial logistic regression. Variable selection was based on Andersen's behavioral model of health services use and featured clinical status, demographic and socioeconomic characteristics, health behaviors, health service use patterns, local health care supply, and other contextual effects. Results We identified 948 individuals (17.2% of the entire sample who presented a pattern in which their ED episodes were typically defined as severe and 1,076 individuals (19.5% who typically presented with non-severe episodes. Individuals who persistently presented to the ED with severe episodes were more likely to be older (AOR 1.52, men (AOR 1.28, current smokers (AOR 1.60, experience diabetes (AOR (AOR 1.80, heart disease (AOR 1.70, hypertension (AOR 1.32 and have a greater amount of

  11. Older adults who persistently present to the emergency department with severe, non-severe, and indeterminate episode patterns.

    Science.gov (United States)

    Kaskie, Brian; Obrizan, Maksym; Jones, Michael P; Bentler, Suzanne; Weigel, Paula; Hockenberry, Jason; Wallace, Robert B; Ohsfeldt, Robert L; Rosenthal, Gary E; Wolinsky, Fredric D

    2011-10-21

    It is well known that older adults figure prominently in the use of emergency departments (ED) across the United States. Previous research has differentiated ED visits by levels of clinical severity and found health status and other individual characteristics distinguished severe from non-severe visits. In this research, we classified older adults into population groups that persistently present with severe, non-severe, or indeterminate patterns of ED episodes. We then contrasted the three groups using a comprehensive set of covariates. Using a unique dataset linking individual characteristics with Medicare claims for calendar years 1991-2007, we identified patterns of ED use among the large, nationally representative AHEAD sample consisting of 5,510 older adults. We then classified one group of older adults who persistently presented to the ED with clinically severe episodes and another group who persistently presented to the ED with non-severe episodes. These two groups were contrasted using logistic regression, and then contrasted against a third group with a persistent pattern of ED episodes with indeterminate levels of severity using multinomial logistic regression. Variable selection was based on Andersen's behavioral model of health services use and featured clinical status, demographic and socioeconomic characteristics, health behaviors, health service use patterns, local health care supply, and other contextual effects. We identified 948 individuals (17.2% of the entire sample) who presented a pattern in which their ED episodes were typically defined as severe and 1,076 individuals (19.5%) who typically presented with non-severe episodes. Individuals who persistently presented to the ED with severe episodes were more likely to be older (AOR 1.52), men (AOR 1.28), current smokers (AOR 1.60), experience diabetes (AOR (AOR 1.80), heart disease (AOR 1.70), hypertension (AOR 1.32) and have a greater amount of morbidity (AOR 1.48) than those who persistently

  12. On the quantitativeness of EDS STEM

    Energy Technology Data Exchange (ETDEWEB)

    Lugg, N.R. [Institute of Engineering Innovation, The University of Tokyo, 2-11-16, Yayoi, Bunkyo-ku, Tokyo 113-8656 (Japan); Kothleitner, G. [Institute for Electron Microscopy and Nanoanalysis, Graz University of Technology, Steyrergasse 17, 8010 Graz (Austria); Centre for Electron Microscopy, Steyrergasse 17, 8010 Graz (Austria); Shibata, N.; Ikuhara, Y. [Institute of Engineering Innovation, The University of Tokyo, 2-11-16, Yayoi, Bunkyo-ku, Tokyo 113-8656 (Japan)

    2015-04-15

    Chemical mapping using energy dispersive X-ray spectroscopy (EDS) in scanning transmission electron microscopy (STEM) has recently shown to be a powerful technique in analyzing the elemental identity and location of atomic columns in materials at atomic resolution. However, most applications of EDS STEM have been used only to qualitatively map whether elements are present at specific sites. Obtaining calibrated EDS STEM maps so that they are on an absolute scale is a difficult task and even if one achieves this, extracting quantitative information about the specimen – such as the number or density of atoms under the probe – adds yet another layer of complexity to the analysis due to the multiple elastic and inelastic scattering of the electron probe. Quantitative information may be obtained by comparing calibrated EDS STEM with theoretical simulations, but in this case a model of the structure must be assumed a priori. Here we first theoretically explore how exactly elastic and thermal scattering of the probe confounds the quantitative information one is able to extract about the specimen from an EDS STEM map. We then show using simulation how tilting the specimen (or incident probe) can reduce the effects of scattering and how it can provide quantitative information about the specimen. We then discuss drawbacks of this method – such as the loss of atomic resolution along the tilt direction – but follow this with a possible remedy: precession averaged EDS STEM mapping. - Highlights: • Signal obtained in EDS STEM maps (of STO) compared to non-channelling signal. • Deviation from non-channelling signal occurs in on-axis experiments. • Tilting specimen: signal close to non-channelling case but atomic resolution is lost. • Tilt-precession series: non-channelling signal and atomic-resolution features obtained. • Associated issues are discussed.

  13. Older veterans and emergency department discharge information.

    Science.gov (United States)

    Hastings, Susan; Stechuchak, Karen; Oddone, Eugene; Weinberger, Morris; Tucker, Dana; Knaack, William; Schmader, Kenneth

    2012-10-01

    Study goals were to assess older veterans' understanding of their emergency department (ED) discharge information and to determine the association between understanding discharge information and patient assessment of overall quality of care. Telephone interviews were conducted with 305 patients aged 65 or older (or their proxies) within 48 h of discharge from a Veterans Affairs Medical Center ED. Patients were asked about their perceived understanding (at the time of ED discharge) of information about their ED diagnosis, expected course of illness, contingency plan (ie, return precautions, who to call if it got worse, potential medication side effects) and follow-up care. Overall quality of ED care was rated on a four-point scale of poor, fair, good or excellent. Patients or their proxies reported not understanding information about their ED diagnosis (21%), expected course of illness (50%), contingency plan (43%), and how soon they needed to follow-up with their primary care provider (25%). In models adjusted for age and race, a positive association was observed between perceived understanding of the cause of the problem (OR 2.3; 95% CI 1.3 to 4.0), expected duration of symptoms (OR 1.6; 95% CI 1.0 to 2.5) and the contingency plan (OR 2.2; CI 1.3 to 3.4), and rating overall ED care as excellent. Older veterans may not understand key items of information at the time ED discharge, and this may have an impact on how they view the quality of ED care. Strategies are needed to improve communication of ED discharge information to older veterans and their families.

  14. Emergency Department Use by Nursing Home Residents: Effect of Severity of Cognitive Impairment

    Science.gov (United States)

    Stephens, Caroline E.; Newcomer, Robert; Blegen, Mary; Miller, Bruce; Harrington, Charlene

    2012-01-01

    Purpose: To examine the 1-year prevalence and risk of emergency department (ED) use and ambulatory care-sensitive (ACS) ED use by nursing home (NH) residents with different levels of severity of cognitive impairment (CI). Design and Methods: We used multinomial logistic regression to estimate the effect of CI severity on the odds of any ED visit…

  15. Rural-Urban Disparities in Child Abuse Management Resources in the Emergency Department

    Science.gov (United States)

    Choo, Esther K.; Spiro, David M.; Lowe, Robert A.; Newgard, Craig D.; Hall, Michael Kennedy; McConnell, Kenneth John

    2010-01-01

    Purpose: To characterize differences in child abuse management resources between urban and rural emergency departments (EDs). Methods: We surveyed ED directors and nurse managers at hospitals in Oregon to gain information about available abuse-related resources. Chi-square analysis was used to test differences between urban and rural EDs.…

  16. ED Triage Decision-Making With Mental Health Presentations: A "Think Aloud" Study.

    Science.gov (United States)

    Clarke, Diana E; Boyce-Gaudreau, Krystal; Sanderson, Ana; Baker, John A

    2015-11-01

    Triage is the process whereby persons presenting to the emergency department are quickly assessed by a nurse and their need for care and service is prioritized. Research examining the care of persons presenting to emergency departments with psychiatric and mental health problems has shown that triage has often been cited as the most problematic aspect of the encounter. Three questions guided this investigation: Where do the decisions that triage nurses make fall on the intuitive versus analytic dimensions of decision making for mental health presentations in the emergency department, and does this differ according to comfort or familiarity with the type of mental health/illness presentation? How do "decision aids" (i.e., structured triage scales) help in the decision-making process? To what extent do other factors, such as attitudes, influence triage nurses' decision making? Eleven triage nurses participating in this study were asked to talk out loud about the reasoning process they would engage in while triaging patients in 5 scenarios based on mental health presentations to the emergency department. Themes emerging from the data were tweaking the results (including the use of intuition and early judgments) to arrive at the desired triage score; consideration of the current ED environment; managing uncertainty and risk (including the consideration of physical reasons for presentation); and confidence in communicating with patients in distress and managing their own emotive reactions to the scenario. Findings support the preference for using the intuitive mode of decision making with only tacit reliance on the decision aid. Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  17. An overview of public health service health-related activities as they relate to the Department of Energy's environmental restoration program

    International Nuclear Information System (INIS)

    Kocher, P.L.; Bashor, M.M.

    1991-01-01

    The Agency for Toxic Substances and Disease Registry (ATSDR) was created by the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA) as an agency of the Public Health Service. Under the Superfund Amendments and Reauthorization Act of 1986 (SARA; CERCLA as amended), the public health responsibilities of ATSDR were greatly expanded. Among the responsibilities are (1) preparing health assessments for each site proposed for or listed on the National Priorities List (NPL) established by the US Environmental Protection Agency; (2) conducting epidemiologic and other health studies around NPL sites; (3) establishing registries of exposed individuals; (4) establishing health surveillance programs; (5) developing toxicological profiles for hazardous substances; (6) performing health and emergency response consultations; and (7) performing other health-related activities (e.g., health education). In October 1990, ATSDR signed a memorandum of understanding (MOU) with the Department of Energy (DOE) headquarters requiring that DOE operations offices sign interagency agreements (IAGs) with ATSDR for its conduct of 104(i) health activities at DOE sites. These activities include health assessments, related health studies such as surveillance programs, epidemiologic studies, and registries of exposed persons, and toxicological profiles of hazardous substances unique to DOE sites. ATSDR's studies will focus more on an assessment of the health risk to human populations residing in and around DOE sites than on an evaluation of the health risk to workers on site. Nevertheless, CERCLA, the MOU, and site-specific IAGs authorize ATSDR's access to health and environmental data concerning each site. The IAGs contemplate that ATSDR work closely with DOE operations offices in their implementation of their respective environmental restoration programs

  18. Transient data acquisition techniques under EDS

    International Nuclear Information System (INIS)

    Telford, S.

    1985-06-01

    This paper is the first of a series which describes the Enrichment Diagnostic System (EDS) developed for the MARS project at Lawrence Livermore National Laboratory. Although EDS was developed for use on AVLIS, the functional requirements, overall design, and specific techniques are applicable to any experimental data acquisition system involving large quantities of transient data. In particular this paper will discuss the techniques and equipment used to do the data acquisition. Included are what types of hardware are used and how that hardware (CAMAC, digital oscilloscopes) is interfaced to the HP computers. In this discussion the author will address the problems encountered and the solutions used, as well as the performance of the instrument/computer interfaces. The second topic the author will discuss is how the acquired data is associated to graphics and analysis portions of EDS through efficient real time data bases. This discussion will include how the acquired data is folded into the overall structure of EDS providing the user immediate access to raw and analyzed data. By example you will see how easily a new diagnostic can be added to the EDS structure without modifying the other parts of the system. 8 figs

  19. Why do children present to emergency departments? Exploring motivators and measures of presentation appropriateness for children presenting to a paediatric emergency department.

    Science.gov (United States)

    Cheek, John A; Braitberg, George; Craig, Simon; West, Adam

    2017-05-01

    To compare the parental motivators and referring general practitioner's (GP's) reasons for advising emergency department (ED) attendance with the assessment of ED medical staff. To compare ED clinician opinion with other published methods that have attempted to define 'primary care suitable' presentations to the ED. A prospective observational study and series of surveys regarding the attendance of children presenting to a single tertiary paediatric ED. Surveys were distributed to the treating ED clinician, the child's parent/guardian, and the referring GP. Results between the three groups were analysed and compared. There were a total of 1069 presentations during the study period. Six hundred (58.4%, 95% CI 55.3-61.4%) presentations were judged as 'ED appropriate' by the treating ED clinician. When compared with methods used to retrospectively judge whether ED patients are considered 'primary care suitable', ED clinicians disagree between 22.4 and 38.8% of the time. For patients who presented directly to ED, 85.6% did so for a medical reason, whilst 32.1% did so for a GP access reason. Being referred by a GP improved the ED clinicians' opinion of the appropriateness of the presentation (49.2 vs. 73.9%, P motivators that drive this behaviour is needed. We believe the solution to increasing utilisation of EDs by children must be a balanced approach that addresses community expectations and appropriately resources EDs. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

  20. Aftercare, Emergency Department Visits, and Readmission in Adolescents

    Science.gov (United States)

    Carlisle, Corine E.; Mamdani, Muhammad; Schachar, Russell; To, Teresa

    2012-01-01

    Objective: U.S. and Canadian data demonstrate decreasing inpatient days, increasing nonurgent emergency department (ED) visits, and short supply of child psychiatrists. Our study aims to determine whether aftercare reduces ED visits and/or readmission in adolescents with first psychiatric hospitalization. Method: We conducted a population-based…

  1. Procedures and Collaborative Information Seeking: A Study of Emergency Departments

    DEFF Research Database (Denmark)

    Hertzum, Morten; Reddy, Madhu

    2015-01-01

    Information seeking is a central and inherently collaborative activity in the emergency department (ED) which is the common entry point to hospitals for nearly all acute patients. In this paper, we investigate how ED clinicians’ collabo-rative information seeking (CIS) is shaped by the procedures...

  2. Estimating Uncompensated Care Charges at Rural Hospital Emergency Departments

    Science.gov (United States)

    Bennett, Kevin J.; Moore, Charity G.; Probst, Janice C.

    2007-01-01

    Context: Rural hospitals face multiple financial burdens. Due to federal law, emergency departments (ED) provide a gateway for uninsured and self-pay patients to gain access to treatment. It is unknown how much uncompensated care in rural hospitals is due to ED visits. Purpose: To develop a national estimate of uncompensated care from patients…

  3. Environmental factors and their association with emergency department hand hygiene compliance: an observational study.

    Science.gov (United States)

    Carter, Eileen J; Wyer, Peter; Giglio, James; Jia, Haomiao; Nelson, Germaine; Kauari, Vepuka E; Larson, Elaine L

    2016-05-01

    Hand hygiene is effective in preventing healthcare-associated infections. Environmental conditions in the emergency department (ED), including crowding and the use of non-traditional patient care areas (ie, hallways), may pose barriers to hand hygiene compliance. We examined the relationship between these environmental conditions and proper hand hygiene. This was a single-site, observational study. From October 2013 to January 2014, trained observers recorded hand hygiene compliance among staff in the ED according to the World Health Organization 'My 5 Moments for Hand Hygiene'. Multivariable logistic regression was used to analyse the relationship between environmental conditions and hand hygiene compliance, while controlling for important covariates (eg, hand hygiene indication, glove use, shift, etc). A total of 1673 hand hygiene opportunities were observed. In multivariable analyses, hand hygiene compliance was significantly lower when the ED was at its highest level of crowding than when the ED was not crowded and lower among hallway care areas than semiprivate care areas (OR=0.39, 95% CI 0.28 to 0.55; OR=0.73, 95% CI 0.55 to 0.97). Unique environmental conditions pose barriers to hand hygiene compliance in the ED setting and should be considered by ED hand hygiene improvement efforts. Further study is needed to evaluate the impact of these environmental conditions on actual rates of infection transmission. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  4. Emergency Department Presentations for Injuries in Older Adults Independently Known to be Victims of Elder Abuse.

    Science.gov (United States)

    Rosen, Tony; Bloemen, Elizabeth M; LoFaso, Veronica M; Clark, Sunday; Flomenbaum, Neal E; Lachs, Mark S

    2016-03-01

    Elder abuse is under-recognized by emergency department (ED) providers, largely due to challenges distinguishing between abuse and accidental trauma. To describe patterns and circumstances surrounding elder abuse-related and potentially abuse-related injuries in ED patients independently known to be physical elder abuse victims. ED utilization of community-dwelling victims of physical elder abuse in New Haven, CT from 1981-1994 was analyzed previously. Cases were identified using Elderly Protective Services data matched to ED records. Sixty-six ED visits were judged to have high probability of being related to elder abuse and 244 were of indeterminate probability. We re-examined these visits to assess whether they occurred due to injury. We identified and analyzed in detail 31 injury-associated ED visits from 26 patients with high probability of being related to elder abuse and 108 visits from 57 patients with intermediate probability and accidental injury. Abuse-related injuries were most common on upper extremities (45% of visits) and lower extremities (32%), with injuries on head or neck noted in 13 visits (42%). Bruising was observed in 39% of visits, most commonly on upper extremities. Forty-two percent of purportedly accidental injuries had suspicious characteristics, with the most common suspicious circumstance being injury occurring more than 1 day prior to presentation, and the most common suspicious injury pattern being maxillofacial injuries. Victims of physical elder abuse commonly have injuries on the upper extremities, head, and neck. Suspicious circumstances and injury patterns may be identified and are commonly present when victims of physical elder abuse present with purportedly accidental injuries. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Adjusting patients streaming initiated by a wait time threshold in emergency department for minimizing opportunity cost.

    Science.gov (United States)

    Kim, Byungjoon B J; Delbridge, Theodore R; Kendrick, Dawn B

    2017-07-10

    Purpose Two different systems for streaming patients were considered to improve efficiency measures such as waiting times (WTs) and length of stay (LOS) for a current emergency department (ED). A typical fast track area (FTA) and a fast track with a wait time threshold (FTW) were designed and compared effectiveness measures from the perspective of total opportunity cost of all patients' WTs in the ED. The paper aims to discuss these issues. Design/methodology/approach This retrospective case study used computerized ED patient arrival to discharge time logs (between July 1, 2009 and June 30, 2010) to build computer simulation models for the FTA and fast track with wait time threshold systems. Various wait time thresholds were applied to stream different acuity-level patients. National average wait time for each acuity level was considered as a threshold to stream patients. Findings The fast track with a wait time threshold (FTW) showed a statistically significant shorter total wait time than the current system or a typical FTA system. The patient streaming management would improve the service quality of the ED as well as patients' opportunity costs by reducing the total LOS in the ED. Research limitations/implications The results of this study were based on computer simulation models with some assumptions such as no transfer times between processes, an arrival distribution of patients, and no deviation of flow pattern. Practical implications When the streaming of patient flow can be managed based on the wait time before being seen by a physician, it is possible for patients to see a physician within a tolerable wait time, which would result in less crowded in the ED. Originality/value A new streaming scheme of patients' flow may improve the performance of fast track system.

  6. What constitutes a good hand offs in the emergency department: a patient's perspective.

    Science.gov (United States)

    Downey, La Vonne; Zun, Leslie; Burke, Trena

    2013-01-01

    The aim is to determine, from the patient's perspective, what constitutes a good hand-off procedure in the emergency department (ED). The secondary purpose is to evaluate what impact a formalized hand-off had on patient knowledge, throughput and customer service This study used a randomized controlled clinical trial involving two unique hand-off approaches and a convenience sample. The study alternated between the current hand-off process that documented the process but not specific elements (referred to as the informal process) to one using the IPASS the BATON process (considered the formal process). Consenting patients completed a 12-question validated questionnaire on how the process was perceived by patients and about their understanding why they waited in the ED. Statistical analysis using SPSS calculated descriptive frequencies and t-tests. In total 107 patients were enrolled: 50 in the informal and 57 in the formal group. Most patients had positive answers to the customer survey. There were significant differences between formal and informal groups: recalling the oncoming and outgoing physician coming to the patient's bed (p = 0.000), with more formal group recalling that than informal group patients; the oncoming physician introducing him/herself (p = 0.01), with more from the formal group answering yes and the physician discussing tests and implications with formal group patients (p = 0.02). This study was done at an urban inner city ED, a fact that may have skewed its results. A comparison of suburban and rural EDs would make the results stronger. It also reflected a very high level of customer satisfaction within the ED. This lack of variance may have meant that the correlation between customer service and handoffs was missed or underrepresented. There was no codified observation of either those using the IPASS the BATON script or those using informal procedures, so no comparison of level and types of information given between the two groups was done

  7. Emergency department attendance patterns during Ramadan.

    Science.gov (United States)

    Butt, Taimur; Khan, Hameed Ullah; Ahmed, Israr; Eldali, Abdelmoneim

    2016-01-01

    Patient attendance in the emergency department (ED) is inherently variable and unpredictable. Resources might be better allocated if use of the ER could be predicted during the month of fasting (Ramadan), healthy adult Muslims do not eat or drink from dawn to sunset and in the Middle East, social activities occur mostly during night. There is no published data that has reported changes in local ED attendance pattern during Ramadan. Determine if there are differences in tertiary care ed attendance during Ramadan compared to other times of the year. Retrospective, using data from the hospital integrated clinical information system. Tertiary care institution in Riyadh, Saudi Arabia. All ED visits during the Islamic calendar years of 1431-1434 (December 18, 2009-October 13, 2013) were analyzed. Patient volume, acuity, demographics and admission rate variability between Ramadan and other months. During the study period of 4 years, of 226075 ED patients, 129178 (57.14%) patients were seen during the day shift (07:00 to 18:59). During Ramadan, 10 293 (60%) patients presented during the night shift compared with the day shift (P many ED patients were actually fasting during the study period. This study was conducted in a tertiary care hospital and the patient population presenting to our ed is predominantly Muslim; therefore, the results may not be generalized to populations that are not predominantly Muslim.

  8. Predictors of early arrival at the emergency department in acute ischaemic stroke.

    LENUS (Irish Health Repository)

    Curran, C

    2012-01-31

    BACKGROUND: A requirement of an effective acute stroke service is the early arrival of patients to the hospital emergency department (ED). This will allow the possible use of thrombolytic therapy or other acute interventions within a limited time window. AIMS: We investigated the predictors of early arrival in a single hospital serving a mixed urban and rural catchment area. METHODS: A retrospective review of all case notes for 1 year was performed. RESULTS: Of 105 acute strokes, 91 were cerebral infarcts and a total of 71 cases presenting initially to the ED had timing available for analysis. 39.4% presented within 3 h, and 12.7% were potentially suitable for thrombolysis. Those living closer to the hospital were not more likely to arrive within 3 h (Z = -0.411, p = 0.68). Presenting directly to the hospital by emergency services (or private transport) was significantly associated with early arrival in a univariate comparison (p < 0.001), and in a multivariate model. CONCLUSION: The only independent predictor of early arrival to the ED is direct presentation. Improved public education of the importance of recognition of stroke symptoms and rapid contact with the emergency services will improve the early attendance following acute stroke, allowing increased use of acute stroke treatments.

  9. TED-Ed lessons & TED-Ed clubs: Educational activities to amplify students' voices

    Science.gov (United States)

    Villias, Georgios

    2017-04-01

    TED-Ed lessons and TED-Ed clubs are two powerful educational tools that can be used in today's school classrooms in order to create an educational environment that is engaging for the students and favors their active participation, created and fostered by TED-Ed. TED-Ed is TED's educational initiative, committed to create lessons worth sharing and amplify the voices and ideas of teachers and students around the world. TED-Ed animated lessons are fully organized lessons structured around an animated video that introduces new topics to learners in an exciting, thought-provoking way. These lessons have been created as a result of the cooperation between expert educators and animators and have been uploaded at the TED-Ed platform (http://ed.ted.com). On the other hand, TED-Ed Clubs are also an interesting way to offer students the chance, the voice and the opportunity to express their thoughts, engage actively on these matters and connect with each other, both at a local, as well as at an international level (http://ed.ted.com/clubs). By developing new TED-Ed lessons or by customizing appropriately existing animated TED-Ed lessons (translating, modifying the questions asked, introducing new discussion topics), I have created and implemented in my student-centered, didactic approach, a series of TED-ED animated lessons directly connected with the Greek national science syllabus that were used to spark students curiosity and initiate a further analytical discussion or introduce other relevant educational activities (http://gvillias.wixsite.com/education). Furthermore, at my school, we established Varvakeio TED-Ed Club, an environment that supports and empowers our students to research, develop and disseminate their own personal ideas that worth spreading. During the year, our members were inspired by watching TED talks presented by experts on their field on various different areas, including social, economical, environmental and technological-scientific issues. Our aim

  10. Metallurgy Department

    DEFF Research Database (Denmark)

    Risø National Laboratory, Roskilde

    The activities of the Metallurgy Department at Risø during 1981 are described. The work is presented in three chapters: General Materials Research, Technology and Materials Development, Fuel Elements. Furthermore, a survey is given of the department's participation in international collaboration...

  11. Impact of prospective verification of intravenous antibiotics in an ED.

    Science.gov (United States)

    Hunt, Allyson; Nakajima, Steven; Hall Zimmerman, Lisa; Patel, Manav

    2016-12-01

    Delay in appropriate antibiotic therapy is associated with an increase in mortality and prolonged length of stay. Automatic dispensing machines decrease the delivery time of intravenous (IV) antibiotics to patients in the emergency department (ED). However, when IV antibiotics are not reviewed by pharmacists before being administered, patients are at risk for receiving inappropriate antibiotic therapy. The objective of this study was to determine if a difference exists in the time to administration of appropriate antibiotic therapy before and after implementation of prospective verification of antibiotics in the ED. This retrospective, institutional review board-approved preimplementation vs postimplementation study evaluated patients 18years or older who were started on IV antibiotics in the ED. Patients were excluded if pregnant, if the patient is a prisoner, if no cultures were drawn, or if the patient was transferred from an outside facility. Appropriate antibiotic therapy was based on empiric source-specific evidence-based guidelines, appropriate pharmacokinetic and pharmacodynamic properties, and microbiologic data. The primary end point was the time from ED arrival to administration of appropriate antibiotic therapy. Of the 1628 evaluated, 128 patients met the inclusion criteria (64 pre vs 64 post). Patients were aged 65.2±17.0years, with most of infections being pneumonia (44%) and urinary tract infections (18%) and most patients being noncritically ill. Time to appropriate antibiotic therapy was reduced in the postgroup vs pregroup (8.1±8.6 vs 15.2±22.8hours, respectively, P=.03). In addition, appropriate empiric antibiotics were initiated more frequently after the implementation (92% post vs 66% pre; P=.0001). There was no difference in mortality or length of stay between the 2 groups. Prompt administration of the appropriate antibiotics is imperative in patients with infections presenting to the ED. The impact of prospective verification of

  12. Characteristics of family violence victims presenting to emergency departments in Hong Kong.

    Science.gov (United States)

    Chan, Ko Ling; Choi, Wai Man Anna; Fong, Daniel Y T; Chow, Chun Bong; Leung, Ming; Ip, Patrick

    2013-01-01

    The Emergency Department (ED) has been shown to be a valuable location to screen for family violence. To investigate the characteristics of family violence victims presenting to EDs in a Chinese population in Hong Kong. This study examined a retrospective cohort of patients presenting to the Accident and Emergency Departments of three regional hospitals in the Kwai Tsing district of Hong Kong for evaluation and management of physical injuries related to family violence during the period of January 1, 1997 to December 31, 2008. A total of 15,797 patients were assessed. The sample comprised cases of intimate partner violence (IPV; n=10,839), child abuse and neglect (CAN; n=3491), and elder abuse (EA; n=1467). Gender differences were found in patterns of ED utilization among the patients. The rates of readmission were 12.9% for IPV, 12.8% for CAN, and 8.9% for EA. Logistic regression showed that being male, being discharged against medical advice, and arriving at the hospital via ambulance were the common factors associated with readmission to the EDs for patients victimized by IPV and CAN. This study investigates the victim profile of a large cohort of a Chinese population, providing a unique data set not previously released in this cultural or medical system. The findings give insights to early identification of victims of family violence in the EDs and suggest that screening techniques focused on multiple forms of family violence would improve identification of violence cases. Multidisciplinary collaboration between health, legal, and social service professionals is also warranted to meet the various needs of victims and to reduce hospital readmissions. Copyright © 2013 Elsevier Inc. All rights reserved.

  13. Association of ED with chronic periodontal disease.

    Science.gov (United States)

    Matsumoto, S; Matsuda, M; Takekawa, M; Okada, M; Hashizume, K; Wada, N; Hori, J; Tamaki, G; Kita, M; Iwata, T; Kakizaki, H

    2014-01-01

    To examine the relationship between chronic periodontal disease (CPD) and ED, the interview sheet including the CPD self-checklist (CPD score) and the five-item version of the International Index of Erectile Function (IIEF-5) was distributed to 300 adult men who received a comprehensive dental examination. Statistical analyses were performed by the Spearman's rank correlation coefficient and other methods. Statistical significance was accepted at the level of Pdysfunction and the systematic inflammatory changes associated with CPD. The present study also suggests that dental health is important as a preventive medicine for ED.

  14. Naloxone Administration in US Emergency Departments, 2000���2011

    OpenAIRE

    Frank, Joseph W.; Levy, Cari; Calcaterra, Susan L.; Hoppe, Jason A.; Binswanger, Ingrid A.

    2015-01-01

    Rates of opioid overdose and opioid-related emergency department (ED) visits have increased dramatically. Naloxone is an effective antidote to potentially fatal opioid overdose, but little is known about naloxone administration in ED settings. We examined trends and correlates of naloxone administration in ED visits nationally from 2000 to 2011. Using data from the National Hospital Ambulatory Medical Care Survey, we examined ED visits involving (1) the administration of naloxone or (2) a dia...

  15. Predicting Hospital Admission for Emergency Department Patients using a Bayesian Network

    OpenAIRE

    Leegon, Jeffrey; Jones, Ian; Lanaghan, Kevin; Aronsky, Dominik

    2005-01-01

    Hospital admission delays in the Emergency Department (ED) reduce volume capacity and contribute to the nation’s ED diversion problem. This study evaluated the accuracy of a Bayesian network for the early prediction of hospital admission status using data from 16,900 ED encounters. The final model included nine variables that are commonly available in many ED settings. The area under the receiver operating characteristic curve was 0.894 (95% CI: 0.887-0.902) for the validati...

  16. Stress in emergency departments: experiences of nurses and doctors.

    LENUS (Irish Health Repository)

    Healy, Sonya

    2012-01-31

    The effects of stressful incidents on emergency department (ED) staff can be profound. Witnessing aggression, violence or the death of patients, or participating in resuscitation, can be emotionally and physically demanding. Despite the frequency of these events, ED staff do not become immune to the stress they cause, and are often ill prepared and under supported to cope with them. This article reports on a study of nurses\\' and doctors\\' attitudes to, and experiences of, workplace stress in three EDs in Ireland, and offers some suggestions on how stress among ED staff can be reduced.

  17. Nontraumatic hypotension and shock in the emergency department and the prehospital setting, prevalence, etiology, and mortality: a systematic review.

    Directory of Open Access Journals (Sweden)

    Jon Gitz Holler

    Full Text Available Acute patients presenting with hypotension in the prehospital or emergency department (ED setting are in need of focused management and knowledge of the epidemiology characteristics might help the clinician. The aim of this review was to address prevalence, etiology and mortality of nontraumatic hypotension (SBP ≤ 90 mmHg with or without the presence of shock in the prehospital and ED setting.We performed a systematic literature search up to August 2013, using Medline, Embase, Cinahl, Dare and The Cochrane Library. The analysis and eligibility criteria were documented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-guidelines and The Cochrane Collaboration. No restrictions on language, publication date, or status were imposed. We used the Newcastle-Ottawa quality assessment scale (NOS-scale and the Strengthening the Reporting of Observational studies in Epidemiology (STROBE-statement to assess the quality.Six observational studies were considered eligible for analysis based on the evaluation of 11,880 identified papers. Prehospital prevalence of hypotension was 19.5/1000 emergency medicine service (EMS contacts, and the prevalence of hypotensive shock was 9.5-19/1000 EMS contacts with an inhospital mortality of shock between 33 to 52%. ED prevalence of hypotension was 4-13/1000 contacts with a mortality of 12%. Information on mortality, prevalence and etiology of shock in the ED was limited. A meta-analysis was not feasible due to substantial heterogeneity between studies.There is inadequate evidence to establish concise estimates of the characteristics of nontraumatic hypotension and shock in the ED or in the prehospital setting. The available studies suggest that 2% of EMS contacts present with nontraumatic hypotension while 1-2% present with shock. The inhospital mortality of prehospital shock is 33-52%. Prevalence of hypotension in the ED is 1% with an inhospital mortality of 12%. Prevalence

  18. Impact of co-located general practitioner (GP