WorldWideScience

Sample records for department ed services

  1. National study of emergency department observation services.

    Science.gov (United States)

    Wiler, Jennifer L; Ross, Michael A; Ginde, Adit A

    2011-09-01

    The objective was to describe patient and facility characteristics of emergency department (ED) observation services in the United States. The authors analyzed the 2007 National Hospital Ambulatory Medical Care Survey (NHAMCS). Characteristics of EDs with observation units (OUs) were compared to those without, and patients with a disposition of ED observation were compared to those with a "short-stay" (observational analysis. An estimated 1,746 U.S. EDs (36%) reported having OUs, of which 56% are administratively managed by ED staff. Fifty-two percent of hospitals with ED-managed OUs are in an urban location, and 89% report ED boarding, compared to 29 and 65% of those that do not have an OU. The admission rate is 38% at those with ED-managed OUs and 15% at those without OUs. Of the 15.1% of all ED patients who are kept in the hospital following an ED visit, one-quarter are kept for either a short-stay admission (1.8%) or an ED observation admission (2.1%). Most (82%) ED observation patients were discharged from the ED. ED observation patients were similar to short-stay admission patients in terms of age (median = 52 years for both, interquartile range = 36 to 70 years), self-pay (12% vs. 10%), ambulance arrival (37% vs. 36%), urgent/emergent triage acuity (77% vs. 74%), use of ≥1 ED medication (64% vs.76%), and the most common primary chief complaints and primary diagnoses. Over one-third of U.S. EDs have an OU. Short-stay admission patients have similar characteristics as ED observation patients and may represent an opportunity for the growth of OUs. © 2011 by the Society for Academic Emergency Medicine.

  2. Psychiatric service users, experiences of emergency departments: a CERQual review oaf qualitative studies

    DEFF Research Database (Denmark)

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

    2017-01-01

    Abstract 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...

  3. National targets, process transformation and local consequences in an NHS emergency department (ED): a qualitative study.

    Science.gov (United States)

    Vezyridis, Paraskevas; Timmons, Stephen

    2014-06-13

    In the attempt to reduce waiting times in emergency departments, various national health services have used benchmarking and the optimisation of patient flows. The aim of this study was to examine staff attitudes and experience of providing emergency care following the introduction of a 4 hour wait target, focusing on clinical, organisational and spatial issues. A qualitative research design was used and semi-structured interviews were conducted with 28 clinical, managerial and administrative staff members working in an inner-city emergency department. A thematic analysis method was employed and NVivo 8 qualitative data analysis software was used to code and manage the emerging themes. The wait target came to regulate the individual and collective timescales of healthcare work. It has compartmentalised the previous unitary network of emergency department clinicians and their workspace. It has also speeded up clinical performance and patient throughput. It has disturbed professional hierarchies and facilitated the development of new professional roles. A new clinical information system complemented these reconfigurations by supporting advanced patient tracking, better awareness of time, and continuous, real-time management of emergency department staff. The interviewees had concerns that this target-oriented way of working forces them to have a less personal relationship with their patients. The imposition of a wait-target in response to a perceived "crisis" of patients' dissatisfaction led to the development of a new and sophisticated way of working in the emergency department, but with deep and unintended consequences. We show that there is a dynamic interrelation of the social and the technical in the complex environment of the ED. While the 4 hour wait target raised the profile of the emergency department in the hospital, the added pressure on clinicians has caused some concerns over the future of their relationships with their patients and colleagues. To

  4. Violence prevention in the ED: linkage of the ED to a social service agency.

    Science.gov (United States)

    Zun, Leslie S; Downey, La Vonne; Rosen, Jodi

    2003-10-01

    was a strong positive correlation of using services and case management (Pearson coefficient = 0.728, significance =.00). The referral of young victims of violence from the ED to psychosocial services could be successful using a case management model and an alliance between a healthcare system and a social service agency.

  5. Using process indicators to optimize service completion of an ED drug and alcohol brief intervention program.

    Science.gov (United States)

    Akin, Joanna; Johnson, J Aaron; Seale, J Paul; Kuperminc, Gabriel P

    2015-01-01

    The strongest evidence for effectiveness of screening, brief intervention, and referral to treatment (SBIRT) programs is in primary care settings. Emergency department (ED) studies have shown mixed results. Implementation of SBIRT into ED settings is complicated by the type of patients seen and the fast-paced, high-throughput nature of the ED environment that makes it difficult to reach patients flagged for SBIRT services. This study uses data from an ED-based SBIRT program to examine the relationship between screen-positive rate, ED patient flow, and SBIRT service delivery. Data for the study (N = 67137) were derived from weekly reports extracted directly from one hospital's electronic health record. Measures included time and day of patient entry, drug/alcohol screen result (positive or negative), and whether the patient was reached by SBIRT specialists. Factorial analysis of variance compared variations in screen-positive rates by day and time and the percentage of patients reached by SBIRT specialists during these periods. Overall, 56% of screen-positive patients received SBIRT services. Only 5% of patients offered SBIRT services refused. Day and time of entry had a significant interaction effect on the reached rate (F12,14166 =3.48, P < .001). Although patient volume was lowest between 11 pm and 7 am, screen-positive rates were highest during this period, particularly on weekends; and patients were least likely to be reached during these periods. When implementing an ED-based SBIRT program, thoughtful consideration should be given to patient flow and staffing to maximize program impact and increase the likelihood of sustainability. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. 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

  7. 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

  8. Can geriatric approaches support the care of old patients in emergency departments? A review from a Swiss ED

    OpenAIRE

    Schoenenberger, Andreas; Exadaktylos, Aristomenis

    2014-01-01

    In the coming decades, old patients will account for an increasing proportion of emergency department (ED) visits. During or after their stay in the ED, they more frequently suffer adverse outcomes than younger patients. There is evidence that specific age-centred approaches improve the outcomes. We therefore reviewed specific conditions needing particular attention in older ED patients, such as cognitive disorders and delirium, impaired mobility and falls, as well as problems related to the ...

  9. MobilED – a mobile tools and services platform for formal and informal learning

    CSIR Research Space (South Africa)

    Ford, M

    2006-10-01

    Full Text Available The MobilED initiative is aimed at designing teaching and learning environments that are meaningfully enhanced with mobile technologies and services. The MobilED deliverables are to develop a set of scenarios and guidelines of how mobile...

  10. The NStED Periodogram Service and Interface for Public CoRoT Data

    CERN Document Server

    von Braun, K; Beekley, A; Berriman, G B; Bryden, G; Chan, B; Ciardi, D R; Good, J; Harbut, M; Kane, S R; Laity, A; Lau, C; Lynn, M; McElroy, D; Plavchan, P; Regelson, M; Rey, R; Ramirez, S V; Stauffer, J; Zhang, A

    2011-01-01

    As part of the NASA-CNES agreement, the NASA Star and Exoplanet Database (NStED) serves as the official US portal for the public CoRoT data products. NStED is a general purpose archive with the aim of providing support for NASA's planet finding and characterization goals. Consequently, the NASA Exoplanet Science Institute (NExScI) developed, and NStED adapted, a periodogram service for CoRoT data to determine periods of variability phenomena and create phased photometric light curves. Through the NStED periodogram interface, the user may choose three different period detection algorithms to use on any photometric time series product, or even upload and analyze their own data. Additionally, the NStED periodogram is remotely accessed by the CoRoT archive as part of its interface. NStED is available at {\\bf http://nsted.ipac.caltech.edu}.

  11. Utilization of Emergency Department Services by the Bedouin Population in Southern Israel

    Directory of Open Access Journals (Sweden)

    Arnon Dov Cohen

    2007-01-01

    Full Text Available Excessive use of the emergency department (ED is associated with increased costs and workload in the ED, patients' inconvenience and disruption of the continuity of care. The study's goal was to describe trends in ED utilization among Bedouins living in southern Israel. A retrospective cross-sectional study was conducted in primary care clinics in southern Israel. Patients included Bedouin and Jewish patients insured by Clalit Health Services. Data was retrieved from a central database. The number of visits to the ED and age-adjusted rates of ED visits during 2000-2003 were determined in the Bedouin vs. Jewish population. All visits that ended in hospitalization were excluded. Data was stratified according to patients' residence (semi-nomadic vs. urban Bedouins and referral origin. Age-adjusted rates of ED visits decreased from 42.9/1000 patients/month in 2000 to 38.3/1000 patients/month in 2003. There were more ED visits in the Bedouin as compared to Jewish population (38.3/1000 vs. 21.8/1000 patients/month. The decrease in ED utilization was more prominent among adult semi-nomadic Bedouins (from 60.8/1000 to 40.3/1000 patients/month. The proportion of referrals by the family physician to ED significantly decreased (among urban Bedouins: from 54.3% to 43.2%, p<0.001; among semi-nomadic Bedouins: from 53.9% to 39.9%, p<0.001, while the proportion of selfreferrals and referrals from physicians other than the family physician increased. A decrease in ED utilization by the Bedouin population during the last years was demonstrated. Utilization of ED services is still increased as compared to the non-Bedouin population. Interventions to control excessive use of ED services in the Bedouin population are currently underway.

  12. Differences in access to services in rural emergency departments of Quebec and Ontario.

    Directory of Open Access Journals (Sweden)

    Richard Fleet

    Full Text Available Rural emergency departments (EDs are important safety nets for the 20% of Canadians who live there. A serious problem in access to health care services in these regions has emerged. However, there are considerable geographic disparities in access to trauma center in Canada. The main objective of this project was to compare access to local 24/7 support services in rural EDs in Quebec and Ontario as well as distances to Levels 1 and 2 trauma centers.Rural EDs were identified through the Canadian Healthcare Association's Guide to Canadian Healthcare Facilities. We selected hospitals with 24/7 ED physician coverage and hospitalization beds that were located in rural communities. There were 26 rural EDs in Quebec and 62 in Ontario meeting these criteria. Data were collected from ministries of health, local health authorities, and ED statistics. Fisher's exact test, the t-test or Wilcoxon-Mann-Whitney test, were performed to compare rural EDs of Quebec and Ontario.All selected EDs of Quebec and Ontario agreed to participate in the study. The number of EDs visits was higher in Quebec than in Ontario (19 322 ± 6 275 vs 13 446 ± 8 056, p = 0.0013. There were no significant differences between Quebec and Ontario's local population and small town population density. Quebec's EDs have better access to advance imaging services such as CT scanner (77% vs 15%, p < .0001 and most the consultant support and ICU (92% vs 31%, p < .0001. Finally, more than 40% of rural EDs in Quebec and Ontario are more than 300 km away from Levels 1 and 2 trauma centers.Considering that Canada has a Universal health care system, the discrepancies between Quebec and Ontario in access to support services are intriguing. A nationwide study is justified to address this issue.

  13. Unplanned 3-day re-attendance rate at Emergency Department (ED) and hospital's bed occupancy rate (BOR).

    Science.gov (United States)

    Sun, Yan; Heng, Bee Hoon; Tay, Seow Yian; Tan, Kelvin Brian

    2015-12-01

    Unplanned re-attendance at the Emergency Department (ED) is often monitored as a quality indicator of the care accorded to patients during their index ED visit. High bed occupancy rate (BOR) has been considered as a matter of reduced patient comfort and privacy. Most hospitals in Singapore operate under BORs above 85 %. This study aims to explore factors associated with the unplanned 3-day ED re-attendance rate and, in particular, if higher BOR is associated with higher 3-day unplanned ED re-attendance rate. This was a multicenter retrospective study using time series data. Three acute tertiary hospitals were selected from all six adult public hospitals in Singapore based on data availability. Daily data from year 2008 to 2013 were collected from the study hospitals' information systems. These included: ED visit date, day of week, month, year, public holiday, daily hospital BOR, daily bed waiting time (BWT) at ED (both median and 95th percentile), daily ED admission rate, and 3-day ED re-attendance rate. The primary outcome of the study was unplanned 3-day ED re-attendance rate from all reasons. Both univariate analysis and generalized linear regression were respectively applied to study the crude and adjusted association between the unplanned 3-day ED re-attendance rate and its potential associated factors. All analyses were conducted using SPSS 18 (PASW 18, IBM). The average age of patients who visited ED was 35 years old (SD = 2), 37 years old (SD = 2), and 40 years old (SD = 2) in hospitals A, B, and C respectively. The average 3-day unplanned ED re-attendance rate was 4.9 % (SE = 0.47 %) in hospital A, 3.9 % (SE = 0.35 %) in hospital B, and 4.4 % (SE = 0.30 %) in hospital C. After controlling for other covariates, the unplanned 3-day ED re-attendance rates were significantly associated with hospital, time trend, day of week, daily average BOR, and ED admission rate. Strong day-of-week effect on early ED re-attendance rate was

  14. Can geriatric approaches support the care of old patients in emergency departments? A review from a Swiss ED.

    Science.gov (United States)

    Schoenenberger, Andreas W; Exadaktylos, Aristomenis K

    2014-01-01

    In the coming decades, old patients will account for an increasing proportion of emergency department (ED) visits. During or after their stay in the ED, they more frequently suffer adverse outcomes than younger patients. There is evidence that specific age-centred approaches improve the outcomes. We therefore reviewed specific conditions needing particular attention in older ED patients, such as cognitive disorders and delirium, impaired mobility and falls, as well as problems related to the activities of daily living, disability, poly-pharmacy, adverse drug effects, co-morbidity and atypical presentation. We also propose steps to further improve the quality of care in older ED patients by using appropriate age-centred management.

  15. 77 FR 43369 - Lexisnexis, a Subsidiary of Reed Elsevier Customer Service Department and Fulfillment Department...

    Science.gov (United States)

    2012-07-24

    ... Employment and Training Administration Lexisnexis, a Subsidiary of Reed Elsevier Customer Service Department...; Lexisnexis, a Subsidiary of Reed Elsevier Customer Service Department and Fulfillment Department, Including..., 2012, applicable to workers of Lexisnexis, a subsidiary of Reed Elsevier, Inc., Customer Service...

  16. Collegiate-Based Emergency Medical Service: Impact on Alcohol-Related Emergency Department Transports at a Small Liberal Arts College

    Science.gov (United States)

    Rosen, Joshua B.; Olson, Mark H.; Kelly, Marianne

    2012-01-01

    Objective: The authors examined the impact of a collegiate-based emergency medical service (CBEMS) on the frequency of emergency department (ED) transports. Participants: Students transported to the ED for acute alcohol intoxication during the Fall 2008 and the Fall 2009 semesters (N = 50). Methods: The frequency of students receiving…

  17. 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…

  18. 78 FR 71591 - Privacy Act of 1974; Computer Matching Program between the U.S. Department of Education (ED) and...

    Science.gov (United States)

    2013-11-29

    ... Privacy Act of 1974; Computer Matching Program between the U.S. Department of Education (ED) and the U.S.... SUPPLEMENTARY INFORMATION: Pursuant to the Privacy Act of 1974, as amended (Privacy Act) (5 U.S.C. 552a), the..., the Computer Matching and Privacy Protection Act of 1988, 54 FR 25818 (June 19, 1989), 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. MobilED: a mobile tools and services platform for formal and informal learning

    CSIR Research Space (South Africa)

    Ford, M

    2009-03-01

    Full Text Available MobilED is a South African initiative aimed at designing teaching and learning environments that are meaningfully enhanced with mobile technologies and services. The deliverables are the development of a set of scenarios and guidelines on how mobile...

  1. Epidemiology of Emergency Medical Services (EMS) Utilization in Four Indian Emergency Departments.

    Science.gov (United States)

    Wijesekera, Olindi; Reed, Amanda; Chastain, Parker S; Biggs, Shauna; Clark, Elizabeth G; Kole, Tamorish; Chakrapani, Anoop T; Ashish, Nandy; Rajhans, Prasad; Breaud, Alan H; Jacquet, Gabrielle A

    2016-12-01

    Introduction Without a universal Emergency Medical Services (EMS) system in India, data on the epidemiology of patients who utilize EMS are limited. This retrospective chart review aimed to quantify and describe the burden of disease and patient demographics of patients who arrived by EMS to four Indian emergency departments (EDs) in order to inform a national EMS curriculum.

  2. Mental health services availability and admission of the seriously mentally ill from the emergency department.

    Science.gov (United States)

    Moseley, Charles; Shen, Jay; Cochran, Christopher

    2008-01-01

    This study used a cross-sectional, multiple logistic regression design to examine the relationship between mental health service availability and the admission of 111,527 seriously mentally ill (SMI) patients from the emergency department (ED) in New York State in 2002. The study found that SMI patients were admitted from the ED in counties that were mental health professional shortage areas and in counties with less long-term inpatient psychiatric days. Contrary to expectations, counties with community mental health centers (CMHCs) had more admissions than counties without CMHCs. The results support prior research that indicates the need for more specialized mental health services for the SMI, including more psychiatric beds.

  3. 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.

  4. Trends in the supply of California’s emergency departments and inpatient services, 2005–2014: a retrospective analysis

    Science.gov (United States)

    Chow, Jessica L; Niedzwiecki, Matthew J; Hsia, Renee Y

    2017-01-01

    Objectives Given increasing demand for emergency care, there is growing concern over the availability of emergency department (ED) and inpatient resources. Existing studies of ED bed supply are dated and often overlook hospital capacity beyond ED settings. We described recent statewide trends in the capacity of ED and inpatient hospital services from 2005 to 2014. Design Retrospective analysis. Setting Using California hospital data, we examined the absolute and per admission changes in ED beds and inpatient beds in all hospitals from 2005 to 2014. Participants Our sample consisted of all patients inpatient and outpatient) from 501 hospital facilities over 10-year period. Outcome measures We analysed linear trends in the total annual ED visits, ED beds, licensed and staffed inpatient hospital beds and bed types, ED beds per ED visit, and inpatient beds per admission (ED and non-ED). Results Between 2005 and 2014, ED visits increased from 9.8 million to 13.2 million (an increase of 35.0%, pbeds also increased (by 29.8%, pbeds. Despite this growth, ED beds per visit decreased by 3.9%, from 6.0 ED beds per 10 000 ED visits in 2005 to 5.8 beds in 2014 (p=0.01). While overall admission numbers declined by 4.9% (p=0.06), inpatient medical/surgical beds per visit grew by 11.3%, from 11.6 medical/surgical beds per 1000 admissions in 2005 to 12.9 beds in 2014 (pbeds per admission, by −15.3% (pbeds cannot keep pace with growing patient demand for acute care. Analysis of ED and inpatient supply should capture dynamic variations in patient demand. Our novel ‘beds pervisit’ metric offers improvements over traditional supply measures. PMID:28495813

  5. Exploring patterns of health service use in older emergency department patients.

    Science.gov (United States)

    Hastings, S Nicole; Horney, Carolyn; Landerman, Lawrence R; Sanders, Linda L; Hocker, Michael B; Schmader, Kenneth E

    2010-10-01

    Study objectives were to identify groups of older patients with similar patterns of health care use in the 12 months preceding an index outpatient emergency department (ED) visit and to identify patient-level predictors of group membership.   Subjects were adults ≥ 65 years of age treated and released from an academic medical center ED. Latent cluster analysis (LCA) models were estimated to identify groups with similar numbers of primary care (PC), specialist, and outpatient ED visits and hospital days within 12 months preceding the index ED visit.   In this sample (n = 308), five groups with distinct patterns of health service use emerged. Low Users (35%) had fewer visits of all types and fewer hospital days compared to sample means. Low Users were more likely to be female and had fewer chronic health conditions relative to the overall sample (p < 0.05). The ED to Supplement Primary Care Provider (PCP) (23%) group had more PCP visits, but also significantly more ED visits. Specialist Heavy (22%) group members had twice as many specialist visits, but no difference in PCP visits. Members of this class were more likely to be white and male (p < 0.05). High Users (15%) received more care in all categories and had more chronic baseline health conditions (p < 0.05) but no differences in demographic characteristics relative to the whole sample. The ED and Hospital as Substitution Care (6%) group had fewer PC and specialist visits, but more ED visits and hospital days.   In this sample of older ED patients, five groups with distinct patterns of health service use were identified. Further study is needed to determine whether identification of these patient groups can add important information to existing risk-assessment methods. © 2010 by the Society for Academic Emergency Medicine.

  6. 7 CFR 652.6 - Department delivery of technical services.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 6 2010-01-01 2010-01-01 false Department delivery of technical services. 652.6... General Provisions § 652.6 Department delivery of technical services. (a) The Department may enter into a... technical assistance services that accelerate conservation program delivery. Related technical...

  7. Feasibility of Non-Mydriatic Ocular Fundus Photography in the Emergency Department: Phase I of the FOTO-ED Study

    Science.gov (United States)

    Bruce, Beau B.; Lamirel, Cédric; Biousse, Valérie; Ward, Antionette; Heilpern, Katherine L.; Newman, Nancy J.; Wright, David W.

    2011-01-01

    Objectives Examination of the ocular fundus is imperative in many acute medical and neurologic conditions, but direct ophthalmoscopy by non-ophthalmologists is underutilized, poorly performed, and difficult without pharmacologic pupillary dilation. The objective was to examine the feasibility of non-mydriatic fundus photography as a clinical alternative to direct ophthalmoscopy by emergency physicians (EPs). Methods Adult patients presenting to the emergency department (ED) with headache, acute focal neurologic deficit, diastolic blood pressure ≥ 120 mmHg, or acute visual change had ocular fundus photographs taken by nurse practitioners using a non-mydriatic fundus camera. Photographs were reviewed by a neuro-ophthalmologist within 24 hours for findings relevant to acute ED patient care. Nurse practitioners and patients rated ease, comfort, and speed of non-mydriatic fundus photography on a 10-point Likert scale (10 best). Timing of visit and photography were recorded by automated electronic systems. Results Three hundred fifty patients were enrolled. There were 1,734 photographs taken during 230 nurse practitioner shifts. Eighty-three percent of the 350 patients had at least one eye with a high quality photograph, while only 3% of patients had no photographs of diagnostic value. Mean ratings were ≥ 8.7 (standard deviation [SD] ≤ 1.9) for all measures. The median photography session lasted 1.9 minutes (interquartile range [IQR] 1.3 to 2.9 minutes), typically accounting for less that 0.5% of the patient’s total ED visit. Conclusions Non-mydriatic fundus photography taken by nurse practitioners is a feasible alternative to direct ophthalmoscopy in the ED. It is performed well by non-physician staff, is well-received by staff and patients, and requires a trivial amount of time to perform. PMID:21906202

  8. Feasibility of nonmydriatic ocular fundus photography in the emergency department: Phase I of the FOTO-ED study.

    Science.gov (United States)

    Bruce, Beau B; Lamirel, Cédric; Biousse, Valérie; Ward, Antionette; Heilpern, Katherine L; Newman, Nancy J; Wright, David W

    2011-09-01

    Examination of the ocular fundus is imperative in many acute medical and neurologic conditions, but direct ophthalmoscopy by nonophthalmologists is underutilized, poorly performed, and difficult without pharmacologic pupillary dilation. The objective was to examine the feasibility of nonmydriatic fundus photography as a clinical alternative to direct ophthalmoscopy by emergency physicians (EPs). Adult patients presenting to the emergency department (ED) with headache, acute focal neurologic deficit, diastolic blood pressure ≥ 120 mm Hg, or acute visual change had ocular fundus photographs taken by nurse practitioners using a nonmydriatic fundus camera. Photographs were reviewed by a neuroophthalmologist within 24 hours for findings relevant to acute ED patient care. Nurse practitioners and patients rated ease, comfort, and speed of nonmydriatic fundus photography on a 10-point Likert scale (10 best). Timing of visit and photography were recorded by automated electronic systems. A total of 350 patients were enrolled. There were 1,734 photographs taken during 230 nurse practitioner shifts. Eighty-three percent of the 350 patients had at least one eye with a high-quality photograph, while only 3% of patients had no photographs of diagnostic value. Mean ratings were ≥ 8.7 (standard deviation [SD] ≤ 1.9) for all measures. The median photography session lasted 1.9 minutes (interquartile range [IQR] = 1.3 to 2.9 minutes), typically accounting for less that 0.5% of the patient's total ED visit. Nonmydriatic fundus photography taken by nurse practitioners is a feasible alternative to direct ophthalmoscopy in the ED. It is performed well by nonphysician staff, is well-received by staff and patients, and requires a trivial amount of time to perform. © 2011 by the Society for Academic Emergency Medicine.

  9. Patterns of dental service utilization following nontraumatic dental condition visits to the emergency department in Wisconsin Medicaid.

    Science.gov (United States)

    Pajewski, Nicholas M; Okunseri, Christopher

    2014-01-01

    To examine patterns of dental service utilization for adult Medicaid enrollees in Wisconsin following nontraumatic dental condition (NTDC) visits to the emergency department (ED). This is a retrospective, observational study of claims for NTDC visits to the ED and dental service encounters from the Wisconsin Medicaid Evaluation and Decision Support database (2001-2009). We used competing risk models to predict probabilities of returning to the ED versus obtaining follow-up care from a dentist. We observed a 43 percent increase in the rate of NTDC visits to the ED, with most of this increase occurring from 2001 to 2005. Within 30 days of an NTDC visit to the ED, ∼29.6 percent of enrollees will first visit a dentist office, while ∼9.9 percent will return to the ED. Young to middle-aged adults (18 to dental providers were more likely to return to the ED following a NTDC visit. Among the enrollees that first visited a dental office following an ED visit, 37.6 percent had an extraction performed at this visit. Almost one in five adult Medicaid enrollees will subsequently return to the ED following a previous NTDC visit. The provision of definitive care for these individuals appears to primarily consist of extractions. © 2012 American Association of Public Health Dentistry.

  10. Factors affecting communication in emergency departments: doctors and nurses' perceptions of communication in a trilingual ED in Hong Kong.

    Science.gov (United States)

    Pun, Jack K H; Matthiessen, Christian M I M; Murray, Kristen A; Slade, Diana

    2015-12-01

    This study investigates clinicians' views of clinician-patient and clinician-clinician communication, including key factors that prevent clinicians from achieving successful communication in a large, high-pressured trilingual Emergency Department (ED) in Hong Kong. Researchers interviewed 28 doctors and nurses in the ED. The research employed a qualitative ethnographic approach. The interviews were audio-recorded, transcribed, translated into English and coded using the Nvivo software. The researchers examined issues in both clinician-patient and clinician-clinician communication. Through thematic analyses, they identified the factors that impede communication most significantly, as well as the relationship between these factors. This research highlights the significant communication issues and patterns in Hong Kong EDs. The clinician interviews revealed that communication in EDs is complex, nuanced and fragile. The data revealed three types of communication issues: (1) the experiential parameter (i.e. processes and procedures), (2) the interpersonal parameter (i.e. clinicians' engagements with patients and other clinicians) and (3) contextual factors (i.e. time pressures, etc.). Within each of these areas, the specific problems were the following: compromises in knowledge transfer at key points of transition (e.g. triage, handover), inconsistencies in medical record keeping, serious pressures on clinicians (e.g. poor clinician-patient ratio and long working hours for clinicians) and a lack of focus on interpersonal skills. These communication problems (experiential, interpersonal and contextual) are intertwined, creating a complex yet weak communication structure that compromises patient safety, as well as patient and clinician satisfaction. The researchers argue that hospitals should develop and implement best-practice policies and educational programmes for clinicians that focus on the following: (1) understanding the primary causes of communication problems in

  11. A new design for the department of information services.

    Science.gov (United States)

    Sheehan, M

    1995-01-01

    This paper describes the structure and function of the department of Information Services at Sacred Heart Health System in Eugene, Oregon. This department has gone through a process of reorganization. The new department design features self-directed work teams with a strong customer service orientation; a mentor role stressing staff development; and a skill-based compensation system.

  12. 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.

  13. Reducing inappropriate emergency department attendances--a review of ambulance service attendances at a regional teaching hospital in Scotland.

    Science.gov (United States)

    Patton, Gareth Gordon; Thakore, Shobhan

    2013-06-01

    Emergency Departments (ED) in the UK have seen increasing attendance rates in recent years. Departments are now seeking strategies to reduce their attendances. A review of all ambulance attendances to the ED at Ninewells Hospital was conducted to identify if patients presenting by ambulance could be seen and treated more appropriately in other parts of the health service. A retrospective review of ambulance attendances to the ED at Ninewells Hospital over 7 non-consecutive days. The ambulance patient report form and the ED notes were reviewed by the duty consultant to deem whether it was appropriate for the patient to be presented to the ED. If inappropriate, an alternative destination was suggested. Additional data was collected on the source of the ambulance call. There were 910 attendances in the 7 days. 295 (32%) presented by ambulance. 32 had incomplete data and were excluded. 185 (70%) and 179 (68%) of the 263 were deemed appropriate from review of the patient report form and notes respectively. Of the inappropriate, 74.4% and 79.7% had primary care suggested as an alternative. Patients who call for their own ambulance and NHS24 had higher rates of inappropriate attendances. The ambulance services present one-third of the patients to the ED at Ninewells Hospital. 30%-32% were found to be attending inappropriately and 74%-80% of these could have been managed in primary care. Reducing inappropriate ambulance attendances could reduce the departmental patient load by 11%.

  14. Emergency department patient satisfaction: customer service training improves patient satisfaction and ratings of physician and nurse skill.

    Science.gov (United States)

    Mayer, T A; Cates, R J; Mastorovich, M J; Royalty, D L

    1998-01-01

    Customer service initiatives in healthcare have become a popular way of attempting to improve patient satisfaction. This study investigates the effect of clinically focused customer service training on patient satisfaction in the setting of a 62,000-visit emergency department and level I trauma center. Analysis of patient complaints, patient compliments, and a statistically verified patient-satisfaction survey indicate that (1) all 14 key quality characteristics identified in the survey increased dramatically in the study period; (2) patient complaints decreased by over 70 percent from 2.6 per 1,000 emergency department (ED) visits to 0.6 per 1,000 ED visits following customer service training; and (3) patient compliments increased more than 100 percent from 1.1 per 1,000 ED visits to 2.3 per 1,000 ED visits. The most dramatic improvement in the patient satisfaction survey came in ratings of skill of the emergency physician, likelihood of returning, skill of the emergency department nurse, and overall satisfaction. These results show that clinically focused customer service training improves patient satisfaction and ratings of physician and nurse skill. They also suggest that such training may offer a substantial competitive market advantage, as well as improve the patients' perception of quality and outcome.

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

    Directory of Open Access Journals (Sweden)

    James R. Langabeer II

    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.

  16. 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 ... Planning: Addressing 21st-Century Public Health Challenges Seasonal Food Safety Fact Sheets Keep your food safe - prepare now ...

  17. 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).

  18. The Ohio Department of Youth Services Juvenile Prison Library System

    Science.gov (United States)

    Herring, Deidra N.

    2009-01-01

    The article is an introduction to The Ohio Department of Youth Services librarians and the services they provide. Information about each juvenile prison facility is revealed and provides an explanation of guidelines and standards for prison libraries. Sixty-eight questions were asked in four in-person interviews to present a profile of the…

  19. Absenteeism rates in students receiving services for CDs, LDs, and EDs: a macroscopic view of the consequences of disability.

    Science.gov (United States)

    Redmond, Sean M; Hosp, John L

    2008-01-01

    Elevated levels of absenteeism have been reported for students receiving special education services, especially students with learning disabilities (LDs) and emotional disturbances (EDs). In contrast, little is known about absenteeism rates associated with students with communication disorders (CDs). Archival records of student attendance for the 1997-2001 academic years from a mid-sized urban school district in the Intermountain West were used to examine absenteeism rates in students receiving services for CDs, LDs, and EDs. Two cohort samples were generated (K-4th grade and 5th-9th grade). Students with CDs displayed absenteeism rates that were comparable to those of students receiving general education. Significant group and group x grade effects were found. Students in the LD and ED groups displayed elevated levels of absenteeism, especially at Grade 9. The outcomes of this study support the characterization of the socioemotional concomitants associated with CDs as being typologically different and exerting a weaker influence on student's health levels than those associated with either LDs or EDs.

  20. SETTING UP TRIAGE SERVICES IN THE EMERGENCY DEPARTMENT: EXPERIENCE FROM A TERTIARY CARE INSTITUTE OF PAKISTAN. A JOURNEY TOWARD EXCELLENCE.

    Science.gov (United States)

    Khursheed, Munawar; Fayyaz, Jabeen; Jamil, Ahsan

    2015-01-01

    The history of triage started from the French battle field for prioritizing patients. Emergency triage was started in early 1950's in USA in order to treat the sickest first. It has now become an integral component of all emergency departments (ED). The basic aim of triage is not only to sort out patients according to the criticality of their illness, but it also serves to streamline the patient flow. This will ultimately enable the ED physician to provide right management at the right time to the right patient in the available resources. In turn has a positive impact in reducing the ED overcrowding. The history of triage at AKUH-ED dated back in 2000. In the beginning physicians and nurse both were assigned to triage desk where they use to sort out the patient according to presenting complaints. At that time the documentation was manual with locally developed triage priorities. With the expansion of ED in 2008, responsibility of triage was shifted to nursing services. Triage policy was established and implemented. Specific triage protocols were developed for guidance and uniformity of care. Manual recording system was replaced by computerized triage data entry software. Enabling the department to monitor patient quality care indicators like total number of patients triaged, triage category, lag time reports and left without being seen by physicians.

  1. Ed. Service d'experimentation et d'information. I.N.R.A. Route de St. Cyr-78, Versailles

    OpenAIRE

    González,Gaspar

    2011-01-01

    C. DEMARQUILLY y PH. WEISS: Tableaux de la valeur alimentaire des fourrages. (Tablas del valor alimenticio de los forrajes.) I.N.R.A. Ministére de l'Agriculture. [Ed. Service d'experimentation et d'information. I.N.R.A. Route de St. Cyr-78, Versailles.] 1970. 64 págs., nueve cuadros y dos anexos, 33 referencias bibliográficas al final (*).

  2. Using the past to predict the future: latent class analysis of patterns of health service use of older adults in the emergency department.

    Science.gov (United States)

    Hastings, S Nicole; Whitson, Heather E; Sloane, Richard; Landerman, Lawrence R; Horney, Carolyn; Johnson, Kimberly S

    2014-04-01

    To classify older adults in the emergency department (ED) according to healthcare use and to examine associations between group membership and future ED visits and hospital admissions. Secondary analysis. Medicare Current Beneficiary Survey. Adults aged 65 and older with at least one treat-and-release ED visit between January 1, 2000, and September 30, 2007 (N = 4,964). Measures of health service use included primary care visits, treat-and-release ED visits, and hospital days in the 12 months preceding the index ED visit. Five groups of individuals in the ED with distinct patterns of health service use were identified. "Primary Carederly" (39%) had low rates of ED and hospital use and a high mean number of primary care visits. "Wellderly" (34%) had fewer visits of all types than other groups. "Chronically Illderly" (14%) had the highest mean number of primary care visits and hospital days. "Acute Carederly" (9.8%) had lowest mean number of primary care visits but higher ED visits and hospital days than all other groups except the "Sickest Elderly." Sickest Elderly (3.2%) had the highest number of ED visits; mean number of hospital days was more than four times that of any other group. Primary Carederly and Wellderly had a lower risk of hospital admission within 30 days of the index ED visit than the other groups. In older adults released from an ED, group membership was associated with future health services use. Classification of individuals using readily available previous visit data may improve targeting of interventions to improve outcomes. Published 2014. This article is a U.S. Government work and is in the public domain in the U.S.A.

  3. Using the Past to Predict the Future: Latent Class Analysis of Patterns of Health Service Use Among Older Emergency Department Patients

    Science.gov (United States)

    Hastings, S. Nicole; Whitson, Heather E.; Sloane, Richard; Landerman, Lawrence R.; Horney, Carolyn; Johnson, Kimberly S.

    2014-01-01

    Objectives To classify older emergency department (ED) patients by health care use and to examine associations between group membership and future ED visits and hospital admissions. Design Secondary analysis Setting Medicare Current Beneficiary Survey Participants Adults aged > = 65 years with at least one treat-and-release ED visit between 1/1/00 and 9/30/07 (N = 4,964). Measurements Measures of health service use included (1) primary care visits, (2) treat-and-release ED visits, and (3) hospital days in the 12 months preceding the index ED visit. Results Five groups of ED patients with distinct patterns of health service use were identified. "Primary Carederly" (39%) had low rates of ED and hospital use and a high mean number of primary care (PC) visits. “Wellderly" (34%) had fewer visits of all types compared to other groups. “Chronically Illderly” (14%) patients had the highest mean number of PC visits and hospital days. “Acute Carederly” (9.8%) had lowest mean number of PC visits but higher ED visits and hospital days than all other groups except the Sickest Elderly. Patients in the “Sickest Elderly” group (3.2%) had the highest number of ED visits; mean number of hospital days was more than four times that of any other group. “Primary Carederly” and “Wellderly” had a lower risk of hospital admission within 30 days of the index ED visit, while all other groups had a higher risk. Conclusion Among older patients released from an ED, group membership was associated with future health services use. Classification of patients using readily available previous visit data may improve targeting of interventions to improve patient outcomes. PMID:24635112

  4. Proposing a competitive intelligence (CI framework for Public Service departments to enhance service delivery

    Directory of Open Access Journals (Sweden)

    Nisha Sewdass

    2012-02-01

    Full Text Available Background: The aim of public service departments in South Africa is to improve service delivery through the transformation and improvement of human resources and the improvement of service delivery practices. Furthermore, it is important for the public service sector in South Africa to improve the quality of its service delivery, not only by comparing its performance with other sectors within South Africa but also by positioning itself amongst the best in the world. This can be achieved by benchmarking with other global industries and by implementing the most recent competitive intelligence strategies, tools and techniques. The environment of the public service organisations consists of competitive forces that impact the functioning of these organisations.Objectives: This article focuses on proposing competitive intelligence-related strategies, tools and techniques for gathering and analysing information in the public service departments in South Africa in order to enhance service delivery.Method: The study was qualitative in nature and was divided into two components, namely, (1 theoretical – through an extensive review of the literature and (2 empirical – an ethnographic study at the chosen public service department, the Department of Home Affairs (DHA. Ethnographic interviews with management-level staff, focus groups and document analysis were used to obtain adequate information to determine the current state of public service delivery in South Africa.Results: The results of the study was the development of a new competitive intelligencerelated framework for gathering and analysing information, and it represents a formal and systematic process of informing managers in public service departments about critical issues that these departments face or are likely to experience in future.Conclusion: The strategic planning tools and techniques of this framework will fill the gap that exists in public service departments. Once this framework has

  5. 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...

  6. Telepsychiatry program eases patient crowding in the ED, expedites mental health services to patients and providers.

    Science.gov (United States)

    2013-11-01

    With funding from the Duke Endowment, the Albemarle Hospital Foundation in Elizabeth City, NC, implemented a telepsychiatry program aimed at decreasing patient backlogs in the health system's EDs, while also quickly connecting patients with needed mental health care. The approach has more than halved LOS for patients who are discharged to inpatient treatment facilities. The approach is also credited with reducing recidivism rates and the need for involuntary commitments. Now the state has announced plans to employ a similar approach statewide. Patients in the ED are connected with psychiatric providers at a remote location through the use of telemedicine carts that are equipped with wireless technology. With expedited psychiatric treatment, administrators say that nearly 30% of patients with involuntary commitment (IVC) orders stabilize to the point that their IVC orders can be rescinded and they can be discharged from the ED to outpatient care. Since the start of the pilot program in March of 2011, project administrators report that the average LOS in the ED for patients discharged to inpatient treatment facilities has decreased from 48 hours to 22.5 hours.

  7. 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.

  8. Effects of a Dedicated Regional Psychiatric Emergency Service on Boarding of Psychiatric Patients in Area Emergency Departments

    Directory of Open Access Journals (Sweden)

    Scott Zeller

    2014-02-01

    Full Text Available Introduction: 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. Methods: 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.Results: 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. Conclusion: 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

  9. Improving service quality by understanding emergency department flow: a White Paper and position statement prepared for the American Academy of Emergency Medicine.

    Science.gov (United States)

    Eitel, Dave R; Rudkin, Scott E; Malvehy, M Albert; Killeen, James P; Pines, Jesse M

    2010-01-01

    Emergency Department (ED) crowding is a common problem in the United States and around the world. Process reengineering methods can be used to understand factors that contribute to crowding and provide tools to help alleviate crowding by improving service quality and patient flow. In this article, we describe the ED as a service business and then discuss specific methods to improve the ED quality and flow. Methods discussed include demand management, critical pathways, process-mapping, Emergency Severity Index triage, bedside registration, Lean and Six Sigma management methods, statistical forecasting, queuing systems, discrete event simulation modeling and balanced scorecards. The purpose of this review is to serve as a background for emergency physicians and managers interested in applying process reengineering methods to improving ED flow, reducing waiting times, and maximizing patient satisfaction. Finally, we present a position statement on behalf of the American Academy of Emergency Medicine addressing these issues.

  10. 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

  11. 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.

  12. 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.

  13. 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 ... of service quality, Multi Attribute Decision Making method: TOPSIS is applied for ... rank the institutions according to the multiple criteria service quality measure.

  14. Contribution of ED admissions to inpatient hospital revenue.

    Science.gov (United States)

    Sacchetti, Alfred; Harris, Russell H; Warden, Todd; Roth, Sandra

    2002-01-01

    Emergency department (ED) practices are traditionally profiled in terms of their patient encounters. Such evaluations reflect a preponderance of outpatient visits while crediting income from admitted patients to traditional hospital-based services. This study evaluates the contribution of ED admissions to inpatient hospital revenue. The study was set at an urban tertiary care community hospital with university affiliation. Information referable to ED patients was collected from the hospital's Universal Billing Code (UB-92)-based patient information warehouse. Data fields referable to hospital charges, insurance type, and disposition were used for analysis of a 1-year period from September 1, 1998 to August 31, 1999. Statistical analysis was through chi square and ANOVA. During the study period 33,174 patients were treated in the ED with 6,671 (20%) admitted to inpatient services. Total hospital charges for all ED patients during this time were $107 million dollars with $9.1 million (8.5%) generated from discharged patients and $98.0 million (91.5%) from admitted ED patients (P revenue for inpatient services for the study period was $288 million of which 34% was contributed from admitted ED patients. ED services represent a major source of inpatient hospital revenue. The recognition of the ED's potential in this area may be lost if income from patients admitted through the ED is credited to traditional hospital-based services.

  15. 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

  16. 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.)

  17. [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.

  18. Referrals from general practitioners to a social services department.

    Science.gov (United States)

    Sheppard, M G

    1983-01-01

    One year's referrals from general practitioners to a social services department were studied. There was a low referral rate and a bias towards women, the elderly and the less affluent. The referrals were predominantly made for practical help with problems of ill health. A high proportion of clients were allocated to non-social work staff, and the social service intervention, generally of short duration, showed a sympathetic response to the practical requests of general practitioners. The limited use of social workers by doctors is considered to be the result of ignorance or scepticism about psychodynamic social work skills. Closer liaison between general practitioners and social workers, and a clearer presentation by social workers of their professional skills, are suggested solutions to this problem.

  19. Managing people with mental health presentations in emergency departments--a service exploration of the issues surrounding responsiveness from a mental health care consumer and carer perspective.

    Science.gov (United States)

    Morphet, Julia; Innes, Kelli; Munro, Ian; O'Brien, Anthony; Gaskin, Cadeyrn J; Reed, Fiona; Kudinoff, Teresa

    2012-08-01

    Mainstreaming of mental health services (MHS) within the Australian medical system has generated a fundamental transformation in the way consumers and carers access emergency MHS. People present to the Emergency Department (ED) with many health issues which can often include the management of their mental illness, physical co morbidity, or substance use. This paper discusses the issues surrounding access to EDs for clients, families and staff in the context of presentations for mental health problems at a southern metropolitan hospital in Victoria. The pilot project utilised focus groups with mental health care consumers and carers to collaboratively focus on and document the mental health client's 'journey of care' in the ED. There is evidence to suggest from this project that the ED mental health client journey needs continuous improvement and evaluation.

  20. Study of patients of road traffic accidents a rriving in emergency department [ED] of V.S hospital at Ahmedabad city, single centre pilot study.

    Directory of Open Access Journals (Sweden)

    Aharnish Shah

    2014-07-01

    Full Text Available Objectives of the study According to the latest world status report on road safety released by WHO, we are now the world leaders in road traffic accident rate & related mortality. Our study intends to find out the epidemiological factors, risk factors, use of safety measures, compliance with traffic laws, presenting injuries & ED intervention required, in patients with road traffic accidents. Materials & methods Our study is a cross sectional observational study in which data was obtained from 150 patients of road traffic accidents arriving at any time to emergency department. Collected data included information about basic details, basic crash characteristics, risk factors, use of safety measures, injuries sustained, ED intervention required & disposition. Results Approximately 77% of the patients belong to 11-50 yr age group. The most common time of RTA is between 6 am to 12 noon [36.67%]. However accidents requiring admission were more during night time [62.74%]. Innocent passengers & pedestrians contributed to 41% of the accident cases. Non compliance with traffic laws & safety measures like driving without license [20%], using mobile phones while driving [10%], not using headlights at night [26%], not using seatbelts [80%], not using helmets [91%], etc were found in a substantial number of cases. Intracranial bleed & skull fractures were significantly (31.2% v/s 0% more in drivers without helmets than those with helmets. ED intervention required in decreasing order were dressing ( 38%, laceration repair (27.33%, splinting (24%, crash intubation (10%, ICD (2.66%. Conclusion: Well equipped secondary & tertiary level trauma centres, specially dedicated to management of trauma patients, with a proper triage plan, are necessary for proper management of trauma patients & better utilisation of resources. Our study shows that an ER physician should be trained in l aceration repair, dressing, splint/slab application, fracture/dislocation reduction

  1. 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...

  2. The organisation of the Department of Veterinary Services in Malaysia.

    Science.gov (United States)

    Mohd Nor, M N; Abu Mustapa, A J; Abu Hassan, M A; Chang, K W

    2003-08-01

    The Department of Veterinary Services (DVS) in Malaysia was established in 1888 as an agency to control exotic and domestic animal diseases. Over the years, the structure and functions of the organisation have evolved to meet the growing demand for veterinary services. The responsibilities of the Veterinary Services are enshrined in the Constitution of Malaysia. The current organisation of the DVS is structured to achieve the following objectives:---to prevent, control and eradicate animal and zoonotic diseases--to facilitate the growth and development of a strong animal industry--to ensure that animal products for human consumption are wholesome, clean, safe and suitable to be consumed--to facilitate the growth and development of the animal feed industry--to ensure the welfare and well-being of all animals. To meet these objectives the DVS has nine different divisions, as follows: Planning and Evaluation, Epidemiology and Veterinary Medicine, Veterinary Public Health, Research and Development, Industry Development, Production and Development of Genetic Resources, Human Resource Development (HRD), Enforcement, and Administration. The development of the animal industry is managed through national development policies, including the Third National Agriculture Policy. The basis for current programmes for disease control and animal industry development is the Eighth Development Plan (2001-2005). Over the period of this Plan, Malaysia will address the need for sanitary and phytosanitary measures by developing specific programmes covering all fields of the animal industry. This is just one way in which Malaysia is meeting the challenges of the increased liberalisation of trade created by the World Trade Organization and the Association of Southeast Asian Nations Free Trade Area. The development of the industry is focused on the major commodities, namely, beef, mutton, poultry meat, eggs, pork and milk. Other commodities receive support if it is considered economically

  3. Real-time demand forecasting in the emergency department.

    Science.gov (United States)

    Jones, Spencer S

    2007-10-11

    Shifts in the supply of and demand for emergency department (ED) services have led to ED overcrowding and make the efficient allocation of ED resources increasingly important. Reliable means of modeling and forecasting the demand for resources are critical to any ED resource planning strategy. Vector Autoregression (VAR) is a flexible multivariate time-series forecasting methodology that is well suited to modeling demand for resources in the ED.

  4. A comparison of adherence to correctly documented triage level of critically ill patients between emergency department and the ambulance service nurses.

    Science.gov (United States)

    Jönsson, Kenneth; Fridlund, Bengt

    2013-07-01

    Priority or triage has always occurred in emergency care. Today it is performed by both nurses in emergency departments (EDs) and ambulance services (ASs) to ensure patient safety. Recent studies have shown that nurses are unlikely to change their first impressions and patients suffering from blunt trauma are undertriaged. Our study aimed to compare and evaluate the adherence to correct triage level documentation, between nurses in the ED and the AS, according to current regulations. Of 592 analysed triage records from a university, a central and a district hospital, the adherence was 64% by ED nurses and 43% by AS nurses (pnurses do not adhere to the triage system and do not correctly document the triage level. Internal feedback and control are two approaches to improve the patient outcome, indicating that organisational actions must be taken.

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

    Science.gov (United States)

    2012-02-01

    ... production in plants (such as cry genes). EPA grants experimental use permits for field testing and... office of Animal and Plant Health Inspection Service/Biotechnology Regulatory Services (APHIS/BRS) and...

  6. 39 CFR 760.1 - Treasury Department regulations; applicability to Postal Service.

    Science.gov (United States)

    2010-07-01

    ... 39 Postal Service 1 2010-07-01 2010-07-01 false Treasury Department regulations; applicability to... OBLIGATIONS; DISBURSEMENT POSTAL MONEY ORDERS APPLICABILITY OF TREASURY DEPARTMENT REGULATIONS § 760.1 Treasury Department regulations; applicability to Postal Service. The provisions of Treasury...

  7. 78 FR 977 - Public Availability of the Department of Transportation FY 2012 Service Contract Inventory

    Science.gov (United States)

    2013-01-07

    ... Public Availability of the Department of Transportation FY 2012 Service Contract Inventory AGENCY: Department of Transportation. ACTION: Notice of Public Availability of FY 2012 Service Contract Inventories..., Public Law 111-117, Department of Transportation is publishing this notice to advise the public of...

  8. 76 FR 79221 - Penske Logistics, LLC, Customer Service Department General Motors and Tier Finished Goods...

    Science.gov (United States)

    2011-12-21

    ... Employment and Training Administration Penske Logistics, LLC, Customer Service Department General Motors and... workers of Penske Logistics, LLC, Customer Service Department, a subsidiary of General Electric/Penske... correct name of the worker group department of the subject firm should read Penske Logistics, LLC...

  9. 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 (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE SURETY COMPANIES...

  10. 20 CFR 1010.240 - Will the Department be monitoring for compliance with priority of service?

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Will the Department be monitoring for compliance with priority of service? 1010.240 Section 1010.240 Employees' Benefits OFFICE OF THE ASSISTANT... SERVICE FOR COVERED PERSONS Understanding Priority of Service § 1010.240 Will the Department be...

  11. 49 CFR 40.399 - How does the Department notify service agents of its decision?

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 1 2010-10-01 2010-10-01 false How does the Department notify service agents of its decision? 40.399 Section 40.399 Transportation Office of the Secretary of Transportation... How does the Department notify service agents of its decision? If you are a service agent involved...

  12. 38 CFR 17.242 - Coordination of programs with Department of Health and Human Services.

    Science.gov (United States)

    2010-07-01

    ... specialized medical resources or medical information services shall be coordinated to a maximum extent... jurisdiction of the Department of Health and Human Services. Grants for Exchange of Information ... with Department of Health and Human Services. 17.242 Section 17.242 Pensions, Bonuses, and...

  13. Department

    African Journals Online (AJOL)

    USER

    2016-09-20

    Sep 20, 2016 ... Department of Mathematics, Faculty of Science, Kibabii University. 2. Department .... be seen that average rainfall exhibited a cyclic pattern with a reducing trend under both scenarios .... Department of Meteorology, University.

  14. 75 FR 47631 - Swets Information Services, Operations Department, Information Technology Group, Marketing Group...

    Science.gov (United States)

    2010-08-06

    ... Technology Group, Marketing Group, Finance Group, Runnemede, NJ; Amended Certification Regarding Eligibility... investigation combined the Operations Department, Information Technology (IT) Group, Marketing Group and the... Information Services, Operations Department, Information Technology Group, Marketing Group, and......

  15. Nations first federal combined solar power purchase launched by EPA, Forest Service, Energy Department and GSA

    Science.gov (United States)

    SAN FRANCISCO - The U.S. Environmental Protection Agency, U.S. Forest Service, Department of Energy and General Services Administration announced the first ever federal partnership to purchase solar power. This action follows President Obama's order

  16. 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 ...

  17. 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......, during a period of reduced opening hours and after closure, compared with the rest of Viborg County. RESULTS: Emergency service use did not change among Morsø municipality residents compared to other Viborg County residents. Compared to men in other parts of the county, Morsø men did not change their use...

  18. Point of care technology or standard laboratory service in an emergency department: is there a difference in time to action? A randomised trial

    DEFF Research Database (Denmark)

    Backer Mogensen, Christian; Borch, Anders; Brandslund, Ivan

    2011-01-01

    Emergency Departments (ED) have a high flow of patients and time is often crucial. New technologies for laboratory analysis have been developed, including Point of Care Technologies (POCT), which can reduce the transport time and time of analysis significantly compared with central laboratory...... services. However, the question is if the time to clinical action is also reduced if a decisive laboratory answer is available during the first contact between the patient and doctor. The present study addresses this question: Does a laboratory answer, provided by POCT to the doctor who first attends...... the patient on admission, change the time to clinical decision in commonly occurring diseases in an ED compared with the traditional service from a central laboratory?...

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

    African Journals Online (AJOL)

    Ngulup

    classification scheme, electronic records management system; and. Development of ...... Workshop for Enhancing the Performance of the African Public Service Commission‟s and. Other Appointing ... Wescott, C. 1999. Guiding principle on ...

  20. 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.

  1. Walk-ins seeking treatment at an emergency department or general practitioner out-of-hours service: a cross-sectional comparison

    Directory of Open Access Journals (Sweden)

    Eichler Klaus

    2011-05-01

    Full Text Available Abstract Background Emergency Departments (ED in Switzerland are faced with increasing numbers of patients seeking non-urgent treatment. The high rate of walks-ins with conditions that may be treated in primary care has led to suggestions that those patients would best cared for in a community setting rather than in a hospital. Efficient reorganisation of emergency care tailored to patients needs requires information on the patient populations using the various emergency services currently available. The aim of this study is to evaluate the differences between the characteristics of walk-in patients seeking treatment at an ED and those of patients who use traditional out-of-hours GP (General Practitioner services provided by a GP-Cooperative (GP-C. Methods In 2007 and 2009 data was collected covering all consecutive patient-doctor encounters at the ED of a hospital and all those occurring as a result of contacting a GP-C over two evaluation periods of one month each. Comparison was made between a GP-C and the ED of the Waid City Hospital in Zurich. Patient characteristics, time and source of referral, diagnostic interventions and mode of discharge were evaluated. Medical problems were classified according to the International Classification of Primary Care (ICPC-2. Patient characteristics were compared using non-parametric tests and multiple logistic regression analysis was applied to investigate independent determinants for contacting a GP-C or an ED. Results Overall a total of 2974 patient encounters were recorded. 1901 encounters were walk-ins and underwent further analysis (ED 1133, GP-C 768. Patients consulting the GP-C were significantly older (58.9 vs. 43.8 years, more often female (63.5 vs. 46.9% and presented with non-injury related medical problems (93 vs. 55.6% in comparison with patients at the ED. Independent determining factors for ED consultation were injury, male gender and younger age. Walk-in distribution in both settings was

  2. Walk-ins seeking treatment at an emergency department or general practitioner out-of-hours service: a cross-sectional comparison.

    Science.gov (United States)

    Chmiel, Corinne; Huber, Carola A; Rosemann, Thomas; Zoller, Marco; Eichler, Klaus; Sidler, Patrick; Senn, Oliver

    2011-05-09

    Emergency Departments (ED) in Switzerland are faced with increasing numbers of patients seeking non-urgent treatment. The high rate of walks-ins with conditions that may be treated in primary care has led to suggestions that those patients would best cared for in a community setting rather than in a hospital. Efficient reorganisation of emergency care tailored to patients needs requires information on the patient populations using the various emergency services currently available. The aim of this study is to evaluate the differences between the characteristics of walk-in patients seeking treatment at an ED and those of patients who use traditional out-of-hours GP (General Practitioner) services provided by a GP-Cooperative (GP-C). In 2007 and 2009 data was collected covering all consecutive patient-doctor encounters at the ED of a hospital and all those occurring as a result of contacting a GP-C over two evaluation periods of one month each. Comparison was made between a GP-C and the ED of the Waid City Hospital in Zurich. Patient characteristics, time and source of referral, diagnostic interventions and mode of discharge were evaluated. Medical problems were classified according to the International Classification of Primary Care (ICPC-2). Patient characteristics were compared using non-parametric tests and multiple logistic regression analysis was applied to investigate independent determinants for contacting a GP-C or an ED. Overall a total of 2974 patient encounters were recorded. 1901 encounters were walk-ins and underwent further analysis (ED 1133, GP-C 768). Patients consulting the GP-C were significantly older (58.9 vs. 43.8 years), more often female (63.5 vs. 46.9%) and presented with non-injury related medical problems (93 vs. 55.6%) in comparison with patients at the ED. Independent determining factors for ED consultation were injury, male gender and younger age. Walk-in distribution in both settings was equal over a period of 24 hours and most common

  3. 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

  4. 78 FR 70584 - ATOS IT Solutions & Services, Inc., Billing and Collections Department, Including Workers Whose...

    Science.gov (United States)

    2013-11-26

    ... Doc No: 2013-28332] DEPARTMENT OF LABOR Employment and Training Administration [TA-W-82,999] ATOS IT... Insurance (UI) Wages are Reported Through Siemens IT Solutions and Services, Mason, Ohio; Amended... workers of ATOS IT Solutions & Services, Inc., Billing and Collections Department, Mason, Ohio....

  5. Factors Shaping Mathematics Lecturers' Service Teaching in Different Departments

    Science.gov (United States)

    Bingolbali, E.; Ozmantar, M. F.

    2009-01-01

    In this article we focus on university lecturers' approaches to the service teaching and factors that influence their approaches. We present data obtained from the interviews with 19 mathematics and three physics lecturers along with the observations of two mathematics lecturers' calculus courses. The findings show that lecturers' approaches to…

  6. Military Base Closures and Affected Defense Department Civil Service Employees

    Science.gov (United States)

    2006-03-07

    employees adversely affected by BRAC. Outplacement subsidies could also be offered to other federal agencies to hire displaced DOD employees through...for its civilians, such as outplacement services, priority placement and separation incentives, will be available to employees under NSPS

  7. Research on Human Resources Development of Rural Public Service Departments in New Countryside Construction

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    On the basis of defining related concepts concerning human resources in rural public service departments,this paper analyses the overall status quo of human resources in China’s rural public service departments and points out the problems existing in human resources in China’s rural public service departments during new countryside construction as follows:first,the constitution structure is not rational;second,the cultural quality of staff is universally low,and the business capacity remains to be promoted;third,the improvement of human resources development environment lags behind,and the supporting reform is short.In the context of new countryside construction,the opportunities faced by the human resources in China’s rural public service departments are as follows:China has elevated strengthening new countryside construction and rural talents construction as important state development strategy;the ideas of service-oriented government and learning-oriented government are put forward;civil servant system is overhauled.Therefore,I advance the development strategy of human resources in China’s rural public service departments as follows:implement elastic personnel system reform in public service departments(including civil servant positions in department),to form the public service personnel system of "able one comes in,mediocre one moves over and shiftless one steps down";audaciously promote young and middle-aged grass-roots cadres with strong business ability,high political quality,acute judgement and decision-making ability;build learning-oriented grass-roots public service organization,to make the staff in rural pubic service departments study assiduously and progress;broaden horizon,and build the human resources development system geared to international standards;in developed regions,the human resources in grass-roots public service departments should introduce enterprise competition model.

  8. Ed Deutschman Interview [video

    OpenAIRE

    Deutschman, Ed

    2011-01-01

    Background: Ed Deutschman was a Navy cadet at the Del Monte Pre-Flight School, located at the now (2013) Naval Postgraduate School. Mr Deutschman visited the Dudley Knox Library on May 2, 2011, and spoke about his service in World War II as a Corsair fighter pilot in the Pacific.

  9. 78 FR 17349 - Public Availability of Department of Commerce FY2012 Service Contract Inventory

    Science.gov (United States)

    2013-03-21

    ... service contract inventory should be directed to Virna Winters, Director for Acquisitions Policy and... Office of the Secretary Public Availability of Department of Commerce FY2012 Service Contract Inventory... Service Contract Inventories. SUMMARY: In accordance with Section 743 of Division C of the Consolidated...

  10. Registered Nurses and Discharge Planning in a Taiwanese ED: A Neglected Issue?

    Science.gov (United States)

    Chang, Wen; Goopy, Suzanne; Lin, Chun-Chih; Barnard, Alan; Liu, Hsueh-Erh; Han, Chin-Yen

    2016-10-01

    Published research on discharge planning is written from the perspective of hospital wards and community services. Limited research focuses on discharge planning in the emergency department (ED). The objective of this study was to identify ED nurses' perceptions of factors influencing the implementation of discharge planning. This qualitative study collected data from 25 ED nurses through in-depth interviews and a drawing task in which participants were asked to depict on paper the implementation of discharge planning in their practice. Factors influencing discharge planning were grouped into three categories: discharge planning as a neglected issue in the ED, heavy workload, and the negative attitudes of ED patients and their families. The study highlighted a need for effective discharge planning to be counted as an essential clinical competency for ED nurses and factored into their everyday workload. Nurses perceived that organizational culture, and parents' and relatives' attitudes were barriers to implementing discharge teaching in the ED.

  11. 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)

  12. EDS becomes CERN Openlab contributor

    CERN Multimedia

    2007-01-01

    "EDS today announced that it has become an official contributor to CERN openlab. The purpose of the joint project between CERN and EDS is to carry out research and development in the field of monitoring, management and operaiton of grid services." (2/3 page)

  13. Depart

    African Journals Online (AJOL)

    USER

    2017-01-26

    Jan 26, 2017 ... Department of Urban and Regional Planning, Ladoke Akintola University of Technology, ... informal automobile workshops in virtually every open space in Nigerian cities that ..... plantation to encourage a green society and.

  14. 76 FR 4725 - Apria Healthcare Customer Service Department; Fourteen Locations in Missouri Cameron, Cape...

    Science.gov (United States)

    2011-01-26

    ... Missouri Cameron, Cape Girardeau, Columbia, Farmington, Fenton, Joplin, Lee's Summit, Pleasant Valley... Healthcare, Customer Service Department, Thirteen Locations in Missouri: Cameron, Cape Girardeau, Columbia...,676J); Cameron, Cape Girardeau, Columbia, Farmington, Fenton, Joplin, Lee's Summit, Pleasant Valley...

  15. U.S. Department of Health and Human Services Office of Inspector General Advisory Opinion List

    Data.gov (United States)

    U.S. Department of Health & Human Services — This OIG website contains a list of recently issued advisory opinions and a link to archives of previously issued advisory opinions. In accordance with section...

  16. Homelessness and housing crises among individuals accessing services within a Canadian emergency department.

    Science.gov (United States)

    Forchuk, C; Reiss, J P; Mitchell, B; Ewen, S; Meier, A

    2015-08-01

    Studies have indicated that individuals who are homeless access hospital emergency departments more frequently and may have different needs than individuals who are housed. Successful interventions have been developed and tested to reduce discharge to homelessness for psychiatric inpatients but have not been similarly tested for discharge from emergency departments. This study was developed to provide baseline data on this issue to inform future emergency department interventions. Findings from the current study suggest that discharge from emergency departments to homelessness happens frequently in London, Canada. Participants are unlikely to spontaneously disclose their housing/homelessness issue when first entering the emergency department, which may result in services that do not adequately meet their complex needs. Screening for housing issues is necessary within emergency departments and psychiatric crisis teams as housing issues may be a reason for accessing care or contribute to the presenting condition. Nurses are in an ideal position to evaluate housing needs among emergency department patients. Services outside of the emergency department are also needed to address housing issues, particularly outside of regular office hours. Individuals who have mental health issues and are homeless or in housing crisis have been found to access emergency departments more frequently than individuals with stable housing. While emergency departments primarily focus on medical issues, homeless individuals may require psychosocial support as well. This study examined issues around housing crises and emergency department use for individuals with mental illness in Canada. Collecting baseline data about these issues is important to inform subsequent interventions. Administrative data from a hospital emergency department and psychiatric crisis service were collected, and five individuals accessing the emergency department for psychiatric reasons were interviewed. Results

  17. Emergency nurse practitioner services in major accident and emergency departments: a United Kingdom postal survey.

    OpenAIRE

    Tye, C C; Ross, F.; Kerry, S. M.

    1998-01-01

    OBJECTIVE: To establish the current and predicted distribution of formal emergency nurse practitioner services in major accident and emergency departments in the United Kingdom; to determine organisational variations in service provision, with specific reference to funding, role configuration, training, and scope of clinical activity. METHODS: Postal survey of senior nurses of all major accident and emergency departments in the United Kingdom (n = 293) in May/June 1996. RESULTS: There were 27...

  18. 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...

  19. Department

    African Journals Online (AJOL)

    USER

    2017-05-25

    May 25, 2017 ... Department of Animal production Federal University of Technology Minna – Niger state,. Nigeria ... principles by poultry farmers in Kwara State, Nigeria. The ma .... usually incur by broiler and layer farmers ... A multi-stage sampling technique .... their birds under intensive care, which is ... husbandry system.

  20. Cooperative Agreement Between the United States Department of the Interior and the State of Florida Department of Agriculture and Consumer Services Division of Forestry

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — An agreement for assistance with forest fire detection, suppression and presuppression services on wildlife refuge lands by the Florida Division of Forestry. The...

  1. Working Paper on Staffing, Services and Organization of Reference Departments in Large Academic Libraries.

    Science.gov (United States)

    Watson, Paula D.; Landis, Martha

    Data from 43 responses to a questionnaire distributed to the academic members of the RASD Discussion Group in Reference Services in Large Research Libraries are summarized in tables. The purpose of the survey was to reflect patterns of staff size, services, and organization in reference departments in large academic libraries. The tables present…

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

    CERN Multimedia

    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

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

    CERN Multimedia

    *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

  4. Return to the emergency department after ventricular shunt evaluation.

    Science.gov (United States)

    Sarda, Samir; Simon, Harold K; Hirsh, Daniel A; Wang, Andrew; Shane Tubbs, R; Chern, Joshua J

    2016-04-01

    OBJECT Patients with CSF shunts are medically complex and frequently present to the emergency department (ED) with suspected shunt malfunction. After adequate evaluation in the ED and proper disposition, some patients return to the ED within a short period of time. In this study, the authors examined the reasons for ED revisits within 7 days of the index ED visit to discern possible preventable returns. METHODS There were 3080 index ED visits made by patients with shunted hydrocephalus between 2010 and 2013. Index ED visits preceded by another ED visit or neurosurgical procedure within 60 days were excluded. Index ED visits for reasons unrelated to shunt function and those that led directly to admissions and shunt revision surgeries were also excluded. The remaining 1509 ED visits were eligible for analysis in this study. Final dispositions from the index ED visit included home (1176 cases), admission to the neurosurgery service for observation (134 cases), and admission to other services (199 cases). Subsequent events within 7 days, including ED revisits, hospital admissions, and shunt-related surgery were recorded, and reasons for the ED revisits were categorized based on whether the visit was related to shunt function concerns. Clinical and socioeconomic factors were analyzed for their association with ED revisits by using statistical methods. RESULTS Of the 1176 patients discharged home from the ED after shunt function evaluation, 101 (8.6%) returned to the ED within 7 days. Of the 134 patients admitted to the neurosurgery service for observation only, 8 (6.0%) returned to the ED within 7 days of discharge. Of the 199 patients admitted to hospital services other than neurosurgery, 13 (6.5%) returned to the ED within 7 days of discharge. The reasons for ED revisits vary (total of 122 visits combining the 3 groups), but at least 60% of the revisits were clearly unrelated to shunt function. A younger age, daytime arrival to the ED, and living within the

  5. Factors influencing satisfaction with emergency department medical service: Patients' and their companions' perspectives.

    Science.gov (United States)

    Son, Heesook; Yom, Young-Hee

    2017-01-01

    To examine the individual determinants that influence satisfaction with medical services at the emergency department and to compare the factors that influence satisfaction for the patients, compared with their companions. Using data from the 2009 Korea Health Panel Survey, Andersen's behavioral model was used to examine the factors that affect satisfaction with service. A logistic regression analysis was conducted with the data. Patients who were older, female, and employed were more satisfied with the service, as were patients who visited more frequently and those who had non-surgical treatment. Companions who had less education, were accompanying non-Medicaid-holders, and spent a longer time in the emergency department were less likely to be satisfied. This was in contrast to those who spent a shorter amount of time in the emergency department and who visited due to illness, rather than injury; these companions were more satisfied with the service. When all the factors were analyzed simultaneously, they differed significantly between the two groups of patients and companions. Different factors contributed to the satisfaction with the services for the patients and their companions. In order to increase the satisfaction levels and improve the quality of care in emergency departments, it is necessary to consider more specific approaches that reflect the different perspectives of the visitors to the emergency department. © 2016 Japan Academy of Nursing Science.

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

    Science.gov (United States)

    2008-04-23

    of services and the increasing importance of services acquisition offer a unique and significant opportunity for conducting research in the management of the service supply chain in the Department of Defense.

  7. 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

  8. Marketing and public relations in the emergency department.

    Science.gov (United States)

    Mayer, T A; Tilson, W; Hemingway, J

    1987-02-01

    This article outlines the elements of successful ED marketing, as well as providing definitions for terms used within the marketing process. In today's competition and rapidly changing environment, marketing and public relations are tools that every ED Medical Director may want to consider. Because the marketing process requires a great deal of time and effort, as well as a high degree of intellectual honesty, it should never be entered into without a strong commitment. However, marketing the ED can be among the most productive, stimulating, and gratifying experiences for the ED Medical Director, the emergency department physicians, and all ED service personnel.

  9. 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,...

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

    Science.gov (United States)

    2009-09-21

    Managing the Services Supply Chain in the Department of Defense: Empirical Study of the Current Management Practices in the Army 21 September...Managing the Services Supply Chain in the Department of Defense: Empirical Study of the Current Management Practices in the Army 5a. CONTRACT NUMBER 5b...Service Supply Chain , Services Acquisition, Service Lifecycle, Contract Management, Project Management, Program Management = = ^Åèìáëáíáçå=oÉëÉ~êÅÜ

  11. 49 CFR 40.403 - Must a service agent notify its clients when the Department issues a PIE?

    Science.gov (United States)

    2010-10-01

    ... Department issues a PIE? 40.403 Section 40.403 Transportation Office of the Secretary of Transportation... Must a service agent notify its clients when the Department issues a PIE? (a) As a service agent, if the Department issues a PIE concerning you, you must notify each of your DOT-regulated...

  12. Exploring Intercollegiate Athletic Department-Community Partnerships through the Lens of Community Service Organizations

    Science.gov (United States)

    Svensson, Per G.; Huml, Matthew R.; Hancock, Meg G.

    2014-01-01

    Institutions of higher education are increasingly engaging in partnerships with local communities. Within a sport context, the creation of the NCAA CHAMPS/Life Skills Program has emphasized partnerships between athletic departments and local community service organizations (CSOs). Prior studies, however, have used student-athletes rather than the…

  13. 75 FR 64710 - Availability of the Fiscal Year 2009 Department of Defense Services Contracts Inventory

    Science.gov (United States)

    2010-10-20

    ... of the Secretary Availability of the Fiscal Year 2009 Department of Defense Services Contracts... 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/PASS) will make available to the...

  14. 77 FR 24990 - Public Availability of the Department of Labor FY 2011 Service Contract Inventory

    Science.gov (United States)

    2012-04-26

    ... Secretary for Administration and Management, Department of Labor. ACTION: Notice of Public Availability of... provides information on service contract actions over $25,000 made in FY 2011. The information is organized... been developed in accordance with guidance issued on November 5, 2010 by the Office of Management...

  15. 77 FR 6584 - Public Availability of Department of Justice FY 2011 Service Contract Inventory

    Science.gov (United States)

    2012-02-08

    ... Availability of Department of Justice FY 2011 Service Contract Inventory AGENCY: Justice Management Division... actions over $25,000 that were made in FY 2011. The information is organized by function to show how... with guidance issued on December 19, 2011 by the Office of Management and Budget's Office of...

  16. 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…

  17. Institutional Effectiveness Assessment Process, 1993-94. Executive Summary. Hospitality and Service Occupations Division, Cosmetology Department.

    Science.gov (United States)

    South Seattle Community Coll., Washington.

    A study was conducted to evaluate student and student employer satisfaction with the services provided by the South Seattle Community College (SSCC) Cosmetology Department. Specifically, the study gathered data related to four outcomes: that students receive an educational experience allowing them to meet their goals; that former and current…

  18. 76 FR 32358 - Meeting of the Defense Department Advisory Committee on Women in the Services (DACOWITS)

    Science.gov (United States)

    2011-06-06

    ... Law 92-463, as amended, notice is hereby given of a forthcoming meeting of the Defense Department... the results of their Workplace and Gender Relations survey. Additionally, the Committee will also... Military Personnel Policy will brief on the laws and policies that restrict the service of female...

  19. Managing the advanced cancer patient in the Australian emergency department environment : Findings from a national survey of emergency department clinicians

    NARCIS (Netherlands)

    T.J. Weiland (Tracey); Lane, H. (Heather); G.A. Jelinek; C.H.L. Marck (Claudia); Weil, J. (Jennifer); M. Boughey (Mark); Philip, J. (Jennifer)

    2015-01-01

    textabstractBackground: Delivery of care to people with advanced cancer in the emergency department (ED) is complicated by competing service demands, workloads and physical design constraints. We explored emergency clinicians’ attitudes to the ED environment when caring for patients who present with

  20. 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...

  1. 38 CFR 17.95 - Outpatient medical services for Department of Veterans Affairs employees and others in emergencies.

    Science.gov (United States)

    2010-07-01

    ... services for Department of Veterans Affairs employees and others in emergencies. 17.95 Section 17.95... Outpatient medical services for Department of Veterans Affairs employees and others in emergencies. Outpatient medical services for which charges shall be made as required by § 17.101 may be authorized...

  2. 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.

  3. Services Supply Chain in the Department of Defense: Drivers of Success in Services Acquisition

    Science.gov (United States)

    2014-04-30

    Maverick Missile, C-20 (Gulfstream IV), and the F-22 Raptor . He was also a contracting squadron commander for an Air Force pilot training base and the...managerial implications. Introduction The service sector represents the largest and the fastest-growing segment of the economies of the United States...labeled a failure because of quality. The group consisting of contracts greater than $1 to $10 million was the largest of all the grouped dollar

  4. 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.

  5. 32 CFR 700.835 - Work, facilities, supplies, or services for other Government departments, State or local...

    Science.gov (United States)

    2010-07-01

    ... other Government departments, State or local governments, foreign governments, private parties and....835 Work, facilities, supplies, or services for other Government departments, State or local... Federal and State governments, local governments, foreign governments, private parties, and...

  6. Textbook Access and Affordability through Academic Library Services: A Department Develops Strategies to Meet the Needs of Students

    Science.gov (United States)

    Eighmy-Brown, Melissa; McCready, Kate; Riha, Emily

    2017-01-01

    In the spring of 2015, the University of Minnesota Libraries formed the Content Services department, which is comprised of Interlibrary Loan, Publishing Services, and the Copyright Permissions Service. These three service points, as well as additional Library units, work together with campus partners to save students money on their course…

  7. Cyclist Injuries Treated in Emergency Department (ED): Consequences and Costs in South-eastern Finland in an Area of 100 000 Inhabitants.

    Science.gov (United States)

    Airaksinen, Noora; Lüthje, Peter; Nurmi-Lüthje, Ilona

    2010-01-01

    In the present study, data of bicycle crashes leading to medical attendance in acute hospital or to death which occurred between June 1(st) 2004 and May 31(st) 2006 were analyzed. The final results consisted of injury data and patient records obtained from Kuusankoski Regional Hospital and from the road accident investigation teams. The total number of cases was 216. The severity of the injuries was classified according to the Abbreviated Injury Scale (2005). The majority of the bicycle crashes considered occurred when the injured was alone, without another party. Crashes were often alcohol-related (31%). Over one third of all cyclists' injuries were head injuries. Only 13% of the injured cyclists wore a helmet. 15% of those who wore a helmet sustained a head injury and, correspondingly, 43% of those who did not. Two bicyclists died. The number of bicycle crashes in the hospital data was at least fourfold compared to the number found in the official police statistics. Systematic collection of data on bicycle crashes in hospital emergency departments should be advanced in order to gain reliable information for prevention.

  8. 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

  9. 38 CFR 17.51 - Emergency use of Department of Defense, Public Health Service or other Federal hospitals.

    Science.gov (United States)

    2010-07-01

    ... Health Service Or Other Federal Hospitals § 17.51 Emergency use of Department of Defense, Public Health... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Emergency use of Department of Defense, Public Health Service or other Federal hospitals. 17.51 Section 17.51...

  10. 38 CFR 17.50 - Use of Department of Defense, Public Health Service or other Federal hospitals with beds...

    Science.gov (United States)

    2010-07-01

    ... Defense, Public Health Service or other Federal hospitals with beds allocated to the Department of... of Department of Defense, Public Health Service or other Federal hospitals with beds allocated to the... hospital covered by the agreement, care may be authorized within the bed allocation for any veteran...

  11. Memorandum of Understanding between the Alaska Department of Fish and Game, Alaska Department of Natural Resources , U.S. Forest Service and U.S. Department of the Interior Bureau of Sport Fisheries and Wildlife : Chickaloon Flats Management Agreement

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The Chickaloon Flats, as per the attached legal description and map involving forty-eight thousand acres, more or less, are recognized by the agreement participants...

  12. Local health department assurance of services and the health of California's seniors.

    Science.gov (United States)

    Rodriguez, Hector P; Herrera, Angelica P; Wang, Yueyan; Jacobson, Dawn M

    2013-01-01

    To examine the extent to which local health department (LHD) assurance of select services known to promote and protect the health of older adults is associated with more favorable population health indicators among seniors. Data from the California Health Interview Survey (CHIS: 2003, 2005, and 2007) were linked with the 2005 wave of the National Association of County and City Health Officials profile survey and the Area Resource File to assess the association of LHD assurance and senior health indicators. Assurance was measured by an index of 5 services, either directly provided or contracted by LHDs: cancer screening, injury prevention, comprehensive primary care, home health care, and chronic disease prevention. Multilevel regression models estimated the association of LHD assurance of services and each of 6 older adult health indicators, controlling for individual, LHD, and county characteristics that included key social determinants of health, such as poverty. Fifty-seven California counties. 33,154 older adults (age 65 and older). Colorectal cancer screening, mammography, healthy eating, physical activity, and multiple falls among older adults. Local health departments provided or contracted a median of 2 of the 5 services. In adjusted analyses, LHD assurance of services was generally unassociated with the seniors' health behaviors, screening, and falls. Greater LHD expenditures per capita were associated with significantly better mammography screening rates (adjusted odds ratio [AOR] = 1.22, P junk food consumption (AOR = 1.14, P activity, and fewer falls among seniors. County-level poverty is most strongly associated with older adult health, underscoring a key barrier to address in local senior health improvement efforts.

  13. Rural telemedicine infrastructure and services in the Department of Cauca, Colombia.

    Science.gov (United States)

    Rendón, Alvaro; Martínez, Andrés; Dulcey, María F; Seoane, Joaquín; Shoemaker, Richard G; Villarroel, Valentín; López, Diego M; Simó, Javier

    2005-08-01

    The development of telemedicine programs for the public health network of the Department of Cauca, Colombia, (Department is the major political and territorial division of the country. The Department of Cauca is located on the Pacific coast in the southwest of the country.) would make it possible to satisfy many identified needs such as medical coordination, continuing education, epidemiologic surveillance, patient referral and counterreferral, and an end to the feeling of isolation among professionals who work in rural health centers. Nevertheless, geographic, economic, and social difficulties, and the lack of a telecommunication infrastructure in areas with these characteristics present a challenge of such magnitude that the majority of existing telemedicine projects in Colombia have been centered in urban or other areas which present fewer difficulties. In the municipality of Silvia, the University of Cauca has established a prototype network using the "Hispano-American Health Link" (EHAS in Spanish) program technologies, which uses very high frequency (VHF) and wireless fidelity, (WiFi, a set of standards for wireless local area networks) radio systems for the deployment of low-cost voice and data networks. Over this network information access and exchange services have been developed, in order to meet the needs identified above. The objectives were to obtain information about the development of the project's activities and their possible impact. Project telecommunication network and information services are described, and the results and conclusions of the first evaluation are presented.

  14. 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

  15. 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...

  16. 78 FR 50097 - Notice of Inventory Completion: U.S. Department of the Interior, National Park Service, Casa...

    Science.gov (United States)

    2013-08-16

    ... Service, Casa Grande Ruins National Monument, Coolidge, AZ AGENCY: National Park Service, Interior. ACTION: Notice. SUMMARY: The U.S. Department of the Interior, National Park Service, Casa Grande Ruins National... these human remains and associated funerary objects should submit a written request to Casa Grande Ruins...

  17. 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 covered persons receive priority of service? 1010.210 Section 1010.210 Employees' Benefits OFFICE OF THE... PRIORITY OF SERVICE FOR COVERED PERSONS Understanding Priority of Service § 1010.210 In which...

  18. 75 FR 45656 - Notice of Inventory Completion: U.S. Department of Agriculture, Forest Service, Siuslaw National...

    Science.gov (United States)

    2010-08-03

    ... National Forest is responsible for notifying the Confederated Tribes of the Coos, Lower Umpqua and Siuslaw... National Park Service Notice of Inventory Completion: U.S. Department of Agriculture, Forest Service, Siuslaw National Forest, Waldport, OR AGENCY: National Park Service, Interior. ACTION: Notice. Notice...

  19. 78 FR 78380 - Notice of Inventory Completion: U.S. Department of the Interior, National Park Service, Fort...

    Science.gov (United States)

    2013-12-26

    ... Service, Fort Bowie National Historic Site, Bowie, AZ AGENCY: National Park Service, Interior. ACTION: Notice. SUMMARY: The U.S. Department of the Interior, National Park Service, Fort Bowie National Historic... control of these human remains should submit a written request to Fort Bowie National Historic Site. If...

  20. 76 FR 7232 - Notice of Inventory Completion: U.S. Department of the Interior, National Park Service, Dinosaur...

    Science.gov (United States)

    2011-02-09

    ... Service, Dinosaur National Monument, Dinosaur, CO AGENCY: National Park Service, Interior. ACTION: Notice. SUMMARY: The U.S. Department of the Interior, National Park Service, Dinosaur National Monument, Dinosaur... culturally affiliated with the human remains may contact Dinosaur National Monument. Disposition of the...

  1. Geriatric Homelessness: Association with Emergency Department Utilization

    Science.gov (United States)

    Hategan, Ana; Tisi, Daniel; Abdurrahman, Mariam; Bourgeois, James A.

    2016-01-01

    Background Homeless adults frequently use emergency departments (EDs), yet previous studies investigating ED utilization by the older segment received little attention. This study sought to characterize older homeless adults who utilized local urban EDs. Methods ED encounters at three hospitals in Hamilton (Ont.) were analyzed, and demographic and clinical characteristics of the older homeless (age > 50) vs. younger counterparts (age ≤ 50) were compared during a 24-month period. Results Of all adults, 1,330 were homeless, of whom 66% were above age 50. Older homeless adults sought less acute care within 30 days from an index visit compared with their younger counterparts. Non-acute illnesses constituted only 18% of triaged cases. Older homeless women with access to a primary care physician (PCP) were 3.3 times more likely to return to ED within 30 days, whereas older homeless men (irrespective of PCP access) were less likely to return to ED. Conclusions Despite high homeless patient acuity, a lesser number of ED visits with increasing age remains concerning because of previously reported high morbidity and mortality rates. Access to primary care may not be enough to reduce ED utilization. Further research is needed to evaluate acute care interventions and their effectiveness in ED, and to identify homeless patients requiring more targeted services. PMID:28050223

  2. 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.

  3. 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....

  4. 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.

  5. 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.

  6. Diversity in the ministry of chaplaincy in the South African Department of Correctional Services

    Directory of Open Access Journals (Sweden)

    Maake J. Masango

    2016-05-01

    Full Text Available This article gives an overview of diversity in the South African Department of Correctional Services and how it challenges the ministry of chaplains. The diversity is manifest in the religious affiliations of inmates, crime categories, various categories of offenders, and programmes and services as unpacked in this article. This article precisely aims to shed light on how the chaplaincy functions within the framework of corrections in South Africa and how the diversity of the inmates’ population impacts on its theory and praxis. The Authors delineate the role that chaplains have to play to remain relevant to the correctional environment and accentuate the required empathic and non-judgmental stance by spiritual care personnel. Religious flexibility and adaptability is essential, as chaplains are managers of all religious activities. The article provides solid insights into what being a correctional chaplain in South Africa entails.

  7. Learning disabilities in the community college and the role of disability services departments.

    Science.gov (United States)

    McCleary-Jones, Voncella

    2007-01-01

    The community college offers educational opportunities to a diverse population of students. Many of the students attending the community college are considered non-traditional, and have numerous factors not faced by traditional-age students that can affect retention in this population. Learning disabled (LD) students attend the community college at a higher rate than other higher education institutions (Barnett, 1996; Bigaj, 1995; & Henderson, 1992). The American Association of Community Colleges (AACC) reported that LDs now constitute the largest single category of disability served by disability service offices in the community colleges (Barnett, 1992). Accommodations are set up by the Disability Support Services Departments, and it is the Disability Services offered by the college that can be the deciding factor for the student regarding the choice of institution (Cocchi, 1997). A trend for the future involves many students who attend the community college self-identifying as being learning disabled and requesting accommodation. Faculty, staff, and administrators in the community college will need to be very familiar with legislation that impacts the rights and availability of services for LD students.

  8. The Impact of Integrating Crisis Teams into Community Mental Health Services on Emergency Department and Inpatient Demand.

    Science.gov (United States)

    Jespersen, Sean; Lawman, Bronwyn; Reed, Fiona; Hawke, Kari; Plummer, Virginia; Gaskin, Cadeyrn J

    2016-12-01

    This investigation focused on the impact of integrating crisis team members into community mental health services on emergency department and adult mental health inpatient unit demand within an Australian public health service. Mixed methods were used including (a) the comparison of service use data with that of two other comparable services (both of which had community-based crisis teams), (b) surveys of (i) patients and carers and (ii) staff, and (c) focus groups with staff. The numbers of emergency department presentations with mental health conditions and adult mental health inpatient separations increased 13.9 and 5.7 %, respectively, from FY2006/07 to FY2012/13. Between the three services, there were minimal differences in the percentages of presentations with mental health conditions, the distribution of mental health presentations across a 24-h period, and the triage categories assigned to these patients. Survey participants reported that patients used the emergency department due to the urgency of situations, perceptions that gaining access to mental health services would take less time, and the unavailability of mental health services when help is needed. Staff identified several issues (e.g. inappropriate referrals) that may be unnecessary in increasing emergency department demand. The integration of crisis team members into community mental health services does not seem to have produced an increase in emergency department admissions or inpatient separations beyond what might be expected from population growth. The potential may exist, however, to reduce emergency department admissions through addressing the issue of inappropriate referrals.

  9. Factors influencing length of stay in the Emergency Department in a Private Hospital in North Jakarta

    Directory of Open Access Journals (Sweden)

    Irwan Juss

    2016-04-01

    Full Text Available Length of stay (LOS is a key measure of Emergency Department (ED throughput and a marker of quality objectives. Time studies that assess ED services may help to clarify the causes of prolonged ED service to patients. The objective of this study was to analyse factors influencing LOS in the ED of Private Hospital X. This study was conducted at the ED of Private Hospital X in North Jakarta. One hundred and seventy one adult patients were admitted via the over a period of three weeks in March 2008. Data recorded included characteristics of patients, service time of nurses, service time of physicians, and overall ED LOS. Anova and independent t-test were performed to determine factors associated with ED LOS. Elderly patients, patients in emergency status, patients with letters of referral, electrocardiogram (ECG training for physicians and advance cardiac life support (ACLS training for nurses were significantly associated with duration of service in the ED. Mean ED LOS was 50 ± 20.7 minutes. Patient category and characteristics of physicians and nurses are important independent variables that influence the ED’s duration of service. Future research is necessary to determine how these and other factors can be incorporated into a model for predicting ED LOS.

  10. 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...

  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. Customer satisfaction in a large urban fire department emergency medical services system.

    Science.gov (United States)

    Persse, David E; Jarvis, Jeffrey L; Corpening, Jerry; Harris, Bobbie

    2004-01-01

    The purpose of this study was to determine if emergency medical services (EMS) customer satisfaction could be assessed using telephone-survey methods. The process by which customer satisfaction with the EMS service in a large, fire department-based EMS system is reported, and five month results are presented. Ten percent of all patients transported during the period of October 15, 2001, through March 15, 2002, were selected for study. In addition, during the same period, all EMS incidents in which a patient was not transported were identified for contact. Customer-service representatives contacted patients via telephone and surveyed them from prepared scripts. A total of 88,528 EMS incidents occurred during the study period. Of these, 53,649 resulted in patient transports and 34,879 did not. Ten percent of patients transported (5,098) were selected for study participation, of which 2,498 were successfully contacted; of these, 2,368 (94.8%) reported overall satisfaction with the service provided. Of the 34,879 incidents without transport, only 5,859 involved patients who were seen but not transported. All of these patients were selected for study. Of these, 2,975 were successfully contacted, with 2,865 (96.3%) reporting overall satisfaction. The most common reason given for nonsatisfaction in both groups was the perception of a long response time. It is possible to conduct a survey of EMS customer satisfaction using telephone-survey methods. Although difficulties exist in contacting patients, useful information is made available with this method. Such surveys should be an integral part of any EMS system's quality-improvement efforts. In this survey, the overwhelming majority of patients, both transported and not transported, were satisfied with their encounter with EMS.

  13. Effect of the smoking cessation services in the out-patient department for patients with coronary heart disease

    Institute of Scientific and Technical Information of China (English)

    赵菁

    2014-01-01

    Objective To evaluate the effects and clinical prognosis of out-patient department-based smoking cessation services for coronary heart disease(CHD)patients.Methods A total of 140 smoking patients diagnosed with coronary heart disease in our cardiovascular department were randomly divided into the intensive

  14. 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

    ... Memorandum of Understanding Between the Department of Energy and U.S. Fish and Wildlife Service Regarding... Department of Energy (DOE) is informing the public of the availability of its Memorandum of Understanding... habitats. ADDRESSES: The MOU is available at http://energy.gov/hss/downloads/memorandum-understanding...

  15. 77 FR 14600 - Public Availability of the Department of Veterans Affairs Fiscal Year (FY) 2011 Service Contract...

    Science.gov (United States)

    2012-03-12

    ... AFFAIRS Public Availability of the Department of Veterans Affairs Fiscal Year (FY) 2011 Service Contract... Contract Inventories. SUMMARY: In accordance with Section 743 of Division C of the Consolidated Appropriations Act of 2010 (Public Law 111-117), Department of Veterans Affairs (VA) is publishing this notice...

  16. 22 CFR 40.82 - Alien who departed the United States to avoid service in the armed forces.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Alien who departed the United States to avoid service in the armed forces. 40.82 Section 40.82 Foreign Relations DEPARTMENT OF STATE VISAS REGULATIONS PERTAINING TO BOTH NONIMMIGRANTS AND IMMIGRANTS UNDER THE IMMIGRATION AND NATIONALITY ACT, AS AMENDED Ineligible for Citizenship. § 40.82...

  17. 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.

  18. 77 FR 11571 - Notice of Intent To Repatriate Cultural Items: U.S. Department of Agriculture, Forest Service...

    Science.gov (United States)

    2012-02-27

    ... National Park Service Notice of Intent To Repatriate Cultural Items: U.S. Department of Agriculture, Forest...; and Logan Museum of Anthropology, Beloit College, Beloit, WI; Correction AGENCY: National Park Service... Protection and Repatriation Act (NAGPRA), 25 U.S.C. 3005, of the intent to repatriate cultural items in...

  19. 75 FR 36522 - Schedule of Fees for Consular Services, Department of State and Overseas Embassies and Consulates

    Science.gov (United States)

    2010-06-28

    ... parents from properly documenting the citizenship of their children at birth, a development the Department... on those who need this service and not discourage the utilization of the service, a development the... crossing on a regular basis for a number of reasons, including commerce, tourism and visiting family....

  20. Challenge cost-share agreement between Polk County Conservation Board, Iowa Department of Natural Resources, and the U.S. Fish And Wildlife Service Neal Smith NWR

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This is a cost-share agreement between the U.S. Fish and Wildlife Service, Polk County Conservation Board, and the Iowa Department of Natural Resources in support...

  1. Oversight of Aegis’s Performance on Security Services Contracts in Iraq with the Department of Defense

    Science.gov (United States)

    2009-01-14

    for three Reconstruction Security Support Services ( RSSS ) contracts. This report focuses on the RSSS contracts, examining the cost of the...SECURITY SERVICES CONTRACTS IN IRAQ WITH THE DEPARTMENT OF DEFENSE What SIGIR Found In addition to the $612.8 million in RSSS contract costs...at costs that are not readily available. Under the RSSS contract, almost 1,400 Aegis personnel provide DoD a variety of security services

  2. 34 CFR 85.942 - ED Deciding Official.

    Science.gov (United States)

    2010-07-01

    ...) Definitions § 85.942 ED Deciding Official. The ED Deciding Official is an ED officer who has delegated authority under the procedures of the Department of Education to decide whether to affirm a suspension or enter a debarment. Authority: E.O. 12549 (3 CFR, 1986 Comp., p. 189), E.O. 12689 ( 3 CFR, 1989 Comp., p...

  3. 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,

  4. Criminal correlates of injury-related emergency department recidivism.

    Science.gov (United States)

    Claassen, Cynthia A; Larkin, Gregory Luke; Hodges, Gayle; Field, Craig

    2007-02-01

    To investigate criminal and high-risk lifestyle factors that predict emergency department (ED) recidivism, a longitudinal (8-year) cohort study of ED trauma patients was conducted. Study patients provided risk and lifestyle behavior information via semi-structured interview. ED revisit and re-injury rates for 1995-2003 were acquired through hospital record review. Lifetime criminal arrest data were obtained for each study subject via record linkage from PublicData.com, an internet-based service. The 8-year ED re-visit rate was 47% (75/161), but revisits were more often medical than injury-related (30% vs. 17%, respectively). Over half (58%) of all injured ED patients had a documented arrest history, and arrests were significantly more common in those who came back to the ED for repeat trauma vs. those who did not revisit the ED (70.4% vs. 55.9%, respectively; p violence-related crimes, 23% (37/161) of 98 drug-related offenses, and 17.4% (28/161) of 89 other non-traffic-related crimes. ED recidivism for trauma care was associated with multiple substance abuse behaviors and drug-related arrests. Significant risk factors for ED recidivism seem to be high-risk substance-abuse-related behaviors and criminal activity, constituting important targets for effective ED-based intervention, referral, and follow-up.

  5. 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.

  6. 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.

  7. 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).

  8. Assessing the impact of service benefits on employee performance in Gauteng Department of Education / T.J. Poopa

    OpenAIRE

    Poopa, Thabang Johannes

    2012-01-01

    The Gauteng Department of Education (GDE) is powered by the Public Service Regulations Government Notice No R441 of 25 May 2001 (as amended) chapter 1, Regulation VIII, Section A, that outlines the principles of managing performance stating that Departments shall manage performance in a consultative, supportive and non-discriminatory manner in order to enhance organizational efficiency and effectiveness, accountability for the use of resources and the achievement of results. It is witnessed t...

  9. Hippi Care Hospital: Towards Proactive Business Processes in Emergency Room Services. Teaching Case

    Science.gov (United States)

    Tan, Kar Way; Shankararaman, Venky

    2014-01-01

    It was 2:35 am on a Saturday morning. Wiki Lim, process specialist from the Process Innovation Centre (PIC) of Hippi Care Hospital (HCH), desperately doodling on her notepad for ideas to improve service delivery at HCH's Emergency Department (ED). HCH has committed to the public that its ED would meet the service quality criterion of serving 90%…

  10. 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

    In the Danish language "haven" means "the garden": A tranquil place with beautiful colours and vegetables where one can relax and prepare for the more stressful activities of modern life. Similarly, the chain store´s fruit and vegetable department can be the haven of the stressed self-service cus......In the Danish language "haven" means "the garden": A tranquil place with beautiful colours and vegetables where one can relax and prepare for the more stressful activities of modern life. Similarly, the chain store´s fruit and vegetable department can be the haven of the stressed self...... 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....

  11. 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.

  12. 77 FR 52055 - Notice of Intent To Repatriate Cultural Items: U.S. Department of Agriculture, Forest Service...

    Science.gov (United States)

    2012-08-28

    .... 3005, of the intent to repatriate cultural items in the possession of the Natural History Museum of Los... this notice. ] History and Description of the Cultural Items In 1926, three unassociated funerary... National Park Service Notice of Intent To Repatriate Cultural Items: U.S. Department of Agriculture,...

  13. Disparities in the Quality of HIV Care When Using US Department of Health and Human Services Indicators

    Science.gov (United States)

    Althoff, Keri N.; Rebeiro, Peter; Brooks, John T.; Buchacz, Kate; Gebo, Kelly; Martin, Jeffrey; Hogg, Robert; Thorne, Jennifer E.; Klein, Marina; Gill, M. John; Sterling, Timothy R.; Yehia, Baligh; Silverberg, Michael J.; Crane, Heidi; Justice, Amy C.; Gange, Stephen J.; Moore, Richard; Kitahata, Mari M.; Horberg, Michael A.; Kirk, Gregory D.; Benson, Constance A.; Bosch, Ronald J.; Collier, Ann C.; Boswell, Stephen; Grasso, Chris; Mayer, Kenneth H.; Hogg, Robert S.; Richard Harrigan, P.; Montaner, Julio SG; Cescon, Angela; Samji, Hasina; Brooks, John T.; Buchacz, Kate; Gebo, Kelly A.; Moore, Richard D.; Moore, Richard D.; Carey, John T.; Horberg, Michael A.; Silverberg, Michael J.; Thorne, Jennifer E.; Goedert, James J.; Jacobson, Lisa P.; Klein, Marina B.; Rourke, Sean B.; Burchell, Ann N.; Rachlis, Anita R.; Hunter-Mellado, Robert F.; Mayor, Angel M.; Gill, M.John; Deeks, Steven G.; Martin, Jeffrey N.; Saag, Michael S.; Mugavero, Michael J.; Willig, James; Eron, Joseph J.; Napravnik, Sonia; Kitahata, Mari M.; Crane, Heidi M.; Justice, Amy C.; Dubrow, Robert; Fiellin, David; Sterling, Timothy R.; Haas, David; Bebawy, Sally; Turner, Megan; Gange, Stephen J.; Anastos, Kathryn; Moore, Richard D.; Saag, Michael S.; Gange, Stephen J.; Kitahata, Mari M.; Althoff, Keri N.; McKaig, Rosemary G.; Justice, Amy C.; Freeman, Aimee M.; Moore, Richard D.; Freeman, Aimee M.; Lent, Carol; Kitahata, Mari M.; Van Rompaey, Stephen E.; Crane, Heidi M.; Morton, Liz; McReynolds, Justin; Lober, William B.; Gange, Stephen J.; Althoff, Keri N.; Abraham, Alison G.; Lau, Bryan; Zhang, Jinbing; Jing, Jerry; Golub, Elizabeth; Modur, Shari; Hanna, David B.; Rebeiro, Peter; Wong, Cherise; Mendes, Adell

    2014-01-01

    We estimated US Department of Health and Human Services (DHHS)–approved human immunodeficiency virus (HIV) indicators. Among patients, 71% were retained in care, 82% were prescribed treatment, and 78% had HIV RNA ≤200 copies/mL; younger adults, women, blacks, and injection drug users had poorer outcomes. Interventions are needed to reduce retention- and treatment-related disparities. PMID:24463281

  14. 78 FR 16523 - Public Availability of Department of the Interior FY 2012 Service Contract Inventory and FY 2011...

    Science.gov (United States)

    2013-03-15

    ... Management, Interior. ACTION: Notice of Public Availability of FY 2012 Service Contract Inventory and the FY... contract actions over $25,000 that the Department made in FY 2012. The information is organized by function... 19, 2011 and November 5, 2010, by the Office of Management and Budget's Office of Federal...

  15. Career opportunities for college graduates with the Agricultural Research Service Agency of the U.S. Department of Agriculture

    Science.gov (United States)

    The Agricultural Research Service is the principal scientific research agency of the U.S. Department of Agriculture. This agency employs more than 7,600 people working at various locations in the United States and U.S. territories. Careers for new scientists span a variety of disciplines such as c...

  16. 78 FR 34128 - Notice of Inventory Completion: U.S. Department of Agriculture, U.S. Forest Service, San Juan...

    Science.gov (United States)

    2013-06-06

    ...The U.S. Department of Agriculture (USDA), Forest Service, San Juan National Forest has completed an inventory of human remains, in consultation with the appropriate Indian tribes or Native Hawaiian organizations, and has determined that there is a cultural affiliation between the human remains and present-day Indian tribes or Native Hawaiian organizations. Lineal descendants or......

  17. 78 FR 34125 - Notice of Inventory Completion: U.S. Department of Agriculture, Forest Service, San Juan National...

    Science.gov (United States)

    2013-06-06

    ...The U.S. Department of Agriculture (USDA), Forest Service, San Juan National Forest has completed an inventory of human remains and associated funerary objects, in consultation with the appropriate Indian tribes or Native Hawaiian organizations, and has determined that there is a cultural affiliation between the human remains and associated funerary objects and present-day Indian tribes or......

  18. 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...

  19. 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.

  20. Realizing Shared Services--A Punctuated Process Analysis of a Public IT Department

    Science.gov (United States)

    Olsen, Timothy John

    2012-01-01

    IT services are increasingly being offered via a shared service model. This model promises the benefits of centralization and consolidation, as well as an increased customer satisfaction. Adopting shared services is not easy as it necessitates a major organizational change, with few documented exemplars to guide managers. This research explores a…

  1. The Global Health Strategy of the Department of Health and Human Services: building on the lessons of PEPFAR.

    Science.gov (United States)

    Daulaire, Nils

    2012-07-01

    Building on its experience as a principal participant in the President's Emergency Plan for AIDS Relief, the Department of Health and Human Services has embarked on a new era of global initiatives that ultimately will protect the health of Americans. The Global Health Strategy announced by health and human services secretary Kathleen Sebelius in January 2012 recognizes that the health of Americans is intertwined with that of the rest of the world. The initiative features ten objectives that range from enhanced global health surveillance and preventing infectious diseases and health threats to health diplomacy. The Global Health Strategy is designed to make optimal use of the department's many specialty agencies and their considerable technical and programmatic expertise. The strategy moves beyond the President's Emergency Plan for AIDS Relief to redefine Health and Human Services' role outside US borders in addressing the health challenges of the twenty-first century.

  2. [Impact of the elderly patient in the emergency department].

    Science.gov (United States)

    Bermúdez Menéndez de la Granda, Manuel; Guzmán Gutiérrez, German; Fernández Fernández, María; Solano Jaurrieta, Juan José

    2017-09-07

    The aging of the population, chronic diseases, and non-urgent visits to the Emergency departments (ED) are considered the reasons for the increase of the demand of care. The aim of this study is to analyse the impact of the older population in the ED, when compared to a younger population. An observational, descriptive and retrospective study including an analysis of the 92,627 patients that attended the ED in Hospitals from Health Area IV belonging to the Principality of Asturias Health Services during 2009. The analysis included the number of visits, degree of urgency when arriving at the ED, length of stay (LOS), destination after ED assessment, demand of care per time of day, laboratory tests, and radiology, complaints, and social services consultation. A comparison was made between the data of patients over and below 70 years of age. At total of 28,965 (31.27%) patients were over 70 years of age, with a frequency rate in the ED of 52.29% (25.70% in those less than 70 years). Patients over 70 years had a higher priority attention through the Manchester triage scale, receiving more laboratory tests, with a higher LOS. They also had a higher probability of being seen by social services, of being admitted, and death. Older patients consult the ED with more justifiable reasons than the younger adult population. Copyright © 2017 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.

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

    Science.gov (United States)

    2015-06-12

    OIF Operation Iraqi Freedom VA Department of Veterans Affairs VA OIG Department of Veterans Affairs Office of Inspector General VBA Veterans Benefits...Figure 3. The Decision Trust Model ...............................................................................20 Figure 4. Demographics-Age...reorganization into the three administrations: Veterans Health Administration (VHA), Veterans Benefits Administration ( VBA ) and National Cemetery

  4. 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

  5. Lean intervention improves patient discharge times, improves emergency department throughput and reduces congestion.

    Science.gov (United States)

    Beck, Michael J; Okerblom, Davin; Kumar, Anika; Bandyopadhyay, Subhankar; Scalzi, Lisabeth V

    2016-12-01

    To determine if a lean intervention improved emergency department (ED) throughput and reduced ED boarding by improving patient discharge efficiency from a tertiary care children's hospital. The study was conducted at a tertiary care children's hospital to study the impact lean that changes made to an inpatient pediatric service line had on ED efficiency. Discharge times from the general pediatrics' service were compared to patients discharged from all other pediatric subspecialty services. The intervention was multifaceted. First, team staffing reconfiguration permitted all discharge work to be done at the patient's bedside using a new discharge checklist. The intervention also incorporated an afternoon interdisciplinary huddle to work on the following day's discharges. Retrospectively, we determined the impact this had on median times of discharge order entry, patient discharge, and percent of patients discharged before noon. As a marker of ED throughput, we determined median hour of day that admitted patients left the ED to move to their hospital bed. As marker of ED congestion we determined median boarding times. For the general pediatrics service line, the median discharge order entry time decreased from 1:43pm to 11:28am (p Lean principles implemented by one hospital service line improved patient discharge times enhanced patient ED throughput, and reduced ED boarding times.

  6. "What do people do if they don't have insurance?": ED to ED Referrals.

    Science.gov (United States)

    Medford-Davis, Laura N; Prasad, Siddharth; Rhodes, Karin V

    2017-08-28

    Up to 20% of patients seen in public emergency departments (EDs) have already been seen for the same complaint at another ED, but little is known about the origin or impact of these duplicate ED visits. The goals of this investigation were to explore (1) whether patients making a repeat ED visit are self-referred or indirectly referred from the other ED; and (2) gather the perspective of affected patients on the health, social, and financial consequences of these duplicate ED visits. This mixed-methods study conducted over a 10-week period during 2016 in a large public hospital ED in Texas prospectively surveyed patients seen in another ED for the same chief complaint. Selected patients presenting with fractures were then enrolled for semi-structured qualitative interviews, which were audiotaped, transcribed, and independently coded by two team members until thematic saturation was reached. 143 patients were identified as being recently seen at another local ED for the same chief complaint prior to presenting to the public hospital; 94% were uninsured and 61% presented with fractures. 27% required admission at the public ED and 95% of those discharged required further outpatient follow-up. 51 patients completed a survey and qualitative interviews were conducted with 23 fracture patients. 53% of patients reported that staff at the first hospital told them to go the public hospital ED, and 23% reported referral from a follow-up physician associated with the first hospital. 73% reported receiving the same tests at both EDs. Interview themes identified multiple healthcare visits for the same injury, concern about complications, disrespectful treatment at the first ED, delayed care, problems accessing needed follow-up care without insurance, loss of work, and financial strain. The majority of patients presenting to a public hospital ED after treatment for the same complaint in another local ED were indirectly referred to the public ED without transferring paperwork or

  7. U.S. Department of the Interior Fish and Wildlife Service : Environmental Assessment : Final (1/2011) for Proposed Hunting Plan for Crane Meadows National Wildlife Refuge

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The United States Fish and Wildlife Service is proposing to provide hunting opportunities on Crane Meadows National Wildlife Refuge in Little Falls, Minnesota that...

  8. 76 FR 5614 - Public Availability of Department of Labor FY 2010 Service Contract Inventory

    Science.gov (United States)

    2011-02-01

    ... Secretary for Administration and Management, Labor. ACTION: Notice of public availability of FY 2010 service... on service contract actions over $25,000 made in FY 2010. The information is organized by function to... in accordance with guidance issued on November 5, 2010, by the Office of Management and...

  9. 78 FR 12357 - Public Availability of Department of Labor FY 2012 Service Contract Inventory

    Science.gov (United States)

    2013-02-22

    ... Secretary for Administration and Management. ACTION: Notice of Public Availability of FY 2012 Service... information on service contract actions over $25,000 made in FY 2012. The information is organized by function... developed in accordance with guidance issued on November 5, 2010, by the Office of Management and...

  10. 76 FR 5364 - Public Availability of Department of Energy FY 2010 Service Contract Inventory

    Science.gov (United States)

    2011-01-31

    ..._sourcing.htm . FOR FURTHER INFORMATION CONTACT: Questions regarding the service contract inventory should be directed to Jeff Davis in the Strategic Programs Division at 202-287-1877 or jeff.davis@hq.doe.gov...

  11. 76 FR 11211 - Meeting of the Defense Department Advisory Committee on Women in the Services (DACOWITS)

    Science.gov (United States)

    2011-03-01

    ... during an open portion of this meeting or at a future meeting. Determination of who will be making an... Services. If members of the public are interested in making an oral statement, a written statement must...

  12. 77 FR 12273 - Public Availability of Department of Energy FY 2011 Service Contract Inventory

    Science.gov (United States)

    2012-02-29

    .../memo/service-contract-inventories-guidance-11052010.pdf . On December 19, 2011, OFPP issued additional...-inventory-guidance.pdf . Except for minor changes to reporting deadlines, the guidance for preparing...

  13. 78 FR 13869 - Public Availability of Department of Energy FY 2012 Service Contract Inventory

    Science.gov (United States)

    2013-03-01

    .../procurement/memo/service-contract-inventories-guidance-11052010.pdf . On December 19, 2011, OFPP issued...-contract-inventory-guidance.pdf . ] Except for minor changes to reporting deadlines, the guidance...

  14. Automation of the Technical Services Department in the Community College Library.

    Science.gov (United States)

    Bial, Raymond; Strickler, Ken

    1987-01-01

    Describes Parkland College Library's efforts to review technical service activities and make recommendations concerning the automation of cataloging, acquisitions, and the public catalog. Traces the steps that have been taken in the development of a "paperless office." (DMM)

  15. 75 FR 45606 - Department of Commerce Measuring and Enhancing Services Trade Data Conference

    Science.gov (United States)

    2010-08-03

    ..., policy planning, and is relevant for trade agreements in support of increased US services exports. DOC..., businesses and policy makers lack the information necessary to understand a major share of the economy and to...

  16. Patterns in emergency-department arrivals and length of stay: Input for visualizations of crowding

    DEFF Research Database (Denmark)

    Hertzum, Morten

    2016-01-01

    Crowding is common in emergency departments (EDs) and increases the risk of medical errors, patient dissatisfaction, and clinician stress. The aim of this study is to investigate patterns in patient visits and bottlenecks in ED work in order to discuss the prospects of visualizing such patterns...... to help manage crowding. We analyze two years of data from a Danish ED for patterns in the patient visits and interview six clinicians from the ED about bottlenecks in their work. The hour of the day explains 50% of the variance in the number of patient arrivals. In addition, there are weekly and yearly...... factors important to the evolving balance between the demand for ED services and the available resources. Visualization of the patterns, thus, appears a promising tool in managing ED crowding. However, visualizations presuppose reliable data and are expected by the clinicians to be accurate and prognostic...

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

    Science.gov (United States)

    2015-11-01

    storage systems to the cloud. DoD’s fast follower approach also allows it to move toward a diversified portfolio of cloud service providers and...However, DoD’s approach to its diversified portfolio may introduce some performance risk. With 32 vendors currently offering solutions, and an...service portfolio . Although not mentioned by name in the Cloud Computing Strategy, milCloud was envisioned to play a central role in the DoD Enterprise

  18. 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

  19. 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.

  20. Use of Emergency Department by Elderly Patients

    Directory of Open Access Journals (Sweden)

    Orhan Akpinar

    2016-01-01

    Full Text Available Aim: Using of EDs by the geriatric population is being increased in parallel to increase of our geriatric population. Objective of this study was to demonstrate what can be done for the EDs to be more effectively benefited by evaluating clinical and demographic data of the patients over 65 years old who presented to an emergency department. Material and Method: Recordings of the patients who presented to Isparta Public Hospital, ED in 2011 were retrospectively screened. All the data were evaluated through SPSS 17.0 software. Results: Of total 114,522 patients who presented to our ED during the study, 14,645 (12.7% were geriatrics. Mean age was found as 74,6 ± 6 years. The most common cause of presentation was found as cardiologic problems as 3,120 (21.3%, followed by respiratory system problems as 2,040 (13.9%, gastrointestinal problems as 1,875 (12.8%, neurological problems as 1,512 (10.3% and musculo-skeletal system problems as 1,230 (8.4% patients. While 71% of these patients were treated in basis of outpatients, 1,877 patients (12.8% were hospitalized and 9 patients were lost in the ED. Discussion: Some regional differences may be seen in the follow-up of geriatric patients. We recommend that, each hospital should arrange its ED services considering its patient profile.

  1. 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.

  2. Development and evaluation of an inpatient [correction of impatient] holistic nursing care services department.

    Science.gov (United States)

    Newshan, Gayle

    2004-08-01

    This paper describes the development and evaluation of a holistic nursing department at a 261-bed conventional, community hospital. Through the holistic nursing department, a nurse visits hospitalized inpatients. The visit might include complementary and alternative modalities (CAM) therapies, such as relaxation techniques, therapeutic touch, aromatherapy, and therapeutic suggestion. Evaluation of visits occurred through a retrospective chart review and patient satisfaction surveys. Main outcome measures were patient satisfaction, physiological changes, and pre- and post-distress scores. Discomfort and distress was decreased and patient satisfaction high when CAM therapies were used in conjunction with traditional inpatient medical and nursing care.

  3. 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.

  4. Ed Deutschman Visit Images, May 2, 2011

    OpenAIRE

    Deutschman, Ed

    2011-01-01

    Background: Ed Deutschman was a Navy cadet at the Del Monte Pre-Flight School, located at the now (2013) Naval Postgraduate School. Mr Deutschman visited the Dudley Knox Library on May 2, 2011, and spoke about his service in World War II as a Corsair fighter pilot in the Pacific.

  5. Psychiatric symptoms and service utilization among refugee children referred to a child psychiatry department: a retrospective comparative case note study.

    Science.gov (United States)

    Vaage, Aina Basilier; Garløv, Ida; Hauff, Edvard; Thomsen, Per Hove

    2007-09-01

    Refugee children may encounter barriers to accessing mental health services. We conducted a case-control study based on a systematic review of clinic records to compare psychopathology and service utilization in refugee and Norwegian children referred to a child psychiatry department in a county in southern Norway. Sixty-one refugee children were compared with 61 Norwegian-born children matched for gender, age and time of referral to the clinic. There was no significant difference in rates of referral or level of service utilization, which were proportional to the population. Compared with Norwegian children, refugee children were diagnosed more frequently with post-traumatic stress disorder and other affective and emotional disorders, and less often with pervasive developmental disorders and attention deficit hyperactivity disorder. The results are discussed in terms of referral pathways and the need for culturally competent care for refugee children.

  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. Emergency department crowding: Factors influencing flow

    NARCIS (Netherlands)

    van der Linden, M.C.

    2015-01-01

    This thesis focuses on emergency department (ED) crowding. In the first part (ED crowding in the Netherlands) the current state of EDs regarding patients’ length of stay and ED managers’ experiences of crowding are described. Part two (input factors) contains three studies which describe the case lo

  8. Case Study:EDS in China

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    @@ Asign that China is quickly moving up the global service outsourcing ranking came earlier this year when EDS (Electronic Data Services), one of the world's leading IT outsourcing companies,announced it would be moving its Asia headquarters to Shanghai from Australia. Recognizing the growing potential of China in this area, the company also announced it would shortly be launching at least two offshore software development centers in the country, with the first location due to be announced at the begining of November.

  9. 76 FR 5778 - Public Availability of the Department of Agriculture FY 2010 Service Contract Inventory

    Science.gov (United States)

    2011-02-02

    ... Procurement and Property Management, USDA. ACTION: Notice of public availability of FY 2010 Service Contract... actions over $25,000 that were made in FY 2010. The information is organized by function to show how... with guidance issued on ] November 5, 2010 by the Office of Management and Budget's Office of...

  10. Services Supply Chain in the Department of Defense: Drivers of Acquisition Management Practices in the Army

    Science.gov (United States)

    2012-04-30

    corhb/Files/Training_Reference_Guidance/ACC%20Pamph let%2070-1%20Final%20Sig%20032610.pdf Williamson, O. E. (1979). Transaction - cost economics: The...Theory and Principal-Agent Problem – Transaction Cost Economics – Service Operations Management – Contractual Theory: How contracts are planned

  11. 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

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

    Science.gov (United States)

    2007-04-30

    Supply Chain in Department of Defense: Implications for the Program Management Infrastructure Published: 30 April 2007 by Rene G. Rendon, Lecturer, and Uday Apte, Professor, Naval Postgraduate School 4th Annual Acquisition Research Symposium of the Naval Postgraduate School: Approved for public release, distribution unlimited. Prepared for: Naval Postgraduate School, Monterey, California 93943 Acquisition Research: Creating Synergy for Informed Change May 16-17, 2007 Report Documentation Page Form ApprovedOMB No. 0704-0188

  13. The Consortium for Social Work Training in Aging: Schools of social work in partnership with county departments of adult and aging services

    OpenAIRE

    Scharlach, Andrew E.; Robinson, B K

    2005-01-01

    This article describes the Consortium for Social Work Training in Aging (CSWTA), a unique partnership among 3 schools of social work and 6 county departments of adult and aging services. Using an innovative collaborative training model that included structured rotations and curricular support, CSWTA contributed to increased student interest in aging, improved knowledge about aging and aging services, and enhanced training capacity of county departments of adult and aging services. This model ...

  14. The Department of Defense Critical Technologies Plan for the Committees on Armed Services United States Congress

    Science.gov (United States)

    1991-05-01

    suppression algorithms Passive * Demonstrate imaging IR * Demonstrate dual band 150 seekers seekers for multipla missions seekers supporting ATR...Program (TrCP) also provides exchange mechi i:, ms through a number of activities in conventional weapons. All of the Services have a number of data and...of 0 Prototyp garner"t and and blolig" aWM degradation enz ms to cloh fibeta and equipment finishos whkih equipmnent surfacesw% c~atiy degrade agenits

  15. Migrating Department of Defense (DoD) Web Service Based Applications to Mobile Computing Platforms

    Science.gov (United States)

    2012-03-01

    Application Archetype MVC Model View Controller NDFD National Digital Forecast Database NOAA National Oceanic and Atmospheric Administration’s NSSC...for Java (GAE-J). GWT and GAE are not required to implement the COLD-T application, any web framework (PHP, Struts, JSF, Spring MVC , etc.) could be...2010. [3] S. D. K. Hyun Jung La, “Balanced MVC Architecture for Developing Service-based Mobile Applications,” IEEE International Conference on E

  16. 基于 WEB 的服务发现流研究%Research on service di scovery stream bas ed on WEB

    Institute of Scientific and Technical Information of China (English)

    仇建平

    2013-01-01

    通过搜集和分析WEB用户行为数据,提出了研究WEB用户行为的一个新的视角,即把人看作是传播的内容,把信息资源看作是对象,在这种思路下,WEB网络可以被看作是一个人类集体服务发现流在信息资源之间分配和流动的网络,即服务发现流网络。应用向量自回归条件异方差模型设计了服务发现流预测算法,为了管理不确定性,引入了一些随机变量,这些随机变量会不断地被预测的各个阶段所积累,但通过使用时间序列分析大大地减轻了这种状况。%By collecting and analyzing the data on the behaviors of WEB users , in this paper , the author proposes a new perspective on researching the behaviors of WEB users , i.e., WEB users are regarded as content propagated in WEB and the information resources are regarded as object .By this means , the WEB may be regarded as a network that a humanity collective service discovery stream is assigned and flows among information resources , i.e., the service discovery stream network .The author applies the vector autoregressive conditional heteroscedasticity model ( VARCH) to the design on the prediction algorithm of the service discovery stream .In order to manage the uncer-tainty, some random variables are introduced , which may be accumulated continually at each prediction stage . However , this situation is mitigated greatly by the application of the analysis on time series .

  17. 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.

  18. Measuring Associations of the Department of Veterans Affairs' Suicide Prevention Campaign on the Use of Crisis Support Services.

    Science.gov (United States)

    Karras, Elizabeth; Lu, Naiji; Zuo, Guoxin; Tu, Xin M; Stephens, Brady; Draper, John; Thompson, Caitlin; Bossarte, Robert M

    2016-08-01

    Campaigns have become popular in public health approaches to suicide prevention; however, limited empirical investigation of their impact on behavior has been conducted. To address this gap, utilization patterns of crisis support services associated with the Department of Veterans Affairs' Veterans Crisis Line (VCL) suicide prevention campaign were examined. Daily call data for the National Suicide Prevention Lifeline, VCL, and 1-800-SUICIDE were modeled using a novel semi-varying coefficient method. Analyses reveal significant increases in call volume to both targeted and broad resources during the campaign. Findings underscore the need for further research to refine measurement of the effects of these suicide prevention efforts.

  19. Standards, Best Practices and Codes of Ethics Impact on IT Service Quality – The Case of Slovenian IT Departments

    Directory of Open Access Journals (Sweden)

    Dzangir Kolar

    2017-03-01

    Full Text Available The purpose of this paper is to explore the critical success factor for implementing standards, best practices and codes of ethics, what their benefits are when implemented and how they impact the quality of information technology (IT services. Through extensive literature review and interview with experts in the field we identified instrumental determinants. The structural equation model (SEM has been used on the case of IT departments in large Slovenian companies to test the hypotheses presented. The study is based on 102 responses from IT managers in large Slovenian companies. Research findings confirmed a positive correlation between used factors.

  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. Pollution prevention opportunity assessment for Sandia National Laboratories/New Mexico's fleet services department.

    Energy Technology Data Exchange (ETDEWEB)

    Richardson, Anastasia Dawn

    2003-06-01

    This Pollution Prevention Opportunity Assessment (PPOA) was conducted for the Sandia National Laboratories/New Mexico's (SNL/NM) Fleet Services Department between December 2001 and August 2002. This is the third PPOA conducted at Fleet in the last decade. The primary purpose of this PPOA was to review progress of past initiatives and to provide recommendations for future waste reduction measures of hazardous and solid waste streams and increasing the purchase of environmentally friendly products. This report contains a summary of the information collected and analyses performed with recommended options for implementation. The Sandia National Laboratories/New Mexico Pollution Prevention Group will work with SNL/NM's Fleet Services to implement these options.

  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 customers to improve patient-oriented services and satisfaction. Copyright © 2015. Published by Elsevier B.V.

  3. 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

    As a result of the increased competition between self-service chains, retail managers try to strengthen store identity and customer loyalty to an increasing degree. In this respect a number of measures, as for example service management and direct marketing programmes, have been instigated. Most...... of which departments are the most important ones to customer attitudes, and how these attitudes are influenced by department specific factors, have been scarce, however. Unlike most other departments of a self-service chain store, the fruit and vegetable department gives ample opportunity...... for differentiation and creation of store identity. This has been demonstrated by a few progressive retailers who changed the fruit and vegetable department into a haven* where the self-service customer gets an inspiring break from the stressful ventures in the aisles with pre-packed goods, which look alike in most...

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

    Directory of Open Access Journals (Sweden)

    Alimohammadzadeh

    2015-12-01

    Full Text Available Background 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. Objectives 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. Materials and Methods 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. Results “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. Conclusion 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

  5. ASSESSMENT AND EVALUATION OF DRUG INFORMATION SERVICE PROVIDED BY PHARMACY PRACTICE DEPARTMENT BASED ON ENQUIRER’S PERSPECTIVE

    Directory of Open Access Journals (Sweden)

    Jeevangi V M

    2012-10-01

    Full Text Available Drug information service refers to activities carried out by pharmacists in providing any drug related information to healthcare professionals to provide better patient care. Providing drug information is a clinical pharmacy service and delivered as part of the multidisciplinary approach to patient care. Accurate information about safety of drugs is very essential for health care professionals in identifying, preventing and managing Adverse Drug Reactions (ADRs, thereby ensuring safe use of medications. The aim of the study was to assess and evaluate the drug information service from enquirer’s perspective. The data was collected from drug information centre through drug information request forms and feedback questionnaires form. A nine months hospital based prospective study was carried out at Basaveshwar Teaching and General Hospital (BTGH, Gulbarga. A total number of 122 queries were received during the study period. Most of the queries were received from general medicine department 82(67.21% and least were from general surgery 2(1.64%. Most of the queries were for update of knowledge 69 (56.56% and time frame for reply was within a day 83 (68.03%, answers were given in printed format 77(63.11%. The majority of queries were regarding dose and administration of drug 49 (36.03% and most preferred resource was Micromedex 75 (52.45%. The quality of the services provided by the centre was appreciated by majority of its users. However there is a need to bring greater awareness about the service in the hospital and to encourage the healthcare professionals to utilize the services for better patient care.

  6. [ANALYSIS OF A NEW ORGANIZATIONAL MODEL APPLIED TO THE PHYSIOTERAPY SERVICE C/O SURGERY DEPARTMENTS].

    Science.gov (United States)

    Rancati, Jacopo Matteo; Incarbone, Fina Maria Teresa; Pinna, Selene; Panella, Lorenzo

    2015-01-01

    The lowering number of physiotherapists c/o surgery departments of Orthopaedic Institute Gaetano Pini of Milan, required the application of a new organizational model based on the centralization of government activities, in order to optimize employment of staff. A programming and reporting tool was developed throught a database. The collected data (from January to December 2013) related to the reported physiotherapists activities were analysed and matched to operating theater's activities in order to find the correlation value. The results are lined up the hypothesis stated in the planning phase of the organizational model's project (in absence of hystorical referral). Correlation between Physiotherapists and Operation Theather's activities was good (r=0.59), giving us a reliable predictional model. This study has some limitations mostly related to the resistence expressed by employees in the change management.

  7. 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.

  8. Structured classification for ED presenting complaints – from free text field-based approach to ICPC-2 ED application

    Directory of Open Access Journals (Sweden)

    Malmström Tomi

    2012-11-01

    Full Text Available Abstract Background Although there is a major need to record and analyse presenting complaints in emergency departments (EDs, no international standard exists. The aim of the present study was to produce structured complaint classification suitable for ED use and to implement it in practice. The structured classification evolved from a study of free text fields and ICPC-2 classification. Methods Presenting complaints in a free text field of ED admissions during a one-year period (n=40610 were analyzed and summarized to 70 presenting complaint groups. The results were compared to ICPC-2 based complaints collected in another ED. An expert panel reviewed the results and produced an ED application of ICPC-2 classification. This study implemented the new classification into an ED. Results The presenting complaints summarized from free text fields and those from ICPC-2 categories were remarkably similar. However, the ICPC-2 classification was too broad for ED; an adapted version was needed. The newly developed classification includes 89 presenting complaints and ED staff found it easy to use. Conclusions ICPC-2 classification can be adapted for ED use. The authors suggest a list of 89 presenting complaints for use in EDs adult patients.

  9. Factors Associated With Emergency Department Visits

    Directory of Open Access Journals (Sweden)

    Parul Agarwal

    2016-05-01

    Full Text Available Objective: The objective of this study was to examine the association of patient- and county-level factors with the emergency department (ED visits among adult fee-for-service (FFS Medicaid beneficiaries residing in Maryland, Ohio, and West Virginia. Methods: A cross-sectional design using retrospective observational data was implemented. Patient-level data were obtained from 2010 Medicaid Analytic eXtract files. Information on county-level health-care resources was obtained from the Area Health Resource file and County Health Rankings file. Results: In adjusted analyses, the following patient-level factors were associated with higher number of ED visits: African Americans (incidence rate ratios [IRR] = 1.47, Hispanics (IRR = 1.63, polypharmacy (IRR = 1.89, and tobacco use (IRR = 2.23. Patients with complex chronic illness had a higher number of ED visits (IRR = 3.33. The county-level factors associated with ED visits were unemployment rate (IRR = 0.94 and number of urgent care clinics (IRR = 0.96. Conclusion: Patients with complex healthcare needs had a higher number of ED visits as compared to those without complex healthcare needs. The study results provide important baseline context for future policy analysis studies around Medicaid expansion options.

  10. Support and services provided by public health regional surveillance teams to Local Health Departments in North Carolina.

    Science.gov (United States)

    Horney, Jennifer A; Markiewicz, Milissa; Meyer, Anne Marie; Macdonald, Pia D M

    2011-01-01

    Since 2001, many states have created regional structures in an effort to better coordinate/public health preparedness and response efforts, consolidate services, and supplement local government capacity. While several studies have identified specific benefits to regionalization, including enhanced networking, coordination, and communication, little research has examined the effect of regionalization on specific preparedness and response activities. To better understand the impact of regionalizing public health workforce assets in North Carolina, a survey aimed at documenting specific support and services that Public Health Regional Surveillance Teams(PHRSTs) provide to local health departments (LHDs) was developed and administered by the North Carolina Preparedness and Emergency Response Research Center, located at the North Carolina Institute for Public Health. Of80 potential types of assistance, 26 (33%) were received by 75% or more LHDs, including 9 related to communication and 7 related to exercises. There was significant variation by PHRST region in both the quantity and quality of support and services reported by LHDs. This variation could not be explained by county- or LHD-level variables. PHRST assistance to LHDs is largely focused on communication and liaison activities, regional exercises, and planning. On the basis of these findings, regionalization may provide North Carolina with benefits consistent with those found in other studies such as improved networking and coordination. However, further research is needed to identify whether regional variation is the result of varying capacity or priorities of the PHRSTs or LHDs and to determine how much variation is acceptable.

  11. Department of the Interior U.S. Fish and Wildlife Service : Final Environmental Assessment for Recreational Fishing Plan : Cypress Creek National Wildlife Refuge

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The primary purpose of the proposed action is to consider recreational fishing opportunities on Cypress Creek NWR. This EA analyzes four different fishing...

  12. A "Patch" to the NYU Emergency Department Visit Algorithm.

    Science.gov (United States)

    Johnston, Kenton J; Allen, Lindsay; Melanson, Taylor A; Pitts, Stephen R

    2017-08-01

    To document erosion in the New York University Emergency Department (ED) visit algorithm's capability to classify ED visits and to provide a "patch" to the algorithm. The Nationwide Emergency Department Sample. We used bivariate models to assess whether the percentage of visits unclassifiable by the algorithm increased due to annual changes to ICD-9 diagnosis codes. We updated the algorithm with ICD-9 and ICD-10 codes added since 2001. The percentage of unclassifiable visits increased from 11.2 percent in 2006 to 15.5 percent in 2012 (p < .01), because of new diagnosis codes. Our update improves the classification rate by 43 percent in 2012 (p < .01). Our patch significantly improves the precision and usefulness of the most commonly used ED visit classification system in health services research. © Health Research and Educational Trust.

  13. Use of lean in the emergency department: a case series of 4 hospitals.

    Science.gov (United States)

    Dickson, Eric W; Anguelov, Zlatko; Vetterick, Diana; Eller, Andrew; Singh, Sabi

    2009-10-01

    We describe the effects of Lean, a process improvement strategy pioneered by Toyota, on quality of care in 4 emergency departments (EDs). Participants in 2 academic and 2 community EDs that instituted Lean as their single process improvement strategy made observations of their behavioral changes over time. They also measured the following metrics related to patient flow, service, and growth from before and after implementation: time from ED arrival to ED departure (length of stay), patient satisfaction, percentage of patients who left without being seen by a physician (2 EDs), the time from ordering to reading radiographs (1 ED), and changes in patient volume. One year post-Lean, length of stay was reduced in 3 of the EDs despite an increase in patient volume in all 4. Each observed an increase of patient satisfaction lagging behind by at least a year. The narratives indicate that the closer Lean implementation was to the original Toyota principles, the better the initial outcomes. The immediate results were also greater in the EDs in which the frontline workers were actively participating in the Lean-driven process changes. A factor that considerably affected the outcomes in the second and third year postimplementation was the level of continuous leadership commitment to Lean. Lean principles adapted to the local culture of care delivery can lead to behavioral changes and sustainable improvements in quality of care metrics in the ED. These improvements are not universal and are affected by leadership and frontline workforce engagement.

  14. The emerging trend in the epidemiology of gunshot injuries in the emergency department of a Nigerian tertiary hospital in a State without formal prehospital emergency medical services

    Directory of Open Access Journals (Sweden)

    Gabriel Uche Pascal Iloh

    2013-01-01

    Full Text Available Background : Gunshot injuries (GSIs though a rarity in Nigeria before the Nigerian civil war have now become rampant with variable epidemiology. It is emerging as a common cause of trauma-related emergency hospitalizations. Aim: The study was aimed at reviewing the epidemiology of gunshot injuries in the emergency department (ED of a Nigerian tertiary hospital over a 5-year period. Materials and Methods: This was a retrospective study of GSIs seen at the ED of Federal Medical Centre, Umuahia, Nigeria using data from medical records, patients′ case notes, ED admission registers, and nurses′ report books. The data collected included age, sex, place of the incidence, time of the incidence, time of presentation to the hospital, anatomic sites, and etiology of the injury. Results : The age ranged from 14 years to 80 years with mean age of 47 ± 8.1 years. There were 95 males and 22 females with a male to female ratio of 4.3:1. The three most common causes were armed robbery (31.6%, kidnapping (21.3%, and police brutality (17.9%. The incident predominantly affected the middle age group (57.3%, occurred mostly during the day time (72.6%, affecting mainly the lower limbs (65.8% and majority (84.6% of the victims presented 1 hour after the injury. None of the victims received prehospital care. Conclusion: There was variability in the epidemiology of GSIs with kidnapping and police brutality emerging among preeminent contributors and downward trend of armed robbery-related GSIs. The incident occurred predominantly during the day time and most victims presented late to the ED. Interventional strategies including the responsible security apparatus system are advocated.

  15. Prospective study of violence against ED workers.

    Science.gov (United States)

    Kowalenko, Terry; Gates, Donna; Gillespie, Gordon Lee; Succop, Paul; Mentzel, Tammy K

    2013-01-01

    Health care support occupations have an assault-injury rate nearly 10 times the general sector. Emergency departments (EDs) are at greatest risk of such events. The objective was to describe the incidence of violence in ED health care workers (HCWs) over 9 months. Specific aims were to (1) identify demographic, occupational, and perpetrator factors related to violent events (VEs) and (2) identify predictors of acute stress in victims and predictors of loss of productivity. A longitudinal, repeated-methods design was used to collect monthly survey data from ED HCWs at 6 hospitals. Surveys assessed number and type of VEs, and feelings of safety and confidence. Victims also completed specific VE surveys. Descriptive statistics and a repeated-measure linear regression model were used. Two hundred thirteen ED HCWs completed 1795 monthly surveys and 827 VEs were reported. Average VE rate per person per 9 months was 4.15. Six hundred one events were physical threats (PTs) (3.01 per person). Two hundred twenty six events were assaults (1.13 per person). Five hundred one VE surveys were completed, describing 341 PTs and 160 assaults. Men perpetrated 63% of PTs and 52% of assaults. Significant differences in VEs were reported between registered nurses (RNs) and medical doctors (MDs) (P = .0017) and patient care assistants (P stress than the MDs (P stress reduced productivity (P stress, and lost productivity. Acute stress has negative consequences on workers' ability to perform their duties. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. 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.

  17. Short-term return visits of 'general internal medicine' patients to the emergency department: extent and risk factors.

    Science.gov (United States)

    Vanbrabant, P; Knockaert, D

    2009-01-01

    Although emergency department (ED) return visits are a significant problem universally, it has not been previously studied in our ED. The aim of this study was to determine the extent of the problem in our ED, to identify the relevant clinical predictor variables and to detect diagnostic errors. A retrospective observational study of ED return visits by patients managed by the General Internal Medicine (GIM) service was performed. The study was performed over a one year period at a tertiary hospital ED. Data are reported as relative risk (RR) and 95% confidence interval (CI). There were a total of 51.210 ED visits during the study period. The total number of ED return visits within 72 hours was 1.124 (2,19%; 95% CI 2,07 to 2,32). The total number of ED patients managed by the GIM service was 9.511. The percentage of patients treated by the GIM service who returned to the ED within 72 hours was 1,48% (95% CI 1,25 to 1,74) when calculated for the whole group and 2,9 % (95% CI 2,46-3,41) for those discharged home from the ED (n = 4.860). The majority (82,98%) of ED return visits by patients discharged from the GIM service were unscheduled and related to their index presenting complaint. Abdominal pain was the commonest initial presenting symptom in the patients who returned to the ED after discharge. Patients with diarrhoea as the initial initial presenting symptom had the highest relative risk of an ED return visit (RR = 4.07). The percentage ED return visits by patients discharged from the ED by the GIM service is 1,48%. Patients presenting with diarrhoea as the initial presenting symptom have the highest relative risk of an early ED return visit. Our main practical conclusion is that patients with abdominal pain need to be re-examined carefully and instructed about potential evolution before discharge.

  18. 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.

  19. 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

  20. 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

  1. The full moon and ED patient volumes: unearthing a myth.

    Science.gov (United States)

    Thompson, D A; Adams, S L

    1996-03-01

    To determine if there is any effect of the full moon on emergency department (ED) patient volume, ambulance runs, admissions, or admissions to a monitored unit, a retrospective analysis of the hospital electronic records of all patients seen in an ED during a 4-year period was conducted in an ED of a suburban community hospital. A full moon occurred 49 times during the study period. There were 150,999 patient visits to the ED during the study period, of which 34,649 patients arrived by ambulance. A total of 35,087 patients was admitted to the hospital and 11,278 patients were admitted to a monitored unit. No significant differences were found in total patient visits, ambulance runs, admissions to the hospital, or admissions to a monitored unit on days of the full moon. The occurrence of a full moon has no effect on ED patient volume, ambulance runs, admissions, or admissions to a monitored unit.

  2. Rebooting the EdD

    Science.gov (United States)

    Wergin, Jon F.

    2011-01-01

    In this essay, Jon Wergin reminds readers of the philosophical and historical foundations of the doctor of education (EdD) degree. He argues that the EdD should be based, in large part, on John Dewey's progressive ideals of democratization and Paulo Freire's concepts of emancipatory education. Drawing on theories of reflective practice,…

  3. A Successful ED Fall Risk Program Using the KINDER 1 Fall RiskAssessment Tool.

    Science.gov (United States)

    Townsend, Ann B; Valle-Ortiz, Marisol; Sansweet, Tracy

    2016-11-01

    Emergency nurses did not perform falls risk assessments routinely on our ED patients; the instrument used was aimed at inpatients. We identified a need to revise fall assessment practices specific to our emergency department. The purpose of the performance improvement project was to reduce ED falls and evaluate the use of an ED-specific fall risk tool, the KINDER 1 Fall Risk Assessment. The plan was to establish fall risk assessment practices at point of ED entry and to decrease total falls.

  4. Determining the rate of follow-up after hospital emergency department visits for dental conditions

    Directory of Open Access Journals (Sweden)

    Meyer B

    2016-03-01

    Full Text Available Beau Meyer,1,2 Eric Adkins,3,4 Nathan M Finnerty,4 Fonda G Robinson5 1Division of Pediatric Dentistry, College of Dentistry, The Ohio State University, Columbus, OH, 2Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 3The Ohio State University Wexner Medical Center Emergency Department, 4Department of Emergency Medicine, College of Medicine, 5Clinic Administration and Patient Care, College of Dentistry, The Ohio State University, Columbus, OH, USA Background: Emergency department (ED visits for dental reasons continue to impact EDs nationwide. This investigation determined the rate of follow-up in an emergency dental clinic (EDC after hospital ED visits for nontraumatic dental conditions. Methods: This prospective investigation reports the number of patients who presented to an ED for nontraumatic dental conditions and the rate of follow-up at an EDC. Upon ED discharge, patients were provided instructions to follow-up for low-cost care at the EDC. Telephone contact was attempted following failed referrals. Descriptive statistics were reported for comparing referral sources and demographic trends. Results: Two hundred and forty-seven referrals were made and 31% followed up for definitive treatment at the EDC. More referrals were made on weekends than on weekdays. Failed referrals were unreachable by telephone in 75% of cases. Tooth extraction was the most common treatment rendered in the EDC. Of the ED patients who accessed EDC care, 14% became comprehensive patients in the EDC's regular dental clinic. Conclusion: Less than one-third of ED referrals to the EDC followed up for definitive care when provided an opportunity to do so, and 75% of referrals were unreachable by telephone in the week following the ED dental visit. Keywords: emergencies, dental health services, health services accessibility, access to care, dental emergency treatment

  5. 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.

  6. A Profile on Emergency Department Utilization in Adolescents and Young Adults with Autism Spectrum Disorders

    Science.gov (United States)

    Liu, Guodong; Pearl, Amanda M.; Kong, Lan; Leslie, Douglas L.; Murray, Michael J.

    2017-01-01

    There has been an increase in utilization of the Emergency Department (ED) in individuals with autism spectrum disorder (ASD) which may reflect a deficit of services (Green et al., "Journal of the American Academy of Child and Adolescent Psychiatry" 40(3):325-332, 2001; Gurney et al., "Archives of Pediatric and Adolescent…

  7. A Profile on Emergency Department Utilization in Adolescents and Young Adults with Autism Spectrum Disorders

    Science.gov (United States)

    Liu, Guodong; Pearl, Amanda M.; Kong, Lan; Leslie, Douglas L.; Murray, Michael J.

    2017-01-01

    There has been an increase in utilization of the Emergency Department (ED) in individuals with autism spectrum disorder (ASD) which may reflect a deficit of services (Green et al., "Journal of the American Academy of Child and Adolescent Psychiatry" 40(3):325-332, 2001; Gurney et al., "Archives of Pediatric and Adolescent…

  8. Department of Defense Prime Contract Awards by Service Category and Federal Supply Classification. Fiscal Years 1996, 1995, 1994, and 1993.

    Science.gov (United States)

    1996-01-01

    Rehabilitation Services 1,260 555 118 357 Q519 Psychiatry Services 16,457 26,100 30,437 30,665 Q520 Podiatry Services 102 0 0 0 Q521 Pulmonary...Musical Inst, Phonographs, and Home-Type Radios 2,620 2,257 1,602 3,465 Recreational and Athletic Equipment 7810 Athletic and Sporting Equipment 7820...Rehabilitation Services Q519 Psychiatry Services Q520 Podiatry Services Q521 Pulmonary Services Q522 Radiology Services Q523 Surgery Services Q525

  9. Electronic Emergency-Department Whiteboards

    DEFF Research Database (Denmark)

    Hertzum, Morten

    2011-01-01

    Purpose. Many emergency departments (EDs) are in a process of transitioning from dry-erase to electronic whiteboards. This study investigates differences in ED clinicians’ perception and assessment of their electronic whiteboards across departments and staff groups and at two points in time. Method....... We conducted a survey consisting of a questionnaire administered when electronic whiteboards were introduced and another questionnaire administered when they had been in use for 8-9 months. The survey involved two EDs and, for reasons of comparison, a paediatric department. Results. The ED...... respondents consider the whiteboard information important to their overview, and they approve of the introduction of electronic whiteboards. With the electronic whiteboards, the ED respondents experience a better overall overview of their work than with dry-erase whiteboards. They also experience...

  10. 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

  11. 76 FR 70735 - Privacy Act of 1974; Department of Homeland Security/U.S. Citizenship and Immigration Services...

    Science.gov (United States)

    2011-11-15

    ... Immigration Services--016 Electronic Immigration System-3 Automated Background Functions System of Records... and Immigration Services--016 Electronic Immigration System-3 Automated Background Functions System of... Immigration Services to collect and maintain certain biographic information about individuals in the...

  12. 76 FR 60059 - Privacy Act of 1974; Department of Homeland Security/U.S. Citizenship and Immigration Services...

    Science.gov (United States)

    2011-09-28

    ... Immigration Services--016 Electronic Immigration System-3 Automated Background Functions System of Records... and Immigration Services--016 Electronic Immigration System-3 Automated Background Functions System of... Immigration Services to collect and maintain certain biographic information about individuals in the...

  13. 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

  14. 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.

  15. 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.

  16. 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.

  17. Physical activity in postdeployment Operation Iraqi Freedom/Operation Enduring Freedom veterans using Department of Veterans Affairs services

    Directory of Open Access Journals (Sweden)

    Lorraine R. Buis, PhD

    2011-10-01

    Full Text Available Veteran activity levels may decrease between Active Duty and postdeployment. We examined attitudes and changes in self-reported activities between the two in Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF veterans using Department of Veterans Affairs (VA services. We conducted an online cross-sectional survey (June-August 2008 of postdeployment OIF/OEF veterans registered with the VA Ann Arbor Healthcare System, Ann Arbor, Michigan. Descriptive statistics summarized demographic data and attitudes, while regression analyses compared physical activities during Active Duty with physical activities postdeployment. Participants (n = 319, 15.6% response rate reported that they believe staying physically fit is important, they worry about gaining weight, and they believe exercise will keep them healthy (77%, 72%, and 90% agree or strongly agree, respectively. Running (30.0%, Exercise with Gym Equipment (21.5%, Occupational Activities (14.9%, and Walking (13.0% were the most frequently reported Active Duty physical activities. The most frequently reported postdeployment physical activities included Walking (21.1%, Running (18.5%, and Exercise with Gym Equipment (17.9%. Health problems (39% and chronic pain (52% were common barriers to physical activity. Postdeployment OIF/OEF veterans using the VA believe physical activity is beneficial, yet many report health problems and/or chronic pain that makes exercise difficult. Physical activity promotes health, and strategies are needed to facilitate physical activity in this population.

  18. Research on plant-parasitic nematode biology conducted by the United States Department of Agriculture-Agricultural Research Service.

    Science.gov (United States)

    Chitwood, David J

    2003-01-01

    The recent de-registration of several chemical nematicides and the impending loss of methyl bromide from the pest-control market necessitate the development of new methods for controlling nematode-induced crop damage. One approach for developing novel target-specific controls is by exploiting fundamental differences between the biological processes of nematodes and their host plants. Researchers of the Agricultural Research Service (ARS) of the US Department of Agriculture are actively exploring these differences. Research accomplishments include the discovery of heat shock protein genes possibly involved in developmental arrest of the soybean cyst nematode, the identification of neuropeptides and female-specific proteins in the soybean cyst nematode, the disruption of nematode reproduction with inhibitors of nematode sterol metabolism, the development of novel morphological and molecular (heat shock protein genes and the D3 segment of large subunit ribosomal DNA) features useful for nematode identification and classification, and the elucidation of the population genetics of potato cyst nematode pathotypes. In addition, several ARS researchers are investigating biological determinants of nematode response to management strategies utilized in agricultural fields. These collective efforts should lead to new chemical and non-chemical alternatives to conventional nematode control strategies.

  19. Analyzing the waiting time pattern for non-critical patients in the emergency department using six sigma approach

    Science.gov (United States)

    Majid, Noriza; Mohd Suradi, Nur Riza; Ahmad Sabri, Safura

    2013-04-01

    This study was conducted to examine the waiting time of non-critical patients in the Emergency Department (ED) of Universiti Kebangsaan Malaysia Medical Centre (UKMMC) using the approach of six sigma (6σ). The define phase is completed by obtaining customers' critical to quality in UKMMC using survey. In measure phase, data on patients to the ED of UKMMC in May 2009 were gathered. Subsequently, analysis phase is performed using cause-and-effect diagram to identify root causes of the problems. Finally, improvements are proposed based on the identified problems. Results show that waiting time is critical to quality for health services in the ED.

  20. Profiling police presentations of mental health consumers to an emergency department.

    Science.gov (United States)

    Lee, Soung; Brunero, Scott; Fairbrother, Greg; Cowan, Darrin

    2008-10-01

    Public mental health systems have been called on to better meet the needs of consumers presenting to health services with the police, yet few studies have examined police presentations among mental health consumers in large public mental health systems. This study was designed to determine the frequency profile and characteristics of consumers of mental health services brought in by police to an emergency department (ED) in Sydney, Australia. Using data from the emergency department information system and obtaining the psychiatric assessment from the medical record, we have examined trends and characteristics in mental health presentations brought in by the police to a general ED between 2003 and 2005. The sample consisted of 542 consumers with a mental health problem brought in by the police to the ED of a 350-bed community hospital. The characteristics of this group were compared with those of all mental health related ED presentations for the same period using logistic regression. Results indicated that police presentations are likely to be young males who are unemployed, have past and present alcohol and other drugs use, present after hours, and are admitted to hospital as a result of their presentation. These consumers are likely to have a presenting problem of a psychotic disorder, less likely to have a presenting problem of depression and/or anxiety, and given a triage code of three or higher. The study results highlight the importance of the availability of 24-hour access to mental health care to ensure a quick care delivery response. Police presentations to EDs with mental health issues are an indicator of significant impact on health services, especially with the current overcrowding of EDs and the associated long waiting times. Systems need to be developed that facilitate collaboration between EDs, hospital security, police services, mental health, and ambulance services.

  1. Defining Emergency Department Necessary Policies Based on Clinical Governance Accreditation Scores

    Directory of Open Access Journals (Sweden)

    Mehrdad Esmailian

    2015-05-01

    Full Text Available Introduction: The role of accreditation scheme in quality improvement of emergency departments (ED has not been thoroughly evaluated in studies. Therefore, this study was designed to appraise the effects of policies defined based on clinical governance accreditation scores, on improvement of the procedures in ED. Methods: The present cohort study was carried out in the ED of Alzahra University Hospital, Isfahan, Iran in 2012-2013. In 2012 the deficiencies in ED of this hospital was determined based on clinical governance indicators. Then the deficiencies were classified based on their importance and changes were made in the ED. Finally, the effects of the changes were evaluated in August 2013. Results: The evaluation made in 2012 showed that 23 clinical and non-clinical procedures were carried out with deficiencies. Over the mentioned period, 6 (26.1% procedures were not done at all, while 17 (73.9% were done without a policy and irregularly. The overall score for clinical and non-clinical procedures in the ED before carrying out the accreditation scheme was 43 / 230 (18.7% of the maximum possible score. The score was raised to 222 equal to 96.5% of the maximum possible score after carrying out the scheme. This increase was statistically significant (p < 0.001. Conclusion: The findings of the present study showed that defining policies for improving the procedures carried out in ED based on accreditation scheme leads to improvement of medical services in ED.

  2. 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.

  3. TechEdSat Project

    Data.gov (United States)

    National Aeronautics and Space Administration — The overall goal of the Technical Education Satellite (TechEdSat) is to employ a small spacecraft to evaluate, demonstrate, and validate two new technologies for...

  4. Referral patterns in elderly emergency department visits

    Directory of Open Access Journals (Sweden)

    Alessandra Buja

    2013-12-01

    Full Text Available OBJECTIVE: To assess elderly individuals' demand for emergency department (ED care, in terms of the characteristics, processes, outcomes, costs by referral pattern. DATA SOURCE: All ED visits involving patients aged 65 and older, extracted from the 2010 dataset of an Local Health Agency, in North-Eastern Italy (no. = 18 648. STUDY DESIGN: Retrospective cohort study. PRINCIPAL FINDINGS: Patients were referred by primary care professionals (PCPs in 43.1% of cases, 1.4% came from nursing homes (NH, and 55.5% were self-referred (SR. The SR group had a higher adjusted odds ratio (aOR for non-urgent conditions (1.98 CI 1.85-2.12, but a lower aOR for conditions amenable to ambulatory care (0.53 CI 0.48-0.59, and a lower consumption of resources. The SR group tend to occur more frequently out of hours, and to coincide with a shorter stay at the ED, lower observation unit activation rates, lower hospitalization rates and a lower consumption of services than other two groups. The average costs for all procedures were lower for the SR patients (mean = 106.04 € ± SD 84.90 € than for those referred by PCPs (mean = 138.14 € ± SD 101.17 € or NH (mean = 143.48 € ± SD 95.28 €. CONCLUSION: Elderly patients coming in ED have different characteristics, outcomes and recourses consume by referral pattern.

  5. 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

  6. Process Improvements to Reform Patient Flow in the Emergency Department.

    Science.gov (United States)

    Whatley, Shawn D; Leung, Alexander K; Duic, Marko

    2016-01-01

    Emergency departments (ED) function to diagnose, stabilize, manage and dispose patients as efficiently as possible. Although problems may be suspected at triage, ED physician input is required at each step of the patient journey through the ED, from diagnosis to disposition. If we want timely diagnosis, appropriate treatment and great outcomes, then ED processes should connect patients and physicians as quickly as possible. This article discusses the key concepts of ED patient flow, value and efficiency. Based on these fundamentals, it describes the significant impact of ED process improvements implemented on measures of ED efficiency at a large community ED in Ontario, Canada.

  7. Optimizing emergency department front-end operations.

    Science.gov (United States)

    Wiler, Jennifer L; Gentle, Christopher; Halfpenny, James M; Heins, Alan; Mehrotra, Abhi; Mikhail, Michael G; Fite, Diana

    2010-02-01

    As administrators evaluate potential approaches to improve cost, quality, and throughput efficiencies in the emergency department (ED), "front-end" operations become an important area of focus. Interventions such as immediate bedding, bedside registration, advanced triage (triage-based care) protocols, physician/practitioner at triage, dedicated "fast track" service line, tracking systems and whiteboards, wireless communication devices, kiosk self check-in, and personal health record technology ("smart cards") have been offered as potential solutions to streamline the front-end processing of ED patients, which becomes crucial during periods of full capacity, crowding, and surges. Although each of these operational improvement strategies has been described in the lay literature, various reports exist in the academic literature about their effect on front-end operations. In this report, we present a review of the current body of academic literature, with the goal of identifying select high-impact front-end operational improvement solutions.

  8. Rate, characteristics, and factors associated with high emergency department utilization

    NARCIS (Netherlands)

    M.C. van der Linden (M. Christien); C.L. van den Brand (Crispijn); N. van der Linden (Naomi); A.H. Rambach (Anna H.J.H.); C. Brumsen (Caro)

    2014-01-01

    textabstractBackground: Patients with high emergency department (ED) utilization account for a disproportionate number of ED visits. The existing research on high ED utilization has raised doubts about the homogeneity of the frequent ED user. Attention to differences among the subgroups of frequent

  9. 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

    OpenAIRE

    Alaska Adrian Kalasa; Supain Cyril Christopher

    2014-01-01

    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...

  10. 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.

  11. 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...

  12. 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 and Mineral Industries (DOGAMI) contracted with Watershed Sciences, Inc. to collect high resolution topographic LiDAR data for...

  13. 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.

  14. Delegations of authority/claims for cost of medical care and services--Department of Veterans Affairs. Final regulations.

    Science.gov (United States)

    1993-07-22

    The Department of Veterans Affairs (VA) has amended VA regulations to increase the settlement and waiver authority delegated to officials within the Office of the General Counsel and District Counsels. This change follows increased authority delegated by the Department of Justice to heads of departments and agencies of the United States.

  15. 77 FR 32993 - Notice of Inventory Completion: U.S. Department of Agriculture, Forest Service, Rio Grande...

    Science.gov (United States)

    2012-06-04

    .... Department of Interior, Bureau of Land Management, Anasazi Heritage Center, has completed an inventory of.... Department of Interior, Bureau of Land Management, Anasazi Heritage Center. This notice is published as part... U.S. Department of Interior, Bureau of Land Management, Anasazi Heritage Center, in...

  16. Funding priorities in animal reproduction at the United States Department of Agriculture's Cooperative State Research, Education, and Extension Service.

    Science.gov (United States)

    Mirando, Mark A; Hamernik, Debora L

    2006-03-01

    The National Research Initiative (NRI) Competitive Grants Program is the U.S. Department of Agriculture's major competitive grants program and is administered by the Cooperative State Research, Education, and Extension Service (CSREES). Since its inception in 1991, the NRI has funded competitive grants in the discipline of animal reproduction. Previously, this program provided funding for a broad range of projects encompassing almost every subdiscipline in reproductive biology of farm animals, including aquatic species important to the aquaculture industry. During fiscal year 2004, the NRI Animal Reproduction Program narrowed the focus of funding priorities to the topics of infertility, basic mechanisms regulating fertility, cryopreservation of gametes, reducing the postpartum interval to conception, and sterilization methods or development of monosex populations. In response to a directive to further narrow the focus of funding priorities for fiscal year 2005 and beyond, CSREES conducted a Stakeholder Workshop on Funding Priorities in Animal Reproduction at the 37th Annual Meeting of the Society for the Study of Reproduction in Vancouver, Canada. More than 75 stakeholder scientists from a cross section of federal, public, and private institutions from across the United States participated in the workshop and provided recommendations to CSREES for future NRI-funding priorities in Animal Reproduction. The recommendations provided by stakeholders included continuing efforts to focus funding priorities into fewer high-impact areas relevant to animal agriculture and aquaculture. Recommendations also included movement back toward subdisciplines of animal reproduction that cut across all applicable species. The three funding priorities that consistently emerged as recommendations from the workshop participants were 1) gonadal function and production of gametes, 2) pituitary-hypothalamic function, and 3) embryo and conceptus development, including interaction between the

  17. Health care utilization before and after an outpatient ED visit in older people.

    Science.gov (United States)

    Horney, Carolyn; Schmader, Kenneth; Sanders, Linda L; Heflin, Mitchell; Ragsdale, Luna; McConnell, Eleanor; Hocker, Michael; Hastings, S Nicole

    2012-01-01

    Older adults in the United States receive a significant amount of care in the emergency department (ED), yet the associations between ED and other types of health care utilization have not been adequately studied in this population. The goals of this study were to examine the relationships between health care use before and after an ED visit among older adults. This retrospective cohort study examined health care use among 308 patients 65 years or older discharged from a university-affiliated ED. Proportional-hazards models were used to assess the relationship between pre-ED health care use (primary care physician [PCP], specialist, ED, and hospital) and risk of return ED visits. Older ED patients in this study had visited other types of providers frequently in the previous year (median number of PCP and specialist visits, 4). Patients who used the ED on 2 or more occasions in the previous year were found to have visited their PCP more often than those without frequent ED use (median number of visits, 7.0 vs 4.0; P < .001). Despite more PCP use in this population, frequent ED use was associated with increased risk of a repeat ED visit (hazard ratio, 2.20; 95% confidence interval, 1.15-4.21), in models adjusted for demographics and health status. Older adults who use the ED are also receiving significant amounts of care from other sources; simply providing additional access to care may not improve outcomes for these vulnerable individuals. Published by Elsevier Inc.

  18. Factors affecting ED length-of-stay in surgical critical care patients.

    Science.gov (United States)

    Davis, B; Sullivan, S; Levine, A; Dallara, J

    1995-09-01

    To determine what patient characteristics are associated with prolonged emergency department (ED) length-of-stay (LOS) for surgical critical care patients, the charts of 169 patients admitted from the ED directly to the operating room (OR) or intensive care unit (ICU) during a 6-week period in 1993 were reviewed. The ED record was reviewed for documentation of factors that might be associated with prolonged ED LOS, such as use of computed tomographic (CT), radiology special procedures, and the number of plain radiographs and consultants. ED LOS was considered to be the time from triage until a decision was made to admit the patient. Using a Cox proportional hazards model, use of CT and special procedures were the strongest independent predictors of prolonged ED length-of-stay. The number of plain radiographs and consultants had only a minimal effect. Use of a protocol-driven trauma evaluation system was associated with a shorter ED LOS. In addition to external factors that affect ED overcrowding, ED patient management decisions may also be associated with prolonged ED length-of-stay. Such ED-based factors may be more important in surgical critical care patients, whose overall ED LOS is affected more by the length of the ED work-up rather than the time spent waiting for a ICU bed or operating suite.

  19. 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

  20. Folic acid use in pregnant patients presenting to the emergency department

    OpenAIRE

    Steenblik, Jacob; Schroeder, Erika; Hatch, Burke; Groke, Steven; Broadwater-Hollifield, Camille; Mallin, Michael; Ahern, Matthew; Madsen, Troy

    2011-01-01

    Background The US Preventive Services Task Force has recommended daily folic acid supplementation for women planning on becoming pregnant in an effort to prevent fetal neural tube defects. We evaluated pregnant patients presenting to the emergency department to determine rates of folic acid supplementation. Methods We surveyed a convenience sample of pregnant patients who presented to the University of Utah Emergency Department (ED) between 1 January 2008, and 30 April 2009, regarding pregnan...

  1. 22 CFR Appendix D to Part 62 - Annual Report-Exchange Visitor Program Services (GC/V), Department of State, Washington, DC 20547...

    Science.gov (United States)

    2010-04-01

    ... Relations DEPARTMENT OF STATE PUBLIC DIPLOMACY AND EXCHANGES EXCHANGE VISITOR PROGRAM Pt. 62, App. D... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Annual Report-Exchange Visitor Program Services... ____ (b) PROGRAM EVALUATION On a separate sheet, please provide a brief narrative report on...

  2. The Consortium for Social Work Training in Aging: Schools of Social Work in Partnership with County Departments of Adult and Aging Services

    Science.gov (United States)

    Scharlach, Andrew E.; Robinson, Barrie K.

    2005-01-01

    This article describes the Consortium for Social Work Training in Aging (CSWTA), a unique partnership among 3 schools of social work and 6 county departments of adult and aging services. Using an innovative collaborative training model that included structured rotations and curricular support, CSWTA contributed to increased student interest in…

  3. 32 CFR Appendix C to Part 57 - Procedures for the Provision of Related Services by the Military Medical Departments to DoDDS...

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 1 2010-07-01 2010-07-01 false Procedures for the Provision of Related Services by the Military Medical Departments to DoDDS Students on IEPs C Appendix C to Part 57 National... to DoDDS Students on IEPs A. Evaluation Procedures (1) Upon request by a DoDDS CSC, the...

  4. Second Annual Evaluation of DCJS Funded School Resource Officer Programs. Report of the Department of Criminal Justice Services, Fiscal Year 1999-2000.

    Science.gov (United States)

    Schuiteman, John G.

    This evaluation report is the second publication from the Virginia Department of Criminal Justice Services' (DCJS) ongoing evaluation of the Virginia School Resource Officer (SRO) program. The findings are based on data submitted by 78 local SRO programs, all of which were awarded grants of federal or state monies from DCJS. The findings are…

  5. Sexual Abuse: Therapeutic & Systems Considerations for the Child and Family. [Report of] Colorado State Department of Social Services Conference (Denver, Colorado, July 7-8, 1982).

    Science.gov (United States)

    Carroll, Claudia A., Ed.; Gottlieb, Bruce, Ed.

    This publication presents papers from a 1982 child sexual abuse conference sponsored by the Colorado State Department of Social Services, designed to identify major issues and trends and to stimulate the exchange of perspectives and practices among persons concerned about preventing and treating child sexual abuse. The first section of the…

  6. 76 FR 60063 - Privacy Act of 1974; Department of Homeland Security/U.S. Citizenship and Immigration Services...

    Science.gov (United States)

    2011-09-28

    ... Immigration Services-014 Electronic Immigration System- 1 Temporary Accounts and Draft Benefit Requests System....S. Citizenship and Immigration Services-014 Electronic Immigration System-1 Temporary Accounts and... Security/U.S. Citizenship and Immigration Services to collect and maintain records on an individual as...

  7. 75 FR 14111 - Schedule of Fees for Consular Services, Department of State and Overseas Embassies and Consulates

    Science.gov (United States)

    2010-03-24

    ... can only determine historical costs, or how much it cost to produce something in the past. As there is... historical data about service costs into forward-looking estimates of how much a service will cost in the... cost for the service or product for the historical base year. Projected cost increases for...

  8. Health Care Services in IBD: Factors Associated with Service Utilization and Preferences for Service Options for Routine and Urgent Care.

    Science.gov (United States)

    Bernstein, Matthew T; Walker, John R; Chhibba, Tarun; Ivekovic, Melony; Singh, Harminder; Targownik, Laura E; Bernstein, Charles N

    2017-09-01

    We aimed to explore factors associated with health service utilization and preference for services, including alternatives to attending the emergency department (ED) when experiencing mild to moderate or severe symptoms. A total of 1143 persons (46% response rate) aged 18 to 65 years in the population-based University of Manitoba IBD Research Registry participated in the survey. Although 61% had a gastroenterologist, when experiencing active symptoms, only 29% felt they could call their gastroenterologist for an urgent appointment, and 42% could call their gastroenterologist for telephone advice. Nine percent of the respondents visited the ED in the previous year. If having severe symptoms, 48% said that they would attend the ED. Visits to the ED were related to higher bowel symptom severity and high health anxiety. When experiencing severe symptoms, women, persons with Crohn's disease and those with high health anxiety, indicated that they would be more likely to use the ED. Considering services which could be available in the future respondents indicated that if acutely symptomatic they would be very likely or likely to use the following services: phone contact with inflammatory bowel disease nurse (77%), phone contact with a gastroenterologist (75%), and going to a walk-in gastroenterology clinic (71%). Persons with inflammatory bowel disease are receptive to options other than the ED when experiencing inflammatory bowel disease symptoms; however, attending the ED remains a prominent choice. Improved access to specialized care may improve timeliness of care and reduce ED attendance. Future research should include the impact of health anxiety on health care utilization.

  9. Advanced musculoskeletal physiotherapists are effective and safe in managing patients with acute low back pain presenting to emergency departments.

    Science.gov (United States)

    Sayer, James M; Kinsella, Rita M; Cary, Belinda A; Burge, Angela T; Kimmel, Lara A; Harding, Paula

    2017-05-25

    Objective The aim of this study was to compare emergency department (ED) key performance indicators for patients presenting with low back pain and seen by an advanced musculoskeletal physiotherapist (AMP) with those seen by other non-AMP clinicians (ED doctors and nurse practitioners).Methods A retrospective audit (October 2012-September 2013) was performed of data from three metropolitan public hospital EDs to compare patients with low back pain seen by AMP and non-AMP clinicians. Outcome measures included ED length of stay, ED wait time, admission rates and re-presentation to the ED.Results One thousand and eighty-nine patients with low back pain were seen during AMP service hours (360 in the AMP group, 729 in the non-AMP group). Patients seen by the AMP had a significantly shorter ED wait time (median 13 vs 32min; Pback pain when managed by an AMP compared with patients seen by doctors and nurse practitioners.What is known about the topic? There is a growing body of literature regarding the role of AMPs in the Australian healthcare system in providing clinical services for patients with musculoskeletal conditions, including settings such as the ED. AMPs have proven to be safe and cost-effective, achieving high patient satisfaction and improved patient outcomes. However, there is little to no information regarding their effect on ED metrics, such as ED length of stay, wait time and admission rates for patients presenting to the ED with low back pain.What does this paper add? This paper demonstrates improved ED metrics for patients presenting to the ED with low back pain when seen by an AMP compared with patients seen by doctors and nurse practitioners. The specific improved metrics for these patients were decreased admission rates, decreased ED length of stay and decreased wait time.What are the implications for clinicians? This paper provides evidence that the AMPs effectively discharge patients admitted to the ED in a timely manner, without evidence of

  10. 77 FR 27746 - Notice of Submission for OMB Review; Office of Special Education and Rehabilitative Services...

    Science.gov (United States)

    2012-05-11

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF EDUCATION Notice of Submission for OMB Review; Office of Special Education and Rehabilitative Services; Annual...@ed.gov or mailed to U.S. Department of Education, 400 Maryland Avenue SW., LBJ, Washington, DC 20202...

  11. 77 FR 56824 - Notice of Submission for OMB Review; Office of Special Education and Rehabilitative Services...

    Science.gov (United States)

    2012-09-14

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF EDUCATION Notice of Submission for OMB Review; Office of Special Education and Rehabilitative Services; Grantee... electronically mailed to ICDocketMgr@ed.gov or mailed to U.S. Department of Education, 400 Maryland Avenue SW...

  12. United States of America Department of Health and Human Services support for advancing influenza vaccine manufacturing in the developing world.

    Science.gov (United States)

    Perdue, Michael L; Bright, Rick A

    2011-07-01

    five years of age. In addition to achievements described in this issue of Vaccine, the programme has been successful from the US perspective because the working relationships established between the US Department of Health and Human Services' (HHS) Assistant Secretary for Preparedness and Response Biomedical Advanced Research and Development Authority (BARDA) and its partners have assisted in advancing influenza vaccine development at many different levels. A few examples of BARDA's support include: establishment of egg-based influenza vaccine production from "scratch", enhancement of live attenuated influenza vaccine (LAIV) production techniques and infrastructure, completion of fill/finish operations for imported bulk vaccine, and training in advanced bio-manufacturing techniques. These HHS-supported programmes have been well-received internationally, and we and our partners hope the successes will stimulate even more interest within the international community in maximizing global production levels for influenza vaccines.

  13. 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.

  14. Access to primary care and visits to emergency departments in England: a cross-sectional, population-based study.

    Directory of Open Access Journals (Sweden)

    Thomas E Cowling

    Full Text Available BACKGROUND: The number of visits to hospital emergency departments (EDs in England has increased by 20% since 2007-08, placing unsustainable pressure on the National Health Service (NHS. Some patients attend EDs because they are unable to access primary care services. This study examined the association between access to primary care and ED visits in England. METHODS: A cross-sectional, population-based analysis of patients registered with 7,856 general practices in England was conducted, for the time period April 2010 to March 2011. The outcome measure was the number of self-referred discharged ED visits by the registered population of a general practice. The predictor variables were measures of patient-reported access to general practice services; these were entered into a negative binomial regression model with variables to control for the characteristics of patient populations, supply of general practitioners and travel times to health services. MAIN RESULT AND CONCLUSION: General practices providing more timely access to primary care had fewer self-referred discharged ED visits per registered patient (for the most accessible quintile of practices, RR = 0.898; P<0.001. Policy makers should consider improving timely access to primary care when developing plans to reduce ED utilisation.

  15. Access to Primary Care and Visits to Emergency Departments in England: A Cross-Sectional, Population-Based Study

    Science.gov (United States)

    Cowling, Thomas E.; Cecil, Elizabeth V.; Soljak, Michael A.; Lee, John Tayu; Millett, Christopher; Majeed, Azeem; Wachter, Robert M.; Harris, Matthew J.

    2013-01-01

    Background The number of visits to hospital emergency departments (EDs) in England has increased by 20% since 2007-08, placing unsustainable pressure on the National Health Service (NHS). Some patients attend EDs because they are unable to access primary care services. This study examined the association between access to primary care and ED visits in England. Methods A cross-sectional, population-based analysis of patients registered with 7,856 general practices in England was conducted, for the time period April 2010 to March 2011. The outcome measure was the number of self-referred discharged ED visits by the registered population of a general practice. The predictor variables were measures of patient-reported access to general practice services; these were entered into a negative binomial regression model with variables to control for the characteristics of patient populations, supply of general practitioners and travel times to health services. Main Result and Conclusion General practices providing more timely access to primary care had fewer self-referred discharged ED visits per registered patient (for the most accessible quintile of practices, RR = 0.898; P<0.001). Policy makers should consider improving timely access to primary care when developing plans to reduce ED utilisation. PMID:23776694

  16. Continuity in a VA patient-centered medical home reduces emergency department visits.

    Directory of Open Access Journals (Sweden)

    Krisda H Chaiyachati

    Full Text Available One major goal of the Patient-Centered Medical Home (PCMH is to improve continuity of care between patients and providers and reduce the utilization of non-primary care services like the emergency department (ED.To characterize continuity under the Veterans Health Administration's PCMH model--the Patient Aligned Care Team (PACT, at one large Veterans Affair's (VA's primary care clinic, determine the characteristics associated with high levels of continuity, and assess the association between continuity and ED visits.Retrospective, observational cohort study of patients at the West Haven VA (WHVA Primary Care Clinic from March 2011 to February 2012.The 13,495 patients with established care at the Clinic, having at least one visit, one year before March 2011.Our exposure variable was continuity of care--a patient seeing their assigned primary care provider (PCP at each clinic visit. The outcome of interest was having an ED visit.The patients encompassed 42,969 total clinic visits, and 3185 (24% of them had 15,458 ED visits. In a multivariable logistic regression analysis, patients with continuity of care--at least one visit with their assigned PCP--had lower ED utilization compared to individuals without continuity (adjusted odds ratio [AOR] 0.54; 95% CI: 0.41, 0.71, controlling for frequency of primary care visits, comorbidities, insurance, distance from the ED, and having a trainee PCP assigned. Likewise, the adjusted rate of ED visits was 544/1000 person-year (PY for patients with continuity vs. 784/1000 PY for patients without continuity (p = 0.001. Compared to patients with low continuity (50% continuity were less likely to utilize the ED.Strong continuity of care is associated with decreased ED utilization in a PCMH model and improving continuity may help reduce the utilization of non-primary care services.

  17. 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…

  18. Treatment of Nausea and Vomiting in Pregnancy: Factors Associated with ED Revisits

    Directory of Open Access Journals (Sweden)

    Brian R. Sharp

    2016-09-01

    Full Text Available Introduction: Nausea and vomiting in pregnancy (NVP is a condition that commonly affects women in the first trimester of pregnancy. Despite frequently leading to emergency department (ED visits, little evidence exists to characterize the nature of ED visits or to guide its treatment in the ED. Our objectives were to evaluate the treatment of NVP in the ED and to identify factors that predict return visits to the ED for NVP. Methods: We conducted a retrospective database analysis using the electronic medical record from a single, large academic hospital. Demographic and treatment variables were collected using a chart review of 113 ED patient visits with a billing diagnosis of “nausea and vomiting in pregnancy” or “hyperemesis gravidarum.” Logistic regression analysis was used with a primary outcome of return visit to the ED for the same diagnoses. Results: There was wide treatment variability of nausea and vomiting in pregnancy patients in the ED. Of the 113 patient visits, 38 (33.6% had a return ED visit for NVP. High gravidity (OR 1.31, 95% CI [1.06-1.61], high parity (OR 1.50 95% CI [1.12-2.00], and early gestational age (OR 0.74 95% CI [0.60-0.90] were associated with an increase in return ED visits in univariate logistic regression models, while only early gestational age (OR 0.74 95% CI [0.59-0.91] was associated with increased return ED visits in a multiple regression model. Admission to the hospital was found to decrease the likelihood of return ED visits (p=0.002. Conclusion: NVP can be difficult to manage and has a high ED return visit rate. Optimizing care with aggressive, standardized treatment in the ED and upon discharge, particularly if factors predictive of return ED visits are present, may improve quality of care and reduce ED utilization for this condition.

  19. Treatment of Nausea and Vomiting in Pregnancy: Factors Associated with ED Revisits

    Science.gov (United States)

    Sharp, Brian R.; Sharp, Kristen M.; Patterson, Brian; Dooley-Hash, Suzanne

    2016-01-01

    Introduction Nausea and vomiting in pregnancy (NVP) is a condition that commonly affects women in the first trimester of pregnancy. Despite frequently leading to emergency department (ED) visits, little evidence exists to characterize the nature of ED visits or to guide its treatment in the ED. Our objectives were to evaluate the treatment of NVP in the ED and to identify factors that predict return visits to the ED for NVP. Methods We conducted a retrospective database analysis using the electronic medical record from a single, large academic hospital. Demographic and treatment variables were collected using a chart review of 113 ED patient visits with a billing diagnosis of “nausea and vomiting in pregnancy” or “hyperemesis gravidarum.” Logistic regression analysis was used with a primary outcome of return visit to the ED for the same diagnoses. Results There was wide treatment variability of nausea and vomiting in pregnancy patients in the ED. Of the 113 patient visits, 38 (33.6%) had a return ED visit for NVP. High gravidity (OR 1.31, 95% CI [1.06–1.61]), high parity (OR 1.50 95% CI [1.12–2.00]), and early gestational age (OR 0.74 95% CI [0.60–0.90]) were associated with an increase in return ED visits in univariate logistic regression models, while only early gestational age (OR 0.74 95% CI [0.59–0.91]) was associated with increased return ED visits in a multiple regression model. Admission to the hospital was found to decrease the likelihood of return ED visits (p=0.002). Conclusion NVP can be difficult to manage and has a high ED return visit rate. Optimizing care with aggressive, standardized treatment in the ED and upon discharge, particularly if factors predictive of return ED visits are present, may improve quality of care and reduce ED utilization for this condition. PMID:27625723

  20. U.S. Department of the Interior Fish and Wildlife Service : Environmental Assessment for Opening Portions of Cypress Creek National Wildlife Refuge for Hunting as Proposed in the 1992 Hunting Plan

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The U.S. Fish and Wildlife Service proposes to open portions of the Cypress Creek National Wildlife Refuge for hunting of Canada geese, white-tailed deer, and other...

  1. 78 FR 72701 - Notice of Inventory Completion: U.S. Department of the Interior, National Park Service, Natural...

    Science.gov (United States)

    2013-12-03

    ... Service, Natural Bridges National Monument, Moab, UT AGENCY: National Park Service, Interior. ACTION... associated funerary object should submit a written request to Natural Bridges National Monument. If no... request with information in support of the request to Natural Bridges National Monument at the address...

  2. Assessing Pesticide Impact on Human Health in Nebraska: A Survey of Ambulance Services and Rescue Squads. Department Report No. 7.

    Science.gov (United States)

    Vitzthum, Edward F.; And Others

    A study examined the employment qualifications, job content, training, and training needs of ambulance service and rescue squad workers in Nebraska. Based on the 268 mail questionnaires that were completed and returned out of a total of 338 sent out, it was concluded that the strengths of the various ambulance and rescue services vary widely. The…

  3. 48 CFR 2937.103-70 - Department of Labor checklist to aid analysis and review of requirements for service contracts.

    Science.gov (United States)

    2010-10-01

    ... checklist to aid analysis and review of requirements for service contracts. 2937.103-70 Section 2937.103-70... contract requirements and performance standards. (a) General. Following is a checklist to aid analysis and... that contractor? (2) If the requirement is for support services (such as system engineering...

  4. Child Study and Consultation Services in the Hawaii State Department of Education: A Summary and Progress Report.

    Science.gov (United States)

    Hawaii State Dept. of Education, Honolulu.

    The role of assessment teams in establishing a psychoeducational clinic in Hawaii is reviewed, along with the need for child study and consultation services. The objectives of such services are listed and the program is explained. Role descriptions of the multidisciplinary team are provided, including the roles of the team coordinator, visiting…

  5. Nurses' evaluation of a new formalized triage system in the emergency department - a qualitative study

    DEFF Research Database (Denmark)

    Johansen, Mette Brehm; Forberg, Jakob Lundager

    2011-01-01

    Formalized triage in the emergency department (ED) is not widely used in Denmark; this study explores the effects of introducing a five-level process triage system in a Danish ED.......Formalized triage in the emergency department (ED) is not widely used in Denmark; this study explores the effects of introducing a five-level process triage system in a Danish ED....

  6. Ill, Itinerant, and Insured: The Top 20 Users of Emergency Departments in Baltimore City

    Directory of Open Access Journals (Sweden)

    Barbara Y. DiPietro

    2012-01-01

    Full Text Available The purpose of this study was to document the clinical and demographic characteristics of the 20 most frequent users of emergency departments (EDs in one urban area. We reviewed administrative records from three EDs and two agencies providing services to homeless people in Baltimore City. The top 20 users accounted for 2,079 visits at the three EDs. Their mean age was 48, and median age was 51. Nineteen patients visited at least 2 EDs, 18 were homeless, and 13 had some form of public insurance. The vast majority of visits (86% were triaged as moderate or high acuity. The five most frequent diagnoses were limb pain (n=9, lack of housing (n=6, alteration of consciousness (n=6, infection with human immunodeficiency virus (HIV (n=5, and nausea/vomiting (n=5. Hypertension, HIV infection, diabetes, substance abuse, and alcohol abuse were the most common chronic illnesses. The most frequent ED users were relatively young, accounted for a high number of visits, used multiple EDs, and often received high triage scores. Homelessness was the most common characteristic of this patient group, suggesting a relationship between this social factor and frequent ED use.

  7. Thermally Induced Silane Dehydrocoupling on Silicon Nanostructures (International ed.)

    Science.gov (United States)

    2016-07-29

    Arkles Gelest Inc. 11 East Steel Rd., Morrisville, PA 19067 (USA) Y. W. Jun, Prof. Dr. K. H. Ahn Department of Chemistry Pohang University of Science...Figure 1a) and elemental analysis by energy-dispersive X-ray (EDS) analysis revealed strong carbon and oxygen signals (Table S2). By contrast, a

  8. Effectiveness of organizational interventions to reduce emergency department utilization: a systematic review.

    Directory of Open Access Journals (Sweden)

    Gemma Flores-Mateo

    Full Text Available BACKGROUND: Emergency department (ED utilization has dramatically increased in developed countries over the last twenty years. Because it has been associated with adverse outcomes, increased costs, and an overload on the hospital organization, several policies have tried to curb this growing trend. The aim of this study is to systematically review the effectiveness of organizational interventions designed to reduce ED utilization. METHODOLOGY/PRINCIPAL FINDINGS: We conducted electronic searches using free text and Medical Subject Headings on PubMed and The Cochrane Library to identify studies of ED visits, re-visits and mortality. We performed complementary searches of grey literature, manual searches and direct contacts with experts. We included studies that investigated the effectiveness of interventions designed to reduce ED visits and the following study designs: time series, cross-sectional, repeated cross-sectional, longitudinal, quasi-experimental studies, and randomized trial. We excluded studies on specific conditions, children and with no relevant outcomes (ED visits, re-visits or adverse events. From 2,348 potentially useful references, 48 satisfied the inclusion criteria. We classified the interventions in mutually exclusive categories: 1 Interventions addressing the supply and accessibility of services: 25 studies examined efforts to increase primary care physicians, centers, or hours of service; 2 Interventions addressing the demand for services: 6 studies examined educational interventions and 17 examined barrier interventions (gatekeeping or cost. CONCLUSIONS/SIGNIFICANCE: The evidence suggests that interventions aimed at increasing primary care accessibility and ED cost-sharing are effective in reducing ED use. However, the rest of the interventions aimed at decreasing ED utilization showed contradictory results. Changes in health care policies require rigorous evaluation before being implemented since these can have a high

  9. 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.

  10. 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...

  11. 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...

  12. 2011 U.S. Department of Agriculture- Natural Resources Conservation Service (USDA-NRCS) Topographic Lidar: Northwest 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...

  13. 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.

  14. Ambulance diversion and emergency department offload delay: resource document for the National Association of EMS Physicians position statement.

    Science.gov (United States)

    Cooney, Derek R; Millin, Michael G; Carter, Alix; Lawner, Benjamin J; Nable, Jose Victor; Wallus, Harry J

    2011-01-01

    The emergency medical services (EMS) system is a component of a larger health care safety net and a key component of an integrated emergency health care system. EMS systems, and their patients, are significantly impacted by emergency department (ED) crowding. While protocols designed to limit ambulance diversion may be effective at limiting time on divert status, without correcting overall hospital throughput these protocols may have a negative effect on ED crowding and the EMS system. Ambulance offload delay, the time it takes to transfer a patient to an ED stretcher and for the ED staff to assume the responsibility of the care of the patient, may have more impact on ambulance turnaround time than ambulance diversion. EMS administrators and medical directors should work with hospital administrators, ED staff, and ED administrators to improve the overall efficiency of the system, focusing on the time it takes to get ambulances back into service, and therefore must monitor and address both ambulance diversions and ambulance offload delay. This paper is the resource document for the National Association of EMS Physicians position statement on ambulance diversion and ED offload time. Key words: ambulance; EMS; diversion; bypass; offload; delay.

  15. Overview of Deployed EDS Technologies

    Energy Technology Data Exchange (ETDEWEB)

    Martz, H E; Crawford, C

    2009-09-24

    The term explosive detection system (EDS) is used by the TSA to describe equipment that is certified to detect explosives in checked bags. The EDS, as certified, by the TSL must consist of device for interrogating a bag and an automated detection algorithm (ATD) for evaluating the results of the interrogation. We only consider CT as the interrogation device in this report. A schematic drawing of a CT-based EDS is shown in Figure 2. The output of the ATD is the binary decision of alarm or non-alarm. Alarms may true- or false-positives. Non-alarms may be true- or false-negatives. False positives are also denoted false alarms. The true detection means that the ATD reports an alarm when a threat is present in the scanned bag. The probability of detecting a threat given that a threat is present is denoted the probability of detection (PD). The probability of false alarm (PFA) is the case when an alarm is reported when a threat is not present in a bag. Certification in this context means passing tests for PD and PFA at the TSL. The results of the EDS include CT cross-sectional images of the bag and specifics about the alarmed objects generated by ATD. These results are presented on a display so that a person may override the decision of ATD and declare the alarm to be a non-alarm. This process is denoted clearing. Bags that are not cleared by the person are sent to a secondary inspection process. Here the bags may be opened or assessed with explosive trace detection (ETD) in order to clear the bags. Bags that are not cleared at this point are evaluated by an ordinance disposal team. The CT scanner along with ATD is denoted Level 1 screening. The process of clearing on a display is denoted Level 2 screening. Secondary inspection is denoted Level 3 screening. Vendors of the deployed EDSs supply the TSA with equipment for all three levels. Therefore, the term EDS may include the equipment provided for Levels 1, 2 and 3. A schematic diagram of an EDS and the levels of

  16. 78 FR 12422 - Public Availability of the Department of Veterans Affairs Fiscal Year (FY) 2011 Service Contract...

    Science.gov (United States)

    2013-02-22

    ... Service Contract Inventory. The FY 2011 analysis report discusses the methodology, analysis, and special... of the inventory on the VA Web site at: http://www.va.gov/oal/business/pps/scaInventory.asp . FOR...

  17. 78 FR 59953 - Notice of Inventory Completion: U.S. Department of Agriculture, Forest Service, Coconino National...

    Science.gov (United States)

    2013-09-30

    ..., Southwestern Region, USDA Forest Service, 333 Broadway Blvd. SE., Albuquerque, NM 87102, telephone (505) 842...., Albuquerque, NM 87102, telephone (505) 842-3238, email fwozniak@fs.fed.us , by October 30, 2013. After...

  18. 75 FR 6321 - Schedule of Fees for Consular Services, Department of State and Overseas Embassies and Consulates

    Science.gov (United States)

    2010-02-09

    ... domestic and overseas consular sites handling a representative sample of all consular services worldwide...) Waiver of immigrant visa $545. ineligibility (collected for USCIS and subject to change). (e) Refugee...

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

    Directory of Open Access Journals (Sweden)

    Bogyun Kim, MSN, RN

    2016-03-01

    Conclusions: 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.

  20. Candidate Success and edTPA: Looking at the Data

    Science.gov (United States)

    Evans, Lesley A.; Kelly, Mary K.; Baldwin, Joni L.; Arnold, Jackie M.

    2016-01-01

    This descriptive study looks at the correlations between Teacher Performance Assessment (edTPA) data and numerous program data points, including GPA, major GPA, and benchmark assignment scores, gathered in an Early Childhood Education (ECE) program. Previous studies have looked to correlate grade point average (GPA) with pre-service teacher…

  1. Can Local Police and Sheriff’s Departments Provide a Higher Degree of Homeland Security Coordination and Collaboration Through Consolidation of Police Services

    Science.gov (United States)

    2010-09-01

    resources and consolidate in ways that would provide the most 21 effective police services at the most cost efficient price ( Katzenbach , 1967...According to John Bryson (2004) in his book, Strategic Planning for Public and Nonprofit Organizations, achieving successful collaboration becomes more...document, Twin Cities Police Department, Larkspur, CA. Katzenbach , N. (1967), Task force report-the police, U.S.task force on the police, the

  2. Professionalising counter fraud specialists (fraud investigators) in the UK public sector: a focus upon Department for Work and Pensions, National Health Service and the Local Authority

    OpenAIRE

    Frimpong, KO

    2013-01-01

    This thesis seeks to examine and explore the professionalisation initiatives of the UK public sector counter fraud specialists (fraud investigators), with a focus upon the Department for Work and Pensions (DWP), National Health Service (NHS) and Local Authority (LA). The conceptual framework used to underpin the study was functionalist / “traits” theory of a profession and professionalisation. The main research question for the thesis concerns the issue of whether counter fraud specialism is ...

  3. Analysis of dentoalveolar trauma incidents treated in the emergency services department at a healthcare teaching institution in Medellin (Colombia) 2007-2012

    OpenAIRE

    2014-01-01

    Introduction: dental trauma is considered a dental emergency and it occurs frequently, especially among young people. The aim of this research was to analyze dentoalveolar trauma incidents treated in the emergency services department of a university clinic in the city of Medellin (Colombia), between 2007 and 2012. Methods: this was a retrospective, descriptive study in which 7.555 clinical histories were revised, the final sample comprising the 549 cases that met inclusion and exclusion crite...

  4. Managing the services supply chain in the Department of Defense: an empirical study of current management practices / by Aruna U. Apte, Uday M. Apte, and Rene G. Rendon.

    OpenAIRE

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

    2009-01-01

    This paper presents the results of our ongoing research on the management of services acquisition in the Department of Defense. In this empirical study we developed and used a web-based survey to collect data on the acquisition strategy, procurement methods, and contract types used at Air Force and Navy installations. Specifically, we studied the current management practices in such areas as life cycle approach, project management, organization/management structure, and training provided to s...

  5. Emergency Psychiatric Services for Individuals with Intellectual Disabilities: Caregivers' Perspectives

    Science.gov (United States)

    Weiss, Jonathan A.; Lunsky, Yona; Gracey, Carolyn; Canrinus, Maaike; Morris, Susan

    2009-01-01

    Background: Strains on the mental health system and inaccessible services for individuals with intellectual disabilities (ID) often force caregivers to bring individuals with ID to the emergency department (ED) when in psychiatric crisis. The purpose of this study was to understand the experience of caregivers and adults with ID and mental health…

  6. 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.

  7. 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.

  8. 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

  9. ED becomes 'lean' and cuts LBTC, LOS times.

    Science.gov (United States)

    2008-04-01

    Lean manufacturing techniques, first developed by Toyota, can be successfully adapted to help improve processes in your ED. St. Luke's Episcopal Hospital in Houston, has used Lean to reduce median length of stay, frequency of diversions, and the percentage of patients who left before treatment was complete (LBTC). Here's why "Lean" can help improve the performance of your ED: It enables you and your staff to see things from the patient's point of view. Lean tools enable you to view the status of your department in real-time and to compare that status with your performance goals. Exercises help identify areas where your processes break down and determine the most likely solutions.

  10. New psych unit eases patient burden in ED.

    Science.gov (United States)

    2008-06-01

    Creating a special unit for psychiatric patients frees up beds in your ED, ensures better care for that patient population, and improves the atmosphere in the main department for the rest of your patients. Consider these suggestions: The creation of a psych unit can be extremely costly. Be prepared to demonstrate projected savings when pitching the idea to administration. Make sure an ED physician has overall responsibility for each patient at all times. Keep a regular group of nurses in rotation. This setup will help ensure smooth handoffs.

  11. Ed Watson - 1940-2006

    CERN Document Server

    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...

  12. 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...

  13. 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

  14. 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…

  15. A Business Process Model and Reengineering Plan for the Student Services Department of the Marine Corps Institute.

    Science.gov (United States)

    1997-09-01

    Department (SSD). The objective of this thesis is to develop the As-Is process model , redesign the processes to increase efficiency and reduce costs, and...develop a To-Be process model to improve the current business processes. Additionally, data flow diagrams of the To-Be processes are developed to assist

  16. 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

    In the Danish language "haven" means "the garden": A tranquil place with beautiful colours and vegetables where one can relax and prepare for the more stressful activities of modern life. Similarly, the chain store´s fruit and vegetable department can be the haven of the stressed self...

  17. 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…

  18. 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.

  19. 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

  20. 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

  1. 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…

  2. 76 FR 77012 - Notice of Inventory Completion: U.S. Department of the Interior, National Park Service, Organ...

    Science.gov (United States)

    2011-12-09

    ... Service, Organ Pipe Cactus National Monument, Ajo, AZ and Arizona State Museum, Tucson, AZ AGENCY... Drive, Ajo, AZ 85321, telephone (520) 387-6849 ext. 7500. SUPPLEMENTARY INFORMATION: Notice is here... of Organ Pipe Cactus National Monument, Ajo, AZ and in the physical custody of the Arizona...

  3. 76 FR 70730 - Privacy Act of 1974; Department of Homeland Security/U.S. Citizenship and Immigration Services...

    Science.gov (United States)

    2011-11-15

    ... sexual contact, limiting or denying others religious beliefs; service in military or other armed groups... concerning him or her, the individual may submit the request to the Chief Privacy Officer and Chief Freedom... this purpose from the Chief Privacy Officer and Chief Freedom of Information Act Officer, http://www...

  4. 78 FR 6112 - Request for Information (RFI): Opportunities To Apply a Department of Health and Human Services...

    Science.gov (United States)

    2013-01-29

    ... physical activity and agree that having this information transmitted via their mobile device would be... Adolescents,'' which uses a developmentally based approach to address children's health needs in the context... necessarily imply the need for dissemination through mobile, Short Message Service messaging. HRSA is...

  5. 75 FR 70026 - Notice of Inventory Completion: U.S. Department of Agriculture, Forest Service, Pacific Northwest...

    Science.gov (United States)

    2010-11-16

    ... Park Service's administrative responsibilities under NAGPRA, 25 U.S.C. 3003(d)(3). The determinations in this notice are the sole responsibility of the museum, institution, or Federal agency that has..., Heritage Program Manager, Gifford Pinchot National Forest, 2455 Highway 141, Trout Lake, WA 98650...

  6. 77 FR 39506 - Notice of Inventory Completion: U.S. Department of Agriculture, Forest Service, Tongass National...

    Science.gov (United States)

    2012-07-03

    ... the National Park Service's administrative responsibilities under NAGPRA, 25 U.S.C. 3003(d)(3). The determinations in this notice are the sole responsibility of the museum, institution, or Federal agency that has... Goldschmidt and Theodore H. Haas, first issued in 1948, reprinted in 1988 by the Sealaska Heritage Association...

  7. 77 FR 5177 - Schedule of Fees for Consular Services, Department of State and Overseas Embassies and Consulates

    Science.gov (United States)

    2012-02-02

    ... referred to as the Cost of Service Study or ``CoSS,'' which is the activity-based costing model that the... published a proposed rule in the Federal Register, 75 FR 6321, on February 9, 2010, proposing to amend... supplementary notice in the Federal Register, 75 FR 14111, on March 24, 2010 (Public Notice 6928)....

  8. Retention and Promotion of High-Quality Civil Service Workers in the Department of Defense Acquisition Workforce

    Science.gov (United States)

    2014-01-01

    quality, other factors that may deter- mine the performance rating include the methods used to monitor the worker’s output, the frequency with which...P. Sanders, and Constance Horner, Civil Service Reform: Building a Government That Works, Washington, D.C.: The Brookings Institution, 1996

  9. 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.

  10. 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…

  11. 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

  12. The Comparison of Self-Efficacy Belief Levels on Anatomy Education between the Undergraduate Students from Physical Therapy and Rehabilitation Department and the Associate Students from Vocational School of Health Services in Western Black Sea Region

    Science.gov (United States)

    Acar, Derya; Colak, Tuncay; Colak, Serap; Gungor, Tugba; Yener, Deniz M.; Aksu, Elif; Guzelordu, Dilsat; Sivri, Ismail; Colak, Enis; Ors, Abdullah

    2017-01-01

    Physical Therapy and Rehabilitation (PTR) undergraduate degree departments and Vocational School of Health Services (VSHS) associate degree departments train healthcare professionals, which is important for both continuance of human health and treatment of various illnesses. Anatomic structures underlie the illnesses that these departments treat…

  13. Application of Structural Equation Model to Evaluate the Perception of Service Quality of Medical Staffs of infectious Disease Department in Chinese Hospitals

    Institute of Scientific and Technical Information of China (English)

    2014-01-01

    Objective To enhance the quality of medical service for Chinese patients through research of service quality from Chinese medical personnel. Methods ServQual scale was used for infection medical staffs randomly by sampling questionnaire in Beijing, Shanghai, Chengdu, Chongqing, Guangzhou and Nanning. The data collected were entered and analyzed using SPSS 20.0. Statistical methods included frequency, factor analysis, reliability analysis, correlation analysis, independent samples t test, one-way analyses of variance, simultaneous regression analysis and structural equation model analysis. Results The Kaiser-Meyer-Olkin value for the factor analysis of the scale was 0.970. The Cronbach’sαfor the reliability analysis was 0.975. The Pearson correlation coefficients were 0.624-0.874 and statistically significant. Undergraduates felt good, PhD students felt bad;the doctors felt bad;managers felt good. Standard 5 dimensions of the regression coefficients were positive, including empathy (β = 0.288), reliability (β =0.241) impacting on perceived service quality mostly. The control ability and stability of the standard error of perceived service quality directly effected value were 0.646 and 0.382, respectively. Conclusions Medical staffs of infectious disease department have poor perception of service quality. Hospitals should improve awareness and of clinicians and deepen the reform of the medical care system.

  14. The utility of transvaginal ultrasound in the ED evaluation of complications of first trimester pregnancy.

    Science.gov (United States)

    Panebianco, Nova L; Shofer, Frances; Fields, J Matthew; Anderson, Kenton; Mangili, Alessandro; Matsuura, Asako C; Dean, Anthony J

    2015-06-01

    For patients with early intrauterine pregnancy (IUP), the sonographic signs of the gestation may be below the resolution of transabdominal ultrasound (TAU); however, it may be identified by transvaginal ultrasound (TVU). We sought to determine how often TVU performed in the emergency department (ED) reveals a viable IUP after a nondiagnostic ED TAU and the impact of ED TVU on patient length of stay (LOS). This was a retrospective cohort study of women presenting to our ED with complications of early pregnancy from January 1, 2007 to February 28, 2009 in a single urban adult ED. Abstractors recorded clinical and imaging data in a database. Patient imaging modality and results were recorded and compared with respect to ultrasound (US) findings and LOS. Of 2429 subjects identified, 795 required TVU as part of their care. Emergency department TVU was performed in 528 patients, and 267 went to radiology (RAD). Emergency department TVU identified a viable IUP in 261 patients (49.6%). Patients having initial ED US had shorter LOS than patients with initial RAD US (median 4.0 vs 6.0 hours; P < .001). Emergency department LOS was shorter for women who had ED TVU performed compared with those sent for RAD TVU regardless of the findings of the US (median 4.9 vs 6.7 hours; P < .001). There was no increased LOS for patients who needed further RAD US after an indeterminate ED TVU (7.0 vs 7.1 hours; P = .43). There was no difference in LOS for those who had a viable IUP confirmed on ED TAU vs ED (median 3.1 vs 3.2 hours, respectively; P < .32). When an ED TVU was performed, a viable IUP was detected 49.6% of the time. Emergency department LOS was significantly shorter for women who received ED TVU after indeterminate ED TAU compared with those sent to RAD for TVU, with more marked time savings among those with live IUP diagnosed on ED TVU. For patients who do not receive a definitive diagnosis of IUP on ED TVU, this approach does not result in increased LOS. Copyright © 2015

  15. 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.

  16. 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

  17. 优质护理服务在急诊科的应用效果探究%Application Effect of High Quality Nursing Service in Emergency Department

    Institute of Scientific and Technical Information of China (English)

    同小利

    2014-01-01

    Objective To study application effect of high quality nursing service in emergency department .Methods 344 cases patients with emergency treatment were divided into observation group and control group , control group given emergency department routine nursing care , observation group given high quality nursing service .Nursing quality and pa-tient satisfaction were compared .Results Observation group nursing quality , patient satisfaction were significantly high-er than control group .Conclusions High quality nursing service can improve the quality of nursing and patients satisfac -tion.%目的:探讨优质护理服务在急诊科的应用效果。方法选取344例急诊患者为研究对象,采用数字表法随即分为观察组和对照组,对照组实施急诊科常规护理,观察组开展优质护理服务。比较两组护理质量及患者满意度。结果观察组护理质量、患者满意度均明显高于对照组。结论优质护理服务可提升急诊科护理质量,提高患者满意度,值得在临床护理工作中的推广应用。

  18. Patient-Centered Care Transition for Patients Admitted through the ED: Improving Patient and Employee Experience

    Directory of Open Access Journals (Sweden)

    Andrea Algauer BSN, RN

    2015-05-01

    Full Text Available With increasing wait times in emergency departments (ED across America, there is a need to streamline the inpatient admission process in order to decrease wait times and more important, to increase patient and employee satisfaction. One inpatient unit at New York-Presbyterian Weill Cornell Medical Center initiated a program to help expedite the inpatient admission process from the ED. The goal of the ED Bridge program is to ease the patient's transition from the ED to an inpatient unit by visiting the patient in the ED and introducing and setting expectations for the inpatient environment (i.e. telemetry alarms, roommates, hourly comfort rounds. Along with improving the patient experience, this program intends to improve the collaboration between ED nurses and inpatient nurses. With the continued support of our nurse management, hospital administrators and most important, our staff, this concept is aimed to increase patient satisfaction scores and subsequently employee satisfaction.

  19. 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.

  20. 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

  1. Real time analysis under EDS

    Energy Technology Data Exchange (ETDEWEB)

    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.

  2. 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...

  3. Enhancing capacity for intern training in the emergency department: the MoLIE project.

    Science.gov (United States)

    Brazil, Victoria A; Greenslade, Jaimi H; Brown, Anthony F

    2011-02-21

    To evaluate an intern educational project, the More Learning for Interns in Emergency (MoLIE) project, designed to increase intern placements in the emergency department (ED). The study was conducted in the ED of the Royal Brisbane and Women's Hospital, Queensland, in 2008. As well as the usual direct contact with patients, interns had 8 hours per week of "off the floor" structured learning time supervised by consultants. This allowed for an increased number of interns to complete a term in the ED over a 1-year period. The study was evaluated by an intern exit feedback survey and a senior staff survey. Numbers of intern placements in the ED; intern satisfaction with the project; senior medical staff satisfaction with interns' skills and performance assessments. The number of interns completing a term in the ED increased from 65 in 2007 to 90 in 2008. Overall, the 90 interns surveyed were highly satisfied with their training. Most agreed or strongly agreed that the sessions were relevant and covered the right mix of clinical and professional issues. Most of the 12 senior staff surveyed felt that the participating interns performed slightly or much better than interns in previous years, and that their experience as supervisors and overall patient care were improved. The project successfully combined increased intern numbers with educational outcomes that were well perceived by interns and senior staff, without adversely affecting service delivery or supervision workload in the ED.

  4. The Impact of Infant Well-Child Care Compliance and Social Risks on Emergency Department Utilization.

    Science.gov (United States)

    Lawson, Nikki R; Klein, Melissa D; Ollberding, Nicholas J; Wurster Ovalle, Victoria; Beck, Andrew F

    2017-09-01

    Deployment of medical and social services at well-child visits promotes child health. A retrospective review of the electronic health record was conducted for infants presenting for their "newborn" visit over a 2-year period at an urban, academic primary care center. Primary outcomes were time to first emergency department (ED) visit, number of ED visits (emergent or nonemergent), and number of nonemergent ED visits by 2 years of life. Records from 212 consecutive newborns were evaluated-59.9% were black/African American and 84.4% publicly insured. A total of 72.6% visited the ED by 2 years of life. Sixty percent received ≥5 well-child visits by 14 months; 25.9% reported ≥1 social risk. There were no statistically significant associations between number of completed well-child visits, or reported social risks, and ED utilization. Renewed focus on preventive care delivery and content and its effect on ED utilization, and other patient outcomes, is warranted.

  5. Emergency department crowding in The Netherlands: managers’ experiences

    NARCIS (Netherlands)

    C. van der Linden (Christien); R. Reijnen (Resi); R. Derlet (Robert); N. van der Linden (Naomi); R. Lindeboom (Robert); C. Lucas (Cees); J. Richards (John)

    2013-01-01

    markdownabstract__Abstract__ __Background__ In The Netherlands, the state of emergency department (ED) crowding is unknown. Anecdotal evidence suggests that current ED patients experience a longer length of stay (LOS) compared to some years ago, which is indicative of ED crowding. However, no multi

  6. Predictors of Emergency Department Utilization Among Children in Vulnerable Families.

    Science.gov (United States)

    Flood, Colin; Sheehan, Karen; Crandall, Marie

    2016-03-08

    Preventable visits to the emergency department (ED) are estimated to represent as much as 56% of overall annual ED utilization and contribute to the high cost of health care in the United States. There are more than 25 million annual pediatric ED visits.

  7. The Effects of Management Information System toward Decision Making in Food and Beverage Service Department in X Resorts and Hotels Bandung

    OpenAIRE

    Agung Gita Subakti; Maria Pia Adiati

    2015-01-01

    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 ...

  8. Remissions in the Valle del Cauca Department (State analysis and rules to orientate network health services: 2003-2004

    Directory of Open Access Journals (Sweden)

    Luis Fernando Rendón

    2005-03-01

    Full Text Available Introduction: The gap between the functions of modulation, financing, articulation and services inside the health system of social security generated disarticulation of the network, with an acute operative and financial crisis. Materials and methods: The Emergency Control Center (CRU in Cali, Colombia, takes charge of remission’s request for patients between different health institutions in the State. During the last year, following up of the information collected about remissions allows analysis of the population attended, its health care system affiliation, cause of remissions, diagnosis profile, and movement of patients between levels of health attention. Results: Of the patients 56 percent were women and 71% were assigned to the state and municipal health secretaries. The more frequent specialties requested were gynecology and obstetrics (24.4%, internal medicine (16.6%, general surgery (15.2% and orthopedics and trauma (12.7%. The majority of remissions were pertinent (89.6%, but not coherent (38.1%. Analysis and discussion: The main weakness of the network were the obstetric and gynecologic attention, the insufficient second level of attention and the high number of patients remitted directly from the first to the third level. This information contributes to decision making related to lay out a ground plan of regional service network, its relation with burden of disease and health programs that needs intervention.

  9. Emergency Department of a Rural Hospital in Ecuador

    Directory of Open Access Journals (Sweden)

    Tara Johnson, MD, MPH

    2016-01-01

    Full Text Available Introduction: There is a paucity of data studying patients and complaints presenting to emergency departments (EDs in low- and middle-income countries. The town of Pedro Vicente Maldonado (PVM is located in the northwestern highlands of Ecuador. Hospital PVM (HPVM is a rural teaching hospital providing family medicine residency training. These physicians provide around-the-clock acute medical care in HPVM’s ED. This study provides a first look at a functioning ED in rural Latin America by reviewing one year of ED visits to HPVM. Methods: All ED visits between April 14, 2013, and April 13, 2014, were included and analyzed, totaling 1,239 patient visits. Data were collected from their electronic medical record and exported into a de-identified Excel® database where it was sorted and categorized. Variables included age, gender, mode of arrival, insurance type, month and day of the week of the service, chief complaint, laboratory and imaging requests, and disposition. We performed descriptive statistics, and where possible, comparisons using Student’s T or chi-square, as appropriate. Results: Of the 1239 total ED visits, 48% were males and 52% females; 93% of the visits were ambulatory, and 7% came by ambulance. Sixty-three percent of the patients had social security insurance. The top three chief complaints were abdominal pain (25.5%, fever (15.1% and trauma (10.8%. Healthcare providers requested labs on 71.3% of patients and imaging on 43.2%. The most frequently requested imaging studies were chest radiograph (14.9%, upper extremity radiograph (9.4%, and electrocardiogram (9.0%. There was no seasonal or day-of-week variability to number of ED patients. The chief complaint of human or animal bite made it more likely the patient would be admitted, and the chief complaint of traumatic injury made it more likely the patient would be transferred. Conclusion: Analysis of patients presenting to a rural ED in Ecuador contributes to the global study

  10. 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.

  11. 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.

  12. Assigning treatment rooms at the Emergency Department

    NARCIS (Netherlands)

    van de Vrugt, Noëlle Maria; Boucherie, Richardus J.

    2016-01-01

    Increasing efficiency at the Emergency Department (ED) reduces overcrowding. At the ED in typical Dutch Hospitals treatment rooms are mostly shared by two residents of different specialties: a Surgeon and an Internist. Each resident uses multiple rooms in parallel; while one patient awaits test resu

  13. Emergency teams in Danish emergency departments

    DEFF Research Database (Denmark)

    Lafrenz, Thomas; Lindberg, Søren Østergaard; La Cour, Jeppe Lerche;

    2012-01-01

    The use of designated emergency teams for cardiac arrest and trauma patients is widely implemented. However, the use of designated teams in Danish emergency departments (EDs) has not been investigated. Our aim was to investigate the use and staffing of emergency teams in Danish EDs....

  14. Assigning treatment rooms at the Emergency Department

    NARCIS (Netherlands)

    Vrugt, van de Maartje; Boucherie, Richard J.

    2016-01-01

    Increasing efficiency at the Emergency Department (ED) reduces overcrowding. At the ED in typical Dutch Hospitals treatment rooms are mostly shared by two residents of different specialties: a Surgeon and an Internist. Each resident uses multiple rooms in parallel; while one patient awaits test resu

  15. Exploration and Practice of Good Quality Nursing Service in Emergency Department%急诊科优质护理服务的实施及效果

    Institute of Scientific and Technical Information of China (English)

    赖兰静; 张慧; 廖云英; 黄谭招

    2014-01-01

    目的:探讨急诊科实施优质护理服务的方法与取得的成效。方法针对急诊科特点,开展优质护理服务,转变护理服务理念,改变工作模式和排班方式,加强护患沟通,优化急诊工作流程,开启急诊绿色通道,强化急救技能培训,改善硬件设施,实行弹性排班和责任制整体护理。结果患者的护理满意率、健康教育知晓率、就诊流程满意率、巡视病人满意率、治疗护理满意率、病室管理满意率及陪检率均比较高。结论在急诊科实施优质护理服务,有利于提高护理质量和患者对护理工作的满意度,同时可激发护士的最大潜能。%Objective To investigate the methods and the results of good quality nursing service in emergency department .Methods According to the characteristics of emergency department , carrying out good quality nursing service , changing service concept and the work schedule, optimizing workflow, opening convenient access , mastering the aid skills, improving the hardware facilities , and implementing humane scheduling and overall good care .Results The patients and their families′attitude toward service satisfaction , treatment process satisfaction, health education awareness , infusion district patrol satisfaction , treatment and care satisfaction , management satisfaction and ward accompany detection rate has improved significantly .Conclusion The implementation of good quality nursing service in emergency department will help to improve the quality of care and patients′satisfaction of nursing work , and inspire the greatest potential nurses .

  16. 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

  17. 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

  18. Biological control of weeds: research by the United States Department of Agriculture-Agricultural Research Service: selected case studies.

    Science.gov (United States)

    Quimby, Paul C; DeLoach, C Jack; Wineriter, Susan A; Goolsby, John A; Sobhian, Rouhollah; Boyette, C Douglas; Abbas, Hamed K

    2003-01-01

    Research by the USDA-Agricultural Research Service (ARS) on biological control of weeds has been practiced for many years because of its inherent ecological and economic advantages. Today, it is further driven by ARS adherence to Presidential Executive Order 13112 (3 February 1999) on invasive species and to USDA-ARS policy toward developing technology in support of sustainable agriculture with reduced dependence on non-renewable petrochemical resources. This paper reports examples or case studies selected to demonstrate the traditional or classical approach for biological control programs using Old World arthropods against Tamarix spp, Melaleuca quinquenervia (Cav) ST Blake and Galium spurium L/G aparine L, and the augmentative approach with a native plant pathogen against Pueraria lobata Ohwi = P montana. The examples illustrated various conflicts of interest with endangered species and ecological complexities of arthropods with associated microbes such as nematodes.

  19. 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.

  20. Improving emergency department patient flow.

    Science.gov (United States)

    Jarvis, Paul Richard Edwin

    2016-06-01

    Emergency departments (ED) face significant challenges in delivering high quality and timely patient care on an ever-present background of increasing patient numbers and limited hospital resources. A mismatch between patient demand and the ED's capacity to deliver care often leads to poor patient flow and departmental crowding. These are associated with reduction in the quality of the care delivered and poor patient outcomes. A literature review was performed to identify evidence-based strategies to reduce the amount of time patients spend in the ED in order to improve patient flow and reduce crowding in the ED. The use of doctor triage, rapid assessment, streaming and the co-location of a primary care clinician in the ED have all been shown to improve patient flow. In addition, when used effectively point of care testing has been shown to reduce patient time in the ED. Patient flow and departmental crowding can be improved by implementing new patterns of working and introducing new technologies such as point of care testing in the ED.

  1. 公立医院客户服务部建设的探索——华山医院东院客户服务部六年实践总结%An exploration of the construction of the customer service department in a public hospital: 6-year experience of Customer Service Department in East Branch, Huashan Hospital

    Institute of Scientific and Technical Information of China (English)

    蔡丽莉

    2012-01-01

    在医院内建立一个功能完整的客户服务部是目前公立医院的创新举措,它整合了医院内除医疗护理外所有的行政事务类服务和管理,树立了一个用对客服务的理念向医院客户传递服务信息建立良好的公共关系的形象.通过与院内外各部门的协调和合作完成部门各岗位的工作运转,在建立一个服务高端人群的医疗模式的同时为病人提供方便、及时、高效、温馨的人性化服务.六年来,华山东院在这方面进行了尝试探索,创建了医院的客户服务工作模式.%The establishment of a functional Customer Service Department is creative and integrated of current public hospitals. It doesn' t only integrate all the service and management in the hospital administration except for nursing, but also conveys a customer-oriented motto to the patients in order to establish a good characteristic of the public relationship. This department works by the coordination with internal and external departments of the hospital. While endeavoring to build a new medical pattern of high-end service, our department has sustained to provide the patients with convenient, prompt, efficient, considerate and personal service as well. We have been exploring in the past 6 years and established the pattern of customer service in the public hospital.

  2. Occupational burns treated in emergency departments.

    Science.gov (United States)

    Reichard, Audrey A; Konda, Srinivas; Jackson, Larry L

    2015-03-01

    Despite reported declines, occupational burn injuries remain a workplace safety concern. More severe burns may result in costly medical treatment and long-term physical and psychological consequences. We used the National Electronic Injury Surveillance System-Occupational Supplement to produce national estimates of burns treated in emergency departments (EDs). We analyzed data trends from 1999 to 2008 and provided detailed descriptions of 2008 data. From 1999 to 2008 there were 1,132,000 (95% CI: ±192,300) nonfatal occupational burns treated in EDs. Burn numbers and rates declined approximately 40% over the 10 years. In 2008, men and younger workers 15-24 years old had the highest rates. Scalds and thermal burns accounted for more than 60% of burns. Accommodation and food service, manufacturing, and construction industries had the largest number of burns. Despite declining burn rates, emphasis is needed on reducing burn hazards to young food service workers and using job specific hazard analyses to prevent burns. © 2015 Wiley Periodicals, Inc.

  3. Goldratt’s Theory Applied to the Problems Associated with an Emergency Department at a Hospital

    OpenAIRE

    Soumya Nayak; Lloyd J. Taylor

    2012-01-01

    Healthcare costs continue to increase dramatically, while quality remains a significant problem. Reform measures initiated by the government will drive expansion of these costs, further stressing taxpayers and employers, and forcing hospitals to adopt fundamental changes as they try to adjust to increased demands for services and to lessening reimbursements from all payers. This struggle is best seen at the point of entry for many at a hospital: the emergency department (ED). It is at the eme...

  4. Using data envelopment analysis for assessing the performance of pediatric emergency department physicians.

    Science.gov (United States)

    Fiallos, Javier; Patrick, Jonathan; Michalowski, Wojtek; Farion, Ken

    2017-03-01

    In attempting to measure the performance of providers in a service industry such as health care, it is crucial that the measurement tool recognize both the efficiency and quality of service provided. We develop a Data Envelopment Analysis (DEA) model to help assess the performance of emergency department (ED) physicians at a partner hospital. The model incorporates efficiency measures as inputs and quality measures as outputs. We demonstrate the importance of a nuanced approach that recognizes the heterogeneity of patients that an ED physician encounters and the important role s/he plays as a mentor for physicians in training. In the study, patients were grouped according to their presenting complaint and ED physicians were assessed on each group separately. Performance variations were evident between physicians within each complaint group as well as between groups. A secondary grouping divided patients based on whether the attending physician was assisted by a trainee. Almost all ED physicians showed better performance scores when not assisted by trainees or ED fellows.

  5. 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.

  6. 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.

  7. 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

  8. 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.

  9. 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...

  10. Nonurgent patients in the emergency department? A French formula to prevent misuse

    Directory of Open Access Journals (Sweden)

    Gainotti Sabina

    2010-03-01

    Full Text Available Abstract Background Overcrowding in emergency department (EDs is partly due to the use of EDs by nonurgent patients. In France, the authorities responded to the problem by creating primary care units (PCUs: alternative structures located near hospitals. The aims of the study were to assess the willingness of nonurgent patients to be reoriented to a PCU and to collect the reasons that prompted them to accept or refuse. Methods We carried out a cross sectional survey on patients' use of EDs. The study was conducted in a French hospital ED. Patients were interviewed about their use of health services, ED visits, referrals, activities of daily living, and insurance coverage status. Patients' medical data were also collected. Results 85 patients considered nonurgent by a triage nurse were asked to respond to a questionnaire. Sex ratio was 1.4; mean age was 36.3 +/- 11.7 years. Most patients went to the ED autonomously (76%; one third (31.8% had consulted a physician. The main reasons for using the ED were difficulty to get an appointment with a general practitioner (22.3%, feelings of pain (68.5%, and the availability of medical services in the ED, like imaging, laboratory tests, and drug prescriptions (37.6%. Traumatisms and wounds were the main medical reasons for going to the ED (43.5%. More than two-thirds of responders (68% were willing to be reoriented towards PCUs. In the multivariate analysis, only employment and the level of urgency perceived by the patient were associated with the willingness to accept reorientation. Employed persons were 4.5 times more likely to accept reorientation (OR = 4.5 CI (1.6-12.9. Inversely, persons who perceived a high level of urgency were the least likely to accept reorientation (OR = 0.9 CI (0.8-0.9. Conclusions Our study provides information on the willingness of ED patients to accept reorientation and shows the limits of its feasibility. Alternative structures such as PCUs near the ED seem to respond

  11. Support for Emergency Department Screening for Intimate Partner Violence Depends on Perceived Risk

    Science.gov (United States)

    Witting, Michael D.; Furuno, Jon P.; Hirshon, Jon Mark; Krugman, Scott D.; Perisse, Andre R. S.; Limcangco, Rhona

    2006-01-01

    Emergency department (ED) screening for intimate partner violence (IPV) faces logistic difficulties and has uncertain efficacy. We surveyed 146 ED visitors and 108 ED care providers to compare their support for ED IPV screening in three hypothetical scenarios of varying IPV risk. Visitor support for screening was 5 times higher for the high-risk…

  12. [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.

  13. Uninsured immigrant and refugee children presenting to Canadian paediatric emergency departments: Disparities in help-seeking and service delivery.

    Science.gov (United States)

    Rousseau, Cécile; Laurin-Lamothe, Audrey; Rummens, Joanna Anneke; Meloni, Francesca; Steinmetz, Nicolas; Alvarez, Fernando

    2013-11-01

    Access to health care for medically uninsured immigrant and refugee children is a public health concern due to the consequences of delayed or substandard care for child development and health. To explore possible differences in help-seeking and service delivery across migratory statuses, institutions and provinces. A review was undertaken of 2035 emergency files of immigrant, refugee and undocumented children without provincial health care coverage who sought care at three major paediatric hospitals in Montreal (Quebec) and Toronto (Ontario) during 2008 and 2009. Refugee claimant children with Interim Federal Health Program benefits consulted for less urgent problems than the overall hospital population, except in one hospital that had a multicultural paediatric ambulatory clinic. Undocumented children and new permanent resident immigrant children within the three-month waiting period for provincial health care coverage were over-represented in the very urgent triage category and presented more often for injuries, trauma and mental health problems than did refugee claimant children. Wide interhospital differences suggest that the predicament of limited access to health care of these groups of vulnerable medically uninsured children needs to be addressed through further research to inform policies and develop training.

  14. 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.

  15. 急诊科实施优质护理服务的体会%Experience of implementing high quality nursing service in emergency department

    Institute of Scientific and Technical Information of China (English)

    潘怡霞

    2016-01-01

    目的:探讨优质护理服务在我院急诊科的实施方法及效果。方法:针对急诊科的特点,将“以人为本,以病人为中心”的服务理念融入到对患者的护理服务中。加强对护理人员管理,强化专科知识、急救技能培训,提高护士的业务水平,转变服务理念,改变护理工作模式,明确岗位职责,弹性排班,严格护理人员绩效考核,细化满意度调查。保持绿色通道的畅通、实行急危重症患者“先抢救,后交费”的抢救原则。落实急诊患者无缝隙管理模式以优化就诊、服务流程,优化就诊环境,进行人性化管理等。结果:急诊护理工作质量明显提高,患者及医生对本科室护理工作的满意度也明显提高。结论:在急诊科实施优质护理服务,提高了护理人员工作积极性,提升了护士的整体素质,减少护患纠纷,营造良好的人文服务氛围,构建和谐护患关系,取得了患者满意、医院满意、政府满意、社会满意的良好效果。%Objective: To explore the implementation methods and effect of high quality nursing service in the emergency department of our hospital. Methods: according to the characteristics of emergency department, the concept of “people oriented, patient centric” service was integrated into the care of patients. Moreover, Enhance the management of nursing personnel, strengthen specialty knowledge and training on first aid skills, improve the professional skill of nurses, change the service concept and the nursing work mode, clear responsibilities, keep flexible scheduling and strict performance appraisal of nursing staff, and refine the satisfaction survey.Keep the Easy Access unimpeded, and implement the principle of “rescue first and payment second” for critically ill patients. Implement the seamless management mode of emergency patients to optimize the treatment and service processes, improve the treatment

  16. Emergency department physician training in Jamaica: a national public hospital survey

    Directory of Open Access Journals (Sweden)

    Williams Eric W

    2008-10-01

    Full Text Available Abstract Background Emergency Department (ED medical officers are often the first medical responders to emergencies in Jamaica because pre-hospital emergency response services are not universally available. Over the past decade, several new ED training opportunities have been introduced locally. Their precise impact on the health care system in Jamaica has not yet been evaluated. We sought to determine the level of training, qualifications and experience of medical officers employed in public hospital EDs across the nation. Methods A database of all medical officers employed in public hospital EDs was created from records maintained by the Ministry of Health in Jamaica. A specially designed questionnaire was administered to all medical officers in this database. Data was analyzed using SPSS Version 10.0. Results There were 160 ED medical officers across Jamaica, of which 47.5% were males and the mean age was 32.3 years (SD +/- 7.1; Range 23–57. These physicians were employed in the EDs for a mean of 2.2 years (SD +/- 2.5; Range 0–15; Median 2.5 and were recent graduates of medical schools (Mean 5.1; SD +/- 5.9; Median 3 years. Only 5.5% of the medical officers had specialist qualifications (grade III/IV, 12.8% were grade II medical officers and 80.5% were grade I house officers or interns. The majority of medical officers had no additional training qualifications: 20.9% were exposed to post-graduate training, 27.9% had current ACLS certification and 10.3% had current ATLS certification. Conclusion The majority of medical officers in public hospital EDs across Jamaica are relatively inexperienced and inadequately trained. Consultant supervision is not available in most public hospital EDs. With the injury epidemic that exists in Jamaica, it is logical that increased training opportunities and resources are required to meet the needs of the population.

  17. 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.

  18. The emergency department occupancy rate: a simple measure of emergency department crowding?

    Science.gov (United States)

    McCarthy, Melissa L; Aronsky, Dominik; Jones, Ian D; Miner, James R; Band, Roger A; Baren, Jill M; Desmond, Jeffrey S; Baumlin, Kevin M; Ding, Ru; Shesser, Robert

    2008-01-01

    We examine the validity of the emergency department (ED) occupancy rate as a measure of crowding by comparing it to the Emergency Department Work Index Score (EDWIN), a previously validated scale. A multicenter validation study was conducted according to ED visit data from 6 academic EDs for a 3-month period in 2005. Hourly ED occupancy rate (ie, total number of patients in ED divided by total number of licensed beds) and EDWIN scores were calculated. The correlation between the scales was determined and their validity evaluated by their ability to discriminate between hours when 1 or more patients left without being seen and hours when the ED was on ambulance diversion, using area under the curve (AUC) statistics estimated from the bootstrap method. We calculated the ED occupancy rate and EDWIN for 2,208 consecutive hours at each of the 6 EDs. The overall correlation between the 2 scales was 0.58 (95% confidence interval [CI] 0.56 to 0.60). The ED occupancy rate (AUC=0.73; 95% CI 0.65 to 0.80) and the EDWIN (AUC=0.65; 95% CI 0.58 to 0.72) did not differ significantly in correctly identifying hours when patients left without being seen. The ED occupancy rate (AUC=0.78; 95% CI 0.75 to 0.80) and the EDWIN (AUC=0.70; 95% CI 0.59 to 0.81) performed similarly for ED diversion hours. The ED occupancy rate and the EDWIN classified leaving without being seen and ambulance diversion hours with moderate accuracy. Although the ED occupancy rate is not ideal, its simplicity makes real-time assessment of crowding feasible for more EDs nationwide.

  19. Statement of Ronald E. Lambertson, U.S. Fish and Wildlife Service, Department of the Interior, before the House Subcommittee on Public Lands and National Parks concerning National Wildlife Refuge additions to the National Wilderness Preservation System

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This document is a statement on the Mattamuskeet, Cedar Island, and Pea Island Wildlife Refuges. Given by Ronald E. Lambertson, it says that there are almost no...

  20. 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...

  1. United States Department of Agriculture-Agricultural Research Service stored-grain areawide integrated pest management program.

    Science.gov (United States)

    Flinn, Paul W; Hagstrum, David W; Reed, Carl; Phillips, Tom W

    2003-01-01

    The USDA Agricultural Research Service (ARS) funded a demonstration project (1998-2002) for areawide IPM for stored wheat in Kansas and Oklahoma. This project was a collaboration of researchers at the ARS Grain Marketing and Production Research Center in Manhattan, Kansas, Kansas State University, and Oklahoma State University. The project utilized two elevator networks, one in each state, for a total of 28 grain elevators. These elevators stored approximately 31 million bushels of wheat, which is approximately 1.2% of the annual national production. Stored wheat was followed as it moved from farm to the country elevator and finally to the terminal elevator. During this study, thousands of grain samples were taken in concrete elevator silos. Wheat stored at elevators was frequently infested by several insect species, which sometimes reached high numbers and damaged the grain. Fumigation using aluminum phosphide pellets was the main method for managing these insect pests in elevators in the USA. Fumigation decisions tended to be based on past experience with controlling stored-grain insects, or were calendar based. Integrated pest management (IPM) requires sampling and risk benefit analysis. We found that the best sampling method for estimating insect density, without turning the grain from one bin to another, was the vacuum probe sampler. Decision support software, Stored Grain Advisor Pro (SGA Pro) was developed that interprets insect sampling data, and provides grain managers with a risk analysis report detailing which bins are at low, moderate or high risk for insect-caused economic losses. Insect density was predicted up to three months in the future based on current insect density, grain temperature and moisture. Because sampling costs money, there is a trade-off between frequency of sampling and the cost of fumigation. The insect growth model in SGA Pro reduces the need to sample as often, thereby making the program more cost-effective. SGA Pro was validated

  2. Emergency Department Presentations following Tropical Cyclone Yasi

    OpenAIRE

    Peter Aitken; Richard Charles Franklin; Jenine Lawlor; Rob Mitchell; Kerrianne Watt; Jeremy Furyk; Niall Small; Leone Lovegrove; Peter Leggat

    2015-01-01

    Introduction Emergency departments see an increase in cases during cyclones. The aim of this study is to describe patient presentations to the Emergency Department (ED) of a tertiary level hospital (Townsville) following a tropical cyclone (Yasi). Specific areas of focus include changes in: patient demographics (age and gender), triage categories, and classification of diseases. Methods Data were extracted from the Townsville Hospitals ED information system (EDIS) for three periods in 2009, 2...

  3. Application of Personalized Service to the Care in Department of Obstetrics%人性化服务在妇产科护理中的应用

    Institute of Scientific and Technical Information of China (English)

    陈颖; 韩宁宁

    2014-01-01

    目的:探索在产科护理中实施人性化服务的临床效果。方法:将80例患者随机分为对照组和观察组各40例,对照组进行常规妇产科护理,观察组实施人性化服务,对2组患者及其家属进行满意度调查,对产妇进行焦虑情况评分并观察并发症发生情况。结果:观察组满意度、产妇焦虑以及并发症发生率显著优于对照组(P<0.05)。结论:产科护理中的人性化服务有助于建立和谐护患关系、减轻患者焦虑等心理负担、控制并发症。%Objective:To explore clinical effects of personalized service carried out in the nursing for the pa-tients in department of obstetrics. Methods:Eighty patients were divided into the control group and the observation group, the control group were administered with routine care in department of obstetrics, and the observation group personalized service, satisfaction degrees of the patients and their family members were investigated, the anxiety of delivery woman was scored, at the same time, the incidence of the complications were observed. Results:The obser-vation group was remarkably superior to the control group in satisfaction degree, the anxiety of delivery woman and the conditions of the complications (P<0.05). Conclusion:Personalized service in the nursing of department of ob-stetrics helps to establish harmonious relationship between the nurses and the patients, to relieve psychological bur-den of the patients and control the incidences of the complications.

  4. Due etimologie venete ed istriane

    Directory of Open Access Journals (Sweden)

    Alberto Zamboni

    1991-12-01

    Full Text Available Un isolato dialetto del Medio Agordino (La Valle, BL attesta per 'ginepro' (Juniperus eommunis L., d'altronde compattamente designato come dzené(iver, deneore il termine bozičo che richiama il busicio dato già per l'area bellunese dal Soravia (1877, 108. II Pellegrini (1964, 28 enota 51 ne riscontra il perfetto corrispondente del Veneto orientale buzíčo documentato al p. 356 (S. Stino di Livenza dali' AIS 599 e l'accosta senz'altro al padovano (in realtà piuttosto veneziano di terraferma brusiehio (eh = (č! segnalato dal Patriarchi (1821, ma I'ed. 1775 e che si giustificherebbe con l'intrusione di 'bruciare' dal noto usodi bruciare le bacche della pianta per suffumigi, cfr. il ted. regionale Feuerbaum (su cui Marzell 2/1972, 1091 e anche il tipo brusìn dell'alta Val di Sole (Pedrotti-Bertoldi 1931, 206s.. Si osservi che anche il grande repertorio poliglotta del Nemnich (3/1794, 267 dà esplicitamente brusichio per Venezia. Sul tipo e sull'etimo il Pellegrini ritorna più avanti (1982, 185 riassumendo la bibliografia precedente e aggiungendo documentazioni dall' ASLEF: bo/ič al p. 172 (Chions, PN e ancora nel friulano occidentale (in pratica sempre nella zona di confine col veneto sbrodicio, sbradicio a Budoia (AppiSanson 1970, 28;

  5. 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.

  6. International perspectives on emergency department crowding.

    Science.gov (United States)

    Pines, Jesse M; Hilton, Joshua A; Weber, Ellen J; Alkemade, Annechien J; Al Shabanah, Hasan; Anderson, Philip D; Bernhard, Michael; Bertini, Alessio; Gries, André; Ferrandiz, Santiago; Kumar, Vijaya Arun; Harjola, Veli-Pekka; Hogan, Barbara; Madsen, Bo; Mason, Suzanne; Ohlén, Gunnar; Rainer, Timothy; Rathlev, Niels; Revue, Eric; Richardson, Drew; Sattarian, Mehdi; Schull, Michael J

    2011-12-01

    The maturation of emergency medicine (EM) as a specialty has coincided with dramatic increases in emergency department (ED) visit rates, both in the United States and around the world. ED crowding has become a public health problem where periodic supply and demand mismatches in ED and hospital resources cause long waiting times and delays in critical treatments. ED crowding has been associated with several negative clinical outcomes, including higher complication rates and mortality. This article describes emergency care systems and the extent of crowding across 15 countries outside of the United States: Australia, Canada, Denmark, Finland, France, Germany, Hong Kong, India, Iran, Italy, The Netherlands, Saudi Arabia, Catalonia (Spain), Sweden, and the United Kingdom. The authors are local emergency care leaders with knowledge of emergency care in their particular countries. Where available, data are provided about visit patterns in each country; however, for many of these countries, no national data are available on ED visits rates or crowding. For most of the countries included, there is both objective evidence of increases in ED visit rates and ED crowding and also subjective assessments of trends toward higher crowding in the ED. ED crowding appears to be worsening in many countries despite the presence of universal health coverage. Scandinavian countries with robust systems to manage acute care outside the ED do not report crowding is a major problem. The main cause for crowding identified by many authors is the boarding of admitted patients, similar to the United States. Many hospitals in these countries have implemented operational interventions to mitigate crowding in the ED, and some countries have imposed strict limits on ED length of stay (LOS), while others have no clear plan to mitigate crowding. An understanding of the causes and potential solutions implemented in these countries can provide a lens into how to mitigate ED crowding in the United States

  7. 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

  8. [Screening sensory and developmental disorders in nursery school children by the Maternal and Infant Protection Service in the Vaucluse (France) department: results, orientations, limits].

    Science.gov (United States)

    Peyronnet, S; Garnier, M-O

    2011-11-01

    The aim of this study was to determine whether to continue the recommendations given by the doctors of the Maternal and Infant Protection (PMI) service within the medical check-ups given to nursery school children in the Vaucluse department in France. This was a longitudinal study conducted based on an observation grid from January to June 2009. A total of 2079 files were retained. This study revealed that more than one-quarter of the children for whom recommendations had been given no longer had care 3 months later; the main cause was the absence of adherence on the part of the family. This result emphasizes the limitation of the mass screenings conducted by the PMI in nursery schools: it raises the problem of access to healthcare for certain children and opens an opportunity for reflection on professional practices to optimize the mission of prevention and the promotion of health.

  9. 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.

  10. 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.

  11. Accuracy of ED Bedside Ultrasound for Identification of Gallstones: Retrospective Analysis of 575 Studies

    Directory of Open Access Journals (Sweden)

    Scruggs, William

    2008-01-01

    Full Text Available Study Objective: To determine the ability of emergency department (ED physicians to diagnose cholelithiasis with bedside ultrasound. Methods: ED gallbladder ultrasounds recorded over 37 months were compared to radiology ultrasound interpretation. Results: Of 1,690 ED gallbladder ultrasound scans performed during this period, radiology ultrasound was performed in 575/1690 (34% cases. ED physician bedside interpretation was 88% sensitive [95% CI, 84-91] and 87% specific [95% CI, 82-91], while positive predictive value (PPV was 91% [88- 94%] and negative predictive value (NPV was 83% [78-87%], using radiology interpretation as the criterion reference. Conclusion: ED physician ultrasound of the gallbladder for cholelithiasis is both sensitive and specific.

  12. Evaluation of emergency department performance

    DEFF Research Database (Denmark)

    Sørup, Christian Michel; Jacobsen, Peter; Forberg, Jakob Lundager

    2013-01-01

    Background Evaluation of emergency department (ED) performance remains a difficult task due to the lack of consensus on performance measures that reflects high quality, efficiency, and sustainability. Aim To describe, map, and critically evaluate which performance measures that the published lite...

  13. The Clinical Effect of Quality Nursing Service in Emergency Department%优质护理服务在急诊科中的临床效果

    Institute of Scientific and Technical Information of China (English)

    綦甲清; 陈书艳

    2015-01-01

    Objective To investigate the effect of the application of quality care in the emergency department. Methods Select 160 cases who were treated in emergency patients, which were randomly divided into two groups, the patients in the observation group were given high quality nursing service,the control group were given routine nursing care,compared two groups of patients with nursing effect.Results Patients in the observation group SAS, SDS scores were lower than the control group,and the nursing satisfaction was higher than that of the control group, the differences were statisticaly significant(P<0.05).Conclusion The clinical application effect of high quality nursing service in patients in emergency department were.%目的 探讨优质护理服务在急诊科中的临床效果.方法 选取急诊科收治的160例患者,将其采用随机数字表法分为两组,观察组患者给予优质护理服务,对照组患者给予常规护理服务,比较两组患者的护理效果.结果 观察组患者 SAS、SDS 评分均低于对照组,且护理满意度高于对照组,差异均有统计学意义(均 P<0.05).结论 急诊科患者应用优质护理服务的临床效果明显.

  14. 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

  15. GeneEd -- A Genetics Educational Resource

    Science.gov (United States)

    ... Javascript on. Feature: Genetics 101 GeneEd — A Genetics Educational Resource Past Issues / Summer 2013 Table of Contents Science ... The Hereditary Material of Life / GeneEd — A Genetics Educational Resource / Using The Genetics Home Reference Website / Understanding the ...

  16. Supplemental standards of ethical conduct and financial disclosure requirements for employees of the Department of Health and Human Services. Interim final rule with request for comments.

    Science.gov (United States)

    2005-02-03

    The Department of Health and Human Services, with the concurrence of the Office of Government Ethics (OGE), is amending the HHS regulation that supplements the OGE Standards of Ethical Conduct. This interim final rule specifies additional procedural and substantive requirements that are necessary to address ethical issues at the National Institutes of Health (NIH) and updates nomenclature, definitions, and procedures applicable to other components of the Department. The rule: Revises the definition of a significantly regulated organization for the Food and Drug Administration (FDA); Updates the organization titles of designated separate agencies; Amends the gift exception for native artwork and craft items received from Indian tribes or Alaska Native organizations; Aligns the FDA prohibited holdings limit with the de minimis holdings exemption in OGE regulations; Revises prior approval procedures for outside activities; and, subject to certain exceptions: Prohibits NIH employees from engaging in certain outside activities with supported research institutions, health care providers or insurers, health-related trade or professional associations, and biotechnology, pharmaceutical, medical device, and other companies substantially affected by the programs, policies, or operations of the NIH; Bars NIH employees who file a public or confidential financial disclosure report from holding financial interests in substantially affected organizations; Subjects NIH non-filer employees to a monetary cap on holdings in such organizations; Specifies for NIH employees prior approval procedures for and limitations on the receipt of certain awards from outside sources; and Imposes a one-year disqualification period during which NIH employees are precluded from official actions involving an award donor. In addition, the Department is adding a new supplemental part to expand financial disclosure reporting requirements for certain outside activities and to ensure that prohibited

  17. Accounting and comparing of expenditure on the medical services given at neuro-surgery department of Imam Khomeyni Hospital in the year of 1994 (1373

    Directory of Open Access Journals (Sweden)

    Abasi Moghadam M

    1998-09-01

    Full Text Available This study was focused on analysis of expenditure on all the medical services given at Neuro-Surgery Department of Imam-Khomeini Hospital in the year of 1994 (1373. In this study, all the information on descriptive method and the techniques of cost analysis and cost per unit of service provided accountancy, were analysed. 573 patients were considered in this study. 522 of them underwent 13 different types of neuro-surgery operations. 92.6% of them total departmental costs were related to current expenditures and 7.4% of that was related to the capial expenditures. The personnel costs with 49% was the highest portion of the total costs. Percentage wise, the costs were as follows: Medicine, materials and equipment 22%, food 17.6%, depreciation 7.4%, fuel, water, electricity and telephone 3.5%. The mean duration of stay was 16.3 days for every in-patient. The percentage of occupied bed was 58% if the percentage of desired bed occupancy was supposed 80%, therefore, 22% of the bed, plus 3512 bed-day were gone wasted. The real cost of med-care policy need to be more rational for the operation and hospitalization. It should be mentioned that the wasted time was 886 hours and wasted cost was 71, 708, 410 Rials in operation room.

  18. Professionally-mediated degradation of employees of security departments of correctional institutions of the Federal Penitentiary Service of the Russian Federation

    Directory of Open Access Journals (Sweden)

    Krasnik V.S.

    2014-09-01

    Full Text Available This article raises the problem of professional destructions of the penitentiary system employees. The hypothesis of the study is as follows: in the course of professional activity the employees of security departments of penitentiary system show professionally conditioned destruction. Study sample consisted of 60 men aged 18 to 40 years, the staff of the penal system (Security Division. The main methods were psychodiagnostic (test method and statistical (mathematical analysis. Analysis of the results led to the conclusion about the impact of the conditions of professional activity on the employee personality, namely the development of professionally caused accentuation of the alarm type in the initial stages of service and professional activities (p = 0.005, as well as the development of professionally caused pedantic (p = 0.000, dysthymic (p = 0.002, stuck (p = 0.005 accentuation types. Thus, this study led to the conclusion that, indeed, depending on the length of service and professional activities of the employees of the penitentiary system professional-mediated degradation occurs.

  19. The effect of tropical cyclones (typhoons) on emergency department visits.

    Science.gov (United States)

    Lin, Chien-Hao; Hou, Sen-Kuang; Shih, Frank Fuh-Yuan; Su, Syi

    2013-09-01

    Case reports have indicated that a tropical cyclone may increase Emergency Department (ED) visits significantly. To examine emergency health care demands across a series of tropical cyclones, and to build a predictive model to analyze a cyclone's potential effect. This was an observational non-concurrent prospective study performed in Taiwan. Twenty hospitals were included. The number of daily ED visits in each hospital was our primary end point, and data were retrieved from the database provided by the National Health Insurance Research Database. Our study examined the period from 2000 to 2008. A total of 22 tropical cyclones (typhoons) that had passed over eastern Taiwan and covered the area under study were included. Multiple linear regression time-series models were employed to estimate the effects of "days since typhoon landfall" and various characteristics of the typhoons on the end point of daily ED visits to each hospital. The final multiple linear regression time-series model showed that the number of daily ED visits increased in areas where a strong typhoon had landed directly, with the increase being evident during the first 2 days since landfall. Our model also indicated that the three most important variables to predict a change in the pattern of daily ED visits were intensity of typhoon, simultaneous heavy rain, and direct landfall. During tropical cyclones, emergency services were under increased demand in selected time periods and areas. Health care authorities should collect information to build local models to optimize their resources allocation in preparation. Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.

  20. 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.

  1. Emergency department overcrowding: the Emergency Department Cardiac Analogy Model (EDCAM).

    Science.gov (United States)

    Richardson, Sandra K; Ardagh, Michael; Gee, Paul

    2005-01-01

    Increasing patient numbers, changing demographics and altered patient expectations have all contributed to the current problem with 'overcrowding' in emergency departments (EDs). The problem has reached crisis level in a number of countries, with significant implications for patient safety, quality of care, staff 'burnout' and patient and staff satisfaction. There is no single, clear definition of the cause of overcrowding, nor a simple means of addressing the problem. For some hospitals, the option of ambulance diversion has become a necessity, as overcrowded waiting rooms and 'bed-block' force emergency staff to turn patients away. But what are the options when ambulance diversion is not possible? Christchurch Hospital, New Zealand is a tertiary level facility with an emergency department that sees on average 65,000 patients per year. There are no other EDs to whom patients can be diverted, and so despite admission rates from the ED of up to 48%, other options need to be examined. In order to develop a series of unified responses, which acknowledge the multifactorial nature of the problem, the Emergency Department Cardiac Analogy model of ED flow, was developed. This model highlights the need to intervene at each of three key points, in order to address the issue of overcrowding and its associated problems.

  2. A population-based study of paediatric emergency department and office visits for concussions from 2003 to 2010.

    Science.gov (United States)

    Macpherson, Alison; Fridman, Liraz; Scolnik, Michal; Corallo, Ashley; Guttmann, Astrid

    2014-12-01

    There is a paucity of information regarding descriptive epidemiology of paediatric concussions over time, and few studies include both emergency department (ED) and physician office visits. To describe trends in visits for paediatric concussions in both EDs and physician offices according to age and sex. A secondary objective was to describe the cause of concussion for children treated in EDs. A retrospective, population-based study using linked health administrative data from all concussion-related visits to the ED or a physician office by school-age children and youth (three to 18 years of age) in Ontario between April 1, 2003 and March 3, 2011 was conducted. The number of children evaluated in both EDs and a physician offices increased between 2003 and 2010, and this linear trend was statistically significant (P=0.002 for ED visits and P=0.001 for office visits). The rate per 100,000 increased from 466.7 to 754.3 for boys and from 208.6 to 440.7 for girls during the study period. Falls accounted for approximately one-third of the paediatric concussions. Hockey/skating was the most common specific cause of paediatric sports-related concussions. The increasing use of health care services for concussions is likely related to changes in incidence over time and increased awareness of concussion as a health issue. Evidence-based prevention initiatives to help reduce the incidence of concussion are warranted, particularly in sports and recreation programs.

  3. A Survey of 25 North Carolina Health Departments/Districts on Knowledge, Attitudes, and Current Practices to Seeking Reimbursement From Third-Party Payers for Sexually Transmitted Disease Services.

    Science.gov (United States)

    Kovar, Cheryl L; Carter, Susan

    2017-06-01

    North Carolina Administrative Code 10A Chapter 41A.0204 (a) states "local health departments shall provide diagnosis, testing, treatment, follow-up, and preventive services for syphilis, gonorrhea, chlamydia, … These services shall be provided upon request and at no charge to the patient." Although health departments/districts may bill governmental or nongovernmental insurance providers for sexually transmitted disease (STD) services, current billing practices are unknown. Because of its high STD morbidity, the eastern region of North Carolina was targeted. Using a Qualtrics Survey developed to measure attitudes as well as knowledge and reimbursement practices, this descriptive study was performed with staff from 25 eastern North Carolina health departments/districts. Snowball sampling was used to allow for greater inclusion. Analysis of data was performed at the individual and agency level based on types of questions in the survey. For knowledge, 87% of the respondents reported being aware of the possibility of reimbursement from third-party payers/commercial insurance carriers for STD services. In regard to current billing of these services, 20 health departments/districts (80%) reported they were billing these payers. When asked about their attitude of seeking reimbursement from commercial insurance, 92% reported it was acceptable or very acceptable. But when asked if STD services should remain a free service at the health department, 55% supported and 45% did not. These data provide a knowledge base for assisting health departments/districts to move forward in improving STD services as well as maximizing reimbursement from third-party payers/commercial insurance carriers when possible.

  4. Encountering anger in the emergency department: identification, evaluations and responses of staff members to anger displays

    NARCIS (Netherlands)

    A. Cheshin; A. Rafaeli; A. Eisenman

    2012-01-01

    Background. Anger manifestations in emergency departments (EDs) occur daily, interrupting workflow and exposing staff to risk. Objectives. How staff assess and recognize patients’ angry outbursts in EDs and elucidate responses to anger expressions, while considering effects of institution guidelines

  5. Emergency department crowding and risk of preventable medical errors.

    Science.gov (United States)

    Epstein, Stephen K; Huckins, David S; Liu, Shan W; Pallin, Daniel J; Sullivan, Ashley F; Lipton, Robert I; Camargo, Carlos A

    2012-04-01

    The objective of the study is to determine the association between emergency department (ED) crowding and preventable medical errors (PME). This was a retrospective cohort study of 533 ED patients enrolled in the National ED Safety Study (NEDSS) in four Massachusetts EDs. Individual patients' average exposure to ED crowding during their ED visit was compared with the occurrence of a PME (yes/no) for the three diagnostic categories in NEDSS: acute myocardial infarction, asthma exacerbation, and dislocation requiring procedural sedation. To accommodate site-to-site differences in available administrative data, ED crowding was measured using one of three previously validated crowding metrics (ED Work Index, ED Workscore, and ED Occupancy). At each site, the continuous measure was placed into site-specific quartiles, and these quartiles then were combined across sites. We found that 46 (8.6%; 95% confidence interval, 6.4-11.3%) of the 533 patients experienced a PME. For those seen during higher levels of ED crowding (quartile 4 vs. quartile 1), the occurrence of PMEs was more than twofold higher, both on unadjusted analysis and adjusting for two potential confounders (diagnosis, site). The association appeared non-linear, with most PMEs occurring at the highest crowding level. We identified a direct association between high levels of ED crowding and risk of preventable medical errors. Further study is needed to determine the generalizability of these results. Should such research confirm our findings, we would suggest that mitigating ED crowding may reduce the occurrence of preventable medical errors.

  6. Better communication in the emergency department.

    Science.gov (United States)

    Burley, Duncan

    2011-05-01

    The emergency nurse practitioner (ENP) role has evolved since the 1980s, when it was introduced into emergency departments (EDs) in the UK (Tye 1997). Nowadays, ENPs see, treat and refer or discharge patients autonomously. They also document patient histories and are expected to communicate effectively with patients who have complex needs. The role has expanded for several reasons, including the need to reduce doctors' working hours, but mainly to make more flexible use of services. Meanwhile, as ED attendances increase (Thompson et aL 2010), ENPs are placed under increasing pressure and may be forced to spend less time with patients than was expected of them when the ENP role was originally devised. This can affect patient history taking and communication, and may lead to poorer patient outcomes and satisfaction. This article concerns a literature review undertaken by the author to identify and overcome the limitations to effective history taking and communication among ENPs. It also highlights good practice in the management of emergency and urgent-care patients with complex needs. There is little primary research on history taking and communication pressures in emergency care but, after a systematic literature search of the British Nursing Index, CINAHL and Medline databases, the author identified eight research articles on the subject. Three themes emerged from the review: interruptions, overload and barriers. According to the review findings, interruptions occur more often in EDs than in primary care settings, and senior doctors and senior nurses are interrupted more often than other staff. These interruptions can increase information overload, leading to medical errors and adverse clinical outcomes. The main barrier to effective history taking is a failure to understand patients who have poor command of the English language. The author's recommendations for practice include increasing the number of staff and training them in managing pressure, communicating

  7. Department of Energy Technology.

    Science.gov (United States)

    1988-03-01

    I-AL95 6A4~LA 1 UWCL*SSZFZKD F/G LO/1 H?. . 12 113l2i 2 -lll 1 36 II IIlIg.- I1I25 11UG’-- 11.6 L 0 tRiso -R-559 Department of N Energy Technology...of neutron flux distribution and absolute thermal flux. - Neutron activation analysis . - Gamma spectroscopy with scintillation detector. - Measurements...Electric design, and a very detailed experimental program has been conduc’ed for the two first fuel cycles (General Electric, 1976 ), yielding a unique

  8. Impact of the ABCDE triage on the number of patient visits to the emergency department

    Directory of Open Access Journals (Sweden)

    Menezes Ricardo

    2010-06-01

    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 specialists are responsible for the initial assessment and treatment. They, thereby, also regulate referral and access to tertiary 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 those patients who need it the most. Methods A face-to-face triage system based on the letters A (patient 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 was applied in the main ED in the City of Vantaa, Finland (Peijas Hospital as an attempt to provide immediate treatment for the most acute patients. The first step was an initial patient assessment by a health care professional (triage nurse. If the patient was not considered to be in need of immediate care (i.e. A-D he was allocated to group E and examined after the more urgent patients were treated. The introduction of this triage system was combined with information to the public on the "correct" use of emergency services. The primary aim of this study was to assess whether the flow of patients was changed by implementing the ABCDE-triage system in the combined ED. To study the effect of the intervention on patient flow, numbers monthly visits to doctors were recorded before and after intervention in Peijas ED and, simultaneously, in control EDs (Myyrmäki in Vantaa, Jorvi and Puolarmetsä in Espoo. To study does the implementation of the triage system redirect patients to other health services, numbers of monthly visits to doctors were also scored in the private health care and public

  9. Fire Department Emergency Response

    Energy Technology Data Exchange (ETDEWEB)

    Blanchard, A. [Westinghouse Savannah River Company, AIKEN, SC (United States); 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.

  10. Etiology of Shock in the Emergency Department

    DEFF Research Database (Denmark)

    Holler, Jon Gitz; Jensen, Helene Kildegaard; Henriksen, Daniel Pilsgaard

    2017-01-01

    INTRODUCTION: The knowledge of the etiology and associated mortality of undifferentiated shock in the emergency department (ED) is limited. We aimed to describe the etiology based proportions and incidence rates (IR) of shock, as well as the associated mortality in the ED. METHODS: Population......-based cohort study at an University Hospital ED in Denmark from January 1, 2000, to December 31, 2011. Patients aged ≥18 years living in the ED-catchment area (N = 225,000) with a first time ED presentation with shock (n = 1,646) defined as hypotension (systolic blood pressure ≤100 mmHg)) and ≥1 organ failures...... were included. Discharge diagnoses defined the etiology and were grouped as; distributive septic shock (SS), distributive non-septic shock (NS)), cardiogenic shock (CS), hypovolemic shock (HS), obstructive shock (OS) and other conditions (OC). Outcomes were etiology-based characteristics, annual IR per...

  11. Transdisciplinary care in the emergency department: A qualitative analysis.

    Science.gov (United States)

    Innes, Kelli; Crawford, Kimberley; Jones, Tamsin; Blight, Renee; Trenham, Catherine; Williams, Allison; Griffiths, D; Morphet, Julia

    2016-03-01

    In response to increasing demands some emergency departments have introduced transdisciplinary care coordination teams. Such teams comprise staff from multiple disciplines who are trained to perform roles outside their usual scope of practice. This study aimed to critically evaluate the patient, carer and ED staff perceptions of the transdisciplinary model of care in an emergency department in a Melbourne metropolitan hospital. The evaluation of the transdisciplinary team involved interviews with patients and carers who have received the transdisciplinary team services, and focus groups with emergency nursing and transdisciplinary team staff. Analysis of the data revealed that the transdisciplinary model provided an essential service, where staff members were capable of delivering care across all disciplines. The ability to perform comprehensive patient assessments ensured safe discharge, with follow-up services in place. The existence of this team was seen to free up time for the emergency nursing staff, enabling them to see other patients, and improving department efficiency while providing quality care and increasing staff satisfaction. This study identified several important factors which contributed to the success of the transdisciplinary team, which was well integrated into the larger emergency department team. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Emergency Department: Basic Prerequisites for the Upgrade of the NHS

    Directory of Open Access Journals (Sweden)

    Georgios Charalambous

    2012-01-01

    Full Text Available The Emergency Department is an autonomous hospital unit comprised of doctors, nurses and paramedics, who deliver emergency care on a 24-hour basis. It provides an interface between patients and their specialized treatment, as well as a point of contact between primary and tertiary care. The need for medical services has increased disproportionately to the available resources for medical care; a fact that has given rise to difficulties in maintaining the effective function of the Emergency Department. As a result, the provision of high standard services is not ensured. In order to help establish and maintain the effective operation of the Emergency Department, new methods should be established which efficiently utilize existing and up-and-coming information and communication technologies. This will allow for the acceleration of the Department’s operational procedures, more effective treatment of emergency cases, and ultimately assists in maintaining a high level of patient satisfaction. The expansion and development of specific services offered by the ED will also assist in the Department becoming a system of qualitative assessment for primary care. This would lead to a better outcome for emergency cases as a result of fast, spherical and effective treatment.

  13. Ridgefield - Invasive Plant Targeted Control and ED/RR

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The proposed project is a part of the Refuge invasive species management program and will help achieve goals and priority habitats identified in the Refuge CCP. The...

  14. Ridgefield Complex - Invasive Plant ED/RR Search 2015

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The proposed project is a part of the Gorge NWRs’ invasives management program and will help achieve goals and improve targeted habitats identified in the Refuges’...

  15. Teaching and Assessing ED Handoffs: A Qualitative Study Exploring Resident, Attending, and Nurse Perceptions

    Directory of Open Access Journals (Sweden)

    Moira Flanigan

    2015-10-01

    Full Text Available Introduction: The Accreditation Council for Graduate Medical Education requires that residency programs ensure resident competency in performing safe, effective handoffs. Understanding resident, attending, and nurse perceptions of the key elements of a safe and effective emergency department (ED handoff is a crucial step to developing feasible, acceptable educational interventions to teach and assess this fundamental competency. The aim of our study was to identify the essential themes of ED-based handoffs and to explore the key cultural and interprofessional themes that may be barriers to developing and implementing successful ED-based educational handoff interventions. Methods: Using a grounded theory approach and constructivist/interpretivist research paradigm, we analyzed data from three primary and one confirmatory focus groups (FGs at an urban, academic ED. FG protocols were developed using open-ended questions that sought to understand what participants felt were the crucial elements of ED handoffs. ED residents, attendings, a physician assistant, and nurses participated in the FGs. FGs were observed, hand-transcribed, audiorecorded and subsequently transcribed. We analyzed data using an iterative process of theme and subtheme identification. Saturation was reached during the third FG, and the fourth confirmatory group reinforced the identified themes. Two team members analyzed the transcripts separately and identified the same major themes. Results: ED providers identified that crucial elements of ED handoff include the following: 1 Culture (provider buy-in, openness to change, shared expectations of sign-out goals; 2 Time (brevity, interruptions, waiting; 3 Environment (physical location, ED factors; 4 Process (standardization, information order, tools. Conclusion: Key participants in the ED handoff process perceive that the crucial elements of intershift handoffs involve the themes of culture, time, environment, and process. Attention

  16. 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.

  17. 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.

  18. Identification of women exposed to acute physical intimate partner violence in an emergency department setting in Finland.

    Science.gov (United States)

    Leppäkoski, Tuija; Astedt-Kurki, Päivi; Paavilainen, Eija

    2010-12-01

    Intimate partner violence (IPV) is seen as a serious health risk factor for women with significant acute and long-term health consequences and it affects women from all ethnic and socioeconomic groups. Knowledge of these consequences of IPV may help emergency department (ED) professionals to identify these women and provide them with appropriate care, including information on a variety of community services, and refer those women to such services if necessary. The study aimed to describe the frequency of ED visits by women exposed to physical intimate partner violence as estimated by ED professionals (nurses, practical nurses, emergency medical technicians) and identification of acute IPV. In this study 'partner' is defined as a woman's husband, former husband, current or former cohabitant or partner. This design was used as part of a larger, descriptive, cross-sectional multi-centre and multi-method study. Data were collected from 28 EDs in 13 Finnish hospital districts. Altogether 488 questionnaires were returned, which yielded a response rate of 51%. The data were analysed using descriptive statistics and quantitative content analysis. Findings showed that 48% (n = 231) of the ED professionals reported that they encountered women in IPV relationships at least once a month. Over one-fifth of the ED professionals reported having repeatedly encountered the same women visiting the ED for IPV related injuries. Over half of the participants reported having problems 'often' or 'now and then' when identifying women exposed to IPV. Those with training on IPV estimated that they had identified women exposed to IPV more often. To conclude, the research suggests that improvement of identification of acute IPV requires that training be arranged and jointly agreed written procedures for handling IPV be introduced. © 2010 The Authors. Scandinavian Journal of Caring Sciences © 2010 Nordic College of Caring Science.

  19. 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.

  20. Tobacco smoking by adult emergency department patients in Australia: a point-prevalence study.

    Science.gov (United States)

    Weiland, Tracey; Jelinek, George A; Taylor, Simone E; Taylor, David McD

    2016-07-15

    Objectives and importance of study: Tobacco smoking is the leading single cause of preventable death. International findings suggest that rates of smoking are higher among emergency department (ED) patients than the general population, suggesting that the ED may be a strategic location in which to initiate smoking cessation programs. We aimed to determine the prevalence of smoking among adult ED patients in Australia, their desire for smoking cessation and preferred methods of cessation. Point-prevalence survey Method: A sample of adult ED patients was recruited from two tertiary referral hospital EDs. Participants were asked whether or not they currently smoked. Smokers were asked 15 additional questions, including about their readiness for smoking cessation. Demographics were collected from patients, and ED presentation characteristics were collected from medical records. Of 443 consecutive ED patients, 348 were eligible and 338 consented to participate. Data for 335 participants were available for analysis and 78 (23.3%; 95% confidence interval [CI] 19.1, 28.1) reported being current smokers. The mean age of smokers was 42.1 years, and 64.1% were male. Forty-one per cent (31/75) reported difficulty refraining from smoking, 78.1% (57/73) anticipated health problems because of smoking and 69.7% (53/76) had a desire to quit. Overall, 23/61 (37.7% of smokers) had a desire to cease smoking in the next month. The majority (44/73, 60.3%) were willing to undergo brief counselling. Multisession face-to-face counselling was most commonly preferred (22/55, 40.0%) and more than one-third (20/55, 36.4%) preferred group counselling. A session with an ED doctor (6/55, 10.9%) and multiple telephone-delivered interventions (7/55, 12.7%) were least preferred. Smoking is more prevalent among ED patients than statistics reported for the general population. Delivery of appropriate brief interventions suited to the stage of change should be trialled, along with referral from ED to

  1. 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......-based cohort study at an University Hospital ED in Denmark from January 1, 2000, to December 31, 2011. All patients aged ≥18 years living in the hospital catchment area with a first time ED presentation with shock (n = 1646) defined as hypotension (systolic blood pressure (SBP) ≤100 mmHg)) and ≥1 organ...... 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...

  2. Reimbursement for Emergency Department Electrocardiography and Radiograph Interpretations: What Is It Worth for the Emergency Physician

    Directory of Open Access Journals (Sweden)

    Wu, Tina

    2009-08-01

    Full Text Available Background: Physician reimbursement laws for diagnostic interpretive services require that only those services provided contemporaneously and /or contribute directly to patient care can be billed for. Despite these regulations, cardiologists and radiologists in many hospitals continue to bill for ECG and plain film diagnostic services performed in the emergency department (ED. The reimbursement value of this care, which is disconnected in time and place from the ED patient encounter, is unknown. In a California community ED with a 32,000 annual census, the emergency physicians (EPs alone, by contract, bill for all ECG readings and plain film interpretations when the radiologists are not available to provide contemporaneous readings.Objectives: To determine the impact of this billing practice on actual EP reimbursement we undertook an analysis that allows calculation of physician reimbursement from billing data.Methods: An IRB-approved analysis of 12 months of billing data cleansed of all patient identifiers was undertaken for 2003. From the data we created a descriptive study with itemized breakdown of reimbursement for radiograph and ECG interpretive services (procedures and the gross resultant physician income.Results: In 2003 EPs at this hospital treated patients during 32,690 ED visits. Total group income in 2003 for radiographs was $173,555 and $91,025 for ECGs, or $19/EP hour and $6/EP hour respectively. For the average full-time EP, the combined total is $2537/month or $30,444 per annum, per EP. This is $8/ED visit (averaged across all patients.Conclusion: As EP-reimbursement is challenged by rising malpractice premiums, uninsured patients, HMO contracts, unfunded government mandates and state budgetary shortfalls, EPs are seeking to preserve their patient services and resultant income. They should also be reimbursed for those services and the liability that they incur. The reimbursement value of ECGs and plain film interpretations to the

  3. States leverage telepsychiatry solutions to ease ED crowding, accelerate care.

    Science.gov (United States)

    2015-02-01

    Many states are having success turning to telepsychiatry-based solutions to connect mental health patients with needed care while also decompressing crowded EDs. Just one year into a statewide telepsychiatry initiative in North Carolina (NC-STeP), administrators say the approach has saved as much as $7 million, and hospital demand for the service is higher than anticipated. In Texas, mental health emergency centers (MHEC) that use telepsychiatry to connect patients in rural areas with needed psychiatric care are freeing up EDs to focus on medical care. In just 11 months, 91 North Carolina hospitals have at least started the process to engage in NC-STeP. Much of the savings from NC-STeP come from involuntary commitment orders being overturned as a result of the telepsychiatry consults, reducing the need for expensive inpatient care. Implementing NC-STeP has involved multiple hurdles including credentialing difficulties and technical/firewall challenges. The Texas model provides 24/7 availability of psychiatrists via telemedicine through a network of MHECs. In-person staff at the MHECs perform basic screening tests and blood draws so that medical clearance can be achieved without the need for an ED visit in most cases. Funding for the MHECs comes from the state, hospitals in the region, and local governmental authorities that reap savings or benefits from the initiative.

  4. 消毒供应中心落实优质护理服务的实践%The practice and effect evaluation of high quality nursing service mode in Central Sterile Supply Department

    Institute of Scientific and Technical Information of China (English)

    刘启华; 郭健

    2011-01-01

    Objective: To explore high quality nursing service mode in Central Sterile Supply Department. Methods: We trained nursing staff by standardized nursing service communicating skills, strengthened the whole department with nursing culture construction,optimized nursing service flow with the center of service objects and implemented high quality nursing service measures. Results: The satisfaction of wards, outpatient clinics,surgical departments were obviously improved (P < 0.01). Conclusion: High quality nursing service mode in Central Sterile Supply Department effectively improves the satisfaction of wards, outpatient clinics and surgical department, mobilizes the enthusiasm and creativity of nursing staff and improves nursing service quality and credibility.%目的:探讨消毒供应中心优质护理服务模式,提升护理服务品质.方法:对工作人员实行规范化护理服务沟通培训,加强科室护理文化建设,以服务对象为中心优化护理服务流程,落实优质护理服务举措.结果:病房、门诊、手术科室满意度提高(P<0.01).结论:消毒供应中心优质护理服务模式有效提高了病房、门诊,手术科室的满意度,调动了工作人员的积极性和创造性,提高了护理工作质量,提升了消毒供应中心护理服务品质及诚信度.

  5. Applicability of the modified Emergency Department Work Index (mEDWIN) at a Dutch emergency department.

    Science.gov (United States)

    Brouns, Steffie H A; van der Schuit, Klara C H; Stassen, Patricia M; Lambooij, Suze L E; Dieleman, Jeanne; Vanderfeesten, Irene T P; Haak, Harm R

    2017-01-01

    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, poccupancy 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.

  6. 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.

  7. A prospective, non-interventional study of assessment and treatment adequacy of pain in the emergency department of a tertiary care cancer hospital

    Directory of Open Access Journals (Sweden)

    P N Jain

    2013-01-01

    Full Text Available Introduction: Pain is the most common reason for emergency department (ED visits by the cancer patients. Treatment inconsistency and inadequacy are reported worldwide in the management of ED pain. We conducted a non-interventional observational study of 100 patients visiting ED with moderate to severe pain in a tertiary care cancer center. Aims: The goal of this study was to describe the characteristics of pain and its treatment by oncologists in ED. Materials and Methods: Management of 100 adult patients with complaints of moderate to severe pain was observed by the investigator in ED. Treatment was provided by the doctors of respective oncological services. Later, patients were interviewed by the investigator to collect data about the details of their pain and treatment adequacy. Results: On arrival to ED, about 65% patients reported severe pain, however no formal pain assessment was performed and no patient received strong opioids. Poor compliance for prescribed analgesic medications was noted in a large number of patients (31%, primarily due to suboptimal pain relief and lack of awareness. Protocol based analgesic treatment was non-existent in ED. Majority of patients remained in significant pain after 30 min of analgesic administration and 24% patients could never achieve more than 50% pain relief at the time of discharge. Conclusion: Due to lack of formal pain assessment and laid down protocols, suboptimal pain management is commonly prevalent in ED. Use of strong opioids continues to be scarce in management of severe pain. There is a need to formulate pain management protocols for ED pain.

  8. Plant immunity: the EDS1 regulatory node.

    Science.gov (United States)

    Wiermer, Marcel; Feys, Bart J; Parker, Jane E

    2005-08-01

    ENHANCED DISEASE SUSCEPTIBILITY 1 (EDS1) and its interacting partner, PHYTOALEXIN DEFICIENT 4 (PAD4), constitute a regulatory hub that is essential for basal resistance to invasive biotrophic and hemi-biotrophic pathogens. EDS1 and PAD4 are also recruited by Toll-Interleukin-1 receptor (TIR)-type nucleotide binding-leucine rich repeat (NB-LRR) proteins to signal isolate-specific pathogen recognition. Recent work points to a fundamental role of EDS1 and PAD4 in transducing redox signals in response to certain biotic and abiotic stresses. These intracellular proteins are important activators of salicylic acid (SA) signaling and also mediate antagonism between the jasmonic acid (JA) and ethylene (ET) defense response pathways. EDS1 forms several molecularly and spatially distinct complexes with PAD4 and a newly discovered in vivo signaling partner, SENESCENCE ASSOCIATED GENE 101 (SAG101). Together, EDS1, PAD4 and SAG101 provide a major barrier to infection by both host-adapted and non-host pathogens.

  9. Emergency Department Visits for Homelessness or Inadequate Housing in New York City before and after Hurricane Sandy.

    Science.gov (United States)

    Doran, Kelly M; McCormack, Ryan P; Johns, Eileen L; Carr, Brendan G; Smith, Silas W; Goldfrank, Lewis R; Lee, David C

    2016-04-01

    Hurricane Sandy struck New York City on October 29, 2012, causing not only a large amount of physical damage, but also straining people's health and disrupting health care services throughout the city. In prior research, we determined that emergency department (ED) visits from the most vulnerable hurricane evacuation flood zones in New York City increased after Hurricane Sandy for several medical diagnoses, but also for the diagnosis of homelessness. In the current study, we aimed to further explore this increase in ED visits for homelessness after Hurricane Sandy's landfall. We performed an observational before-and-after study using an all-payer claims database of ED visits in New York City to compare the demographic characteristics, insurance status, geographic distribution, and health conditions of ED patients with a primary or secondary ICD-9 diagnosis of homelessness or inadequate housing in the first week after Hurricane Sandy's landfall versus the baseline weekly average in 2012 prior to Hurricane Sandy. We found statistically significant increases in ED visits for diagnosis codes of homelessness or inadequate housing in the week after Hurricane Sandy's landfall. Those accessing the ED for homelessness or inadequate housing were more often elderly and insured by Medicare after versus before the hurricane. Secondary diagnoses among those with a primary ED diagnosis of homelessness or inadequate housing also differed after versus before Hurricane Sandy. These observed differences in the demographic, insurance, and co-existing diagnosis profiles of those with an ED diagnosis of homelessness or inadequate housing before and after Hurricane Sandy suggest that a new population cohort-potentially including those who had lost their homes as a result of storm damage-was accessing the ED for homelessness or other housing issues after the hurricane. Emergency departments may serve important public health and disaster response roles after a hurricane, particularly for

  10. 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…

  11. 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.

  12. A National Survey of Emergency Department Triage in Sweden

    Science.gov (United States)

    Göransson, Katarina; Ehrenberg, Anna; Ehnfors, Margareta

    2003-01-01

    The aim of this study was to identify the organisation of and knowledge about triage work in Swedish emergency departments (ED) as a first step to understanding what is necessary for decision support in ED triage systems in Sweden. A national survey using telephone interviews for data collection was used. Results showed great variety in how work regarding ED triage is organised and performed. The variety occurs in several areas including education, personnel performing triage, facilities available and scales used. PMID:14728356

  13. REASONS TO ACCESS TO A PEDIATRIC EMERGENCY DEPARTMENT

    OpenAIRE

    Freitas, Ana Cristina; Moreira, Ana Raquel; Tomé, Soraia; Cardoso, Raquel

    2016-01-01

    Introduction: Hospital emergency department (ED) utilization by non-urgent situations is common and leads to worse care, patients and professionals dissatisfaction and increasing costs.Objective: To determine the reasons and adequacy for the use of a hospital pediatric ED. Methods: Descriptive, cross-sectional study between October 10 and December 31 2013 at an hospital pediatric ED, through analysis of questionnaires completed by child caretakers and with clinical data provided by the doctor...

  14. Emergency department transfers and hospital admissions from residential aged care facilities: a controlled pre-post design study.

    Science.gov (United States)

    Hullick, Carolyn; Conway, Jane; Higgins, Isabel; Hewitt, Jacqueline; Dilworth, Sophie; Holliday, Elizabeth; Attia, John

    2016-05-12

    Older people living in Residential Aged Care Facilities (RACF) are a vulnerable, frail and complex population. They are more likely than people who reside in the community to become acutely unwell, present to the Emergency Department (ED) and require admission to hospital. For many, hospitalisation carries with it risks. Importantly, evidence suggests that some admissions are avoidable. A new collaborative model of care, the Aged Care Emergency Service (ACE), was developed to provide clinical support to nurses in the RACFs, allowing residents to be managed in place and avoid transfer to the ED. This paper examines the effects of the ACE service on RACF residents' transfer to hospital using a controlled pre-post design. Four intervention RACFs were matched with eight control RACFs based on number of total beds, dementia specific beds, and ratio of high to low care beds in Newcastle, Australia, between March and November 2011. The intervention consisted of a clinical care manual to support care along with a nurse led telephone triage line, education, establishing goals of care prior to ED transfer, case management when in the ED, along with the development of collaborative relationships between stakeholders. Outcomes included ED presentations, length of stay, hospital admission and 28-day readmission pre- and post-intervention. Generalised estimating equations were used to estimate mean differences in outcomes between intervention and controls RACFs, pre- and post-intervention means, and their interaction, accounting for repeated measures and adjusting for matching factors. Residents had a mean age of 86 years. ED presentations ranged between 16 and 211 visits/100 RACF beds/year across all RACFs. There was no overall reduction in ED presentations (OR = 1.17, p = 0.56) with the ACE intervention. However, when compared to the controls, the intervention group reduced their ED length of stay by 45 min (p = 0.0575), and was 40 % less likely to be admitted

  15. Emergency department utilization rates and modalities among immigrant population. A 5-year survey in a large Italian urban emergency department

    Directory of Open Access Journals (Sweden)

    Marcello Zinelli

    2014-04-01

    Full Text Available The rates and modalities of healthcare services utilization for migrant population may differ from natives, since the health needs of the former are influenced by some factors such as health status, self-perceived needs, healthseeking behavior, language barriers and cultural differences. Only scarce and often conflicting data have been published so far on migrants’ utilization of healthcare services in Europe, and even less data are available on emergency departments (EDs. The aim of this cross-sectional study was to compare utilization rates and modalities of presentation to the large urban ED of the University Hospital of Parma, Italy (averaging 85,000 visits per year, by Italian native and foreign-born populations during 2008-2012. Throughout the study period 424,466 ED visits were recorded, 64,435 (15.4% of which by foreign-born patients. A significant difference between utilization rates was observed for all the triage-codes, with higher rates for foreign-born low-acuity codes (green plus white codes: 87.5 vs 73.9, P<0.0001 and lower rates for high-acuity codes (yellow plus red codes: 12.5 vs 26.1%, P<0.0001. The utilization rate was 253.9 visits per 1000 inhabitants for the Italian-native group and 309.7 per 1000 for the foreign-born group (odds ratio 1.23; 95% CI: 1.01-1.48; P=0.034. Different modalities of presentation were also observed, with a high rate of selfreferrals (82.3 vs 71.4%, P<0.001. The results of this study suggest that a better knowledge of available Italian healthcare services among immigrants is advisable and should be encouraged.

  16. 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

  17. Complaints and Diagnoses of Emergency Department Patients in the Netherlands: A Comparative Study of Integrated Primary and Emergency Care

    OpenAIRE

    2015-01-01

    OBJECTIVE: In the Netherlands, an increasing number of emergency departments (EDs) and general practitioner cooperatives collaborate by creating one Emergency-Care-Access-Point (ECAP). This has resulted in fewer patients at ECAP EDs. The objective of this study was to explore differences in patient characteristics, presented complaints and ED discharge diagnoses between EDs with an ECAP and EDs without an ECAP. METHODS: A retrospective observational study was performed with 1800 consecutive p...

  18. Emergency Department Overcrowding and Ambulance Turnaround Time.

    Science.gov (United States)

    Lee, Yu Jin; Shin, Sang Do; Lee, Eui Jung; Cho, Jin Seong; Cha, Won Chul

    2015-01-01

    The aims of this study were to describe overcrowding in regional emergency departments in Seoul, Korea and evaluate the effect of crowdedness on ambulance turnaround time. This study was conducted between January 2010 and December 2010. Patients who were transported by 119-responding ambulances to 28 emergency centers within Seoul were eligible for enrollment. Overcrowding was defined as the average occupancy rate, which was equal to the average number of patients staying in an emergency department (ED) for 4 hours divided by the number of beds in the ED. After selecting groups for final analysis, multi-level regression modeling (MLM) was performed with random-effects for EDs, to evaluate associations between occupancy rate and turnaround time. Between January 2010 and December 2010, 163,659 patients transported to 28 EDs were enrolled. The median occupancy rate was 0.42 (range: 0.10-1.94; interquartile range (IQR): 0.20-0.76). Overcrowded EDs were more likely to have older patients, those with normal mentality, and non-trauma patients. Overcrowded EDs were more likely to have longer turnaround intervals and traveling distances. The MLM analysis showed that an increase of 1% in occupancy rate was associated with 0.02-minute decrease in turnaround interval (95% CI: 0.01 to 0.03). In subgroup analyses limited to EDs with occupancy rates over 100%, we also observed a 0.03 minute decrease in turnaround interval per 1% increase in occupancy rate (95% CI: 0.01 to 0.05). In this study, we found wide variation in emergency department crowding in a metropolitan Korean city. Our data indicate that ED overcrowding is negatively associated with turnaround interval with very small practical significance.

  19. Prevalence of victims of violence admitted to an emergency department

    Science.gov (United States)

    Hofner, M; Python, N; Martin, E; Gervasoni, J; Graz, B; Yersin, B

    2005-01-01

    Objective: To collect data on the consultation frequency and demographic profile of victims of violence attending an emergency department (ED) in Switzerland. Methods: We undertook screening of all admitted adult patients (>16 years) in the ED of the CHUV, Lausanne, Switzerland, over a 1 month period, using a modified version of the Partner Violence Screen questionnaire. Exclusionary criteria were: life threatening injury (National Advisory Committee on Aeronautics score ⩾4), or inability to understand or speak French, to give oral informed consent, or to be questioned without a family member or accompanying person being present. Data were collected on history of physical and/or psychological violence during the previous 12 months, the type of violence experienced by the patient, and if violence was the reason for the current consultation. Sociodemographic data were obtained from the registration documents. Results: The final sample consisted of 1602 patients (participation rate of 77.2%), with a refusal rate of 1.1%. Violence during the past 12 months was reported by 11.4% of patients. Of the total sample, 25% stated that violence was the reason for the current consultation; of these, 95% of patients were confirmed as victims of violence by the ED physicians. Patients reporting violence were more likely to be young and separated from their partner. Men were more likely to be victims of public violence and women more commonly victims of domestic violence. Conclusions: Based on this monthly prevalence rate, we estimate that over 3000 adults affected by violence consult our ED per annum. This underlines the importance of the problem and the need to address it. Health services organisations should establish measures to improve quality of care for victims. Guidelines and educational programmes for nurses and physicians should be developed in order to enhance providers' skills and basic knowledge of all types of violence, how to recognise and interact appropriately

  20. Teams Are Now Used by Many Technical Services Departments in Academic Libraries. A Review of: Zhu, L. (2011. Use of teams in technical services in academic libraries. Library Collections, Acquisitions, & Technical Services 35, 69-82. doi:10.1016/j.lcats.2011.03.013

    Directory of Open Access Journals (Sweden)

    Kirsty Thomson

    2012-06-01

    Full Text Available Objective – An investigation of the use ofteams in technical services, provision oftraining on team-working, characteristics oftechnical services teams, and the effectivenessof teams.Design – Survey comprising of 19 closedquestions and one open question.Setting – Technical services departments inacademic libraries.Subjects– Responses were received from 322library staff members. Of those, 294 answeredthe survey question about team-basedtechnical services and 55.9% of respondentscompleted the full survey.Methods – An online survey was promotedvia seven technical services electronic mail listsand was conducted using SurveyMonkey.Main Results – The survey found that 39% oftechnical services were entirely team-based,18% were partly team-based, and 43% did notuse teams. Information was gathered about thenumber of teams, team nomenclature, andhow long teams have been used. This researchhighlighted the lack of provision of trainingand documentation about working in teams.Conclusion – Many respondents have team-basedtechnical services, and most participantsfound that working in teams had a positiveimpact. A systematic application of this surveyis planned for the future.

  1. 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

  2. Urgent Care Transfers to an Academic Pediatric Emergency Department.

    Science.gov (United States)

    McCarthy, Jennifer L; Clingenpeel, Joel M; Perkins, Amy M; Eason, Margaret K

    2017-10-02

    The aim of this study was to investigate the hypothesis that a significant percentage of urgent care center to pediatric ED transfers can be discharged home without emergency department (ED) resource utilization. A retrospective chart review was completed for a 6-month period on all patients transferred from urgent care centers. A data collection tool focusing on demographics, diagnoses, reason for transfer, ED resource utilization, ED disposition, and 72-hour ED return was used. Each encounter was classified as "urgent" or "nonurgent" based on resource utilization criteria. Descriptive statistics were reported for demographics, encounter data, and 72-hour ED return stratified by nonurgent versus urgent classification. Two-sample t, χ, and Fisher exact tests were used to assess differences in characteristics between the nonurgent and urgent groups. One hundred nine patients met inclusion criteria. Of these, 93 (85%) were discharged from the ED. Twenty nine (27%) of the transferred patients were discharged without ED resource utilization. Seventy-two-hour return was noted for only 1 patient who was again discharged at the subsequent encounter. A large proportion of patients transferred from urgent care centers were directly discharged from the ED without any ED resource utilization. Eliminating or reducing such transfers has the potential to limit the amount of nonurgent ED visits, thus producing cost savings and better patient care.

  3. 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.

  4. Characteristics of frequent emergency department presenters to an Australian emergency medicine network

    Directory of Open Access Journals (Sweden)

    Markham Donna

    2011-12-01

    Full Text Available Abstract Background To describe the characteristics of emergency department (ED patients defined as frequent presenters (FP presenting to an Australian emergency department network and compare these with a cohort of non-frequent presenters (NFP. Method A retrospective chart review utilising an electronic emergency medicine patient medical record database was performed on patients presenting to Southern Health EDs from March 2009 to March 2010. Non-frequent presenters were defined as patients presenting less than 5 times and frequent presenters as presenting 8 or more times in the study period. Characteristics of both groups were described and compared. Results During the 12-month study period there were 540 FP patients with 4549 admissions and 73,089 NFP patients with 100,943 admissions. FP patients were slightly older with a significant increase in frequency of patients between the ages of 70 to 79 years and they were more likely to be divorced or separated than NFP patients. Frequent presenters to the emergency department were more likely to utilise the ambulance service to arrive at the hospital, or in the custody of police than NFP patients. FPs were more likely to be admitted to hospital, more likely to have an admission to a mental health bed than NFP patients and more likely to self-discharge from the emergency department while waiting for care. Conclusions There are major implications for the utilisation of limited ED resources by frequent presenters. By further understanding the characteristics of FP we may be able to address the specific health care needs of this population in more efficient and cost effective ways. Further research analysing the effectiveness of targeted multidisciplinary interventions aiming to reduce the frequency of ED attendances may be warranted.

  5. 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

  6. 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.…

  7. 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.…

  8. Unscheduled return visits to a Dutch inner-city emergency department

    NARCIS (Netherlands)

    M.C. van der Linden (M. Christien); R. Lindeboom (Robert); R.J. de Haan (Rob); N. van der Linden (Naomi); E.R. de Deckere (Ernie RJT); C. Lucas (Cees); S. Rhemrev (Steven); J.C. Goslings (Carel)

    2014-01-01

    textabstractBackground Unscheduled return visits to the emergency department (ED) may reflect shortcomings in care. This study characterized ED return visits with respect to incidence, risk factors, reasons and post-ED disposition. We hypothesized that risk factors for unscheduled return and reasons

  9. Unscheduled return visits to a Dutch inner-city emergency department

    NARCIS (Netherlands)

    M.C. van der Linden (M. Christien); R. Lindeboom (Robert); R.J. de Haan (Rob); N. van der Linden (Naomi); E.R. de Deckere (Ernie RJT); C. Lucas (Cees); S. Rhemrev (Steven); J.C. Goslings (Carel)

    2014-01-01

    textabstractBackground Unscheduled return visits to the emergency department (ED) may reflect shortcomings in care. This study characterized ED return visits with respect to incidence, risk factors, reasons and post-ED disposition. We hypothesized that risk factors for unscheduled return and reasons

  10. Canadian EdGEO National Workshop Program

    Science.gov (United States)

    Clinton, L. A.; Haidl, F. M.; Hymers, L. A.; van der Flier-Keller, E.

    2009-05-01

    Established in the early 1970s, EdGEO supports locally driven geosciences workshops for Canadian teachers. Workshops are organized by geoscientists and teachers, and typically have field, laboratory and classroom components. Grants of up to $3000 per workshop are available from the National EdGEO Program. By providing educational opportunities for today's teachers and, through them, their students, EdGEO seeks to cultivate a heightened awareness of our planet. EdGEO workshops provide teachers with potential fieldtrip sites for their students and the knowledge, enthusiasm and materials to inspire their students to engage in geoscience. Networking opportunities with local experts promote the importance of the geoscience profession. The expected result is an improved capacity on the part of Canadians to understand the Earth and to make informed decisions, especially with regard to the use of mineral and energy resources, the maintenance and remediation of the environment, and response to geological hazards. There exists a critical need to provide teachers with training and resources to tackle their Earth science curricula. In 2008, EdGEO supported fourteen workshops, with an unprecedented 521 teachers attending. These teachers then used our resources to reach an estimated 14,000 students during that single academic year. EdGEO workshops are locally driven and are therefore very diverse. Workshops are strongly tied to the provincial curriculum, focus on a specific geoscience topic, or may be largely field-based to demonstrate and practice how field activities could be incorporated into Earth science teaching. Many strive to include all of these important components. Geoscientists and teachers work collaboratively to develop and deliver EdGEO workshops to ensure that the activities can be effectively used in the classroom. The length of these professional development opportunities range from two-hour sessions to several days, and can generally accommodate up to twenty

  11. 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.

  12. 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/

  13. Impact of Mandatory HIV Screening in the Emergency Department: A Queuing Study.

    Science.gov (United States)

    Liu, Nan; Stone, Patricia W; Schnall, Rebecca

    2016-04-01

    To improve HIV screening rates, New York State in 2010 mandated that all persons 13-64 years receiving health care services, including care in emergency departments (EDs), be offered HIV testing. Little attention has been paid to the effect of screening on patient flow. Time-stamped ED visit data from patients eligible for HIV screening, 7,844 of whom were seen by providers and 767 who left before being seen by providers, were retrieved from electronic health records in one adult ED. During day shifts, 10% of patients left without being seen, and during evening shifts, 5% left without being seen. All patients seen by providers were offered testing, and 6% were tested for HIV. Queuing models were developed to evaluate the effect of HIV screening on ED length of stay, patient waiting time, and rate of leaving without being seen. Base case analysis was conducted using actual testing rates, and sensitivity analyses were conducted to evaluate the impact of increasing the testing rate. Length of ED stay of patients who received HIV tests was 24 minutes longer on day shifts and 104 minutes longer on evening shifts than for patients not tested for HIV. Increases in HIV testing rate were estimated to increase waiting time for all patients, including those who left without being seen. Our simulation suggested that incorporating HIV testing into ED patient visits not only adds to practitioner workload but also increases patient waiting time significantly during busy shifts, which may increase the rate of leaving without being seen. © 2016 Wiley Periodicals, Inc.

  14. Development and Testing of Emergency Department Patient Transfer Communication Measures

    Science.gov (United States)

    Klingner, Jill; Moscovice, Ira

    2012-01-01

    Purpose: Communication problems are a major contributing factor to adverse events in hospitals. 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…

  15. 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...

  16. Computed radiography in an emergency department setting

    Science.gov (United States)

    Andriole, Katherine P.; Gould, Robert G.; Arenson, Ronald L.

    1997-05-01

    Evaluation of radiologist and non-radiologist physician acceptance of computed radiography (CR) as an alternative to film-based radiography in an emergency department (ED) is performed. All emergency department radiographs are performed using photostimulable phosphor plates and rad by a computed radiography laser reader placed in the former emergency department darkroom. Soft copy images are simultaneously transmitted to high- and medium-resolution dual-monitor display stations located in radiology and ED reading rooms respectively. The on-call radiologist is automatically paged by the Radiology Information System (RIS) upon exam completion, to read the new ED imaging study. Patient demographic information including relevant clinical history is conveyed to the radiologist via the RIS. A 'wet read' preliminary radiology report is immediately transmitted back to the ED. Radiology and ED physicians are surveyed to ascertain preferences for CR or traditional screen-film, based on system implementation, image viewing and clinical impact issues. Preliminary results indicate a preference for filmless CR among the ED physicians if digital reliability and speed issues are met. This preference appears to be independent of physician level of experience. Inexperienced radiologists-in-training appear to have less comfort with softcopy reading for primary diagnosis. However, additional training in softcopy reading techniques can improve confidences. Image quality issues are most important tot he radiologist, while speed and reliability are the major issues for ED physicians. Reasons for CR preference include immediate access to images on display stations, near-zero exam retake rates, and improved response time and communication between radiology and the emergency department clinician.

  17. Rapid Primary Care Follow-up from the ED to Reduce Avoidable Hospital Admissions.

    Science.gov (United States)

    Carmel, Amanda S; Steel, Peter; Tanouye, Robert; Novikov, Aleksey; Clark, Sunday; Sinha, Sanjai; Tung, Judy

    2017-08-01

    Hospital admissions from the emergency department (ED) now account for approximately 50% of all admissions. Some patients admitted from the ED may not require inpatient care if outpatient care could be optimized. However, access to primary care especially immediately after ED discharge is challenging. Studies have not addressed the extent to which hospital admissions from the ED may be averted with access to rapid (next business day) primary care follow-up. We evaluated the impact of an ED-to-rapid-primary-care protocol on avoidance of hospitalizations in a large, urban medical center. We conducted a retrospective review of patients referred from the ED to primary care (Weill Cornell Internal Medicine Associates - WCIMA) through a rapid-access-to-primary-care program developed at New York-Presbyterian / Weill Cornell Medical Center. Referrals were classified as either an avoided admission or not, and classifications were performed by both emergency physician (EP) and internal medicine physician reviewers. We also collected outcome data on rapid visit completion, ED revisits, hospitalizations and primary care engagement. EPs classified 26 (16%) of referrals for rapid primary care follow-up as avoided admissions. Of the 162 patients referred for rapid follow-up, 118 (73%) arrived for their rapid appointment. There were no differences in rates of ED revisits or subsequent hospitalizations between those who attended the rapid follow-up and those who did not attend. Patients who attended the rapid appointment were significantly more likely to attend at least one subsequent appointment at WCIMA during the six months after the index ED visit [N=55 (47%) vs. N=8 (18%), P=0.001]. A rapid-ED-to-primary-care-access program may allow EPs to avoid admitting patients to the hospital without risking ED revisits or subsequent hospitalizations. This protocol has the potential to save costs over time. A program such as this can also provide a safe and reliable ED discharge option

  18. Support and monitoring of families after child abuse detection based on parental characteristics at the Emergency Department.

    Science.gov (United States)

    Diderich, H M; Pannebakker, F D; Dechesne, M; Buitendijk, S E; Oudesluys-Murphy, A M

    2015-03-01

    The 'Hague Protocol' enables professionals at the adult Emergency Department (ED) to detect child abuse based on three parental characteristics: (i) suicide attempt or self-harm, (ii) domestic violence or (iii) substance abuse, and to refer them to the Reporting Centre for Child Abuse and Neglect (RCCAN). This study investigates what had happened to the families three months after this referral. ED referrals based on parental characteristics (N = 100) in which child abuse was confirmed after investigation by the RCCAN were analysed. Information was collected regarding type of child abuse, reason for reporting, duration of problems prior to the ED referral, previous involvement of support services or other agencies, re-occurrence of the problems and outcome of the RCCAN monitoring according to professionals and the families. Of the 100 referred cases, 68 families were already known to the RCCAN, the police or family support services, prior to the ED referral. Of the 99 cases where information was available, existing support was continued or intensified in 31, a Child Protection Services (CPS) report had to be made in 24, new support was organized for 27 cases and in 17 cases support was not necessary, because the domestic problems were already resolved. Even though the RCCAN is mandated to monitor all referred families after three months, 31 cases which were referred internally were not followed up. Before referral by the ED two thirds of these families were already known to organizations. Monitoring may help provide a better, more sustained service and prevent and resolve domestic problems. A national database could help to link data and to streamline care for victims and families. We recommend a Randomized Controlled Trial to test the effectiveness of this Protocol in combination with the outcomes of the provided family support. © 2014 John Wiley & Sons Ltd.

  19. Perceptions of Emergency Department Crowding in Pennsylvania

    Directory of Open Access Journals (Sweden)

    Pines, Jesse M

    2013-02-01

    Full Text Available Introduction: The state of emergency department (ED crowding in Pennsylvania has not previously been reported.Methods: We assessed perceptions of ED crowding by surveying medical directors/chairs from Pennsylvania EDs in the spring of 2008.Results: A total of 106 completed the questionnaire (68% response rate. A total of 83% (86/104 agreed that ED crowding was a problem; 26% (27/105 reported that at least half of admitted patients boarded for more than 4 hours. Ninety-eight percent (102/104 agreed that patient satisfaction suffers during crowding and 79% (84/106 stated that quality suffers. Sixty-five percent (68/105 reported that crowding had worsened during the past 2 years. Several hospital interventions were used to alleviate crowding: expediting discharges, 81% (86/106; prioritizing ED patients for inpatient beds, 79% (84/ 106; and ambulance diversion, 55% (57/105. Almost all respondents who had improved ED operations reported that it had reduced crowding.Conclusion: ED crowding is a common problem in Pennsylvania and is worsening in the majority of hospitals, despite the implementation of a variety of interventions. [West J EmergMed. 2013;14(1:1–10.

  20. Parental responses to child experiences of trauma following presentation at emergency departments: a qualitative study.

    Science.gov (United States)

    Williamson, Victoria; Creswell, Cathy; Butler, Ian; Christie, Hope; Halligan, Sarah L

    2016-11-07

    Parents are often children's main source of support following fear-inducing traumatic events, yet little is known about how parents provide that support. The aim of this study was to examine parents' experiences of supporting their child following child trauma exposure and presentation at an emergency department (ED). Semistructured qualitative interviews analysed using thematic analysis. The setting for this study was two National Health Service EDs in England. 20 parents whose child experienced a traumatic event and attended an ED between August 2014 and October 2015. Parents were sensitive to their child's distress and offered reassurance and support for their child to resume normal activities. However, parental beliefs often inhibited children's reinstatement of pretrauma routines. Support often focused on preventing future illness or injury, reflective of parents' concerns for their child's physical well-being. In a minority of parents, appraisals of problematic care from EDs contributed to parents' anxiety and perceptions of their child as vulnerable post-trauma. Forgetting the trauma and avoidance of discussion were encouraged as coping strategies to prevent further distress. Parents highlighted their need for further guidance and support regarding their child's physical and emotional recovery. This study provides insight into the experiences of and challenges faced by parents in supporting their child following trauma exposure. Perceptions of their child's physical vulnerability and treatment influenced parents' responses and the supportive strategies employed. These findings may enable clinicians to generate meaningful advice for parents following child attendance at EDs post-trauma. 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/.

  1. Characteristics of Cannabis-Only and Other Drug Users Who Visit the Emergency Department

    Science.gov (United States)

    Woodruff, Susan I.; McCabe, Cameron T.; Hohman, Melinda; Clapp, John D.; Shillington, Audrey M.; Eisenberg, Kimberly; Sise, C. Beth; Castillo, Edward M.; Chan, Theodore C.; Sise, Michael J.

    2016-01-01

    Abstract Emergency department (ED) settings have gained interest as venues for illegal drug misuse prevention and intervention, with researchers and practitioners attempting to capitalize on the intersection of need and opportunity within these settings. This study of 686 adult patients visiting two EDs for various reasons who admitted drug use compared daily cannabis-only users, nondaily cannabis-only users, and other drug users on sociodemographic and drug-related severity outcomes. The three drug use groups did not differ on most sociodemographic factors or medical problem severity scores. Forty-five percent of the sample was identified as having a drug use problem. ED patients who used drugs other than cannabis were at particular risk for high drug use severity indicators and concomitant problems such as psychiatric problems and alcohol use severity. However, 19–29% of cannabis-only users were identified as having problematic drug use. Furthermore, daily cannabis-only users fared less well than nondaily cannabis users with regard to drug use severity indicators and self-efficacy for avoiding drug use. Results may assist emergency medicine providers and medical social workers in matching patients to appropriate intervention. For example, users of drugs other than cannabis (and perhaps heavy, daily cannabis-only users) may need referral to specialty services for further assessment. Enhancement of motivation and self-efficacy beliefs could be an important target of prevention and treatment for cannabis-only users screened in the ED. PMID:27689138

  2. 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

  3. Differences in police, ambulance, and emergency department reporting of traffic injuries on Karachi-Hala road, Pakistan

    Directory of Open Access Journals (Sweden)

    Lagarde Emmanuel

    2011-03-01

    Full Text Available Abstract Background Research undertaken in developing countries has assessed discrepancies in police reporting of Road Traffic Injury (RTI for urban settings only. The objective of this study was to assess differences in RTI reporting across police, ambulance, and hospital Emergency Department (ED datasets on an interurban road section in Pakistan. Methods The study setting was the 196-km long Karachi-Hala road section. RTIs reported to the police, Edhi Ambulance Service (EAS, and five hospital EDs in Karachi during 2008 (Jan to Dec were compared in terms of road user involved (pedestrians, motorcyclists, four-wheeled vehicle occupants and outcome (died or injured. Further, records from these data were matched to assess ascertainment of traffic injuries and deaths by the three datasets. Results A total of 143 RTIs were reported to the police, 531 to EAS, and 661 to hospital EDs. Fatality per hundred traffic injuries was twice as high in police records (19 per 100 RTIs than in ambulance (10 per 100 RTIs and hospital ED records (9 per 100 RTIs. Pedestrian and motorcyclist involvement per hundred traffic injuries was lower in police records (8 per 100 RTIs than in ambulance (17 per 100 RTIs and hospital ED records (43 per 100 RTIs. Of the 119 deaths independently identified after matching, police recorded 22.6%, EAS 46.2%, and hospital ED 50.4%. Similarly, police data accounted for 10.6%, EAS 43.5%, and hospital ED 54.9% of the 1 095 independently identified injured patients. Conclusions Police reporting, particularly of non-fatal RTIs and those involving vulnerable road users, should be improved in Pakistan.

  4. The role of plain radiographs in patients with acute abdominal pain at the ED

    NARCIS (Netherlands)

    van Randen, Adrienne; Lameris, Wytze; Luitse, Jan S. K.; Gorzeman, Michiel; Hesselink, Erik J.; Dolmans, Dennis E. J. G. J.; Peringa, Jan; van Geloven, Anna A. W.; Bossuyt, Patrick M.; Stoker, Jaap; Boermeester, Marja A.

    2011-01-01

    Objective: The purpose of this study was to evaluate the added value of plain radiographs on top of clinical assessment in unselected patients presenting with acute abdominal pain at the emergency department (ED). Methods: In a multicenter prospective trial, patients with abdominal pain more than 2

  5. The role of plain radiographs in patients with acute abdominal pain at the ED

    NARCIS (Netherlands)

    Randen, A. van; Lameris, W.; Luitse, J.S.; Gorzeman, M.; Hesselink, E.J.; Dolmans, D.E.; Peringa, J.; Geloven, A.A. van; Bossuyt, P.M.; Stoker, J.; Boermeester, M.A.; Gooszen, H.G.

    2011-01-01

    OBJECTIVE: The purpose of this study was to evaluate the added value of plain radiographs on top of clinical assessment in unselected patients presenting with acute abdominal pain at the emergency department (ED). METHODS: In a multicenter prospective trial, patients with abdominal pain more than 2

  6. Contingent Valuation Analysis of an Otolaryngology and Ophthalmology Emergency Department: The Value of Acute Specialty Care.

    Science.gov (United States)

    Naunheim, Matthew R; Kozin, Elliot D; Sethi, Rosh K; Ota, H G; Gray, Stacey T; Shrime, Mark G

    2017-03-01

    Specialty emergency departments (EDs) provide a unique mechanism of health care delivery, but the value that they add to the medical system is not known. Evaluation of patient preferences to determine value can have a direct impact on resource allocation and direct-to-specialist care. To assess the feasibility of contingent valuation (CV) methodology using a willingness-to-pay (WTP) survey to evaluate specialty emergency services, in the context of an ophthalmology- and otolaryngology-specific ED. Contingent valuation analysis of a standalone otolaryngology and ophthalmology ED. Participants were English-speaking adults presenting to a dedicated otolaryngology and ophthalmology ED. The WTP questions were assessed using a payment card format, with reference to an alternative modality of treatment (ie, general ED), and were analyzed with multivariate regression. Validated WTP survey administered from October 14, 2014, through October 1, 2015. Sociodemographic data, level of distress, referral data, income, and WTP. A total of 327 of 423 (77.3%) ED patients responded to the WTP survey, with 116 ophthalmology and 211 otolaryngology patients included (52.3% female; mean [range] age, 46 [18-90] years). The most common reason for seeking care at this facility was a reputation for specialty care for both ear, nose, and throat (80 [37.9%]) and ophthalmology (43 [37.1%]). Mean WTP for specialty-specific ED services was $377 for ophthalmology patients, and $321 for otolaryngology patients ($340 overall; 95% CI, $294 to $386), without significant difference between groups (absolute difference, $56; 95% CI, $-156 to $43). Self-reported level of distress was higher among ear, nose, and throat vs ophthalmology patients (absolute difference, 0.47 on a Likert scale of 1-7; 95% CI, 0.10 to 0.84). Neither level of distress, income, nor demographic characteristics influenced WTP, but patients with higher estimates of total visit cost were more likely to have higher WTP (β coefficient

  7. 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...... that the clinicians follow in the ED. Based on observations in two Danish EDs, we identify four pro-cedures prominent to how CIS is accomplished: the triage procedure, the timeouts, the coordinating nurse, and the recurrent opportunities for information seeking at the whiteboard. We then discuss how CIS activities...

  8. 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...... that the clinicians follow in the ED. Based on observations in two Danish EDs, we identify four pro-cedures prominent to how CIS is accomplished: the triage procedure, the timeouts, the coordinating nurse, and the recurrent opportunities for information seeking at the whiteboard. We then discuss how CIS activities...

  9. 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.

  10. Understanding patient acceptance and refusal of HIV testing in the emergency department

    OpenAIRE

    Christopoulos Katerina A; Weiser Sheri D; Koester Kimberly A; Myers Janet J; White Douglas AE; Kaplan Beth; Morin Stephen F

    2012-01-01

    ABSTRACT Background Despite high rates of patient satisfaction with emergency department (ED) HIV testing, acceptance varies widely. It is thought that patients who decline may be at higher risk for HIV infection, thus we sought to better understand patient acceptance and refusal of ED HIV testing. Methods In-depth interviews with fifty ED patients (28 accepters and 22 decliners of HIV testing) in three ED HIV testing programs that serve vulnerable urban populations in northern California. Re...

  11. 7 CFR 1220.108 - Department.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Department. 1220.108 Section 1220.108 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS... means the United States Department of Agriculture....

  12. Timeliness of interfacility transfer for ED patients with ST-elevation myocardial infarction.

    Science.gov (United States)

    Ward, Michael J; Kripalani, Sunil; Storrow, Alan B; Liu, Dandan; Speroff, Theodore; Matheny, Michael; Thomassee, Eric J; Vogus, Timothy J; Munoz, Daniel; Scott, Carol; Fredi, Joseph L; Dittus, Robert S

    2015-03-01

    Most US hospitals lack primary percutaneous coronary intervention (PCI) capabilities to treat patients with ST-elevation myocardial infarction (STEMI) necessitating transfer to PCI-capable centers. Transferred patients rarely meet the 120-minute benchmark for timely reperfusion, and referring emergency departments (EDs) are a major source of preventable delays. We sought to use more granular data at transferring EDs to describe the variability in length of stay at referring EDs. We retrospectively analyzed a secondary data set used for quality improvement for patients with STEMI transferred to a single PCI center between 2008 and 2012. We conducted a descriptive analysis of the total time spent at each referring ED (door-in-door-out [DIDO] interval), periods that comprised DIDO (door to electrocardiogram [EKG], EKG-to-PCI activation, and PCI activation to exit), and the relationship of each period with overall time to reperfusion (medical contact-to-balloon [MCTB] interval). We identified 41 EDs that transferred 620 patients between 2008 and 2012. Median MCTB was 135 minutes (interquartile range [IQR] 114,172). Median overall ED DIDO was 74 minutes (IQR 56,103) and was composed of door to EKG, 5 minutes (IQR 2,11); EKG-to-PCI activation, 18 minutes (IQR 7,37); and PCI activation to exit, 44 minutes (IQR 34,56). Door-in door-out accounted for the largest proportion (60%) of overall MCTB and had the largest variability (coefficient of variability, 1.37) of these intervals. In this cohort of transferring EDs, we found high variability and substantial delays after EKG performance for patients with STEMI. Factors influencing ED decision making and transportation coordination after PCI activation are a potential target for intervention to improve the timeliness of reperfusion in patients with STEMI. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Cooperative agreement between the Fish and Wildlife Service, U.S. Department of the Interior and Conservation Commission of the State of Missouri for the purpose of conducting an historic weapons deer hunt on certain lands within the Mingo National Wildlife Refuge

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This is an agreement between the U.S. Fish and Wildlife Service and the Conservation Commission of the State of Missouri to allow an historic weapons deer hunt on...

  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

    k^s^i=mlpqdo^ar^qb=p`elli= models; and Schiele and McCue (2006) studied the acquisition of consulting services in the public sector. Although these...Aeronautics and Astronautics. Schiele , J. J., & McCue, C. P. (2006). Professional service acquisition in public sector procurement. International

  15. An Iterative, Low-Cost Strategy to Building Information Systems Allows a Small Jurisdiction Local Health Department to Increase Efficiencies and Expand Services.

    Science.gov (United States)

    Lovelace, Kay A; Shah, Gulzar H

    2016-01-01

    The objective of this case study was to describe the process and outcomes of a small local health department's (LHD's) strategy to build and use information systems. The case study is based on a review of documents and semi-structured interviews with key informants in the Pomperaug District Health Department. Interviews were recorded, transcribed, coded, and analyzed. The case study here suggests that small LHDs can use a low-resource, incremental strategy to build information systems for improving departmental effectiveness and efficiency. Specifically, we suggest that the elements for this department's success were simple information systems, clear vision, consistent leadership, and the involvement, training, and support of staff.

  16. MobilED – an accessible mobile learning platform for Africa

    CSIR Research Space (South Africa)

    Ford, M

    2007-05-01

    Full Text Available MobilED is a 3-year international collaborative project aimed at creating meaningful learning environments using mobile phone technologies and services. The outputs were a set of learning scenarios that were successfully tested in schools and a...

  17. ED staff and clinicians learn essential human relations skills.

    Science.gov (United States)

    1999-01-01

    Smile training for the emergency department? An increasingly popular customer service training program for physicians and staff in the emergency department teaches how to improve personal interactions with patients. Without focusing on how patients are treated beyond their medical ailments, course developers warn, hospitals may be alienating patients who might decide not to pay their hospital bill or might take their business elsewhere in the future.

  18. Domestic violence in an inner-city ED.

    Science.gov (United States)

    Ernst, A A; Nick, T G; Weiss, S J; Houry, D; Mills, T

    1997-08-01

    A confidential written survey was conducted at the emergency department (ED) of Charity Hospital in New Orleans to determine the prevalence of domestic violence (DV) for male and female ED patients and to determine the demographics of DV. Four violence parameters were calculated for patients who had a partner at the time of presentation: 1) present physical; 2) present nonphysical; 3) past physical; and 4) past nonphysical. Out of the 516 patients enrolled, 283 were women and 233 were men. On the basis of Index of Spouse Abuse scoring, 14% of men and 22% of women had experienced past nonphysical violence, and 28% of men and 33% of women had experienced past physical violence. Of the 157 men and 207 women with partners at the time of presentation, 11% men and 15% women reported present nonphysical violence, and 20% men and 19% of the women reported present physical violence. Logistic-regression models demonstrated that women experienced significantly more past and present nonphysical violence but not physical violence than men. Alcohol, drug use, and suicidal ideation were found to be significant predictors associated with DV. In conclusion, DV rates were high in the New Orleans population, with nearly equal rates of past and present physical violence for men and women.

  19. The Highland Health Advocates: a preliminary evaluation of a novel programme addressing the social needs of emergency department patients.

    Science.gov (United States)

    Losonczy, Lia Ilona; Hsieh, Dennis; Wang, Michael; Hahn, Christopher; Trivedi, Tarak; Rodriguez, Marcela; Fahimi, Jahan; Alter, Harrison

    2017-09-01

    Patients commonly come to the emergency department (ED) with social needs. To address this, we created the Highland Health Advocates (HHA), an ED-based help desk and medical-legal partnership using undergraduate volunteers to help patients navigate public resources and provide onsite legal and social work referrals. We were able to provide these services in English and Spanish. We aimed to determine the social needs of the patients who presented to our ED and the potential impact of the programme in resolving those needs and connecting them to a 'medical home' (defined as a consistent, primary source of medical care such as a primary care doctor or clinic). ED patients at a US safety net hospital were enrolled in a 1:2 ratio in a quasi-experiment comparing those who received intervention from the HHA during a limited access rollout with controls who received usual care on days with no help desk. We collected a baseline social needs evaluation, with follow-up assessments at 1 and 6 months. Primary outcomes were linkages for the primary identified need and to a medical home within 1 month. Other outcomes at 6 months included whether a patient (1) felt helped; 2) had a decreased number of ED visits; (3) had the primary identified need met; (4) had a primary doctor; and (5) had a change in self-reported health status. We enrolled 459 subjects (intervention=154, control=305). Housing (41%), employment (23%) and inability to pay bills (22%) were participants' top identified needs. At baseline, 32% reported the ED as their medical home, with the intervention cohort having higher ED utilisation (>1 ED visit in the prior month: 49% vs 24%). At 1 month, 185 (40%) subjects were reached for follow-up, with more HHA subjects linked to a resource (59% vs 37%) and a medical home (92% vs 76%). At 6 months, 75% of subjects felt HHA was helpful and more subjects in the HHA group had a doctor (93% v 69%). No difference was found in ED utilisation, primary need resolution or self

  20. Department of Education

    Science.gov (United States)

    ... MORE NEWS > John B. King, Jr. Secretary of Education Bio Speeches @JohnKingatED How Do I Find...? Student ... Succeeds Act (ESSA) FERPA Civil Rights Data & Research Education Statistics Postsecondary Education Data ED Data Express Nation's ...