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1.
J Healthc Eng ; 2020: 8857553, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33029339

RESUMO

Data envelopment analysis (DEA) is a powerful nonparametric engineering tool for estimating technical efficiency and production capacity of service units. Assuming an equally proportional change in the output/input ratio, we can estimate how many additional medical resource health service units would be required if the number of hospitalizations was expected to increase during an epidemic outbreak. This assessment proposes a two-step methodology for hospital beds vacancy and reallocation during the COVID-19 pandemic. The framework determines the production capacity of hospitals through data envelopment analysis and incorporates the complexity of needs in two categories for the reallocation of beds throughout the medical specialties. As a result, we have a set of inefficient healthcare units presenting less complex bed slacks to be reduced, that is, to be allocated for patients presenting with more severe conditions. The first results in this work, in collaboration with state and municipal administrations in Brazil, report 3772 beds feasible to be evacuated by 64% of the analyzed health units, of which more than 82% are moderate complexity evacuations. The proposed assessment and methodology can provide a direction for governments and policymakers to develop strategies based on a robust quantitative production capacity measure.


Assuntos
Leitos/provisão & distribução , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Hospitais , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Leitos/estatística & dados numéricos , Betacoronavirus , Engenharia Biomédica , Brasil/epidemiologia , Infecções por Coronavirus/tratamento farmacológico , Eficiência Organizacional/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Determinação de Necessidades de Cuidados de Saúde , Alocação de Recursos , Estatísticas não Paramétricas
2.
Artigo em Inglês | MEDLINE | ID: mdl-33028002

RESUMO

This study examined the difficulties of running online physical education classes in the context of coronavirus disease 2019 (COVID-19) and used the findings to develop an efficient operation plan to address these difficulties. Six middle and high school physical education teachers participated; three were experts in online physical education and active in the Korea Council School Physical Education Promotion, and three were recommended teachers making efforts to improve the online classes offered by the Korea Ministry of Education. A qualitative case study method employing phenomenological procedures to collect and analyze the data was used. The difficulties of operating middle and high school online physical education classes for the first time included (1) the monotony of the classes within their limited environmental conditions and limited educational content that did not adequately convey the value of physical education, (2) trial-and-error methods applied nationwide, resulting from a lack of expertise in operating online physical education classes, and (3) very limited evaluation guidelines proposed by the Korea Ministry of Education, which made systematic evaluation with online methods impossible. To address the identified problems and facilitate the efficient operation of online physical education classes, changes in strategic learning methods are needed to understand online physical education characteristics and thereby better communicate the value of physical education. It is also necessary to cultivate teaching expertise through sharing online physical education classes, where collaboration among physical education teachers is central. In addition, evaluation processes should be less formal to encourage active student participation.


Assuntos
Infecções por Coronavirus/prevenção & controle , Educação a Distância/organização & administração , Pandemias/prevenção & controle , Educação Física e Treinamento/métodos , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/epidemiologia , Eficiência Organizacional , Humanos , Pneumonia Viral/epidemiologia , República da Coreia/epidemiologia , Instituições Acadêmicas , Estudantes/psicologia
3.
BMJ Glob Health ; 5(9)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32967981

RESUMO

INTRODUCTION: There has been little systematic exploration into what affects timeliness of epidemic response, despite the potential for earlier responses to be more effective. Speculations have circulated that previous exposure to major epidemics helped health systems respond more quickly to COVID-19. This study leverages organisational memory theory to test whether health systems with any, more severe, or more recent exposure to major epidemics enacted timelier COVID-19 policy responses. METHODS: A data set was constructed cataloguing 846 policies across 178 health systems in total, 37 of which had major epidemics within the last 20 years. Hypothesis testing used OLS regressions with World Health Organization region fixed effects, controlling for several health system expenditure and political variables. RESULTS: Results show that exposure to any major epidemics was associated with providing earlier response in the following policy categories: all policies, surveillance/response, distancing, and international travel policies. The effect was about 6-10 days earlier response. The significance of this variable was largely nullified with the addition of the other two independent variables. Neither total cases nor years since previous epidemics showed no statistical significance. CONCLUSION: This study suggests that health systems may learn from past major epidemics. Policymakers ought to institutionalise lessons from COVID-19. Future studies can examine specific generalisable lessons and whether timelier responses correlated with lower health and economic impacts.


Assuntos
Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/prevenção & controle , Planejamento em Desastres/organização & administração , Surtos de Doenças/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Eficiência Organizacional , Humanos , Inovação Organizacional , Pneumonia Viral/epidemiologia , Fatores de Tempo
4.
Hu Li Za Zhi ; 67(5): 65-73, 2020 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-32978767

RESUMO

BACKGROUND & PROBLEMS: Efficient handover is essential to ensuring high levels of caring quality and patient safety. In our psychiatric acute ward, it was noticed that there were many valueless tasks being performed during the nursing handover process that negatively affected efficiency. PURPOSE: To apply lean management principles to improve the nursing handover process in the psychiatric acute ward. RESOLUTION: In order to find the rightful solution, our task team analyzed the problem using the Value Chart of Lean Management and detected that the handover process was slowed down by motion, waiting, and defects. According to the rules of lean management, group discussion, decision making, and the cost-benefit matrix, we proposed improvement solutions including visual stocktaking, adjusting handover patterns, switching the handover location, and systematizing nursing handover procedures. RESULTS: The time required for stocktaking was shortened from 5 to 2 minutes (60% improvement). The waiting time was shortened from 114 to 49.6 minutes (56.6% improvement). The efficiency of the handover process increased from 66% to 90%. CONCLUSIONS: Applying lean management principles helped detect critical problems and reduce waste, which enhanced efficiency, improved handover, and helped maximize nursing value and benefit in an increasingly complex environment.


Assuntos
Unidades Hospitalares/organização & administração , Transtornos Mentais/enfermagem , Transferência da Responsabilidade pelo Paciente/organização & administração , Melhoria de Qualidade/organização & administração , Eficiência Organizacional/estatística & dados numéricos , Humanos , Pesquisa em Avaliação de Enfermagem
5.
Plast Reconstr Surg ; 146(4): 913-919, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32970013

RESUMO

BACKGROUND: Even before seeing a physician, patients must first gain access to the hospital system. At large hospitals with high patient volumes, access to specialty care can pose a particular challenge. This study examines the effects of specific initiatives to increase clinic capacity, appointment use, and ease of scheduling on both patient satisfaction and hospital revenue. METHODS: In 2017, a task force at a large, multidisciplinary pediatric hospital instituted a number of initiatives to increase patient access to ambulatory specialty clinics. Clinic sessions were standardized to a 4-hour template, and unscheduled, "held" appointment slots were required to be made available ("flipped") 72 hours before the appointment. A patient-centered electronic scheduling platform was also implemented. Patient satisfaction was assessed using Press Ganey scores. Revenue estimates were calculated for increases in "new" and "return" patient appointments. RESULTS: Total new appointment slots increased by over 44 percent, with over 53,000 appointments added annually. The number of held appointment slots declined by 93 percent. A total of 17,996 annual appointments were added in surgical subspecialties, and an additional 14,756 more surgical appointments were completed. Over 2000 appointments were scheduled by means of the online patient portal. Press Ganey "ease-of-scheduling" scores increased from 57 percent to 72 percent over the intervention period. Hospitalwide, these initiatives generated an estimated $8.3 million in revenue opportunity. CONCLUSION: Standardizing clinic sessions and optimizing clinic availability generates new appointment opportunities, improves patient experience, and increases hospital revenue.


Assuntos
Instituições de Assistência Ambulatorial/economia , Instituições de Assistência Ambulatorial/organização & administração , Agendamento de Consultas , Eficiência Organizacional/economia , Hospitais Pediátricos/economia , Hospitais Pediátricos/organização & administração , Satisfação do Paciente/estatística & dados numéricos , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Criança , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Estudos Retrospectivos
6.
Int J Equity Health ; 19(1): 152, 2020 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-32887629

RESUMO

BACKGROUND: General Government Health Expenditure (GGHE) in Mauritius accounted for only 10% of General Government Expenditure for the fiscal year 2018. This is less than the pledge taken under the Abuja 2001 Declaration to allocate at least 15% of national budget to the health sector. The latest National Health Accounts also urged for an expansion in the fiscal space for health. As public hospitals in Mauritius absorb 70% of GGHE, maximising returns of hospitals is essential to achieve Universal Health Coverage. More so, as Mauritius is bracing for its worst recession in 40 years in the aftermath of the COVID-19 pandemic public health financing will be heavily impacted. A thorough assessment of hospital efficiency and its implications on effective public health financing and fiscal space creation is, therefore, vital to inform ongoing health reform agenda. OBJECTIVES: This paper aims to examine the trend in hospital technical efficiency over the period 2001-2017, to measure the elasticity of hospital output to changes in inputs variables and to assess the impact of improved hospital technical efficiency in terms of fiscal space creation. METHODS: Annual health statistics released by the Ministry of Health and Wellness and national budget of the Ministry of Finance, Economic Planning and Development were the principal sources of data. Applying Stochastic Frontier Analysis, technical efficiency of public regional hospitals was estimated under Cobb-Douglas, Translog and Multi-output distance functions, using STATA 11. Hospital beds, doctors, nurses and non-medical staff were used as input variables. Output variable combined inpatients and outpatients seen at Accident Emergency, Sorted and Unsorted departments. Efficiency scores were used to determine potential efficiency savings and fiscal space creation. FINDINGS: Mean technical efficiency scores, using the Cobb Douglas, Translog and Multi-output functions, were estimated at 0.83, 0.84 and 0.89, respectively. Nurses and beds are the most important factors in hospital production, as a 1% increase in the number of beds and nurses, result in an increase in hospital outputs by 0.73 and 0.51%, respectively. If hospitals are to increase their inputs by 1%, their outputs will increase by 1.16%. Hospital output process has an increasing return to scale. With technical efficiencies improving to scores of 0.95 and 1.0 in 2021-2022, potential savings and fiscal space creation at hospital level, would amount to MUR 633 million (US$ 16.2 million) and MUR 1161 million (US$ 29.6 million), respectively. CONCLUSION: Fiscal space creation through full technical efficiency, is estimated to represent 8.9 and 9.2% of GGHE in fiscal year 2021-2022 and 2022-2023, respectively. This will allow without any restrictions the funding of the national response for HIV, vaccine preventable diseases as well as building a resilient health system to mitigate impact of emerging infectious diseases as experienced with COVID-19.


Assuntos
Eficiência Organizacional/estatística & dados numéricos , Financiamento Governamental/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Hospitais Públicos/economia , Hospitais Públicos/organização & administração , Infecções por Coronavirus/epidemiologia , Reforma dos Serviços de Saúde , Humanos , Maurício , Pandemias , Pneumonia Viral/epidemiologia , Cobertura Universal do Seguro de Saúde
7.
Aust Health Rev ; 44(5): 741-747, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862832

RESUMO

Objective A pilot study to: (1) describe the ability of emergency physicians to provide primary consults at an Australian, major metropolitan, adult emergency department (ED) during the COVID-19 pandemic when compared with historical performance; and (2) to identify the effect of system and process factors on productivity. Methods A retrospective cross-sectional description of shifts worked between 1 and 29 February 2020, while physicians were carrying out their usual supervision, flow and problem-solving duties, as well as undertaking additional COVID-19 preparation, was documented. Effect of supervisory load, years of Australian registration and departmental flow factors were evaluated. Descriptive statistical methods were used and regression analyses were performed. Results A total of 188 shifts were analysed. Productivity was 4.07 patients per 9.5-h shift (95% CI 3.56-4.58) or 0.43 patients per h, representing a 48.5% reduction from previously published data (P<0.0001). Working in a shift outside of the resuscitation area or working a day shift was associated with a reduction in individual patient load. There was a 2.2% (95% CI: 1.1-3.4, P<0.001) decrease in productivity with each year after obtaining Australian medical registration. There was a 10.6% (95% CI: 5.4-15.6, P<0.001) decrease in productivity for each junior physician supervised. Bed access had no statistically significant effect on productivity. Conclusions Emergency physicians undertake multiple duties. Their ability to manage their own patients varies depending on multiple ED operational factors, particularly their supervisory load. COVID-19 preparations reduced their ability to see their own patients by half. What is known about the topic? An understanding of emergency physician productivity is essential in planning clinical operations. Medical productivity, however, is challenging to define, and is controversial to measure. Although baseline data exist, few studies examine the effect of patient flow and supervision requirements on the emergency physician's ability to perform primary consults. No studies describe these metrics during COVID-19. What does this paper add? This pilot study provides a novel cross-sectional description of the effect of COVID-19 preparations on the ability of emergency physicians to provide direct patient care. It also examines the effect of selected system and process factors in a physician's ability to complete primary consults. What are the implications for practitioners? When managing an emergency medical workforce, the contribution of emergency physicians to the number of patients requiring consults should take into account the high volume of alternative duties required. Increasing alternative duties can decrease primary provider tasks that can be completed. COVID-19 pandemic preparation has significantly reduced the ability of emergency physicians to manage their own patients.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Eficiência Organizacional/estatística & dados numéricos , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/tendências , Corpo Clínico Hospitalar/organização & administração , Assistência Centrada no Paciente/organização & administração , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Agendamento de Consultas , Austrália , Betacoronavirus/patogenicidade , Estudos Transversais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Previsões , Humanos , Masculino , Corpo Clínico Hospitalar/estatística & dados numéricos , Corpo Clínico Hospitalar/tendências , Pessoa de Meia-Idade , Pandemias/estatística & dados numéricos , Assistência Centrada no Paciente/estatística & dados numéricos , Projetos Piloto , Estudos Retrospectivos
8.
BMJ Health Care Inform ; 27(3)2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32830110

RESUMO

INTRODUCTION: We present the integration of telemedicine into the healthcare system of West China Hospital of Sichuan University (WCH), one of the largest hospitals in the world with 4300 inpatient beds, as a means for maximising the efficiency of healthcare delivery during the COVID-19 pandemic. METHODS: Implemented on 22 January 2020, the telemedicine technology allowed WCH providers to conduct teleconsultations, telerounds, teleradiology and tele-intensive care unit, which in culmination provided screening, triage and treatment for COVID-19 and other illnesses. To encourage its adoption, the government and the hospital publicised the platform on social media and waived fees. DISCUSSION: From 1 February to 1 April 2020, 10557 online COVID-19 consultations were conducted for 6662 individuals; meanwhile, 32676 patients without COVID completed virtual follow-ups. We discuss that high-quality, secure, affordable and user-friendly telemedical platforms should be integrated into global healthcare systems to help decrease the transmission of the virus and protect healthcare providers from infection.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Telemedicina/organização & administração , Betacoronavirus , China , Comportamento Cooperativo , Assistência à Saúde/organização & administração , Eficiência Organizacional , Humanos , Unidades de Terapia Intensiva , Marketing de Serviços de Saúde/organização & administração , Aplicativos Móveis , Pandemias , Qualidade da Assistência à Saúde , Triagem/organização & administração
9.
Artigo em Inglês | MEDLINE | ID: mdl-32823922

RESUMO

Objective: To evaluate the relationship between the ownership structure of hospitals and the possibility of their being positioned on the frontier of technical efficiency in the economic crisis period 2010-2012, adjusting for hospital variables and regional characteristics in the areas where the Spanish National Health System (SNHS) hospitals are located. Methods: 230 National Health System hospitals were studied over the two-year period 2010-2012 according to their ownership structure-public hospitals, private hospitals and public-private partnership (PPP)-data envelopment analysis orientated to inputs was used to measure the overall technical efficiency, pure efficiency and efficiency of scale. A generalised linear mixed model (GLMM) with binomial distribution and logit link function was used to analyse the hospital and regional variables associated with positioning on the frontier. Results: There are substantial differences between the average pure technical efficiency of public, private and PPP hospitals, as well as a greater number of PPP models being positioned on the efficiency frontier (91.67% in 2012). The odds of being positioned on the frontier are 41.7 times higher in PPP models than in public hospitals. The average annual household income per region is related to the greater odds of hospitals being positioned on the frontier of efficiency. Conclusions: During the most acute period of recession in the Spanish economy, PPP formulas favoured hospital efficiency, by increasing the odds of being positioned on the frontier of efficiency when compared to private and public hospitals. The position on the frontier of efficiency of a hospital is related to the wealth of its region.


Assuntos
Eficiência Organizacional , Hospitais Privados/organização & administração , Hospitais Públicos/organização & administração , Análise Multinível , Propriedade , Humanos , Parcerias Público-Privadas , Espanha
10.
Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med ; 28(Special Issue): 785-790, 2020 Aug.
Artigo em Russo | MEDLINE | ID: mdl-32856826

RESUMO

The article considers the first results of the Federal priority health care project that began in 2018 in Russia, aimed at organizing a new model of medical care. The mechanism of operation of a perfect polyclinic from the point of view of lean production is formed and developed thanks to management decisions based on the principles of lean production, allowing to increase the efficiency of the health care system. Definition of technology "lean clinic", using basic tools and structuring of losses in the field of medicine, according to the methodology of lean production, along with the generalization of positive foreign experience of introduction of technologies of lean production in health and its adaptation in Russia, will create a comfortable environment for doctors, medical staff and patients. The article presents statistical and analytical data on the regional practice of implementing the concept of "lean polyclinic", as well as expert assessments that allow us to draw conclusions about the progress of the project.


Assuntos
Assistência à Saúde , Eficiência Organizacional , Instituições de Assistência Ambulatorial , Humanos , Federação Russa
11.
PLoS One ; 15(8): e0237775, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32813739

RESUMO

Nile tilapia, Oreochromis niloticus is the third most commonly farmed finfish species in the world, accounting for nearly 5% of global aquaculture production. In the past few decades much of the success of this species has been attributed to the development and distribution of Genetically Improved Farmed Tilapia (GIFT). Despite the increasing availability of GIFT, the productivity of small-scale farming remains highly variable, particularly in developing nations. Commercial fish-feed pellets can increase fish farm productivity; however, many small-scale farmers rely on other means of feeding fish due to the high cost and limited availability of commercial fish feed pellets. Therefore, understanding how locally-sourced feeds affect the production of GIFT is an important step towards improving feeding practices, particularly for farmers with low financial capital. This study used stable isotope analysis (SIA) and 16S rRNA gene sequencing to compare the effects of a locally-sourced vegetable-based diet and commercial pellet-based diets on the relative condition, nutrient assimilation patterns and gastrointestinal microbiota of GIFT. GIFT fed a locally-sourced diet were smaller, and in a significantly poorer condition than those fed with commercial fish feeds. SIA showed no differences in dietary carbon between the two diets; however, δ13C, poor fish condition and the abundance of specific bacterial taxa (of such as Fusobacteria) were correlated. SIA revealed that GIFT fed locally-sourced diets that predominantly consisted of vegetables were significantly enriched in δ15N despite a perceived lack of dietary protein. This enrichment suggests that GIFT fed a locally-sourced diet may be supplementing their diet via cannibalism, a behaviour representative of poor farming practice. Overall this study highlights the need to increase the availability of suitable GIFT feeds in developing nations. The development a low-cost feed alternative could improve the success of small-scale GIFT farmers in PNG, increasing both food and income security within the region.


Assuntos
Ração Animal , Animais Geneticamente Modificados/metabolismo , Aquicultura/métodos , Ciclídeos/metabolismo , Microbioma Gastrointestinal/fisiologia , Animais , Animais Geneticamente Modificados/genética , Animais Geneticamente Modificados/microbiologia , Aquicultura/economia , Aquicultura/organização & administração , Canibalismo , Ciclídeos/genética , Ciclídeos/microbiologia , DNA Bacteriano/isolamento & purificação , Suplementos Nutricionais/economia , Eficiência Organizacional/economia , Fazendas/economia , Fazendas/organização & administração , New South Wales , Nutrientes/metabolismo , RNA Ribossômico 16S/genética
12.
Proc Natl Acad Sci U S A ; 117(33): 19837-19843, 2020 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-32732433

RESUMO

Social distancing is the core policy response to coronavirus disease 2019 (COVID-19). But, as federal, state and local governments begin opening businesses and relaxing shelter-in-place orders worldwide, we lack quantitative evidence on how policies in one region affect mobility and social distancing in other regions and the consequences of uncoordinated regional policies adopted in the presence of such spillovers. To investigate this concern, we combined daily, county-level data on shelter-in-place policies with movement data from over 27 million mobile devices, social network connections among over 220 million Facebook users, daily temperature and precipitation data from 62,000 weather stations, and county-level census data on population demographics to estimate the geographic and social network spillovers created by regional policies across the United States. Our analysis shows that the contact patterns of people in a given region are significantly influenced by the policies and behaviors of people in other, sometimes distant, regions. When just one-third of a state's social and geographic peer states adopt shelter-in-place policies, it creates a reduction in mobility equal to the state's own policy decisions. These spillovers are mediated by peer travel and distancing behaviors in those states. A simple analytical model calibrated with our empirical estimates demonstrated that the "loss from anarchy" in uncoordinated state policies is increasing in the number of noncooperating states and the size of social and geographic spillovers. These results suggest a substantial cost of uncoordinated government responses to COVID-19 when people, ideas, and media move across borders.


Assuntos
Infecções por Coronavirus/prevenção & controle , Análise Custo-Benefício , Eficiência Organizacional , Modelos Logísticos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Quarentena/organização & administração , Infecções por Coronavirus/economia , Demografia/estatística & dados numéricos , Humanos , Pandemias/economia , Pneumonia Viral/economia , Quarentena/economia , Quarentena/métodos , Distância Social , Mídias Sociais/estatística & dados numéricos , Transportes/estatística & dados numéricos , Estados Unidos
14.
Emerg Med Clin North Am ; 38(3): 573-587, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32616280

RESUMO

Emergency department crowding is a multifactorial issue with causes intrinsic to the emergency department and to the health care system. Understanding that the causes of emergency department crowding span this continuum allows for a more accurate analysis of its effects and a more global consideration of potential solutions. Within the emergency department, boarding of inpatients is the most appreciable effect of hospital-wide crowding, and leads to further emergency department crowding. We explore the concept of emergency department crowding, and its causes, effects, and potential strategies to overcome this problem.


Assuntos
Aglomeração , Serviço Hospitalar de Emergência/organização & administração , Eficiência Organizacional , Serviço Hospitalar de Emergência/estatística & dados numéricos , Humanos
15.
Emerg Med Clin North Am ; 38(3): 589-605, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32616281

RESUMO

Staffing and productivity are key concepts to understand when managing an emergency department. Provider productivity is not static, starts out high, and decreases throughout the shift in a stepwise manner. It is commonly measured by patients per hour or relative value units per hour, and is impacted by factors from the presence of residents to shift length. Appropriate staffing requires thorough understanding of the workforce and the variable patient demand of the department. Matching capacity to this demand potentially improves overall throughput and efficiency. Once knowledgeable about these factors, we provide a case study to showcase their application.


Assuntos
Eficiência Organizacional , Serviço Hospitalar de Emergência/organização & administração , Recursos Humanos/organização & administração , Eficiência Organizacional/normas , Serviço Hospitalar de Emergência/normas , Humanos , Recursos Humanos/normas
16.
Emerg Med Clin North Am ; 38(3): 617-631, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32616283

RESUMO

This article introduces a clinical audience to the process of emergency department (ED) design, particularly relating to academic EDs. It explains some of the major terms, processes, and key decisions that clinical staff will experience as participants in the design process. Topics covered include an overview of the planning and design process, issues related to determining needed patient capacity, the impact of patient flow models on design, and a description of several common ED design types and their advantages and disadvantages.


Assuntos
Serviço Hospitalar de Emergência/organização & administração , Arquitetura de Instituições de Saúde , Eficiência Organizacional , Arquitetura de Instituições de Saúde/métodos , Humanos , Capacidade de Resposta ante Emergências/organização & administração
17.
Emerg Med Clin North Am ; 38(3): 633-646, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32616284

RESUMO

Lean engineering is based on a process improvement strategy originally developed at Toyota and has been used in many different industries to maximize efficiency by minimizing waste. Lean improvement projects are frequently instituted in emergency departments in an effort to improve processes and thereby improve patient care. Such projects have been undertaken with success in many emergency departments in order to improve metrics such as door-to-provider time, left without being seen rate, and patient length of stay. By reducing waste in the system, Lean processes aim to maximize efficiency and minimize delay and redundancy to the extent possible.


Assuntos
Eficiência Organizacional , Serviço Hospitalar de Emergência/organização & administração , Melhoria de Qualidade/organização & administração , Eficiência Organizacional/normas , Serviço Hospitalar de Emergência/normas , Humanos , Tempo de Internação , Satisfação do Paciente , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde
18.
Emerg Med Clin North Am ; 38(3): 715-727, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32616290

RESUMO

Academic emergency departments (EDs) play a vital role in provision of emergency care and contribute to training of resident physicians. Academic EDs also generate innovations and discoveries through clinical research within academic medical centers. However, academic EDs face challenges when initiating operational process improvement efforts because of the medical complexity of patients, academic culture within academic medical centers, and variability in productivity and specialty training of trainees. To optimize operations within academic EDs, it is critical to understand characteristics shared by academic EDs, how to implement process improvement initiatives, trainee impact on ED operations, and how to promote operational research.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Eficiência Organizacional , Humanos , Melhoria de Qualidade/organização & administração , Qualidade da Assistência à Saúde/organização & administração
19.
Ann Glob Health ; 86(1): 70, 2020 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-32676299

RESUMO

Background: In December 2019, early cases of COVID-19 were identified in Wuhan, China. By late January 2020, it was evident that COVID-19 was rapidly spreading and represented a national health emergency. In order to contain the spread of COVID-19, China adopted a centralized treatment plan by appointing designated hospitals in each region. Shantou Central Hospital is a Grade A Class A general hospital in Guangdong Province. It was appointed as a provincial COVID-19 designated treatment hospital on January 21, 2020, to provide all COVID-19-related treatments for the city of Shantou. The nursing department at Shantou Central Hospital is fully responsible for hospital nursing administration, nursing human resource management, nursing quality management, and all nursing tasks related to hospital medical care, nursing, teaching, scientific research, preventive healthcare, and so on. Objective: To summarize the role of nursing management in transforming a general hospital into a designated hospital for treatment of COVID-19 patients. Methods: We undertook a series of nursing management measures in the strategic phase and the implementation phase. Findings: Through a series of nursing management measures, all COVID-19 patients admitted to our hospital were cured and discharged. All non-COVID-19 patients and staff hospitalized during the same period were not infected with the virus. During this period, our hospital completed 7,466 operations. Hence, our nursing management measures were effective. Conclusions: Our efficient nursing management system, first of all, effectively mobilized all available manpower; secondly, up-skilled and trained personnel within a very short period of time; thirdly, provided reliable logistical support for front-line protection equipments; and finally, motivated nurses during this very difficult time to make a significant positive contribution to the fight against COVID-19 pandemic.


Assuntos
Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/enfermagem , Hospitais Gerais/organização & administração , Recursos Humanos de Enfermagem no Hospital/organização & administração , Pneumonia Viral/epidemiologia , Pneumonia Viral/enfermagem , Betacoronavirus , China/epidemiologia , Eficiência Organizacional , Humanos , Pandemias
20.
PLoS One ; 15(7): e0234204, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32730270

RESUMO

Increasing concerns about air pollution and the promise of enhancing energy security have stimulated the growth of electric vehicles (EVs) worldwide. Compared with gasoline vehicles (GVs), EVs have no emissions and are more environmentally friendly to the sustainable transportation system. Since these two types of vehicles with different emission externalities and observable differences, in this paper, we propose a differentiable road pricing for EVs and GVs to simultaneously manage congestion and emissions by establishing a two-class bi-objective optimization (TCBO) model. First, we investigate whether the differentiable road pricing can induce user equilibrium pattern into a unique pareto-efficient pattern. Then performance of the bi-criteria system optimal is measured by bounding the deviation gap of the Pareto frontier. Specifically, we bound how far the total system travel time and total system emissions at a given Pareto optimum can deviate from their respective single-criterion based system optimum. Finally, we investigate the maximum efficiency gain of the bi-criteria system achieved through implementing differentiable road pricing by comparing total system travel time and total system emissions under two states. After defining two types of price of anarchy (POA), the theoretical bound for the worst possible ratio of total system travel time\ total system emissions in user equilibrium state to the total system travel time\ total system emissions in Pareto-efficient state is derived out. In order to validate the feasibility of theoretical bound, we conduct case studies to calculate the numerical bound of POA based on two Chinese cities: Shenzhen and Lasa. Overall, quantifying the maximum efficiency of differentiable road pricing is beneficial for improving the network designing, policy implementation and social efficiency with regard to congestion and emissions caused by EV and GV users.


Assuntos
Poluição do Ar/prevenção & controle , Automóveis/economia , Custos e Análise de Custo , Poluentes Atmosféricos , Condução de Veículo/psicologia , Eficiência Organizacional , Eletricidade , Gasolina , Humanos , Motivação , Fatores de Tempo , Viagem , Emissões de Veículos
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