Theoretical Conceptualization and Action Plan: Contributing Factors and Potential Responses

2021 ◽  
pp. 221-241
Author(s):  
Charles W. Russo ◽  
Jarrod Sadulski
Keyword(s):  
Action Plan ◽  
Contributing Factors ◽  
Theoretical Conceptualization

Emergency department surge and overcrowding: An interdisciplinary solution for an institutional issue.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 242-242 ◽  
Author(s):  
Susan Gaeta ◽  
Toni Edwards ◽  
Sorayah Bourenane ◽  
Carmen E. Gonzalez ◽  
Karen McFarland ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Action Plan ◽  
Cancer Center ◽  
Contributing Factors ◽  
Improvement Project ◽  
Safety Risks ◽  
Ed Overcrowding ◽  
Systematic Solution ◽  
Md Anderson

242 Background: Emergency Department (ED) surges at MD Anderson Cancer Center (MDACC) lead to overcrowding, safety risks, privacy concerns, staff burnout, and adverse events associated with delays in care, including death. In 2015, the ED Interdisciplinary Quality & Safety Committee (EDIQSC) at MDACC was developed to review and address safety events. We report on the preliminary results of a quality improvement project with a long-term goal of developing a systematic solution of proactively responding to ED surge and overcrowding (EDSO). Methods: First, EDIQSC reviewed the current literature regarding EDSO. Subsequently an ED Surge and ED Overcrowding Committee (EDSOC) was established to identify solutions to address patient safety risks and improve patient experience in the ED. Results: Literature review showed that NEDOCS (Weiss, SJ et al) was the best scoring tool to calculate ED Overcrowding levels. EDSOC’s weekly meetings facilitated by the Office of Performance Improvement (OPI) explored factors related to EDSO via FMEA a quality improvement tool that proactively evaluate process associated risks. In addition, the following immediate solutions were implemented in the ED: daily status reporting by ED to institutional leaders, a “fast-track” care area implementation, senior executive rounding during ED Surge, electronic medical record (EMR) configuration for high census accommodation, continuous ED Nursing Leadership unit needs assessment, and prioritization of needs based on hospital throughput. Additional interventions in current development include a real-time EMR dashboard accurately reflecting ED capacity, and a NEDOCS guided interdisciplinary operational action plan. Conclusions: ED Surge & Overcrowding is a complex issue with various external and internal contributing factors that cannot be solved with one approach. It is a dynamic, interdisciplinary system that requires vigilant planning, assessment of downstream change effects, stakeholder agility and continuous risk anticipation. EDSOC continues these efforts in an attempt to develop and implement a comprehensive, interdisciplinary tool to direct institutional operations during times of ED Surge & Overcrowding.

scholarly journals A case study of systems analysis to improve service in a multidisciplinary outpatient clinic

2012 ◽  
Vol 1 (1) ◽  
pp. 15 ◽  
Author(s):  
Abhijit Basu
Keyword(s):  
Service Delivery ◽  
Systems Analysis ◽  
Action Plan ◽  
District General Hospital ◽  
Service Improvement ◽  
Successful Implementation ◽  
Analysis Tool ◽  
Outpatient Services ◽  
Contributing Factors ◽  
Large Patient

Background/objective: Innovative ways of improving service delivery often requires testing new ideas. Systems analysis is a validated tool to investigate adverse incidents. This paper describes an innovative usage of this tool for service improvement and redesign in an out-patient setting involving a multidisciplinary team treating women with diabetes in pregnancy at an outer metropolitan health facility in Australia. Methods: Systems analysis tool was chosen to determine the probable causes for prolongation of clinic time causing dissatisfaction amongst the service users and the staff. It provided the template for an action plan regarding work and environmental, organizational process, team, individual, task and patient factors. Remedial actions were implemented over a six month period following this analysis. Timely completion of clinic was the chosen indicator of successful implementation. Results: Several interlinked layers of contributory factors were identified through systems analysis. The large patient load regardless of disease severity was the major contributor. Space restriction for consultation, lesser continuity in the team structure, dated guideline and limited communication between the team members were other factors. Changes implemented included redistribution of patients, adopting new evidence based guidelines, better patient selection accessing the dedicated one-stop clinic and a small change in capacity involving human resources. The service delivery process was restructured in tandem over six months. As a result of these interventions the clinics finished on time generating much greater level of satisfaction among the women attending the clinic and the staff. Conclusions: Redesigning service is an ongoing quality improvement process linked to user and provider satisfaction. Systems analysis is a tool designed to address adverse incidents and identify contributing factors. This study describes an innovative use of the systems analysis tool to improve outpatient services at a district general hospital. 

The Influence of Language Context on Repetitive Speech Use in Children With Autism Spectrum Disorder

2020 ◽  
Vol 29 (1) ◽  
pp. 327-334 ◽  
Author(s):  
Allison Gladfelter ◽  
Cassidy VanZuiden
Keyword(s):  
Autism Spectrum Disorder ◽  
Autism Spectrum ◽  
Individual Characteristics ◽  
Receptive Vocabulary ◽  
Spectrum Disorder ◽  
School Age Children ◽  
Social Responsiveness ◽  
Contributing Factors ◽  
Children With Asd ◽  
Language Context

Purpose Although repetitive speech is a hallmark characteristic of autism spectrum disorder (ASD), the contributing factors that influence repetitive speech use remain unknown. The purpose of this exploratory study was to determine if the language context impacts the amount and type of repetitive speech produced by children with ASD. Method As part of a broader word-learning study, 11 school-age children with ASD participated in two different language contexts: storytelling and play. Previously collected language samples were transcribed and coded for four types of repetitive speech: immediate echolalia, delayed echolalia, verbal stereotypy, and vocal stereotypy. The rates and proportions of repetitive speech were compared across the two language contexts using Wilcoxon signed-ranks tests. Individual characteristics were further explored using Spearman correlations. Results The children produced lower rates of repetitive speech during the storytelling context than the play-based context. Only immediate echolalia differed between the two contexts based on rate and approached significance based on proportion, with more immediate echolalia produced in the play-based context than in the storytelling context. There were no significant correlations between repetitive speech and measures of social responsiveness, expressive or receptive vocabulary, or nonverbal intelligence. Conclusions The children with ASD produced less immediate echolalia in the storytelling context than in the play-based context. Immediate echolalia use was not related to social skills, vocabulary, or nonverbal IQ scores. These findings offer valuable insights into better understanding repetitive speech use in children with ASD.

1118: The Incidence and Duration of Postoperative Ileus in Patients Undergoing Radical Cystectomy. A Multivariate Analysis of Contributing Factors

2005 ◽  
Vol 173 (4S) ◽  
pp. 303-303
Author(s):  
Diana Wiessner ◽  
Rainer J. Litz ◽  
Axel R. Heller ◽  
Mitko Georgiev ◽  
Oliver W. Hakenberg ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Radical Cystectomy ◽  
Postoperative Ileus ◽  
Contributing Factors

Blood Pressure and Contributing Factors in Inhabitants of Estonia: 15-year Trends

2003 ◽  
Vol 12 (2) ◽  
pp. 1-1
Author(s):  
JELENA ABINA ◽  
OLGA VOLOZH ◽  
ELEONORA SOLODKAYA ◽  
MERILEID SAAVA
Keyword(s):  
Blood Pressure ◽  
Contributing Factors

Efficacy of Crisis Intervention

Crisis ◽  
1999 ◽  
Vol 20 (2) ◽  
pp. 78-85 ◽  
Author(s):  
Thomas Reisch ◽  
Petra Schlatter ◽  
Wolfgang Tschacher
Keyword(s):  
Crisis Intervention ◽  
Intervention Program ◽  
Suicide Ideation ◽  
Indirect Evidence ◽  
Well Being ◽  
Term Therapy ◽  
Contributing Factors ◽  
Step Therapy ◽  
Long Term Therapy ◽  
The Impact

This study assesses the efficacy of the treatment approach implemented in the Bern Crisis Intervention Program, where particular emphasis is placed on the remediation of suicide ideation and suicidal behavior, and depression, fear, and phobia are generally considered to be contributing factors. Four questionnaires addressing psychopathology, emotional well-being, social anxiety, and personality were administered prior to and after the treatment of 51 patients over a period of 2 to 3 weeks. The reduction of symptoms contributing to suicidal ideation and behavior was interpreted as indirect evidence of an antisuicidal effect of the program. Significant improvements were found in the psychopathology ratings, with depression and anxiety showing the largest reductions. The impact on personality and social phobia, however, was only moderate, and on average patients still exhibited symptoms after attending the program. This residual symptomatology points to the necessity of introducing a two-step therapy approach of intensive intervention targeted at the precipitating causes of the crisis, augmented by long-term therapy to treat underlying problems.

Differences in Suicidal Thoughts and Behaviors Among Three Racial Groups

Crisis ◽  
2020 ◽  
Vol 41 (3) ◽  
pp. 172-178
Author(s):  
Brooke A. Ammerman ◽  
Martha K. Fahlgren ◽  
Kristen M. Sorgi ◽  
Michael S. McCloskey
Keyword(s):  
Suicide Attempts ◽  
Health Concern ◽  
Future Research ◽  
Racial Groups ◽  
Contributing Factors ◽  
Suicidal Thoughts ◽  
Final Sample ◽  
And Behaviors ◽  
Assessment Procedures ◽  
Suicidal Thoughts And Behaviors

Abstract. Background: Despite being a major public health concern, it is unclear how suicidal thoughts and behaviors differentially impact separate racial groups. Aims: The aim of the current study was to examine the occurrence of nonlethal suicide events, in addition to suicide attempt characteristics and factors contributing to suicide attempts. Method: A final sample of 7,094 undergraduates from a large northeastern university, identifying as members of three racial groups (White [67.30%], Black [17.30%], and Asian [15.40%]), completed online questionnaires. Results: White participants reported increased likelihood of endorsing lifetime suicidal ideation and plan, whereas Black participants reported decreased likelihood of these events; no differences were found in rates of lifetime suicide attempts. Black participants' suicidal behavior may involve greater ambivalence of intent. A higher proportion of Asian participants endorsed interpersonal factors as contributing to their suicide attempts, whereas a greater percentage of White participants reported internal contributing factors. Limitations: Findings are limited by the sample size and assessment of lifetime suicidal thoughts and behaviors. Conclusion: The findings present a more nuanced look at attitudes and actions related to suicidal thoughts and behaviors that may inform future research and risk assessment procedures.

Suicide after Deployment in UN Peacekeeping Missions—A Danish Pilot Study

Crisis ◽  
2002 ◽  
Vol 23 (2) ◽  
pp. 55-58 ◽  
Author(s):  
J. Hansen-Schwartz ◽  
G. Jessen ◽  
K. Andersen ◽  
H.O. Jørgensen
Keyword(s):  
Pilot Study ◽  
Future Research ◽  
Prevention Strategies ◽  
Contributing Factors ◽  
Un Peacekeeping ◽  
Peacekeeping Missions

Summary: This pilot study looks at the frequency of suicide among Danish soldiers who took part in the UN mandated forces (UNMF) during the 1990's. In a contingent of nearly 4000 Danish UN soldiers four suicides were documented, two of whom committed suicide less than one month before deployment and two who committed suicide within a year after discharge from mission. Contributing factors, prevention strategies, and implications for future research are discussed.

Child and Adolescent Suicide Deaths in New Mexico, 1990-1994

Crisis ◽  
2000 ◽  
Vol 21 (1) ◽  
pp. 36-44 ◽  
Author(s):  
DD Werenko ◽  
LM Olson ◽  
L Fullerton-Gleason ◽  
AW Lynch ◽  
RE Zumwalt ◽  
...  
Keyword(s):  
New Mexico ◽  
Cause Of Death ◽  
American Indians ◽  
Adolescent Suicide ◽  
Suicide Attempts ◽  
Medical Examiner ◽  
Contributing Factors ◽  
Targeted Interventions ◽  
And Gender ◽  
Youth Activity

The suicide death rate in New Mexico is consistently higher than the national rate. Among adolescents, suicide is the third leading cause of death nationally, but in New Mexico it is the second leading cause of death. This study describes the pattern of adolescent suicide deaths in New Mexico. We conducted a retrospective review of all medical examiner autopsies for adolescent suicides (ages 20 years and younger) in New Mexico from 1990-1994. Records were reviewed for demographics and possible contributing factors such as depression, previous attempts, and alcohol and drug use. We identified 184 suicide deaths among children and adolescents ages 9-20 years for an overall rate of 12.9 per 100,000. Our rates for ages 5-9 years (0.2), 10-14 years (3.8), and 15-19 years (22.3) are over twice the U.S. rates. Suicide deaths resulted primarily from firearms (67%), hanging (16%), poisoning (6%), inhalation (4%), and other methods (7%). Method varied by ethnicity (p = .01) and gender (p = .03); males and non-Hispanic Whites were overrepresented among firearm deaths. Firearm ownership was known in 60 (48%) of the firearm deaths. Of these, 53% of the firearms belonged to a family member, 25% to the decedent, and 22% to a friend. Over one-third of decedents (41%) experienced mental disorders, primarily depressed mood and clinical depression. Previous suicide attempts were noted for 15% of the decedents. Some 50% of the decedents had alcohol or drugs present at the time of death; among American Indians/Alaska Natives, 74% had drugs or alcohol present (p = .003). Targeted interventions are needed to reduce adolescent suicide in New Mexico. We suggest raising awareness about acute and chronic contributing factors to suicide; training physicians to look for behavioral manifestations of depression; and involving physicians, teachers, and youth activity leaders in efforts to limit firearm accessibility, such as advising parents to remove firearms from their households.

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