Appointment Overbooking and Scheduling: Tradeoffs Between Schedule Efficiency and Timely Access to Service

2017 ◽  
pp. 245-255 ◽  
Author(s):  
Yan Chen ◽  
Hari Balasubramanian ◽  
Yong-Hong Kuo
Keyword(s):  
Timely Access

South Asian Stories: Firsthand Client Perspectives on Barriers to Accessing Speech-Language Pathology Services

2012 ◽  
Vol 19 (1) ◽  
pp. 29-36 ◽  
Author(s):  
Nidhi Mahendra
Keyword(s):  
South Asian ◽  
Empirical Support ◽  
Communication Disorders ◽  
Speech Language Pathology ◽  
Client Experiences ◽  
Individual Interviews ◽  
Timely Access ◽  
Phenomenological Perspective ◽  
Case Vignettes ◽  
Language Pathology

This article details the experience of two South Asian individuals with family members who had communication disorders. I provide information on intrinsic and extrinsic barriers reported by these clients in responses to a survey and during individual ethnographic interviews. These data are part of a larger study and provide empirical support of cultural and linguistic barriers that may impede timely access to and utilization of speech-language pathology (SLP) services. The purpose of this article is to shed light on barriers and facilitators that influence South Asian clients' access to SLP services. I provide and briefly analyze two case vignettes to provide readers a phenomenological perspective on client experiences. Data about barriers limiting access to SLP services were obtained via client surveys and individual interviews. These two clients' data were extracted from a larger study (Mahendra, Scullion, Hamerschlag, Cooper, & La, 2011) in which 52 racially/ethnically diverse clients participated. Survey items and interview questions were designed to elicit information about client experiences when accessing SLP services. Results reveal specific intrinsic and extrinsic barriers that affected two South Asian clients' access to SLP services and have important implications for all providers.

Evaluations for New Healthcare Environment Commissioning and Operational Decision Making Using Simulation and Human Factors: A Case Study of an Interventional Trauma Operating Room

2021 ◽  
pp. 193758672199966
Author(s):  
Mirette Dubé ◽  
Jason Laberge ◽  
Elaine Sigalet ◽  
Jonas Shultz ◽  
Christine Vis ◽  
...  
Keyword(s):  
Decision Making ◽  
Human Factors ◽  
Operating Room ◽  
Healthcare Services ◽  
Healthcare Team ◽  
Healthcare Environment ◽  
New Process ◽  
Timely Access ◽  
Operational Decision Making

Purpose: The aim of this article is to provide a case study example of the preopening phase of an interventional trauma operating room (ITOR) using systems-focused simulation and human factor evaluations for healthcare environment commissioning. Background: Systems-focused simulation, underpinned by human factors science, is increasingly being used as a quality improvement tool to test and evaluate healthcare spaces with the stakeholders that use them. Purposeful real-to-life simulated events are rehearsed to allow healthcare teams opportunity to identify what is working well and what needs improvement within the work system such as tasks, environments, and processes that support the delivery of healthcare services. This project highlights salient evaluation objectives and methods used within the clinical commissioning phase of one of the first ITORs in Canada. Methods: A multistaged evaluation project to support clinical commissioning was facilitated engaging 24 stakeholder groups. Key evaluation objectives highlighted include the evaluation of two transport routes, switching of operating room (OR) tabletops, the use of the C-arm, and timely access to lead in the OR. Multiple evaluation methods were used including observation, debriefing, time-based metrics, distance wheel metrics, equipment adjustment counts, and other transport route considerations. Results: The evaluation resulted in several types of data that allowed for informed decision making for the most effective, efficient, and safest transport route for an exsanguinating trauma patient and healthcare team; improved efficiencies in use of the C-arm, significantly reduced the time to access lead; and uncovered a new process for switching OR tabletop due to safety threats identified.

scholarly journals Development of unmanned aerial vehicle (UAV) networks delivering early defibrillation for out-of-hospital cardiac arrests (OHCA) in areas lacking timely access to emergency medical services (EMS) in Germany: a comparative economic study

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e043791
Author(s):  
Jan Bauer ◽  
Dieter Moormann ◽  
Reinhard Strametz ◽  
David A Groneberg
Keyword(s):  
Cost Effectiveness ◽  
Emergency Medical Services ◽  
Rural Areas ◽  
Medical Services ◽  
Secondary Outcome ◽  
Annual Average ◽  
Emergency Medical ◽  
Life Years ◽  
Timely Access ◽  
The Cost

ObjectivesThis study wants to assess the cost-effectiveness of unmanned aerial vehicles (UAV) equipped with automated external defibrillators (AED) in out-of-hospital cardiac arrests (OHCA). Especially in rural areas with longer response times of emergency medical services (EMS) early lay defibrillation could lead to a significant higher survival in OHCA.Participants3296 emergency medical stations in Germany.SettingRural areas in Germany.Primary and secondary outcome measuresThree UAV networks providing 80%, 90% or 100% coverage for rural areas lacking timely access to EMS (ie, time-to-defibrillation: >10 min) were developed using a location allocation analysis. For each UAV network, primary outcome was the cost-effectiveness using the incremental cost-effectiveness ratio (ICER) calculated by the ratio of financial costs to additional life years gained compared with current EMS.ResultsCurrent EMS with 3926 emergency stations was able to gain 1224 life years on annual average in the study area. The UAV network providing 100% coverage consisted of 1933 UAV with average annual costs of €43.5 million and 1845 additional life years gained on annual average (ICER: €23 568). The UAV network providing 90% coverage consisted of 1074 UAV with average annual costs of €24.2 million and 1661 additional life years gained on annual average (ICER: €14 548). The UAV network providing 80% coverage consisted of 798 UAV with average annual costs of €18.0 million and 1477 additional life years gained on annual average (ICER: €12 158).ConclusionThese results reveal the relevant life-saving potential of all modelled UAV networks. Furthermore, all analysed UAV networks could be deemed cost-effective. However, real-life applications are needed to validate the findings.

scholarly journals Equitable Access of Naloxone Programs in Durham Region, Ontario, Canada

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L Martignetti ◽  
W Sun
Keyword(s):  
Service Providers ◽  
Methodological Approach ◽  
Equitable Access ◽  
Descriptive Phenomenology ◽  
Environmental Scan ◽  
Key Informant ◽  
Timely Access ◽  
Qualitative Descriptive ◽  
New Policies ◽  
Key Informant Interview

Abstract Background In 2019 there were over 1500 opioid-related deaths in the province of Ontario, Canada. While the opioid crisis is affecting many socioeconomic groups and communities across Canada not all are being affected equally despite the presence of naloxone distribution programs in Ontario. This qualitative exploratory study seeks to understand facilitators and barriers that influence equitable access of naloxone programs in Durham Region, Ontario, Canada. Methods An environmental scan will be conducted to examine the availability and distribution of naloxone across community pharmacies and organizations in Durham Region. A qualitative descriptive phenomenology will be the methodological approach where key informant interviews will explore experiences of users and providers of naloxone programs. Key informants will include service providers and clients of both Ontario Naloxone Program and Ontario Naloxone Program for Pharmacies in Durham Region. The harm reduction framework will be used to guide data analysis where thematic analysis will be conducted to generate overarching themes about the phenomenon. Results The environmental scan will result in the creation of a map outlining availability and distribution of naloxone programs to examine possible gaps that exist in Durham Region. It is expected that key informant interview findings will help understand where inequity exists in accessing Ontario's naloxone programs in Durham Region by highlighting its barriers and facilitators. Conclusions Findings generated will be used for larger scale studies in the future examining equitable access of naloxone distribution programs in Canada. This study will have implications to provide recommendations to policymakers for developing new policies to facilitate timely access of naloxone to mitigate risk of opioid-related harms. Key messages This research will help to better understand the inequities that exist in Ontario's naloxone distribution programs. This research will help to inform recommendations to improve policies surrounding Ontario's naloxone distribution programs.

scholarly journals LESSONS FROM THE RESIDENT EXPERIENCE WITH THE R3 PROGRAM

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S776-S776
Author(s):  
Edward A Miller ◽  
Pamela Nadash ◽  
Elizabeth Simpson ◽  
Natalie Shellito ◽  
Marc Cohen
Keyword(s):  
Emotional Support ◽  
Supportive Services ◽  
Promotion Strategy ◽  
Senior Housing ◽  
Building Trust ◽  
Appropriate Care ◽  
Timely Access ◽  
Health Related ◽  
Lower Health ◽  
Privacy And Confidentiality

Abstract Understanding the resident experience is a critical step to creating a sustainable and replicable model of affordable resident-centered housing with supportive services programs. This study thus draws lessons from focus groups with participants in the R3 program for designing and implementing such initiatives in affordable senior housing. Findings indicate that the R3 program brings value to residents: they benefit from reliable information on health-related issues, as well as emotional support and assistance with accessing appropriate care. By focusing on prevention and ensuring timely access to services, findings suggest how the intervention could promote seniors living independently longer and lower health system costs. Results also suggest ways to improve the effectiveness of housing with services programs, including providing clarity regarding the purpose of the program, its components and staffing, building trust between program staff and residents, addressing concerns about privacy and confidentiality, and implementing a multipronged marketing and promotion strategy.

scholarly journals The effectiveness of different patient referral systems to shorten waiting times for elective surgeries: systematic review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dimuthu Rathnayake ◽  
Mike Clarke
Keyword(s):  
Primary Care ◽  
Health Systems ◽  
Elective Surgery ◽  
Waiting Times ◽  
Surgical Care ◽  
High Income ◽  
Surgical Patients ◽  
Timely Access ◽  
Referral Systems

Abstract Background Long waiting times for elective surgery are common to many publicly funded health systems. Inefficiencies in referral systems in high-income countries are more pronounced than lower and middle-income countries. Primary care practitioners play a major role in determining which patients are referred to surgeon and might represent an opportunity to improve this situation. With conventional methods of referrals, surgery clinics are often overcrowded with non-surgical referrals and surgical patients experience longer waiting times as a consequence. Improving the quality of referral communications should lead to more timely access and better cost-effectiveness for elective surgical care. This review summarises the research evidence for effective interventions within the scope of primary-care referral methods in the surgical care pathway that might shorten waiting time for elective surgeries. Methods We searched PubMed, EMBASE, SCOPUS, Web of Science and Cochrane Library databases in December-2019 to January-2020, for articles published after 2013. Eligibility criteria included major elective surgery lists of adult patients, excluding cancer related surgeries. Both randomised and non-randomised controlled studies were eligible. The quality of evidence was assessed using ROBINS-I, AMSTAR 2 and CASP, as appropriate to the study method used. The review presentation was limited to a narrative synthesis because of heterogeneity. The PROSPERO registration number is CRD42019158455. Results The electronic search yielded 7543 records. Finally, nine articles were considered as eligible after deduplication and full article screening. The eligible research varied widely in design, scope, reported outcomes and overall quality, with one randomised trial, two quasi-experimental studies, two longitudinal follow up studies, three systematic reviews and one observational study. All the six original articles were based on referral methods in high-income countries. The included research showed that patient triage and prioritisation at the referral stage improved timely access and increased the number of consultations of surgical patients in clinics. Conclusions The available studies included a variety of interventions and were of medium to high quality researches. Managing patient referrals with proper triaging and prioritisation using structured referral formats is likely to be effective in health systems to shorten the waiting times for elective surgeries, specifically in high-income countries.

scholarly journals Evaluating the Long-Term Efficacy of COVID-19 Vaccines

2021 ◽  
Author(s):  
Dan-Yu Lin ◽  
Donglin Zeng ◽  
Peter B Gilbert
Keyword(s):  
Large Scale ◽  
Crossover Designs ◽  
Phase 3 ◽  
Term Efficacy ◽  
Timely Access ◽  
Efficacious Vaccine ◽  
Trial Participants ◽  
Ongoing Phase

Abstract Large-scale deployment of safe and durably effective vaccines can curtail the COVID-19 pandemic.1−3 However, the high vaccine efficacy (VE) reported by ongoing phase 3 placebo-controlled clinical trials is based on a median follow-up time of only about two months4−5 and thus does not pertain to long-term efficacy. To evaluate the duration of pro- tection while allowing trial participants timely access to efficacious vaccine, investigators can sequentially cross participants over from the placebo arm to the vaccine arm according to priority groups. Here, we show how to estimate potentially time-varying placebo-controlled VE in this type of staggered vaccination of participants. In addition, we compare the per- formance of blinded and unblinded crossover designs in estimating long-term VE.

scholarly journals Book Availability Revisited: Turnaround Time for Recalls versus Interlibrary Loans

2003 ◽  
Vol 64 (4) ◽  
pp. 283-299 ◽  
Author(s):  
David J. Gregory ◽  
Wayne A. Pedersen
Keyword(s):  
Real Time ◽  
Phase 1 ◽  
Academic Library ◽  
Turnaround Time ◽  
Phase 2 ◽  
Interlibrary Loan ◽  
Reasonable Alternative ◽  
Local Institution ◽  
Timely Access ◽  
Average Turnaround Time

Librarians typically view interlibrary loan (ILL) as a means of providing access to items not owned by the local institution. However, they are less likely to explore ILL’s potential in providing timely access to items locally owned, but temporarily unavailable, particularly in the case of monographs in circulation. In a two-part study, the authors test the assumption that, on average, locally owned books that a patron finds unavailable (due to checkout) can be obtained more quickly via recall than via ILL. Phase 1 of this study establishes an average turnaround time for circulation recalls in a large academic library for comparison with well-established turnaround times for ILL borrowing transactions. In Phase 2, a more rigorous paired study of recalls and ILL compares the ability of each system to handle identical requests in real time. Results demonstrate that, under some circumstances, ILL provides a reasonable alternative to the internal recall process. The findings also underscore the need for more holistic, interservice models for improving not just access, but also the timeliness of access, to monograph collections.

Referral Criteria for Assessment and Treatment: In an Ambulatory Dysphagia Clinic

2012 ◽  
Vol 73 (4) ◽  
pp. 189-194
Author(s):  
Klara Lorinczi ◽  
Vanessa Denheyer ◽  
Amanda Pickard ◽  
Alice Lee ◽  
Diana R. Mager
Keyword(s):  
Health Care ◽  
Retrospective Chart Review ◽  
Wait Times ◽  
Health Care Teams ◽  
Treatment Services ◽  
Referral Criteria ◽  
Assessment And Treatment ◽  
Timely Access ◽  
Interdisciplinary Health Care Teams ◽  
Interdisciplinary Health Care

Dysphagia is highly prevalent in patients with chronic neurological disorders and can increase the risk for comorbidities such as aspiration pneumonia and malnutrition. Treatment includes timely access to interdisciplinary health care teams with specialized skills in dysphagia management. A retrospective chart review (n=99 of 125 charts screened) was conducted to evaluate the effectiveness of referral criteria to identify and triage patients with suspected dysphagia to an ambulatory dysphagia clinic. Variables collected included demographic information (age), anthropometric information (body mass index [BMI], each patient’s sex), reason for referral, primary medical diagnosis, symptomatology (e.g., pneumonia, chest congestion), nutrition and swallowing interventions, clinic wait times, missed/cancelled appointments, and referring health care professional. The mean age and mean BMI ± standard deviation of patients reviewed were 68.7 years ± 18.4 years and 25.2 kg/m2 ± 6.7 kg/m2, respectively. Average clinic wait times were 158 days (13 to 368 days) for routine and 52 days (0 to 344 days) for urgent assessments (p<0.001). The most common reason(s) for referral was/were related to dysphagia (n=83), surgery (n=50), and/or gastrointestinal symptomatology (n=28); 80% to 90% of patients received varying diagnostic and treatment services for dysphagia. Development of effective referral criteria is critical to ensure that clients with dysphagia receive timely diagnostic, treatment, and nutrition interventions by interdisciplinary health care teams specializing in dysphagia.

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