scholarly journals LO21: Consistency of CTAS scores by presenting complaint pre and post eCTAS implementation in 35 emergency departments across Ontario

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S14-S15
Author(s):  
S. McLeod ◽  
C. Thompson ◽  
B. Borgundvaag ◽  
L. Thabane ◽  
H. Ovens ◽  
...  
Keyword(s):  
Emergency Departments ◽  
Improve Patient Safety ◽  
Vital Signs ◽  
Decision Support Tool ◽  
High Volume ◽  
Population Based ◽  
Primary Objective ◽  
Absolute Difference ◽  
Altered Level ◽  
Support Tool

Introduction: eCTAS is a real time electronic triage decision-support tool designed to improve patient safety and quality of care by standardizing the application of the Canadian Triage and Acuity Scale (CTAS). The tool dynamically calculates a recommended CTAS score based on the presenting complaint, vital signs and selected clinical modifiers. The primary objective was to assess consistency of CTAS score distributions across 35 emergency departments (EDs) by 16 presenting complaints pre and post eCTAS implementation. Methods: This retrospective cohort study used population-based administrative data from January 2016 to December 2018 from all hospital EDs in Ontario that had implemented eCTAS with at least 9 months of data. Following a 3-month stabilization period, we compared data for 6 months post-eCTAS implementation to the same 6-month period the previous year (pre-implementation) to account for potential seasonal variation, patient volume and case-mix. We included triage encounters of adult (≥18 years) patients if they had one of 16 pre-specified high-volume, presenting complaints. A paired-samples t-test was used to determine consistency by estimating the absolute difference in CTAS distribution for each presenting complaint, by each hospital, pre and post eCTAS implementation, compared to the overall average of the 35 EDs. Results: There were 183,231 triage encounters in the pre-eCTAS cohort and 179,983 in the post-eCTAS cohort from 35 EDs across the province. Triage scores were more consistent with the overall average after eCTAS implementation in 6 (37.5%) presenting complaints: chest pain (cardiac features) (p < 0.001), extremity weakness/symptoms of cerebrovascular accident (p < 0.001), fever (p < 0.001), shortness of breath (p < 0.001), syncope (p = 0.02), and hyperglycemia (p = 0.03). Triage consistency was similar pre and post eCTAS implementation for the presenting complaints of altered level of consciousness, anxiety/situational crisis, confusion, depression/suicidal/deliberate self-harm, general weakness, head injury, palpitations, seizure, substance misuse/intoxication or vertigo. Conclusion: A standardized, electronic approach to performing triage assessments increased consistency in CTAS scores across many, but not all, high-volume CEDIS complaints. This does not reflect triage accuracy, as there are no known benchmarks for triage accuracy. Improvements in consistency were greatest for sentinel presenting complaints with a minimum allowable CTAS score.

Neural Network Ensemble Approach to Pushed Convoys Dispatching Problems

2020 ◽  
Vol 27 (1) ◽  
pp. 70-82 ◽  
Author(s):  
Aleksandar Radonjić ◽  
Danijela Pjevčević ◽  
Vladislav Maraš
Keyword(s):  
Neural Network ◽  
Decision Support Tool ◽  
Primary Objective ◽  
Danube River ◽  
Decision Making Process ◽  
Neural Network Ensemble ◽  
Support Tool ◽  
Shipping Company ◽  
The Republic ◽  
Power Measurements

AbstractThis paper investigates the use of neural networks (NNs) for the problem of assigning push boats to barge convoys in inland waterway transportation (IWT). Push boat–barge convoy assignmentsare part of the daily decision-making process done by dispatchers in IWT companiesforwhich a decision support tool does not exist. The aim of this paper is to develop a Neural Network Ensemble (NNE) model that will be able to assist in push boat–barge convoy assignments based on the push boat power.The primary objective of this paper is to derive an NNE model for calculation of push boat Shaft Powers (SHPs) by using less than 100% of the experimental data available. The NNE model is applied to a real-world case of more than one shipping company from the Republic of Serbia, which is encountered on the Danube River. The solution obtained from the NNE model is compared toreal-world full-scale speed/power measurements carried out on Serbian push boats, as well as with the results obtained from the previous NNE model. It is found that the model is highly accurate, with scope for further improvements.

scholarly journals Type of facility influences lengths of stay of children presenting to high volume emergency departments

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Rhonda J. Rosychuk ◽  
Brian H. Rowe
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Emergency Departments ◽  
High Volume ◽  
Population Based ◽  
Initial Assessment ◽  
Teaching Hospitals ◽  
Emergency Department Crowding ◽  
Academic Teaching ◽  
The Impact

Abstract Background Emergency department crowding may impact patient and provider outcomes. We describe emergency department crowding metrics based on presentations by children to different categories of high volume emergency departments in Alberta, Canada. Methods This population-based retrospective study extracted all presentations made by children (age < 18 years) during April 2010 to March 2015 to 15 high volume emergency departments: five regional, eight urban, and two academic/teaching. Time to physician initial assessment, and length of stay for discharges and admissions were calculated based on the start of presentation and emergency department facility. Multiple metrics, including the medians for hourly, facility-specific time to physician initial assessment and length of stay were obtained. Results About half (51.2%) of the 1,124,119 presentations were made to the two academic/teaching emergency departments. Males presented more than females (53.6% vs 46.4%) and the median age was 5 years. Pediatric presentations to the three categories of emergency departments had mostly similar characteristics; however, urban and academic/teaching emergency departments had more severe triage scores and academic/teaching emergency departments had higher admissions. Across all emergency departments, the medians of the metrics for time to physician initial assessment, length of stay for discharges and for admission were 1h11min, 2h21min, and 6h29min, respectively. Generally, regional hospitals had shorter times than urban and academic/teaching hospitals. Conclusions Pediatric presentations to high volume emergency departments in this province suggest similar delays to see providers; however, length of stay for discharges and admissions were shorter in regional emergency departments. Crowding is more common in urban and especially academic emergency departments and the impact of crowding on patient outcomes requires further study.

scholarly journals Mobile Decision Support Tool for Emergency Departments and Mass Casualty Incidents (EDIT): Initial Study

10.2196/10727 ◽  
2018 ◽  
Vol 6 (6) ◽  
pp. e10727 ◽  
Author(s):  
Nicholas Boltin ◽  
Diego Valdes ◽  
Joan M Culley ◽  
Homayoun Valafar
Keyword(s):  
Decision Support ◽  
Emergency Departments ◽  
Decision Support Tool ◽  
Initial Study ◽  
Mass Casualty ◽  
Mass Casualty Incidents ◽  
Support Tool

scholarly journals Primary Care Clinicians Attitudes and Knowledge of Pharmacogenetics in a Large, Multi-state, Healthcare System

2018 ◽  
Vol 9 (2) ◽  
pp. 6
Author(s):  
Megan Olander ◽  
Stephen Waring ◽  
David D Stenehjem ◽  
Allise Taran ◽  
Paul L Raneli ◽  
...  
Keyword(s):  
Primary Care ◽  
Conflicts Of Interest ◽  
Human Subjects ◽  
Decision Support Tool ◽  
Clinical Decision ◽  
Primary Objective ◽  
Pharmacogenetic Testing ◽  
Support Tool ◽  
Medication Therapy ◽  
Primary Care Clinicians

  Background: Considerable progress has been made in the way of pharmacogenetic research and the development of clinical recommendations; however, its implementation into clinical practice has been slower than anticipated. We sought to better understand its lack of clinical uptake within primary care. Aim: The primary objective of this survey was to ascertain primary care clinicians’ perceptions of pharmacogenetic use and implementation in an integrated health system of metropolitan and rural settings across several states. Methods: Primary care clinicians (including MDs, DOs, NPs, and PAs) were invited to participate in a survey via email. Questions about pharmacogenetics knowledge and perceptions were presented to assess current understanding and usage of pharmacogenetics in practice. Results: The rate of response for the survey was 17%. Of the 90 respondents, 58% were female, 69% were MDs/DOs, 20% were NPs, and 11% were PAs. Fifty-eight percent of respondents received their clinical degree in or after 2000. Ninety percent of respondents noted that they were uncomfortable ordering a pharmacogenetics test, with 76% stating they were uncomfortable applying the results of a pharmacogenetic test. Notably, 78% of respondents were interested in having pharmacogenetic testing available through Medication Therapy Management (MTM) services, although PAs were significantly less interested as compared to NPs and MD/DOs. Ninety-five percent of respondents were interested in a clinical decision support tool relevant to pharmacogenetic results. Conclusions: As a whole, prescribing clinicians in primary care clinics are uncomfortable in the ordering, interpreting, and applying pharmacogenetic results to individual patients. However, favorable attitudes towards providing pharmacogenetic testing through existing MTM clinics provides the opportunity for pharmacists to advance existing practices. Conflict of Interest: We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties Treatment of Human Subjects: IRB determined project was non-HSR   Type: Student Project

Optimization of Complex Engineered Systems Under Risk and Uncertainty

2007 ◽  
Author(s):  
Seung-Kyum Choi ◽  
Mervyn Fathianathan ◽  
Dirk Schaefer
Keyword(s):  
Large Scale ◽  
Optimization Procedure ◽  
Decision Support Tool ◽  
Primary Objective ◽  
Risk And Uncertainty ◽  
Support Tool ◽  
Structural Problems ◽  
Complex Engineered Systems ◽  
Engineered Systems ◽  
Karhunen Loeve Transform

The advances in information technology significantly impact the engineering design process. The primary objective of this research is to develop a novel probabilistic decision support tool to assist management of structural systems under risk and uncertainty by utilizing a stochastic optimization procedure and IT tools. The proposed mathematical and computational framework will overcome the drawbacks of the traditional methods and will be critically demonstrated through large-scale structural problems. The efficiency of the proposed procedure is achieved by the combination of the Karhunen-Loeve transform with the stochastic analysis of polynomial chaos expansion to common optimization procedures. The proposed technology, comprising new and adapted current capabilities, will provide robust and physically reasonable solutions for practical engineering problems.

scholarly journals The Use and Effectiveness of an Online Diagnostic Support System for Blood Film Interpretation: Comparative Observational Study

10.2196/20815 ◽  
2021 ◽  
Vol 23 (8) ◽  
pp. e20815
Author(s):  
Claire Hutchinson ◽  
Michelle Brereton ◽  
Julie Adams ◽  
Barbara De La Salle ◽  
Jon Sims ◽  
...  
Keyword(s):  
Decision Support ◽  
Support System ◽  
Continuing Professional Development ◽  
Decision Support Tool ◽  
Blood Film ◽  
Primary Objective ◽  
Morphological Features ◽  
Support Tool ◽  
Laboratory Service ◽  
Secondary Objective

Background The recognition and interpretation of abnormal blood cell morphology is often the first step in diagnosing underlying serious systemic illness or leukemia. Supporting the staff who interpret blood film morphology is therefore essential for a safe laboratory service. This paper describes an open-access, web-based decision support tool, developed by the authors to support morphological diagnosis, arising from earlier studies identifying mechanisms of error in blood film reporting. The effectiveness of this intervention was assessed using the unique resource offered by the online digital morphology Continuing Professional Development scheme (DM scheme) offered by the UK National External Quality Assessment Service for Haematology, with more than 3000 registered users. This allowed the effectiveness of decision support to be tested within a defined user group, each of whom viewed and interpreted the morphology of identical digital blood films. Objective The primary objective of the study was to test the effectiveness of the decision support system in supporting users to identify and interpret abnormal morphological features. The secondary objective was to determine the pattern and frequency of use of the system for different case types, and to determine how users perceived the support in terms of their confidence in decision-making. Methods This was a comparative study of identical blood films evaluated either with or without decision support. Selected earlier cases from the DM scheme were rereleased as new cases but with decision support made available; this allowed a comparison of data sets for identical cases with or without decision support. To address the primary objectives, the study used quantitative evaluation and statistical comparisons of the identification and interpretation of morphological features between the two different case releases. To address the secondary objective, the use of decision support was assessed using web analytical tools, while a questionnaire was used to assess user perceptions of the system. Results Cases evaluated with the aid of decision support had significantly improved accuracy of identification for relevant morphological features (mean improvement 9.8%) and the interpretation of those features (mean improvement 11%). The improvement was particularly significant for cases with higher complexity or for rarer diagnoses. Analysis of website usage demonstrated a high frequency of access for web pages relevant to each case (mean 9298 for each case, range 2661-24,276). Users reported that the decision support website increased their confidence for feature identification (4.8/5) and interpretation (4.3/5), both within the context of training (4.6/5) and also in their wider laboratory practice (4.4/5). Conclusions The findings of this study demonstrate that directed online decision support for blood morphology evaluation improves accuracy and confidence in the context of educational evaluation of digital films, with effectiveness potentially extending to wider laboratory use.

scholarly journals The Use and Effectiveness of an Online Diagnostic Support System for Blood Film Interpretation: Comparative Observational Study (Preprint)

2020 ◽  
Author(s):  
Claire Hutchinson ◽  
Michelle Brereton ◽  
Julie Adams ◽  
Barbara De La Salle ◽  
Jon Sims ◽  
...  
Keyword(s):  
Decision Support ◽  
Support System ◽  
Continuing Professional Development ◽  
Decision Support Tool ◽  
Blood Film ◽  
Primary Objective ◽  
Morphological Features ◽  
Support Tool ◽  
Laboratory Service ◽  
Secondary Objective

BACKGROUND The recognition and interpretation of abnormal blood cell morphology is often the first step in diagnosing underlying serious systemic illness or leukemia. Supporting the staff who interpret blood film morphology is therefore essential for a safe laboratory service. This paper describes an open-access, web-based decision support tool, developed by the authors to support morphological diagnosis, arising from earlier studies identifying mechanisms of error in blood film reporting. The effectiveness of this intervention was assessed using the unique resource offered by the online digital morphology Continuing Professional Development scheme (DM scheme) offered by the UK National External Quality Assessment Service for Haematology, with more than 3000 registered users. This allowed the effectiveness of decision support to be tested within a defined user group, each of whom viewed and interpreted the morphology of identical digital blood films. OBJECTIVE The primary objective of the study was to test the effectiveness of the decision support system in supporting users to identify and interpret abnormal morphological features. The secondary objective was to determine the pattern and frequency of use of the system for different case types, and to determine how users perceived the support in terms of their confidence in decision-making. METHODS This was a comparative study of identical blood films evaluated either with or without decision support. Selected earlier cases from the DM scheme were rereleased as new cases but with decision support made available; this allowed a comparison of data sets for identical cases with or without decision support. To address the primary objectives, the study used quantitative evaluation and statistical comparisons of the identification and interpretation of morphological features between the two different case releases. To address the secondary objective, the use of decision support was assessed using web analytical tools, while a questionnaire was used to assess user perceptions of the system. RESULTS Cases evaluated with the aid of decision support had significantly improved accuracy of identification for relevant morphological features (mean improvement 9.8%) and the interpretation of those features (mean improvement 11%). The improvement was particularly significant for cases with higher complexity or for rarer diagnoses. Analysis of website usage demonstrated a high frequency of access for web pages relevant to each case (mean 9298 for each case, range 2661-24,276). Users reported that the decision support website increased their confidence for feature identification (4.8/5) and interpretation (4.3/5), both within the context of training (4.6/5) and also in their wider laboratory practice (4.4/5). CONCLUSIONS The findings of this study demonstrate that directed online decision support for blood morphology evaluation improves accuracy and confidence in the context of educational evaluation of digital films, with effectiveness potentially extending to wider laboratory use.

A protocol for sampling pastures in hill country

2016 ◽  
Vol 78 ◽  
pp. 203-209 ◽  
Author(s):  
K.J. Hutchinson ◽  
D.R. Scobie ◽  
J. Beautrais ◽  
A.D. Mackay ◽  
G.M. Rennie ◽  
...  
Keyword(s):  
Random Sampling ◽  
Geographical Information Systems ◽  
Field Measurements ◽  
Decision Support Tool ◽  
Accurate Estimate ◽  
Ease Of Use ◽  
Geographical Information ◽  
Support Tool ◽  
Topographic Complexity ◽  
Hill Country

To develop a protocol to guide pasture sampling for estimation of paddock pasture mass in hill country, a range of pasture sampling strategies, including random sampling, transects and stratification based on slope and aspect, were evaluated using simulations in a Geographical Information Systems computer environment. The accuracy and efficiency of each strategy was tested by sampling data obtained from intensive field measurements across several farms, regions and seasons. The number of measurements required to obtain an accurate estimate was related to the overall pasture mass and the topographic complexity of a paddock, with more variable paddocks requiring more samples. Random sampling from average slopes provided the best balance between simplicity and reliability. A draft protocol was developed from the simulations, in the form of a decision support tool, where visual determination of the topographic complexity of the paddock, along with the required accuracy, were used to guide the number of measurements recommended. The protocol was field tested and evaluated by groups of users for efficacy and ease of use. This sampling protocol will offer farmers, consultants and researchers an efficient, reliable and simple way to determine pasture mass in New Zealand hill country settings. Keywords: hill country, feed budgeting, protocol pasture mass, slope

Sign in / Sign up

Export Citation Format

Share Document