980 An Audit of a Surgical Ambulatory Service [SAmS] Performance Pre And Post COVID-19 - The Impact of Senior Decision Making

Abstract Introduction Surgical Ambulatory Units have emerged to refine the management of unscheduled care with the aim of reducing admissions and offering timely, accurate treatment strategies. There are 12 principles which underpin an efficient ambulatory Service, one of which is to have a 'Consultant led and delivered Service'. Consequent to the COVID Pandemic we reallocated Consultants to our Ambulatory Service and reviewed the impact of this initiative. Method Two periods - Pre COVID 6-17/1/20 and Post COVID 27/4 -10/5/20 were compared with respect to volume, case mix, procedures performed and outcomes in terms of investigations, and completed episodes. Data was retrieved from case notes and electronic databases. Results There were no demographic differences across the groups. The case mix and referral patterns were similar as was the volume. There were no differences in procedures or investigations ordered. In the Pre COVID group 20% of sessions were Consultant led compared with 100% in the Post COVID group. In the post COVID group 64% of cases were completed on the index attendance compared with 27% in the pre COVID group. Conclusions A Consultant presence in SAmS enhances decision making and risk management and is critical for the efficacy of the Service with respect to patient flow and resource management.

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Effectiveness of clinical criteria in directing patient flow from the emergency department to a medical assessment unit in Queensland, Australia: a retrospective chart review of hospital administrative data

BMC Health Services Research ◽

10.1186/s12913-021-06537-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sonya Osborne ◽

Helen Cleak ◽

Nicole White ◽

Xing Lee ◽

Anthony Deacon ◽

...

Keyword(s):

Decision Making ◽

Emergency Department ◽

Patient Flow ◽

Demographic Data ◽

Time Of Day ◽

Admission Criteria ◽

Random Allocation ◽

Medical Assessment ◽

Clinical Criteria ◽

The Impact

Abstract Background Medical Assessment Units (MAUs) have become a popular model of acute medical care to improve patient flow through timely clinical assessment and patient management. The purpose of this study was to determine the effectiveness of a consensus-derived set of clinical criteria for patient streaming from the Emergency Department (ED) to a 15-bed MAU within the highly capacity-constrained environment of a large quaternary hospital in Queensland, Australia. Methods Clinically coded data routinely submitted for inter-hospital benchmarking purposes was used to identify the cohort of medical admission patients presenting to the ED in February 2016 (summer) and June 2016 (winter). A retrospective review of patient medical records for this cohort was then conducted to extract MAU admission data, de-identified patient demographic data, and clinical criteria. The primary outcome was the proportion of admissions that adhered to the MAU admission criteria. Results Of the total of 540 included patients, 386 (71 %) patients were deemed to meet the MAU eligibility admission criteria. Among patients with MAU indications, 66 % were correctly transferred (95 % CI: 61 to 71) to the MAU; this estimated sensitivity was statistically significant when compared with random allocation (p-value < 0.001). Transfer outcomes for patients with contraindications were subject to higher uncertainty, with a high proportion of these patients incorrectly transferred to the MAU (73 % transferred; 95 % CI: 50 to 89 %; p-value = 0.052). Conclusions Based on clinical criteria, approximately two-thirds of patients were appropriately transferred to the MAU; however, a larger proportion of patients were inappropriately transferred to the MAU. While clinical criteria and judgement are generally established as the process in making decisions to transfer patients to a limited-capacity MAU, our findings suggest that other contextual factors such as bed availability, time of day, and staffing mix, including discipline profile of decision-making staff during ordinary hours and after hours, may influence decisions in directing patient flow. Further research is needed to better understand the interplay of other determinants of clinician decision making behaviour to inform strategies for improving more efficient use of MAUs, and the impact this has on clinical outcomes, length of stay, and patient flow measures in MAUs.

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Multimorbidity Clustering of the Emergency Department Patient Flow: Impact Analysis of New Unscheduled Care Clinics

10.21203/rs.3.rs-125764/v1 ◽

2020 ◽

Author(s):

Adrien Wartelle ◽

Farah Mourad-Chehade ◽

Farouk Yalaoui ◽

Hélène Questiaux ◽

Thomas Monneret ◽

...

Keyword(s):

Emergency Department ◽

Emergency Departments ◽

Patient Flow ◽

Temporal Trends ◽

Healthcare Delivery ◽

Period Effect ◽

Care Services ◽

Unscheduled Care ◽

Before And After ◽

The Impact

Abstract Background: In France, the number of admissions to emergency departments doubled between 1996 and 2016, leading to overcrowding. To cope with the resultant overcrowding, redirecting patients to new healthcare services is a viable solution, to spread demand more evenly across available healthcare delivery points, and render care more efficient. The goal of this study was to analyse the impact of opening new unscheduled care services on variations in patient attendance at a large emergency department. Methods: We performed a before-and-after study investigating the use of unscheduled care services in the Aube Department (Eastern France), focusing on emergency department attendance of Troyes Hospital. We applied a hierarchical clustering based on co-occurrence of diagnoses, to divide the population into different multimorbidity profiles and study their temporal trends. A multivariate logistic regression model was constructed to adjust the period effect for appropriate confounders. Results: In total, 120,718 visits to the emergency department were recorded over a 24-month period (2018-2019), and 14 clusters were identified accounting for 94.76% of all visits. The before-and-after analysis showed a decrease of 57.95 visits per week in 7 specific clusters, while the consumption of unscheduled health care services increased by 328.12 visits per week.Conclusions: Using an innovative and reliable methodology to evaluate changes in patient flow through the emergency department, our results could help to inform public health policy regarding the implementation of unscheduled care services, to ease pressure on emergency departments.

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Regional inactivations of primate ventral prefrontal cortex reveal two distinct mechanisms underlying negative bias in decision making

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.1422440112 ◽

2015 ◽

Vol 112 (13) ◽

pp. 4176-4181 ◽

Cited By ~ 29

Author(s):

Hannah F. Clarke ◽

Nicole K. Horst ◽

Angela C. Roberts

Keyword(s):

Decision Making ◽

Prefrontal Cortex ◽

Attentional Control ◽

Behavioral Treatment ◽

Treatment Strategies ◽

Negative Bias ◽

Cognitive Behavioral Treatment ◽

Instrumental Approach ◽

The Impact ◽

Ventral Prefrontal Cortex

Dysregulation of the orbitofrontal and ventrolateral prefrontal cortices is implicated in anxiety and mood disorders, but the specific contributions of each region are unknown, including how they gate the impact of threat on decision making. To address this, the effects of GABAergic inactivation of these regions were studied in marmoset monkeys performing an instrumental approach–avoidance decision-making task that is sensitive to changes in anxiety. Inactivation of either region induced a negative bias away from punishment that could be ameliorated with anxiolytic treatment. However, whereas the effects of ventrolateral prefrontal cortex inactivation on punishment avoidance were seen immediately, those of orbitofrontal cortex inactivation were delayed and their expression was dependent upon an amygdala–anterior hippocampal circuit. We propose that these negative biases result from deficits in attentional control and punishment prediction, respectively, and that they provide the basis for understanding how distinct regional prefrontal dysregulation contributes to the heterogeneity of anxiety disorders with implications for cognitive-behavioral treatment strategies.

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Quota Women Are Threatening to Men

Swiss Journal of Psychology ◽

10.1024/1421-0185/a000195 ◽

2017 ◽

Vol 76 (3) ◽

pp. 107-116 ◽

Cited By ~ 4

Author(s):

Klea Faniko ◽

Till Burckhardt ◽

Oriane Sarrasin ◽

Fabio Lorenzi-Cioldi ◽

Siri Øyslebø Sørensen ◽

...

Keyword(s):

Decision Making ◽

Organizational Performance ◽

Gender Stereotypes ◽

Perceived Threat ◽

Preferential Treatment ◽

Public Sector Employees ◽

Different Types ◽

Low Levels ◽

Women In Decision Making ◽

The Impact

Abstract. Two studies carried out among Albanian public-sector employees examined the impact of different types of affirmative action policies (AAPs) on (counter)stereotypical perceptions of women in decision-making positions. Study 1 (N = 178) revealed that participants – especially women – perceived women in decision-making positions as more masculine (i.e., agentic) than feminine (i.e., communal). Study 2 (N = 239) showed that different types of AA had different effects on the attribution of gender stereotypes to AAP beneficiaries: Women benefiting from a quota policy were perceived as being more communal than agentic, while those benefiting from weak preferential treatment were perceived as being more agentic than communal. Furthermore, we examined how the belief that AAPs threaten men’s access to decision-making positions influenced the attribution of these traits to AAP beneficiaries. The results showed that men who reported high levels of perceived threat, as compared to men who reported low levels of perceived threat, attributed more communal than agentic traits to the beneficiaries of quotas. These findings suggest that AAPs may have created a backlash against its beneficiaries by emphasizing gender-stereotypical or counterstereotypical traits. Thus, the framing of AAPs, for instance, as a matter of enhancing organizational performance, in the process of policy making and implementation, may be a crucial tool to countering potential backlash.

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