A clinical decisions unit improves emergency general surgery care delivery

2015 ◽  
Vol 20 (4) ◽  
pp. 191-198 ◽  
Author(s):  
Chris Johnstone ◽  
Rachel Harwood ◽  
Andrew Gilliam ◽  
Andrew Mitchell
Keyword(s):  
Decision Making ◽  
Hospital Stay ◽  
General Surgery ◽  
Care Delivery ◽  
Fixed Bed ◽  
Surgical Care ◽  
Early Discharge ◽  
Clinical Decisions ◽  
Readmission Rates ◽  
Content Type

Purpose – Early access to senior decision makers and investigations has improved outcomes for many conditions. A surgical clinical decisions unit (CDU) was created to allow rapid assessment and investigation by on-call senior surgical team members to facilitate decision making and, if appropriate, discharge within a set time frame (less than four hours). The purpose of this paper is to compare outcomes for unscheduled general surgery admissions to the hospital before and after commissioning this unit. Design/methodology/approach – Prospectively collected hospital episode statistics data were compared for all general surgical admissions for one year prior to (July 2010-June 2011) and two years after (July 2011-June 2013) the introduction of the CDU. Statistical analysis using the Mann Whitney U-test was performed. Findings – More patients were discharged within 24 hours (12 per cent vs 20 per cent, p < 0.001) and total hospital stay decreased (4.6 days vs 3.2 days, p < 0.001) following introduction of CDU. Admission via A & E (273 vs 212, p < 0.01) was also decreased. Overall there was a 25.3 per cent reduction in emergency surgical admissions. No difference was noted in 30-day readmission rates (47 vs 49, p=0.29). Originality/value – The introduction of a CDU in has increased early discharge rates and facilitated safe early discharge, reducing overall hospital stay for unscheduled general surgical admissions. This has decreased fixed bed costs and improved patient flow by decreasing surgical care episodes routed through the emergency department (ED). In all, 30-day readmission rates have not been influenced by shorter hospital stay. Service redesign involving early senior decision making and patient investigation increases efficiency and patient satisfaction within unscheduled general surgical care. Not original but significant in that the model has not been widely implemented and this is a useful addition to the literature.

Improving service engagement in healthcare through internet of things based healthcare systems

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Vaidik Bhatt ◽  
Samyadip Chakraborty
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Service Delivery ◽  
Care Delivery ◽  
Care Service ◽  
Health Care Service ◽  
Content Type ◽  
Service Engagement ◽  
Physician Patient ◽  
Health Care Service Delivery

Purpose The purpose of the study was to empirically validate the linkages between IoT adoption and how it overarched influenced the patient care service engagement. This contributes to the body of knowledge and helps hospital managers to understand the relationship and relevance of IoT adoption; otherwise healthcare sector are late movers towards technology adoption. This gives a nuanced framework towards establishing empirically validated framework which will motivate healthcare services providers to be motivated to adopt and implement IoT enabled care delivery. The physician patient interaction and alignment during decision making will foster positive word of mouth, superior care service and reduce extra overheads for healthcare providers without compromise or rather with increment in service delivery proposition. Design/methodology/approach The study theoretically and empirically describes that with the adoption of internet of things (IoT) devices in health care, better services can be provided to patients by using partial least square – structure equation modelling-based robust technique and explains the better understanding of the health-care process with the help of information pervasiveness, physician-patient orientation and improved patient and physician involvement in the decision-making process. Findings This study shows that wearable IoT device adoption in health-care service delivery opens new opportunities and disrupts the conventional and traditional way of health-care service delivery by empowering the patient to take part in decision-making and enhancing their engagement in health-care service delivery. Research limitations/implications The study might influence by generalizability. Perception-based cross-examination knowledge from the patient’s perspective. It is likely that patients who use these devices will grow accustomed to using them and become more capable of using them. Thus, time-series tests have not been used to catch enhanced skills. New patients’ experiences will be altered over time. Regardless, non-response bias and traditional process bias received excessive interest. Practical implications The study aims at unravelling how the adoption of IoT enabled practices and usage of IoT devices bolsters the available data points in the context of healthcare especially with respect to patient care delivery. The study conceptualizes and empirically validates how the usage of IoT interface enabled technology enables better patient treatment and caregiver participation. The study puts forth a nuanced understanding regarding how pervasively available ubiquitous care information fosters shared decision making. This study further emphasizes that importance of ensuring a reliable computing environment devoid of privacy and security risks. The study attempts at Emphasizing empirically how the enhanced information pervasiveness catapults the patient-provider interactions, through health data exchange. Highlighting the importance of search feature in cloud storage and recovery mechanisms. The study not only fulfills the overarching linkage between enhanced service engagement with IoT adoption, it provides a mental map and ready to refer framework for hospital and healthcare experts to refer to, which prescribes thar care providers must build new methods aimed at empowerment of patients to participate and take more inclusive role. This unique confluence between patients and physicians will unravel the sync; helping not only avoid costly decision errors, but also improve patient care delivery environment. Patients should be permitted to participate in decision-making,inspire patients to be participatory. Originality/value The study efforts to empirically investigate and discover the link between how wearable sensor-based IoT enhances health-care service engagement is underway. Using primary data this linkage validation allows the community and readers at large to gain a nuanced understanding of how superior interaction is enabled by a digital-health-care process with the help of IoT-enabled information pervasiveness, physician-patient orientation and empowered involvement.

Impact of relatedness, uncertainty and slack on corporate entrepreneurship decisions

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Robert Garrett ◽  
Shaunn Mattingly ◽  
Jeff Hornsby ◽  
Alireza Aghaey
Keyword(s):  
Decision Making ◽  
Hierarchical Linear Modeling ◽  
Cognitive Strategies ◽  
Corporate Entrepreneurship ◽  
New Venture ◽  
Organizational Level ◽  
Linear Modeling ◽  
Slack Resources ◽  
Content Type ◽  
Positive Effect

PurposeThe purpose of this study is to evaluate the effect of opportunity relatedness and uncertainty on the decision of a corporate entrepreneur to pursue a venturing opportunity.Design/methodology/approachThe study uses a conjoint experimental design to reveal the structure of respondents' decision policies. Data were gathered from 47 useable replies from corporate entrepreneurs and were analyzed with hierarchical linear modeling (HLM).FindingsResults show that product relatedness, market relatedness, perceived certainty about expected outcomes and slack resources all have a positive effect on the willingness of a corporate entrepreneur to pursue a new venture idea. Moreover, slack was found to diminish the positive effect of product relatedness on the likelihood to pursue a venturing opportunity.Practical implicationsBy providing a better understanding of decision-making schemas of corporate entrepreneurs, the findings of this study help improve the practice of entrepreneurship at the organizational level. In order to make more accurate opportunity assessments, corporate entrepreneurs need to be aware of their cognitive strategies and need to factor in the salient criteria affecting such assessments.Originality/valueThis paper adds to the limited understanding of corporate-level decision-making with regard to pursuing venturing opportunities. More specifically, the paper adds new insights regarding how relatedness and uncertainty affect new venture opportunity assessments in the presence (or lack thereof) of slack resources.

Making investment decisions in stock markets using a forecasting-Markowitz based decision-making approaches

2019 ◽  
Vol 15 (2) ◽  
pp. 647-659 ◽  
Author(s):  
Zahra Moeini Najafabadi ◽  
Mehdi Bijari ◽  
Mehdi Khashei
Keyword(s):  
Decision Making ◽  
Time Series ◽  
Stock Markets ◽  
Time Series Prediction ◽  
Investment Decisions ◽  
Rate Of Return ◽  
Expected Returns ◽  
Prediction Methods ◽  
Content Type ◽  
Markowitz Model

Purpose This study aims to make investment decisions in stock markets using forecasting-Markowitz based decision-making approaches. Design/methodology/approach The authors’ approach offers the use of time series prediction methods including autoregressive, autoregressive moving average and artificial neural network, rather than calculating the expected rate of return based on distribution. Findings The results show that using time series prediction methods has a significant effect on improving investment decisions and the performance of the investments. Originality/value In this study, in contrast to previous studies, the alteration in the Markowitz model started with the investment expected rate of return. For this purpose, instead of considering the distribution of returns and determining the expected returns, time series prediction methods were used to calculate the future return of each asset. Then, the results of different time series methods replaced the expected returns in the Markowitz model. Finally, the overall performance of the method, as well as the performance of each of the prediction methods used, was examined in relation to nine stock market indices.

scholarly journals Analysis of risk scores and duration of hospital stay in prognosis of STEMI patients after pPCI

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
SR Thangasami ◽  
JS Prajapati ◽  
GL Dubey ◽  
VR Pandey ◽  
PM Shaniswara ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Stay ◽  
Early Discharge ◽  
Risk Scores ◽  
Timi Score ◽  
Study Population ◽  
Event Rates ◽  
Grace Score

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Advances in the immediate management of ST elevation myocardial infarction (STEMI) have led to a dramatic decline in mortality and reduction in hospital length of stay (LOS). We analysed the prognostic value of selected risk models in STEMI treated with primary percutaneous coronary intervention (PPCI) and to identify additional parameters to strengthen risk scores in categorizing patients for safe early discharge and to identify parameters prolonging hospital stay. Purpose To assess parameters and risk scores to categorize patients for safe early discharge following STEMI and to assess the composite of death, MI, unstable angina (UA), stroke, unplanned hospitalization at the end of 30 days, 6 months and at 1year follow up. Methods The study included 222 patients, who were diagnosed as STEMI, treated with successful pPCI. The risk scores like TIMI score, GRACE score, ZWOLLE score, CADILLAC score were calculated for all patients from the baseline clinical data collected on admission. Routine blood investigations along with Brain natri-uretic peptide (BNP) were done for all patients. The entire cohort was divided into three groups on the basis of length of stay: ≤3 days (n = 150), 4–5 days (n = 47), and &gt;5 days (n = 25). All-cause mortality and major cardiovascular events (MACEs) were assessed up to 1 year. Results The mean age group (yrs) of the study population was 53.92 ± 12.9. Patients in LOS &lt;3 days had a mean age (yrs) of 52.41 ± 11.74, patients in LOS 4-5 days group had 54.19 ±13.59 and patient with LOS &gt;5 days had 62.52 ± 15.32. The most important parameters that predicted hospital stay in our study are BNP levels OR: 1.003, 95% CI: 1.002-1.004, P &lt; 0.001, GRACE score OR: 1.02 ,95% CI: 1.01-1.03, P &lt; 0.001, TIMI score OR: 1.35, 95% CI: 1.18-1.55, P = 0.007, ZWOLLE score OR: 1.26, 95% CI: 1.16-1.37, P &lt; 0.001, CADILLAC score OR: 1.24, 95% CI; 1.15-1.3: P &lt; 0.001. 32 (14.4%) patients expired in the study population. 36% patients of LOS &gt;5 days expired in 1year follow up with maximum mortality in the first 6 months. 56% of the patients in LOS &gt; 5 days had an adverse cardiac event in 1 year follow up. Patients in LOS &gt;5 days had increased event rates in 30 days,6 months and in 1 year follow up. Patients with LOS 4-5 days (30%) had increased event rates than patients in LOS &lt; 3 days (19%).Unadjusted Kaplan Meir survival curves for 1 year mortality among hospital survivors showed a significant increase in mortality at 6 months in length of stay&gt; 5 days group. (P value &lt; 0.001). CONCLUSION Long hospital stay after PCI among patients with STEMI was associated with increased long-term all-cause mortality. Addition of BNP to this risk scores can better predict the course of hospital stay and adverse clinical outcomes in follow up. Long hospital stay may be used as a marker to identify patients at higher risk for long-term mortality. Abstract Figure. Kaplan meir survival curve

Predictors of Successful Early Discharge for Total Hip and Knee Arthroplasty in Octogenarians

2021 ◽  
pp. 155633162110306
Author(s):  
Andrew B. Kay ◽  
Danielle Y. Ponzio ◽  
Courtney D. Bell ◽  
Fabio Orozco ◽  
Zachary D. Post ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Knee Arthroplasty ◽  
Early Discharge ◽  
Readmission Rates ◽  
Patients Âgés ◽  
Total Hip ◽  
Hip And Knee Arthroplasty ◽  
Student’S T ◽  
American Society ◽  
American Society Of Anesthesiologists

Background: Decreased length of stay after total joint arthroplasty (TJA) is becoming a more common way to contain healthcare costs and increase patient satisfaction. There is little evidence to support “early” discharge in elderly patients. Purpose: We sought to identify preoperative factors that correlated with early discharge (by postoperative day [POD] 1) in comparison to late discharge (after POD2) in octogenarians after TJA. Methods: In a retrospective cohort study from a single institution, we identified 482 patients ages 80 to 89 who underwent primary TJA from January 2014 to December 2017; 319 had total knee arthroplasty (TKA) and 163 had total hip arthroplasty (THA). Data collected included preoperative knee range of motion (ROM), demographics, and comorbidities; 90-day readmission and mortality rates were also evaluated. P values for continuous data were calculated using student’s t test and for categorical data using χ2 testing. Results: Of octogenarian patients, 30.9% were discharged by POD1. Early discharge was associated with being male, married, and nonsmoking, as well as having an American Society of Anesthesiologists (ASA) score of 2, independent preoperative ambulation, and a postoperative caregiver. Type of procedure (TKA vs THA), body mass index, laterality, preoperative range of motion (ROM) for TKA, and single vs multilevel home did not affect the probability of early discharge. Discharge on POD1 was not associated with increased 90-day readmission rates. There were no deaths. Conclusion: Early discharge for octogenarians can be successfully implemented in a select subset of patients without increasing 90-day readmission or death rates. There are multiple factors that predict successful early discharge.

Service decision-making processes at three New York state cooperative public library systems

2014 ◽  
Vol 35 (6/7) ◽  
pp. 418-432
Author(s):  
Xiaoai Ren
Keyword(s):  
Decision Making ◽  
New York ◽  
New York State ◽  
Public Library ◽  
Organizational Structures ◽  
Annual Reports ◽  
Content Type ◽  
York State ◽  
Decision Making Processes ◽  
And Cluster Analysis

Purpose – The purpose of this paper is to look at the organizational structure and service provisions of cooperative public library systems in New York State. The study also seeks to ask questions of how cooperative public library systems decide what services to provide. Design/methodology/approach – Descriptive statistics, factor analysis and cluster analysis were applied on New York State public library systems’ 2008 annual reports to generate quantitative profiles of public library systems and their service transactions. Three cooperative public library systems displaying different service features were purposefully selected for further study of their service decision-making processes. The face-to-face and phone interviews were adopted in the study. Findings – Research findings from this study provide information on specific service variations across cooperative public library systems. The findings also provide differences of service decision-making processes in addition to the factors that might cause these differences. Originality/value – This study adds knowledge of public library systems’ management and organizational structures, therefore fills a knowledge gap on public library systems. It can also serve as the baseline for future studies using newer annual report data and therefore to study the changing roles and services of cooperative public library systems in New York State.

Crisis or opportunity: Marks and Spencer’s tryst with Indian retail

2020 ◽  
Vol 16 (6) ◽  
pp. 671-690
Author(s):  
Arunima Rana ◽  
Ravi Shankar
Keyword(s):  
Decision Making ◽  
International Business ◽  
Brand Management ◽  
Secondary Data ◽  
Business Environment ◽  
Special Focus ◽  
Retail Sector ◽  
Content Type ◽  
Competitor Analysis ◽  
Fashion Retail

Research methodology The case is written using secondary data sources (namely, research documents, press information, journal articles and published interviews). Publicly declared company information has further been leveraged to augment case facts. All information sources have been duly acknowledged in the reference section. Case overview/synopsis The case is written in the backdrop of COVID-19 pandemic and its effect on the Indian retail industry, revolving around scenarios in which a multinational retailer has to decide on its long- and short-term strategy in such an economic crisis. The case story has been developed around Marks and Spencer’s retail venture in the Indian market. With the COVID-19 pandemic impacting business at various levels, with countries moving to lock down and economies shrinking to recessionary levels, one of the worst affected sectors is retail. The teaching case builds upon Mark and Spencer’s initial decision of not entering and extending its food/grocery business in India. While it remained a dominant player in Indian fashion retail for almost two decades, it needs to re-think its decision of entering food retail owing to a pandemic situation affecting its offline sales/store footfall and increasing competition from global fashion brands such as Zara and H&M that had flooded the Indian fashion retail sector. The case provides a context for students to perform environmental factor and competitor analysis for a sector, with special focus on decision making in a changing crisis scenario. Complexity academic level This case could be used in undergraduate and MBA classroom programme, across subjects such as retail management, marketing management, international business, international business environment and strategic business management. This case fits while discussing topics such as business environmental factors, competitor analysis, decision-making under crisis, market entry decision, omnichannel retail strategy, consumer behaviour and brand management.

The hidden power of language

2020 ◽  
Vol 11 (1) ◽  
pp. 187-206
Author(s):  
Philipp Hummel ◽  
Jacob Hörisch
Keyword(s):  
Decision Making ◽  
Value Creation ◽  
Cost Reduction ◽  
Social Consequences ◽  
Decision Makers ◽  
Social Aspects ◽  
Social Aspect ◽  
Content Type ◽  
Current Accounting ◽  
Cost Reductions

Purpose Stakeholder theory research identifies changes in language as one possible mechanism to overcome the deficiencies of current accounting practices with regard to social aspects. This study aims to examine the effects of the terms used for specific accounts on company internal decision-making, drawing on the example of “value creation accounting”. Design/methodology/approach The study uses a survey based-experiment to analyze the effects of terms used for specific accounts on decision-making, with a focus on social aspects (in particular expenditures for staff) in cost reduction and expenditure decisions. Findings The findings indicate that wordings, which more closely relate to value creation than to costs, decrease cost reductions and increase the priority ascribed to the social aspect of reducing staff costs in times of financial shortage. The effects of terms used on cost reductions are stronger among female decision makers. Practical implications The analysis suggests that conventional accounting language best suits organizations that aim at incentivizing decision makers to primarily cut costs. By contrast, if an organization follows an approach that puts importance on social aspects in times of financial shortage and on not doing too sharp cost reductions, value creation-oriented language is the more effective approach. Social implications The study suggests that the specific terminology used for accounts should be chosen more carefully and with awareness for the possible effects on cost reduction decisions as well as on social consequences. Originality/value This study contributes to a better understanding of the relevance of language in accounting. It suggests that the terms used for accounts should be chosen purposefully because of their far-reaching potential consequences for stakeholders as well as for the organization.

Employing needs-based funding formulae – some unavoidable tradeoffs

2017 ◽  
Vol 31 (7) ◽  
pp. 1092-1102
Author(s):  
Tal Gilead ◽  
Iris BenDavid-Hadar
Keyword(s):  
Decision Making ◽  
Resource Allocation ◽  
Design Methodology ◽  
Social Equity ◽  
School Resources ◽  
Content Type ◽  
Funding Formula ◽  
Policy Goals ◽  
Theoretical Investigations ◽  
Schooling System

Purpose The method by which the state allocates resources to its schooling system can serve as an important instrument for achieving desired improvements in levels of educational attainment, social equity and other social policy goals. In many school systems, the allocation of school resources is done according to a needs-based funding formula. The purpose of this paper is to provide a deeper understanding of some significant tradeoffs involved in employing needs-based funding formulae. Design/methodology/approach The paper is based on theoretical investigations of normative aspects involved in using needs-based funding formulae. Findings There are a number of underexplored complications and difficulties that arise from the use of needs-based funding formulae. Dealing with these involves significant tradeoffs that require taking normative decisions. Understanding these tradeoffs is important for improving the use of needs-based funding formulae. Originality/value The paper highlights three under-examined issues that emerge from the current use of needs-based funding formulae. These issues are: to what extent funding formulae should be responsive to social and economic needs? To what extent should funding formulae allow for the use of discretion in resource allocation? To what degree needs-based formulae funding should be linked to outcomes? By discussing these issues and the tradeoffs involved in them, the paper provides a deeper understanding of significant aspects stemming from the use of needs-based funding formulae. This, in turn, can serve as a basis for an improved and better informed process for decision making regarding the use of funding formulae.

Has Lean improved organizational decision making?

2016 ◽  
Vol 29 (5) ◽  
pp. 536-549 ◽  
Author(s):  
Pascale Simons ◽  
Jos Benders ◽  
Jochen Bergs ◽  
Wim Marneffe ◽  
Dominique Vandijck
Keyword(s):  
Decision Making ◽  
Design Methodology ◽  
Lean Management ◽  
Structured Interviews ◽  
Organizational Decision Making ◽  
Content Type ◽  
Organizational Contexts ◽  
Sustainable Improvement ◽  
Care Processes ◽  
Practical Implications

Purpose – Sustainable improvement is likely to be hampered by ambiguous objectives and uncertain cause-effect relations in care processes (the organization’s decision-making context). Lean management can improve implementation results because it decreases ambiguity and uncertainties. But does it succeed? Many quality improvement (QI) initiatives are appropriate improvement strategies in organizational contexts characterized by low ambiguity and uncertainty. However, most care settings do not fit this context. The purpose of this paper is to investigate whether a Lean-inspired change program changed the organization’s decision-making context, making it more amenable for QI initiatives. Design/methodology/approach – In 2014, 12 professionals from a Dutch radiotherapy institute were interviewed regarding their perceptions of a Lean program in their organization and the perceived ambiguous objectives and uncertain cause-effect relations in their clinical processes. A survey (25 questions), addressing the same concepts, was conducted among the interviewees in 2011 and 2014. The structured interviews were analyzed using a deductive approach. Quantitative data were analyzed using appropriate statistics. Findings – Interviewees experienced improved shared visions and the number of uncertain cause-effect relations decreased. Overall, more positive (99) than negative Lean effects (18) were expressed. The surveys revealed enhanced process predictability and standardization, and improved shared visions. Practical implications – Lean implementation has shown to lead to greater transparency and increased shared visions. Originality/value – Lean management decreased ambiguous objectives and reduced uncertainties in clinical process cause-effect relations. Therefore, decision making benefitted from Lean increasing QI’s sustainability.

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