Unnecessary wait hours: a novel ED system-level metric

2020 ◽  
Vol 37 (9) ◽  
pp. 552-554
Author(s):  
Heather A Heaton ◽  
David M Nestler ◽  
Kalyan S Pasupathy ◽  
Phichet Wutthisirisart ◽  
Mustafa Y Sir ◽  
...  
Keyword(s):  
Opposite Effect ◽  
Care Delivery ◽  
System Level ◽  
Space Efficiency ◽  
A Value ◽  
Number Of Patients ◽  
Before And After ◽  
Ed Operations ◽  
The Relationship

BackgroundEmergency department (ED) operations leaders are under increasing pressure to make care delivery more efficient. Publicly reported ED efficiency metrics are traditionally patient centred and do not show situational or facility-based improvement opportunities. We propose the consideration of a novel metric, the ‘Number of Unnecessary Waits (NUW)’ and the corresponding ‘Unnecessary Wait Hours (UWH)’, to measure space efficiency, and we describe how we used NUW to evaluate operational changes in our ED.MethodsUWH summarises the relationship between the number of available rooms and the number of patients waiting by returning a value equal to the number of unnecessary patient waits. We used this metric to evaluate reassigning a clinical technician assistant (CTA) to the new role of flow CTA.ResultsWe retrospectively analysed 3.5 months of data from before and after creation of the flow CTA. NUW metric analysis suggested that the flow CTA decreased the amount of unnecessary wait hours, while higher patient volumes had the opposite effect.ConclusionsSituational system-level metrics may provide a new dimension to evaluating ED operational efficiencies. Studies focussed on system-level metrics to evaluate an ED practice are needed to understand the role these metrics play in evaluation of a department’s operations.

The relationship between the timing of a palliative care consult and utilization outcomes for ventilator-assisted intensive care unit patients

2013 ◽  
Vol 13 (2) ◽  
pp. 217-221 ◽  
Author(s):  
Salonie Pereira ◽  
Andrzej Kozikowski ◽  
Renee Pekmezaris ◽  
Suzanne Sunday ◽  
Tanveer Mir ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Care Delivery ◽  
Retrospective Chart Review ◽  
Improve Patient Care ◽  
Medication Costs ◽  
Number Of Patients ◽  
Before And After ◽  
The Relationship

AbstractObjective:Given the great number of chronic care patients facing the end of life and the challenges of critical care delivery, there has been emerging evidence supporting the benefit of palliative care in the intensive care unit (ICU). We studied the relationship between the timing of a palliative care consult (PCC) and two utilization outcomes — length of stay (LOS) and pharmacy costs — in ventilator-assisted ICU patients.Method:A retrospective chart review was conducted (N = 90). Summed pharmacy costs were compared using a paired t test before and after PCC. Spearman correlations were performed between days to PCC and ICU LOS, ventilator days, and days to death following ventilator discontinuation.Results:Number of days from admission to PCC was correlated with total days on ventilator (ρ = 0.685, p < 0.0001) and total ICU LOS (ρ = 0.654, p < 0.0001). Number of days to PCC was correlated with pre-PCC total medication costs (ρ = 0.539, p < 0.0001). Median medication costs were significantly reduced after the PCC (p < 0.0001), from $230.96 to 30.62. Median medication costs decreased for all categories except for analgesics, antiemetics, and opioids. The number of patients receiving opioid infusion increased (37 vs. 90%) after PCC (p < 0.0001).Significance of results:Earlier timing for PCC in the ICU is associated with a lower LOS through quicker mechanical ventilation (MV) withdrawal, presenting a unique opportunity to both decrease costs and improve patient care.

scholarly journals The Underestimated Value of Internal Marketing: Impact on Employee Satisfaction and Customer Satisfaction through Organisational Restructure

2021 ◽  
Author(s):  
◽  
Monica Nicole Micek
Keyword(s):  
Customer Satisfaction ◽  
Customer Service ◽  
Employee Satisfaction ◽  
Internal Marketing ◽  
Technological Advances ◽  
Before And After ◽  
Working Together ◽  
Internal Procedures ◽  
The Relationship

<p>Internal Marketing, a long-debated concept amongst academics and practitioners, is suggested to be a competitive advantage to organisations that utilise its practices. Often dismissed as merely selling the marketing of a product or service to employees within an organisation, Internal Marketing encompasses a combination of the key elements of communication, training, and feedback in order to create motivated, customer-orientated employees. Through employees and managers working together towards a well communicated organisational cause of Internal Marketing, internal procedures can evolve to better service and satisfy customers.  Organisational restructures are an ongoing concern as technological advances, value-adding business process, and globalisation change the way that businesses run and operate. In order to save on costs of operations, employment, and office rental space, downsizing an organisation may initially present itself as a cost-saving practice. Often unconsidered are the front-line customer-facing employees and customers of an organisation. Employees may feel distraught and concerned about losing their job, or having to find a new job, which may affect customer service, and subsequently customers may face the brunt of the domino effect, either intentionally or unintentionally, due to employees’ emotional disconnection from the organisation.  This research is an exploratory study into Internal Marketing, specifically around an organisational restructure, to better understand its impact on employees and customers through different stages of a restructure. Through the use of online surveys, participants were asked to recall an organisational restructure they were involved in within the last five years. They were asked to report their perceptions of Internal Marketing, their own satisfaction with their job at the time, and their perceptions of Customer Satisfaction throughout different stages of the organisational restructure.  The analysis found that Internal Marketing does have a significant positive relationship with Employee Satisfaction both during and after an organisational restructure. Although no significant relationship was found between Employee Satisfaction and Customer Satisfaction at any stage of the restructure, there is a trend within the data suggesting that the relationship may be stronger before and after an organisational restructure.  Benefits and contribution of this research for academics include development of a conceptual model, as well as the benefits and effects of Internal Marketing, and extending the existing literature. For practitioners, benefits include insights into better understanding of the role of Internal Marketing. Specifically, the differences in perception of the practice between employees and managers, and why it is important to understand and address Employee Satisfaction and Customer Satisfaction during an organisational restructure.</p>

scholarly journals PENGARUH REVIU RKA-K/L OLEH APIP TERHADAP EFISIENSI ALOKASI ANGGARAN KEMENTERIAN AGAMA

2019 ◽  
Vol 1 (1) ◽  
pp. 12
Author(s):  
Edy Effendi ◽  
Muhammad Imron
Keyword(s):  
Linear Regression ◽  
Simple Linear Regression ◽  
Independent Variables ◽  
Dependent Variables ◽  
Before And After ◽  
The Impact ◽  
The Relationship ◽  
Positive Effect

Research on the role of the APIP review of the Ministry/agency Work Plan and Budget document to determine the impact on the efficiency of ministry/agency spending (case study at the Ministry of Religion). The method used in this study uses simple linear regression with dummy. The use of linear regression is used to examine the relationship between independent variables (certain types of expenditure) and dependent variables (total expenditure). Whereas, dummy is used to find out before and after the APIP review is done. Throughout the author's search, this research has never been done. Based on the results of linear regression obtained, the APIP review significantly had a positive effect on official travel expenditure and honorarium but did not significantly affect building spending and equipment. Abstrak   Penelitian atas peran reviu APIP atas dokumen Rencana Kerja dan Anggaran Kementerian Negara/Lembaga untuk mengetahui dampaknya terhadap efisiensi belanja kementerian/lembaga (studi kasus pada Kementerian Agama). Metode yang digunakan dalam penelitian ini menggunakan regresi linier sederhana dengan dummy. Penggunaan regresi liner digunakan untuk meneliti hubungan antara variable independen (jenis belanja tertentu) dan variable dependen (total belanja). Sedangkan, dummy digunakan untuk mengetahui sebelum dan setelah reviu APIP dilakukan. Sepanjang penelusuran penulis, penelitian ini belum pernah dilakukan. Berdasarkan hasil regresi linier diperoleh, reviu APIP signifikan berpengaruh positif terhadap  belanja perjalanan dinas dan honorarium tetapi tidak signifikan berbengaruh terhadap belanja gedung dan alat.

Celebrity transgression and consumers’ forgiveness: does religiosity matter?

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Anwar Sadat Shimul ◽  
Matthew Barber ◽  
Mohammad Ishmam Abedin
Keyword(s):  
Purchase Intention ◽  
Structural Equation ◽  
Online Survey ◽  
Intrinsic Religiosity ◽  
Content Type ◽  
Equation Modelling ◽  
Before And After ◽  
The Relationship ◽  
Practical Implications

Purpose This paper aims to examine the role of religiosity on consumers’ forgiveness when celebrities get involved in transgression. The celebrity’s reaction and its impact on consumers’ forgiveness is tested as well. In addition, consumers’ attitudes towards the brand and celebrity as well as purchase intention for the endorsed brand are examined both before and after the transgression. Design/methodology/approach Data (n = 356) were collected through a self-administered online survey and analysed though structural equation modelling in AMOS 26. Findings The results show that consumers’ attitude towards celebrity, brand and purchase intention gets weaker once the celebrity gets into transgression. Consumers tend to forgive more if the celebrity apologises (vs denies) for the wrongdoing. The hypothesised relationship between attitude towards celebrity and purchase intention did not sustain after the transgression. In addition, consumers’ intrinsic religiosity strengthens the relationship between attitude towards the celebrity and purchase intention. Practical implications The findings of this research present valuable implications for brands practitioners. Brands should formulate actionable contingency plans to mitigate the negative ramifications of celebrity transgressions. Specifically, intrinsic religiosity and celebrity apologies should assist consumers in forgiving the transgression and negate the implications that could have arisen if the celebrity instead denied the transgressions. Originality/value This research extends the previous research by examining religiosity and forgiveness within the context of celebrity transgressions. To the best of the authors’ knowledge, this is one of the first few research studies to consider the role religiosity plays in consumers’ intention to forgive celebrity transgressions.

The Role of Attention in Multisensory Integration

2020 ◽  
pp. 1-13
Author(s):  
Christopher Mole
Keyword(s):  
Multisensory Integration ◽  
Temporal Relations ◽  
Integration Process ◽  
Attention Process ◽  
Before And After ◽  
The Relationship

Abstract Evidence concerning the relationship between attention and multisensory integration has long been thought to lead us into a paradox. The paradox has its roots in evidence that seems to show that attention exerts an influence on integration, and that integration also exerts an influence on attention. This creates an appearance of paradox only if it is understood to imply that particular instances of the integration process must occur both before and after particular instances of the attention process. But this appearance of paradox can be removed if we can find a way to resist the idea that there must be fixed temporal relations between the instances of these processes. That idea can seem hard to resist if both are understood to be processes of the sort that are brought to a halt by their own completion. Reflection on a metaphysical distinction between different sorts of process shows this understanding can be rejected. The appearance of paradox is thereby removed.

Ventilatory response to moderate and severe hypoxia in adult dogs: role of endorphins

1988 ◽  
Vol 65 (3) ◽  
pp. 1383-1388 ◽  
Author(s):  
J. I. Schaeffer ◽  
G. G. Haddad
Keyword(s):  
Ventilatory Response ◽  
Minute Ventilation ◽  
Severe Hypoxia ◽  
Moderate Hypoxia ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Before And After ◽  
The Relationship ◽  
Arterial Po2

To determine the role of opioids in modulating the ventilatory response to moderate or severe hypoxia, we studied ventilation in six chronically instrumented awake adult dogs during hypoxia before and after naloxone administration. Parenteral naloxone (200 micrograms/kg) significantly increased instantaneous minute ventilation (VT/TT) during severe hypoxia, (inspired O2 fraction = 0.07, arterial PO2 = 28-35 Torr); however, consistent effects during moderate hypoxia (inspired O2 fraction = 0.12, arterial PO2 = 40-47 Torr) could not be demonstrated. Parenteral naloxone increased O2 consumption (VO2) in severe hypoxia as well. Despite significant increases in ventilation post-naloxone during severe hypoxia, arterial blood gas tensions remained the same. Control studies revealed that neither saline nor naloxone produced a respiratory effect during normoxia; also the preservative vehicle of naloxone induced no change in ventilation during severe hypoxia. These data suggest that, in adult dogs, endorphins are released and act to restrain ventilation during severe hypoxia; the relationship between endorphin release and moderate hypoxia is less consistent. The observed increase in ventilation post-naloxone during severe hypoxia is accompanied by an increase in metabolic rate, explaining the isocapnic response.

Distribution of antithrombin III in rabbits: role of host and protein

1987 ◽  
Vol 252 (3) ◽  
pp. R457-R461
Author(s):  
E. Regoeczi
Keyword(s):  
Plasma Proteins ◽  
Antithrombin Iii ◽  
The Body ◽  
Unknown Mechanism ◽  
A Value ◽  
Catabolic Rate ◽  
At Iii ◽  
Body Compartments ◽  
The Relationship

Unlike in the case of some other species, the plasma curve of iodine-labeled antithrombin III (I-AT-III) in rabbits requires fitting with a three-term exponential function for obtaining reliable estimates of the catabolic rate and distribution of I-AT-III among various body compartments (Carlson, Atencio, and Simon. J. Clin. Invest. 74: 191-199, 1984). To decide whether this phenomenon is referable to the host or the protein, the behavior of rabbit and human I-AT-III was comparatively analyzed in rabbits. Data obtained with rabbit I-AT-III confirmed the findings by Carlson and co-workers. Human I-AT-III assumed a distribution that closely paralleled that of homologous I-AT-III, thus suggesting that the pattern of distribution is determined by the host species rather than its AT-III. Rabbits metabolized human I-AT-III 1.61 times faster than homologous I-AT-III by an unknown mechanism not involving immune response; a facet that may prove useful for the identification of the sites of catabolism of AT-III. The exponent of the body weight was calculated for the relationship between species size and AT-III turnover. A value of 0.5 was obtained that is distinctly lower than the exponents found earlier for some other plasma proteins.

Social enterprises, health-care provision and ethical capital

2014 ◽  
Vol 10 (2) ◽  
pp. 105-120 ◽  
Author(s):  
Lucy Frith
Keyword(s):  
Health Care ◽  
Health Care Delivery ◽  
Health Care Services ◽  
Care Delivery ◽  
Social Enterprises ◽  
Ethical Perspective ◽  
Content Type ◽  
Care Services ◽  
The Relationship

Purpose – The aim of this paper is to advance a conceptual understanding of the role of social enterprises in health care by developing the concept of ethical capital. Social enterprises have been an important part of both the coalition and the previous government’s vision for improving health-care delivery. One of the central arguments for increasing the role of social enterprises in health care is they can provide the benefits of a public service ethos with the efficiencies and innovatory strategies of a business. Social enterprises are well placed to promote the type of values that should underpin health care delivery. Design/methodology/approach – This paper explores the conceptual issues raised by using social enterprises to provide health-care services that were previously provided by the National Health Service (NHS) from an ethical perspective. Findings – It will be argued that conceptualising social enterprises as organisations that can and should produce ethical capital could be a useful way of developing the debate over social enterprises in health care. Practical implications – The paper provides suggestions on how ethical capital might be produced and monitored in social enterprises. Originality/value – This paper advances the debate over the use of the concept of ethical capital in social enterprises and explores the relationship between ethical and social capital – both under researched areas. It also contributes to the emerging discussions of social enterprises in current health policy and their role in the radically reformed English NHS.

The Moderating Role of Insulin-Like Growth Factor 1 in the Relationship Between Cognitive and Aerobic Endurance Change

2017 ◽  
Vol 30 (2) ◽  
pp. 84-89 ◽  
Author(s):  
Jason R. Anderson ◽  
Dayana Calvo ◽  
Ellen Glickman ◽  
John Gunstad ◽  
Mary Beth Spitznagel
Keyword(s):  
Growth Factor ◽  
Step Test ◽  
Insulin Like Growth Factor ◽  
Blood Draw ◽  
Before And After ◽  
Global Cognition ◽  
Average Serum ◽  
The Relationship ◽  
Moderating Role

Background: Improvements in cognition often accompany fitness improvements in older adults, and research suggests insulin-like growth factor 1 (IGF-1) may influence this association. No prior work has examined this in mild cognitive impairment (MCI). We predicted that IGF-1 would moderate the relationship between cognition and aerobic endurance improvement, such that greater baseline IGF-1 would accompany a stronger relationship between cognition and aerobic endurance change. Method: Twenty-seven individuals with MCI completed assessments of aerobic endurance (2-minute step test [2MST]) and global cognition (Modified Mini-Mental State [3MS]) before and after a 6-month period of twice-weekly exercise. Serum IGF-1 levels were assessed at baseline via fasted blood draw. The Johnson-Neyman technique determined whether baseline IGF-1 levels moderated the relationship between changes in aerobic endurance (Δ2MST) and cognition (Δ3MS). Results: A significant interaction was found; however, Δ2MST was inversely associated with Δ3MS in individuals with above-average serum IGF-1 levels; this relationship was strengthened as IGF-1 increased and was not seen when IGF-1 was below average. Conclusion: The relationship between cognitive and aerobic endurance change varies as a function of IGF-1 in persons with MCI. Additional work is needed to clarify the mechanisms of these findings.

scholarly journals Who is more likely to influence others? A value-based approach to pro-environmental social influence behavior (Preprint)

2019 ◽  
Author(s):  
Andrea Kis ◽  
Mark Verschoor ◽  
Rebecca Sargisson
Keyword(s):  
Social Influence ◽  
Current Knowledge ◽  
Environmental Behavior ◽  
Environmental Behaviors ◽  
A Value ◽  
Environmental Actions ◽  
The Relationship ◽  
Influence Behavior

Biospheric values can promote, and egoistic values inhibit, a broad range of pro-environmental behaviors. However, people who strongly endorse egoistic values might undertake pro-environmental behavior involving attempts to influence others. We used a questionnaire to assess the relationship between values and the likelihood that with 193 students will attempt to influence their housemates to engage in pro-environmental behavior. To measure this type of influence behavior, we developed and used the Environmental Social Influence Behavior (E-SIB) questionnaire. Both biospheric and egoistic values promoted influence behaviors. Biospheric values more strongly predicted the likelihood of social-influence actions as egoistic values decreased, except when egoistic values were high. We discuss the connections between values and social-influence behaviors, and current knowledge on the role of egoistic values in environmental actions.

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