scholarly journals Rethinking preparedness planning in disaster emergency care: lessons from a beyond-surge-capacity event

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Sheuwen Chuang ◽  
David D. Woods ◽  
Morgan Reynolds ◽  
Hsien-Wei Ting ◽  
Asher Balkin ◽  
...  
Keyword(s):  
Emergency Care ◽  
Large Scale ◽  
Patient Flow ◽  
Surge Capacity ◽  
Preparedness Plan ◽  
Preparedness Planning ◽  
Wide Range ◽  
Care Systems ◽  
Hospital Readiness ◽  
Depth Interviews

Abstract Background Large-scale burn disasters can produce casualties that threaten medical care systems. This study proposes a new approach for developing hospital readiness and preparedness plan for these challenging beyond-surge-capacity events. Methods The Formosa Fun Coast Dust Explosion (FFCDE) was studied. Data collection consisted of in-depth interviews with clinicians from four initial receiving hospitals and their relevant hospital records. A detailed timeline of patient flow and emergency department (ED) workload changes of individual hospitals were examined to build the EDs' overload patterns. Data analysis of the multiple hospitals' responses involved chronological process-tracing analysis, synthesis, and comparison analysis in developing an integrated adaptations framework. Results A four-level ED overload pattern was constructed. It provided a synthesis of specifics on patient load changes and the process by which hospitals' surge capacity was overwhelmed over time. Correspondingly, an integrated 19 adaptations framework presenting holistic interrelations between adaptations was developed. Hospitals can utilize the overload patterns and overload metrics to design new scenarios with diverse demands for surge capacity. The framework can serve as an auxiliary tool for directive planning and cross-check to address the insufficiencies of preparedness plans. Conclusions The study examined a wide-range spectrum of emergency care responses to the FFCDE. It indicated that solely depending on policies or guidelines for preparedness plans did not contribute real readiness to MCIs. Hospitals can use the study's findings and proposal to rethink preparedness planning for the future beyond surge capacity events.

scholarly journals On the Front (Phone) Lines: Results of a COVID-19 Hotline in Northeast Ohio

2020 ◽  
Author(s):  
David Margolius ◽  
Mary Hennekes ◽  
Jimmy Yaho ◽  
Douglas Einstadter ◽  
Douglas Gunzler ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Care ◽  
Smoking Status ◽  
Health Care Systems ◽  
Patient Characteristics ◽  
Care Practice ◽  
Scarce Resources ◽  
Wide Range ◽  
Care Systems ◽  
At Home

ABSTRACT Importance: Severe acute respiratory syndrome coronavirus (SARS-CoV-2) and the associated coronavirus disease of 2019 (COVID-19) have presented immense challenges for health care systems. Many regions have struggled to adapt to disruptions to health care practice and employ systems that effectively manage the demand for services. Objective: To examine the effectiveness of the first five weeks of a 24/7 physician-staffed COVID-19 hotline. Design: Cohort study using electronic health records. Setting: A single large health care system in Northeast Ohio. Participants: During 5 weeks of operation, 10,112 patients called the hotline (callers) and were evaluated by a registered nurse (RN) using standardized protocols. Of these, 4,213 (42%) were referred for a physician telehealth visit (telehealth patients). The mean age of callers was 42 years. 67% were female, 51% white, and 46% were on Medicaid or uninsured. Intervention: Physician telehealth visits for COVID-19. Main Outcomes and Measures: We describe clinical diagnosis, patient characteristics (age, sex race/ethnicity, smoking status, insurance status), and visit disposition. We use logistic regression to evaluate associations between patient characteristics, visit disposition and subsequent emergency department use, hospitalization, and SARS-Cov-2 PCR testing. Results: Common caller concerns included cough, fever, and shortness of breath. Most telehealth patients (79%) were advised to self-isolate at home, 14% were determined to be unlikely to have COVID-19, 3% were advised to seek emergency care, and 4% had miscellaneous other dispositions. A total of 287 (7%) patients had a subsequent ED visit, and 44 (1%) were hospitalized with a COVID-19 diagnosis. Of the callers, 482 (5%) had a COVID-19 test reported with 69 (14%) testing positive. Among patients advised to stay at home, 83% had no further face-to-face visits. In multivariable results, only a physician recommendation to seek emergency care was associated with emergency room use (OR=4.73, 95%CI 1.37-16.39, p=.014). Only older age was associated with having a positive test result. Conclusions and Relevance: Robust, physician-directed telehealth services can meet a wide range of needs during the acute phase of a pandemic, conserving scarce resources such as personal protective equipment and testing supplies and preventing the spread of infections to patients and health care workers.

Hospital Preparedness Plans for Chemical Incidents and Threats: A Systematic Review

2019 ◽  
Vol 14 (4) ◽  
pp. 477-485
Author(s):  
Parisa Moradi Majd ◽  
Hesam Seyedin ◽  
Hasan Bagheri ◽  
Nader Tavakoli
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Final Analysis ◽  
Cochrane Library ◽  
Job Descriptions ◽  
Preparedness Plan ◽  
Preparedness Planning ◽  
Wide Range ◽  
Hospital Preparedness ◽  
Chemical Incidents

ABSTRACTIn a wide range of events, people may be acutely exposured to chemical substances. Particular hospital preparedness plans and vital resources are essential for appropriate health-care measures. The present study aimed to conduct a systematic review to summarize and evaluate the existing evidence on hospital preparedness plans or protocols against chemical incidents and threats. In this aim, through May 15, 2018, 5 electronic databases were searched in MEDLINE (PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar) for the following key words: hospital preparedness, plan, protocol, chemical incident, and chemical threat. The final review included 11 peer-reviewed papers that met inclusion criteria. The systematic review was performed using the Preferred Reporting Items for the Systematic reviews and Meta-Analysis protocol (PRISMA) (www.prisma-statement.org). Finally, of 16,540 selected papers, 11 papers were included in the final analysis. The thematic analyses revealed 11 major categories of chemical incidents and threats planning, such as planning requirements, planning prerequisites, preparation team member (multidisciplinary team), decontamination, personal protective equipment, education and training, job descriptions and roles, communication, database, staff /volunteer organization, as well as planning barriers and challenges for chemical incidents. Most countries have launched hospital preparedness planning against chemical incidents and threat activities, but the preparedness of hospitals is often less than desirable. Many items, such as databases, hospital preparation team members, communications, etc., are still challenging.

scholarly journals A qualitative exploration of patient flow in a developing Caribbean emergency department

2020 ◽  
Author(s):  
Loren De Freitas ◽  
Steve Goodacre ◽  
Rachel O’Hara ◽  
Praveen Thokala ◽  
Seetharaman Hariharan
Keyword(s):  
Emergency Department ◽  
Developing Countries ◽  
Trinidad And Tobago ◽  
Emergency Care ◽  
Patient Flow ◽  
Process Mapping ◽  
Factors Influencing ◽  
Emergency Care Systems ◽  
Care Systems ◽  
The Caribbean

AbstractObjectivesEmergency departments (EDs) are complex adaptive systems and improving patient flow requires understanding how ED processes work. This is important for developing countries where flow concerns are compounded by resource constraints. The Caribbean is one region with developing emergency care systems and limited research in the area. This study aimed to explore the patient flow process in an emergency department in Trinidad and Tobago, identifying organizational factors influencing patient flow.MethodsMultiple qualitative methods, including non-participant observations, observational process mapping and informal conversational interviews were used to explore patient flow. The process maps were generated from the observational process mapping. Thematic analysis was used to analyze the data.SettingThe study was conducted at a major tertiary level emergency department in Trinidad and Tobago.ParticipantsPatient and staff journeys in the emergency department were observed.ResultsSix broad categories were identified-1) ED organizational work processes, 2) ED design and layout, 3) material resources, 4) nursing staff levels, roles, skill mix and use 5) non-clinical ED staff and 6) external clinical and non-clinical departments. The study findings were combined with existing literature to produce a model of factors influencing ED patient flow. Barriers and facilitators to patient flow were highlighted.ConclusionThe knowledge gained may be used to strengthen the emergency care system in the local context. The model of ED patient flow may be used to systematically examine factors influencing patient flow, informing policy and practice. However, the study findings should be validated in other settings.Article summaryStrengths and limitations of this studyPrevious studies have been predominantly conducted in developed countries using quantitative methodsStrengthening emergency care systems is becoming a priority in developing countries but the Caribbean remains an under-represented region.This study explores ED patient flow in a developing Caribbean country using a multi-method qualitative design, primarily observational process mappingSingle observer used to collect dataSinge site may produce context specific findings

scholarly journals Can health and social care integration make long-term progress? Findings from key informant surveys of the integration Pioneers in England

2019 ◽  
Vol 28 (1) ◽  
pp. 14-26
Author(s):  
Bob Erens ◽  
Gerald Wistow ◽  
Nicholas Mays ◽  
Tommaso Manacorda ◽  
Nick Douglas ◽  
...  
Keyword(s):  
Integrated Care ◽  
Large Scale ◽  
Social Care ◽  
Community Health Services ◽  
Content Type ◽  
Barriers To Change ◽  
Health And Social Care ◽  
Wide Range ◽  
Key Informant ◽  
Care Systems

Purpose All areas in England are expected by National Health Service (NHS) England to develop integrated care systems (ICSs) by April 2021. ICSs bring together primary, secondary and community health services, and involve local authorities and the voluntary sector. ICSs build on previous pilots, including the Integrated Care Pioneers in 25 areas from November 2013 to March 2018. This analysis tracks the Pioneers’ self-reported progress, and the facilitators and barriers to improve service coordination over three years, longer than previous evaluations in England. The paper aims to discuss these issues. Design/methodology/approach Annual online key informant (KI) surveys, 2016–2018, are used for this study. Findings By the fourth year of the programme (2017), KIs had shifted from reporting plans to implementation of a wide range of initiatives. In 2018, informants reported fewer “significant” barriers to change than previously. While some progress in achieving local integration objectives was evident, it was also clear that progress can take considerable time. In parallel, there appears to have been a move away from aspects of personalised care associated with user control, perhaps in part because the emphasis of national objectives has shifted towards establishing large-scale ICSs with a particular focus on organisational fragmentation within the NHS. Research limitations/implications Because these are self-reports of changes, they cannot be objectively verified. Later stages of the evaluation will look at changes in outcomes and user experiences. Originality/value The current study shows clearly that the benefits of integrating health and social care are unlikely to be apparent for several years, and expectations of policy makers to see rapid improvements in care and outcomes are likely to be unrealistic.

scholarly journals A challenge for healthcare system resilience after an earthquake: The crowdedness of a first-aid hospital by non-urgent patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249522
Author(s):  
You-Xuan Lin ◽  
Chi-Hao Lin ◽  
Chih-Hao Lin
Keyword(s):  
Healthcare System ◽  
Waiting Time ◽  
Emergency Care ◽  
Patient Flow ◽  
Discrete Event ◽  
Severe Case ◽  
First Aid ◽  
Response Measure ◽  
Preparedness Planning ◽  
The Impact

After a violent earthquake, the supply of medical services may fall short of the rising demand, leading to overcrowding in hospitals, and, consequently, a collapse in the healthcare system. This paper takes the emergency care system in Taiwan as the research context, where first-aid hospitals are ranked to three levels, advanced, intermediate, and general, and, currently, emphasizes on a general emergency responsibility hospital. Having limited capacity and capability, a general emergency responsibility hospital treats minor and moderate injuries, from which the majority of earthquake-induced casualties suffer. The purpose of this study is to analyze the impact of this group of earthquake-induced non-urgent patients on the performance of a hospital. A patient flow model was built to represent patients’ paths throughout emergency care. Based on the model, discrete event simulation was applied to simulate patients’ trajectories and states of a hospital under four seismic scenarios, where patient visits are 1.4, 1.6, 1.9, and 2.3 times the normal number. A healthcare performance index, Crowdedness Index (CI), is proposed to measure crowdedness on a daily basis, which is defined as the ratio of the average waiting time for treatment to the recommended maximal waiting time. Results of simulations rendered the establishment of empirical equations, describing the relation between the maximum CIs and the patient growth ratios. In the most severe case in this study, the maximum CI exceeds 92 and it takes 10 days to recover from the quality drop. This highlights the problem a general emergency responsibility hospital may encounter if no emergency response measure is implemented. Findings are provided pertaining to the predication of a recovery curve and the alarming level of patient increase, which are supportive information for preparedness planning as well as response measure formulation to improve resilience.

Electron microscopy study of reactively sputter-deposited Ti/N films on silicon

1992 ◽  
Vol 50 (2) ◽  
pp. 1362-1363
Author(s):  
V. C. Kannan ◽  
A. K. Singh ◽  
R. B. Irwin ◽  
S. Chittipeddi ◽  
F. D. Nkansah ◽  
...  
Keyword(s):  
Integrated Circuits ◽  
Large Scale ◽  
Hexagonal Phase ◽  
Microscopy Study ◽  
Electron Microscopy Study ◽  
Process Conditions ◽  
Tin Films ◽  
Wide Range ◽  
Fcc Phase ◽  
Circuits Vlsi

Titanium nitride (TiN) films have historically been used as diffusion barrier between silicon and aluminum, as an adhesion layer for tungsten deposition and as an interconnect material etc. Recently, the role of TiN films as contact barriers in very large scale silicon integrated circuits (VLSI) has been extensively studied. TiN films have resistivities on the order of 20μ Ω-cm which is much lower than that of titanium (nearly 66μ Ω-cm). Deposited TiN films show resistivities which vary from 20 to 100μ Ω-cm depending upon the type of deposition and process conditions. TiNx is known to have a NaCl type crystal structure for a wide range of compositions. Change in color from metallic luster to gold reflects the stabilization of the TiNx (FCC) phase over the close packed Ti(N) hexagonal phase. It was found that TiN (1:1) ideal composition with the FCC (NaCl-type) structure gives the best electrical property.

THE SOME QUESTIONS OF AUTONOMOUS MOTION AND MANAGEMENT OF LAND-MOBILE ROBOTIC COMPLEXES FOR UKRAINIAN GROUND FORCESE

2019 ◽  
pp. 53-58
Author(s):  
О. Кravchuk ◽  
V. Symonenkov ◽  
I. Symonenkova ◽  
O. Hryhorev
Keyword(s):  
Large Scale ◽  
Armed Forces ◽  
Distributed Information ◽  
Wide Range ◽  
Highly Effective ◽  
Information Management Systems ◽  
Robotic Devices ◽  
Principles And Standards ◽  
And Control ◽  
The Eu

Today, more than forty countries of the world are engaged in the development of military-purpose robots. A number of unique mobile robots with a wide range of capabilities are already being used by combat and intelligence units of the Armed forces of the developed world countries to conduct battlefield intelligence and support tactical groups. At present, the issue of using the latest information technology in the field of military robotics is thoroughly investigated, and the creation of highly effective information management systems in the land-mobile robotic complexes has acquired a new phase associated with the use of distributed information and sensory systems and consists in the transition from application of separate sensors and devices to the construction of modular information subsystems, which provide the availability of various data sources and complex methods of information processing. The purpose of the article is to investigate the ways to increase the autonomy of the land-mobile robotic complexes using in a non-deterministic conditions of modern combat. Relevance of researches is connected with the necessity of creation of highly effective information and control systems in the perspective robotic means for the needs of Land Forces of Ukraine. The development of the Armed Forces of Ukraine management system based on the criteria adopted by the EU and NATO member states is one of the main directions of increasing the effectiveness of the use of forces (forces), which involves achieving the principles and standards necessary for Ukraine to become a member of the EU and NATO. The inherent features of achieving these criteria will be the transition to a reduction of tasks of the combined-arms units and the large-scale use of high-precision weapons and land remote-controlled robotic devices. According to the views of the leading specialists in the field of robotics, the automation of information subsystems and components of the land-mobile robotic complexes can increase safety, reliability, error-tolerance and the effectiveness of the use of robotic means by standardizing the necessary actions with minimal human intervention, that is, a significant increase in the autonomy of the land-mobile robotic complexes for the needs of Land Forces of Ukraine.

Stirring and aeration system for the upgrading of small waste water treatment plants

1994 ◽  
Vol 29 (12) ◽  
pp. 149-156 ◽  
Author(s):  
Marcus Höfken ◽  
Katharina Zähringer ◽  
Franz Bischof
Keyword(s):  
Waste Water ◽  
Water Treatment ◽  
Large Scale ◽  
Waste Water Treatment ◽  
Water Treatment Plants ◽  
Waste Water Treatment Plants ◽  
Basic Fluid ◽  
Aeration System ◽  
Technical Realization ◽  
Wide Range

A novel agitating system has been developed which allows for individual or combined operation of stirring and aeration processes. Basic fluid mechanical considerations led to the innovative hyperboloid design of the stirrer body, which ensures high efficiencies in the stirring and the aeration mode, gentle circulation with low shear forces, excellent controllability, and a wide range of applications. This paper presents the basic considerations which led to the operating principle, the technical realization of the system and experimental results in a large-scale plant. The characteristics of the system and the differences to other stirring and aeration systems are illustrated. Details of the technical realization are shown, which conform to the specific demands of applications in the biological treatment of waste water. Special regard is given to applications in the upgrading of small compact waste water treatment plants.

Thin structure of heterogeneous and multiphase fluid flows

2012 ◽  
Vol 9 (1) ◽  
pp. 175-180
Author(s):  
Yu.D. Chashechkin
Keyword(s):  
Large Scale ◽  
Fundamental System ◽  
Fluid Flows ◽  
Regular Solutions ◽  
Flow Models ◽  
Group Methods ◽  
Wide Range ◽  
Thin Structure ◽  
Multiphase Fluid ◽  
Complete Solutions

According to the results of visualization of streams, the existence of structures in a wide range of scales is noted: from galactic to micron. The use of a fundamental system of equations is substantiated based on the results of comparing symmetries of various flow models with the usage of theoretical group methods. Complete solutions of the system are found by the methods of the singular perturbations theory with a condition of compatibility, which determines the characteristic equation. A comparison of complete solutions with experimental data shows that regular solutions characterize large-scale components of the flow, a rich family of singular solutions describes formation of the thin media structure. Examples of calculations and observations of stratified, rotating and multiphase media are given. The requirements for the technique of an adequate experiment are discussed.

Integrative Data Analysis from a Unifying Research Synthesis Perspective

2018 ◽  
Author(s):  
Eun-Young Mun ◽  
Anne E. Ray
Keyword(s):  
Data Analysis ◽  
Large Scale ◽  
Research Synthesis ◽  
Alcohol Intervention ◽  
Data Set ◽  
Integrative Data Analysis ◽  
Level Data ◽  
Model Complex ◽  
Wide Range ◽  
Individual Participant

Integrative data analysis (IDA) is a promising new approach in psychological research and has been well received in the field of alcohol research. This chapter provides a larger unifying research synthesis framework for IDA. Major advantages of IDA of individual participant-level data include better and more flexible ways to examine subgroups, model complex relationships, deal with methodological and clinical heterogeneity, and examine infrequently occurring behaviors. However, between-study heterogeneity in measures, designs, and samples and systematic study-level missing data are significant barriers to IDA and, more broadly, to large-scale research synthesis. Based on the authors’ experience working on the Project INTEGRATE data set, which combined individual participant-level data from 24 independent college brief alcohol intervention studies, it is also recognized that IDA investigations require a wide range of expertise and considerable resources and that some minimum standards for reporting IDA studies may be needed to improve transparency and quality of evidence.

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