Conceptual Model of Emergency Department Utilization among Deaf and Hard-of-Hearing Patients: A Critical Review

Deaf and hard-of-hearing (DHH) populations are understudied in health services research and underserved in healthcare systems. Existing data indicate that adult DHH patients are more likely to use the emergency department (ED) for less emergent conditions than non-DHH patients. However, the lack of research focused on this population’s ED utilization impedes the development of health promotion and quality improvement interventions to improve patient health and quality outcomes. The purpose of this study was to develop a conceptual model describing patient and non-patient (e.g., community, health system, provider) factors influencing ED utilization and ED care processes among DHH people. We conducted a critical review and used Andersen’s Behavioral Model of Health Services Use and the PRECEDE-PROCEED Model to classify factors based on their theoretical and/or empirically described role. The resulting Conceptual Model of Emergency Department Utilization Among Deaf and Hard-of-Hearing Patients provides predisposing, enabling, and reinforcing factors influencing DHH patient ED care seeking and ED care processes. The model highlights the abundance of DHH patient and non-DHH patient enabling factors. This model may be used in quality improvement interventions, health services research, or in organizational planning and policymaking to improve health outcomes for DHH patients.

Life Cycle Analysis of Sotol Production in Mexico

Sotol is a Mexican distilled spirit produced in Northern Mexico. The estimated annual production of sotol is at around 5,200 hl per year. This industry grows at an average rate of 5% per year. The Mexican Sotol Council and the Sotol Certificate Council are regulatory bodies dedicated to monitoring that sotol producers comply with the Official Mexican Standard NOM-159-SCFI-2004. Currently, those regulatory bodies try to improve the sotol production process and good practice guidelines to contribute to cleaner production. This paper reports a case study of artisanal sotol production in Chihuahua State in Mexico. Life cycle assessment (LCA) technique was used to compute the environmental impact of sotol and its performance to identify system hotspots and propose improvement interventions. SimaPro software, v.9.1®, is used for the LCA, applying CML-IA baseline V3.05/EU25 method to evaluate and select environmental impact categories. The system boundary included the stages of harvest, cooking, milling, fermentation, distillation, bottling, and packaging. The findings indicate that each of the stages required for sotol beverage processing significantly affects the marine ecosystem. The milling and bottling stages have the highest environmental impact. A 750-ml bottle of artisan sotol causes 5.92 kg CO2 eq, based on empirical data. Sotol makers should focus on reducing energy consumption caused by input transportation and equipment for milling.

Quantification of Resilience Considering Different Migration Biographies: A Case Study of Pune, India

Urbanization proceeds globally and is often driven by migration. Simultaneously, cities face severe exposure to environmental hazards such as floods and heatwaves posing threats to millions of urban households. Consequently, fostering urban households’ resilience is imperative, yet often impeded by the lack of its accurate assessment. We developed a structural equation model to quantify households’ resilience, considering their assets, housing, and health properties. Based on a household survey (n = 1872), we calculate the resilience of households in Pune, India with and without migration biography and compare different sub-groups. We further analyze how households are exposed to and affected by floods and heatwaves. Our results show that not migration as such but the type of migration, particularly, the residence zone at the migration destination (formal urban or slum) and migration origin (urban or rural) provide insights into households’ resilience and affectedness by extreme weather events. While on average, migrants in our study have higher resilience than non-migrants, the sub-group of rural migrants living in slums score significantly lower than the respective non-migrant cohort. Further characteristics of the migration biography such as migration distance, time since arrival at the destination, and the reasons for migration contribute to households’ resilience. Consequently, the opposing generalized notions in literature of migrants either as the least resilient group or as high performers, need to be overcome as our study shows that within one city, migrants are found both at the top and the bottom of the resilience range. Thus, we recommend that policymakers include migrants’ biographies when assessing their resilience and when designing resilience improvement interventions to help the least resilient migrant groups more effectively.

Reducing Hospital-acquired Pressure Injuries Among Pediatric Patients Receiving ECMO: A Retrospective Study Examining Quality Improvement Outcomes

BACKGROUND: Pediatric patients immobilized for certain procedures, such as extracorporeal membrane oxygenation (ECMO), are at high risk for developing hospital-acquired pressure injuries (HAPIs). PURPOSE: To evaluate the rate of HAPI occurrence in ECMO patients before and after implementation of prevention interventions. METHODS: Patients younger than 18 years of age who were placed on ECMO from January 2012 through March 2020 were identified, and patient data, including the development of a stage 3, 4, or unstageable pressure injuries, were abstracted. From August 2018 through December 2018, HAPI prevention interventions were implemented, which included targeted HAPI prevention and ECMO provider education, fluidized positioner provider education, and the addition of 2 wound care interventions for ECMO patients. RESULTS: Of the 120 ECMO patients identified, 5 (4.2%) developed a HAPI. All patients developed HAPI in the occipital region, and 1 patient developed an additional HAPI on their back. The median age of patients with HAPI was 1 month (interquartile range [IQR], 0.3–6.8 months). The median duration from ECMO cannulation to identification of HAPI was 9.5 days (IQR, 4.8–32.3 days). The median total run time was 4.9 days (IQR, 2.5-7.6 days): 8.5 days for patients who did develop a HAPI and 4.8 days for those who did not develop a HAPI (P = .02). The overall HAPI rate dropped from 4.8% of ECMO patients before quality improvement interventions to 0% of ECMO patients after quality improvement interventions. CONCLUSIONS: The development of stage 3, 4, or unstageable HAPIs in pediatric ECMO patients was low (4.2%) over the period studied (January 2012 through March 2020). As of the time of this writing, no HAPIs occurred after implementation of provider education in 2018.

Process Improvement Approaches for Increasing the Response of Emergency Departments against the COVID-19 Pandemic: A Systematic Review

The COVID-19 pandemic has strongly affected the dynamics of Emergency Departments (EDs) worldwide and has accentuated the need for tackling different operational inefficiencies that decrease the quality of care provided to infected patients. The EDs continue to struggle against this outbreak by implementing strategies maximizing their performance within an uncertain healthcare environment. The efforts, however, have remained insufficient in view of the growing number of admissions and increased severity of the coronavirus disease. Therefore, the primary aim of this paper is to review the literature on process improvement interventions focused on increasing the ED response to the current COVID-19 outbreak to delineate future research lines based on the gaps detected in the practical scenario. Therefore, we applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to perform a review containing the research papers published between December 2019 and April 2021 using ISI Web of Science, Scopus, PubMed, IEEE, Google Scholar, and Science Direct databases. The articles were further classified taking into account the research domain, primary aim, journal, and publication year. A total of 65 papers disseminated in 51 journals were concluded to satisfy the inclusion criteria. Our review found that most applications have been directed towards predicting the health outcomes in COVID-19 patients through machine learning and data analytics techniques. In the overarching pandemic, healthcare decision makers are strongly recommended to integrate artificial intelligence techniques with approaches from the operations research (OR) and quality management domains to upgrade the ED performance under social-economic restrictions.