A single-entry model and wait time for hip and knee replacement in eastern health region of Newfoundland and Labrador 2011–2019

Background A single-entry model in healthcare consolidates waiting lists through a central intake and allows patients to see the next available health care provider based on the prioritization. This study aimed to examine whether and to what extent the prioritization reduced wait times for hip and knee replacement surgeries. Method The survival regression method was used to estimate the effects of priority levels on wait times for consultation and surgery for hip and knee replacements. The sample data included patients who were referred to the Orthopedic Central Intake clinic at the Eastern Health region of Newfoundland and Labrador and had surgery of hip and knee replacements between 2011 and 2019. Result After adjusting for covariates, the hazard of having consultation booked was greater in patients with priority 1 and 2 than those in priority 3 when and at 90 days after the referral was made for both hip and knee replacements. Regarding wait time for surgery after the decision for surgery was made, while the hazard of having surgery was lower in priority 2 than in priority 3 when and indifferent at 182 days after the decision was made, it was not significantly different between priority 1 and priority 3 among hip replacement patients. Priority levels were not significantly related to the hazard of having surgery for a knee replacement after the decision for surgery was made. Overall, the hazard of having surgery after the referral was made by a primary care physician was greater for patients in high priority than those in low priority. Preferring a specific surgeon indicated at referral was found to delay consultation and it was not significantly related to the total wait time for surgery. Incomplete referral forms prolonged wait time for consultation and patients under age 65 had a longer total wait time than those aged 65 or above. Conclusion Patients with high priority could have a consultation booked earlier than those with low priority and prioritization in a single entrance model shortens the total wait time for surgery. However, the association between priority levels and wait for surgery after the decision for surgery was made has not well-established.

Method for simulating processes of processing inhomogeneous data in buffer drives of routers

The article proposes a method for modeling the processing of heterogeneous data in the buffer storage of routers. In contrast to the existing approaches, in the developed method, in the analytical description of the processes of functioning of buffer storage devices of routers under the influence of heterogeneous traffic of subscribers of a special-purpose communication network, the apparatus of the theory of cellular automata was used, which made it possible to take into account the probability of timely processing of data of all used priority levels of communication directions.As a result of the experiment carried out on the basis of a real special communication network, it was found that the developed method of modeling the processes of processing inhomogeneous data of buffer storage devices of routers makes it possible to increase the accuracy of determining the probability of timely delivery of priority information to subscribers of a special purpose communication network, in comparison with the existing standardized methods.

34 Improving workflow efficiency by implementing priority indication in paging communication

Primary Subject area Hospital Paediatrics Background Paging is an important method of communication in hospitals but can also interrupt clinical care unnecessarily. These interruptions decrease workflow efficiency and negatively affect patient care. Objectives The goal of this project was to decrease clinical care interruptions from non-urgent pages to pediatric residents by implementing a priority indication system that was: (1) consistently used (90% pages with a priority level indicated); (2) clearly defined (80% concordance in the priority levels between senders and recipients); and (3) satisfying to end users (80% rating the paging system as satisfied). Design/Methods The Plan-Do-Study-Act method of quality improvement was used. The study was conducted at an academic children’s hospital, where numeric paging occurs through a switchboard operator. Three priority levels (1 being most urgent) with a respective expected callback time (5-15, 15-30, 60+ minutes) were determined through a pilot study and stakeholder consensus. A priority level was selected by the page sender and displayed beside a callback number. Process measures were indication of priority levels and concordance of priority levels between senders and recipients. Outcome measures were reduced interruptions to clinical care from non-urgent pages and user satisfaction. Balancing measures included patient safety incidents. Run charts, surveys, and page logs were used to track the impact of interventions. Results In the first two months, 1325 out of 2208 (60%) pages had a priority level indicated. In the subsequent two months after providing feedback to users, the proportion increased to 1822 out of 2410 (76%). Subsequent bimonthly indication rates have ranged between 74% and 83%. Among pages with a priority level indicated over 16 months (n=13,934), 26% were assigned priority 1, 62% priority 2, and 11% priority 3. There was a 74% concordance in priority levels between senders and recipients. 26% of pages were received while a resident was directly interacting with a patient. Fewer residents felt that their workflow was being frequently interrupted by non-urgent pages (from 65% to 39%). End user satisfaction improved. There were no patient safety incidents. Conclusion Using existing infrastructure, we implemented a paging priority indication system that decreased interruptions to clinical care. Residents reported improved workflow efficiency, and end users expressed improved satisfaction with paging communication. The gap in the perception of urgency between senders and recipients will need to be further evaluated. While a priority level indication is particularly pertinent to hospitals using numeric pagers, a standardized indication of priority levels can also be beneficial in hospitals using an alternative communication system.

Optimalisasi Penyaluran Bantuan Pemerintah Untuk UMKM Menggunakan Metode Fuzzy C-Means

Indonesian MSMEs were very seriously affected by the Covid-19 pandemic, which caused the Indonesian economy has experienced deceleration. The Indonesian government has taken several steps to keep economic activity running, such as direct cash assistance for micro-scale businesses but is having problems in obtaining real data so that assistance is not on target, the clustering method using Fuzzy C-Means (FCM) is used for grouping MSME data. FCM allows the data to be a member of all clusters in which each cluster has a membership degree value of 0-1. The data used is from the website of the Sleman Regency Cooperatives and SME Service. FCM classifies MSME data based on the attributes of revenue, assets and number of workers. This research resulted in grouping MSME data into 3 priority levels for MSMEs in obtaining assistance, namely high priority, medium priority, and low priority. The results of this study show that the number of MSMEs with high priority is 23,023 MSMEs, medium priority is 9,774 MSMEs and low priority is 3,159 MSMEs. The validation test of the FCM method uses the Partition Coefficient Index (PCI) which has a value of 0.826 which means that value good because it is close to 1.

The association between length of stay in the emergency department and short-term mortality

The detrimental effects of increased length of stay at the emergency department (ED-LOS) for patient outcome have been sparsely studied in the Swedish setting. Our aim was to further explore the association between ED-LOS and short-term mortality in patients admitted to the EDs of two large University hospitals in Sweden. All adult patients (> 18 years) visiting the ED at the Karolinska University Hospital, Sweden, from 1/1/2010 to 1/1/2015 (n = 639,385) were retrospectively included. Logistic regression analysis was used to determine association between ED-LOS and 7- and 30-day mortality rates. All patients were triaged according to the RETTS-A into different levels of medical urgency and subsequently separated into five quintiles of ED-LOS. Mortality rate was highest in highest triage priority level (7-day mortality 5.24%, and 30-day mortality 9.44%), and decreased by lower triage priority group. For patients with triage priority levels 2–4, prolonged ED-LOS was associated with increased mortality, especially for lowest priority level, OR for priority level 4 and highest quintile of ED-LOS 30-day mortality 1.49 (CI 95% 1.20–1.85). For patients with highest triage priority level the opposite was at hand, with decreasing mortality risk with increasing quintile of ED-LOS for 7-day mortality, and lower mortality for the two highest quintile of ED-LOS for 30-day mortality. In patients not admitted to in-hospital care higher ED-LOS was associated with higher mortality. Our data suggest that increased ED-LOS could be associated with slightly increased short-term mortality in patients with lower clinical urgency and dismissed from the ED.

Priority levels in cancer patients admitted to medical intensive care at a safety net hospital.

e18599 Background: Admissions of cancer patients to intensive care units (ICU) are increasing with improved mortality. While ICU care can be lifesaving, its higher cost does not always result in reduced mortality. Moreover, timely goals of care (GOC) discussions correlate with less ICU use in those with certain cancers. We investigate if hospital mortality and disposition outcomes for cancer patients correlate to triage by ICU providers. Methods: This subgroup analysis of a prospective cohort of 808 patients admitted to the ICU from 1 July 2015- 15 June 2016 at an academic safety net hospital included 106 patients diagnosed with cancer. Medical records were reviewed by ICU physicians, who assigned priority ranks using Society of Critical Care Medicine guidelines: 1: critically ill, needing treatment/monitoring not provided outside of ICU, 2: not critically ill, but requiring close monitoring/potentially immediate intervention, 3: critically ill patients with reduced likelihood of recovery, 4: not appropriate for ICU, equivalent outcomes achieved with non-ICU care. We did a chart review for factors like prior therapy and documentation of GOC discussions. Statistical tests were conducted to examine if priority levels correlate with disposition, mortality, and length of stay (LOS). Results: χ2-tests revealed priority rank correlated with disposition after hospitalization (p<.05) with group 3 having the highest proportion of deaths and lowest proportion of discharges home. It revealed that mortality rate differed by group (p<.05) with logistic regression showing that priority 3 predicted increased mortality (p<.05). ANCOVA indicated ICU LOS differed by priority group (p<.05), with priority 3 averaging the longest LOS. While priority 3 had the most in-hospital GOC discussions, relatively few were documented pre-hospitalization. Conclusions: Overall, our patients were accurately triaged, with worse mortality and discharge outcomes among priority 3 and a dearth of pre-hospitalization GOC documentation for all groups. Our data show the importance of triaging patients and having early, frequent GOC discussions to minimize ICU admission given increasing demand and costs. GOC discussions are associated with less aggressive medical care near death and better patient quality of life. Thus, holding these talks with our sickest patients prior to potential ICU admission is an area to improve cost-effective high quality care.[Table: see text]

The urgency of vaccination against Covid-19 in dentists

The requirement of vaccines for the prevention of Covid-19 has become one of the health priorities of different countries worldwide (1, 2). However, most societies still do not have the necessary number of vaccines to cover their entire target population (3, 4). This is especially true in countries that delayed negotiations with the supply companies, and which will, unfortunately, have to wait a long time for the arrival of sufficient quantities to protect their populations. On theother hand, the global vaccination process has established priority levels among its citizens, specifically starting with the so-called first line of action that is health professionals attending Covid-19 patients, due to the great risk to which they are exposed. Additionally, the health organizations of the different countries have proposed to continue the vaccination process according to different criteria, one being the risk levels of the professions. This criterion is aimed at prioritizing professionals most exposed to contagion, but according to their daily practice, what professionals are really the most exposed to contagion?

Analisis Variable yang Memengaruhi Minat Pemilihan Perguruan Tinggi

Kebijakan Promosi dari Universitas untuk mendapatkan mahasiswa baru merupakan hal yang vital bagi kelancaran proses penerimaan Mahasiswa Baru. Pihak lembaga perlu mengkaji dan melakukan analisis yang baik sebelum melakukan promosi. Di era sekarang, banyak media yang dapat dijadikan sebagai media promosi. Dengan berkembangnya cara penyebaran informasi serta banyaknya media pihak yang berkepentingan sudah seharusnya jeli mana yang mendapat prioritas lebih dari semua banyak lini media tempat promosi. Ketika tingkat prioritas sudah ditentukan maka upaya promosi akan menjadi lebih mudah dan lebih tepat sasaran. Akan tetapi penentuan tingkat prioritas tidak dapat dilakukan secara asal dan sembarangan. Perlu dilakukan pengkajian yang lebih dalam bukan hanya sekedar intuisi belaka. Penelitian ini membahas tentang pengaruh promosi dengan minat calon mahasiswa memilih AMIKOM sebagai universitas pilihan dengan acuan tiga variable yaitu sosial media, website, dan referensi alumni. Pengolahan data menggunakan software SPSS dan SPSS AMOS untuk mencari validitas, reliabilitas dan uji hipotesis. Hasil yang didapatkan adalah semua variable signifikan, dengan urutan dari nilai tertinggi ke terendah adalah Sosial Media, Referensi Alumni, dan Website. Kata Kunci—Promosi, Validitas, Reliabilitas, HipotesisPromotion policy from the University to get new students is vital for the smooth process of admission of New Students. The institution needs to review and conduct a good analysis before conducting a promotion. In this era, many media can be used as promotional media. With the development of ways of disseminating information and the many media interested parties it should be observant which gets priority over all the many lines of media wherepromotion. When the priority level has been determined, the promotion effort will be easier and more targeted. However, the determination of priority levels cannot be done arbitrarily and carelessly. Deeper studies need to be done not just mere intuition. This study discusses the effect of promotion with the interest of prospective students choosing AMIKOM as the university of choice with three variables reference, namely social media, website, and alumni reference. Data processing using SPSS and SPSS AMOS software to find validity, reliability, and hypothesis testing. The results obtained are all significant variables, with the order from highest to lowest values are Social Media, Alumni Reference, and Website.Keywords— Promotion, Validity, Reliability, Hypothesis

Evaluation on Triaging Pathway Strategy Guidelines for Cases with Elipidae Bite during COVID-19 Pandemic at Emergency Department

Introduction: Emergency departments (ED) typically practice a triage system to classify patients into priority levels. A triage system is commonly used in crowded emergency rooms to determine which patient should be seen and treated immediately.Objective: The objective of this study was to evaluate the effectiveness of triaging pathway guidelines for critical cases seen in the Emergency Department during the COVID-19 outbreak.Case Presentation: Emergency Department, Taiping Hospital is practicing a triaging system which consists of two divisions; cases with respiratory symptoms (SARI) and cases without symptoms of respiratory impairment (non-SARI). A patient with snake bite was presented at the Emergency Department, Taiping Hospital with symptoms of numbness at the site of the bite and a complaint of difficulty to open the eyes, while tachycardia was noted. However, no shortness of breath or difficulty in breathing was reported. COVID-19 rapid screening was done and the patient was treated under Red Zone (non-SARI). Luckily, the patient survived and was stable with no reaction observed after treated with Neuro Polyvalent Antivenom 50ml in 500ml normal saline over one hour.Conclusion: The available patient triaging pathway strategy guideline was effectively practiced by paramedics when managing critical cases at the Emergency Department during COVID-19 outbreak. Other emergency departments are advised to practice effective and appropriate triaging pathway strategy guidelines to save patients’ lives.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S15