Main features and control strategies to reduce overcrowding in emergency departments. A systematic review of the literature

Purpose: Overcrowding is a problem that affects emergency departments (ED) all over the world; it occurs due to a disproportion between user demand and the physical, human and structural resources available. Essential prerequisites to assessing and managing the phenomenon are its accurate measurement and an understanding of its impact. The objective of this systematic review is to identify the characteristics of the problem, analyzing the proposed strategies aimed at improving patient flow, delay in services provided and overcrowding of emergency departments. Methods: To achieve our objectives, a manual computerized search was performed in the bibliographic databases using as keywords “Emergency Department”, “Overcrowding”, “Emergency Room”, “Emergency Service”, “Emergency Unit”“,Emergency Ward”, “Emergency Outpatient Unit”, “Emergency Hospital”, “Crowding”, “Mass Gathering”, “Management” and “Comprehensive Health Care”. Two independent reviewers analyzed abstracts, titles and full text articles for admissibility, according to the selected inclusion and exclusion criteria. Results: The process lead to include 19 articles. It was possible to group the solutions proposed in five categories: work organization, investment in primary care, creation of new dedicated professional figures, work and structural modifications and implementation of predictive simulation models using mathematical algorithms. Conclusion: The most effective measures to guarantee an improvement in the flow of patients are represented by both improving the efficiency of human resources and by developing predictive mathematical models, regardless of the type of hospital and its location. Considering the complexity of EDs and the multiple characteristics of overcrowding and that the causes of crowding are different and site-specific, a careful examination of the specifics of each ED is necessary to identify improving fields

Resource productivity management in the services sector

School of Managemen

Use of Standardized Patient Scenarios to Train Medical Assistants in an Ambulatory Rehabilitation Medicine Clinic

Objectives: To improve the efficiency of our outpatient Rehabilitation Medicine clinic without sacrificing high value/quality patient care. To clarify the responsibilities of the MA and identify areas of redundancy in the rooming process. To demonstrate the utility of in-situ simulation for MA training. To reduce the time it takes for MAs to complete all assigned tasks to 10 minutes or less per encounter in at least 50% of patient encounters within two months from the time of intervention. To potentially highlight other areas in which to improve clinic efficiency and overall patient satisfaction (e.g. front desk registration process, resident and attending physician encounters, clinic and exam room accessibility).https://jdc.jefferson.edu/patientsafetyposters/1051/thumbnail.jp

Value for money in schools: Report for the Audit Office

In January 2008, the Audit Commission appointed FGS, in association with the University of Southampton, to carry out a review in relation to Value for Money (VfM) in schools. Examining VfM in schools requires a detailed consideration of both the inputs and the outputs relating to the education system; in other words, the costs and benefits associated with schools. In this context, inputs are relatively straightforward to express: staffing typically represents around 70% of school costs, with the remainder comprising of operating and maintenance expenditure. However, defining the outputs from schools (pupil outcomes) is an altogether more complex task. The most tangible measure of pupil outcomes is the results they achieve in examinations. Even so, both in the UK and overseas, it is widely recognised that pupils’ levels of achievement are influenced by a range of factors other than the quality of schooling they receive (for example, their family background or their track record of achievement at earlier stages of their education). Put simply, pupils’ current levels of attainment are likely to be enhanced if they have a high level of prior educational attainment, and therefore schools may make a less significant contribution to student outcomes. In assessing the value for money which schools deliver through their day-to-day activities, it is therefore necessary to take account of the progress pupils make in their time at school (or ‘value added’ by the school), rather than just their levels of attainment, which are influenced by a host of factors other than schooling. <br/

Mental Disorders and Medical Comorbidity

Presents findings on factors behind the prevalence of patients with both mental and medical conditions; mortality, quality of care, and cost burdens; and evidence-based treatment approaches, including self-management support. Outlines policy implications

Analysis of a photovoltaic/thermal solar collector for building integration

The idea of combining photovoltaic and solar thermal collectors (PVT collectors) to provide electrical and heat energy is not new, however it is an area that has received only limited attention. With concern growing over energy sources and their usage, PVTs have become a focus point of interest in the field of solar energy research. Although PVTs are not as prevalent as solar thermal systems, the integration of photovoltaic and solar thermal collectors into the walls or roofing structure of a building could provide greater opportunity for the use of renewable solar energy technologies in domestic, commercial and industrial applications. As such, the design of a novel building integrated photovoltaic/thermal (BIPVT) solar collector is theoretically analysed through the use of a modified Hottel-Whillier model. The thermal efficiency under a range of conditions was subsequently determined and results showing how key design parameters influence the performance of the BIPVT system are presented