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

An Optimisation-based Framework for Complex Business Process: Healthcare Application

The Irish healthcare system is currently facing major pressures due to rising demand, caused by population growth, ageing and high expectations of service quality. This pressure on the Irish healthcare system creates a need for support from research institutions in dealing with decision areas such as resource allocation and performance measurement. While approaches such as modelling, simulation, multi-criteria decision analysis, performance management, and optimisation can – when applied skilfully – improve healthcare performance, they represent just one part of the solution. Accordingly, to achieve significant and sustainable performance, this research aims to develop a practical, yet effective, optimisation-based framework for managing complex processes in the healthcare domain. Through an extensive review of the literature on the aforementioned solution techniques, limitations of using each technique on its own are identified in order to define a practical integrated approach toward developing the proposed framework. During the framework validation phase, real-time strategies have to be optimised to solve Emergency Department performance issues in a major hospital. Results show a potential of significant reduction in patients average length of stay (i.e. 48% of average patient throughput time) whilst reducing the over-reliance on overstretched nursing resources, that resulted in an increase of staff utilisation between 7% and 10%. Given the high uncertainty in healthcare service demand, using the integrated framework allows decision makers to find optimal staff schedules that improve emergency department performance. The proposed optimum staff schedule reduces the average waiting time of patients by 57% and also contributes to reduce number of patients left without treatment to 8% instead of 17%. The developed framework has been implemented by the hospital partner with a high level of success

Mindfulness-Based Stress Reduction to Decrease Burnout in Emergency Nurses: A Quality Improvement Project at an Academic Medical Center

Nursing burnout, categorized by increased emotional exhaustion (EE), depersonalization (DE), or decreased personal achievement (PA), is rising in the United States. Emergency Department (ED) nurses at an academic medical center in the western United States experience burnout related to workplace violence and trauma exposure exacerbated by a global pandemic. Burnout can lead to adverse health impacts for nurses, increased institutional costs, and adverse patient outcomes. Improving mindfulness or awareness of the present can reduce burnout in ED nurses. A mindfulness pilot project was conducted with staff nurses (n=20) and nurse leaders (n=4) in the ED. Participants attended Mindfulness-Based Stress Reduction (MBSR) classes for eight weeks and practiced mindfulness outside of class. The impact of MBSR was measured before and after the pilot using the Five-Facet Mindfulness Questionnaire Short Form and Maslach Burnout Inventory for Medical Personnel. Overall, ED staff nurses experienced an 11% improvement in mindfulness, a 1% decrease in EE, a 6% decrease in DE, and a 10% increase in PA. ED nurse leaders experienced a 7% improvement in mindfulness, 14% reduction in EE, 36% decrease in DE, and 4% improvement in PA. This pilot project suggests that MBSR is an effective way to increase mindfulness and reduce burnout. Engagement with MBSR classes and participation in mindfulness activities outside of class improved mindfulness and reduced burnout among participants. Due to the promising outcome, this work is recommended to be repeated in the ED setting and expanded to other high-stress environments

An Integrated Framework for Staffing and Shift Scheduling in Hospitals

Over the years, one of the main concerns confronting hospital management is optimising the staffing and scheduling decisions. Consequences of inappropriate staffing can adversely impact on hospital performance, patient experience and staff satisfaction alike. A comprehensive review of literature (more than 1300 journal articles) is presented in a new taxonomy of three dimensions; problem contextualisation, solution approach, evaluation perspective and uncertainty. Utilising Operations Research methods, solutions can provide a positive contribution in underpinning staffing and scheduling decisions. However, there are still opportunities to integrate decision levels; incorporate practitioners view in solution architectures; consider staff behaviour impact, and offer comprehensive applied frameworks. Practitioners’ perspectives have been collated using an extensive exploratory study in Irish hospitals. A preliminary questionnaire has indicated the need of effective staffing and scheduling decisions before semi-structured interviews have taken place with twenty-five managers (fourteen Directors and eleven head nurses) across eleven major acute Irish hospitals (about 50% of healthcare service deliverers). Thematic analysis has produced five key themes; demand for care, staffing and scheduling issues, organisational aspects, management concern, and technology-enabled. In addition to other factors that can contribute to the problem such as coordination, environment complexity, understaffing, variability and lack of decision support. A multi-method approach including data analytics, modelling and simulation, machine learning, and optimisation has been employed in order to deliver adequate staffing and shift scheduling framework. A comprehensive portfolio of critical factors regarding patients, staff and hospitals are included in the decision. The framework was piloted in the Emergency Department of one of the leading and busiest university hospitals in Dublin (Tallaght Hospital). Solutions resulted from the framework (i.e. new shifts, staff workload balance, increased demands) have showed significant improvement in all key performance measures (e.g. patient waiting time, staff utilisation). Management team of the hospital endorsed the solution framework and are currently discussing enablers to implement the recommendation

The entropy of suffering : an inquiry into the consequences of the 4-Hour Rule for the patient-doctor relationship in Australian public hospitals

As a medical practitioner, predominantly working in Australian public hospitals, I have always been interested in the factors that shape and influence my and my colleagues’ performance in the practice of medicine. In 2011, the Australian Government instituted a range of reforms to the public health-care system, including some directed at improving access for patients to Emergency Departments, which had, over many years, become increasingly overwhelmed by the number and complexity of presentations. This included a target of four hours within which patients in Emergency Departments were to be discharged, admitted or transferred to alternative institutions. These reforms generated widespread strong emotional responses from medical and other health staff with whom I worked, and I was prompted to consider the origins of these powerful human reactions to the administrative intervention. Emergency Departments are often described, derisively, as chaotic working environments. However, this epithet may instead be describing something quite profound about the ontological nature of hospitals and Emergency Departments — that they are, indeed, non-linear dynamical physical systems in which phenomena of complexity exist. Other human-centred interactional and transactional systems have been successfully examined from a complexity perspective, including economics and human physiology. Framing inquiry into Emergency Departments, and the humans who encounter each other within them, from a complexity perspective might also then prove useful in defining and characterising the complex and manifold relationships and interactions between people, technology and systemic organising principles. This health services research evaluates the lived experience of four medical practitioners through the paradigm of phenomenological inquiry, as actors on a performance landscape of clinical encounters and as key sources of information about the structure and functions of that performance manifold. Inquiry into and analysis of these rich descriptive data yield strong inferences that non-linear dynamics are operating across scales — from the cellular to the organisational. The complexity perspective provides a unifying explanatory power for making sense of how energetic transactions and transformations between patients, health-care practitioners, technology and the hospital system unfold to result in the recovery from injury and trauma. Specifically, literature on interoception suggests that human biological systems are exquisitely sensitive to changes in dynamic steady-states that might indicate increased entropy. This inquiry suggests that suffering is a phenomenological experience of sudden increases in entropy. An explanatory model in complexity, using the Second Law of Thermodynamics in open systems, suggests that entropy — that is, suffering — can be understood as being transferred and expelled from patient to doctor. Framing in this explanatory model would suggest that the patient-doctor relationship is a powerful systemic attractor in a dynamic system. Elaborating this construct of energetic dynamics further suggests that insertion of system controllers, such as time-based targets, can have profound non-linear effects on the function of these dynamics and, hence, the outcomes of these patient-doctor encounters. The implications of this inquiry include a new and powerful reframing of the ontological characterisation of the practice of medicine in Emergency Departments in terms of nonlinear open thermodynamic functions operating at distance from equilibrium. It recommends a more thoughtful consideration of human experiences such as suffering and its relief. Giving priority and visibility to suffering within health-care, a recrudescence of times past when technology in medicine was limited, may elucidate ways of practising that improve patient experiences and health outcomes. Furthermore, the findings suggest that medical practitioners, health workers and administrators are called on to deeply consider embracing complex dynamics as problem framing references, and to engage with methodologies that build better theories about the nature of phenomena under investigation. Rather than seeking to diminish or extinguish the complexities of Emergency Departments, researchers and practitioners might acknowledge and engage with the next wave of complexity-informed health-care research to better understand how and why health-care relieves suffering and restores human function

Factors Analyze on the Performance of Nurses in the Implementation of Patient Safety

Nurse have an important good role for safety of patients by monitoring the patients\u27 condition to prevent the occurrence of incidents, provide health education, detect faults and near misses, and perform other tasks to solve a problem of the patients by high-quality care. The problems have been existing in ER related to the implementation of patient safety is that the patient safety has not been accomplished in accordance with the SPO and Patient Safety Guide. The purpose of this study is to analyze the factors associated with the performance of nurses in the implementation of patient safety. The research uses analytical descriptive design with cross sectional approach. The number of samples used is 23 respondents with total sampling technique . The calculation results of multiple regression analysis of patient safety knowledge factors have the most dominant influence with standardized ß coefficient of 0.678 and 0.329 meaning that it has a significant effect while the supervision does not. Optimizing the development of the individual nurse requires efforts to increase knowledge and skills in the context of patient safety; therefore, they are able to show high-quality performance

Connecting Healthcare – Leveraging Technology to Promote Value-Based Care in the Emergency Department

The emergency department is a fast-paced and complex environment that serves hundreds of thousands of people a day across the state of Georgia. The establishment of a culture of value-based care in the emergency department is attainable but often falls short when the staff cannot properly leverage the technology available to them. Framed by the Complex Adaptive Theory and The Input/Throughput/Output Model of ED Patient Flow, the purpose of this qualitative case study was to explore how emergency department leaders and staff could better leverage technology to develop and sustain a culture of value-based care. The 30 participants in this study were members of the executive suite, as well as members of the emergency department staff in Georgia. The data were collected through online surveys consisting of open-ended questions. Thematic analysis of the data yielded 5 key themes, including (1) training, (2) time, (3) access to information, (4) troubleshooting, and (5) vendor selection. A key recommendation from this study includes researching the effectiveness of post-implementation health information technology in the emergency department, as it relates to sustaining a culture of value-based care

STRESS-STRAIN CAPACITY ANALYSIS FOR THE IMPACT OF NATURAL DISASTERS ON COUPLED INFRASTRUCTURE FACILITIES

Infrastructure facilities serve as the backbone of the communities and industries by sustaining social and economic activities through their services. However, the physical impact of a disaster can have an adverse effect on the functioning of the infrastructure. In addition, the affected infrastructure facilities are unable to adequately meet the needs of the community immediately after the disaster. Thus, to compensate for gaps in services, infrastructure facilities are likely to run their systems, such that it puts additional stress on their resources that exceeds their designed capacities at the expense of level of service. For example, after the devastating earthquake in Haiti in 2010, disrupted utility services, limited available road networks, and the lack of civic governance influenced the capacity of all essential service providers such as hospitals. Furthermore, the hospitals that were impacted by the earthquake had limited resources, such as water and power utility for operating the hospitals, beds for patients, medical staff, and medical supplies, to meet the increased health needs of the community. As a result, the hospitals in Haiti had to put excessive stress on their available resources, as their remaining capacities were not enough to accommodate the increased number of patients without assistance from NGOs or other external entities. If the emergency managers of the hospitals were able to evaluate their remaining capacities based on the excessive stress so that they could make appropriate strategies for mitigating the excessive stress ahead of time, the infrastructure facility would have serviced the affected communities more efficiently

Occupational Stress and Job Burnout of Female Medical Staff: The Moderating Role of Psychological Capital and Social Support

The medical field is quite challenging as employees have to work day and night under extreme pressure and long and irregular working hours. This work pressure and exhaustion lead to occupational stress. Occupational stress, when unaddressed, leads to burnout which severely affects the physical and mental health of females in the medical field. This study investigates the relationship between occupational stress and job burnout on a sample of female medical staff working in the public health sector with the moderating role of psychological capital and social support between the relationship of occupational stress and job burnout. The research comprises a sample of 250 female medical employees that are working in public hospitals of the twin cities of Pakistan Results show that occupational stress causes job burnout, and psychological capital moderates the relation between occupational stress and job burnout. The three dimensions of psychological capital, namely, self-efficacy, resilience, and Hope, moderate the relation while optimism does not moderate the relationship. Results also show that family support acts as a moderator between stress and burnout, but supervisory support does not moderate the relationship. This study highlights that coping strategies help medical health workers in dealing with stress and burnout. In addition, family support plays an essential role in minimizing the stress of female health workers. Therefore, the administration of hospitals should arrange training to enhance the psychological capital of their health workers to keep them stress-free and ultimately efficient in their work