Decreasing Wait Times for New Referrals to an Outpatient Specialty Clinic

Abstract New patients to an Outpatient Allergy Clinic are waiting for 60 days or more for an appointment which is of concern because of severe allergic reactions, such as anaphylaxis, from which they could suffer. The aim of this project was to reduce the wait time by 25 percent or 15 days for all newly referred patients to the Children’s Outpatient Allergy clinic by August 1, 2016. The clinic is affiliated with a Children’s hospital, services adults and children, and sees approximately 750 patients monthly. Many patients have been on service for years. Implementation The implementation included a ‘buy in’ from stakeholders, an in-service for top referral sources, and adjusting the scheduling matrix to include seeing more new patients daily. Evaluation Currently, there are four ‘new patient slots’ created for each provider daily, with 36 new patients scheduled. The staff has shown increased effectiveness and efficiency. Recent authorizations received have been properly completed. The wait time for new patients is now 43 – 45 days. There is no available data yet for patient satisfaction scores. Conclusion Wait times for new patients have decreased by 25 percent from 60 days to 45 days, the number of new patients seen weekly has increased from 20 to 36 and complete authorization requests are being received. The recommendation is to maintain sustainability of this project by having a clinic champion, maintaining the support of the management team and including the results as an integral part of the daily work flow. Nursing Relevance Reduction in wait times will lead to improving patient satisfaction scores which is a key indicator of quality care and very relevant to nursing. This project focuses on the CNL curriculum element of Care Environment Management, utilizing the CNL competency role of Team Manager as its framework

Epibenthic and benthic microcrustaceans (copepods, cladocerans, ostracods) from a nearshore area in southeastern Lake Michigan

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110059/1/lno19772261059.pd

Meal management practices used in the homes of Oregon State University home economics graduates

The purpose of this study was to examine the meal management practices used in the homes of selected home economics graduates. A total of 296 questionnaires were mailed to Oregon State University home economics graduates for the years 1945, 1950, 1955, and 1960. Forty-nine percent (146) of the questionnaires were returned. Of these, 140 questionnaires were tabulated and analyzed. Findings from this study show that over three-fifths of the homemakers and the children age five or under ate all meals at home. Nearly three-fifths of the husbands and the children age six and above ate all meals at home except the weekday noon meal. Forty percent of the families ate breakfast together as a family every day, six percent ate the noon meal together, and 81 percent ate the evening meal together every day. Meals appeared to be on a more routine time schedule during the week than on weekends. The dining room table and the kitchen table were the more popular areas in the home for serving family meals. Eighty-eight percent of the homemakers felt it was important or very important for all family members to eat together as often as possible. The homemaker carried the major responsibility for preparing the breakfast, noon, and evening meals. However, other family members assisted. The meal time tasks with which the homemakers received the most help were setting the table, clearing the table, washing the dishes, and serving the food. The daughters helped most with meal time tasks. Homemakers spent more time preparing the evening meal than the other two meals, and they spent more time preparing the breakfast than the noon meal. They also spent more time preparing all meals on the weekend than on weekdays. The majority of the homemakers spent 30 minutes or less preparing the breakfast and noon meals and 60 minutes or less preparing the evening meal. Apartment or blue-plate service was the most popular service for the breakfast and noon meals. For the evening meal, country or American service was used most often. Only nine percent of the homemakers used a tray regularly for meal service, and only two percent used a cart regularly. Sixty-two percent of the homemakers purchased their groceries for a definite period of time and then planned their meals, while 17 percent planned their menus before purchasing their groceries. All of the homemakers owned a refrigerator. All except two indicated owning and using a range. Over 60 percent owned a toaster, a freezer, a dishwasher, an electric fry pan, a blender, and an electric mixer with stand. Eighty-six percent of the homemakers used paper napkins regularly on weekdays, while none used cloth napkins regularly on weekdays. Fabric table cloths were more popular with the homemakers than were plastic ones. Ninety-four percent of the homemakers occasionally used paper plates and cups. They were used for picnics or outdoor meals, some daily meals, and for guest meals. The majority of the homemakers, 71 percent, said that they did enjoy cooking, particularly for special occasions. Though nearly half said they liked to serve meals in a creative way, 68 percent used a simple, basic type of service due to limited time. The homemakers in 91 percent of the homes were the major food shoppers. Thirty-four percent of the families usually shopped for food once per week, while 39 percent made a major shopping trip and additional trips as needed. Fifty-six percent of the homemakers shopped on Thursday or Friday. Over 60 percent of the homemakers never had completely prepared dinners or foods such as pizza and fried chicken delivered to their homes. However, dairy products were delivered regularly to 49 percent of the homes. Fifty-seven percent of the homemakers invited guests for meals once or twice a month, and over half usually entertained from three to six guests at a time for meals. When asked about having guests help with meal preparation and cleanup, 36 percent of the homemakers preferred no help from guests, while 27 percent said they enjoyed help, and nine percent did not object to help. Chi-square tests were used to test for relationships between types of meal service and selected demographic factors and between methods of meal planning and selected demographic factors. Significant relationships were found between the type of meal service used and the employment status of the homemaker, the number of children, the income of the family, and the age of the homemaker. Significant relationships were also found between the method of planning meals and the age of the homemaker. The results of these tests showed that apartment or blue-plate service was used most frequently for the weekday breakfast meal by full-time homemakers and least frequently by homemakers employed part time. As the number of children in the family increased, the use of apartment or blue-plate service for this meal decreased. Apartment or blue-plate service was used most frequently for the weekday noon meal by full-time homemakers and least frequently by homemakers employed full time. As the level of income increased up to $20,000, the use of apartment or blue-plate service for the weekday noon meal decreased. A larger percentage of the younger homemakers used apartment or blue-plate service for the weekday noon meal. The youngest and the oldest homemakers in this study, rather than those in the middle age group, planned their meals after groceries were purchased rather than before groceries were purchased

The composition of particulates in Lake Michigan using S.E.M. and light microscope techniques

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/24549/1/0000829.pd

Consecuencias de la menopausia precoz post-quirúrgica en mujeres atendidas por ooforectomía bilateral en el Hospital Escuela Bertha Calderón Roque de Managua, Enero 1994-Enero 2000

Se proponen recomendaciones dirigidas a pacientes, personal de salud, autoridades gubernamentales y no gubernamentales que trabajan con mujeres, en función de disminuir la enfermedad e incapacidad producto de consecuencias quirúrgicas evitables, mediante la estructuración de un eje integrador, de promoción, recuperación y rehabilitación, enmarcado en el programa de modernización del sector salud, con la finalidad de contribuir a mejorar la calidad de vida de estas persona

Zooplankton sampling strategies for environmental studies

This study characterizes sources of variation in total zooplankton abundance estimates at seven stations within the 5–10 m depth contour of southeastern Lake Michigan which were sampled monthly, April through October, for the 1975 to 1979 period. Month, year, and station were statistically significant factors affecting abundance estimates as were all interactions. Month was the largest source of variance either as a main effect or interaction. Smallest coefficients of variation were associated with subsampling (mean 6.1%) and replicate sampling (mean 15.1%). The between-station coefficient of variation averaged 39.0% and tended to be highest during the summer. For a given station and month, the between-year coefficient of variation averaged 73.4% while the between-month coefficient of variation for a single station in a given year averaged 95.1%. A table shows the estimated number of replications necessary to detect a true difference in two population means as a function of coefficient of variation. Environmental studies designed to detect spatial alterations should conduct such analyses on a cruise-by-cruise basis. Cruises should consist of a large number of stations and be conducted at least once during each season. Studies designed to detect temporal alterations require more frequent sampling because of the greater variability associated with temporal data sets. Because spatial variability adds little to the overall variability of such data sets, only a few representative stations need be sampled during each cruise.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/42924/1/10750_2004_Article_BF00008773.pd

The effects of power plant passage on zooplankton mortalities: Eight years of study at the Donald C. Cook nuclear plant

Zooplankton mortalities resulting from passage through the Donald C. Cook Nuclear Plant (southeastern Lake Michigan) were studied over an 8-year (1975-1982) period. The power plant operated at a low [Delta]T (Diaptomus spp, Eurytemora affinis and Limnocalanus macrurus) were most sensitive to plant passage, cyclopoid copepods least sensitive, while cladocerans (Daphnia spp, Eubosmina coregoni) were intermediate in sensitivity. There was no relationship between zooplankton mortalities and temperature ([Delta]T, discharge water temperature), suggesting that thermal stresses were not the major source of mortality. The single exception was September 1978 when discharge water temperatures exceeded 35[deg]C and there were large differences between intake and discharge water zooplankton mortalities (net mortality differences of 14-22% for the two units). Mechanical stresses appeared to be the major cause of zooplankton mortality. However, there was only a weak relationship between mortality as a result of plant passage and zooplankton size. Based on our long-term preoperational (1970-1974) and operational (1975-1982) ecological studies in the vicinity of the power plant, we hypothesize that fish predation, rather than power plant operation, probably was the major source of zooplankton mortality in inshore waters during much of the year.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/26160/1/0000237.pd

PCBs and other toxicants in Mysis relicta

This research considers the role of Mysis relicta in the recycling of toxic organics in the Lake Michigan ecosystem. Mysids were collected at a station 20 km offshore of Grand Haven, Michigan in spring, summer, and autumn and then size-sorted. In October 1980 and May 1981, plankton samples were collected in two size categories: >78 µm and >156 µm. Mysid fecal pellets and Pontoporeia hoyi were collected in May 1981 while a fourhorn sculpin ( Myoxocephalus quadicornis ) was collected in October 1980. Concentrated extracts of all samples were analyzed for chlorinated hydrocarbons using electron capture gas chromatography. Toxic organics detected were, in order of concentration: PCB, DDE, dieldrin, γ-chlordane, and HCB. DDT, DDD, and α-chlordane were detected less frequently. PCB concentrations in mysids were similar to those observed in their plankton diet and there was no evidence of increased bioaccumulation with increased mysid age. Dieldrin and DDE generally occurred in higher concentrations in older than in younger mysids. Dieldrin concentrations were lower in the plankton than in mysids. Certain toxicants (PCBs, DDD, dieldrin, and γ-chlordane) occurred in higher concentrations in Pontoporeia hoyi than in mysids. Concentrations in the sculpin generally were intermediate to those in amphipods and mysids. Our study suggests that mysids have a significant role in the recycling of toxic organics and that the characteristic pathways vary with the contaminant.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/42919/1/10750_2004_Article_BF00008114.pd

Adaptations in a hierarchical food web of southeastern Lake Michigan

Two issues in ecological network theory are: (1) how to construct an ecological network model and (2) how do entire networks (as opposed to individual species) adapt to changing conditions? We present a novel method for constructing an ecological network model for the food web of southeastern Lake Michigan (USA) and we identify changes in key system properties that are large relative to their uncertainty as this ecological network adapts fromone time point to a second time point in response to multiple perturbations. To construct our foodweb for southeastern Lake Michigan,we followed the list of seven recommendations outlined in Cohen et al. [Cohen, J.E., et al., 1993.Improving foodwebs. Ecology 74, 252–258] for improving food webs. We explored two inter-related extensions of hierarchical system theory with our food web; the first one was that subsystems react to perturbations independently in the short-term and the second onewas that a system’s properties change at a slower rate than its subsystems’ properties. We used Shannon’s equations to provide quantitative versions of the basic food web properties: number of prey, number of predators, number of feeding links, and connectance (or density).We then compared these properties between the two time-periods by developing distributions of each property for each time period that took uncertainty about the property into account.We compared these distributions, and concluded that non-overlapping distributions indicated changes in these properties that were large relative to their uncertainty. Two subsystems were identified within our food web system structure (p \u3c 0.001). One subsystem had more non-overlapping distributions in food web properties between Time 1 and Time 2 than the other subsystem. The overall system had all overlapping distributions in food web properties between Time 1 and Time 2. These results supported both extensions of hierarchical systems theory. Interestingly, the subsystemwithmore non-overlapping distributions in foodweb propertieswas the subsystemthat contained primarily benthic taxa, contrary to expectations that the identifiedmajor perturbations (lower phosphorous inputs and invasive species) would more greatly affect the subsystem containing primarily pelagic taxa. Future food-web research shouldemploy rigorous statistical analysis and incorporate uncertainty in food web properties for a better understanding of how ecological networks adapt