Use of Emergency Departments by Frail Elderly Patients : Temporal Patterns and Case Complexity

Emergency department (ED) care for frail elderly patients is associated with an increased use of resources due to their complex medical needs and frequently difficult psycho-social situation. To better target their needs with specially trained staff, it is vital to determine the times during which these particular patients present to the ED. Recent research was inconclusive regarding this question and the applied methods were limited to coarse time windows. Moreover, there is little research on time variation of frail ED patients’ case complexity. This study examines differences in arrival rates for frail vs. non-frail patients in detail and compares case complexity in frail patients within vs. outside of regular GP working hours. Arrival times and case variables (admission rate, ED length of stay [LOS], triage level and comorbidities) were extracted from the EHR of an ED in an urban German teaching hospital. We employed Poisson time series regression to determine patterns in hourly arrival rates over the week. Frail elderly patients presented more likely to the ED during already high frequented hours, especially at midday and in the afternoon. Case complexity for frail patients was significantly higher compared to non-frail patients, but varied marginally in time only with respect to triage level and ED LOS. The results suggest that frailty-attuned emergency care should be available in EDs during the busiest hours. Based on EHR data, hospitals thus can tailor their staff needs

Understanding the Characteristics of Frequent Users of Emergency Departments : What Role Do Medical Conditions Play?

Frequent users of emergency departments (ED) pose a significant challenge to hospital emergency services. Despite a wealth of studies in this field, it is hardly understood, what medical conditions lead to frequent attendance. We examine (1) what ambulatory care sensitive conditions (ACSC) are linked to frequent use, (2) how frequent users can be clustered into subgroups with respect to their diagnoses, acuity and admittance, and (3) whether frequent use is related to higher acuity or admission rate. We identified several ACSC that highly increase the risk for heavy ED use, extracted four major diagnose subgroups and found no significant effect neither for acuity nor admission rate. Our study indicates that especially patients in need of (nursing) care form subgroups of frequent users, which implies that quality of care services might be crucial for tackling frequent use. Hospitals are advised to regularly analyze their ED data in the EHR to better align resources

Cognitive Performance of Users Is Affected by Electronic Handovers Depending on Role, Task and Human Factors

Patient handovers are cognitively demanding, crucial for information continuity and patient safety, but error prone. This study investigated the effect of an electronic handover tool, i.e. the handoverEHR, on the memory and care planning performance of nurse students (n=32) in a randomised, controlled cross-over design with the factors handover task and handover role. On a descriptive level, handover recipients could improve their memory performance with electronic support, handover givers their performance of writing care plans. Statistically meaningful differences occurred, however, only when the participants were givers. Without handover experience and with low fluency to word problems, givers performed badly in the most demanding of the handover tasks. Final recommendations, however, can only be made after replicating this study in a clinical setting with mixed groups

Simplification of biochemical models: a general approach based on the analysis of the impact of individual species and reactions on the systems dynamics

Background: Given the complex mechanisms underlying biochemical processes systems biology researchers tend to build ever increasing computational models. However, dealing with complex systems entails a variety of problems, e.g. difficult intuitive understanding, variety of time scales or non-identifiable parameters. Therefore, methods are needed that, at least semi-automatically, help to elucidate how the complexity of a model can be reduced such that important behavior is maintained and the predictive capacity of the model is increased. The results should be easily accessible and interpretable. In the best case such methods may also provide insight into fundamental biochemical mechanisms. Results: We have developed a strategy based on the Computational Singular Perturbation (CSP) method which can be used to perform a "biochemically-driven" model reduction of even large and complex kinetic ODE systems. We provide an implementation of the original CSP algorithm in COPASI (a COmplex PAthway SImulator) and applied the strategy to two example models of different degree of complexity - a simple one-enzyme system and a full-scale model of yeast glycolysis. Conclusion: The results show the usefulness of the method for model simplification purposes as well as for analyzing fundamental biochemical mechanisms. COPASI is freely available at http://www.copasi.org

Impacts of a capillary barrier on infiltration and subsurface stormflow in layered slope deposits monitored with 3-D ERT and hydrometric measurements

Identifying principles of water movement in the shallow subsurface is crucial for adequate process-based hydrological models. Hillslopes are the essential interface for water movement in catchments. The shallow subsurface on slopes typically consists of different layers with varying characteristics. The aim of this study was to draw conclusions about the infiltration behaviour, to identify water flow pathways and derive some general interpretations for the validity of the water movement on a hillslope with periglacial slope deposits (cover beds), where the layers differ in their sedimentological and hydrological properties. Especially the described varying influence of the basal layer (LB) as an impeding layer on the one hand and as a remarkable pathway for rapid subsurface stormflow on the other. We used a time lapse 3-D electrical resistivity tomography (ERT) approach combined with punctual hydrometric data to trace the spreading and the progression of an irrigation plume in layered slope deposits during two irrigation experiments. This multi-technical approach enables us to connect the high spatial resolution of the 3-D ERT with the high temporal resolution of the hydrometric devices. Infiltration through the uppermost layer was dominated by preferential flow, whereas the water flow in the deeper layers was mainly matrix flow. Subsurface stormflow due to impeding characteristic of the underlying layer occurs in form of "organic layer interflow" and at the interface to the first basal layer (LB1). However, the main driving factor for subsurface stormflow is the formation of a capillary barrier at the interface to the second basal layer (LB2). The capillary barrier prevents water from entering the deeper layer under unsaturated conditions and diverts the seepage water according to the slope inclination. With higher saturation, the capillary barrier breaks down and water reaches the highly conductive deeper layer. This highlights the importance of the capillary barrier effect for the prevention or activation of different flow pathways under variable hydrological conditions

Characteristics of German Hospitals Adopting Health IT Systems : Results from an Empirical Study

Hospital characteristics that facilitate IT adoption have been described by the literature extensively, however with controversial results. The aim of this study therefore is to draw a set of the most important variables from previous studies and include them in a combined analysis for testing their contribution as single factors and their interactions. Total number of IT systems installed and number of clinical IT systems in the hospital were used as criterion variables. Data from a national survey of German hospitals served as basis. Based on a stepwise multiple regression analysis four variables were identified to significantly explain the degree of IT adoption (60% explained variance): 1) hospital size, 2) IT department, 3) reference customer and 4) ownership (private vs. public). Our results replicate previous findings with regard to hospital size and ownership. In addition our study emphasizes the importance of a reliable internal structure for IT projects (existence of an IT department) and the culture of testing and installing most recent IT products (being a reference customer). None of the interactions between factors was significant

Analyzing Supply Risks and Product Characteristics - A Systematic Literature Review

The environment in which companies operate is increasingly volatile and complex. This results in an increased exposure to disruptions. Past disruptions have especially affected procurement. Thus, companies need to prepare for disruptions. The preparedness for disruptions in the context of procurement is significantly influenced by the design of the procurement strategy. However, a high number of purchased articles and a variety of influencing factors lead to high complexity in procurement. The systematic design of the procurement strategy should therefore take into account the criticality of the purchased articles. This enables to focus on the purchased articles that have a high impact on the disruption preparedness. Existing approaches regarding the design of the procurement strategy in uncertain environments either lack practical applicability and objective evaluation or focus on the criticality of raw materials rather than of purchased articles. Therefore, a data-based approach for the systematic design of the procurement strategy in the context of the Internet of Production has been proposed. One central aspect of this approach is the identification of success-critical purchased articles. Thus, this paper proposes a framework for characterizing purchased articles regarding supply risks by combining two systematic analyses. First, a systematic literature review is performed to answer the question of what factors can be used to describe the supply risks of purchased articles. The results are analyzed regarding sources and impacts of risks and thus contribute to a structured characterization of supply risks. Second, existing criticality assessment approaches for raw materials are analyzed to identify categories and indicators that describe purchased articles. The results of both reviews provide the basis for linking product characteristics with supply risks and assessing product criticality which will be integrated into an app prototype

Building Nursing Knowledge to Meet the Needs of Disruptive Technology Healthcare Re-Design.

This paper provides a discourse based upon the key development of nursing in response to the emerging 4Ds of health technology re-design. Building informatics capability among health professionals is a workforce issue necessitated through the increasing prevalence of information technology and digitization of healthcare affecting the entire health workforce, specifically front-line nurses. The key concepts will be explored of Digitization, Distribution, Disruption and Diversity, a framework recognising the tsunami of technology such as Big Data analytics, comprehensive decision support systems for nursing, nanobots, robotics, and pharmacogenomics and the impact these have upon the nursing workforce