Improving Emergency Department Capacity Efficiency

Objective. The demand for emergency services has risen dramatically around the world. Many Emergency Departments (EDs) have signs of low capacity efficiency (which we define as the rate at which a production facility with limited resources can convert input into output); insufficient resources (staffing, equipment, facilities), inefficient ways to use them, or both. Our purpose was to investigate how to improve ED capacity efficiency through layout planning and present some novel ideas of ED bottlenecks. Methods. We adopted an industrial engineering perspective to one Finnish ED as a case example. In contrary to a simple case report we used more generalizable methods and demand-supply chain analysis to improve capacity efficiency. Results. This study resulted in concrete and generalizable improvements of capacity efficiency concerning both ED premises and staffing. The former includes designing patient locations, organizing beds, improving space usage and optimizing an ED layout. The latter identified the demand for different specialties and optimal allocation of nursing staff. Conclusion. We present a rather unique combination of ways to enhance ED functionality by using methods of industrial engineering

A four-way patient search method for the retrospective identification of poisoning patients

When studying emergency department (ED) visits, electronic health record systems of hospitals provide a good basis for retrospective studies. However, many intoxication patients presenting to the ED, may not be identified retrospectively if only a single search method is applied. In this study, a new four-way combined patient search method was used to retrospectively identify intoxication patients presenting to the ED. The search included reason for admission to the ED, laboratory results related to intoxication diagnostics, ICD-10 codes, and a novel free word search (FWS) of patient records. After the automated search, the researcher read the medical records of potential substance abuse patients to form comprehensive profiles and remove irrelevant cases. The addition of a free word search identified 36% more substance abuse patients than the combination of the other three methods mentioned above. Patients identified by the FWS search alone were generally admitted to the ED for trauma or mental health problems and were often found to be heavily under the influence of alcohol and/or drugs. The main intoxicants were ethanol and benzodiazepines. The free word search was highly complementary to traditional patient search methods, highlighting the importance of the combined patient search method in retrospective data collection.Peer reviewe

Developing Policy Pathways : Redesigning Transition Arenas for Mid-range Planning

Sustainability transitions require new policy pathways that significantly reduce the environmental impacts caused by, for example, energy production, mobility and food production. Transition management (TM) is one of the approaches aiming at the creation of new ways to govern transitions. It uses transitions arenas (TA) as a key process and platform where new policy pathways are created in collaboration with multiple (frontrunner) stakeholders. TM’s ambitious and demanding agenda is not easy to implement. There is a continued need for testing and developing new ways of carrying out its key processes. We redesigned the TA process in the context of energy system change in Finland by 2030, focusing on interim goals, mid-range change pathways and developing a new notation system that allows participants to directly create the pathways. The resulting renewed TA process results in more specific and detailed mid-range pathways that provide more concreteness to how to implement long-term transition goals. It helps to bridge long-term national visions/strategies and low carbon experiments that are already running. The Finnish TA work created eight ambitious change pathways, pointing towards new and revised policy goals for Finland and identifying specific policy actions. Evaluation of the TA, 6–9 months after its completion underscores that an effective TA needs to be embedded by design in the particular political context that it seeks to influence. It is too early to say to what degree the pathways will be followed in practice but there are positive signs already