Solving the worldwide emergency department crowding problem - what can we learn from an Israeli ED?

ED crowding is a prevalent and important issue facing hospitals in Israel and around the world, including North and South America, Europe, Australia, Asia and Africa. ED crowding is associated with poorer quality of care and poorer health outcomes, along with extended waits for care. Crowding is caused by a periodic mismatch between the supply of ED and hospital resources and the demand for patient care. In a recent article in the Israel Journal of Health Policy Research, Bashkin et al. present an Ishikawa diagram describing several factors related to longer length of stay (LOS), and higher levels of ED crowding, including management, process, environmental, human factors, and resource issues. Several solutions exist to reduce ED crowding, which involve addressing several of the issues identified by Bashkin et al. This includes reducing the demand for and variation in care, and better matching the supply of resources to demands in care in real time. However, what is needed to reduce crowding is an institutional imperative from senior leadership, implemented by engaged ED and hospital leadership with multi-disciplinary cross-unit collaboration, sufficient resources to implement effective interventions, access to data, and a sustained commitment over time. This may move the culture of a hospital to facilitate improved flow within and across units and ultimately improve quality and safety over the long-term

Dissipative control of energy flow in interconnected systems

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/76668/1/AIAA-1993-3770-736.pd

A Feedback-Based Regularized Primal-Dual Gradient Method for Time-Varying Nonconvex Optimization

This paper considers time-varying nonconvex optimization problems, utilized to model optimal operational trajectories of systems governed by possibly nonlinear physical or logical models. Algorithms for tracking a Karush-Kuhn-Tucker point are synthesized, based on a regularized primal-dual gradient method. In particular, the paper proposes a feedback-based primal-dual gradient algorithm, where analytical models for system state or constraints are replaced with actual measurements. When cost and constraint functions are twice continuously differentiable, conditions for the proposed algorithms to have bounded tracking error are derived, and a discussion of their practical implications is provided. Illustrative numerical simulations are presented for an application in power systems

Covariance Averaging in the Analysis of Uncertain Systems

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/57803/1/CovarianceAveragingTAC1993.pd

Enhancing physical therapy students\u27 attitudes toward telecommunication technology by using a demonstration model

The purpose of this study was to assess and enhance the attitudes and knowledge of physical therapy students toward telecommunication technology. A questionnaire was given to appraise the attitudes and knowledge of 156 physical therapy students toward telecommunication technology. The intervention was a one hour presentation on applications relevant to physical therapy practice. The majority of students expressed interest in telecommunication before the presentation, and felt that expanded use of telecommunication was important to the profession. However, only a minority of students demonstrated knowledge about specific medical telecommunication applications. The post-intervention questionnaire showed the presentation to be effective in changing students\u27 attitudes toward telecommunication, and increasing their knowledge relevant to the practice of physical therapy. If physical therapy curricula were to include exposure to telecommunication, perhaps physical therapists will be more inclined to use the technology in the future