The organisational and communication implications of electronic ordering systems for hospital pathology services

Computerised Provider Order Entry (CPOE) systems provide clinicians with the ability to electronically enter hospital orders for laboratory tests and services. CPOE is able to integrate with hospital information systems and provide point of care decision support to users thereby making a potentially significant contribution to the efficiency and effectiveness of care delivery. The evidence of the impact of CPOE systems on pathology services is not extensive and insufficient attention has been paid to their effect on organisational and communication processes. This thesis aimed to investigate the implications of CPOE systems for pathology laboratories, their work processes and relationships with other hospital departments, using comparative examinations to identify the tasks they are involved in and the particular needs the laboratories expect to be filled by the new system. This longitudinal study of a CPOE system was carried out over three years using multiple cases from a hospital pathology service based at a large Sydney teaching hospital. Multi-methods using quantitative and qualitative data were employed to achieve triangulation of data, theory and methods. The findings provide evidence of a significant 14.3% reduction of laboratory turnaround times from 42 to 36 minutes when laboratory data for two months were compared before and after CPOE implementation. The findings also reveal changes in the pattern and organisation of information communication, highlighting transformations in the way that work is planned, negotiated and synchronised. These findings are drawn together in a comprehensive organisational communication framework that is highly relevant for developing a contingent and situational understanding of the impact of CPOE on pathology services

Thermal Performance of a Multi-Axis Smoothing Cell

Multi Axis Robots have traditionally been used in industry for pick and place, de-burring, and welding operations. Increasing technological advances have broadened their application and today robots are increasingly being used for higher precision applications in the medical and nuclear sectors. In order to use robots in such roles it is important to understand their performance. Thermal effects in machine tools are acknowledged to account for up to 70% of all errors (Bryan J. , 1990) and therefore need to be considered. This research investigates thermal influences on the accuracy and repeatability of a six degree of freedom robotic arm, which forms an integral part of a smoothing cell. The cell forms part of a process chain currently being developed for the processing of high accuracy freeform surfaces, intended for use on the next generation of ground based telescopes. The robot studied was a FANUC 710i/50 with a lapping spindle the end effector. The robot geometric motions were characterised and the structure was thermally mapped at the latter velocity. The thermal mapping identified the key areas of the robot structure requiring more detailed analysis. Further investigation looked into thermal variations in conjunction with geometric measurements in order to characterise the robot thermal performance. Results showed thermal variations of up to 13ºC over a period of six hours, these produced errors of up to 100μm over the 1300mm working stroke slow. Thermal modelling carried out predicted geometric variation of 70μm to 122μm for thermal variations up to 13ºC over a period of six hours. The modelling was 50% to 75% efficient in predicting thermal error magnitudes in the X axis. With the geometric and modelling data a recommendation for offline compensation would enable significant improvement in the robots positioning capability to be achieved

Non-homogeneous random walks on a semi-infinite strip

We study the asymptotic behaviour of Markov chains (Xn,ηn) on Z+×S, where Z+ is the non-negative integers and S is a finite set. Neither coordinate is assumed to be Markov. We assume a moments bound on the jumps of Xn, and that, roughly speaking, ηn is close to being Markov when Xn is large. This departure from much of the literature, which assumes that ηn is itself a Markov chain, enables us to probe precisely the recurrence phase transitions by assuming asymptotically zero drift for Xn given ηn. We give a recurrence classification in terms of increment moment parameters for Xn and the stationary distribution for the large- X limit of ηn. In the null case we also provide a weak convergence result, which demonstrates a form of asymptotic independence between Xn (rescaled) and ηn. Our results can be seen as generalizations of Lamperti’s results for non-homogeneous random walks on Z+ (the case where S is a singleton). Motivation arises from modulated queues or processes with hidden variables where ηn tracks an internal state of the system

The performance and assessment of hospital trauma teams

The purpose of the trauma team is to provide advanced simultaneous care from relevant specialists to the seriously injured trauma patient. When functioning well, the outcome of the trauma team performance should be greater than the sum of its parts. Trauma teams have been shown to reduce the time taken for resuscitation, as well as time to CT scan, to emergency department discharge and to the operating room. These benefits are demonstrated by improved survival rates, particularly for the most severely injured patients, both within and outside of dedicated trauma centres. In order to ensure the best possible performance of the team, the leadership skills of the trauma team leader are essential and their non-technical skills have been shown to be particularly important. Team performance can be enhanced through a process of audit and assessment of the workings of the team and the evidence currently available suggests that this is best facilitated through the process of video review of the trauma resuscitation. The use of human patient simulators to train and assess trauma teams is becoming more commonplace and this technique offers a safe environment for the future education of trauma team staff

Deposition, diffusion, and nucleation on an interval

Motivated by nanoscale growth of ultra-thin films, we study a model of deposition, on an interval substrate, of particles that perform Brownian motions until any two meet, when they nucleate to form a static island, which acts as an absorbing barrier to subsequent particles. This is a continuum version of a lattice model studied in the applied literature. We show that the associated interval-splitting process converges in the sparse deposition limit to a Markovian process (in the vein of Brennan and Durrett) governed by a splitting density with a compact Fourier series expansion but, apparently, no simple closed form. We show that the same splitting density governs the fixed deposition rate, large time asymptotics of the normalized gap distribution, so these asymptotics are independent of deposition rate. The splitting density is derived by solving an exit problem for planar Brownian motion from a right-angled triangle, extending work of Smith and Watson

Editorial - special issue on informatics for ageing and aged-care

2 page(s

The safety implications of missed test results for hospitalised patients: a systematic review

Background: Failure to follow-up test results is a critical safety issue. The objective was to systematically review evidence quantifying the extent of failure to follow-up test results and the impact on patient outcomes. Methods: The authors searched Medline, CINAHL, Embase, Inspec and the Cochrane Database from 1990 to March 2010 for English-language articles which quantified the proportion of diagnostic tests not followed up for hospital patients. Four reviewers independently reviewed titles, abstracts and articles for inclusion. Results: Twelve studies met the inclusion criteria and demonstrated a wide variation in the extent of the problem and the impact on patient outcomes. A lack of follow-up of test results for inpatients ranged from 20.04% to 61.6% and for patients treated in the emergency department ranged from 1.0% to 75% when calculated as a proportion of tests. Two areas where problems were particularly evident were: critical test results and results for patients moving across healthcare settings. Systems used to manage followup of test results were varied and included paperbased, electronic and hybrid paper-and-electronic systems. Evidence of the effectiveness of electronic test management systems was limited. Conclusions: Failure to follow up test results for hospital patients is a substantial problem. Evidence of the negative impacts for patients when important results are not actioned, matched with advances in the functionality of clinical information systems, presents a convincing case for the need to explore solutions. These should include interventions such as on-line endorsement of results.6 page(s

The role of perceived source location in auditory stream segregation: separation affects sound organization, common fate does not

The human auditory system is capable of grouping sounds originating from different sound sources into coherent auditory streams, a process termed auditory stream segregation. Several cues can influence auditory stream segregation, but the full set of cues and the way in which they are integrated is still unknown. In the current study, we tested whether auditory motion can serve as a cue for segregating sequences of tones. Our hypothesis was that, following the principle of common fate, sounds emitted by sources moving together in space along similar trajectories will be more likely to be grouped into a single auditory stream, while sounds emitted by independently moving sources will more often be heard as two streams. Stimuli were derived from sound recordings in which the sound source motion was induced by walking humans. Although the results showed a clear effect of spatial separation, auditory motion had a negligible influence on stream segregation. Hence, auditory motion may not be used as a primitive cue in auditory stream segregation

The impact of PACS on clinician work practices in the intensive care unit: a systematic review of the literature

Objective To assess evidence of the impact of Picture Archiving and Communication Systems (PACS) on clinicians' work practices in the intensive care unit (ICU). Methods We searched Medline, Pre-Medline, CINAHL, Embase, and the SPIE Digital Library databases for English-language publications between 1980 and September 2010 using Medical Subject Headings terms and keywords. Results Eleven studies from the USA and UK were included. All studies measured aspects of time associated with the introduction of PACS, namely the availability of images, the time a physician took to review an image, and changes in viewing patterns. Seven studies examined the impact on clinical decision-making, with the majority measuring the time to image-based clinical action. The effect of PACS on communication modes was reported in five studies. Discussion PACS can impact on clinician work practices in three main areas. Most of the evidence suggests an improvement in the efficiency of work practices. Quick image availability can impact on work associated with clinical decision-making, although the results were inconsistent. PACS can change communication practices, particularly between the ICU and radiology; however, the evidence base is insufficient to draw firm conclusions in this area. Conclusion The potential for PACS to impact positively on clinician work practices in the ICU and improve patient care is great. However, the evidence base is limited and does not reflect aspects of contemporary PACS technology. Performance measures developed in previous studies remain relevant, with much left to investigate to understand how PACS can support new and improved ways of delivering care in the intensive care setting.8 page(s

A comprehensive overview of social network measures for older adults : a systematic review

Objectives: The size and type of older adults' social networks is associated with health, mental and social outcomes. Investigators within many disciplines are now measuring social networks, but it is not always clear what they are assessing, or which measures may best meet their objectives. To undertake a systematic review to identify (i) social network measures used for older adults, (ii) variety of social network dimensions and (iii) how measures have developed over time. Materials and Methods: The MEDLINE, EMBASE, CINAHL, PsycInfo and Cochrane Library databases were systematically searched to identify social network instruments, followed by categorization of the domains into quantitative, qualitative and alter domains. Results: A total of 229 studies and 21 social network measures were included, with 11 quantitative dimensions (e. g., size, frequency), 5 qualitative dimensions (e.g., support satisfaction, emotional bond) and 7 alter members (e. g., family, neighbours) of social networks identified. Measures commonly clustered on quantifiable network size (n = 19), availability of supportive networks (n = 14) and presence of family ties (n = 21). The period between 1985 and 1995 produced the greatest number of newly developed social network measures (n = 10) with a stronger focus on qualitative features. Discussion and Implications: This review provides researchers with an organized summary of measures and dimensions for consideration when appraising social connections in older adults. This can enable better study design through providing information that makes explicit inevitable trade-offs between survey length, comprehensiveness of dimension coverage, and utilization of the measure for researchers