A retrospective case note analysis of the recognition and management of deteriorating patients prior to critical care admission

This study explores the use of early warning scores (EWS) in deteriorating patients. These are widely used tools to measure vital signs and highlight abnormal physiology in acutely unwell patients. Measurements of the process in the management of the deteriorating patient includes time to first assessment of such patients. The level of clinician involved in the subsequent management is also investigated to determine whether escalation of care was appropriate. This work is a retrospective case note analysis of the recognition and management of deteriorating patients prior to critical care admission. Research Questions 1. What violations in the optimum process are associated with sub-optimal recognition and management of deteriorating patients and delayed critical care admission in patients triggering early warning scores in acute care wards? 2. Are there independent variables which can predict the delay in the recognition and management of deteriorating patients and subsequent critical care admission? Methods The literature was reviewed to determine the optimum process of recognition and management of deteriorating patients in acute care wards. A data collection tool was then specifically designed and locally validated to extract objective data from the case records. A sample of 157 patients admitted to critical care from acute wards over a 6 month period were included in the study. The case records were then retrospectively reviewed and information was extracted using the data collection tool. Results The accuracy and frequency of early warning scores were measured and findings demonstrated that 59% of Early Warning Scores (EWS) were miscalculated. The most frequent of those miscalculated were the intermediate scores (4 or 5) (error rate - 52%) followed by the higher scores (6 or more) (error rate - 32%). The least frequently miscalculated were the lower scores (0 -3) (error rate 15%). Descriptive data from the sample such as age, ward, diagnosis, time of hospital admission, time and day of transfer / EWS triggering were included. From the total case records reviewed, 110 patients had abnormal Early Warning Scores (4 or more) and were included in the inferential data analysis. The independent variables related to the processes objectively measurable in the recognition and management of deteriorating patients were included. After descriptive analysis the independent variables were cross-tabulated with the dependent variable using Pearson chi-square. The dependent variable was identified from the literature. This was whether time from triggering an abnormal EWS to critical care admission was delayed more than 6 hours. The subsequent predictor variables were then entered in to a binary logistic regression model for statistical analysis using SPSS version 21 software. Binominal Logistic Regression Analysis identified three significant variables predicting delay of the recognition and management of deteriorating patients. • Frequency of EWS measurement not increased appropriately • Length of stay prior to critical care admission 12-36 hours • If no consultant review during 6 hours of abnormal EWS   Implications for Future Practice This study highlights areas of risk in the detection of patients’ clinical deterioration in acute wards. These findings should guide quality improvement to prevent unnecessary morbidity and mortality. As a key area of patient risk included the lack of frequency and accuracy of EWS measurements, staff education is required to ensure staff are given the appropriate knowledge to understand the use of the tool. Regular review of the frequency of measurement is also required as this was statistically significant in the delay to critical care admission. The high risk time from admission of 12-36 hours needs further investigation. This study also highlights the need for senior decision makers to be involved in the care of deteriorating patients to improve outcomes

Antecedents of Small Business Performance

This article focuses on what makes small businesses successful and whether consistent patterns of success can be identified

Perceptions of leadership traits and affective behaviors: The effect on U.S. presidential election success: Working paper series--05-11

This paper addresses leadership quality using follower assessments of traits and affective relationships. We compare US presidential candidates who were successful in their bids for the presidency to those who were unsuccessful. Perceived knowledge, charisma, morality and decency, as well as warmth and compassion are significantly different between these two groups, indicating that these perceptual qualities are key factors in election success. Each of these perceptual qualities is also significantly linked with follower assessments of leadership quality. Additionally, findings indicate that assessments of follower positive and negative affect (including pride, hopefulness, fear and anger) toward leaders are significantly related to follower assessments of leadership ratings

Expatriate Selection: The Key To International Success

The types of criteria used to evaluate individuals' success in expatriate assignments and variables, which could represent expatriates' knowledge skills and abilities (KSAs), were investigated in this study.  The four most common criteria are (a) technical competencies; (b) human relational skills; (c) spouse and family adaptability; and (d) desirability to serve overseas.  Another attempt was made to understand the relationships between firm's selection strategies and expatriate success.  Success was viewed from a multidimensional perspective.  In addition, the tasks and responsibilities of expatriates vary by company, by industry, and by country.  A contingency approach for selection was discussed briefly

Critical Success Factors for E-commerce in Thailand: A Multiple Case Study Analysis

A number of developing countries have adopted e-commerce strategies in seeking to boost their economies and competitiveness to a new level. Thailand is one of these developing countries struggling to develop a successful e-commerce plan that will fit the needs of Thai markets. The goal of this research was to identify the critical success factors (CSFs) for ecommerce in Thailand. The researcher conducted detailed case studies of nine e-commerce companies from different industries in Thailand. Results showed that social behavior and national culture, more specifically issues pertaining to trust and shopping behavior, were critical to the success of e-commerce in Thailand. Hofstede’s cultural dimensions could explain the phenomenon. The study also found that Thailand’s infrastructure also played an important role in the success of its ecommerce development. The findings provided a framework to guide development of e-commerce ventures in Thailand and other developing countries with similar culture and infrastructures

Infosys Technologies: Improving Organizational Knowledge Flow

Nandan Nilekani, the chief executive officer (CEO) of Infosys Technologies (Infosys), sat at his desk at the company’s headquarters in Bangalore, India, reading an email from one of his account managers in his North American operations. The manager, Vivek Pradhan, had just landed a project with a major Detroit automobile manufacturer, and was commenting to Nandan on how instrumental the company’s knowledge management (KM) program was in his securing the project. Vivek told Nandan that his client had given him 48 hours to develop a pre-proposal on upgrading its nationwide sales and order operations. He added that his technical team had never seen such a project. Vivek felt he could never meet his pre-proposal deadline, but that evening he received an email from Nandan announcing the launch of a new Domain Competency Group (DCG) as part of the company’s nascent knowledge management (KM) initiative. As stated in the email: DCG would serve as a centralized think-tank to provide round-the-clock knowledge support on various industrial domains to our practice units around the world. Vivek further explained that a quick call to the DCG contact number helped him locate a similar project completed for a German automotive company. He was sent the necessary materials, including a client presentation, which proved very similar to what his client had in mind. After reading the email, Nandan sat back in his chair feeling quite pleased at the success of the five-year-old KM program. Infosys’ KM implementation was guided by the KM Maturity Model (KMM) (see Exhibit 1). 2 Infosys was currently working towards attaining the fourth level of KM maturity. However, one requirement was seriously lacking and would impede progress to the next level: Infosys did not have robust metrics for assessing productivity benefits of the KM program

A Model For Technology Adoption In China: Extending Caselli And Coleman

Focusing on China, a country pushing toward a more market-oriented system at warped speed, we suggest that previous models of technology adoption and/or diffusion may not be suitable for countries migrating from centralized control. We support the work of Au and Yeung (2007), who suggest that China may suffer from a risk avoidance attitude at the firm level based on previous attitudes of control. Relying on the literature and supported by an in-depth analysis of the Chinese machine tool industry we extend the work of Caselli and Coleman (2001, 2002) and advance an expanded model of technology adoption specific to emerging markets, such as China, experiencing a transformation from centrally controlled economy toward a market one

Leadership quality and follower affect - A study of U.S. presidential candidates: Working paper series--07-02

Using data from the seven most recent US presidential elections, two related analyses are conducted. The first presents an analysis of variance comparing Democratic and Republican Party candidates who were successful in securing votes to those who were unsuccessful in securing votes, using follower perceptions of candidate intelligence, candidate's degree of charisma, and follower feelings of positive and negative affect toward these candidates as the units for analysis. Here, perceived intelligence, feelings of pride and hope, as well as feelings of fear and anger, were found to be statistically different between the two groups. Specifically, candidates perceived to be higher in intelligence, who generated stronger feelings of pride and hope, and weaker feelings of fear and anger were more likely to receive voting support from their followers. The second analysis presents a regression model using follower assessments of candidates' leadership quality as dependent upon certain leader perceptual traits, including follower assessments of candidate intelligence and inspirational qualities, as well as follower affective responses (in terms of feelings of pride, hope, fear and anger) toward all candidates. Here, candidates perceived to be higher in intelligence, perceived to possess stronger degrees of inspirational quality, and who were judged more "likeable" in terms of generating stronger degrees of positive follower affect and lower degrees of negative follower affect are considered better quality leaders

Investigating Barriers to Knowledge Management Implementation In the U.S. MIlitary: A Focus on Managerial Influences

The knowledge management literature identifies a variety of factors that may influence KM implementation in organizations. Over the past ten years, each of the U. S. military services has implemented KM programs to varying degrees. Although knowledge management research continues to grow, little has focused exclusively on efforts in the military context. Using Holsapple and Joshi’s KM “influences” framework (2000)--which addresses managerial, resource, and environmental factors--as guiding theory, this multiple-case study reports on the “managerial” factors that have influenced KM implementation across the U. S. military services. The results indicate a number of negative managerial influence factors (i.e. barriers) have thwarted progress, the most significant being lack of leadership commitment & lack of evidence/measurement that reveal a return on investment. Identification of these influence factors not only reinforces existing theory, but also offers a practical guide for specific interventions that focus on leadership & user KM education, KM proponent leadership/organizations, and service-wide policy, guidance, and governance

Applying Task Force Recommendations on Integrating Science and Practice in Health Service Psychology Education

The proper role of research skills and training to conduct research in professional psychology education has been controversial throughout the history of the field. An extensive effort was undertaken recently to address that issue and identify ways the field might move forward in a more unified manner. In 2015, the American Psychological Association (APA) Board of Educational Affairs convened a task force to address one of the recommendations made by the Health Service Psychology Education Collaborative in 2013. That recommendation stated that the education and training of health service psychologists (HSPs) include an integrative approach to science and practice that incorporates scientific-mindedness, training in research skills, and goes well beyond merely “consuming” research findings. The task force subsequently developed recommendations related to the centrality of science competencies for HSPs and how these competencies extend beyond training in evidence-based practice. This article discusses the findings of the task force and the implications of its recommendations for education and training in HSP. The challenges and opportunities associated with implementing these recommendations in HSP graduate programs are examined