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- Cheng, I, et al.
(författare)
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Factors associated with failure of emergency wait-time targets for high acuity discharges and intensive care unit admissions
- 2018
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Ingår i: CJEM. - : Springer Science and Business Media LLC. - 1481-8043 .- 1481-8035. ; 20:1, s. 112-124
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveOntario established emergency department length-of-stay (EDLOS) targets but has difficulty achieving them. We sought to determine predictors of target time failure for discharged high acuity patients and intensive care unit (ICU) admissions.MethodsThis was a retrospective, observational study of 2012 Sunnybrook Hospital emergency department data. The main outcome measure was failing to meet government EDLOS targets for high acuity discharges and ICU emergency admissions. The secondary outcome measures examined factors for low acuity discharges and all admissions, as well as a run chart for 2015 – 2016 ICU admissions. Multiple logistic regression models were created for admissions, ICU admissions, and low and high acuity discharges. Predictor variables were at the patient level from emergency department registries.ResultsFor discharged high acuity patients, factors predicting EDLOS target failure were having physician initial assessment duration (PIAD)>2 hours (OR 5.63 [5.22-6.06]), consultation request (OR 10.23 [9.38-11.14]), magnetic resonance imaging (MRI) (OR 19.33 [12.94-28.87]), computed tomography (CT) (OR 4.24 [3.92-4.59]), and ultrasound (US) (OR 3.47 [3.13-3.83]). For ICU admissions, factors predicting EDLOS target failure were bed request duration (BRD)>6 hours (OR 364.27 [43.20-3071.30]) and access block (AB)>1 hour (OR 217.27 [30.62-1541.63]). For discharged low acuity patients, factors predicting failure for the 4-hour target were PIAD>2 hours (OR 15.80 [13.35-18.71]), consultation (OR 20.98 [14.10-31.22]), MRI (OR 31.68 [6.03-166.54]), CT (OR 16.48 [10.07-26.98]), and troponin I (OR 13.37 [6.30-28.37]).ConclusionSunnybrook factors predicting failure of targets for high acuity discharges and ICU admissions were hospital-controlled. Hospitals should individualize their approach to shortening EDLOS by analysing its patient population and resource demands.
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- Cheng, I, et al.
(författare)
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Cost-effectiveness of a physician-nurse supplementary triage assessment team at an academic tertiary care emergency department
- 2016
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Ingår i: CJEM. - : Springer Science and Business Media LLC. - 1481-8043 .- 1481-8035. ; 18:3, s. 191-204
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveThe purpose of this study was to evaluate the cost-effectiveness of physician-nurse supplementary triage assistance team (MDRNSTAT) from a hospital and patient perspective.MethodsThis was a cost-effectiveness evaluation of a cluster randomized control trial comparing the MDRNSTAT with nurse-only triage in the emergency department (ED) between the hours of 0800 and 1500. Cost was MDRNSTAT salary. Revenue was from Ontario’s Pay-for-Results and patient volume-case mix payment programs. The incremental cost-effectiveness ratio was based on MDRNSTAT cost and three consequence assessments: 1) per additional patient-seen; 2) per physician initial assessment (PIA) hour saved; and 3) per ED length of stay (EDLOS) hour saved. Patient opportunity cost was determined. Patient satisfaction was quantified by a cost-benefit ratio. A sensitivity analysis extrapolating MDRNSTAT to different working hours, salary, and willingness-to-pay data was performed.ResultsThe added cost of the MDRNSTAT was $3,597.27 [$1,729.47 to ∞] per additional patient-seen, $75.37 [$67.99 to $105.30] per PIA hour saved, and $112.99 [$74.68 to $251.43] per EDLOS hour saved. From the hospital perspective, the cost-benefit ratio was 38.6 [19.0 to ∞] and net present value of –$447,996 [–$435,646 to –$459,900]. For patients, the cost-benefit ratio for satisfaction was 2.8 [2.3 to 4.6]. If MDRNSTAT performance were consistently implemented from noon to midnight, it would be more cost-effective.ConclusionsThe MDRNSTAT is not a cost-effective daytime strategy but appears to be more feasible during time periods with higher patient volume, such as late morning to evening.
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- Larsson, A, et al.
(författare)
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Structuring a research infrastructure: A study of the rise and fall of a large-scale distributed biobank facility
- 2018
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Ingår i: SOCIAL SCIENCE INFORMATION SUR LES SCIENCES SOCIALES. - : SAGE Publications. - 0539-0184. ; 57:2, s. 196-222
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- This study analyses the perceived key interests, importance, influences and participation of different actors in harmonizing the processes and mechanisms of a distributed research infrastructure. It investigates the EU-funded initiative, BioBanking and Molecular Resource Infrastructure in Sweden (BBMRI.se), which seeks to harmonize the biobanking standards. The study interviews multiple actors involved throughout the development process. Their responses are analysed via a framework based on the IIED Stakeholder Power Analysis Tool. The BBMRI.se formation was facilitated by two parallel processes, with domestic and European/foreign origin, with leading scientists becoming ‘National Champions’. The respondents joined the organization under the premise that it would be a collaborative endeavour, but they were disappointed to learn the deliberative elements were more prevalent. In conclusion, the resulting autonomous structure caused disarray, while also fuelling interpersonal differences, ultimately leading to the closure of the infrastructure. Hence, it is necessary to clearly identify potential collaborative and deliberative elements already at the outset while also securing wider forms of communication between the participating actors, when establishing distributed research infrastructures. Moreover, while prior literature suggests that research infrastructures counteracts fragmentation, these results illustrate that this is not the case for this distributed research infrastructure.
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