Every Minute Counts: Using Process Improvement and Performance Feedback to Improve Patient Flow in an Emergency Department

Prolonged emergency department (ED) visits are associated with a number of adverse outcomes for patients as well as lower patient satisfaction scores and increased costs. Several factors that influence the length of ED visits are out of the control of hospital employees, but some opportunities exist to improve performance. For this study, the ED department of a 150-bed hospital in the southeastern United States wanted to improve door-to-discharge time. To do so, a subprocess of door-to-discharge time was targeted, door-to-order. After analyzing the process, the team created standard orders for the 10 most common presenting conditions in the ER with preapproval, allowing nurses to submit the orders without the provider first visiting the patient. Following the process change, daily feedback was added to increase utilization of the preapproved orders. Reductions in door-to-order times and door-to-discharge were observed and patient satisfaction remained stable. Implications for future research in this area are discussed.     

信息不对称下价格随机的应急数量折扣契约研究

以市场需求和市场价格随机波动的二级供应链为研究对象，寻找其在信息不对称条件下绩效优化的路径。通过显示原理分别构建生产成本和销售成本信息不对称时应急供应链的数量折扣契约模型，得到最优订货量与最佳批发价策略。通过具体的算例加以验证，分析了信息不对称程度对供应链上成员及整个供应链绩效的影响。研究结果表明：当突发事件造成市场价格随机波动和市场需求变化时，供应链上的跟随者能从隐瞒私人信息中获利。但当市场需求增大时，整个供应链绩效受损，反之则反是。这与以往研究在市场需求随机、市场价格固定和信息不对称条件下的结论迥异。     

Measuring and Achieving Equity in Multiperiod Emergency Material Allocation

Emergency material allocation is an important part of postdisaster emergency logistics that is significant for improving rescue effectiveness and reducing disaster losses. However, the traditional single‐period allocation model often causes local surpluses or shortages and high cost, and prevents the system from achieving an equitable or optimal multiperiod allocation. To achieve equitable allocation of emergency materials in the case of serious shortages relative to the demand by victims, this article introduces a multiperiod model for allocation of emergency materials to multiple affected locations (using an exponential utility function to reflect the disutility loss due to material shortfalls), and illustrates the relationship between equity of allocations and the cost of emergency response. Finally, numerical examples are presented to demonstrate both the feasibility and the usefulness of the proposed model for achieving multiperiod equitable allocation of emergency material among multiple disaster locations. The results indicate that the introduction of a nonlinear utility function to reflect the disutility of large shortfalls can make the material allocation fairer, and minimize large losses due to shortfalls. We found that achieving equity has a significant but not unreasonable impact on emergency costs. We also illustrate that using differing utility functions for different types of materials adds an important dimension of flexibility.     

Children in immediate danger: Emergency removals in Finnish and Irish child protection

This paper presents a qualitative analysis of front‐line practices regarding emergency removals in Finnish and Irish child protection. It examines how the responses to children's immediate danger are framed by legislation and how front‐line practitioners assess the child's situation and make emergency placement decisions. The data consist of interviews with 16 Irish and 33 Finnish social workers. These child welfare protection systems respond differently to a task that appears to be similar. The Irish team‐based practice rests on the social workers' shared assessment of the child's needs, and the formal decision is made by the courts (or police officers at night‐time); and the Finnish practice involves only one single social worker who makes both the assessment and the removal decision. The Irish system is tightly time regulated, whereas the Finnish system provides a more flexible time frame. Both approaches put a lot of stress on social workers' practice, which also includes creative workarounds (e.g., “planned emergency removals” in Finland). Future research will need to explore these features from the point of view of a child's right to protection.     

重大突发公共卫生事件中的中小企业多维度社会责任问题探索

企业承担必要的社会责任是企业自身伦理道德的内在要求。肺炎疫情这一重大突发公共卫生事件给中国及世界经济造成了极大的冲击和影响，这就更需要中小企业在这个特殊时期肩负起更大的社会责任。梳理了企业社会责任的相关文献，并从社会、员工、消费者、供应商等维度研究了中小企业在重大突发公共卫生事件时期应当承担的社会责任。     

疫情防控期间大学生焦虑水平及其影响因素研究

为了解大学生在新型冠状病毒肺炎疫情防控期间的焦虑状况，采用汉密顿焦虑量表（HAMA），对四川、云南、重庆三省（直辖市）的3 178名大学生进行在线问卷测试。结果发现：新冠肺炎疫情防控期间大学生焦虑水平高于常模，并且与大学生的性别、就读学历层次、就读学科、每日上网时间等存在显著相关性。其中，28.48%的大学生还可能有严重焦虑；女性、专科层次、尚不清楚就读学科的大学生群体焦虑水平更为明显；精神性焦虑是新冠肺炎疫情防控期间大学生焦虑的主要特质；每日上网时间与大学生精神性焦虑水平呈显著正相关。在公共卫生事件突发时期，应积极关注大学生的心理健康状态，采取针对性措施加以有效疏导和干预，促进其心理健康发展。     

Development of the Emergency Department Senior Abuse Identification (ED Senior AID) tool

Emergency departments (EDs) are an important health care setting for the identification of elder abuse (EA). Our objective was to develop an ED-based tool to identify EA. The initial tool included a brief cognitive assessment, questions to detect multiple domains of EA, and a physical examination. Refinement of the tool was based on input from clinical experts and nurse and patient feedback. The revised tool, which included 15 questions about EA, was then tested in an academic ED. We calculated the inter-rater reliability, sensitivity, and specificity of individual EA questions. Among ED patients age≥65 (N = 259), 17 (7%) screened positive for suspicion of EA. We identified a combination of six questions that cover the included domains of EA, demonstrated good or excellent inter-rater reliability, and had a sensitivity and specificity of 94% (95% confidence interval (CI) 71–100%) and 90% (95% CI 85–93%), respectively. These results inform a proposed screening tool for multisite validation testing.     

学习迁移的系统理论:PPEE理论模型的建构和意义

学习是人类社会永恒的主题。为了更好地利用过去的经验，增强学习效果，个人和组织进行学习迁移具有重要意义。学习迁移是指将在以往通过学习或解决问题所获得的经验，用于解决之后所遇到的问题。本文力图建立系统的学习迁移理论，研究人、问题、环境的因素对于学习迁移的影响。本文采用理论推导的研究方法，在前人研究的基础上，提出相应的理论模型。本文运用系统的观点，构建了学习迁移的PPEE理论模型，认为人的因素、问题的因素、人和问题的交互作用、以及环境的调节作用，会共同影响学习迁移的效果。本理论主要从五个方面论述学习迁移的机制。首先，将人的因素按照不同层面划分为后端基本能力、中端心理过程、前端知识结构，讨论了其各自对学习迁移效果的直接影响。其次，将问题的因素划分为形象相似性和抽象相似性，并根据这两个维度构建了四种问题间关系类型，并探究了其与学习迁移效果之间的关系。第三，同时考虑人的因素和问题的因素，研究了二者之间的互动对于学习迁移效果的影响。第四，将环境因素划分为时间紧迫性和空间重要性两个维度，探讨了人和环境，以及问题和环境之间的互动对学习迁移效果的影响。第五，基于系统整体的方面，研究人、问题、环境三者之间的互动对学习迁移效果的交互影响。本文还认为，该模型不仅适用于个人，也同样适用于团队、组织、地区、甚至国家和社会等各个层面，影响各个层面主体的学习迁移。本文最后总结了研究的理论和实践贡献，并提出了未来研究课题。本文对丰富学习理论、特别是学习迁移理论，以及推动教育和管理实践的发展进步具有重要的意义。     

传染病防治和应急法律体系的立法与运行的思考

在新冠肺炎疫情暴发后,现行突发公共卫生事件应急相关法律法规在运行中暴露出组织领导、监测预警、信息公布、物资储备等方面的不足。文章通过对传染病防治和突发公共卫生应急相关法律、法规、行政规章等立法现状的梳理,结合新冠肺炎疫情应对中暴露的不足,比较国外成熟法律和管理模式,从传染病防治和应急体制机制、传染病分级、监测系统与信息公开、应急储备系统、应急措施与公民权利保障等方面,提出完善传染病防治和突发公共卫生事件应急法律体系的建议。     

国外重大突发公共卫生事件心理危机干预措施及启示

2020年初,新型冠状病毒肺炎疫情给患者、医护工作者乃至普通民众带来了严重的心理危机。我国逐渐成熟的心理危机干预系统在疫情期间取得成效,但同时也反映出心理危机干预系统建设存在欠缺。文章介绍了美国、以色列等发达国家处置突发公共卫生事件心理危机的机构设置、管理系统、治疗手段、信息沟通系统等干预措施,为加强我国突发公共卫生事件心理危机干预体系建设提供了科学依据和建议。