Ambulance offload delays have recently become one of the most significant operational challenges for Emergency Medical Services (EMS) providers. Offload delays occur when an ambulance arriving at a hospital Emergency Department (ED) is blocked until a bed becomes available for the patient. To formally investigate the effect of patient routing decisions on EMS offload delays, we introduce a stylized queueing network model with blocking. Following a decomposition approach, we develop an approximation scheme to find explicit solutions that can be used to find proper patient allocation policies to multiple hospitals in a region. We introduce a Markov chain representation for a single ED network and solve for its exact steady state distribution. A comprehensive numerical study is carried out to validate the approximation approaches and to gain insight into ambulance offload delays. By keeping the total offload delays at minimal levels, we observe that it is better to load larger EDs more heavily than smaller ones due to resource pooling. 相似文献
Objective: To pilot test the feasibility of implementing an elder abuse (EA) screening tool (DETECT) designed for medics.
Methods: Testing occurred between September 17th, 2015 and October 26th, 2015. MedStar Mobile Healthcare medics completed the DETECT tool when responding to calls for community-dwelling patients 65 years of age or older.
Results: The DETECT tool was used 1,248 times by 97% of medics responding to an eligible 911 call. Medics responded affirmatively to at least one screening item on 209 of the completed screenings (16.8%). Immediately following the introduction of the DETECT tool, there was an increase of 5.4 (226% above baseline) reports per month (p = 0.0056).
Conclusions: The DETECT tool was easily incorporated into medic’s field-based practice and resulted in an increase in medic generated reports of EA to APS. Future research designed to evaluate the tool’s validity and reliability are warranted. 相似文献
Environmental issues have become critical concerns of businesses in recent years. The Singapore Environment Ministry is urging organizations to consider adopting the ISO 14000 Environmental Management Standards. The main purpose of this study was to investigate and identify a number of variables which would be able to predict the motivation of organizations in adopting the ISO 14000 Standards. Through extensive literature search eight possible predictive variables/factors (cost savings, top management concern, employee welfare, meeting environmental regulations, meeting customer expectations, concern over trade barriers, following head office environmental practices, and gaining competitive advantages) were identified. In total, 300 pre-tested survey questionnaires were mailed out to companies from the Electronic and Chemical industries in Singapore. A response rate of about 20% was obtained. The survey instrument was tested for reliability and validity. Using stepwise discriminant analysis, a predictive discriminant function was developed. Only four out of the originally identified eight variables were included in the model. Possible benefits of such a model for Singapore and other industrializing countries are highlighted. 相似文献
In presence of interval-censored data, we propose a general three-state disease model with covariates. Such data can arise, for example, in epidemiologic studies of infectious disease where both the times of infection and disease onset are not directly observed, or in cancer studies where the time of disease metastasis is known up to a specified interval. The proposed model allows the distributions of the transition times between states to depend on covariates and the time in the previous state. An estimation procedure for the underlying distributions and the model coefficients is suggested with the EM algorithm. The EMS algorithm (Smoothed EM algorithm) is also considered to obtain smooth estimates of the distributions. The proposed method is illustrated with data from an AIDS study and a study of patients with malignant melanoma. 相似文献
ABSTRACTOut-of-hospital cardiac arrest (OHCA) is a significant public health issue. Although OHCA occurs relatively infrequently in the collegiate environment, educational institutions with on-campus emergency medical services (EMS) agencies are uniquely positioned to provide high-quality resuscitation care in an expedient fashion. Georgetown University's on-campus EMS program recently updated its medical protocols to reflect the latest literature in resuscitation science. In a high-performance CPR (HPCPR) resuscitation, minimally interrupted chest compressions are emphasized, along with a coordinated team-based approach. 相似文献