Decreasing Psychiatric Admission Wait Time in the Emergency Department by Facilitating Psychiatric Discharges.

PubMed

Stover, Pamela R; Harpin, Scott

2015-12-01

Limited capacity in a psychiatric unit contributes to long emergency department (ED) admission wait times. Regulatory and accrediting agencies urge hospitals nationally to improve patient flow for better access to care for all types of patients. The purpose of the current study was to decrease psychiatric admission wait time from 10.5 to 8 hours and increase the proportion of patients discharged by 11 a.m. from 20% to 50%. The current study compared pre- and post-intervention data. Plan-Do-Study-Act cycles aimed to improve discharge processes and timeliness through initiation of new practices. Admission wait time improved to an average of 5.1 hours (t = 3.87, p = 0.006). The proportion of discharges occurring by 11 a.m. increased to 46% (odds ratio = 3.42, p < 0.0001). Improving discharge planning processes and timeliness in a psychiatric unit significantly decreased admission wait time from the ED, improving access to psychiatric care. Copyright 2015, SLACK Incorporated.

Inverse statistics in the foreign exchange market

NASA Astrophysics Data System (ADS)

Jensen, M. H.; Johansen, A.; Petroni, F.; Simonsen, I.

2004-09-01

We investigate intra-day foreign exchange (FX) time series using the inverse statistic analysis developed by Simonsen et al. (Eur. Phys. J. 27 (2002) 583) and Jensen et al. (Physica A 324 (2003) 338). Specifically, we study the time-averaged distributions of waiting times needed to obtain a certain increase (decrease) ρ in the price of an investment. The analysis is performed for the Deutsch Mark (DM) against the US for the full year of 1998, but similar results are obtained for the Japanese Yen against the US. With high statistical significance, the presence of “resonance peaks” in the waiting time distributions is established. Such peaks are a consequence of the trading habits of the market participants as they are not present in the corresponding tick (business) waiting time distributions. Furthermore, a new stylized fact, is observed for the (normalized) waiting time distribution in the form of a power law Pdf. This result is achieved by rescaling of the physical waiting time by the corresponding tick time thereby partially removing scale-dependent features of the market activity.

Backfilling with guarantees granted upon job submission.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Leung, Vitus Joseph; Bunde, David P.; Lindsay, Alexander M.

2011-01-01

In this paper, we present scheduling algorithms that simultaneously support guaranteed starting times and favor jobs with system desired traits. To achieve the first of these goals, our algorithms keep a profile with potential starting times for every unfinished job and never move these starting times later, just as in Conservative Backfilling. To achieve the second, they exploit previously unrecognized flexibility in the handling of holes opened in this profile when jobs finish early. We find that, with one choice of job selection function, our algorithms can consistently yield a lower average waiting time than Conservative Backfilling while still providingmore » a guaranteed start time to each job as it arrives. In fact, in most cases, the algorithms give a lower average waiting time than the more aggressive EASY backfilling algorithm, which does not provide guaranteed start times. Alternately, with a different choice of job selection function, our algorithms can focus the benefit on the widest submitted jobs, the reason for the existence of parallel systems. In this case, these jobs experience significantly lower waiting time than Conservative Backfilling with minimal impact on other jobs.« less

A model to create an efficient and equitable admission policy for patients arriving to the cardiothoracic ICU.

PubMed

Yang, Muer; Fry, Michael J; Raikhelkar, Jayashree; Chin, Cynthia; Anyanwu, Anelechi; Brand, Jordan; Scurlock, Corey

2013-02-01

To develop queuing and simulation-based models to understand the relationship between ICU bed availability and operating room schedule to maximize the use of critical care resources and minimize case cancellation while providing equity to patients and surgeons. Retrospective analysis of 6-month unit admission data from a cohort of cardiothoracic surgical patients, to create queuing and simulation-based models of ICU bed flow. Three different admission policies (current admission policy, shortest-processing-time policy, and a dynamic policy) were then analyzed using simulation models, representing 10 yr worth of potential admissions. Important output data consisted of the "average waiting time," a proxy for unit efficiency, and the "maximum waiting time," a surrogate for patient equity. A cardiothoracic surgical ICU in a tertiary center in New York, NY. Six hundred thirty consecutive cardiothoracic surgical patients admitted to the cardiothoracic surgical ICU. None. Although the shortest-processing-time admission policy performs best in terms of unit efficiency (0.4612 days), it did so at expense of patient equity prolonging surgical waiting time by as much as 21 days. The current policy gives the greatest equity but causes inefficiency in unit bed-flow (0.5033 days). The dynamic policy performs at a level (0.4997 days) 8.3% below that of the shortest-processing-time in average waiting time; however, it balances this with greater patient equity (maximum waiting time could be shortened by 4 days compared to the current policy). Queuing theory and computer simulation can be used to model case flow through a cardiothoracic operating room and ICU. A dynamic admission policy that looks at current waiting time and expected ICU length of stay allows for increased equity between patients with only minimum losses of efficiency. This dynamic admission policy would seem to be a superior in maximizing case-flow. These results may be generalized to other surgical ICUs.

The utilization of six sigma and statistical process control techniques in surgical quality improvement.

PubMed

Sedlack, Jeffrey D

2010-01-01

Surgeons have been slow to incorporate industrial reliability techniques. Process control methods were applied to surgeon waiting time between cases, and to length of stay (LOS) after colon surgery. Waiting times between surgeries were evaluated by auditing the operating room records of a single hospital over a 1-month period. The medical records of 628 patients undergoing colon surgery over a 5-year period were reviewed. The average surgeon wait time between cases was 53 min, and the busiest surgeon spent 291/2 hr in 1 month waiting between surgeries. Process control charting demonstrated poor overall control of the room turnover process. Average LOS after colon resection also demonstrated very poor control. Mean LOS was 10 days. Weibull's conditional analysis revealed a conditional LOS of 9.83 days. Serious process management problems were identified in both analyses. These process issues are both expensive and adversely affect the quality of service offered by the institution. Process control mechanisms were suggested or implemented to improve these surgical processes. Industrial reliability and quality management tools can easily and effectively identify process control problems that occur on surgical services. © 2010 National Association for Healthcare Quality.

The effect of in-office waiting time on physician visit frequency among working-age adults.

PubMed

Tak, Hyo Jung; Hougham, Gavin W; Ruhnke, Atsuko; Ruhnke, Gregory W

2014-10-01

Disparities in unmet health care demand resulting from socioeconomic, racial, and financial factors have received a great deal of attention in the United States. However, out-of-pocket costs alone do not fully reflect the total opportunity cost that patients must consider as they seek medical attention. While there is an extensive literature on the price elasticity of demand for health care, empirical evidence regarding the effect of waiting time on utilization is sparse. Using the nationally representative 2003 Community Tracking Study Household Survey, the most recent iteration containing respondents' physician office visit frequency and estimated in-office waiting time in the United States (N = 23,484), we investigated the association between waiting time and calculated time cost with the number of physician visits among a sample of working-age adults. To avoid the bias that literature suggests would result from excluding respondents with zero physician visits, we imputed waiting time for the essential inclusion of such individuals. On average, respondents visited physician offices 3.55 times, during which time they waited 28.7 min. The estimates from a negative binomial model indicated that a doubling of waiting time was associated with a 7.7 percent decrease (p-value < 0.001) in physician visit frequency. For women and unemployed respondents, who visited physicians more frequently, the decrease was even larger, suggesting a stronger response to greater waiting times. We believe this finding reflects the discretionary nature of incremental visits in these groups, and a consequent lower perceived marginal benefit of additional visits. The results suggest that in-office waiting time may have a substantial influence on patients' propensity to seek medical attention. Although there is a belief that expansions in health insurance coverage increase health care utilization by reducing financial barriers to access, our results suggest that unintended consequences may arise if in-office waiting time increases. Copyright © 2014 Elsevier Ltd. All rights reserved.

Access to Medication Abortion Among California's Public University Students.

PubMed

Upadhyay, Ushma D; Cartwright, Alice F; Johns, Nicole E

2018-06-09

A proposed California law will require student health centers at public universities to provide medication abortion. To understand its potential impact, we sought to describe current travel time, costs, and wait times to access care at the nearest abortion facilities. We projected total medication abortion use based on campus enrollment figures and age- and state-adjusted abortion rates. We calculated distance and public transit time from campuses to the nearest abortion facility. We contacted existing abortion-providing facilities to determine costs, insurance acceptance, and wait times. We estimate 322 to 519 California public university students seek medication abortions each month. As many as 62% of students at these universities were more than 30 minutes from the closest abortion facility via public transportation. Average cost of medication abortion was $604, and average wait time to the first available appointment was one week. College students face cost, scheduling, and travel barriers to abortion care. Offering medication abortion on campus could reduce these barriers. Copyright © 2018 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

The waiting time problem in a model hominin population.

PubMed

Sanford, John; Brewer, Wesley; Smith, Franzine; Baumgardner, John

2015-09-17

Functional information is normally communicated using specific, context-dependent strings of symbolic characters. This is true within the human realm (texts and computer programs), and also within the biological realm (nucleic acids and proteins). In biology, strings of nucleotides encode much of the information within living cells. How do such information-bearing nucleotide strings arise and become established? This paper uses comprehensive numerical simulation to understand what types of nucleotide strings can realistically be established via the mutation/selection process, given a reasonable timeframe. The program Mendel's Accountant realistically simulates the mutation/selection process, and was modified so that a starting string of nucleotides could be specified, and a corresponding target string of nucleotides could be specified. We simulated a classic pre-human hominin population of at least 10,000 individuals, with a generation time of 20 years, and with very strong selection (50% selective elimination). Random point mutations were generated within the starting string. Whenever an instance of the target string arose, all individuals carrying the target string were assigned a specified reproductive advantage. When natural selection had successfully amplified an instance of the target string to the point of fixation, the experiment was halted, and the waiting time statistics were tabulated. Using this methodology we tested the effect of mutation rate, string length, fitness benefit, and population size on waiting time to fixation. Biologically realistic numerical simulations revealed that a population of this type required inordinately long waiting times to establish even the shortest nucleotide strings. To establish a string of two nucleotides required on average 84 million years. To establish a string of five nucleotides required on average 2 billion years. We found that waiting times were reduced by higher mutation rates, stronger fitness benefits, and larger population sizes. However, even using the most generous feasible parameters settings, the waiting time required to establish any specific nucleotide string within this type of population was consistently prohibitive. We show that the waiting time problem is a significant constraint on the macroevolution of the classic hominin population. Routine establishment of specific beneficial strings of two or more nucleotides becomes very problematic.

Impact of Lean on patient cycle and waiting times at a rural district hospital in KwaZulu-Natal

PubMed Central

Naidoo, Logandran

2016-01-01

Background Prolonged waiting time is a source of patient dissatisfaction with health care and is negatively associated with patient satisfaction. Prolonged waiting times in many district hospitals result in many dissatisfied patients, overworked and frustrated staff, and poor quality of care because of the perceived increased workload. Aim The aim of the study was to determine the impact of Lean principles techniques, and tools on the operational efficiency in the outpatient department (OPD) of a rural district hospital. Setting The study was conducted at the Catherine Booth Hospital (CBH) – a rural district hospital in KwaZulu-Natal, South Africa. Methods This was an action research study with pre-, intermediate-, and post-implementation assessments. Cycle and waiting times were measured by direct observation on two occasions before, approximately two-weekly during, and on two occasions after Lean implementation. A standardised data collection tool was completed by the researcher at each of the six key service nodes in the OPD to capture the waiting times and cycle times. Results All six service nodes showed a reduction in cycle times and waiting times between the baseline assessment and post-Lean implementation measurement. Significant reduction was achieved in cycle times (27%; p < 0.05) and waiting times (from 11.93 to 10 min; p = 0.03) at the Investigations node. Although the target reduction was not achieved for the Consulting Room node, there was a significant reduction in waiting times from 80.95 to 74.43 min, (p < 0.001). The average efficiency increased from 16.35% (baseline) to 20.13% (post-intervention). Conclusion The application of Lean principles, tools and techniques provides hospital managers with an evidence-based management approach to resolving problems and improving quality indicators. PMID:27543283

Impact of animal-assisted therapy for outpatients with fibromyalgia.

PubMed

Marcus, Dawn A; Bernstein, Cheryl D; Constantin, Janet M; Kunkel, Frank A; Breuer, Paula; Hanlon, Raymond B

2013-01-01

Animal-assisted therapy using dogs trained to be calm and provide comfort to strangers has been used as a complementary therapy for a range of medical conditions. This study was designed to evaluate the effects of brief therapy dog visits for fibromyalgia patients attending a tertiary outpatient pain management facility compared with time spent in a waiting room. Open label with waiting room control. Tertiary care, university-based, outpatient pain management clinic. A convenience sample of fibromyalgia patients was obtained through advertisements posted in the clinic. Participants were able to spend clinic waiting time with a certified therapy dog instead of waiting in the outpatient waiting area. When the therapy dog was not available, individuals remained in the waiting area. OUTCOME MEASURES.: Self-reported pain, fatigue, and emotional distress were recorded using 11-point numeric rating scales before and after the therapy dog visit or waiting room time. Data were evaluated from 106 therapy dog visits and 49 waiting room controls, with no significant between-group demographic differences in participants. Average intervention duration was 12 minutes for the therapy dog visit and 17 minutes for the waiting room control. Significant improvements were reported for pain, mood, and other measures of distress among patients after the therapy dog visit, but not the waiting room control. Clinically meaningful pain relief (≥2 points pain severity reduction) occurred in 34% after the therapy dog visit and 4% in the waiting room control. Outcome was not affected by the presence of comorbid anxiety or depression. Brief therapy dog visits may provide a valuable complementary therapy for fibromyalgia outpatients. Wiley Periodicals, Inc.

SU-E-T-266: Development of Evaluation System of Optimal Synchrotron Controlling Parameter for Spot Scanning Proton Therapy with Multiple Gate Irradiations in One Operation Cycle

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yamada, T; Fujii, Y; Hitachi Ltd., Hitachi-shi, Ibaraki

2015-06-15

Purpose: We have developed a gated spot scanning proton beam therapy system with real-time tumor-tracking. This system has the ability of multiple-gated irradiation in a single synchrotron operation cycle controlling the wait-time for consecutive gate signals during a flat-top phase so that the decrease in irradiation efficiency induced by irregular variation of gate signal is reduced. Our previous studies have shown that a 200 ms wait-time is appropriate to increase the average irradiation efficiency, but the optimal wait-time can vary patient by patient and day by day. In this research, we have developed an evaluation system of the optimal wait-timemore » in each irradiation based on the log data of the real-time-image gated proton beam therapy (RGPT) system. Methods: The developed system consists of logger for operation of RGPT system and software for evaluation of optimal wait-time. The logger records timing of gate on/off, timing and the dose of delivered beam spots, beam energy and timing of X-ray irradiation. The evaluation software calculates irradiation time in the case of different wait-time by simulating the multiple-gated irradiation operation using several timing information. Actual data preserved in the log data are used for gate on and off time, spot irradiation time, and time moving to the next spot. Design values are used for the acceleration and deceleration times. We applied this system to a patient treated with the RGPT system. Results: The evaluation system found the optimal wait-time of 390 ms that reduced the irradiation time by about 10 %. The irradiation time with actual wait-time used in treatment was reproduced with accuracy of 0.2 ms. Conclusion: For spot scanning proton therapy system with multiple-gated irradiation in one synchrotron operation cycle, an evaluation system of the optimal wait-time in each irradiation based on log data has been developed. Funding Support: Japan Society for the Promotion of Science (JSPS) through the FIRST Program.« less

VA residential substance use disorder treatment program providers' perceptions of facilitators and barriers to performance on pre-admission processes.

PubMed

Ellerbe, Laura S; Manfredi, Luisa; Gupta, Shalini; Phelps, Tyler E; Bowe, Thomas R; Rubinsky, Anna D; Burden, Jennifer L; Harris, Alex H S

2017-04-04

In the U.S. Department of Veterans Affairs (VA), residential treatment programs are an important part of the continuum of care for patients with a substance use disorder (SUD). However, a limited number of program-specific measures to identify quality gaps in SUD residential programs exist. This study aimed to: (1) Develop metrics for two pre-admission processes: Wait Time and Engagement While Waiting, and (2) Interview program management and staff about program structures and processes that may contribute to performance on these metrics. The first aim sought to supplement the VA's existing facility-level performance metrics with SUD program-level metrics in order to identify high-value targets for quality improvement. The second aim recognized that not all key processes are reflected in the administrative data, and even when they are, new insight may be gained from viewing these data in the context of day-to-day clinical practice. VA administrative data from fiscal year 2012 were used to calculate pre-admission metrics for 97 programs (63 SUD Residential Rehabilitation Treatment Programs (SUD RRTPs); 34 Mental Health Residential Rehabilitation Treatment Programs (MH RRTPs) with a SUD track). Interviews were then conducted with management and front-line staff to learn what factors may have contributed to high or low performance, relative to the national average for their program type. We hypothesized that speaking directly to residential program staff may reveal innovative practices, areas for improvement, and factors that may explain system-wide variability in performance. Average wait time for admission was 16 days (SUD RRTPs: 17 days; MH RRTPs with a SUD track: 11 days), with 60% of Veterans waiting longer than 7 days. For these Veterans, engagement while waiting occurred in an average of 54% of the waiting weeks (range 3-100% across programs). Fifty-nine interviews representing 44 programs revealed factors perceived to potentially impact performance in these domains. Efficient screening processes, effective patient flow, and available beds were perceived to facilitate shorter wait times, while lack of beds, poor staffing levels, and lengths of stay of existing patients were thought to lengthen wait times. Accessible outpatient services, strong patient outreach, and strong encouragement of pre-admission outpatient treatment emerged as facilitators of engagement while waiting; poor staffing levels, socioeconomic barriers, and low patient motivation were viewed as barriers. Metrics for pre-admission processes can be helpful for monitoring residential SUD treatment programs. Interviewing program management and staff about drivers of performance metrics can play a complementary role by identifying innovative and other strong practices, as well as high-value targets for quality improvement. Key facilitators of high-performing facilities may offer programs with lower performance useful strategies to improve specific pre-admission processes.

The distribution of first-passage times and durations in FOREX and future markets

NASA Astrophysics Data System (ADS)

Sazuka, Naoya; Inoue, Jun-ichi; Scalas, Enrico

2009-07-01

Possible distributions are discussed for intertrade durations and first-passage processes in financial markets. The view-point of renewal theory is assumed. In order to represent market data with relatively long durations, two types of distributions are used, namely a distribution derived from the Mittag-Leffler survival function and the Weibull distribution. For the Mittag-Leffler type distribution, the average waiting time (residual life time) is strongly dependent on the choice of a cut-off parameter tmax, whereas the results based on the Weibull distribution do not depend on such a cut-off. Therefore, a Weibull distribution is more convenient than a Mittag-Leffler type if one wishes to evaluate relevant statistics such as average waiting time in financial markets with long durations. On the other hand, we find that the Gini index is rather independent of the cut-off parameter. Based on the above considerations, we propose a good candidate for describing the distribution of first-passage time in a market: The Weibull distribution with a power-law tail. This distribution compensates the gap between theoretical and empirical results more efficiently than a simple Weibull distribution. It should be stressed that a Weibull distribution with a power-law tail is more flexible than the Mittag-Leffler distribution, which itself can be approximated by a Weibull distribution and a power-law. Indeed, the key point is that in the former case there is freedom of choice for the exponent of the power-law attached to the Weibull distribution, which can exceed 1 in order to reproduce decays faster than possible with a Mittag-Leffler distribution. We also give a useful formula to determine an optimal crossover point minimizing the difference between the empirical average waiting time and the one predicted from renewal theory. Moreover, we discuss the limitation of our distributions by applying our distribution to the analysis of the BTP future and calculating the average waiting time. We find that our distribution is applicable as long as durations follow a Weibull law for short times and do not have too heavy a tail.

Usefulness of a fast track list for anxious patients in a upper GI endoscopy.

PubMed

Cardin, Fabrizio; Andreotti, Alessandra; Zorzi, Manuel; Terranova, Claudio; Martella, Bruno; Amato, Bruno; Militello, Carmelo

2012-01-01

To determine whether patients with no alarm signs who ask the endoscopist to shorten their waiting time due to test result anxiety, represent a risk category for a major organic pathology. At our open-access endoscopy service, we set up an expedite list for six months for outpatients who complained that the waiting time for gastroscopy was too long. Over this period we studied 373 gastroscopy patients. In addition to personal details, we collected information on the presence of Hp infection and compliance with dyspepsia guideline indications for gastroscopy. Average waiting time was 38.2 days (SD 12.7). The 66 patients who considered the waiting time too long underwent gastroscopy within 15 days. We made 5 diagnoses of esophageal and gastric tumour and gastric ulcer (7.6%) among the expedite list patients and 14 (4.6%) among those on the normal list (p=0.31). On including duodenal peptic disease in the analysis, the total prevalence rate rose to 19.7% in the short-wait group and to 10.4% (p=0.036) in the longer-wait group. Our data suggests that asking to be fast-tracked does not have prognostic impact on the diagnosis of a major (gastric ulcer and cancer) pathology.

Modeling and simulation of M/M/c queuing pharmacy system with adjustable parameters

NASA Astrophysics Data System (ADS)

Rashida, A. R.; Fadzli, Mohammad; Ibrahim, Safwati; Goh, Siti Rohana

2016-02-01

This paper studies a discrete event simulation (DES) as a computer based modelling that imitates a real system of pharmacy unit. M/M/c queuing theo is used to model and analyse the characteristic of queuing system at the pharmacy unit of Hospital Tuanku Fauziah, Kangar in Perlis, Malaysia. The input of this model is based on statistical data collected for 20 working days in June 2014. Currently, patient waiting time of pharmacy unit is more than 15 minutes. The actual operation of the pharmacy unit is a mixed queuing server with M/M/2 queuing model where the pharmacist is referred as the server parameters. DES approach and ProModel simulation software is used to simulate the queuing model and to propose the improvement for queuing system at this pharmacy system. Waiting time for each server is analysed and found out that Counter 3 and 4 has the highest waiting time which is 16.98 and 16.73 minutes. Three scenarios; M/M/3, M/M/4 and M/M/5 are simulated and waiting time for actual queuing model and experimental queuing model are compared. The simulation results show that by adding the server (pharmacist), it will reduce patient waiting time to a reasonable improvement. Almost 50% average patient waiting time is reduced when one pharmacist is added to the counter. However, it is not necessary to fully utilize all counters because eventhough M/M/4 and M/M/5 produced more reduction in patient waiting time, but it is ineffective since Counter 5 is rarely used.

Impact of Lean on patient cycle and waiting times at a rural district hospital in KwaZulu-Natal.

PubMed

Naidoo, Logandran; Mahomed, Ozayr H

2016-07-26

Prolonged waiting time is a source of patient dissatisfaction with health care and is negatively associated with patient satisfaction. Prolonged waiting times in many district hospitals result in many dissatisfied patients, overworked and frustrated staff, and poor quality of care because of the perceived increased workload. The aim of the study was to determine the impact of Lean principles techniques, and tools on the operational efficiency in the outpatient department (OPD) of a rural district hospital. The study was conducted at the Catherine Booth Hospital (CBH) - a rural district hospital in KwaZulu-Natal, South Africa. This was an action research study with pre-, intermediate-, and post-implementation assessments. Cycle and waiting times were measured by direct observation on two occasions before, approximately two-weekly during, and on two occasions after Lean implementation. A standardised data collection tool was completed by the researcher at each of the six key service nodes in the OPD to capture the waiting times and cycle times. All six service nodes showed a reduction in cycle times and waiting times between the baseline assessment and post-Lean implementation measurement. Significant reduction was achieved in cycle times (27%; p < 0.05) and waiting times (from 11.93 to 10 min; p = 0.03) at the Investigations node. Although the target reduction was not achieved for the Consulting Room node, there was a significant reduction in waiting times from 80.95 to 74.43 min, (p < 0.001). The average efficiency increased from 16.35% (baseline) to 20.13% (post-intervention). The application of Lean principles, tools and techniques provides hospital managers with an evidence-based management approach to resolving problems and improving quality indicators.

How Long Are Cancer Patients Waiting for Oncological Therapy in Poland?

PubMed

Osowiecka, Karolina; Rucinska, Monika; Nowakowski, Jacek J; Nawrocki, Sergiusz

2018-03-23

The five-year relative survival rate in Poland is approximately 10% lower compared with the average for Europe. One of the factors that may contribute to the inferior treatment results in Poland could be the long time between cancer suspicion and the beginning of treatment. The aim of the study was to determine the real waiting time for cancer diagnosis and treatment in Poland. The study was carried out in six cancer centers on a group of 1373 patients, using a questionnaire to interview patients. The median waiting time was estimated as follows: (A) from suspicion (the date of the first visit, with symptoms, to a doctor or a preventive or screening test) until histopathological diagnosis; (B) from suspicion until initial treatment; and (C) from diagnosis until initial treatment. The median times from suspicion to treatment, from suspicion to diagnosis, and from diagnosis to treatment, were 10.6, 5.6, and 5.0 weeks, respectively. Using multivariate analysis, the strongest influence was estimated, in a case of tumor localization, to be the method of initial treatment and facilities. The waiting time for cancer treatment in Poland is too long. The highest influence on waiting time was determined, in the case of tumors, as the type of cancer and factors related to the health care system.

Appointment Template Redesign in a Women's Health Clinic Using Clinical Constraints to Improve Service Quality and Efficiency.

PubMed

Huang, Y; Verduzco, S

2015-01-01

Patient wait time is a critical element of access to care that has long been recognized as a major problem in modern outpatient health care delivery systems. It impacts patient and medical staff productivity, stress, quality and efficiency of medical care, as well as health-care cost and availability. This study was conducted in a Women's Health Clinic. The objective was to improve clinic service quality by redesigning patient appointment template using the clinical constraints. The proposed scheduling template consisted of two key elements: the redesign of appointment types and the determination of the length of time slots using defined constraints. The re-classification technique was used for the redesign of appointment visit types to capture service variation for scheduling purposes. Then, the appointment length was determined by incorporating clinic constraints or goals, such as patient wait time, physician idle time, overtime, finish time, lunch hours, when the last appointment was scheduled, and the desired number of appointment slots, to converge the optimal length of appointment slots for each visit type. The redesigned template was implemented and the results indicated a 73% reduction in average patient waiting from the reported 40 to 11 minutes. The patient no-show rate was reduced by 4% from 24% to 20%. The morning section on average finished about 11:50 am. The clinic day was finished around 4:45 pm. Provider average idle time was estimated to be about 5 minutes, which can be used for charting/documenting patients. This study provided an alternative method of redesigning appointment scheduling templates using only the clinical constraints rather than the traditional way that required an objective function. This paper also documented the employed methods step by step in a real clinic setting. The implementation results concluded a significant improvement on patient wait time and no-show rate.

Appointment Template Redesign in a Women’s Health Clinic Using Clinical Constraints to Improve Service Quality and Efficiency

PubMed Central

Verduzco, S.

2015-01-01

Summary Background Patient wait time is a critical element of access to care that has long been recognized as a major problem in modern outpatient health care delivery systems. It impacts patient and medical staff productivity, stress, quality and efficiency of medical care, as well as health-care cost and availability. Objectives This study was conducted in a Women’s Health Clinic. The objective was to improve clinic service quality by redesigning patient appointment template using the clinical constraints. Methods The proposed scheduling template consisted of two key elements: the redesign of appointment types and the determination of the length of time slots using defined constraints. The re-classification technique was used for the redesign of appointment visit types to capture service variation for scheduling purposes. Then, the appointment length was determined by incorporating clinic constraints or goals, such as patient wait time, physician idle time, overtime, finish time, lunch hours, when the last appointment was scheduled, and the desired number of appointment slots, to converge the optimal length of appointment slots for each visit type. Results The redesigned template was implemented and the results indicated a 73% reduction in average patient waiting from the reported 40 to 11 minutes. The patient no-show rate was reduced by 4% from 24% to 20%. The morning section on average finished about 11:50 am. The clinic day was finished around 4:45 pm. Provider average idle time was estimated to be about 5 minutes, which can be used for charting/documenting patients. Conclusions This study provided an alternative method of redesigning appointment scheduling templates using only the clinical constraints rather than the traditional way that required an objective function. This paper also documented the employed methods step by step in a real clinic setting. The implementation results concluded a significant improvement on patient wait time and no-show rate. PMID:26171075

Graph transformation method for calculating waiting times in Markov chains.

PubMed

Trygubenko, Semen A; Wales, David J

2006-06-21

We describe an exact approach for calculating transition probabilities and waiting times in finite-state discrete-time Markov processes. All the states and the rules for transitions between them must be known in advance. We can then calculate averages over a given ensemble of paths for both additive and multiplicative properties in a nonstochastic and noniterative fashion. In particular, we can calculate the mean first-passage time between arbitrary groups of stationary points for discrete path sampling databases, and hence extract phenomenological rate constants. We present a number of examples to demonstrate the efficiency and robustness of this approach.

Solving the negative impact of congestion in the postanesthesia care unit: a cost of opportunity analysis.

PubMed

Ruiz-Patiño, Alejandro; Acosta-Ospina, Laura Elena; Rueda, Juan-David

2017-04-01

Congestion in the postanesthesia care unit (PACU) leads to the formation of waiting queues for patients being transferred after surgery, negatively affecting hospital resources. As patients recover in the operating room, incoming surgeries are delayed. The purpose of this study was to establish the impact of this phenomenon in multiple settings. An operational mathematical study based on the queuing theory was performed. Average queue length, average queue waiting time, and daily queue waiting time were evaluated. Calculations were based on the mean patient daily flow, PACU length of stay, occupation, and current number of beds. Data was prospectively collected during a period of 2 months, and the entry and exit time was recorded for each patient taken to the PACU. Data was imputed in a computational model made with MS Excel. To account for data uncertainty, deterministic and probabilistic sensitivity analyses for all dependent variables were performed. With a mean patient daily flow of 40.3 and an average PACU length of stay of 4 hours, average total lost surgical opportunity time was estimated at 2.36 hours (95% CI: 0.36-4.74 hours). Cost of opportunity was calculated at $1592 per lost hour. Sensitivity analysis showed that an increase of two beds is required to solve the queue formation. When congestion has a negative impact on cost of opportunity in the surgical setting, queuing analysis grants definitive actions to solve the problem, improving quality of service and resource utilization. Copyright © 2016 Elsevier Inc. All rights reserved.

CULTURAL COMPETENCE IN OUTPATIENT SUBSTANCE ABUSE TREATMENT: MEASUREMENT AND RELATIONSHIP TO WAIT TIME AND RETENTION

PubMed Central

Guerrero, Erick; Andrews, Christina M.

2011-01-01

BACKGROUND Culturally competent practice is broadly acknowledged to be an important strategy to increase the quality of services for racial/ethnic minorities in substance abuse treatment. However, few empirically derived measures of organizational cultural competence exist, and relatively little is known about how these measures affect treatment outcomes. METHOD Using a nationally representative sample of outpatient substance abuse treatment (OSAT) programs, this study used item response theory to create two measures of cultural competence-organizational practices and managers' culturally sensitive beliefs—and examined their relationship to client wait time and retention using Poisson regression modeling RESULTS The most common and precisely measured organizational practices reported by OSAT managers included matching providers and clients based on language/dialect; offering cross-cultural training; and fostering connections with community and faith-based organizations connected to racial and ethnic minority groups. The most culturally sensitive belief among OSAT managers was support for language/dialect matching for racial and ethnic minority clients. Results of regression modeling indicate that organizational practices were not related to either outcome. However, managers' culturally sensitive beliefs were negatively associated with average wait time (p < 0.05), and positively associated with average retention (p < 0.01). CONCLUSIONS Managers' culturally sensitive beliefs—considered to be influential for effective implementation of culturally competent practices—may be particularly relevant in influencing wait time and retention in OSAT organizations that treat Latinos and African American clients. PMID:21680111

An empirical analysis of the impact of choice on waiting times.

PubMed

Siciliani, Luigi; Martin, Steve

2007-08-01

Policy-makers often claim that enhancing patient choice induces more competition among hospitals and may therefore reduce waiting times. This paper tests this claim using 120 English NHS hospitals over the period 1999-2001. Several proxies for the degree of choice (or competition) are constructed including: (a) the number of hospitals within the catchment area of each hospital; (b) the number of hospitals in the catchment area of each hospital standardised by the population of the catchment area; (c) the inverse of the Herfindahl index (or 'the number of effective competitors'). Several control variables are included: the availability of doctors, junior doctors, nurses, and other personnel; the availability of acute beds; the emergency admission rate; the day-case rate; the average length of inpatient stay; an indicator of case-mix; and mortality and re-admission rates. We find that more choice is significantly associated with lower waiting times at the sample mean (five hospitals) although the quantitative effect is modest: an extra hospital in a catchment area will only reduce waiting by at most a few days (or 1-2% reduction in waiting). There is also some evidence that increases in choice can boost waiting times when the degree of choice is very high (i.e. more than 11 hospitals are included in the catchment area). Copyright 2007 John Wiley & Sons, Ltd.

Using queuing theory and simulation model to optimize hospital pharmacy performance.

PubMed

Bahadori, Mohammadkarim; Mohammadnejhad, Seyed Mohsen; Ravangard, Ramin; Teymourzadeh, Ehsan

2014-03-01

Hospital pharmacy is responsible for controlling and monitoring the medication use process and ensures the timely access to safe, effective and economical use of drugs and medicines for patients and hospital staff. This study aimed to optimize the management of studied outpatient pharmacy by developing suitable queuing theory and simulation technique. A descriptive-analytical study conducted in a military hospital in Iran, Tehran in 2013. A sample of 220 patients referred to the outpatient pharmacy of the hospital in two shifts, morning and evening, was selected to collect the necessary data to determine the arrival rate, service rate, and other data needed to calculate the patients flow and queuing network performance variables. After the initial analysis of collected data using the software SPSS 18, the pharmacy queuing network performance indicators were calculated for both shifts. Then, based on collected data and to provide appropriate solutions, the queuing system of current situation for both shifts was modeled and simulated using the software ARENA 12 and 4 scenarios were explored. Results showed that the queue characteristics of the studied pharmacy during the situation analysis were very undesirable in both morning and evening shifts. The average numbers of patients in the pharmacy were 19.21 and 14.66 in the morning and evening, respectively. The average times spent in the system by clients were 39 minutes in the morning and 35 minutes in the evening. The system utilization in the morning and evening were, respectively, 25% and 21%. The simulation results showed that reducing the staff in the morning from 2 to 1 in the receiving prescriptions stage didn't change the queue performance indicators. Increasing one staff in filling prescription drugs could cause a decrease of 10 persons in the average queue length and 18 minutes and 14 seconds in the average waiting time. On the other hand, simulation results showed that in the evening, decreasing the staff from 2 to 1 in the delivery of prescription drugs, changed the queue performance indicators very little. Increasing a staff to fill prescription drugs could cause a decrease of 5 persons in the average queue length and 8 minutes and 44 seconds in the average waiting time. The patients' waiting times and the number of patients waiting to receive services in both shifts could be reduced by using multitasking persons and reallocating them to the time-consuming stage of filling prescriptions, using queuing theory and simulation techniques.

Using Queuing Theory and Simulation Model to Optimize Hospital Pharmacy Performance

PubMed Central

Bahadori, Mohammadkarim; Mohammadnejhad, Seyed Mohsen; Ravangard, Ramin; Teymourzadeh, Ehsan

2014-01-01

Background: Hospital pharmacy is responsible for controlling and monitoring the medication use process and ensures the timely access to safe, effective and economical use of drugs and medicines for patients and hospital staff. Objectives: This study aimed to optimize the management of studied outpatient pharmacy by developing suitable queuing theory and simulation technique. Patients and Methods: A descriptive-analytical study conducted in a military hospital in Iran, Tehran in 2013. A sample of 220 patients referred to the outpatient pharmacy of the hospital in two shifts, morning and evening, was selected to collect the necessary data to determine the arrival rate, service rate, and other data needed to calculate the patients flow and queuing network performance variables. After the initial analysis of collected data using the software SPSS 18, the pharmacy queuing network performance indicators were calculated for both shifts. Then, based on collected data and to provide appropriate solutions, the queuing system of current situation for both shifts was modeled and simulated using the software ARENA 12 and 4 scenarios were explored. Results: Results showed that the queue characteristics of the studied pharmacy during the situation analysis were very undesirable in both morning and evening shifts. The average numbers of patients in the pharmacy were 19.21 and 14.66 in the morning and evening, respectively. The average times spent in the system by clients were 39 minutes in the morning and 35 minutes in the evening. The system utilization in the morning and evening were, respectively, 25% and 21%. The simulation results showed that reducing the staff in the morning from 2 to 1 in the receiving prescriptions stage didn't change the queue performance indicators. Increasing one staff in filling prescription drugs could cause a decrease of 10 persons in the average queue length and 18 minutes and 14 seconds in the average waiting time. On the other hand, simulation results showed that in the evening, decreasing the staff from 2 to 1 in the delivery of prescription drugs, changed the queue performance indicators very little. Increasing a staff to fill prescription drugs could cause a decrease of 5 persons in the average queue length and 8 minutes and 44 seconds in the average waiting time. Conclusions: The patients' waiting times and the number of patients waiting to receive services in both shifts could be reduced by using multitasking persons and reallocating them to the time-consuming stage of filling prescriptions, using queuing theory and simulation techniques. PMID:24829791

Evaluating a Collaborative Approach to Improve Prior Authorization Efficiency in the Treatment of Hepatitis C Virus.

PubMed

Dunn, Emily E; Vranek, Kathryn; Hynicka, Lauren M; Gripshover, Janet; Potosky, Darryn; Mattingly, T Joseph

A team-based approach to obtaining prior authorization approval was implemented utilizing a specialty pharmacy, a clinic-based pharmacy technician specialist, and a registered nurse to work with providers to obtain approval for medications for hepatitis C virus (HCV) infection. The objective of this study was to evaluate the time to approval for prescribed treatment of HCV infection. A retrospective observational study was conducted including patients treated for HCV infection by clinic providers who received at least 1 oral direct-acting antiviral HCV medication. Patients were divided into 2 groups, based on whether they were treated before or after the implementation of the team-based approach. Student t tests were used to compare average wait times before and after the intervention. The sample included 180 patients, 68 treated before the intervention and 112 patients who initiated therapy after. All patients sampled required prior authorization approval by a third-party payer to begin therapy. There was a statistically significant reduction (P = .02) in average wait time in the postintervention group (15.6 ± 12.1 days) once adjusted using dates of approval. Pharmacy collaboration may provide increases in efficiency in provider prior authorization practices and reduced wait time for patients to begin treatment.

Evaluating a Collaborative Approach to Improve Prior Authorization Efficiency in the Treatment of Hepatitis C Virus

PubMed Central

Dunn, Emily E.; Vranek, Kathryn; Hynicka, Lauren M.; Gripshover, Janet; Potosky, Darryn

2017-01-01

Objective: A team-based approach to obtaining prior authorization approval was implemented utilizing a specialty pharmacy, a clinic-based pharmacy technician specialist, and a registered nurse to work with providers to obtain approval for medications for hepatitis C virus (HCV) infection. The objective of this study was to evaluate the time to approval for prescribed treatment of HCV infection. Methods: A retrospective observational study was conducted including patients treated for HCV infection by clinic providers who received at least 1 oral direct-acting antiviral HCV medication. Patients were divided into 2 groups, based on whether they were treated before or after the implementation of the team-based approach. Student t tests were used to compare average wait times before and after the intervention. Results: The sample included 180 patients, 68 treated before the intervention and 112 patients who initiated therapy after. All patients sampled required prior authorization approval by a third-party payer to begin therapy. There was a statistically significant reduction (P = .02) in average wait time in the postintervention group (15.6 ± 12.1 days) once adjusted using dates of approval. Conclusions: Pharmacy collaboration may provide increases in efficiency in provider prior authorization practices and reduced wait time for patients to begin treatment. PMID:28665904

Occupation times and ergodicity breaking in biased continuous time random walks

NASA Astrophysics Data System (ADS)

Bel, Golan; Barkai, Eli

2005-12-01

Continuous time random walk (CTRW) models are widely used to model diffusion in condensed matter. There are two classes of such models, distinguished by the convergence or divergence of the mean waiting time. Systems with finite average sojourn time are ergodic and thus Boltzmann-Gibbs statistics can be applied. We investigate the statistical properties of CTRW models with infinite average sojourn time; in particular, the occupation time probability density function is obtained. It is shown that in the non-ergodic phase the distribution of the occupation time of the particle on a given lattice point exhibits bimodal U or trimodal W shape, related to the arcsine law. The key points are as follows. (a) In a CTRW with finite or infinite mean waiting time, the distribution of the number of visits on a lattice point is determined by the probability that a member of an ensemble of particles in equilibrium occupies the lattice point. (b) The asymmetry parameter of the probability distribution function of occupation times is related to the Boltzmann probability and to the partition function. (c) The ensemble average is given by Boltzmann-Gibbs statistics for either finite or infinite mean sojourn time, when detailed balance conditions hold. (d) A non-ergodic generalization of the Boltzmann-Gibbs statistical mechanics for systems with infinite mean sojourn time is found.

The Psychosocial Influences of Waiting Periods on Patients Undergoing Endoscopic Submucosal Dissection.

PubMed

Nagao, Noriko; Tsuchiya, Aya; Ando, Sae; Arita, Mizue; Toyonaga, Takashi; Miyawaki, Ikuko

This study aimed to clarify psychosocial influences of waiting periods on patients undergoing endoscopic submucosal dissection for cancer at an advanced medical care facility in Japan. Subjects were consenting patients hospitalized from 2009 to 2010. Qualitative and quantitative data were gathered about patients' characteristics, disease and stage, and waiting period. Qualitative content analysis was used to analyze free statements and interview data. Subjects included 154 patients with an average wait period of 46.28 days for admission. Qualitative analysis revealed the following wait period perceptions. For calmness, results indicated (1) no anxiety, (2) relief based on doctors' positive judgment, (3) whatever happens/no choice, and (4) trust in doctor. For uneasiness, perceptions included (1) the sooner, the better/eagerly waiting, (2) anxiety and concern, and (3) emotional instability. Four waiting period coping types were identified: (1) making phone inquiries, (2) busy and forgot about the medical procedure, (3) relief from anxiety, and (4) unable to function well in daily life. Patients need to be educated about cancer progression and provided an estimated wait time. They also require more information about how to manage daily life such as monitoring factors from the nursing domain including physical condition, digestive symptoms, diet, and exercise.

The Psychosocial Influences of Waiting Periods on Patients Undergoing Endoscopic Submucosal Dissection

PubMed Central

Tsuchiya, Aya; Ando, Sae; Arita, Mizue; Toyonaga, Takashi; Miyawaki, Ikuko

2017-01-01

This study aimed to clarify psychosocial influences of waiting periods on patients undergoing endoscopic submucosal dissection for cancer at an advanced medical care facility in Japan. Subjects were consenting patients hospitalized from 2009 to 2010. Qualitative and quantitative data were gathered about patients' characteristics, disease and stage, and waiting period. Qualitative content analysis was used to analyze free statements and interview data. Subjects included 154 patients with an average wait period of 46.28 days for admission. Qualitative analysis revealed the following wait period perceptions. For calmness, results indicated (1) no anxiety, (2) relief based on doctors' positive judgment, (3) whatever happens/no choice, and (4) trust in doctor. For uneasiness, perceptions included (1) the sooner, the better/eagerly waiting, (2) anxiety and concern, and (3) emotional instability. Four waiting period coping types were identified: (1) making phone inquiries, (2) busy and forgot about the medical procedure, (3) relief from anxiety, and (4) unable to function well in daily life. Patients need to be educated about cancer progression and provided an estimated wait time. They also require more information about how to manage daily life such as monitoring factors from the nursing domain including physical condition, digestive symptoms, diet, and exercise. PMID:26987103

Improving Efficiency and Quality of the Children's ASD Diagnostic Pathway: Lessons Learned from Practice.

PubMed

Rutherford, Marion; Burns, Morag; Gray, Duncan; Bremner, Lynne; Clegg, Sarah; Russell, Lucy; Smith, Charlie; O'Hare, Anne

2018-05-01

The 'autism diagnosis crisis' and long waiting times for assessment are as yet unresolved, leading to undue stress and limiting access to effective support. There is therefore a significant need for evidence to support practitioners in the development of efficient services, delivering acceptable waiting times and effectively meeting guideline standards. This study reports statistically significant reductions in waiting times for autism diagnostic assessment following a children's health service improvement programme. The average wait between referral and first appointment reduced from 14.2 to 10.4 weeks (t(21) = 4.3, p < 0.05) and between referral and diagnosis shared, reduced from 270 to 122.5 days, (t(20) = 5.5, p < 0.05). The proportion of girls identified increased from 5.6 to 2.7:1. Methods reported include: local improvement action planning; evidence based pathways; systematic clinical data gathering and a training plan. This is a highly significant finding for many health services wrestling with the challenges of demand and capacity for autism diagnosis and assessment.

Motion of kinesin in a viscoelastic medium

NASA Astrophysics Data System (ADS)

Knoops, Gert; Vanderzande, Carlo

2018-05-01

Kinesin is a molecular motor that transports cargo along microtubules. The results of many in vitro experiments on kinesin-1 are described by kinetic models in which one transition corresponds to the forward motion and subsequent binding of the tethered motor head. We argue that in a viscoelastic medium like the cytosol of a cell this step is not Markov and has to be described by a nonexponential waiting time distribution. We introduce a semi-Markov kinetic model for kinesin that takes this effect into account. We calculate, for arbitrary waiting time distributions, the moment generating function of the number of steps made, and determine from this the average velocity and the diffusion constant of the motor. We illustrate our results for the case of a waiting time distribution that is Weibull. We find that for realistic parameter values, viscoelasticity decreases the velocity and the diffusion constant, but increases the randomness (or Fano factor).

Using Discrete Event Simulation to predict KPI's at a Projected Emergency Room.

PubMed

Concha, Pablo; Neriz, Liliana; Parada, Danilo; Ramis, Francisco

2015-01-01

Discrete Event Simulation (DES) is a powerful factor in the design of clinical facilities. DES enables facilities to be built or adapted to achieve the expected Key Performance Indicators (KPI's) such as average waiting times according to acuity, average stay times and others. Our computational model was built and validated using expert judgment and supporting statistical data. One scenario studied resulted in a 50% decrease in the average cycle time of patients compared to the original model, mainly by modifying the patient's attention model.

STEPS: lean thinking, theory of constraints and identifying bottlenecks in an emergency department.

PubMed

Ryan, A; Hunter, K; Cunningham, K; Williams, J; O'Shea, H; Rooney, P; Hickey, F

2013-04-01

This study aimed to identify the bottlenecks in patients' journeys through an emergency department (ED). For each stage of the patient journey, the average times were compared between two groups divided according to the four hour time frame and disproportionate delays were identified using a significance test These bottlenecks were evaluated with reference to a lean thinking value-stream map and the five focusing steps of the theory of constraints. A total of 434 (72.5%) ED patients were tracked over one week. Logistic regression showed that patients who had radiological tests, blood tests or who were admitted were 4.4, 4.1 and 7.7 times more likely, respectively, to stay over four hours in the ED than those who didn't The stages that were significantly delayed were the time spent waiting for radiology (p = 0.001), waiting for the in-patient team (p = 0.004), waiting for a bed (p < 0.001) and ED doctor turnaround time (p < 0.001).

Impact of co-located general practitioner (GP) clinics and patient choice on duration of wait in the emergency department.

PubMed

Sharma, Anurag; Inder, Brett

2011-08-01

To empirically model the determinants of duration of wait of emergency (triage category 2) patients in an emergency department (ED) focusing on two questions: (i) What is the effect of enhancing the degree of choice for non-urgent (triage category 5) patients on duration of wait for emergency (category 2) patients in EDs; and (ii) What is the effect of co-located GP clinics on duration of wait for emergency patients in EDs? The answers to these questions will help in understanding the effectiveness of demand management strategies, which are identified as one of the solutions to ED crowding. The duration of wait for each patient (difference between arrival time and time first seen by treating doctor) was modelled as a function of input factors (degree of choice, patient characteristics, weekend admission, metro/regional hospital, concentration of emergency (category 2) patients in hospital service area), throughput factors (availability of doctors and nurses) and output factor (hospital bed capacity). The unit of analysis was a patient episode and the model was estimated using a survival regression technique. The degree of choice for non-urgent (category 5) patients has a non-linear effect: more choice for non-urgent patients is associated with longer waits for emergency patients at lower values and shorter waits at higher values of degree of choice. Thus more choice of EDs for non-urgent patients is related to a longer wait for emergency (category 2) patients in EDs. The waiting time for emergency patients in hospital campuses with co-located GP clinics was 19% lower (1.5 min less) on average than for those waiting in campuses without co-located GP clinics. These findings suggest that diverting non-urgent (category 5) patients to an alternative model of care (co-located GP clinics) is a more effective demand management strategy and will reduce ED crowding.

Redesigning emergency department patient flows: application of Lean Thinking to health care.

PubMed

King, Diane L; Ben-Tovim, David I; Bassham, Jane

2006-08-01

To describe in some detail the methods used and outcome of an application of concepts from Lean Thinking in establishing streams for patient flows in a teaching general hospital ED. Detailed understanding was gained through process mapping with staff followed by the identification of value streams (those patients likely to be discharged from the ED, those who were likely to be admitted) and the implementation of a process of seeing those patients that minimized complex queuing in the ED. Streaming had a significant impact on waiting times and total durations of stay in the ED. There was a general flattening of the waiting time across all groups. A slight increase in wait for Triage categories 2 and 3 patients was offset by reductions in wait for Triage category 4 patients. All groups of patients spent significantly less overall time in the department and the average number of patients in the ED at any time decreased. There was a significant reduction in number of patients who do not wait and a slight decrease in access block. The streaming of patients into groups of patients cared for by a specific team of doctors and nurses, and the minimizing of complex queues in this ED by altering the practices in relation to the function of the Australasian Triage Scale improved patient flow, thereby decreasing potential for overcrowding.

Effectiveness of Multimedia for Transplant Preparation for Kidney Transplant Waiting List Patients.

PubMed

Charoenthanakit, C; Junchotikul, P; Sittiudomsuk, R; Saiyud, A; Pratumphai, P

2016-04-01

A multimedia program could effectively advise patients about preparing for transplantation while on the waiting list for a kidney transplant. This study aimed to compare knowledge about transplant preparation for patients on a kidney transplant waiting list before and after participating in a multimedia program, and to evaluate patient satisfaction with the multimedia program. Research design was quasiexperimental with the use of 1 group. Subjects were 186 patients on the kidney transplant waiting list after HLA matching in Ramathibodi Hospital. The questionnaires were developed by the researchers. The statistical tools used were basic statistics, percentage, average, standard deviation, and the difference of score between before and after participation in the multimedia program (t test). The evaluation knowledge for transplant preparation for kidney transplant waiting list patients after participating in the multimedia program averaged 85.40%, and there was an increased improvement of score by an average 3.27 out of a possible full score of 20 (P < .05). The result of patient satisfaction for the multimedia program had good average, 4.58. Copyright © 2016 Elsevier Inc. All rights reserved.

When lives are put on hold: Lengthy asylum processes decrease employment among refugees.

PubMed

Hainmueller, Jens; Hangartner, Dominik; Lawrence, Duncan

2016-08-01

European governments are struggling with the biggest refugee crisis since World War II, but there exists little evidence regarding how the management of the asylum process affects the subsequent integration of refugees in the host country. We provide new causal evidence about how one central policy parameter, the length of time that refugees wait in limbo for a decision on their asylum claim, affects their subsequent economic integration. Exploiting exogenous variation in wait times and registry panel data covering refugees who applied in Switzerland between 1994 and 2004, we find that one additional year of waiting reduces the subsequent employment rate by 4 to 5 percentage points, a 16 to 23% drop compared to the average rate. This deleterious effect is remarkably stable across different subgroups of refugees stratified by gender, origin, age at arrival, and assigned language region, a pattern consistent with the idea that waiting in limbo dampens refugee employment through psychological discouragement, rather than a skill atrophy mechanism. Overall, our results suggest that marginally reducing the asylum waiting period can help reduce public expenditures and unlock the economic potential of refugees by increasing employment among this vulnerable population.

When lives are put on hold: Lengthy asylum processes decrease employment among refugees

PubMed Central

Hainmueller, Jens; Hangartner, Dominik; Lawrence, Duncan

2016-01-01

European governments are struggling with the biggest refugee crisis since World War II, but there exists little evidence regarding how the management of the asylum process affects the subsequent integration of refugees in the host country. We provide new causal evidence about how one central policy parameter, the length of time that refugees wait in limbo for a decision on their asylum claim, affects their subsequent economic integration. Exploiting exogenous variation in wait times and registry panel data covering refugees who applied in Switzerland between 1994 and 2004, we find that one additional year of waiting reduces the subsequent employment rate by 4 to 5 percentage points, a 16 to 23% drop compared to the average rate. This deleterious effect is remarkably stable across different subgroups of refugees stratified by gender, origin, age at arrival, and assigned language region, a pattern consistent with the idea that waiting in limbo dampens refugee employment through psychological discouragement, rather than a skill atrophy mechanism. Overall, our results suggest that marginally reducing the asylum waiting period can help reduce public expenditures and unlock the economic potential of refugees by increasing employment among this vulnerable population. PMID:27493995

[Bioethical study on the expectations of women awaiting assisted reproduction in a public hospital in the Federal District, Brazil].

PubMed

Samrsla, Mônica; Nunes, Juliana Cezar; Kalume, Carolina; da Cunha, Antônio Carlos Rodrigues; Garrafa, Volnei

2007-01-01

To analyze the expectations of women who wait for Assisted Reproduction Treatment-RA in the public hospital chosen as the reference in the Public Health Network in the Federal District-HRAS, Brazil. For thirty days, 51 women of the 56 who went to the HRAS for infertility treatment were interviewed by a questionnaire including 10 objective questions related to the topic. This trial was divided into two groups. The first, the "control group", comprised 27 patients recently sent to the reference public hospital from local health care centers or a regional hospital. The second, the "study group", comprising 24 women already diagnosed by the medical staff of HRAS and in the waiting line for "in vitro" fertilization. According to the input provided by the two groups, results show that the average waiting time for treatment is so long that women actually age during this time and face the risk of having a dangerous pregnancy before they receive treatment. These results show that women unable to pay for treatment in a private fertilization clinic have a poorer chance of achieving RA: the health problem concerning this specific population ignores redressing or income distribution processes. Data show that, notwithstanding, this waiting period imposed by the State, expectations of the patients waiting for RA are reinforced. There is no basis to provide information about the waiting time. The unpredictable availability of the medication needed for in vitro fertilization, jeopardizes the future of this service offering the treatment.

A study on the impact of prioritising emergency department arrivals on the patient waiting time.

PubMed

Van Bockstal, Ellen; Maenhout, Broos

2018-05-03

In the past decade, the crowding of the emergency department has gained considerable attention of researchers as the number of medical service providers is typically insufficient to fulfil the demand for emergency care. In this paper, we solve the stochastic emergency department workforce planning problem and consider the planning of nurses and physicians simultaneously for a real-life case study in Belgium. We study the patient arrival pattern of the emergency department in depth and consider different patient acuity classes by disaggregating the arrival pattern. We determine the personnel staffing requirements and the design of the shifts based on the patient arrival rates per acuity class such that the resource staffing cost and the weighted patient waiting time are minimised. In order to solve this multi-objective optimisation problem, we construct a Pareto set of optimal solutions via the -constraints method. For a particular staffing composition, the proposed model minimises the patient waiting time subject to upper bounds on the staffing size using the Sample Average Approximation Method. In our computational experiments, we discern the impact of prioritising the emergency department arrivals. Triaging results in lower patient waiting times for higher priority acuity classes and to a higher waiting time for the lowest priority class, which does not require immediate care. Moreover, we perform a sensitivity analysis to verify the impact of the arrival and service pattern characteristics, the prioritisation weights between different acuity classes and the incorporated shift flexibility in the model.

[How many patient transfer rooms are necessary for my OR suite? : Effect of the number of OR transfer rooms on waiting times and patient throughput in the OR - analysis by simulation].

PubMed

Messer, C; Zander, A; Arnolds, I V; Nickel, S; Schuster, M

2015-12-01

In most hospitals the operating rooms (OR) are separated from the rest of the hospital by transfer rooms where patients have to pass through for reasons of hygiene. In the OR transfer room patients are placed on the OR table before surgery and returned to the hospital bed after surgery. It could happen that the number of patients who need to pass through a transfer room at a certain point in time exceed the number of available transfer rooms. As a result the transfer rooms become a bottleneck where patients have to wait and which, in turn, may lead to delays in the OR suite. In this study the ability of a discrete event simulation to analyze the effect of the duration of surgery and the number of ORs on the number of OR transfer rooms needed was investigated. This study was based on a discrete event simulation model developed with the simulation software AnyLogic®. The model studied the effects of the number of OR transfer rooms on the processes in an OR suite of a community hospital by varying the number of ORs from one to eight and using different surgical portfolios. Probability distributions for the process duration of induction, surgery and recovery and transfer room processes were calculated on the basis of real data from the community hospital studied. Furthermore, using a generic simulation model the effect of the average duration of surgery on the number of OR transfer rooms needed was examined. The discrete event simulation model enabled the analysis of both quantitative as well as qualitative changes in the OR process and setting. Key performance indicators of the simulation model were patient throughput per day, the probability of waiting and duration of waiting time in front of OR transfer rooms. In the case of a community hospital with 1 transfer room the average proportion of patients waiting before entering the OR was 17.9 % ± 9.7 % with 3 ORs, 37.6 % ± 9.7 % with 5 ORs and 62.9 % ± 9.1 % with 8 ORs. The average waiting time of patients in the setting with 3 ORs was 3.1 ± 2.7 min, with 5 ORs 5.0 ± 5.8 min and with 8 ORs 11.5 ± 12.5 min. Based on this study the community hospital needs a second transfer room starting from 4 ORs so that there is no bottleneck for the subsequent OR processes. The average patient throughput in a setting with 4 ORs increased significantly by 0.3 patients per day when a second transfer room is available. The generic model showed a strong effect of the average duration of surgery on the number of transfer rooms needed. There was no linear correlation between the number of transfer rooms and the number of ORs. The shorter the average duration of surgery, the earlier an additional transfer room is required. Thus, hospitals with shorter duration of surgery and fewer ORs may need the same or more transfer rooms than a hospital with longer duration of surgery and more ORs. However, with respect to an economic analysis, the costs and benefits of installing additional OR transfer rooms need to be calculated using the profit margins of the specific hospital.

Developmental changes in anger expression and attention focus: Learning to wait

PubMed Central

Cole, Pamela M.; Tan, Patricia Z.; Hall, Sarah E.; Zhang, Yiyun; Crnic, Keith A.; Blair, Clancy B.; Li, Runze

2011-01-01

Being able to wait is an essential part of self-regulation. The present study examined the developmental course of changes in the latency to and duration of target waiting behaviors by following 65 boys and 55 girls from rural and semi-rural economically strained homes from ages 18 to 48 months. Age-related changes in latency to and duration of children’s anger expressions and attention focus (e.g., self-initiated distraction) during an eight minute wait for a gift were found. On average, at 18 and 24 months of age, children were quick to react angrily and slower to shift attention away from the desired object than they were at later ages. Over time, children were quicker to distract themselves. By 36 months, distractions occurred before children expressed anger, and anger expressions were briefer. At 48 months, children typically made a quick bid to mother about demands of waiting before distracting themselves; on average, they did not appear angry until the latter half of the wait. Unexpectedly, children bid to their mothers as much at age 48 months as they had at 18 months; however bids became less angry as children got older. Developmental changes in distraction and bidding predicted age-related changes in the latency to anger. Findings are discussed in terms of the neurocognitive control of attention around age 30 months, the limitations of children’s self-regulatory efforts at age 48 months, and the importance of fostering children’s ability to forestall, as well as modulate, anger. PMID:21639619

Effect of match-run frequencies on the number of transplants and waiting times in kidney exchange.

PubMed

Ashlagi, Itai; Bingaman, Adam; Burq, Maximilien; Manshadi, Vahideh; Gamarnik, David; Murphey, Cathi; Roth, Alvin E; Melcher, Marc L; Rees, Michael A

2018-05-01

Numerous kidney exchange (kidney paired donation [KPD]) registries in the United States have gradually shifted to high-frequency match-runs, raising the question of whether this harms the number of transplants. We conducted simulations using clinical data from 2 KPD registries-the Alliance for Paired Donation, which runs multihospital exchanges, and Methodist San Antonio, which runs single-center exchanges-to study how the frequency of match-runs impacts the number of transplants and the average waiting times. We simulate the options facing each of the 2 registries by repeated resampling from their historical pools of patient-donor pairs and nondirected donors, with arrival and departure rates corresponding to the historical data. We find that longer intervals between match-runs do not increase the total number of transplants, and that prioritizing highly sensitized patients is more effective than waiting longer between match-runs for transplanting highly sensitized patients. While we do not find that frequent match-runs result in fewer transplanted pairs, we do find that increasing arrival rates of new pairs improves both the fraction of transplanted pairs and waiting times. © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.

Modeling level of urban taxi services using neural network

DOE Office of Scientific and Technical Information (OSTI.GOV)

Xu, J.; Wong, S.C.; Tong, C.O.

1999-05-01

This paper is concerned with the modeling of the complex demand-supply relationship in urban taxi services. A neural network model is developed, based on a taxi service situation observed in the urban area of Hong Kong. The input consists of several exogenous variables including number of licensed taxis, incremental charge of taxi fare, average occupied taxi journey time, average disposable income, and population and customer price index; the output consists of a set of endogenous variables including daily taxi passenger demand, passenger waiting time, vacant taxi headway, average percentage of occupied taxis, taxi utilization, and average taxi waiting time. Comparisonsmore » of the estimation accuracy are made between the neural network model and the simultaneous equations model. The results show that the neural network-based macro taxi model can obtain much more accurate information of the taxi services than the simultaneous equations model does. Although the data set used for training the neural network is small, the results obtained thus far are very encouraging. The neural network model can be used as a policy tool by regulator to assist with the decisions concerning the restriction over the number of taxi licenses and the fixing of the taxi fare structure as well as a range of service quality control.« less

The relative ease of obtaining a dermatologic appointment in Boston: how methods drive results.

PubMed

Weingold, David Howard; Lack, Michael Dweight; Yanowitz, Karen Leslie

2009-06-01

Recent reports have indicated long wait times for dermatologic appointments even for changing moles. Our objective was to determine the wait time for a person willing to make multiple calls and accept an appointment from any dermatologist at any satellite location for a changing mole from a dermatologist who advertised in a Boston, MA, telephone book. We telephoned each practice listed in a Boston, MA, telephone book. Patients making one call to each dermatologic practice on average obtained an appointment in 18 days. Patients calling two practices were offered an appointment on average in 7 days. Patients calling 3 practices were also offered an appointment in 1 week. We only telephoned practices listed in a Boston, MA, telephone book and we only surveyed one urban area. These results suggest that a reasonable concerned patient who was willing to make multiple calls to different providers in Boston, MA, can be seen in a timely fashion.

Analyzing patient's waiting time in emergency & trauma department in public hospital - A case study

NASA Astrophysics Data System (ADS)

Roslan, Shazwa; Tahir, Herniza Md; Nordin, Noraimi Azlin Mohd; Zaharudin, Zati Aqmar

2014-09-01

Emergency and Trauma Department (ETD) is an important element for a hospital. It provides medical service, which operates 24 hours a day in most hospitals. However overcrowding is not exclusion for ETD. Overflowing occurs due to affordable services provided by public hospitals, since it is funded by the government. It is reported that a patient attending ETD must be treated within 90 minutes, in accordance to achieve the Key Performance Indicator (KPI). However, due to overcrowd situations, most patients have to wait longer than the KPI standard. In this paper, patient's average waiting time is analyzed. Using Chi-Square Test of Goodness, patient's inter arrival per hour is also investigated. As conclusion, Monday until Wednesday was identified as the days that exceed the KPI standard while Chi-Square Test of Goodness showed that the patient's inter arrival is independent and random.

Consultation sequencing of a hospital with multiple service points using genetic programming

NASA Astrophysics Data System (ADS)

Morikawa, Katsumi; Takahashi, Katsuhiko; Nagasawa, Keisuke

2018-07-01

A hospital with one consultation room operated by a physician and several examination rooms is investigated. Scheduled patients and walk-ins arrive at the hospital, each patient goes to the consultation room first, and some of them visit other service points before consulting the physician again. The objective function consists of the sum of three weighted average waiting times. The problem of sequencing patients for consultation is focused. To alleviate the stress of waiting, the consultation sequence is displayed. A dispatching rule is used to decide the sequence, and best rules are explored by genetic programming (GP). The simulation experiments indicate that the rules produced by GP can be reduced to simple permutations of queues, and the best permutation depends on the weight used in the objective function. This implies that a balanced allocation of waiting times can be achieved by ordering the priority among three queues.

Specific timely appointments for triage reduced waiting lists in an outpatient physiotherapy service.

PubMed

Harding, K E; Bottrell, J

2016-12-01

Waiting lists with triage systems are commonly used in outpatient physiotherapy but may not be effective. Could an alternative model of access and triage reduce waiting times over a sustained period with no additional resources? Observational study comparing retrospective data for 11 months prior to the introduction of a new model of access compared with data for the equivalent 11 months afterwards. Patients referred to a physiotherapy outpatient department at an outer metropolitan hospital before (n=721) and after (n=707) the introduction of the new model. A model of access and triage known as 'specific timely appointments for triage' (STAT), in which appointment slots are preserved in advance specifically for new patients based on calculation of average demand. Time from referral to first assessment, number of appointments per patient, occasions of non-attendance and total length of stay in the service. Median time from referral to first appointment was 18 days [interquartile range (IQR) 11 to 33 days] in the pre-intervention group, compared with 14 days (IQR 9 to 21 days) in the post-intervention group (P<0.01). The number of physiotherapy appointments also reduced (IQR 2 to 6 vs IQR 1 to 4; P<0.01). There were no changes in non-attendance rates or total time in the service. Waiting time for outpatient physiotherapy was 22% lower in the year following the introduction of the STAT model. While acknowledging the limitations of a pre- and post-measurement design, this model may have potential for reducing waiting times for outpatient physiotherapy without additional resources. Copyright © 2015 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

How Does the Supply Requisitioning Process Affect Average Customer Wait Time Onboard U.S. Navy Destroyers?

DTIC Science & Technology

2013-06-01

17  D.  NAVAL TACTICAL COMMAND SUPPORT SYSTEM .........................17  1.  Operational Maintenance Management System–Next Generation...Management .......................................................................................21  4.  Method ...Business Administration MDT Mean Down Time MTBM Mean Time Between Maintenance NAVSUP Naval Supply Systems Command NC Not Carried NIS Not in Stock

A Conceptual Framework for Improving Critical Care Patient Flow and Bed Use.

PubMed

Mathews, Kusum S; Long, Elisa F

2015-06-01

High demand for intensive care unit (ICU) services and limited bed availability have prompted hospitals to address capacity planning challenges. Simulation modeling can examine ICU bed assignment policies, accounting for patient acuity, to reduce ICU admission delays. To provide a framework for data-driven modeling of ICU patient flow, identify key measurable outcomes, and present illustrative analysis demonstrating the impact of various bed allocation scenarios on outcomes. A description of key inputs for constructing a queuing model was outlined, and an illustrative simulation model was developed to reflect current triage protocol within the medical ICU and step-down unit (SDU) at a single tertiary-care hospital. Patient acuity, arrival rate, and unit length of stay, consisting of a "service time" and "time to transfer," were estimated from 12 months of retrospective data (n = 2,710 adult patients) for 36 ICU and 15 SDU staffed beds. Patient priority was based on acuity and whether the patient originated in the emergency department. The model simulated the following hypothetical scenarios: (1) varied ICU/SDU sizes, (2) reserved ICU beds as a triage strategy, (3) lower targets for time to transfer out of the ICU, and (4) ICU expansion by up to four beds. Outcomes included ICU admission wait times and unit occupancy. With current bed allocation, simulated wait time averaged 1.13 (SD, 1.39) hours. Reallocating all SDU beds as ICU decreased overall wait times by 7.2% to 1.06 (SD, 1.39) hours and increased bed occupancy from 80 to 84%. Reserving the last available bed for acute patients reduced wait times for acute patients from 0.84 (SD, 1.12) to 0.31 (SD, 0.30) hours, but tripled subacute patients' wait times from 1.39 (SD, 1.81) to 4.27 (SD, 5.44) hours. Setting transfer times to wards for all ICU/SDU patients to 1 hour decreased wait times for incoming ICU patients, comparable to building one to two additional ICU beds. Hospital queuing and simulation modeling with empiric data inputs can evaluate how changes in ICU bed assignment could impact unit occupancy levels and patient wait times. Trade-offs associated with dedicating resources for acute patients versus expanding capacity for all patients can be examined.

A microprocessor based high speed packet switch for satellite communications

NASA Technical Reports Server (NTRS)

Arozullah, M.; Crist, S. C.

1980-01-01

The architectures of a single processor, a three processor, and a multiple processor system are described. The hardware circuits, and software routines required for implementing the three and multiple processor designs are presented. A bit-slice microprocessor was designed and microprogrammed. Maximum throughput was calculated for all three designs. Queue theoretic models for these three designs were developed and utilized to obtain analytical expressions for the average waiting times, overall average response times and average queue sizes. From these expressions, graphs were obtained showing the effect on the system performance of a number of design parameters.

Modeling and simulation of queuing system for customer service improvement: A case study

NASA Astrophysics Data System (ADS)

Xian, Tan Chai; Hong, Chai Weng; Hawari, Nurul Nazihah

2016-10-01

This study aims to develop a queuing model at UniMall by using discrete event simulation approach in analyzing the service performance that affects customer satisfaction. The performance measures that considered in this model are such as the average time in system, the total number of student served, the number of student in waiting queue, the waiting time in queue as well as the maximum length of buffer. ARENA simulation software is used to develop a simulation model and the output is analyzed. Based on the analysis of output, it is recommended that management of UniMall consider introducing shifts and adding another payment counter in the morning.

Short Stature and Access to Lung Transplantation in the United States. A Cohort Study

PubMed Central

Sell, Jessica L.; Bacchetta, Matthew; Goldfarb, Samuel B.; Park, Hanyoung; Heffernan, Priscilla V.; Robbins, Hilary A.; Shah, Lori; Raza, Kashif; D’Ovidio, Frank; Sonett, Joshua R.; Arcasoy, Selim M.

2016-01-01

Rationale: Anecdotally, short lung transplant candidates suffer from long waiting times and higher rates of death on the waiting list compared with taller candidates. Objectives: To examine the relationship between lung transplant candidate height and waiting list outcomes. Methods: We conducted a retrospective cohort study of 13,346 adults placed on the lung transplant waiting list in the United States between 2005 and 2011. Multivariable-adjusted competing risk survival models were used to examine associations between candidate height and outcomes of interest. The primary outcome was the time until lung transplantation censored at 1 year. Measurements and Main Results: The unadjusted rate of lung transplantation was 94.5 per 100 person-years among candidates of short stature (<162 cm) and 202.0 per 100 person-years among candidates of average stature (170–176.5 cm). After controlling for potential confounders, short stature was associated with a 34% (95% confidence interval [CI], 29–39%) lower rate of transplantation compared with average stature. Short stature was also associated with a 62% (95% CI, 24–96%) higher rate of death or removal because of clinical deterioration and a 42% (95% CI, 10–85%) higher rate of respiratory failure while awaiting lung transplantation. Conclusions: Short stature is associated with a lower rate of lung transplantation and higher rates of death and respiratory failure while awaiting transplantation. Efforts to ameliorate this disparity could include earlier referral and listing of shorter candidates, surgical downsizing of substantially oversized allografts for shorter candidates, and/or changes to allocation policy that account for candidate height. PMID:26554631

One-Stop Clinic Utilization in Plastic Surgery: Our Local Experience and the Results of a UK-Wide National Survey.

PubMed

Gorman, Mark; Coelho, James; Gujral, Sameer; McKay, Alastair

2015-01-01

Introduction. "See and treat" one-stop clinics (OSCs) are an advocated NHS initiative to modernise care, reducing cancer treatment waiting times. Little studied in plastic surgery, the existing evidence suggests that though they improve care, they are rarely implemented. We present our experience setting up a plastic surgery OSC for minor skin surgery and survey their use across the UK. Methods. The OSC was evaluated by 18-week wait target compliance, measures of departmental capacity, and patient satisfaction. Data was obtained from 32 of the 47 UK plastic surgery departments to investigate the prevalence of OSCs for minor skin cancer surgery. Results. The OSC improved 18-week waiting times, from a noncompliant mean of 80% to a compliant 95% average. Department capacity increased 15%. 95% of patients were highly satisfied with and preferred the OSC to a conventional service. Only 25% of UK plastic surgery units run OSCs, offering varying reasons for not doing so, 42% having not considered their use. Conclusions. OSCs are underutilised within UK plastic surgery, where a significant proportion of units have not even considered their benefit. This is despite associated improvements in waiting times, department capacity, and levels of high patient satisfaction. We offer our considerations and local experience instituting an OSC service.

One-Stop Clinic Utilization in Plastic Surgery: Our Local Experience and the Results of a UK-Wide National Survey

PubMed Central

Gorman, Mark; Coelho, James; Gujral, Sameer; McKay, Alastair

2015-01-01

Introduction. “See and treat” one-stop clinics (OSCs) are an advocated NHS initiative to modernise care, reducing cancer treatment waiting times. Little studied in plastic surgery, the existing evidence suggests that though they improve care, they are rarely implemented. We present our experience setting up a plastic surgery OSC for minor skin surgery and survey their use across the UK. Methods. The OSC was evaluated by 18-week wait target compliance, measures of departmental capacity, and patient satisfaction. Data was obtained from 32 of the 47 UK plastic surgery departments to investigate the prevalence of OSCs for minor skin cancer surgery. Results. The OSC improved 18-week waiting times, from a noncompliant mean of 80% to a compliant 95% average. Department capacity increased 15%. 95% of patients were highly satisfied with and preferred the OSC to a conventional service. Only 25% of UK plastic surgery units run OSCs, offering varying reasons for not doing so, 42% having not considered their use. Conclusions. OSCs are underutilised within UK plastic surgery, where a significant proportion of units have not even considered their benefit. This is despite associated improvements in waiting times, department capacity, and levels of high patient satisfaction. We offer our considerations and local experience instituting an OSC service. PMID:26236502

Third degree waiting time discrimination: optimal allocation of a public sector healthcare treatment under rationing by waiting.

PubMed

Gravelle, Hugh; Siciliani, Luigi

2009-08-01

In many public healthcare systems treatments are rationed by waiting time. We examine the optimal allocation of a fixed supply of a given treatment between different groups of patients. Even in the absence of any distributional aims, welfare is increased by third degree waiting time discrimination: setting different waiting times for different groups waiting for the same treatment. Because waiting time imposes dead weight losses on patients, lower waiting times should be offered to groups with higher marginal waiting time costs and with less elastic demand for the treatment.

Quality initiatives: improving patient flow for a bone densitometry practice: results from a Mayo Clinic radiology quality initiative.

PubMed

Aakre, Kenneth T; Valley, Timothy B; O'Connor, Michael K

2010-03-01

Lean Six Sigma process improvement methodologies have been used in manufacturing for some time. However, Lean Six Sigma process improvement methodologies also are applicable to radiology as a way to identify opportunities for improvement in patient care delivery settings. A multidisciplinary team of physicians and staff conducted a 100-day quality improvement project with the guidance of a quality advisor. By using the framework of DMAIC (define, measure, analyze, improve, and control), time studies were performed for all aspects of patient and technologist involvement. From these studies, value stream maps for the current state and for the future were developed, and tests of change were implemented. Comprehensive value stream maps showed that before implementation of process changes, an average time of 20.95 minutes was required for completion of a bone densitometry study. Two process changes (ie, tests of change) were undertaken. First, the location for completion of a patient assessment form was moved from inside the imaging room to the waiting area, enabling patients to complete the form while waiting for the technologist. Second, the patient was instructed to sit in a waiting area immediately outside the imaging rooms, rather than in the main reception area, which is far removed from the imaging area. Realignment of these process steps, with reduced technologist travel distances, resulted in a 3-minute average decrease in the patient cycle time. This represented a 15% reduction in the initial patient cycle time with no change in staff or costs. Radiology process improvement projects can yield positive results despite small incremental changes.

Access to specialist gastroenterology care in Canada: The Practice Audit in Gastroenterology (PAGE) Wait Times Program

PubMed Central

Armstrong, David; Barkun, Alan NG; Chen, Ying; Daniels, Sandra; Hollingworth, Roger; Hunt, Richard H; Leddin, Desmond

2008-01-01

BACKGROUND: Canadian wait time data are available for the treatment of cancer and heart disease, as well as for joint replacement, cataract surgery and diagnostic imaging procedures. Wait times for gastroenterology consultation and procedures have not been studied, although digestive diseases pose a greater economic burden in Canada than cancer or heart disease. METHODS: Specialist physicians completed the practice audit if they provided digestive health care, accepted new patients and recorded referral dates. For patients seen for consultation or investigation over a one-week period, preprogrammed personal digital assistants were used to collect data including the main reason for referral, initial referral and consultation dates, procedure dates (if performed), personal and family history, and patient symptoms, signs and test results. Patient triaging, appropriateness of the referral and timeliness of care were noted. RESULTS: Over 10 months, 199 physicians recorded details of 5559 referrals, including 1903 visits for procedures. The distribution of total wait times (from referral to procedure) nationally was highly skewed at 91/203 days (median/75th percentile), with substantial interprovincial variation: British Columbia, 66/185 days; Alberta, 134/284 days; Ontario, 110/208 days; Quebec, 71/149 days; New Brunswick, 104/234 days; and Nova Scotia, 42/84 days. The percentage of physicians by province offering average-risk screening colonoscopy varied from 29% to 100%. DISCUSSION: Access to specialist gastroenterology care in Canada is limited by long wait times, which exceed clinically reasonable waits for specialist treatment. Although exhibiting some methodological limitations, this large practice audit sampling offers broadly generalized results, as well as a means to identify barriers to health care delivery and evaluate strategies to address these barriers, with the goals of expediting appropriate care for patients with digestive health disorders and ameliorating the personal and societal burdens imposed by digestive diseases. PMID:18299734

Reducing wait time in a hospital pharmacy to promote customer service.

PubMed

Slowiak, Julie M; Huitema, Bradley E; Dickinson, Alyce M

2008-01-01

The purpose of this study was to compare the effects of 2 different interventions on wait times at a hospital outpatient pharmacy: (1) giving feedback to employees about customer satisfaction with wait times and (2) giving a combined intervention package that included giving more specific feedback about actual wait times and goal setting for wait time reduction in addition to the customer satisfaction feedback. The relationship between customer satisfaction ratings and wait times was examined to determine whether wait times affected customer service satisfaction. Participants were 10 employees (4 pharmacists and 6 technicians) of an outpatient pharmacy. Wait times and customer satisfaction ratings were collected for "waiting customers." An ABCBA' within-subjects design was used to assess the effects of the interventions on both wait time and customer satisfaction, where A was the baseline (no feedback and no goal setting); B was the customer satisfaction feedback; C was the customer satisfaction feedback, the wait time feedback, and the goal setting for wait time reduction; and A' was a follow-up condition that was similar to the original baseline condition. Wait times were reduced by approximately 20%, and there was concomitant increased shift in levels of customer satisfaction, as indicated by the correlation between these variables (r = -0.57 and P < .05). Given the current prescription-filling process, we do not expect that major, additional reductions in wait times could be produced. Many variables may account for the variability in any individual customer's wait time. Data from this study may provide useful preliminary benchmarking data for standard pharmacy wait times.

About influence of input rate random part of nonstationary queue system on statistical estimates of its macroscopic indicators

NASA Astrophysics Data System (ADS)

Korelin, Ivan A.; Porshnev, Sergey V.

2018-05-01

A model of the non-stationary queuing system (NQS) is described. The input of this model receives a flow of requests with input rate λ = λdet (t) + λrnd (t), where λdet (t) is a deterministic function depending on time; λrnd (t) is a random function. The parameters of functions λdet (t), λrnd (t) were identified on the basis of statistical information on visitor flows collected from various Russian football stadiums. The statistical modeling of NQS is carried out and the average statistical dependences are obtained: the length of the queue of requests waiting for service, the average wait time for the service, the number of visitors entered to the stadium on the time. It is shown that these dependencies can be characterized by the following parameters: the number of visitors who entered at the time of the match; time required to service all incoming visitors; the maximum value; the argument value when the studied dependence reaches its maximum value. The dependences of these parameters on the energy ratio of the deterministic and random component of the input rate are investigated.

Traffic-related air pollution in the community of San Ysidro, CA, in relation to northbound vehicle wait times at the US-Mexico border Port of Entry

NASA Astrophysics Data System (ADS)

Quintana, Penelope J. E.; Dumbauld, Jill J.; Garnica, Lynelle; Chowdhury, M. Zohir; Velascosoltero, José; Mota-Raigoza, Arturo; Flores, David; Rodríguez, Edgar; Panagon, Nicolas; Gamble, Jamison; Irby, Travis; Tran, Cuong; Elder, John; Galaviz, Vanessa E.; Hoffman, Lisa; Zavala, Miguel; Molina, Luisa T.

2014-05-01

The San Diego/Tijuana US-Mexico border crossing at the San Ysidro Port of Entry (POE) is the world's busiest international land border crossing (GSA, 2013). San Ysidro, California, is the US community immediately adjacent to the border crossing. More than 90% of San Ysidro residents are Hispanic, and the average household income is less than 60% of the San Diego regional average. This study investigated the San Ysidro POE as a source of traffic-related air pollutants in San Ysidro, especially in relation to wind direction and northbound vehicle wait times. The pollutants ultrafine particulate matter (UFP), black carbon (BC), and particulate matter <2.5 μm in diameter (PM2.5) were periodically sampled through the course of 2010 at four rooftop locations: one commercial establishment near the POE, two elementary schools in San Ysidro, and a coastal estuary reference site. Weather data from two nearby sites and northbound border wait times were also collected. Results indicate consistently higher daytime BC and UFP concentrations at the measurement sites near the POE. Pollution concentrations were higher during low wind speeds or when wind was blowing from the POE towards San Ysidro. In February, March and November measurements, black carbon pollution appeared to be significantly positively associated with the POE northbound wait times when the wind direction was blowing from the POE towards San Ysidro or during low wind speeds, but not when the wind direction was from the west/northwest towards the POE. This pilot study is the first to investigate the potential effect of the POE, especially the long northbound traffic delays, on the nearby community of San Ysidro. Disparities in traffic exposures are an environmental justice issue and this should be taken into account during planning and operation of POEs.

A baseline maritime satellite communication system

NASA Technical Reports Server (NTRS)

Durrani, S. H.; Mcgregor, D. N.

1974-01-01

This paper describes a baseline system for maritime communications via satellite during the 1980s. The system model employs three geostationary satellites with global coverage antennas. Access to the system is controlled by a master station; user access is based on time-ordered polling or random access. Each Thor-Delta launched satellite has an RF power of 100 W (spinner) or 250 W (three-axis stabilized), and provides 10 equivalent duplex voice channels for up to 1500 ships with average waiting times of approximately 2.5 minutes. The satellite capacity is bounded by the available bandwidth to 50 such channels, which can serve up to 10,000 ships with an average waiting time of 5 minutes. The ships must have peak antenna gains of approximately 15.5 dB or 22.5 dB for the two cases (10 or 50 voice channels) when a spinner satellite is used; the required gains are 4 dB lower if a three-axis stabilized satellite is used. The ship antenna requirements can be reduced by 8 to 10 dB by employing a high-gain multi-beam phased array antenna on the satellite.

Time while waiting: patients' experiences of scheduled surgery.

PubMed

Carr, Tracey; Teucher, Ulrich C; Casson, Alan G

2014-12-01

Research on patients' experiences of wait time for scheduled surgery has centered predominantly on the relative tolerability of perceived wait time and impacts on quality of life. We explored patients' experiences of time while waiting for three types of surgery with varied wait times--hip or knee replacement, shoulder surgery, and cardiac surgery. Thirty-two patients were recruited by their surgeons. We asked participants about their perceptions of time while waiting in two separate interviews. Using interpretative phenomenological analysis (IPA), we discovered connections between participant suffering, meaningfulness of time, and agency over the waiting period and the lived duration of time experience. Our findings reveal that chronological duration is not necessarily the most relevant consideration in determining the quality of waiting experience. Those findings helped us create a conceptual framework for lived wait time. We suggest that clinicians and policy makers consider the complexity of wait time experience to enhance preoperative patient care. © The Author(s) 2014.

Temporal correlation functions of concentration fluctuations: an anomalous case.

PubMed

Lubelski, Ariel; Klafter, Joseph

2008-10-09

We calculate, within the framework of the continuous time random walk (CTRW) model, multiparticle temporal correlation functions of concentration fluctuations (CCF) in systems that display anomalous subdiffusion. The subdiffusion stems from the nonstationary nature of the CTRW waiting times, which also lead to aging and ergodicity breaking. Due to aging, a system of diffusing particles tends to slow down as time progresses, and therefore, the temporal correlation functions strongly depend on the initial time of measurement. As a consequence, time averages of the CCF differ from ensemble averages, displaying therefore ergodicity breaking. We provide a simple example that demonstrates the difference between these two averages, a difference that might be amenable to experimental tests. We focus on the case of ensemble averaging and assume that the preparation time of the system coincides with the starting time of the measurement. Our analytical calculations are supported by computer simulations based on the CTRW model.

Managing pediatric dental trauma in a hospital emergency department.

PubMed

Mitchell, Jonathan; Sheller, Barbara; Velan, Elizabeth; Caglar, Derya; Scott, Joanna

2014-01-01

The purpose of this study was to: (1) examine types of dental trauma presenting to a hospital emergency department (ED); (2) describe the medical services provided to these patients; and (3) quantify time spent during ED encounters for dental trauma emergencies. Records of 265 patients who presented to the ED with dental trauma over a three-year period were reviewed. Demographics, injury types, triage acuity, pain scores, and dental/medical treatment and times were analyzed. Patient demographics and injury types were similar to previous studies. Eighty-two percent of patients received mid-level triage scores; 41 percent of patients had moderate to severe pain. The most frequently provided medical services were administration of analgesics and/or prescriptions (78 percent). The mean times were: 51 minutes waiting for a physician; 55 minutes with dentists; and 176 minutes total time. Higher triage acuity and pain levels resulted in significantly longer wait times for physician assessment. Dental evaluation, including treatment, averaged 32 percent of time spent at the hospital. A dental clinic is the most efficient venue for treating routine dental trauma. Patients in this study spent the majority of time waiting for physicians and receiving nondental services. Most patients required no medical intervention beyond prescriptions commonly used in dental practice.

Discovering the impact of preceding units' characteristics on the wait time of cardiac surgery unit from statistic data.

PubMed

Liu, Jiming; Tao, Li; Xiao, Bo

2011-01-01

Prior research shows that clinical demand and supplier capacity significantly affect the throughput and the wait time within an isolated unit. However, it is doubtful whether characteristics (i.e., demand, capacity, throughput, and wait time) of one unit would affect the wait time of subsequent units on the patient flow process. Focusing on cardiac care, this paper aims to examine the impact of characteristics of the catheterization unit (CU) on the wait time of cardiac surgery unit (SU). This study integrates published data from several sources on characteristics of the CU and SU units in 11 hospitals in Ontario, Canada between 2005 and 2008. It proposes a two-layer wait time model (with each layer representing one unit) to examine the impact of CU's characteristics on the wait time of SU and test the hypotheses using the Partial Least Squares-based Structural Equation Modeling analysis tool. Results show that: (i) wait time of CU has a direct positive impact on wait time of SU (β = 0.330, p < 0.01); (ii) capacity of CU has a direct positive impact on demand of SU (β = 0.644, p < 0.01); (iii) within each unit, there exist significant relationships among different characteristics (except for the effect of throughput on wait time in SU). Characteristics of CU have direct and indirect impacts on wait time of SU. Specifically, demand and wait time of preceding unit are good predictors for wait time of subsequent units. This suggests that considering such cross-unit effects is necessary when alleviating wait time in a health care system. Further, different patient risk profiles may affect wait time in different ways (e.g., positive or negative effects) within SU. This implies that the wait time management should carefully consider the relationship between priority triage and risk stratification, especially for cardiac surgery.

The British Columbia Nephrologists' Access Study (BCNAS) - a prospective, health services interventional study to develop waiting time benchmarks and reduce wait times for out-patient nephrology consultations.

PubMed

Schachter, Michael E; Romann, Alexandra; Djurdev, Ognjenka; Levin, Adeera; Beaulieu, Monica

2013-08-29

Early referral and management of high-risk chronic kidney disease may prevent or delay the need for dialysis. Automatic eGFR reporting has increased demand for out-patient nephrology consultations and in some cases, prolonged queues. In Canada, a national task force suggested the development of waiting time targets, which has not been done for nephrology. We sought to describe waiting time for outpatient nephrology consultations in British Columbia (BC). Data collection occurred in 2 phases: 1) Baseline Description (Jan 18-28, 2010) and 2) Post Waiting Time Benchmark-Introduction (Jan 16-27, 2012). Waiting time was defined as the interval from receipt of referral letters to assessment. Using a modified Delphi process, Nephrologists and Family Physicians (FP) developed waiting time targets for commonly referred conditions through meetings and surveys. Rules were developed to weigh-in nephrologists', FPs', and patients' perspectives in order to generate waiting time benchmarks. Targets consider comorbidities, eGFR, BP and albuminuria. Referred conditions were assigned a priority score between 1-4. BC nephrologists were encouraged to centrally triage referrals to see the first available nephrologist. Waiting time benchmarks were simultaneously introduced to guide patient scheduling. A post-intervention waiting time evaluation was then repeated. In 2010 and 2012, 43/52 (83%) and 46/57 (81%) of BC nephrologists participated. Waiting time decreased from 98(IQR44,157) to 64(IQR21,120) days from 2010 to 2012 (p = <.001), despite no change in referral eGFR, demographics, nor number of office hrs/wk. Waiting time improved most for high priority patients. An integrated, Provincial initiative to measure wait times, develop waiting benchmarks, and engage physicians in active waiting time management associated with improved access to nephrologists in BC. Improvements in waiting time was most marked for the highest priority patients, which suggests that benchmarks had an influence on triaging behavior. Further research is needed to determine whether this effect is sustainable.

46 CFR 9.10 - Waiting time.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 1 2010-10-01 2010-10-01 false Waiting time. 9.10 Section 9.10 Shipping COAST GUARD... § 9.10 Waiting time. The same construction should be given the act when charging for waiting time as... for duty the waiting time amounts to at least one hour. ...

46 CFR 9.10 - Waiting time.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 1 2012-10-01 2012-10-01 false Waiting time. 9.10 Section 9.10 Shipping COAST GUARD... § 9.10 Waiting time. The same construction should be given the act when charging for waiting time as... for duty the waiting time amounts to at least one hour. ...

46 CFR 9.10 - Waiting time.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 1 2011-10-01 2011-10-01 false Waiting time. 9.10 Section 9.10 Shipping COAST GUARD... § 9.10 Waiting time. The same construction should be given the act when charging for waiting time as... for duty the waiting time amounts to at least one hour. ...

Impact of wait times on the effectiveness of transcatheter aortic valve replacement in severe aortic valve disease: a discrete event simulation model.

PubMed

Wijeysundera, Harindra C; Wong, William W L; Bennell, Maria C; Fremes, Stephen E; Radhakrishnan, Sam; Peterson, Mark; Ko, Dennis T

2014-10-01

There is increasing demand for transcatheter aortic valve replacement (TAVR) as the primary treatment option for patients with severe aortic stenosis who are high-risk surgical candidates or inoperable. We used mathematical simulation models to estimate the hypothetical effectiveness of TAVR with increasing wait times. We applied discrete event modelling, using data from the Placement of Aortic Transcatheter Valves (PARTNER) trials. We compared TAVR with medical therapy in the inoperable cohort, and compared TAVR to conventional aortic valve surgery in the high-risk cohort. One-year mortality and wait-time deaths were calculated in different scenarios by varying TAVR wait times from 10 days to 180 days, while maintaining a constant wait time for surgery at a mean of 15.6 days. In the inoperable cohort, the 1-year mortality for medical therapy was 50%. When the TAVR wait time was 10 days, the TAVR wait-time mortality was 1.9% with a 1-year mortality of 31.5%. TAVR wait-time deaths increased to 28.9% with a 180-day wait, with a 1-year mortality of 41.4%. In the high-risk cohort, the wait-time deaths and 1-year mortality for the surgical patients were 2.5% and 27%, respectively. The TAVR wait-time deaths increased from 2.2% with a 10-day wait to 22.4% with a 180-day wait, and a corresponding increase in 1-year mortality from 24.5% to 32.6%. Mortality with TAVR exceeded surgery when TAVR wait times exceeded 60 days. Modest increases in TAVR wait times have a substantial effect on the effectiveness of TAVR in inoperable patients and high-risk surgical candidates. Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Two Effective Ways to Implement Wait Time. A Symposium on Wait Time.

ERIC Educational Resources Information Center

Swift, J. Nathan; And Others

The effects of instructional guides and a wait time feedback device (called a "Wait Timer") on the classroom interaction of middle school science teachers are examined. The Wait Timer, an unobtrusive indicator of wait time, is an automatic device that activates a light when a person speaks. The duration of the light at the end of a…

Indoor Temperatures in Patient Waiting Rooms in Eight Rural Primary Health Care Centers in Northern South Africa and the Related Potential Risks to Human Health and Wellbeing

PubMed Central

Wright, Caradee Y.; Street, Renée A.; Cele, Nokulunga; Kunene, Zamantimande; Balakrishna, Yusentha; Albers, Patricia N.; Mathee, Angela

2017-01-01

Increased temperatures affect human health and vulnerable groups including infants, children, the elderly and people with pre-existing diseases. In the southern African region climate models predict increases in ambient temperature twice that of the global average temperature increase. Poor ventilation and lack of air conditioning in primary health care clinics, where duration of waiting time may be as long as several hours, pose a possible threat to patients seeking primary health care. Drawing on information measured by temperature loggers installed in eight clinics in Giyani, Limpopo Province of South Africa, we were able to determine indoor temperatures of waiting rooms in eight rural primary health care facilities. Mean monthly temperature measurements inside the clinics were warmer during the summer months of December, January and February, and cooler during the autumn months of March, April and May. The highest mean monthly temperature of 31.4 ± 2.7 °C was recorded in one clinic during February 2016. Maximum daily indoor clinic temperatures exceeded 38 °C in some clinics. Indoor temperatures were compared to ambient (outdoor) temperatures and the mean difference between the two showed clinic waiting room temperatures were higher by 2–4 °C on average. Apparent temperature (AT) incorporating relative humidity readings made in the clinics showed ‘realfeel’ temperatures were >4 °C higher than measured indoor temperature, suggesting a feeling of ‘stuffiness’ and discomfort may have been experienced in the waiting room areas. During typical clinic operational hours of 8h00 to 16h00, mean ATs fell into temperature ranges associated with heat–health impact warning categories of ‘caution’ and ‘extreme caution’. PMID:28067816

Indoor Temperatures in Patient Waiting Rooms in Eight Rural Primary Health Care Centers in Northern South Africa and the Related Potential Risks to Human Health and Wellbeing.

PubMed

Wright, Caradee Y; Street, Renée A; Cele, Nokulunga; Kunene, Zamantimande; Balakrishna, Yusentha; Albers, Patricia N; Mathee, Angela

2017-01-06

Increased temperatures affect human health and vulnerable groups including infants, children, the elderly and people with pre-existing diseases. In the southern African region climate models predict increases in ambient temperature twice that of the global average temperature increase. Poor ventilation and lack of air conditioning in primary health care clinics, where duration of waiting time may be as long as several hours, pose a possible threat to patients seeking primary health care. Drawing on information measured by temperature loggers installed in eight clinics in Giyani, Limpopo Province of South Africa, we were able to determine indoor temperatures of waiting rooms in eight rural primary health care facilities. Mean monthly temperature measurements inside the clinics were warmer during the summer months of December, January and February, and cooler during the autumn months of March, April and May. The highest mean monthly temperature of 31.4 ± 2.7 °C was recorded in one clinic during February 2016. Maximum daily indoor clinic temperatures exceeded 38 °C in some clinics. Indoor temperatures were compared to ambient (outdoor) temperatures and the mean difference between the two showed clinic waiting room temperatures were higher by 2-4 °C on average. Apparent temperature (AT) incorporating relative humidity readings made in the clinics showed 'realfeel' temperatures were >4 °C higher than measured indoor temperature, suggesting a feeling of 'stuffiness' and discomfort may have been experienced in the waiting room areas. During typical clinic operational hours of 8h00 to 16h00, mean ATs fell into temperature ranges associated with heat-health impact warning categories of 'caution' and 'extreme caution'.

Changes to physician processing times in response to clinic congestion and patient punctuality: a retrospective study.

PubMed

Chambers, Chester G; Dada, Maqbool; Elnahal, Shereef; Terezakis, Stephanie; DeWeese, Theodore; Herman, Joseph; Williams, Kayode A

2016-10-18

We examine interactions among 3 factors that affect patient waits and use of overtime in outpatient clinics: clinic congestion, patient punctuality and physician processing rates. We hypothesise that the first 2 factors affect physician processing rates, and this adaptive physician behaviour serves to reduce waiting times and the use of overtime. 2 urban academic clinics and an affiliated suburban clinic in metropolitan Baltimore, Maryland, USA. Appointment times, patient arrival times, start of service and physician processing times were collected for 105 visits at a low-volume suburban clinic 1, 264 visits at a medium-volume academic clinic 2 and 22 266 visits at a high-volume academic clinic 3 over 3 distinct spans of time. Data from the first clinic were previously used to document an intervention to influence patient punctuality. This included a policy that tardy patients were rescheduled. Clinicians' processing times were gathered, conditioned on whether the patient or clinician was tardy to test the first hypothesis. Probability distributions of patient unpunctuality were developed preintervention and postintervention for the clinic in which the intervention took place and these data were used to seed a discrete-event simulation. Average physician processing times differ conditioned on tardiness at clinic 1 with p=0.03, at clinic 2 with p=10 -5 and at clinic 3 with p=10 -7 . Within the simulation, the adaptive physician behaviour degrades system performance by increasing waiting times, probability of overtime and the average amount of overtime used. Each of these changes is significant at the p<0.01 level. Processing times differed for patients in different states in all 3 settings studied. When present, this can be verified using data commonly collected. Ignoring these behaviours leads to faulty conclusions about the efficacy of efforts to improve clinic flow. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Wait Time for Counseling Affecting Perceived Stigma and Attitude toward the University

ERIC Educational Resources Information Center

Blau, Gary; DiMino, John; Sheridan, Natalie; Stein, Alexander; Casper, Steven; Chessler, Marcy; Beverly, Clyde

2015-01-01

A sample of 99 undergraduates in counseling was divided into two groups based on wait time from triage to intake, "less wait time" (up to two weeks) versus "more wait time" (at least two weeks). The less wait time group showed "higher willingness to recommend the university," "higher institutional…

Reducing pharmacy wait time to promote customer service: a follow-up study.

PubMed

Slowiak, Julie M; Huitema, Bradley E

2015-01-01

The present study had 3 objectives: (1) to evaluate the effects of 2 different interventions (feedback regarding customer satisfaction with wait time and combined feedback and goal setting) on wait time in a hospital outpatient pharmacy; (2) to assess the extent to which the previously applied interventions maintained their effects; and (3) to evaluate the differences between the effects of the original study and those of the present follow-up study. Participants were 10 employees (4 pharmacists and 6 technicians) of an outpatient pharmacy. Wait times and customer satisfaction ratings were collected for "waiting customers." An ABCB within-subjects design was used to assess the effects of the interventions on both wait time and customer satisfaction, where A was the baseline (no feedback and no goal setting); B was the customer satisfaction feedback; and C was the customer satisfaction feedback, the wait time feedback, and the goal setting for wait time reduction. Wait time decreased after baseline when the combined intervention was introduced, and wait time increased with the reintroduction of satisfaction feedback (alone). The results of the replication study confirm the pattern of the results of the original study and demonstrate high sensitivity of levels of customer satisfaction with wait time. The most impressive result of the replication is the nearly 2-year maintenance of lower wait time between the end of the original study and the beginning (baseline) of the replication.

Patient Satisfaction Is Associated With Time With Provider But Not Clinic Wait Time Among Orthopedic Patients.

PubMed

Patterson, Brendan M; Eskildsen, Scott M; Clement, R Carter; Lin, Feng-Chang; Olcott, Christopher W; Del Gaizo, Daniel J; Tennant, Joshua N

2017-01-01

Clinic wait time is considered an important predictor of patient satisfaction. The goal of this study was to determine whether patient satisfaction among orthopedic patients is associated with clinic wait time and time with the provider. The authors prospectively enrolled 182 patients at their outpatient orthopedic clinic. Clinic wait time was defined as the time between patient check-in and being seen by the surgeon. Time spent with the provider was defined as the total time the patient spent in the examination room with the surgeon. The Consumer Assessment of Healthcare Providers and Systems survey was used to measure patient satisfaction. Factors associated with increased patient satisfaction included patient age and increased time with the surgeon (P=.024 and P=.037, respectively), but not clinic wait time (P=.625). Perceived wait time was subject to a high level of error, and most patients did not accurately report whether they had been waiting longer than 15 minutes to see a provider until they had waited at least 60 minutes (P=.007). If the results of the current study are generalizable, time with the surgeon is associated with patient satisfaction in orthopedic clinics, but wait time is not. Further, the study findings showed that patients in this setting did not have an accurate perception of actual wait time, with many patients underestimating the time they waited to see a provider. Thus, a potential strategy for improving patient satisfaction is to spend more time with each patient, even at the expense of increased wait time. [Orthopedics. 2017; 40(1):43-48.]. Copyright 2016, SLACK Incorporated.

Wait Time and Effective Social Studies Instruction: What Can Research in Science Education Tell Us?

ERIC Educational Resources Information Center

Atwood, Virgina A.; Wilen, William W.

1991-01-01

Defines wait time as the length of time teachers wait for answers from students after asking a question. Maintains that increasing wait time can stimulate reflective thinking and student involvement. Reviews the research literature on wait time studies in science education. Finds that student responses improve and participation expands with…

Do we perform surgical programming well? How can we improve it?

PubMed

Albareda, J; Clavel, D; Mahulea, C; Blanco, N; Ezquerra, L; Gómez, J; Silva, J M

The objective is to establish the duration of our interventions, intermediate times and surgical performance. This will create a virtual waiting list to apply a mathematical programme that performs programming with maximum performance. Retrospective review of 49 surgical sessions obtaining the delay in start time, intermediate time and surgical performance. Retrospective review of 4,045 interventions performed in the last 3 years to obtain the average duration of each type of surgery. Creation of a virtual waiting list of 700 patients in order to perform virtual programming through the MIQCP-P until achieving optimal performance. Our surgical performance with manual programming was 75.9%, ending 22.4% later than 3pm. The performance in the days without suspensions was 78.4%. The delay at start time was 9.7min. The optimum performance was 77.5% with a confidence of finishing before 15h of 80.6%. The waiting list has been scheduled in 254 sessions. Our manual surgical performance without suspensions (78.4%) was superior to the optimal (77.5%), generating days finished later than 3pm and suspensions. The possibilities for improvement are to achieve punctuality at the start time and adjust the schedule to the ideal performance. The virtual programming has allowed us to obtain our ideal performance and to establish the number of operating rooms necessary to solve the waiting list created. The data obtained in virtual mathematical programming are reliable enough to implement this model with guarantees. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

The British Columbia Nephrologists’ Access Study (BCNAS) – a prospective, health services interventional study to develop waiting time benchmarks and reduce wait times for out-patient nephrology consultations

PubMed Central

2013-01-01

Background Early referral and management of high-risk chronic kidney disease may prevent or delay the need for dialysis. Automatic eGFR reporting has increased demand for out-patient nephrology consultations and in some cases, prolonged queues. In Canada, a national task force suggested the development of waiting time targets, which has not been done for nephrology. Methods We sought to describe waiting time for outpatient nephrology consultations in British Columbia (BC). Data collection occurred in 2 phases: 1) Baseline Description (Jan 18-28, 2010) and 2) Post Waiting Time Benchmark-Introduction (Jan 16-27, 2012). Waiting time was defined as the interval from receipt of referral letters to assessment. Using a modified Delphi process, Nephrologists and Family Physicians (FP) developed waiting time targets for commonly referred conditions through meetings and surveys. Rules were developed to weigh-in nephrologists’, FPs’, and patients’ perspectives in order to generate waiting time benchmarks. Targets consider comorbidities, eGFR, BP and albuminuria. Referred conditions were assigned a priority score between 1-4. BC nephrologists were encouraged to centrally triage referrals to see the first available nephrologist. Waiting time benchmarks were simultaneously introduced to guide patient scheduling. A post-intervention waiting time evaluation was then repeated. Results In 2010 and 2012, 43/52 (83%) and 46/57 (81%) of BC nephrologists participated. Waiting time decreased from 98(IQR44,157) to 64(IQR21,120) days from 2010 to 2012 (p = <.001), despite no change in referral eGFR, demographics, nor number of office hrs/wk. Waiting time improved most for high priority patients. Conclusions An integrated, Provincial initiative to measure wait times, develop waiting benchmarks, and engage physicians in active waiting time management associated with improved access to nephrologists in BC. Improvements in waiting time was most marked for the highest priority patients, which suggests that benchmarks had an influence on triaging behavior. Further research is needed to determine whether this effect is sustainable. PMID:23988113

How Does the Supply Requisitioning Process Affect Average Customer Wait Time Onboard U.S. Navy Destroyers?

DTIC Science & Technology

2013-05-07

warfare qualifications SWSCO and NASO. Next, LCDR Saucedo reported to the Fleet Industrial Supply Center, San Diego, where she assumed the duties as the...16  D.  NAVAL TACTICAL COMMAND SUPPORT SYSTEM .................. 17  1.  Operational Maintenance ...21  4.  Method

Orientational dynamics in a room temperature ionic liquid: Are angular jumps predominant?

NASA Astrophysics Data System (ADS)

Das, Suman; Mukherjee, Biswaroop; Biswas, Ranjit

2018-05-01

Reorientational dynamics of the constituent ions in a room temperature ionic liquid, 1-butyl-3-methylimidazolium hexafluorophosphate ([BMIM][PF6]), are explored via molecular dynamics simulations, and several features of orientation dynamics are summarized. The anion, [PF6]-, not only exhibits a higher propensity to orientation jumps than the cation, [BMIM]+ but also accesses a wider jump angle distribution and larger peak-angle. Jump and waiting time distributions for both the ions depict power-law dependences, suggesting temporally heterogeneous dynamics for the medium. This heterogeneity feature is further highlighted by the finding that the simulated first rank (ℓ = 1) and second rank (ℓ = 2) average reorientational correlation times reflect a severe break-down of Debye's ℓ(ℓ + 1) law for orientational diffusion in an isotropic homogeneous medium. Simulated average H-bond lifetime resides between the mean orientation jump and waiting times, while the structural H-bond relaxation suggests, as in normal liquids, a pronounced presence of translational motion of the partnering ions. Average simulated jump trajectories reveal a strong rotation-translation coupling and indicate relatively larger changes in spatial and angular arrangements for the anion during an orientation jump. In fact, a closer inspection of all these results points toward more heterogeneous dynamics for [PF6]- than [BMIM]+. This is a new observation and may simply be linked to the ion-size. However, such a generalization warrants further study.

UNificatins and Extensions of the Multiple Access Communications Problem,

DTIC Science & Technology

1981-07-01

Control , Stability and Waiting Time in a Slotted ALOHA Random Access System ," IEEE...quceing, them, the control procedure must tolerate a larger average number of’ messages in the system if it is to limit the number of times that the system ...running fas- ter than real time to provide some flow control for that class . The virtual clocks for every other class merely act as a "gate" which

Plastic surgery outpatient audit: principles and practice of "consultant only" clinics.

PubMed

Griffiths, R W

1990-11-01

The effect of instituting "consultant only" clinics on plastic surgery outpatient activity was to produce a 19% reduction in both clinic sessions and new patient bookings, but a 50% reduction in booked follow-up patients; non-attender rates reduced from 20% to 11% (Northern General Hospital, April 1986-March 1989). Mean clinic attendances reduced from 35 to 26 (Northern General Hospital) and from 33 to 27 (Barnsley District Hospital)--26% and 18%, respectively. Analysis of new referrals to such clinics in the 6 months January-June 1989 showed 41% of patients came from general practitioners, although 80% of "aesthetic" conditions came from this source. 31% of referrals were for malignancy, 51/72 (70%) being basal cell carcinomas. Malignancies waited on average 4 weeks, benign conditions 15 weeks, and "aesthetic" conditions 28 weeks from referral to consultation. Such clinic management has dramatically reduced follow-up episodes, but regulation of new patient attendances is associated with appreciable waiting times for non-malignant conditions. To reduce such waiting times and pursue a "consultant only" clinic policy nationally requires many more consultants.

[Dealing with Waiting Times in Health Systems - An International Comparative Overview].

PubMed

Finkenstädt, V

2015-10-01

Waiting times in the health system are a form of rationing that exists in many countries. Previous studies on this topic are mainly related to the problem of international comparability of waiting times or on the presentation of national strategies as to how they should be reduced. This review adds to this analysis and examines how the OECD countries deal with waiting times in the health-care system and investigates which information is published about waiting for what purpose. Furthermore, waiting times and the type of health system financing are compared. A systematic internet research on waiting times in the health-care system was conducted on the websites of the competent authorities (Ministry of Health or other authorities and institutions). The identified publications were then examined for the purpose of their deployment. Finally, the OECD Health Data were analysed to determine the relationship between tax and contribution financing of public health care expenditure. The primary form of financing was compared with the results of the waiting time analysis. 16 OECD countries are identified which officially collect and publish administrative data on waiting times on the Internet. The data are processed differently depending on the country. By providing this information, two main objectives are pursued: a public monitoring of waiting times in the health system (14 countries) and information for patients on waiting times (9 countries). Official statistics on waiting times exist mainly in countries with tax-financed health systems, whereas this is not the case in the majority of OECD countries with health systems that are funded through contributions. The publication of administrative waiting times data is primarily intended to inform the patient and as a performance indicator in terms of access to health care. Even if data on waiting times are published, the publication of indicators and the management of waiting lists alone will not solve the problem. Rather, the analysis shows that in tax-funded health systems access to medical care is frequently rationed and the demand side is often regulated by waiting lists. © Georg Thieme Verlag KG Stuttgart · New York.

Traffic pollutants measured inside vehicles waiting in line at a major US-Mexico Port of Entry.

PubMed

Quintana, Penelope J E; Khalighi, Mehdi; Castillo Quiñones, Javier Emmanuel; Patel, Zalak; Guerrero Garcia, Jesus; Martinez Vergara, Paulina; Bryden, Megan; Mantz, Antoinette

2018-05-01

At US-Mexico border Ports of Entry, vehicles idle for long times waiting to cross northbound into the US. Long wait times at the border have mainly been studied as an economic issue, however, exposures to emissions from idling vehicles can also present an exposure risk. Here we present the first data on in-vehicle exposures to driver and passengers crossing the US-Mexico border at the San Ysidro, California Port of Entry (SYPOE). Participants were recruited who regularly commuted across the border in either direction and told to drive a scripted route between two border universities, one in the US and one in Mexico. Instruments were placed in participants' cars prior to commute to monitor-1-minute average levels of the traffic pollutants ultrafine particles (UFP), black carbon (BC) and carbon monoxide (CO) in the breathing zone of drivers and passengers. Location was determined by a GPS monitor. Results reported here are for 68 northbound participant trips. The highest median levels of in-vehicle UFP were recorded during the wait to cross at the SYPOE (median 29,692particles/cm 3 ) significantly higher than the portion of the commute in the US (median 20,508particles/cm 3 ) though not that portion in Mexico (median 22, 191particles/cm 3 ). In-vehicle BC levels at the border were significantly lower than in other parts of the commute. Our results indicate that waiting in line at the SYPOE contributes a median 62.5% (range 15.5%-86.0%) of a cross-border commuter's exposure to UFP and a median 44.5% (range (10.6-79.7%) of exposure to BC inside the vehicle while traveling in the northbound direction. Reducing border wait time can significantly reduce in-vehicle exposures to toxic air pollutants such as UFP and BC, and these preventable exposures can be considered an environmental justice issue. Copyright © 2017 Elsevier B.V. All rights reserved.

Improving Procedure Start Times and Decreasing Delays in Interventional Radiology: A Department's Quality Improvement Initiative.

PubMed

Villarreal, Monica C; Rostad, Bradley S; Wright, Richard; Applegate, Kimberly E

2015-12-01

To identify and reduce reasons for delays in procedure start times, particularly the first cases of the day, within the interventional radiology (IR) divisions of the Department of Radiology using principles of continuous quality improvement. An interdisciplinary team representative of the IR and preprocedure/postprocedure care area (PPCA) health care personnel, managers, and data analysts was formed. A standardized form was used to document both inpatient and outpatient progress through the PPCA and IR workflow in six rooms and to document reasons for delays. Data generated were used to identify key problems areas, implement improvement interventions, and monitor their effects. Project duration was 6 months. The average number of on-time starts for the first case of the day increased from 23% to 56% (P value < .01). The average number of on-time, scheduled outpatients increased from 30% to 45% (P value < .01). Patient wait time to arrive at treatment room once they were ready for their procedure was reduced on average by 10 minutes (P value < .01). Patient care delay duration per 100 patients was reduced from 30.3 to 21.6 hours (29% reduction). Number of patient care delays per 100 patients was reduced from 46.6 to 40.1 (17% reduction). Top reasons for delay included waiting for consent (26% of delays duration) and laboratory tests (12%). Many complex factors contribute to procedure start time delays within an IR practice. A data-driven and patient-centered, interdisciplinary team approach was effective in reducing delays in IR. Copyright © 2015 AUR. Published by Elsevier Inc. All rights reserved.

Outpatient Office Wait Times and Quality of Care for Medicaid Patients

PubMed Central

Oostrom, Tamar; Einav, Liran; Finkelstein, Amy

2018-01-01

Time spent in the doctor’s waiting room captures an important aspect of the healthcare experience. We analyzed data on 21 million outpatient visits obtained from electronic health record systems, allowing us to measure time spent in the waiting room beyond the scheduled appointment time. Median wait time was just over 4 minutes. Almost one-fifth of visits had waits longer than 20 minutes, and 10% were over 30 minutes. Waits were shorter for early morning appointments, younger patients, and at larger practices. Median wait time was 4.1 minutes for privately-insured and 4.6 minutes for Medicaid patients; adjusting for patient and appointment characteristics, Medicaid patients were 20% more likely than the privately-insured to wait longer than 20 minutes (P<0.001), with most of this disparity explained by differences in practices and providers they saw. Wait time for Medicaid patients relative to the privately-insured was longer in states with relatively lower Medicaid reimbursement rates. PMID:28461348

CONSUMER PREFERENCES FOR SCANNING MODALITY TO DIAGNOSE FOCAL LIVER LESIONS.

PubMed

Whitty, Jennifer; Filby, Alexandra; Smith, Adam B; Carr, Louise M

2015-01-01

Differences in the process of using liver imaging technologies might be important to patients. This study aimed to investigate preferences for scanning modalities used in diagnosing focal liver lesions. A discrete choice experiment was administered to 504 adults aged 25 ≥years. Respondents made repeated choices between two hypothetical scans, described according to waiting time for scan and results, procedure type, the chance of minor side-effects, and whether further scanning procedures were likely to be required. Choice data were analyzed using mixed-logit models with respondent characteristics used to explain preference heterogeneity. Respondents preferred shorter waiting times, the procedure to be undertaken with a handheld scanner on a couch instead of within a body scanner, no side-effects, and no follow–up scans (p≤.01). The average respondent was willing to wait an additional 2 weeks for the scan if it resulted in avoiding side-effects, 1.5 weeks to avoid further procedures or to be told the results immediately, and 1 week to have the scan performed on a couch with a handheld scanner. However, substantial heterogeneity was observed in the strength of preference for desirable imaging characteristics. An average individual belonging to a general population sub–group most likely to require imaging to characterize focal liver lesions in the United Kingdom would prefer contrast–enhanced ultrasound over magnetic resonance imaging or computed tomography. Insights into the patient perspective around differential characteristics of imaging modalities have the potential to be used to guide recommendations around the use of these technologie

Waiting time of inpatients before elective surgical procedures at a State Government Teaching Hospital in India.

PubMed

Ray, Shreyasi; Kirtania, Jyotirmay

2017-01-01

Abundant published literature exists addressing the issues of outpatient waiting lists before surgery. However, there is no published literature on inpatient waiting time before elective surgical procedures. This study aims to measure the inpatient waiting time, identify the factors that affect the inpatient waiting time, and recommend the ways of reducing the waiting time of inpatients before elective surgical procedures, at a state government teaching hospital in India. Descriptive research methods and quality control tools were used for this prospective observational study. Descriptive statistics, Shapiro-Wilk test of normality, Wilcoxon-Mann-Whitney Test, and Kruskal-Wallis test were used. Pareto charts were used to highlight the most important modifiable factors among the set of factors causing increased waiting time. We also applied the M/M/c model (Erlang - A model) of queue theory to analyze the traffic intensity and system congestion. The median waiting time of inpatients before elective surgery was 12 days (interquartile range = 11.5 days). The waiting time was influenced significantly (P < 0.05) by the patient's age, physical status, and the financial status. The surgical specialty, blood product booking and procurement, cross-specialty consultation before surgery, and Intensive Care Unit booking were the other important factors. Modifiable and nonmodifiable factors affecting the inpatient waiting time of surgical patients were identified. Control measures that can reduce the waiting time of inpatients before elective surgery were identified.

Bus-stop Based Real Time Passenger Information System - Case Study Maribor

NASA Astrophysics Data System (ADS)

Čelan, Marko; Klemenčič, Mitja; Mrgole, Anamarija L.; Lep, Marjan

2017-10-01

Real time passenger information system is one of the key element of promoting public transport. For the successful implementation of real time passenger information systems, various components should be considered, such as: passenger needs and requirements, stakeholder involvement, technological solution for tracking, data transfer, etc. This article carrying out designing and evaluation of real time passenger information (RTPI) in the city of Maribor. The design phase included development of methodology for selection of appropriate macro and micro location of the real-time panel, development of a real-time passenger algorithm, definition of a technical specification, financial issues and time frame. The evaluation shows that different people have different requirements; therefore, the system should be adaptable to be used by various types of people, according to the age, the purpose of journey, experience of using public transport, etc. The average difference between perceived waiting time for a bus is 35% higher than the actual waiting time and grow with the headway increase. Experiences from Maribor have shown that the reliability of real time passenger system (from technical point of view) must be close to 100%, otherwise the system may have negative impact on passengers and may discourage the use of public transport. Among considered events of arrivals during the test period, 92% of all prediction were accurate. The cost benefit analysis has focused only on potential benefits from reduced perceived users waiting time and foreseen costs of real time information system in Maribor for 10 years’ period. Analysis shows that the optimal number for implementing real time passenger information system at the bus stops in Maribor is set on 83 bus stops (approx. 20 %) with the highest number of passenger. If we consider all entries at the chosen bus stops, the total perceived waiting time on yearly level could be decreased by about 60,000 hours.

SU-F-P-20: Predicting Waiting Times in Radiation Oncology Using Machine Learning

DOE Office of Scientific and Technical Information (OSTI.GOV)

Joseph, A; Herrera, D; Hijal, T

Purpose: Waiting times remain one of the most vexing patient satisfaction challenges facing healthcare. Waiting time uncertainty can cause patients, who are already sick or in pain, to worry about when they will receive the care they need. These waiting periods are often difficult for staff to predict and only rough estimates are typically provided based on personal experience. This level of uncertainty leaves most patients unable to plan their calendar, making the waiting experience uncomfortable, even painful. In the present era of electronic health records (EHRs), waiting times need not be so uncertain. Extensive EHRs provide unprecedented amounts ofmore » data that can statistically cluster towards representative values when appropriate patient cohorts are selected. Predictive modelling, such as machine learning, is a powerful approach that benefits from large, potentially complex, datasets. The essence of machine learning is to predict future outcomes by learning from previous experience. The application of a machine learning algorithm to waiting time data has the potential to produce personalized waiting time predictions such that the uncertainty may be removed from the patient’s waiting experience. Methods: In radiation oncology, patients typically experience several types of waiting (eg waiting at home for treatment planning, waiting in the waiting room for oncologist appointments and daily waiting in the waiting room for radiotherapy treatments). A daily treatment wait time model is discussed in this report. To develop a prediction model using our large dataset (with more than 100k sample points) a variety of machine learning algorithms from the Python package sklearn were tested. Results: We found that the Random Forest Regressor model provides the best predictions for daily radiotherapy treatment waiting times. Using this model, we achieved a median residual (actual value minus predicted value) of 0.25 minutes and a standard deviation residual of 6.5 minutes. This means that the majority of our estimates are within 6.5 minutes of the actual wait time. Conclusion: The goal of this project was to define an appropriate machine learning algorithm to estimate waiting times based on the collective knowledge and experience learned from previous patients. Our results offer an opportunity to improve the information that is provided to patients and family members regarding the amount of time they can expect to wait for radiotherapy treatment at our centre. AJ acknowledges support by the CREATE Medical Physics Research Training Network grant of the Natural Sciences and Engineering Research Council (Grant number: 432290) and from the 2014 Q+ Initiative of the McGill University Health Centre.« less

An Efficient Wait-Free Vector

DOE PAGES

Feldman, Steven; Valera-Leon, Carlos; Dechev, Damian

2016-03-01

The vector is a fundamental data structure, which provides constant-time access to a dynamically-resizable range of elements. Currently, there exist no wait-free vectors. The only non-blocking version supports only a subset of the sequential vector API and exhibits significant synchronization overhead caused by supporting opposing operations. Since many applications operate in phases of execution, wherein each phase only a subset of operations are used, this overhead is unnecessary for the majority of the application. To address the limitations of the non-blocking version, we present a new design that is wait-free, supports more of the operations provided by the sequential vector,more » and provides alternative implementations of key operations. These alternatives allow the developer to balance the performance and functionality of the vector as requirements change throughout execution. Compared to the known non-blocking version and the concurrent vector found in Intel’s TBB library, our design outperforms or provides comparable performance in the majority of tested scenarios. Over all tested scenarios, the presented design performs an average of 4.97 times more operations per second than the non-blocking vector and 1.54 more than the TBB vector. In a scenario designed to simulate the filling of a vector, performance improvement increases to 13.38 and 1.16 times. This work presents the first ABA-free non-blocking vector. Finally, unlike the other non-blocking approach, all operations are wait-free and bounds-checked and elements are stored contiguously in memory.« less

Efficiency of performing pulmonary procedures in a shared endoscopy unit: procedure time, turnaround time, delays, and procedure waiting time.

PubMed

Verma, Akash; Lee, Mui Yok; Wang, Chunhong; Hussein, Nurmalah B M; Selvi, Kalai; Tee, Augustine

2014-04-01

The purpose of this study was to assess the efficiency of performing pulmonary procedures in the endoscopy unit in a large teaching hospital. A prospective study from May 20 to July 19, 2013, was designed. The main outcome measures were procedure delays and their reasons, duration of procedural steps starting from patient's arrival to endoscopy unit, turnaround time, total case durations, and procedure wait time. A total of 65 procedures were observed. The most common procedure was BAL (61%) followed by TBLB (31%). Overall procedures for 35 (53.8%) of 65 patients were delayed by ≥ 30 minutes, 21/35 (60%) because of "spillover" of the gastrointestinal and surgical cases into the time block of pulmonary procedure. Time elapsed between end of pulmonary procedure and start of the next procedure was ≥ 30 minutes in 8/51 (16%) of cases. In 18/51 (35%) patients there was no next case in the room after completion of the pulmonary procedure. The average idle time of the room after the end of pulmonary procedure and start of next case or end of shift at 5:00 PM if no next case was 58 ± 53 minutes. In 17/51 (33%) patients the room's idle time was >60 minutes. A total of 52.3% of patients had the wait time >2 days and 11% had it ≥ 6 days, reason in 15/21 (71%) being unavailability of the slot. Most pulmonary procedures were delayed due to spillover of the gastrointestinal and surgical cases into the block time allocated to pulmonary procedures. The most common reason for difficulty encountered in scheduling the pulmonary procedure was slot unavailability. This caused increased procedure waiting time. The strategies to reduce procedure delays and turnaround times, along with improved scheduling methods, may have a favorable impact on the volume of procedures performed in the unit thereby optimizing the existing resources.

Using discrete-event simulation in strategic capacity planning for an outpatient physical therapy service.

PubMed

Rau, Chi-Lun; Tsai, Pei-Fang Jennifer; Liang, Sheau-Farn Max; Tan, Jhih-Cian; Syu, Hong-Cheng; Jheng, Yue-Ling; Ciou, Ting-Syuan; Jaw, Fu-Shan

2013-12-01

This study uses a simulation model as a tool for strategic capacity planning for an outpatient physical therapy clinic in Taipei, Taiwan. The clinic provides a wide range of physical treatments, with 6 full-time therapists in each session. We constructed a discrete-event simulation model to study the dynamics of patient mixes with realistic treatment plans, and to estimate the practical capacity of the physical therapy room. The changes in time-related and space-related performance measurements were used to evaluate the impact of various strategies on the capacity of the clinic. The simulation results confirmed that the clinic is extremely patient-oriented, with a bottleneck occurring at the traction units for Intermittent Pelvic Traction (IPT), with usage at 58.9 %. Sensitivity analysis showed that attending to more patients would significantly increase the number of patients staying for overtime sessions. We found that pooling the therapists produced beneficial results. The average waiting time per patient could be reduced by 45 % when we pooled 2 therapists. We found that treating up to 12 new patients per session had no significantly negative impact on returning patients. Moreover, we found that the average waiting time for new patients decreased if they were given priority over returning patients when called by the therapists.

The surgical waiting time initiative: A review of the Nigerian situation

PubMed Central

Abdulkareem, Imran Haruna

2014-01-01

SUMMARY The concept of surgical waiting time initiative (SWAT) was introduced in developed countries to reduce elective surgery waiting lists and increase efficiency of care. It was supplemented by increasing popularity of day surgery, which shortens elective waiting lists and minimises cancellations. It is established in Western countries, but not in developing countries like Nigeria where it is still evolving. A search was carried out in Pub Med, Google, African journals online (AJOL), Athens and Ovid for relevant publications on elective surgery waiting list in Nigeria, published in English language. Words include waiting/wait time, waiting time initiative, time to surgery, waiting for operations, waiting for intervention, waiting for procedures and time before surgery in Nigeria. A total of 37 articles published from Nigeria in relation to various waiting times were found from the search and fulfilled the inclusion criteria. Among them, 11 publications (29.7%) were related to emergency surgery waiting times, 10 (27%) were related to clinic waiting times, 9 (24.3%) were related to day case surgery, 2 (5.5%) were related to investigation waiting times and only 5 (13.5%) articles were specifically published on elective surgery waiting times. A total of 9 articles (24.5%) were published from obstetrics and gynaecology (OG), 7 (19%) from general surgery, 5 (13.5%) from public health, 3 (8%) from orthopaedics, 3 (8%) from general practice (GP), 3 (8%) from paediatrics/paediatric surgery, 2 (5.5%) from ophthalmology, 1 (2.7%) from ear, nose and throat (ENT), 1 (2.7%) from plastic surgery, 1 (2.7%) from urology and only 1 (2.7%) article was published from dental/maxillofacial surgery. Waiting times mean different things to different health practitioners in Nigeria. There were only 5/37 articles (13.5%) specifically related to elective surgery waiting times in Nigerian hospitals, which show that the concept of the SWAT is still evolving in Nigeria. Of the 37, 11 (24.5%) publications were from obstetrics and gynaecology (O & G) alone, but these were mostly related to emergency antenatal care rather than surgery. Therefore, more research and initiative needs to be undertaken from all the surgical sub-specialties in order to disseminate this concept of SWAT towards early diagnosis and treatment of elective life-threatening conditions, as well as effective patient care. Adopting this concept will help healthcare managers and policy makers to stream line and ring face resources to cater for non-urgent or semi-urgent cases presenting to our hospitals in Nigeria. PMID:25538359

The surgical waiting time initiative: A review of the Nigerian situation.

PubMed

Abdulkareem, Imran Haruna

2014-11-01

The concept of surgical waiting time initiative (SWAT) was introduced in developed countries to reduce elective surgery waiting lists and increase efficiency of care. It was supplemented by increasing popularity of day surgery, which shortens elective waiting lists and minimises cancellations. It is established in Western countries, but not in developing countries like Nigeria where it is still evolving. A search was carried out in Pub Med, Google, African journals online (AJOL), Athens and Ovid for relevant publications on elective surgery waiting list in Nigeria, published in English language. Words include waiting/wait time, waiting time initiative, time to surgery, waiting for operations, waiting for intervention, waiting for procedures and time before surgery in Nigeria. A total of 37 articles published from Nigeria in relation to various waiting times were found from the search and fulfilled the inclusion criteria. Among them, 11 publications (29.7%) were related to emergency surgery waiting times, 10 (27%) were related to clinic waiting times, 9 (24.3%) were related to day case surgery, 2 (5.5%) were related to investigation waiting times and only 5 (13.5%) articles were specifically published on elective surgery waiting times. A total of 9 articles (24.5%) were published from obstetrics and gynaecology (OG), 7 (19%) from general surgery, 5 (13.5%) from public health, 3 (8%) from orthopaedics, 3 (8%) from general practice (GP), 3 (8%) from paediatrics/paediatric surgery, 2 (5.5%) from ophthalmology, 1 (2.7%) from ear, nose and throat (ENT), 1 (2.7%) from plastic surgery, 1 (2.7%) from urology and only 1 (2.7%) article was published from dental/maxillofacial surgery. Waiting times mean different things to different health practitioners in Nigeria. There were only 5/37 articles (13.5%) specifically related to elective surgery waiting times in Nigerian hospitals, which show that the concept of the SWAT is still evolving in Nigeria. Of the 37, 11 (24.5%) publications were from obstetrics and gynaecology (O & G) alone, but these were mostly related to emergency antenatal care rather than surgery. Therefore, more research and initiative needs to be undertaken from all the surgical sub-specialties in order to disseminate this concept of SWAT towards early diagnosis and treatment of elective life-threatening conditions, as well as effective patient care. Adopting this concept will help healthcare managers and policy makers to stream line and ring face resources to cater for non-urgent or semi-urgent cases presenting to our hospitals in Nigeria.

Should I stay or should I go? Hospital emergency department waiting times and demand.

PubMed

Sivey, Peter

2018-03-01

In the absence of the price mechanism, hospital emergency departments rely on waiting times, alongside prioritisation mechanisms, to restrain demand and clear the market. This paper estimates by how much the number of treatments demanded is reduced by a higher waiting time. I use variation in waiting times for low-urgency patients caused by rare and resource-intensive high-urgency patients to estimate the relationship. I find that when waiting times are higher, more low-urgency patients are deterred from treatment and leave the hospital during the waiting period without being treated. The waiting time elasticity of demand for low-urgency patients is approximately -0.25 and is highest for the lowest-urgency patients. Copyright © 2017 John Wiley & Sons, Ltd.

[Influence of waiting time on patient and companion satisfaction].

PubMed

Fontova-Almató, A; Juvinyà-Canal, D; Suñer-Soler, R

2015-01-01

To evaluate patient and companion satisfaction of a hospital Emergency Department and its relationship with waiting time. Prospective, observational study. Hospital de Figueres Emergency Department (Girona, Spain). sociodemographic characteristics, satisfaction level, real and perceived waiting time for triage and being seen by a physician. A total of 285 responses were received from patients and companions. The mean age of the patients and companions (n=257) was 54.6years (SD=18.3). The mean overall satisfaction (n=273) was 7.6 (SD=2.2). Lower perceived waiting time until nurse triage was related to higher overall satisfaction (Spearman rho (ρ)=-0.242, P<.001), and lower perceived waiting time until being seen by physician, with a higher overall satisfaction (ρ=-0.304; P<.001). Users who were informed about estimated waiting time showed higher satisfaction than those who were not informed (P=.001). Perceived waiting time and the information about estimated waiting time determined overall satisfaction. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

Evaluating the primary-to-specialist referral system for elective hip and knee arthroplasty.

PubMed

Fyie, Ken; Frank, Cy; Noseworthy, Tom; Christiansen, Tanya; Marshall, Deborah A

2014-02-01

Persistently long waiting times for hip and knee total joint arthroplasty (TJA) specialist consultations have been identified as a problem. This study described referral processes and practices, and their impact on the waiting time from referral to consultation for TJA. A mixed-methods retrospective study incorporating semi-structured interviews, patient chart reviews and observational studies was conducted at three clinic sites in Alberta, Canada. A total of 218 charts were selected for analysis. Standardized definitions were applied to key event dates. Performance measures included waiting times percentage of referrals initially accepted. Voluntary (patient-related) and involuntary (health system-related) waiting times were quantified. All three clinics had defined, but differing, referral processing rules. The mean time from referral to consultation ranged from 51 to 139 business days. Choosing a specific surgeon for consultation rather than a next available surgeon lengthened waits by 10-47 business days. Involuntary waiting times accounted for at least 11% of total waiting time. Approximately 40-80% of the time patients with TJA wait for surgery was in the consultation period. Fifty-four per cent of new referrals were initially rejected, prolonging patient waits by 8-46 business days. Our results suggest that variation in referral processing led to increased waiting times for patients. The large proportion of total wait attributable to waiting for a surgical consultation makes failure to measure and evaluate this period a significant omission. Improving referral processes and decreasing variation between clinics would improve patient access to these specialist referrals in Alberta. © 2013 John Wiley & Sons, Ltd.

International comparisons of waiting times in health care--limitations and prospects.

PubMed

Viberg, Nina; Forsberg, Birger C; Borowitz, Michael; Molin, Roger

2013-09-01

Long waiting times for health care is an important health policy issue in many countries, and many have introduced some form of national waiting time guarantees. International comparison of waiting times are critical for countries to improve policy and for patients to be able to make informed choices, especially in Europe, where patients have the right to seek care in other countries if there is undue delay. The objective of this study was to describe how countries measure waiting times and to assess whether waiting times can be compared internationally. Twenty-three OECD countries were included. Information was collected through scientific articles, official and unofficial documents and web pages. Fifteen of the 23 countries monitor and publish national waiting time statistics and have some form of waiting time guarantees. There are significant differences in how waiting times are measured: whether they measure the "ongoing" or "completed" waiting period what kind of care the patient is waiting for; the parameters used; and where in the patient journey the measurement begins. Current national waiting time statistics are of limited use for comparing health care availability among the various countries due to the differences in measurements and data collection. Different methodological issues must be taken into account when making such cross-country comparisons. Within the given context of national sovereignty of health systems it would be desirable if countries could collaborate in order to facilitate international comparisons. Such comparisons would be of benefit to all involved in the process of continuous improvement of health services. They would also benefit patients who seek cross-border alternatives for their care. Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Can We Predict Patient Wait Time?

PubMed

Pianykh, Oleg S; Rosenthal, Daniel I

2015-10-01

The importance of patient wait-time management and predictability can hardly be overestimated: For most hospitals, it is the patient queues that drive and define every bit of clinical workflow. The objective of this work was to study the predictability of patient wait time and identify its most influential predictors. To solve this problem, we developed a comprehensive list of 25 wait-related parameters, suggested in earlier work and observed in our own experiments. All parameters were chosen as derivable from a typical Hospital Information System dataset. The parameters were fed into several time-predicting models, and the best parameter subsets, discovered through exhaustive model search, were applied to a large sample of actual patient wait data. We were able to discover the most efficient wait-time prediction factors and models, such as the line-size models introduced in this work. Moreover, these models proved to be equally accurate and computationally efficient. Finally, the selected models were implemented in our patient waiting areas, displaying predicted wait times on the monitors located at the front desks. The limitations of these models are also discussed. Optimal regression models based on wait-line sizes can provide accurate and efficient predictions for patient wait time. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

The effect of waiting times on demand and supply for elective surgery: Evidence from Italy.

PubMed

Riganti, Andrea; Siciliani, Luigi; Fiorio, Carlo V

2017-09-01

Waiting times are a major policy concern in publicly funded health systems across OECD countries. Economists have argued that, in the presence of excess demand, waiting times act as nonmonetary prices to bring demand for and supply of health care in equilibrium. Using administrative data disaggregated by region and surgical procedure over 2010-2014 in Italy, we estimate demand and supply elasticities with respect to waiting times. We employ linear regression models with first differences and instrumental variables to deal with endogeneity of waiting times. We find that demand is inelastic to waiting times while supply is more elastic. Estimates of demand elasticity are between -0.15 to -0.24. Our results have implications on the effectiveness of policies aimed at increasing supply and their ability to reduce waiting times. Copyright © 2017 John Wiley & Sons, Ltd.

Electron Waiting Times of a Cooper Pair Splitter

NASA Astrophysics Data System (ADS)

Walldorf, Nicklas; Padurariu, Ciprian; Jauho, Antti-Pekka; Flindt, Christian

2018-02-01

Electron waiting times are an important concept in the analysis of quantum transport in nanoscale conductors. Here we show that the statistics of electron waiting times can be used to characterize Cooper pair splitters that create spatially separated spin-entangled electrons. A short waiting time between electrons tunneling into different leads is associated with the fast emission of a split Cooper pair, while long waiting times are governed by the slow injection of Cooper pairs from a superconductor. Experimentally, the waiting time distributions can be measured using real-time single-electron detectors in the regime of slow tunneling, where conventional current measurements are demanding. Our work is important for understanding the fundamental transport processes in Cooper pair splitters and the predictions may be verified using current technology.

Waiting time effect of a GM type orifice pulse tube refrigerator

NASA Astrophysics Data System (ADS)

Zhu, Shaowei; Kakimi, Yasuhiro; Matsubara, Yoichi

In a general GM type orifice pulse tube refrigerator, there are two short periods during which both the high pressure valve and the low pressure valve are closed in one cycle. We call the short period `waiting time'. The pressure differences across the high pressure valve and the low pressure valve are decreased by using long waiting time. The pressure difference loss is decreased. Thus, the cooling capacity and the efficiency are increased, and the no-load temperature is decreased. The mechanism of the waiting time is discussed with numerical analysis and verified by experiments. Experiments show that there is an optimum waiting time for the no-load temperature, the cooling capacity and the efficiency, respectively. The no-load temperature of 40.3 K was achieved with a 90° waiting time. The cooling capacity of 58 W at 80 K was achieved with a 60° waiting time. The no-load temperature of 45.1 K and the cooling capacity of 45 W at 80 K were achieved with a 1° waiting time.

Do waiting times affect health outcomes? Evidence from coronary bypass.

PubMed

Moscelli, Giuseppe; Siciliani, Luigi; Tonei, Valentina

2016-07-01

Long waiting times for non-emergency services are a feature of several publicly-funded health systems. A key policy concern is that long waiting times may worsen health outcomes: when patients receive treatment, their health condition may have deteriorated and health gains reduced. This study investigates whether patients in need of coronary bypass with longer waiting times are associated with poorer health outcomes in the English National Health Service over 2000-2010. Exploiting information from the Hospital Episode Statistics (HES), we measure health outcomes with in-hospital mortality and 28-day emergency readmission following discharge. Our results, obtained combining hospital fixed effects and instrumental variable methods, find no evidence of waiting times being associated with higher in-hospital mortality and weak association between waiting times and emergency readmission following a surgery. The results inform the debate on the relative merits of different types of rationing in healthcare systems. They are to some extent supportive of waiting times as an acceptable rationing mechanism, although further research is required to explore whether long waiting times affect other aspects of individuals' life. Copyright © 2016 Elsevier Ltd. All rights reserved.

Waiting endurance time estimation of electric two-wheelers at signalized intersections.

PubMed

Huan, Mei; Yang, Xiao-bao

2014-01-01

The paper proposed a model for estimating waiting endurance times of electric two-wheelers at signalized intersections using survival analysis method. Waiting duration times were collected by video cameras and they were assigned as censored and uncensored data to distinguish between normal crossing and red-light running behavior. A Cox proportional hazard model was introduced, and variables revealing personal characteristics and traffic conditions were defined as covariates to describe the effects of internal and external factors. Empirical results show that riders do not want to wait too long to cross intersections. As signal waiting time increases, electric two-wheelers get impatient and violate the traffic signal. There are 12.8% of electric two-wheelers with negligible wait time. 25.0% of electric two-wheelers are generally nonrisk takers who can obey the traffic rules after waiting for 100 seconds. Half of electric two-wheelers cannot endure 49.0 seconds or longer at red-light phase. Red phase time, motor vehicle volume, and conformity behavior have important effects on riders' waiting times. Waiting endurance times would decrease with the longer red-phase time, the lower traffic volume, or the bigger number of other riders who run against the red light. The proposed model may be applicable in the design, management and control of signalized intersections in other developing cities.

Waiting Endurance Time Estimation of Electric Two-Wheelers at Signalized Intersections

PubMed Central

Huan, Mei; Yang, Xiao-bao

2014-01-01

The paper proposed a model for estimating waiting endurance times of electric two-wheelers at signalized intersections using survival analysis method. Waiting duration times were collected by video cameras and they were assigned as censored and uncensored data to distinguish between normal crossing and red-light running behavior. A Cox proportional hazard model was introduced, and variables revealing personal characteristics and traffic conditions were defined as covariates to describe the effects of internal and external factors. Empirical results show that riders do not want to wait too long to cross intersections. As signal waiting time increases, electric two-wheelers get impatient and violate the traffic signal. There are 12.8% of electric two-wheelers with negligible wait time. 25.0% of electric two-wheelers are generally nonrisk takers who can obey the traffic rules after waiting for 100 seconds. Half of electric two-wheelers cannot endure 49.0 seconds or longer at red-light phase. Red phase time, motor vehicle volume, and conformity behavior have important effects on riders' waiting times. Waiting endurance times would decrease with the longer red-phase time, the lower traffic volume, or the bigger number of other riders who run against the red light. The proposed model may be applicable in the design, management and control of signalized intersections in other developing cities. PMID:24895659

[Waiting time for the first colposcopic examination in women with abnormal Papanicolaou test].

PubMed

Nascimento, Maria Isabel do; Rabelo, Irene Machado Moraes Alvarenga; Cardoso, Fabrício Seabra Polidoro; Musse, Ricardo Neif Vieira

2015-08-01

To evaluate the waiting times before obtaining the first colposcopic examination for women with abnormal Papanicolaou smears. Retrospective cohort study conducted on patients who required a colposcopic examination to clarify an abnormal pap test, between 2002 January and 2008 August, in a metropolitan region of Brazil. The waiting times were defined as: Total Waiting Time (interval between the date of the pap test result and the date of the first colposcopic examination); Partial A Waiting Time (interval between the date of the pap test result and the date of referral); Partial B Waiting Time (interval between the date of referral and the date of the first colposcopic examination). Means, medians, relative and absolute frequencies were calculated. The Kruskal-Wallis test and Pearson's chi-square test were used to determine statistical significance. A total of 1,544 women with mean of age of 34 years (SD=12.6 years) were analyzed. Most of them had access to colposcopic examination within 30 days (65.8%) or 60 days (92.8%) from referral. Mean Total Waiting Time, Partial A Waiting Time, and Partial B Waiting Time were 94.5 days (SD=96.8 days), 67.8 days (SD=95.3 days) and 29.2 days (SD=35.1 days), respectively. A large part of the women studied had access to colposcopic examination within 60 days after referral, but Total waiting time was long. Measures to reduce the waiting time for obtaining the first colposcopic examination can help to improve the quality of care in the context of cervical cancer control in the region, and ought to be addressed at the phase between the date of the pap test results and the date of referral to the teaching hospital.

Outpatient clinic waiting time, provider communication styles and satisfaction with healthcare in India.

PubMed

Mehra, Payal

2016-08-08

Purpose - The purpose of this paper is to evaluate the impact of extended waiting time on patients' perceptions of provider communication skills and in-clinic satisfaction, in three major cities in India. Design/methodology/approach - In total, 625 patients were interviewed. The multivariate general linear model was used to determine the causality and relationship between the independent and the dependent variable. A moderation analysis was also conducted to assess waiting time role as a potential moderator in doctor-patient communication. Findings - Results show that patients with higher waiting time were less satisfied with health care quality. Male patients and patients of male providers were more affected by extended waiting time than female patients and patients of female providers. The advanced regression analysis, however, suggests weak support for waiting time and its effect on overall satisfaction with clinic quality. Waiting time did not moderate the relationship between satisfaction with dominant communication style, and overall satisfaction at the outpatient clinic. Research limitations/implications - A cross-sectional study does not easily lend itself to explaining causality with certainty. Thus, sophisticated techniques, such as structural equation modelling may also be utilized to assess the influence of extended waiting time on satisfaction with healthcare at outpatient clinics. Practical implications - Findings are relevant for providers as the onus is on them to ensure patient satisfaction. They should initiate a workable waiting time assessment model at the operational level. Originality/value - There has been a relatively lesser focus on patient waiting time in patient-provider satisfaction studies. In India, this aspect is still vastly unexplored especially in the context of outpatient clinics. Gender wise pattern of patient satisfaction and waiting time is also missing in most studies.

Sci-Fri AM: Quality, Safety, and Professional Issues 04: Predicting waiting times in Radiation Oncology using machine learning

DOE Office of Scientific and Technical Information (OSTI.GOV)

Joseph, Ackeem; Herrera, David; Hijal, Tarek

We describe a method for predicting waiting times in radiation oncology. Machine learning is a powerful predictive modelling tool that benefits from large, potentially complex, datasets. The essence of machine learning is to predict future outcomes by learning from previous experience. The patient waiting experience remains one of the most vexing challenges facing healthcare. Waiting time uncertainty can cause patients, who are already sick and in pain, to worry about when they will receive the care they need. In radiation oncology, patients typically experience three types of waiting: Waiting at home for their treatment plan to be prepared Waiting inmore » the waiting room for daily radiotherapy Waiting in the waiting room to see a physician in consultation or follow-up These waiting periods are difficult for staff to predict and only rough estimates are typically provided, based on personal experience. In the present era of electronic health records, waiting times need not be so uncertain. At our centre, we have incorporated the electronic treatment records of all previously-treated patients into our machine learning model. We found that the Random Forest Regression model provides the best predictions for daily radiotherapy treatment waiting times (type 2). Using this model, we achieved a median residual (actual minus predicted value) of 0.25 minutes and a standard deviation residual of 6.5 minutes. The main features that generated the best fit model (from most to least significant) are: Allocated time, median past duration, fraction number and the number of treatment fields.« less

Public involvement in the priority setting activities of a wait time management initiative: a qualitative case study.

PubMed

Bruni, Rebecca A; Laupacis, Andreas; Levinson, Wendy; Martin, Douglas K

2007-11-16

As no health system can afford to provide all possible services and treatments for the people it serves, each system must set priorities. Priority setting decision makers are increasingly involving the public in policy making. This study focuses on public engagement in a key priority setting context that plagues every health system around the world: wait list management. The purpose of this study is to describe and evaluate priority setting for the Ontario Wait Time Strategy, with special attention to public engagement. This study was conducted at the Ontario Wait Time Strategy in Ontario, Canada which is part of a Federal-Territorial-Provincial initiative to improve access and reduce wait times in five areas: cancer, cardiac, sight restoration, joint replacements, and diagnostic imaging. There were two sources of data: (1) over 25 documents (e.g. strategic planning reports, public updates), and (2) 28 one-on-one interviews with informants (e.g. OWTS participants, MOHLTC representatives, clinicians, patient advocates). Analysis used a modified thematic technique in three phases: open coding, axial coding, and evaluation. The Ontario Wait Time Strategy partially meets the four conditions of 'accountability for reasonableness'. The public was not directly involved in the priority setting activities of the Ontario Wait Time Strategy. Study participants identified both benefits (supporting the initiative, experts of the lived experience, a publicly funded system and sustainability of the healthcare system) and concerns (personal biases, lack of interest to be involved, time constraints, and level of technicality) for public involvement in the Ontario Wait Time Strategy. Additionally, the participants identified concern for the consequences (sustainability, cannibalism, and a class system) resulting from the Ontario Wait Times Strategy. We described and evaluated a wait time management initiative (the Ontario Wait Time Strategy) with special attention to public engagement, and provided a concrete plan to operationalize a strategy for improving public involvement in this, and other, wait time initiatives.

Public involvement in the priority setting activities of a wait time management initiative: a qualitative case study

PubMed Central

Bruni, Rebecca A; Laupacis, Andreas; Levinson, Wendy; Martin, Douglas K

2007-01-01

Background As no health system can afford to provide all possible services and treatments for the people it serves, each system must set priorities. Priority setting decision makers are increasingly involving the public in policy making. This study focuses on public engagement in a key priority setting context that plagues every health system around the world: wait list management. The purpose of this study is to describe and evaluate priority setting for the Ontario Wait Time Strategy, with special attention to public engagement. Methods This study was conducted at the Ontario Wait Time Strategy in Ontario, Canada which is part of a Federal-Territorial-Provincial initiative to improve access and reduce wait times in five areas: cancer, cardiac, sight restoration, joint replacements, and diagnostic imaging. There were two sources of data: (1) over 25 documents (e.g. strategic planning reports, public updates), and (2) 28 one-on-one interviews with informants (e.g. OWTS participants, MOHLTC representatives, clinicians, patient advocates). Analysis used a modified thematic technique in three phases: open coding, axial coding, and evaluation. Results The Ontario Wait Time Strategy partially meets the four conditions of 'accountability for reasonableness'. The public was not directly involved in the priority setting activities of the Ontario Wait Time Strategy. Study participants identified both benefits (supporting the initiative, experts of the lived experience, a publicly funded system and sustainability of the healthcare system) and concerns (personal biases, lack of interest to be involved, time constraints, and level of technicality) for public involvement in the Ontario Wait Time Strategy. Additionally, the participants identified concern for the consequences (sustainability, cannibalism, and a class system) resulting from the Ontario Wait Times Strategy. Conclusion We described and evaluated a wait time management initiative (the Ontario Wait Time Strategy) with special attention to public engagement, and provided a concrete plan to operationalize a strategy for improving public involvement in this, and other, wait time initiatives. PMID:18021393

Nonergodic property of the space-time coupled CTRW: Dependence on the long-tailed property and correlation

NASA Astrophysics Data System (ADS)

Liu, Jian; Li, Baohe; Chen, Xiaosong

2018-02-01

The space-time coupled continuous time random walk model is a stochastic framework of anomalous diffusion with many applications in physics, geology and biology. In this manuscript the time averaged mean squared displacement and nonergodic property of a space-time coupled continuous time random walk model is studied, which is a prototype of the coupled continuous time random walk presented and researched intensively with various methods. The results in the present manuscript show that the time averaged mean squared displacements increase linearly with lag time which means ergodicity breaking occurs, besides, we find that the diffusion coefficient is intrinsically random which shows both aging and enhancement, the analysis indicates that the either aging or enhancement phenomena are determined by the competition between the correlation exponent γ and the waiting time's long-tailed index α.

Impact of audio/visual systems on pediatric sedation in magnetic resonance imaging.

PubMed

Lemaire, Colette; Moran, Gerald R; Swan, Hans

2009-09-01

To evaluate the use of an audio/visual (A/V) system in pediatric patients as an alternative to sedation in magnetic resonance imaging (MRI) in terms of wait times, image quality, and patient experience. Pediatric MRI examinations from April 8 to August 11, 2008 were compared to those 1 year prior to the installation of the A/V system. Data collected included age, requisition receive date, scan date, and whether sedation was used. A posttest questionnaire was used to evaluate patient experience. Image quality was assessed by two radiologists. Over the 4 months in 2008 there was an increase of 7.2% (115; P < 0.05) of pediatric patients scanned and a decrease of 15.4%, (67; P = 0.32) requiring sedation. The average sedation wait time decreased by 33% (5.8 months) (P < 0.05). Overall, the most positively affected group was the 4-10 years. The questionnaire resulted in 84% of participants expressing a positive reaction to the A/V system. Radiological evaluation revealed no changes in image quality between A/V users and sedates. The A/V system was a successful method to reduce patient motion and obtain a quality diagnostic MRI without the use of sedation in pediatric patients. It provided a safer option, a positive experience, and decreased wait times.

Priority Queuing Models for Hospital Intensive Care Units and Impacts to Severe Case Patients

PubMed Central

Hagen, Matthew S.; Jopling, Jeffrey K; Buchman, Timothy G; Lee, Eva K.

2013-01-01

This paper examines several different queuing models for intensive care units (ICU) and the effects on wait times, utilization, return rates, mortalities, and number of patients served. Five separate intensive care units at an urban hospital are analyzed and distributions are fitted for arrivals and service durations. A system-based simulation model is built to capture all possible cases of patient flow after ICU admission. These include mortalities and returns before and after hospital exits. Patients are grouped into 9 different classes that are categorized by severity and length of stay (LOS). Each queuing model varies by the policies that are permitted and by the order the patients are admitted. The first set of models does not prioritize patients, but examines the advantages of smoothing the operating schedule for elective surgeries. The second set analyzes the differences between prioritizing admissions by expected LOS or patient severity. The last set permits early ICU discharges and conservative and aggressive bumping policies are contrasted. It was found that prioritizing patients by severity considerably reduced delays for critical cases, but also increased the average waiting time for all patients. Aggressive bumping significantly raised the return and mortality rates, but more conservative methods balance quality and efficiency with lowered wait times without serious consequences. PMID:24551379

Surveillance or Self-Surveillance? Behavioral Cues Can Increase the Rate of Drivers’ Pro-Environmental Behavior at a Long Wait Stop

PubMed Central

Meleady, Rose; Abrams, Dominic; Van de Vyver, Julie; Hopthrow, Tim; Mahmood, Lynsey; Player, Abigail; Lamont, Ruth; Leite, Ana C.

2017-01-01

By leaving their engines idling for long periods, drivers contribute unnecessarily to air pollution, waste fuel, and produce noise and fumes that harm the environment. Railway level crossings are sites where many cars idle, many times a day. In this research, testing two psychological theories of influence, we examine the potential to encourage drivers to switch off their ignition while waiting at rail crossings. Two field studies presented different signs at a busy rail crossing site with a 2-min average wait. Inducing public self-focus (via a “Watching Eyes” stimulus) was not effective, even when accompanied by a written behavioral instruction. Instead, cueing a private-self focus (“think of yourself”) was more effective, doubling the level of behavioral compliance. These findings confirm the need to engage the self when trying to instigate self-regulatory action, but that cues evoking self-surveillance may sometimes be more effective than cues that imply external surveillance. PMID:29200472

Influence of positive distractions on children in two clinic waiting areas.

PubMed

Pati, Debajyoti; Nanda, Upali

2011-01-01

To examine the influence of positive distraction on the behavior and activity of children in two clinic waiting areas. People spend a considerable proportion of time waiting in hospitals. Studies show that the quality of waiting environments influences the perception of quality of care and caregivers, that perception of waiting time is a better indicator of patient satisfaction than actual waiting time, and that the waiting environment contributes to the perception of wait time. In fact, the attractiveness of the physical environment in waiting areas has been shown to be significantly associated with higher perceived quality of care, less anxiety, and higher reported positive interaction with staff. Can positive distractions in waiting areas improve the waiting experience, as indicated by the behavior and activities of children waiting for treatment? Five distraction conditions were randomly introduced in the waiting area of the dental and cardiac clinics of a major pediatric tertiary care center through a single plasma screen intervention. The attention, behavior, and activities of waiting children were recorded. Data on 158 pediatric patients were collected over 12 days during December 2008 and January 2009. Data analysis shows that the introduction of distraction conditions was associated with more calm behavior and less fine and gross movement, suggesting significant calming effects associated with the distraction conditions. Data also suggest that positive distraction conditions are significant attention grabbers and could be an important contributor to improving the waiting experience for children in hospitals by improving environmental attractiveness.

The relationship between educational attainment and waiting time among the elderly in Norway.

PubMed

Carlsen, Fredrik; Kaarboe, Oddvar Martin

2015-11-01

We investigate whether educational attainment affects waiting time of elderly patients in somatic hospitals. We consider three distinct pathways; that patients with different educational attainment have different disease patterns, that patients with different levels of education receive treatments at different hospitals, and that patient choice and supply of local health services within hospital catchment areas explain unequal waiting time of different educational groups. We find evidence of an educational gradient in waiting time for male patients, but not for female patients. Conditional on age, male patients with tertiary education wait 45% shorter than male patients with secondary or primary education. The first pathway is not quantitatively important as controlling for disease patters has little effect on relative waiting times. The second pathway is important. Relative to patients with primary education, variation in waiting time and education level across local hospitals contributes to higher waiting time for male patients with secondary education and female patients with secondary or tertiary education and lower waiting time for male patients with tertiary education. These effects are in the order of 15-20%. The third pathway is also quantitatively important. The educational gradients within catchment areas disappear when we control for travel distance and supply of private specialists. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Individual and system influences on waiting time for substance abuse treatment.

PubMed

Carr, Carey J A; Xu, Jiangmin; Redko, Cristina; Lane, D Timothy; Rapp, Richard C; Goris, John; Carlson, Robert G

2008-03-01

Waiting time is a contemporary reality of many drug abuse treatment programs, resulting in substantial problems for substance users and society. Individual and system factors that influence waiting time are diverse and may vary at different points in the treatment continuum. This study assessed waiting time preceding clinical assessment at a centralized intake unit and during the period after the assessment but before treatment entry. The present study included 577 substance abusers who were enrolled in a large clinical trial of two brief treatment interventions in a midsize metropolitan area in Ohio. Bivariate analyses identified individual and system factors that influenced preassessment and postassessment waiting time, as well as total wait to treatment services. Multivariate analyses demonstrated that longer wait time for an assessment is influenced by being court referred, less belief in having a substance abuse problem, and less desire for change. A shorter wait to actually enter treatment is predicted by having a case manager, being more ready for treatment, and having less severe employment and alcohol problems. The different influences present during the two waiting periods suggest that assessment and treatment programs need to implement system changes and entry enhancement interventions that are specific to the needs of substance abusers at each waiting period.

Equity in specialist waiting times by socioeconomic groups: evidence from Spain.

PubMed

Abásolo, Ignacio; Negrín-Hernández, Miguel A; Pinilla, Jaime

2014-04-01

In countries with publicly financed health care systems, waiting time--rather than price--is the rationing mechanism for access to health care services. The normative statement underlying such a rationing device is that patients should wait according to need and irrespective of socioeconomic status or other non-need characteristics. The aim of this paper is to test empirically that waiting times for publicly funded specialist care do not depend on patients' socioeconomic status. Waiting times for specialist care can vary according to the type of medical specialty, type of consultation (review or diagnosis) and the region where patients' reside. In order to take into account such variability, we use Bayesian random parameter models to explain waiting times for specialist care in terms of need and non-need variables. We find that individuals with lower education and income levels wait significantly more time than their counterparts.

Hospital discharge queues in Massachusetts.

PubMed

Gruenberg, L W; Willemain, T R

1982-02-01

There is growing concern over the inappropriate utilization of health care facilities. The high cost of hospital care and the apparent shortage of nursing home beds have focused attention on one aspect of this problem: the clinically unnecessary days (sometimes called "administrative days" or "ADs") spent in hospitals by patients who are awaiting placement in long-term care facilities. In this study, data from a 1976 Massachusetts Department of Public Health survey of patients backed up in hospitals were analyzed to determine the magnitude of the problem and to examine the influence of several major factors that had been hypothesized in previous studies to contribute to the backup. We demonstrate that the average delay of a patient found waiting in a "snapshot" survey (which is often used to estimate the magnitude of the problem) is significantly greater than the average delay experienced by a typical discharged patient. We show that there are at least two major factors that influence the delay time: nursing home preferences in accepting certain types of patients and nursing home occupancy rates in the hospital service area. Neither medical-surgical occupancy rate nor the number of AD patients waiting in the hospital was significantly correlated with the delay time.

Addition of Adult-to-Adult Living Donation to Liver Transplant Programs Improves Survival but at an Increased Cost1-2

PubMed Central

Northup, Patrick G.; Abecassis, Michael M.; Englesbe, Michael J.; Emond, Jean C.; Lee, Vanessa D.; Stukenborg, George J.; Tong, Lan; Berg, Carl L.

2011-01-01

We performed a cost-effectiveness analysis exploring the cost and benefits of LDLT using outcomes data from the Adult to Adult Living Donor Liver Transplantation Cohort Study (A2ALL). A multistage Markov decision analysis model was developed with treatment strategies including medical management only (strategy 1), waiting list with possible deceased donor liver transplant (strategy 2), and waiting list with possible LDLT or DDLT (strategy 3) over ten years. Decompensated cirrhosis with medical management offered 2.0 quality adjusted life years (QALY) survival while costing an average of $65,068, waiting list with possible DDLT offered 4.4 QALY survival and a mean cost $151,613, and waiting list with possible DDLT or LDLT offered 4.9 QALY survival and a mean cost $208,149. Strategy 2 had an incremental cost effectiveness ratio (ICER) of $35,976 over strategy 1 while strategy 3 produced an ICER of $106,788 over strategy 2. On average, strategy 3 cost $47,693 more per QALY than strategy 1. Both DDLT and LDLT are cost-effective compared to medical management of cirrhosis over our ten year study period. The addition of LDLT to a standard waiting list DDLT program is effective at improving recipient survival and preventing waiting list deaths but at a greater cost. PMID:19177435

An Efficient Randomized Algorithm for Real-Time Process Scheduling in PicOS Operating System

NASA Astrophysics Data System (ADS)

Helmy*, Tarek; Fatai, Anifowose; Sallam, El-Sayed

PicOS is an event-driven operating environment designed for use with embedded networked sensors. More specifically, it is designed to support the concurrency in intensive operations required by networked sensors with minimal hardware requirements. Existing process scheduling algorithms of PicOS; a commercial tiny, low-footprint, real-time operating system; have their associated drawbacks. An efficient, alternative algorithm, based on a randomized selection policy, has been proposed, demonstrated, confirmed for efficiency and fairness, on the average, and has been recommended for implementation in PicOS. Simulations were carried out and performance measures such as Average Waiting Time (AWT) and Average Turn-around Time (ATT) were used to assess the efficiency of the proposed randomized version over the existing ones. The results prove that Randomized algorithm is the best and most attractive for implementation in PicOS, since it is most fair and has the least AWT and ATT on average over the other non-preemptive scheduling algorithms implemented in this paper.

ÖGRO survey on radiotherapy capacity in Austria : Status quo and estimation of future demands.

PubMed

Zurl, Brigitte; Bayerl, Anja; De Vries, Alexander; Geinitz, Hans; Hawliczek, Robert; Knocke-Abulesz, Tomas-Henrik; Lukas, Peter; Pötter, Richard; Raunik, Wolfgang; Scholz, Brigitte; Schratter-Sehn, Annemarie; Sedlmayer, Felix; Seewald, Dietmar; Selzer, Edgar; Kapp, Karin S

2018-04-01

A comprehensive evaluation of the current national and regional radiotherapy capacity in Austria with an estimation of demands for 2020 and 2030 was performed by the Austrian Society for Radiation Oncology, Radiobiology and Medical Radiophysics (ÖGRO). All Austrian centers provided data on the number of megavoltage (MV) units, treatment series, fractions, percentage of retreatments and complex treatment techniques as well as the daily operating hours for the year 2014. In addition, waiting times until the beginning of radiotherapy were prospectively recorded over the first quarter of 2015. National and international epidemiological prediction data were used to estimate future demands. For a population of 8.51 million, 43 MV units were at disposal. In 14 radiooncological centers, a total of 19,940 series with a mean number of 464 patients per MV unit/year and a mean fraction number of 20 (range 16-24) per case were recorded. The average re-irradiation ratio was 14%. The survey on waiting times until start of treatment showed provision shortages in 40% of centers with a mean waiting time of 13.6 days (range 0.5-29.3 days) and a mean maximum waiting time of 98.2 days. Of all centers, 21% had no or only a limited ability to deliver complex treatment techniques. Predictions for 2020 and 2030 indicate an increased need in the overall number of MV units to a total of 63 and 71, respectively. This ÖGRO survey revealed major regional differences in radiooncological capacity. Considering epidemiological developments, an aggravation of the situation can be expected shortly. This analysis serves as a basis for improved public regional health care planning.

Psychiatric Emergency Services - Can Duty-Hour Changes Help Residents and Patients?

PubMed

Brainch, Navjot; Schule, Patrick; Laurel, Faith; Bodic, Maria; Jacob, Theresa

2018-04-14

Limitations on resident duty hours have been widely introduced with the intention of decreasing resident fatigue and improving patient outcomes. While there is evidence of improvement in resident well-being and education following such initiatives, they have inadvertently resulted in increased number of hand-offs between clinicians leading to potential errors in patient care. Current literature emphasizes need for more specialty/setting-specific scheduling, while considering residents' opinions when implementing duty-hour reforms. There are no reports examining the impact of duty-hour changes on residents or patients in psychiatric emergency service (PES) settings. Our purpose was to assess the impact of a recent scheduling change and decrease in overall duty hours, on resident well-being and sense of burnout, while also evaluating changes to patient wait-time and length of stay (LOS) in PES. Residents completed Maslach Burnout Inventory and anonymous surveys focusing on: fatigue, sleep, life outside work for shifts - regular (8 am-8 pm) and swing shifts (12 pm-10 pm). Data from the electronic medical records were collected for 6 months pre- and post-schedule change (January 2016-February 2017), for LOS and patient wait-time. Residents' preference for shifts was split. However, 86% reported getting enough sleep during swing shifts, while 83% reported lack of sleep during regular shifts. The average patient wait-time and LOS significantly decreased from 169 to 147 and 690 to 515 min, respectively. The change to swing shifts significantly impacts LOS and patient wait-time. The short shifts demonstrated an improvement in well-being for residents, but were not the singular factor for overall resident satisfaction.

A Cross-Sectional Survey of Population-Wide Wait Times for Patients Seeking Medical vs. Cosmetic Dermatologic Care.

PubMed

Yadav, Geeta; Goldberg, Hanna R; Barense, Morgan D; Bell, Chaim M

2016-01-01

Though previous work has examined some aspects of the dermatology workforce shortage and access to dermatologic care, little research has addressed the effect of rising interest in cosmetic procedures on access to medical dermatologic care. Our objective was to determine the wait times for Urgent and Non-Urgent medical dermatologic care and Cosmetic dermatology services at a population level and to examine whether wait times for medical care are affected by offering cosmetic services. A population-wide survey of dermatology practices using simulated calls asking for the earliest appointment for a Non-Urgent, Urgent and Cosmetic service. Response rates were greater than 89% for all types of care. Wait times across all types of care were significantly different from each other (all P < 0.05). Cosmetic care was associated with the shortest wait times (3.0 weeks; Interquartile Range (IQR) = 0.4-3.4), followed by Urgent care (9.0 weeks; IQR = 2.1-12.9), then Non-Urgent Care (12.7 weeks; IQR = 4.4-16.4). Wait times for practices offering only Urgent care were not different from practices offering both Urgent and Cosmetic care (10.3 vs. 7.0 weeks). Longer wait times and greater variation for Urgent and Non-Urgent dermatologic care and shorter wait times and less variation for Cosmetic care. Wait times were significantly longer in regions with lower dermatologist density. Provision of Cosmetic services did not increase wait times for Urgent care. These findings suggest an overall dermatology workforce shortage and a need for a more streamlined referral system for dermatologic care.

In the queue for coronary artery bypass grafting: patients' perceptions of risk and 'maximal acceptable waiting time'.

PubMed

Llewellyn-Thomas, H; Thiel, E; Paterson, M; Naylor, D

1999-04-01

To elicit patients' maximal acceptable waiting times (MAWT) for non-urgent coronary artery bypass grafting (CABG), and to determine if MAWT is related to prior expectations of waiting times, symptom burden, expected relief, or perceived risks of myocardial infarction while waiting. Seventy-two patients on an elective CABG waiting list chose between two hypothetical but plausible options: a 1-month wait with 2% risk of surgical mortality, and a 6-month wait with 1% risk of surgical mortality. Waiting time in the 6-month option was varied up if respondents chose the 6-month/lower risk option, and down if they chose the 1-month/higher risk option, until the MAWT switch point was reached. Patients also reported their expected waiting time, perceived risks of myocardial infarction while waiting, current function, expected functional improvement and the value of that improvement. Only 17 (24%) patients chose the 6-month/1% risk option, while 55 (76%) chose the 1-month/2% risk option. The median MAWT was 2 months; scores ranged from 1 to 12 months (with two outliers). Many perceived high cumulative risks of myocardial infarction if waiting for 1 (upper quartile, > or = 1.45%) or 6 (upper quartile, > or = 10%) months. However, MAWT scores were related only to expected waiting time (r = 0.47; P < 0.0001). Most patients reject waiting 6 months for elective CABG, even if offered along with a halving in surgical mortality (from 2% to 1%). Intolerance for further delay seems to be determined primarily by patients' attachment to their scheduled surgical dates. Many also have severely inflated perceptions of their risk of myocardial infarction in the queue. These results suggest a need for interventions to modify patients' inaccurate risk perceptions, particularly if a scheduled surgical date must be deferred.

An optimal general type-2 fuzzy controller for Urban Traffic Network.

PubMed

Khooban, Mohammad Hassan; Vafamand, Navid; Liaghat, Alireza; Dragicevic, Tomislav

2017-01-01

Urban traffic network model is illustrated by state-charts and object-diagram. However, they have limitations to show the behavioral perspective of the Traffic Information flow. Consequently, a state space model is used to calculate the half-value waiting time of vehicles. In this study, a combination of the general type-2 fuzzy logic sets and the Modified Backtracking Search Algorithm (MBSA) techniques are used in order to control the traffic signal scheduling and phase succession so as to guarantee a smooth flow of traffic with the least wait times and average queue length. The parameters of input and output membership functions are optimized simultaneously by the novel heuristic algorithm MBSA. A comparison is made between the achieved results with those of optimal and conventional type-1 fuzzy logic controllers. Copyright © 2016 ISA. Published by Elsevier Ltd. All rights reserved.

Parental satisfaction with paediatric care, triage and waiting times.

PubMed

Fitzpatrick, Nicholas; Breen, Daniel T; Taylor, James; Paul, Eldho; Grosvenor, Robert; Heggie, Katrina; Mahar, Patrick D

2014-04-01

The present study aims to determine parental and guardian's perceptions of paediatric emergency care and satisfaction with care, waiting times and triage category in a community ED. A structured questionnaire was provided to parents or guardians of paediatric patients presenting to emergency. The survey evaluated parent perceptions of waiting time, environment/facilities, professionalism and communication skills of staff and overall satisfaction of care. One hundred and thirty-three completed questionnaires were received from parents of paediatric patients. Responses were overall positive with respect to the multiple domains assessed. Parents generally considered waiting times to be appropriate and consistent with triage categories. Overall satisfaction was not significantly different for varying treatment or waiting times. Patients triaged as semi-urgent were of the opinion that waiting times were less appropriate than urgent, less-urgent or non-urgent patients. On the basis of the present study, patient perceptions and overall satisfaction of care does not appear to be primarily influenced by time spent waiting or receiving treatment. Attempts made at the triage process to ensure that semi-urgent patients have reasonable expectations of waiting times might provide an opportunity to improve these patients' expectations and perceptions. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

The influence of insurance status on waiting times in German acute care hospitals: an empirical analysis of new data

PubMed Central

2009-01-01

Background There is an ongoing debate in Germany about the assumption that patients with private health insurance (PHI) benefit from better access to medical care, including shorter waiting times (Lüngen et al. 2008), compared to patients with statutory health insurance (SHI). Problem Existing analyses of the determinants for waiting times in Germany are a) based on patient self-reports and b) do not cover the inpatient sector. This paper aims to fill both gaps by (i) generating new primary data and (ii) analyzing waiting times in German hospitals. Methods We requested individual appointments from 485 hospitals within an experimental study design, allowing us to analyze the impact of PHI versus SHI on waiting times (Asplin et al. 2005). Results In German acute care hospitals patients with PHI have significantly shorter waiting times than patients with SHI. Conclusion Discrimination in waiting times by insurance status does occur in the German acute hospital sector. Since there is very little transparency in treatment quality in Germany, we do not know whether discrimination in waiting times leads to discrimination in the quality of treatment. This is an important issue for future research. PMID:20025744

Outpatient Office Wait Times And Quality Of Care For Medicaid Patients.

PubMed

Oostrom, Tamar; Einav, Liran; Finkelstein, Amy

2017-05-01

The time patients spend in a doctor's waiting room prior to a scheduled appointment is an important component of the quality of the overall health care experience. We analyzed data on twenty-one million outpatient visits obtained from electronic health record systems, which allowed us to measure time spent in the waiting room beyond the scheduled appointment time. Median wait time was a little more than four minutes. Almost one-fifth of visits had waits longer than twenty minutes, and 10 percent were more than thirty minutes. Waits were shorter for early-morning appointments, for younger patients, and at larger practices. Median wait time was 4.1 minutes for privately insured patients and 4.6 minutes for Medicaid patients. After adjustment for patient and appointment characteristics, Medicaid patients were 20 percent more likely than the privately insured patients to wait longer than twenty minutes, with most of this disparity explained by differences in practices and providers they saw. Wait times for Medicaid patients relative to privately insured patients were longer in states with relatively lower Medicaid reimbursement rates. The study complements other work that suggests that Medicaid patients face some additional barriers in the receipt of care. Project HOPE—The People-to-People Health Foundation, Inc.

Waiting time disparities in breast cancer diagnosis and treatment: a population-based study in France.

PubMed

Molinié, F; Leux, C; Delafosse, P; Ayrault-Piault, S; Arveux, P; Woronoff, A S; Guizard, A V; Velten, M; Ganry, O; Bara, S; Daubisse-Marliac, L; Tretarre, B

2013-10-01

Waiting times are key indicators of a health's system performance, but are not routinely available in France. We studied waiting times for diagnosis and treatment according to patients' characteristics, tumours' characteristics and medical management options in a sample of 1494 breast cancers recorded in population-based registries. The median waiting time from the first imaging detection to the treatment initiation was 34 days. Older age, co-morbidity, smaller size of tumour, detection by organised screening, biopsy, increasing number of specimens removed, multidisciplinary consulting meetings and surgery as initial treatment were related to increased waiting times in multivariate models. Many of these factors were related to good practices guidelines. However, the strong influence of organised screening programme and the disparity of waiting times according to geographical areas were of concern. Better scheduling of diagnostic tests and treatment propositions should improve waiting times in the management of breast cancer in France. Copyright © 2013 Elsevier Ltd. All rights reserved.

Waiting times in the ambulatory sector--the case of chronically ill patients.

PubMed

Sundmacher, Leonie; Kopetsch, Thomas

2013-09-10

First, the influence of determinants on the waiting times of chronically ill patients in the ambulatory sector is investigated. The determinants are subdivided into four groups: (1) need, (2) socio-economic factors, (3) health system and (4) patient time pressures. Next, the influence of waiting times on the annual number of consultations is examined to assess whether the existing variation in waiting times influences the frequency of medical examinations. The waiting times of chronically ill patients are analysed since regular ambulatory care for this patient group could both improve treatment outcomes and lower costs. Individual data from the 2010 Representative Survey conducted by the National Association of Statutory Health Insurance Physicians (KBV) together with regional data from the Federal Office of Construction and Regional Planning. This is a retrospective observational study. The dependent variables are waiting times in the ambulatory sector and the number of consultations of General Practitioners (GPs) and specialist physicians in the year 2010. The explanatory variables of interest are 'need' and 'health system' in the first model and 'length of waiting times' in the second. Negative binomial models with random effects are used to estimate the incidence rate ratios of increased waiting times and number of consultations. Subsequently, the models are stratified by urban and rural areas. In the pooled regression the factor 'privately insured' shortens the waiting time for treatment by a specialist by approximately 28% (about 3 days) in comparison with members of the statutory health insurance system. The category of insurance has no influence on the number of consultations of GPs. In addition, the regression results stratified by urban and rural areas show that in urban areas the factor 'privately insured' reduces the waiting time for specialists by approximately 35% (about 3.3 days) while in rural areas there is no evidence of statistical influence. In neither of the models, however, does the waiting time have a documentable effect on the number of consultations in the ambulatory sector. In our random sample, characteristics of the health care system have an influence on the waiting time for specialists, but the waiting time has no documentable effect on the number of consultations in the ambulatory sector. In the present analysis this applies to consultations of both GPs and specialists. Nevertheless, it does not rule out the possibility that the length of waiting times might influence the treatment outcomes of certain patient populations.

'Waiting for' and 'waiting in' public and private hospitals: a qualitative study of patient trust in South Australia.

PubMed

Ward, Paul R; Rokkas, Philippa; Cenko, Clinton; Pulvirenti, Mariastella; Dean, Nicola; Carney, A Simon; Meyer, Samantha

2017-05-05

Waiting times for hospital appointments, treatment and/or surgery have become a major political and health service problem, leading to national maximum waiting times and policies to reduce waiting times. Quantitative studies have documented waiting times for various types of surgery and longer waiting times in public vs private hospitals. However, very little qualitative research has explored patient experiences of waiting, how this compares between public and private hospitals, and the implications for trust in hospitals and healthcare professionals. The aim of this paper is to provide a deep understanding of the impact of waiting times on patient trust in public and private hospitals. A qualitative study in South Australia, including 36 in-depth interviews (18 from public and 18 from private hospitals). Data collection occurred in 2012-13, and data were analysed using pre-coding, followed by conceptual and theoretical categorisation. Participants differentiated between experiences of 'waiting for' (e.g. for specialist appointments and surgery) and 'waiting in' (e.g. in emergency departments and outpatient clinics) public and private hospitals. Whilst 'waiting for' public hospitals was longer than private hospitals, this was often justified and accepted by public patients (e.g. due to reduced government funding), therefore it did not lead to distrust of public hospitals. Private patients had shorter 'waiting for' hospital services, increasing their trust in private hospitals and distrust of public hospitals. Public patients also recounted many experiences of longer 'waiting in' public hospitals, leading to frustration and anxiety, although they rarely blamed or distrusted the doctors or nurses, instead blaming an underfunded system and over-worked staff. Doctors and nurses were seen to be doing their best, and therefore trustworthy. Although public patients experienced longer 'waiting for' and 'waiting in' public hospitals, it did not lead to widespread distrust in public hospitals or healthcare professionals. Private patients recounted largely positive stories of reduced 'waiting for' and 'waiting in' private hospitals, and generally distrusted public hospitals. The continuing trust by public patients in the face of negative experiences may be understood as a form of exchange trust norm, in which institutional trust is based on base-level expectations of consistency and minimum standards of care and safety. The institutional trust by private patients may be understood as a form of communal trust norm, whereby trust is based on the additional and higher-level expectations of flexibility, reduced waiting and more time with healthcare professionals.

Decreasing Wait Times and Increasing Patient Satisfaction: A Lean Six Sigma Approach.

PubMed

Godley, Mary; Jenkins, Jeanne B

2018-06-08

Patient satisfaction scores in the vascular interventional radiology department were low, especially related to wait times in registration and for tests/treatments, with low scores for intentions to recommend. The purpose of our quality improvement project was to decrease wait times and improve patient satisfaction using Lean Six Sigma's define, measure, analyze, improve, and control (DMAIC) framework with a pre-/postintervention design. There was a statistically significant decrease in wait times (P < .0019) and an increase in patient satisfaction scores in 3 areas: registration wait times (from 17 to 99 percentiles), test/treatment (from 19 to 60 percentiles), and likelihood to recommend (from 6 to 97 percentiles). Lean Six Sigma was an effective framework for use in decreasing wait times and improving patient satisfaction.

The PROCARE consortium: toward an improved allocation strategy for kidney allografts.

PubMed

Otten, H G; Joosten, I; Allebes, W A; van der Meer, A; Hilbrands, L B; Baas, M; Spierings, E; Hack, C E; van Reekum, F; van Zuilen, A D; Verhaar, M C; Bots, M L; Seelen, M A J; Sanders, J S F; Hepkema, B G; Lambeck, A J; Bungener, L B; Roozendaal, C; Tilanus, M G J; Vanderlocht, J; Voorter, C E; Wieten, L; van Duijnhoven, E; Gelens, M; Christiaans, M; van Ittersum, F; Nurmohamed, A; Lardy, N M; Swelsen, W T; van Donselaar-van der Pant, K A M I; van der Weerd, N C; Ten Berge, I J M; Bemelman, F J; Hoitsma, A J; de Fijter, J W; Betjes, M G H; Roelen, D L; Claas, F H J

2014-10-01

Kidney transplantation is the best treatment option for patients with end-stage renal failure. At present, approximately 800 Dutch patients are registered on the active waiting list of Eurotransplant. The waiting time in the Netherlands for a kidney from a deceased donor is on average between 3 and 4 years. During this period, patients are fully dependent on dialysis, which replaces only partly the renal function, whereas the quality of life is limited. Mortality among patients on the waiting list is high. In order to increase the number of kidney donors, several initiatives have been undertaken by the Dutch Kidney Foundation including national calls for donor registration and providing information on organ donation and kidney transplantation. The aim of the national PROCARE consortium is to develop improved matching algorithms that will lead to a prolonged survival of transplanted donor kidneys and a reduced HLA immunization. The latter will positively affect the waiting time for a retransplantation. The present algorithm for allocation is among others based on matching for HLA antigens, which were originally defined by antibodies using serological typing techniques. However, several studies suggest that this algorithm needs adaptation and that other immune parameters which are currently not included may assist in improving graft survival rates. We will employ a multicenter-based evaluation on 5429 patients transplanted between 1995 and 2005 in the Netherlands. The association between key clinical endpoints and selected laboratory defined parameters will be examined, including Luminex-defined HLA antibody specificities, T and B cell epitopes recognized on the mismatched HLA antigens, non-HLA antibodies, and also polymorphisms in complement and Fc receptors functionally associated with effector functions of anti-graft antibodies. From these data, key parameters determining the success of kidney transplantation will be identified which will lead to the identification of additional parameters to be included in future matching algorithms aiming to extend survival of transplanted kidneys and to diminish HLA immunization. Computer simulation studies will reveal the number of patients having a direct benefit from improved matching, the effect on shortening of the waiting list, and the decrease in waiting time. Copyright © 2014. Published by Elsevier B.V.

High emergency organ allocation rule in lung transplantation: a simulation study.

PubMed

Riou, Julien; Boëlle, Pierre-Yves; Christie, Jason D; Thabut, Gabriel

2017-10-01

The scarcity of suitable organ donors leads to protracted waiting times and mortality in patients awaiting lung transplantation. This study aims to assess the short- and long-term effects of a high emergency organ allocation policy on the outcome of lung transplantation. We developed a simulation model of lung transplantation waiting queues under two allocation strategies, based either on waiting time only or on additional criteria to prioritise the sickest patients. The model was informed by data from the United Network for Organ Sharing. We compared the impact of these strategies on waiting time, waiting list mortality and overall survival in various situations of organ scarcity. The impact of a high emergency allocation strategy depends largely on the organ supply. When organ supply is sufficient (>95 organs per 100 patients), it may prevent a small number of early deaths (1 year survival: 93.7% against 92.4% for waiting time only) without significant impact on waiting times or long-term survival. When the organ/recipient ratio is lower, the benefits in early mortality are larger but are counterbalanced by a dramatic increase of the size of the waiting list. Consequently, we observed a progressive increase of mortality on the waiting list (although still lower than with waiting time only), a deterioration of patients' condition at transplant and a decrease of post-transplant survival times. High emergency organ allocation is an effective strategy to reduce mortality on the waiting list, but causes a disruption of the list equilibrium that may have detrimental long-term effects in situations of significant organ scarcity.

High emergency organ allocation rule in lung transplantation: a simulation study

PubMed Central

Boëlle, Pierre-Yves; Christie, Jason D.; Thabut, Gabriel

2017-01-01

The scarcity of suitable organ donors leads to protracted waiting times and mortality in patients awaiting lung transplantation. This study aims to assess the short- and long-term effects of a high emergency organ allocation policy on the outcome of lung transplantation. We developed a simulation model of lung transplantation waiting queues under two allocation strategies, based either on waiting time only or on additional criteria to prioritise the sickest patients. The model was informed by data from the United Network for Organ Sharing. We compared the impact of these strategies on waiting time, waiting list mortality and overall survival in various situations of organ scarcity. The impact of a high emergency allocation strategy depends largely on the organ supply. When organ supply is sufficient (>95 organs per 100 patients), it may prevent a small number of early deaths (1 year survival: 93.7% against 92.4% for waiting time only) without significant impact on waiting times or long-term survival. When the organ/recipient ratio is lower, the benefits in early mortality are larger but are counterbalanced by a dramatic increase of the size of the waiting list. Consequently, we observed a progressive increase of mortality on the waiting list (although still lower than with waiting time only), a deterioration of patients’ condition at transplant and a decrease of post-transplant survival times. High emergency organ allocation is an effective strategy to reduce mortality on the waiting list, but causes a disruption of the list equilibrium that may have detrimental long-term effects in situations of significant organ scarcity. PMID:29181383

The effect of early education on patient anxiety while waiting for elective cardiac catheterization.

PubMed

Harkness, Karen; Morrow, Lydia; Smith, Kelly; Kiczula, Michele; Arthur, Heather M

2003-07-01

A supply-demand mismatch with respect to cardiac catheterization (CATH) often results in patients experiencing waiting times that vary from a few weeks to several months. Long delays can impose both physical and psychological distress for patients. The purpose of this study was to examine the effect of a psychoeducational nursing intervention at the beginning of the waiting period on patient anxiety during the waiting time for elective CATH. This was a 2-group randomized controlled trial. Intervention patients received a nurse-delivered, detailed information/education session within 2 weeks of being placed on the waiting list for elective CATH. Control group patients received usual care. The mean waiting time for CATH was 13.4+/-7.2 weeks, which did not differ between groups (P=0.509). Anxiety increased in both groups over the waiting time (P=0.028). Health-related quality of life deteriorated over the waiting time in both groups (P<0.05). On a visual analogue scale, there was a significant difference (P=0.002) between the intervention (4.0+/-2.7) and control (5.2+/-3.0) groups in self-reported anxiety 2 weeks prior to CATH. The waiting period prior to elective CATH has a negative impact on patients' perceived anxiety and quality of life and a simple intervention, provided at the beginning of the waiting period, may positively affect the experience of waiting.

An investigation of the impact of prolonged waiting times on blood donors in Ireland.

PubMed

McKeever, T; Sweeney, M R; Staines, A

2006-02-01

The aim of this study was to investigate the impact of prolonged queuing times on blood donors, by measuring their satisfaction levels, and positive and negative affects. As donation times have increased over the past number of years within the Irish Blood Transfusion Service, this is an important issue to examine in a climate where voluntary donors are becoming scarce and demands on people's time are increasing. Eighty-five blood donors were sampled from one urban and one rural blood donor clinic. The respondents conducted a questionnaire by means of face-to-face interview, while waiting in the clinic. The questionnaire contained the Positive and Negative Affect Scale (PANAS), and a waiting satisfaction scale. Both actual and perceived waiting times of the donors were noted. Waiting time was found to be negatively related to satisfaction. Inexperienced donors expressed higher levels of negative affect than experienced donors. Urban donors were significantly more satisfied than rural donors. There was a significant difference in perceived waiting time between lone donors and those queuing in a group, with those waiting alone perceiving their wait as shorter. While all respondents stated that they intended to donate again, over one-third stated that prolonged waiting times would be their most likely deterrent. However, only 15% stated that long queuing times might actually prevent them from donating in the future, and almost all respondents said that they would recommend donation to a friend, despite long queuing times. Although our results show that the respondents were not satisfied with current waiting times, it did not seem to affect their future intentions to donate. These findings provide some optimism for the future of blood donation in Ireland, as they suggest a strong sense of commitment to donation within the population sampled. Future research could explore the application of 'the service industry' approach to waiting times to blood donation clinics.

[Opportunity cost for men who visit family medicine units in the city of Querétaro, Mexico].

PubMed

Martínez Carranza, Edith Olimpia; Villarreal Ríos, Enrique; Vargas Daza, Emma Rosa; Galicia Rodríguez, Liliana; Martínez González, Lidia

2010-12-01

To determine the opportunity cost for men who seek care in the family medicine units (FMU) of the Mexican Social Security Institute (IMSS, Instituto Mexicano del Seguro Social) in the city of Querétaro. A sample was selected of 807 men, ages 20 to 59 years, who sought care through the family medicine, laboratory, and pharmacy services provided by the FMU at the IMSS in Querétaro. Patients referred for emergency services and those who left the facilities without receiving care were excluded. The sample (n = 807) was calculated using the averages for an infinite population formula, with a confidence interval of 95% (CI95%) and an average opportunity cost of US$5.5 for family medicine, US$3.1 for laboratory services, and US$2.3 for pharmacy services. Estimates included the amount of time spent on travel, waiting, and receiving care; the number of people accompanying the patient, and the cost per minute of paid and unpaid job activities. The opportunity cost was calculated using the estimated cost per minute for travel, waiting, and receiving care for patients and their companions. The opportunity cost for the patient travel was estimated at US$0.97 (CI95%: 0.81-1.15), while wait time was US$5.03 (CI95%: 4.08-6.09) for family medicine, US$0.06 (CI95%: 0.05-0.08) for pharmacy services, and US$1.89 (CI95%: 1.56-2.25) for laboratory services. The average opportunity cost for an unaccompanied patient visit varied between US$1.10 for pharmacy services alone and US$8.64 for family medicine, pharmacy, and laboratory services. The weighted opportunity cost for family medicine was US$6.24. Given that the opportunity cost for men who seek services in FMU corresponds to more than half of a minimum salary, it should be examined from an institutional perspective whether this is the best alternative for care.

Use of Radio Frequency Identification to Establish Emergency Medical Service Offload Times.

PubMed

Steer, Sheila; Bhalla, Mary C; Zalewski, Jon; Frey, Jennifer; Nguyen, Victor; Mencl, Francis

2016-01-01

Emergency medical services (EMS) crews often wait for emergency department (ED) beds to become available to offload their patients. Presently there is no national benchmark for EMS turnaround or offload times, or method for objectively and reliably measuring this. This study introduces a novel method for monitoring offload times and identifying variance. We performed a descriptive, observational study in a large urban community teaching hospital. We affixed radio frequency identification (RFID) tags (Confidex Survivor™, Confidex, Inc., Glen Ellyn, IL) to 65 cots from 19 different EMS agencies and placed a reader (CaptureTech Weatherproof RFID Interpreter, Barcoding Inc., Baltimore, Maryland) in the ED ambulance entrance, allowing for passive recording of traffic. We recorded data for 16 weeks starting December 2009. Offload times were calculated for each visit and analyzed using STATA to show variations in individual and cumulative offload times based on the time of day and day of the week. Results are presented as median times, confidence intervals (CIs), and interquartile ranges (IQRs). We collected data on 2,512 visits. Five hundred and ninety-two were excluded because of incomplete data, leaving 1,920 (76%) complete visits. Average offload time was 13.2 minutes. Median time was 10.7 minutes (IQR 8.1 minutes to 15.4 minutes). A total of 43% of the patients (833/1,920, 95% CI 0.41-0.46) were offloaded in less than 10 minutes, while 27% (513/1,920, 95% CI 0.25-0.29) took greater than 15 minutes. Median times were longest on Mondays (11.5 minutes) and shortest on Wednesdays (10.3 minutes). Longest daily median offload time occurred between 1600 and 1700 (13.5 minutes), whereas the shortest median time was between 0800 and 0900 (9.3 minutes). Cumulative time spent waiting beyond 15 minutes totaled 72.5 hours over the study period. RFID monitoring is a simple and effective means of monitoring EMS traffic and wait times. At our institution, most squads are able to offload their patients within 15 minutes, with many in less than 10 minutes. Variations in wait times are seen and are a topic for future study.

Lean methodology improves efficiency in outpatient academic uro-oncology clinics.

PubMed

Skeldon, Sean C; Simmons, Andrea; Hersey, Karen; Finelli, Antonio; Jewett, Michael A; Zlotta, Alexandre R; Fleshner, Neil E

2014-05-01

To determine if lean methodology, an industrial engineering tool developed to optimize manufacturing efficiency, can successfully be applied to improve efficiencies and quality of care in a hospital-based high-volume uro-oncology clinic. Before the lean initiative, baseline data were collected on patient volumes, wait times, cycle times (patient arrival to discharge), nursing assessment time, patient teaching, and physician ergonomics (via spaghetti diagram). Value stream analysis and a rapid improvement event were carried out, and significant changes were made to patient check-in, work areas, and nursing face time. Follow-up data were obtained at 30, 60, and 90 days. The Student t test was used for analysis to compare performance metrics with baseline. The median cycle time before the lean initiative was 46 minutes. This remained stable at 46 minutes at 30 days but improved to 35 minutes at 60 days and 41 minutes at 90 days. Shorter wait times allowed for increased nursing and physician face time. The average length of the physician assessment increased from 7.5 minutes at baseline to 10.6 minutes at 90 days. The average proportion of value-added time compared with the entire clinic visit increased from 30.6% at baseline to 66.3% at 90 days. Using lean methodology, we were able to shorten the patient cycle time and the time to initial assessment as well as integrate both an initial registered nurse assessment and registered nurse teaching to each visit. Lean methodology can effectively be applied to improve efficiency and patient care in an academic outpatient uro-oncology clinic setting. Copyright © 2014 Elsevier Inc. All rights reserved.

The Impact of One-Dose Package of Medicines on Patient Waiting Time in Dispensing Pharmacy: Application of a Discrete Event Simulation Model.

PubMed

Furushima, Daisuke; Yamada, Hiroshi; Kido, Michiko; Ohno, Yuko

2018-01-01

Improvement in patient waiting time in dispensing pharmacies is an important element for patient and pharmacists. The One-Dose Package (ODP) of medicines was implemented in Japan to support medicine adherence among elderly patients; however, it also contributed to increase in patient waiting times. Given the projected increase in ODP patients in the near future owing to rapid population aging, development of improved strategies is a key imperative. We conducted a cross-sectional survey at a single dispensing pharmacy to clarify the impact of ODP on patient waiting time. Further, we propose an improvement strategy developed with use of a discrete event simulation (DES) model. A total of 673 patients received pharmacy services during the study period. A two-fold difference in mean waiting time was observed between ODP and non-ODP patients (22.6 and 11.2 min, respectively). The DES model was constructed with input parameters estimated from observed data. Introduction of fully automated ODP (A-ODP) system was projected to reduce the waiting time for ODP patient by 0.5 times (from 23.1 to 11.5 min). Furthermore, assuming that 40% of non-ODP patients would transfer to ODP, the waiting time was predicted to increase to 56.8 min; however, introduction of the A-ODP system decreased the waiting time to 20.4 min. Our findings indicate that ODP is one of the elements that increases the waiting time and that it might become longer in the future. Introduction of the A-ODP system may be an effective strategy to improve waiting time.

Scheduling for anesthesia at geographic locations remote from the operating room.

PubMed

Dexter, Franklin; Wachtel, Ruth E

2014-08-01

Providing general anesthesia at locations away from the operating room, called remote locations, poses many medical and scheduling challenges. This review discusses how to schedule procedures at remote locations to maximize anesthesia productivity (see Video, Supplemental Digital Content 1). Anesthesia labour productivity can be maximized by assigning one or more 8-h or 10-h periods of allocated time every 2 weeks dedicated specifically to each remote specialty that has enough cases to fill those periods. Remote specialties can then schedule their cases themselves into their own allocated time. Periods of allocated time (called open, unblocked or first come first served time) can be used by remote locations that do not have their own allocated time. Unless cases are scheduled sequentially into allocated time, there will be substantial extra underutilized time (time during which procedures are not being performed and personnel sit idle even though staffing has been planned) and a concomitant reduction in percent productivity. Allocated time should be calculated on the basis of usage. Remote locations with sufficient hours of cases should be allocated time reserved especially for them in which to schedule their cases, with a maximum waiting time of 2 weeks, to achieve an average wait of 1 week.

Waiting for cataract surgery--effects of a maximum waiting-time guarantee.

PubMed

Hanning, Marianne; Lundström, Mats

2007-01-01

To evaluate the effects of the Maximum Waiting-time Guarantee (MWG) policy for cataract surgery on volume, indications, waiting times and priority setting in Sweden. Comparison between 1993 and 1994, when the guarantee had been in force for one year, and 1998 and 1999, when the policy had been terminated for one year. Data from the National Cataract Registry covering 156,657 cataract operations for the years studied. The number of operations increased by 43% between the two study periods. Of this increase, 61% were patients with a visual acuity above 0.5 in the better eye, i.e. low-priority patients. Waiting times were longer for all patient categories in the later period and differences in waiting times between patients with differing priority diminished. Variations among the units in priority setting and waiting times were substantial, and increased after the Guarantee was terminated. The Guarantee with its explicit indications was an effective policy instrument to limit waiting times and improve access for patients with the greatest need. It is unlikely that the Guarantee caused any 'crowding out' of other patient groups. When the Guarantee was not in force, indications for surgery widened. This, however, resulted in longer waiting times for all patient groups. After the Guarantee was terminated, the already substantial differences in access and indications among ophthalmic units became even greater.

Application of a smartphone nurse call system for nursing care.

PubMed

Chuang, Shu-Ting; Liu, Yi-Fang; Fu, Zi-Xuan; Liu, Kuang-Chung; Chien, Sou-Hsin; Lin, Chin-Lon; Lin, Pi-Yu

2015-02-01

Traditionally, a patient presses the nurse call button and alerts the central nursing station. This system cannot reach the primary care nurse directly. The aim of this study was to apply a new smartphone system through the cloud system and information technology that linked a smartphone and a mobile nursing station for nursing care service. A smartphone and mobile nursing station were integrated into a smartphone nurse call system through the cloud and information technology for better nursing care. Waiting time for a patient to contact the most responsible nurse was reduced from 3.8 min to 6 s. The average time for pharmacists to locate the nurse for medication problem was reduced from 4.2 min to 1.8 min by the new system. After implementation of the smartphone nurse call system, patients received a more rapid response. This improved patients' satisfaction and reduced the number of complaints about longer waiting time due to the shortage of nurses.

Application of Queueing Theory to the Analysis of Changes in Outpatients' Waiting Times in Hospitals Introducing EMR

PubMed Central

Cho, Kyoung Won; Kim, Seong Min; Chae, Young Moon

2017-01-01

Objectives This research used queueing theory to analyze changes in outpatients' waiting times before and after the introduction of Electronic Medical Record (EMR) systems. Methods We focused on the exact drawing of two fundamental parameters for queueing analysis, arrival rate (λ) and service rate (µ), from digital data to apply queueing theory to the analysis of outpatients' waiting times. We used outpatients' reception times and consultation finish times to calculate the arrival and service rates, respectively. Results Using queueing theory, we could calculate waiting time excluding distorted values from the digital data and distortion factors, such as arrival before the hospital open time, which occurs frequently in the initial stage of a queueing system. We analyzed changes in outpatients' waiting times before and after the introduction of EMR using the methodology proposed in this paper, and found that the outpatients' waiting time decreases after the introduction of EMR. More specifically, the outpatients' waiting times in the target public hospitals have decreased by rates in the range between 44% and 78%. Conclusions It is possible to analyze waiting times while minimizing input errors and limitations influencing consultation procedures if we use digital data and apply the queueing theory. Our results verify that the introduction of EMR contributes to the improvement of patient services by decreasing outpatients' waiting time, or by increasing efficiency. It is also expected that our methodology or its expansion could contribute to the improvement of hospital service by assisting the identification and resolution of bottlenecks in the outpatient consultation process. PMID:28261529

Application of Queueing Theory to the Analysis of Changes in Outpatients' Waiting Times in Hospitals Introducing EMR.

PubMed

Cho, Kyoung Won; Kim, Seong Min; Chae, Young Moon; Song, Yong Uk

2017-01-01

This research used queueing theory to analyze changes in outpatients' waiting times before and after the introduction of Electronic Medical Record (EMR) systems. We focused on the exact drawing of two fundamental parameters for queueing analysis, arrival rate (λ) and service rate (µ), from digital data to apply queueing theory to the analysis of outpatients' waiting times. We used outpatients' reception times and consultation finish times to calculate the arrival and service rates, respectively. Using queueing theory, we could calculate waiting time excluding distorted values from the digital data and distortion factors, such as arrival before the hospital open time, which occurs frequently in the initial stage of a queueing system. We analyzed changes in outpatients' waiting times before and after the introduction of EMR using the methodology proposed in this paper, and found that the outpatients' waiting time decreases after the introduction of EMR. More specifically, the outpatients' waiting times in the target public hospitals have decreased by rates in the range between 44% and 78%. It is possible to analyze waiting times while minimizing input errors and limitations influencing consultation procedures if we use digital data and apply the queueing theory. Our results verify that the introduction of EMR contributes to the improvement of patient services by decreasing outpatients' waiting time, or by increasing efficiency. It is also expected that our methodology or its expansion could contribute to the improvement of hospital service by assisting the identification and resolution of bottlenecks in the outpatient consultation process.

A Cross-Sectional Survey of Population-Wide Wait Times for Patients Seeking Medical vs. Cosmetic Dermatologic Care

PubMed Central

Yadav, Geeta; Goldberg, Hanna R.; Barense, Morgan D.; Bell, Chaim M.

2016-01-01

Background Though previous work has examined some aspects of the dermatology workforce shortage and access to dermatologic care, little research has addressed the effect of rising interest in cosmetic procedures on access to medical dermatologic care. Our objective was to determine the wait times for Urgent and Non-Urgent medical dermatologic care and Cosmetic dermatology services at a population level and to examine whether wait times for medical care are affected by offering cosmetic services. Methods A population-wide survey of dermatology practices using simulated calls asking for the earliest appointment for a Non-Urgent, Urgent and Cosmetic service. Results Response rates were greater than 89% for all types of care. Wait times across all types of care were significantly different from each other (all P < 0.05). Cosmetic care was associated with the shortest wait times (3.0 weeks; Interquartile Range (IQR) = 0.4–3.4), followed by Urgent care (9.0 weeks; IQR = 2.1–12.9), then Non-Urgent Care (12.7 weeks; IQR = 4.4–16.4). Wait times for practices offering only Urgent care were not different from practices offering both Urgent and Cosmetic care (10.3 vs. 7.0 weeks). Interpretation Longer wait times and greater variation for Urgent and Non-Urgent dermatologic care and shorter wait times and less variation for Cosmetic care. Wait times were significantly longer in regions with lower dermatologist density. Provision of Cosmetic services did not increase wait times for Urgent care. These findings suggest an overall dermatology workforce shortage and a need for a more streamlined referral system for dermatologic care. PMID:27632206

Improving wait times to care for individuals with multimorbidities and complex conditions using value stream mapping.

PubMed

Sampalli, Tara; Desy, Michel; Dhir, Minakshi; Edwards, Lynn; Dickson, Robert; Blackmore, Gail

2015-04-05

Recognizing the significant impact of wait times for care for individuals with complex chronic conditions, we applied a LEAN methodology, namely - an adaptation of Value Stream Mapping (VSM) to meet the needs of people with multiple chronic conditions and to improve wait times without additional resources or funding. Over an 18-month time period, staff applied a patient-centric approach that included LEAN methodology of VSM to improve wait times to care. Our framework of evaluation was grounded in the needs and perspectives of patients and individuals waiting to receive care. Patient centric views were obtained through surveys such as Patient Assessment of Chronic Illness Care (PACIC) and process engineering based questions. In addition, LEAN methodology, VSM was added to identify non-value added processes contributing to wait times. The care team successfully reduced wait times to 2 months in 2014 with no wait times for care anticipated in 2015. Increased patient engagement and satisfaction are also outcomes of this innovative initiative. In addition, successful transformations and implementation have resulted in resource efficiencies without increase in costs. Patients have shown significant improvements in functional health following Integrated Chronic Care Service (ICCS) intervention. The methodology will be applied to other chronic disease management areas in Capital Health and the province. Wait times to care in the management of multimoribidities and other complex conditions can add a significant burden not only on the affected individuals but also on the healthcare system. In this study, a novel and modified LEAN methodology has been applied to embed the voice of the patient in care delivery processes and to reduce wait times to care in the management of complex chronic conditions. © 2015 by Kerman University of Medical Sciences.

Space, place and (waiting) time: reflections on health policy and politics.

PubMed

Sheard, Sally

2018-02-19

Health systems have repeatedly addressed concerns about efficiency and equity by employing trans-national comparisons to draw out the strengths and weaknesses of specific policy initiatives. This paper demonstrates the potential for explicit historical analysis of waiting times for hospital treatment to add value to spatial comparative methodologies. Waiting times and the size of the lists of waiting patients have become key operational indicators. In the United Kingdom, as National Health Service (NHS) financial pressures intensified from the 1970s, waiting times have become a topic for regular public and political debate. Various explanations for waiting times include the following: hospital consultants manipulate NHS waiting lists to maintain their private practice; there is under-investment in the NHS; and available (and adequate) resources are being used inefficiently. Other countries have also experienced ongoing tensions between the public and private delivery of universal health care in which national and trans-national comparisons of waiting times have been regularly used. The paper discusses the development of key UK policies, and provides a limited Canadian comparative perspective, to explore wider issues, including whether 'waiting crises' were consciously used by policymakers, especially those brought into government to implement new economic and managerial strategies, to diminish the autonomy and authority of the medical professional in the hospital environment.

Statistical modeling of storm-level Kp occurrences

USGS Publications Warehouse

Remick, K.J.; Love, J.J.

2006-01-01

We consider the statistical modeling of the occurrence in time of large Kp magnetic storms as a Poisson process, testing whether or not relatively rare, large Kp events can be considered to arise from a stochastic, sequential, and memoryless process. For a Poisson process, the wait times between successive events occur statistically with an exponential density function. Fitting an exponential function to the durations between successive large Kp events forms the basis of our analysis. Defining these wait times by calculating the differences between times when Kp exceeds a certain value, such as Kp ??? 5, we find the wait-time distribution is not exponential. Because large storms often have several periods with large Kp values, their occurrence in time is not memoryless; short duration wait times are not independent of each other and are often clumped together in time. If we remove same-storm large Kp occurrences, the resulting wait times are very nearly exponentially distributed and the storm arrival process can be characterized as Poisson. Fittings are performed on wait time data for Kp ??? 5, 6, 7, and 8. The mean wait times between storms exceeding such Kp thresholds are 7.12, 16.55, 42.22, and 121.40 days respectively.

Study on queueing behavior in pedestrian evacuation by extended cellular automata model

NASA Astrophysics Data System (ADS)

Hu, Jun; You, Lei; Zhang, Hong; Wei, Juan; Guo, Yangyong

2018-01-01

This paper proposes a pedestrian evacuation model for effective simulation of evacuation efficiency based on extended cellular automata. In the model, pedestrians' momentary transition probability to a target position is defined in terms of the floor field and queueing time, and the critical time is defined as the waiting time threshold in a queue. Queueing time and critical time are derived using Fractal Brownian Motion through analysis of pedestrian arrival characteristics. Simulations using the platform and actual evacuations were conducted to study the relationships among system evacuation time, average system velocity, pedestrian density, flow rate, and critical time. The results demonstrate that at low pedestrian density, evacuation efficiency can be improved through adoption of the shortest route strategy, and critical time has an inverse relationship with average system velocity. Conversely, at higher pedestrian densities, it is better to adopt the shortest queueing time strategy, and critical time is inversely related to flow rate.

Numbers or apologies? Customer reactions to telephone waiting time fillers.

PubMed

Munichor, Nira; Rafaeli, Anat

2007-03-01

The authors examined the effect of time perception and sense of progress in telephone queues on caller reactions to 3 telephone waiting time fillers: music, apologies, and information about location in the queue. In Study 1, conducted on 123 real calls, call abandonment was lowest, and call evaluations were most positive with information about location in the queue as the time filler. In Study 2, conducted with 83 participants who experienced a simulated telephone wait experience, sense of progress in the queue rather than perceived waiting time mediated the relationship between telephone waiting time filler and caller reactions. The findings provide insight for the management and design of telephone queues, as well as theoretical insight into critical cognitive processes that underlie telephone waiting, opening up an important new research agenda. (c) 2007 APA, all rights reserved.

Waiting times for hospital admissions: the impact of GP fundholding.

PubMed

Propper, Carol; Croxson, Bronwyn; Shearer, Arran

2002-03-01

Waiting times for hospital care are a significant issue in the UK National Health Service (NHS). The reforms of the health service in 1990 gave a subset of family doctors (GP fundholders) both the ability to choose the hospital where their patients were treated and the means to pay for some services. One of the key factors influencing family doctors' choice of hospital was patient waiting time. However, without cash inducements, hospitals would get no direct reward from giving shorter waiting times to a subset of patients. Using a unique dataset, we investigate whether GP fundholders were able to secure shorter waiting times for their patients, whether they were able to do so in cases where they had no financial rewards to offer hospitals, and whether the impact of fundholding spilled over into shorter waiting times for all patients.

Pediatric access to dermatologists: Medicaid versus private insurance.

PubMed

Chaudhry, Sofia B; Armbrecht, Eric S; Shin, Yoon; Matula, Sarah; Caffrey, Charles; Varade, Reena; Jones, Lisa; Siegfried, Elaine

2013-05-01

There is disparity in access to outpatient care for Medicaid beneficiaries. This inequity disproportionately impacts children. Access for children with skin disease may be especially limited. We sought to compare access to dermatologists for new pediatric patients insured by Medicaid versus a private plan. We surveyed 13 metropolitan markets by conducting secret-shopper scripted telephone calls to dermatology providers listed by Medicaid health plans. Paired calls, differing by insurance type, were made to each office on the same day, portraying a parent requesting a new appointment for a child with eczema. We called the offices of 723 Medicaid-listed providers. Final analysis included 471 dermatologists practicing general dermatology. Of these, an average of 44% refused a new Medicaid-insured pediatric patient. The average wait time for an appointment did not significantly vary between insurance types. Assuming that dermatologists not listed as Medicaid providers do not see Medicaid-insured children, our data indicate that pediatric Medicaid acceptance rates ranged from 6% to 64% by market, with an overall market size-weighted average acceptance rate of 19%. Relative reimbursement levels for Medicaid-insured patients did not correlate with acceptance rates. Although the most current health plan directories were used to create calling lists, these are dynamic. The sample sizes of confirmed appointments were in part limited by a lack of referral letters and/or health plan identification numbers. Only confirmed appointments were used to calculate average wait times. Access to dermatologists is limited for Medicaid-insured children with eczema. Copyright © 2012 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

Associations Between Waiting Times, Service Times, and Patient Satisfaction in an Endocrinology Outpatient Department: A Time Study and Questionnaire Survey.

PubMed

Xie, Zhenzhen; Or, Calvin

2017-01-01

The issue of long patient waits has attracted increasing public attention due to the negative effects of waiting on patients' satisfaction with health care. The present study examined the associations between actual waiting time, perceived acceptability of waiting time, actual service time, perceived acceptability of service time, actual visit duration, and the level of patient satisfaction with care. We conducted a cross-sectional time study and questionnaire survey of endocrinology outpatients visiting a major teaching hospital in China. Our results show that actual waiting time was negatively associated with patient satisfaction regarding several aspects of the care they received. Also, patients who were less satisfied with the sociocultural atmosphere and the identity-oriented approach to their care tended to perceive the amounts of time they spent waiting and receiving care as less acceptable. It is not always possible to prevent dissatisfaction with waiting, or to actually reduce waiting times by increasing resources such as increased staffing. However, several improvements in care services can be considered. Our suggestions include providing clearer, more transparent information to keep patients informed about the health care services that they may receive, and the health care professionals who are responsible for those services. We also suggest that care providers are encouraged to continue to show empathy and respect for patients, that patients are provided with private areas where they can talk with health professionals and no one can overhear, and that hospital staff treat the family members or friends who accompany patients in a courteous and friendly way.

Associations Between Waiting Times, Service Times, and Patient Satisfaction in an Endocrinology Outpatient Department: A Time Study and Questionnaire Survey

PubMed Central

Xie, Zhenzhen; Or, Calvin

2017-01-01

The issue of long patient waits has attracted increasing public attention due to the negative effects of waiting on patients’ satisfaction with health care. The present study examined the associations between actual waiting time, perceived acceptability of waiting time, actual service time, perceived acceptability of service time, actual visit duration, and the level of patient satisfaction with care. We conducted a cross-sectional time study and questionnaire survey of endocrinology outpatients visiting a major teaching hospital in China. Our results show that actual waiting time was negatively associated with patient satisfaction regarding several aspects of the care they received. Also, patients who were less satisfied with the sociocultural atmosphere and the identity-oriented approach to their care tended to perceive the amounts of time they spent waiting and receiving care as less acceptable. It is not always possible to prevent dissatisfaction with waiting, or to actually reduce waiting times by increasing resources such as increased staffing. However, several improvements in care services can be considered. Our suggestions include providing clearer, more transparent information to keep patients informed about the health care services that they may receive, and the health care professionals who are responsible for those services. We also suggest that care providers are encouraged to continue to show empathy and respect for patients, that patients are provided with private areas where they can talk with health professionals and no one can overhear, and that hospital staff treat the family members or friends who accompany patients in a courteous and friendly way. PMID:29161947

Transition in the waiting-time distribution of price-change events in a global socioeconomic system

NASA Astrophysics Data System (ADS)

Zhao, Guannan; McDonald, Mark; Fenn, Dan; Williams, Stacy; Johnson, Nicholas; Johnson, Neil F.

2013-12-01

The goal of developing a firmer theoretical understanding of inhomogeneous temporal processes-in particular, the waiting times in some collective dynamical system-is attracting significant interest among physicists. Quantifying the deviations between the waiting-time distribution and the distribution generated by a random process may help unravel the feedback mechanisms that drive the underlying dynamics. We analyze the waiting-time distributions of high-frequency foreign exchange data for the best executable bid-ask prices across all major currencies. We find that the lognormal distribution yields a good overall fit for the waiting-time distribution between currency rate changes if both short and long waiting times are included. If we restrict our study to long waiting times, each currency pair’s distribution is consistent with a power-law tail with exponent near to 3.5. However, for short waiting times, the overall distribution resembles one generated by an archetypal complex systems model in which boundedly rational agents compete for limited resources. Our findings suggest that a gradual transition arises in trading behavior between a fast regime in which traders act in a boundedly rational way and a slower one in which traders’ decisions are driven by generic feedback mechanisms across multiple timescales and hence produce similar power-law tails irrespective of currency type.

Wait times for gastroenterology consultation in Canada: The patients’ perspective

PubMed Central

Paterson, WG; Barkun, AN; Hopman, WM; Leddin, DJ; Paré, P; Petrunia, DM; Sewitch, MJ; Switzer, C; van Zanten, S Veldhuyzen

2010-01-01

Long wait times for health care have become a significant issue in Canada. As part of the Canadian Association of Gastroenterology’s Human Resource initiative, a questionnaire was developed to survey patients regarding wait times for initial gastroenterology consultation and its impact. A total of 916 patients in six cities from across Canada completed the questionnaire at the time of initial consultation. Self-reported wait times varied widely, with 26.8% of respondents reporting waiting less than two weeks, 52.4% less than one month, 77.1% less than three months, 12.5% reported waiting longer than six months and 3.6% longer than one year. One-third of patients believed their wait time was too long, with 9% rating their wait time as ‘far too long’; 96.4% believed that maximal wait time should be less than three months, 78.9% believed it should be less than one month and 40.3% believed it should be less than two weeks. Of those working or attending school, 22.6% reported missing at least one day of work or school because of their symptoms in the month before their appointment, and 9.0% reported missing five or more days in the preceding month. A total of 20.2% of respondents reported being very worried about having a serious disease (ie, scored 6 or higher on 7-point Likert scale), and 17.6% and 14.8%, respectively, reported that their symptoms caused major impairment of social functioning and with the activities of daily living. These data suggest that a significant proportion of Canadians with digestive problems are not satisfied with their wait time for gastroenterology consultation. Furthermore, while awaiting consultation, many patients experience an impaired quality of life because of their gastrointestinal symptoms. PMID:20186353

Emergency department patient satisfaction survey in Imam Reza Hospital, Tabriz, Iran

PubMed Central

2011-01-01

Introduction Patient satisfaction is an important indicator of the quality of care and service delivery in the emergency department (ED). The objective of this study was to evaluate patient satisfaction with the Emergency Department of Imam Reza Hospital in Tabriz, Iran. Methods This study was carried out for 1 week during all shifts. Trained researchers used the standard Press Ganey questionnaire. Patients were asked to complete the questionnaire prior to discharge. The study questionnaire included 30 questions based on a Likert scale. Descriptive and analytical statistics were used throughout data analysis in a number of ways using SPSS version 13. Results Five hundred patients who attended our ED were included in this study. The highest satisfaction rates were observed in the terms of physicians' communication with patients (82.5%), security guards' courtesy (78.3%) and nurses' communication with patients (78%). The average waiting time for the first visit to a physician was 24 min 15 s. The overall satisfaction rate was dependent on the mean waiting time. The mean waiting time for a low rate of satisfaction was 47 min 11 s with a confidence interval of (19.31, 74.51), and for very good level of satisfaction it was 14 min 57 s with a (10.58, 18.57) confidence interval. Approximately 63% of the patients rated their general satisfaction with the emergency setting as good or very good. On the whole, the patient satisfaction rate at the lowest level was 7.7 with a confidence interval of (5.1, 10.4), and at the low level it was 5.8% with a confidence interval of (3.7, 7.9). The rate of satisfaction for the mediocre level was 23.3 with a confidence interval of (19.1, 27.5); for the high level of satisfaction it was 28.3 with a confidence interval of (22.9, 32.8), and for the very high level of satisfaction, this rate was 32.9% with a confidence interval of (28.4, 37.4). Conclusion The study findings indicated the need for evidence-based interventions in emergency care services in areas such as medical care, nursing care, courtesy of staff, physical comfort and waiting time. Efforts should focus on shortening waiting intervals and improving patients' perceptions about waiting in the ED, and also improving the overall cleanliness of the emergency room. PMID:21407998

Waiting time distribution revealing the internal spin dynamics in a double quantum dot

NASA Astrophysics Data System (ADS)

Ptaszyński, Krzysztof

2017-07-01

Waiting time distribution and the zero-frequency full counting statistics of unidirectional electron transport through a double quantum dot molecule attached to spin-polarized leads are analyzed using the quantum master equation. The waiting time distribution exhibits a nontrivial dependence on the value of the exchange coupling between the dots and the gradient of the applied magnetic field, which reveals the oscillations between the spin states of the molecule. The zero-frequency full counting statistics, on the other hand, is independent of the aforementioned quantities, thus giving no insight into the internal dynamics. The fact that the waiting time distribution and the zero-frequency full counting statistics give a nonequivalent information is associated with two factors. Firstly, it can be explained by the sensitivity to different timescales of the dynamics of the system. Secondly, it is associated with the presence of the correlation between subsequent waiting times, which makes the renewal theory, relating the full counting statistics and the waiting time distribution, no longer applicable. The study highlights the particular usefulness of the waiting time distribution for the analysis of the internal dynamics of mesoscopic systems.

Funding models for outreach ophthalmology services.

PubMed

Turner, Angus W; Mulholland, Will; Taylor, Hugh R

2011-01-01

This paper aims to describe funding models used and compare the effects of funding models for remuneration on clinical activity and cost-effectiveness in outreach eye services in Australia. Cross-sectional case study based in remote outreach ophthalmology services in Australia. Key stake-holders from eye services in nine outreach regions participated in the study. Semistructured interviews were conducted to perform a qualitative assessment of outreach eye services' funding mechanisms. Records of clinical activity were used to statistically compare funding models. Workforce availability (supply of ophthalmologists), costs of services, clinical activity (surgery and clinic consultation rates) and waiting times. The supply of ophthalmologists (full-time equivalence) to all remote regions was below the national average (up to 19 times lower). Cataract surgery rates were also below national averages (up to 10 times lower). Fee-for-service funding significantly increased clinical activity. There were also trends to shorter waiting times and lower costs per attendance. For outreach ophthalmology services, the funding model used for clinician reimbursement may influence the efficiency and costs of the services. Fee-for-service funding models, safety-net funding options or differential funding/incentives need further exploration to ensure isolated disadvantaged areas prone to poor patient attendance are not neglected. In order for outreach eye health services to be sustainable, remuneration rates need to be comparable to those for urban practice. © 2011 The Authors. Clinical and Experimental Ophthalmology © 2011 Royal Australian and New Zealand College of Ophthalmologists.

Enhancing outpatient clinics management software by reducing patients' waiting time.

PubMed

Almomani, Iman; AlSarheed, Ahlam

The Kingdom of Saudi Arabia (KSA) gives great attention to improving the quality of services provided by health care sectors including outpatient clinics. One of the main drawbacks in outpatient clinics is long waiting time for patients-which affects the level of patient satisfaction and the quality of services. This article addresses this problem by studying the Outpatient Management Software (OMS) and proposing solutions to reduce waiting times. Many hospitals around the world apply solutions to overcome the problem of long waiting times in outpatient clinics such as hospitals in the USA, China, Sri Lanka, and Taiwan. These clinics have succeeded in reducing wait times by 15%, 78%, 60% and 50%, respectively. Such solutions depend mainly on adding more human resources or changing some business or management policies. The solutions presented in this article reduce waiting times by enhancing the software used to manage outpatient clinics services. Both quantitative and qualitative methods have been used to understand current OMS and examine level of patient's satisfaction. Five main problems that may cause high or unmeasured waiting time have been identified: appointment type, ticket numbering, doctor late arrival, early arriving patient and patients' distribution list. These problems have been mapped to the corresponding OMS components. Solutions to the above problems have been introduced and evaluated analytically or by simulation experiments. Evaluation of the results shows a reduction in patient waiting time. When late doctor arrival issues are solved, this can reduce the clinic service time by up to 20%. However, solutions for early arriving patients reduces 53.3% of vital time, 20% of the clinic time and overall 30.3% of the total waiting time. Finally, well patient-distribution lists make improvements by 54.2%. Improvements introduced to the patients' waiting time will consequently affect patients' satisfaction and improve the quality of health care services. Copyright © 2016 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

The 2012 SAGE wait times program: Survey of Access to GastroEnterology in Canada

PubMed Central

Leddin, Desmond; Armstrong, David; Borgaonkar, Mark; Bridges, Ronald J; Fallone, Carlo A; Telford, Jennifer J; Chen, Ying; Colacino, Palma; Sinclair, Paul

2013-01-01

BACKGROUND: Periodically surveying wait times for specialist health services in Canada captures current data and enables comparisons with previous surveys to identify changes over time. METHODS: During one week in April 2012, Canadian gastroenterologists were asked to complete a questionnaire (online or by fax) recording demographics, reason for referral, and dates of referral and specialist visits for at least 10 consecutive new patients (five consultations and five procedures) who had not been seen previously for the same indication. Wait times were determined for 18 indications and compared with those from similar surveys conducted in 2008 and 2005. RESULTS: Data regarding adult patients were provided by 173 gastroenterologists for 1374 consultations, 540 procedures and 293 same-day consultations and procedures. Nationally, the median wait times were 92 days (95% CI 85 days to 100 days) from referral to consultation, 55 days (95% CI 50 days to 61 days) from consultation to procedure and 155 days (95% CI 142 days to 175 days) (total) from referral to procedure. Overall, wait times were longer in 2012 than in 2005 (P<0.05); the wait time to same-day consultation and procedure was shorter in 2012 than in 2008 (78 days versus 101 days; P<0.05), but continued to be longer than in 2005 (P<0.05). The total wait time remained longest for screening colonoscopy, increasing from 201 days in 2008 to 279 days in 2012 (P<0.05). DISCUSSION: Wait times for gastroenterology services continue to exceed recommended targets, remain unchanged since 2008 and exceed wait times reported in 2005. PMID:23472243

Survey of Access to GastroEnterology in Canada: The SAGE wait times program

PubMed Central

Leddin, Desmond; Bridges, Ronald J; Morgan, David G; Fallone, Carlo; Render, Craig; Plourde, Victor; Gray, Jim; Switzer, Connie; McHattie, Jim; Singh, Harminder; Walli, Eric; Murray, Iain; Nestel, Anthony; Sinclair, Paul; Chen, Ying; Irvine, E Jan

2010-01-01

BACKGROUND: Assessment of current wait times for specialist health services in Canada is a key method that can assist government and health care providers to plan wisely for future health needs. These data are not readily available. A method to capture wait time data at the time of consultation or procedure has been developed, which should be applicable to other specialist groups and also allows for assessment of wait time trends over intervals of years. METHODS: In November 2008, gastroenterologists across Canada were asked to complete a questionnaire (online or by fax) that included personal demographics and data from one week on at least five consecutive new consultations and five consecutive procedure patients who had not previously undergone a procedure for the same indication. Wait times were collected for 18 primary indications and results were then compared with similar survey data collected in 2005. RESULTS: The longest wait times observed were for screening colonoscopy (201 days) and surveillance of previous colon cancer or polyps (272 days). The shortest wait times were for cancer-likely based on imaging or physical examination (82 days), severe or rapidly progressing dysphagia or odynophagia (83 days), documented iron-deficiency anemia (90 days) and dyspepsia with alarm symptoms (99 days). Compared with 2005 data, total wait times in 2008 were lengthened overall (127 days versus 155 days; P<0.05) and for most of the seven individual indications that permitted data comparison. CONCLUSION: Median wait times for gastroenterology services continue to exceed consensus conference recommended targets and have significantly worsened since 2005. PMID:20186352

Stochastic nature of series of waiting times.

PubMed

Anvari, Mehrnaz; Aghamohammadi, Cina; Dashti-Naserabadi, H; Salehi, E; Behjat, E; Qorbani, M; Nezhad, M Khazaei; Zirak, M; Hadjihosseini, Ali; Peinke, Joachim; Tabar, M Reza Rahimi

2013-06-01

Although fluctuations in the waiting time series have been studied for a long time, some important issues such as its long-range memory and its stochastic features in the presence of nonstationarity have so far remained unstudied. Here we find that the "waiting times" series for a given increment level have long-range correlations with Hurst exponents belonging to the interval 1/2

Impact of Appointment Waiting Time on Attendance Rates at a Clinical Cancer Genetics Service.

PubMed

Shaw, Tarryn; Metras, Julie; Ting, Zoe Ang Li; Courtney, Eliza; Li, Shao-Tzu; Ngeow, Joanne

2018-05-24

The increase in demand for clinical cancer genetics services has impacted the ability to provide services timeously. Given limited resources, this often results in extended appointment waiting times. Over the last 3 years, the Cancer Genetics Service at the National Cancer Centre Singapore has continued to experience a steady increase in demand for its service. Nevertheless, significant no-show rates have been reported. This study sought to determine whether an association exists between appointment waiting times and attendance rates. Data was gathered for all participants meeting inclusion criteria. Attendance rates and appointment waiting times were calculated. The relationship between mean waiting times for those who did and did not attend their scheduled appointments was evaluated using Welch's t test and linear regression model. The results showed a significant difference in mean appointment waiting times between patients who did and did not attend (32.66 versus 43.50 days respectively; p < 0.0001). Furthermore, patients who waited for longer than 37 days were significantly less likely to attend. No-show rates increased as the waiting time increased, at a rate of 19.60% per 20 days and 21.40% per 30 days. In conclusion, appointment waiting time is a significant predictor for patient attendance. Strategies to ensure patients receive an appointment within the necessary timeframe at the desired setting are important to ensure that individuals at increased cancer risk attend their appointments in order to manage their cancer risks effectively.

Shorter Perceived Outpatient MRI Wait Times Associated With Higher Patient Satisfaction.

PubMed

Holbrook, Anna; Glenn, Harold; Mahmood, Rabia; Cai, Qingpo; Kang, Jian; Duszak, Richard

2016-05-01

The aim of this study was to assess differences in perceived versus actual wait times among patients undergoing outpatient MRI examinations and to correlate those times with patient satisfaction. Over 15 weeks, 190 patients presenting for outpatient MR in a radiology department in which "patient experience" is one of the stated strategic priorities were asked to (1) estimate their wait times for various stages in the imaging process and (2) state their satisfaction with their imaging experience. Perceived times were compared with actual electronic time stamps. Perceived and actual times were compared and correlated with standardized satisfaction scores using Kendall τ correlation. The mean actual wait time between patient arrival and examination start was 53.4 ± 33.8 min, whereas patients perceived a mean wait time of 27.8 ± 23.1 min, a statistically significant underestimation of 25.6 min (P < .001). Both shorter actual and perceived wait times at all points during patient encounters were correlated with higher satisfaction scores (P < .001). Patients undergoing outpatient MR examinations in an environment designed to optimize patient experience underestimated wait times at all points during their encounters. Shorter perceived and actual wait times were both correlated with higher satisfaction scores. As satisfaction surveys play a larger role in an environment of metric transparency and value-based payments, better understanding of such factors will be increasingly important. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

In the queue for total joint replacement: patients' perspectives on waiting times. Ontario Hip and Knee Replacement Project Team.

PubMed

Llewellyn-Thomas, H A; Arshinoff, R; Bell, M; Williams, J I; Naylor, C D

1998-02-01

We assessed patients on the waiting lists of a purposive sample of orthopaedic surgeons in Ontario, Canada, to determine patients' attitudes towards time waiting for hip or knee replacement. We focused on 148 patients who did not have a definite operative date, obtaining complete information on 124 (84%). Symptom severity was assessed with the Western Ontario/McMaster Osteoarthritis Index and a disease-specific standard gamble was used to elicit patients' overall utility for their arthritic state. Next, in a trade-off task, patients considered a hypothetical choice between a 1-month wait for a surgeon who could provide a 2% risk of post-operative mortality, or a 6-month wait for joint replacement with a 1% risk of post-operative mortality. Waiting times were then shifted systematically until the patient abandoned his/her initial choice, generating a conditional maximal acceptable wait time. Patients were divided in their attitudes, with 57% initially choosing a 6-month wait with a 1% mortality risk. The overall distribution of conditional maximum acceptable wait time scores ranged from 1 to 26 months, with a median of 7 months. Utility values were independently but weakly associated with patients' tolerance of waiting times (adjusted R-square = 0.059, P = 0.004). After splitting the sample along the median into subgroups with a relatively 'low' and 'high' tolerance for waiting, the subgroup with the apparently lower tolerance for waiting reported lower utility scores (z = 2.951; P = 0.004) and shorter times since their surgeon first advised them of the need for surgery (z = 3.014; P = 0.003). These results suggest that, in the establishment and monitoring of a queue management system for quality-of-life-enhancing surgery, patients' own perceptions of their overall symptomatic burden and ability to tolerate delayed relief should be considered along with information derived from clinical judgements and pre-weighted health status instruments.

Indication criteria for cataract extraction and gender differences in waiting time.

PubMed

Smirthwaite, Goldina; Lundström, Mats; Albrecht, Susanne; Swahnberg, Katarina

2014-08-01

The purpose of this study was to investigate national indication criteria tool for cataract extraction (NIKE), a clinical tool for establishing levels of indications for cataract surgery, in relation to gender differences in waiting times for cataract extraction (CE). Data were collected by The Swedish National Cataract Register (NCR). Eye clinics report to NCR voluntarily and on regular basis (98% coverage). Comparisons regarding gender difference in waiting times were performed between NIKE-categorized and non-NIKE-categorized patients, as well as between different indication groups within the NIKE-system. All calculations were performed in spss version 20. Multivariate analyses were carried out using logistic regression, and single variable analyses were carried out by Student's t-test or chi square as appropriate. Gender, age, visual acuity and NIKE-categorization were associated with waiting time. Female patients had a longer waiting time to CE than male, both within and outside the NIKE-system. Gender difference in waiting time was somewhat larger among patients who had not been categorized by NIKE. In the non-NIKE-categorized group, women waited 0.20 months longer than men. In the group which was NIKE-categorized, women waited 0.18 months longer than men. It is reasonable to assume that prioritizing patients by means of NIKE helps to reduce the gender differences in waiting time. Gender differences in waiting time have decreased as NIKE was introduced and there may be a variety of explanations for this. However, with the chosen study design, we could not distinguish between effects related to NIKE and those due to other factors which occurred during the study period. © 2013 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

The effect of external non-driving factors, payment type and waiting and queuing on fatigue in long distance trucking.

PubMed

Williamson, Ann; Friswell, Rena

2013-09-01

The aim of this study was to explore the effects of external influences on long distance trucking, in particular, incentive-based remuneration systems and the need to wait or queue to load or unload on driver experiences of fatigue. Long distance truck drivers (n=475) were recruited at truck rest stops on the major transport corridors within New South Wales, Australia and asked to complete a survey by self-administration or interview. The survey covered demographics, usual working arrangements, details of the last trip and safety outcomes including fatigue experiences. On average drivers' last trip was over 2000 km and took 21.5 h to complete with an additional 6h of non-driving work. Incentive payments were associated with longer working hours, greater distances driven and higher fatigue for more drivers. Drivers required to wait in queues did significantly more non-driving work and experienced fatigue more often than those who did not. Drivers who were not paid to wait did the longest trips with average weekly hours above the legal working hours limits, had the highest levels of fatigue and the highest levels of interference by work with family life. In contrast, drivers who were paid to wait did significantly less work with shorter usual hours and shorter last trips. Multivariate analysis showed that incentive-based payment and unpaid waiting in queues were significant predictors of driver fatigue. The findings suggest that mandating payment of drivers for non-driving work including waiting would reduce the amount of non-driving work required for drivers and reduce weekly hours of work. In turn this would reduce driver fatigue and safety risk as well as enhancing the efficiency of the long distance road transport industry. Copyright © 2013 Elsevier Ltd. All rights reserved.

Waiting time for cancer treatment and mental health among patients with newly diagnosed esophageal or gastric cancer: a nationwide cohort study.

PubMed

Song, Huan; Fang, Fang; Valdimarsdóttir, Unnur; Lu, Donghao; Andersson, Therese M-L; Hultman, Christina; Ye, Weimin; Lundell, Lars; Johansson, Jan; Nilsson, Magnus; Lindblad, Mats

2017-01-03

Except for overall survival, whether or not waiting time for treatment could influences other domains of cancer patients' overall well-being is to a large extent unknown. Therefore, we performed this study to determine the effect of waiting time for cancer treatment on the mental health of patients with esophageal or gastric cancer. Based on the Swedish National Quality Register for Esophageal and Gastric Cancers (NREV), we followed 7,080 patients diagnosed 2006-2012 from the time of treatment decision. Waiting time for treatment was defined as the interval between diagnosis and treatment decision, and was classified into quartiles. Mental disorders were identified by either clinical diagnosis through hospital visit or prescription of psychiatric medications. For patients without any mental disorder before treatment, the association between waiting time and subsequent onset of mental disorders was assessed by hazard ratios (HRs) with 95% confidence interval (CI), derived from multivariable-adjusted Cox model. For patients with a preexisting mental disorder, we compared the rate of psychiatric care by different waiting times, allowing for repeated events. Among 4,120 patients without any preexisting mental disorder, lower risk of new onset mental disorders was noted for patients with longer waiting times, i.e. 18-29 days (HR 0.86; 95% CI 0.74-1.00) and 30-60 days (HR 0.79; 95% CI 0.67-0.93) as compared with 9-17 days. Among 2,312 patients with preexisting mental disorders, longer waiting time was associated with more frequent psychiatric hospital care during the first year after treatment (37.5% higher rate per quartile increase in waiting time; p for trend = 0.0002). However, no such association was observed beyond one year nor for the prescription of psychiatric medications. These data suggest that waiting time to treatment for esophageal or gastric cancer may have different mental health consequences for patients depending on their past psychiatric vulnerabilities. Our study sheds further light on the complexity of waiting time management, and calls for a comprehensive strategy that takes into account different domains of patient well-being in addition to the overall survival.

Stochastic nature of series of waiting times

NASA Astrophysics Data System (ADS)

Anvari, Mehrnaz; Aghamohammadi, Cina; Dashti-Naserabadi, H.; Salehi, E.; Behjat, E.; Qorbani, M.; Khazaei Nezhad, M.; Zirak, M.; Hadjihosseini, Ali; Peinke, Joachim; Tabar, M. Reza Rahimi

2013-06-01

Although fluctuations in the waiting time series have been studied for a long time, some important issues such as its long-range memory and its stochastic features in the presence of nonstationarity have so far remained unstudied. Here we find that the “waiting times” series for a given increment level have long-range correlations with Hurst exponents belonging to the interval 1/2

RECONCILIATION OF WAITING TIME STATISTICS OF SOLAR FLARES OBSERVED IN HARD X-RAYS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Aschwanden, Markus J.; McTiernan, James M., E-mail: aschwanden@lmsal.co, E-mail: jimm@ssl.berkeley.ed

2010-07-10

We study the waiting time distributions of solar flares observed in hard X-rays with ISEE-3/ICE, HXRBS/SMM, WATCH/GRANAT, BATSE/CGRO, and RHESSI. Although discordant results and interpretations have been published earlier, based on relatively small ranges (<2 decades) of waiting times, we find that all observed distributions, spanning over 6 decades of waiting times ({Delta}t {approx} 10{sup -3}-10{sup 3} hr), can be reconciled with a single distribution function, N({Delta}t) {proportional_to} {lambda}{sub 0}(1 + {lambda}{sub 0{Delta}}t){sup -2}, which has a power-law slope of p {approx} 2.0 at large waiting times ({Delta}t {approx} 1-1000 hr) and flattens out at short waiting times {Delta}t {approx}

Influence of nurse navigation on wait times for breast cancer care in a Canadian regional cancer center.

PubMed

Baliski, Christopher; McGahan, Colleen E; Liberto, Caitlyn M; Broughton, Sandra; Ellard, Susan; Taylor, Marianne; Bates, Janet; Lai, Anky

2014-05-01

The wait times for breast cancer care in our region do not meet acceptable benchmarks. We implemented the Interior Breast Rapid Access Investigation and Diagnosis (IB-RAPID) nurse navigation program to address this issue. The IB-RAPID prospective database was reviewed for patients entering the program between April 1, 2011 and April 30, 2012 (2011/2012 cohort), and was compared with patients from the same area in 2010. The main end point was the time between the 1st diagnostic imaging test and the surgery. Multiple linear regression was performed to investigate factors influencing the wait times. The wait times decreased with the introduction of IB-RAPID (59 vs 48 days; median). Stage of disease, total number of biopsies, and magnetic resonance imaging (MRI) use influenced wait times. MRI significantly delayed surgical intervention in both groups with those not having an MRI having a shorter wait time to surgery (68.5 vs 57.6 days; mean) in 2011/2012. The implementation of nurse navigation for patients with breast cancer appears to be effective at reducing the wait times for surgical treatment. Copyright © 2014 Elsevier Inc. All rights reserved.

How to report and monitor the performance of waiting list management.

PubMed

Torkki, Markus; Linna, Miika; Seitsalo, Seppo; Paavolainen, Pekka

2002-01-01

Potential problems concerning waiting list management are often monitored using mean waiting times based on empirical samples. However, the appropriateness of mean waiting time as an indicator of access can be questioned if a waiting list is not managed well, e.g., if the queue discipline is violated. This study was performed to find out about the queue discipline in waiting lists for elective surgery to reveal potential discrepancies in waiting list management. There were 1,774 waiting list patients for hallux valgus or varicose vein surgery or sterilization. The waiting time distributions of patients receiving surgery and of patients still waiting for an operation are presented in column charts. The charts are compared with two model charts. One model chart presents a high queue discipline (first in-first out) and another a poor queue discipline (random) queue. There were significant differences in waiting list management across hospitals and patient categories. Examples of a poor queue discipline were found in queues for hallux valgus and varicose vein operations. A routine waiting list reporting should be used to guarantee the quality of waiting list management and to pinpoint potential problems in access. It is important to monitor not only the number of patients in the waiting list but also the queue discipline and the balance between demand and supply of surgical services. The purpose for this type of reporting is to ensure that the priority setting made at health policy level also works in practise.

The ecology of the patient visit: physical attractiveness, waiting times, and perceived quality of care.

PubMed

Becker, Franklin; Douglass, Stephanie

2008-01-01

This study examined the relationship between the attractiveness of the physical environment of healthcare facilities and patient perceptions of quality, service, and waiting time through systematic observations and patient satisfaction surveys at 7 outpatient practices at Weill Cornell Medical Center. Findings indicate positive correlations between more attractive environments and higher levels of perceived quality, satisfaction, staff interaction, and reduction of patient anxiety. The comparison of actual observed time and patients' perception of time showed that patients tend to overestimate shorter waiting times and underestimate longer waiting times in both the waiting area and the examination room. Further examinations of the way outpatient-practice environments impact patient and staff perceptions and how those perceptions impact behavior and medical outcomes are suggested.

Public views on a wait time management initiative: a matter of communication

PubMed Central

2010-01-01

Background Many countries have tried to reduce waiting times for health care through formal wait time reduction strategies. Our paper describes views of members of the public about a wait time management initiative - the Ontario Wait Time Strategy (OWTS) (Canada). Scholars and governmental reports have advocated for increased public involvement in wait time management. We provide empirically derived recommendations for public engagement in a wait time management initiative. Methods Two qualitative studies: 1) an analysis of all emails sent by the public to the (OWTS) email address; and 2) in-depth interviews with members of the Ontario public. Results Email correspondents and interview participants supported the intent of the OWTS. However they wanted more information about the Strategy and its actions. Interview participants did not feel they were sufficiently made aware of the Strategy and email correspondents requested additional information beyond what was offered on the Strategy's website. Moreover, the email correspondents believed that some of the information that was provided on the Strategy's website and through the media was inaccurate, misleading, and even dishonest. Interview participants strongly supported public involvement in the OWTS priority setting. Conclusions Findings suggest the public wanted increased communication from and with the OWTS. Effective communication can facilitate successful public engagement, and in turn fair and legitimate priority setting. Based on the study's findings we developed concrete recommendations for improving public involvement in wait time management. PMID:20687952

Public views on a wait time management initiative: a matter of communication.

PubMed

Bruni, Rebecca A; Laupacis, Andreas; Levinson, Wendy; Martin, Douglas K

2010-08-05

Many countries have tried to reduce waiting times for health care through formal wait time reduction strategies. Our paper describes views of members of the public about a wait time management initiative--the Ontario Wait Time Strategy (OWTS) (Canada). Scholars and governmental reports have advocated for increased public involvement in wait time management. We provide empirically derived recommendations for public engagement in a wait time management initiative. Two qualitative studies: 1) an analysis of all emails sent by the public to the (OWTS) email address; and 2) in-depth interviews with members of the Ontario public. Email correspondents and interview participants supported the intent of the OWTS. However they wanted more information about the Strategy and its actions. Interview participants did not feel they were sufficiently made aware of the Strategy and email correspondents requested additional information beyond what was offered on the Strategy's website. Moreover, the email correspondents believed that some of the information that was provided on the Strategy's website and through the media was inaccurate, misleading, and even dishonest. Interview participants strongly supported public involvement in the OWTS priority setting. Findings suggest the public wanted increased communication from and with the OWTS. Effective communication can facilitate successful public engagement, and in turn fair and legitimate priority setting. Based on the study's findings we developed concrete recommendations for improving public involvement in wait time management.

Placing wireless tablets in clinical settings for patient education.

PubMed

Stribling, Judy C; Richardson, Joshua E

2016-04-01

The authors explored the feasibility and possible benefit of tablet-based educational materials for patients in clinic waiting areas. We distributed eight tablets preloaded with diagnosis-relevant information in two clinic waiting areas. Patients were surveyed about satisfaction, usability, and effects on learning. Technical issues were resolved. Thirty-seven of forty patients completed the survey. On average, the patients were satisfied in all categories. Placing tablet-based educational materials in clinic waiting areas is relatively easy to implement. Patients using tablets reported satisfaction across three domains: usability, education, and satisfaction.

Emergency department waiting times: Do the raw data tell the whole story?

PubMed

Green, Janette; Dawber, James; Masso, Malcolm; Eagar, Kathy

2014-02-01

To determine whether there are real differences in emergency department (ED) performance between Australian states and territories. Cross-sectional analysis of 2009-10 attendances at an ED contributing to the Australian non-admitted patient ED care database. The main outcome measure was difference in waiting time across triage categories. There were more than 5.8 million ED attendances. Raw ED waiting times varied by a range of factors including jurisdiction, triage category, geographic location and hospital peer group. All variables were significant in a model designed to test the effect of jurisdiction on ED waiting times, including triage category, hospital peer group, patient socioeconomic status and patient remoteness. When the interaction between triage category and jurisdiction entered the model, it was found to have a significant effect on ED waiting times (P<0.001) and triage was also significant (P<0.001). Jurisdiction was no longer statistically significant (P=0.248 using all triage categories and 0.063 using only Australian Triage Scale 2 and 3). Although the Council of Australian Governments has adopted raw measures for its key ED performance indicators, raw waiting time statistics are misleading. There are no consistent differences in ED waiting times between states and territories after other factors are accounted for. WHAT IS KNOWN ABOUT THE TOPIC? The length of time patients wait to be treated after presenting at an ED is routinely used to measure ED performance. In national health agreements with the federal government, each state and territory in Australia is expected to meet waiting time performance targets for the five ED triage categories. The raw data indicate differences in performance between states and territories. WHAT DOES THIS PAPER ADD? Measuring ED performance using raw data gives misleading results. There are no consistent differences in ED waiting times between the states and territories after other factors are taken into account. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? Judgements regarding differences in performance across states and territories for triage waiting times need to take into account the mix of patients and the mix of hospitals.

Pooled Open Blocks Shorten Wait Times for Nonelective Surgical Cases.

PubMed

Zenteno, Ana C; Carnes, Tim; Levi, Retsef; Daily, Bethany J; Price, Devon; Moss, Susan C; Dunn, Peter F

2015-07-01

Assess the impact of the implementation of a data-driven scheduling strategy that aimed to improve the access to care of nonelective surgical patients at Massachusetts General Hospital (MGH). Between July 2009 and June 2010, MGH experienced increasing throughput challenges in its perioperative environment: approximately 30% of the nonelective patients were waiting more than the prescribed amount of time to get to surgery, hampering access to care and aggravating the lack of inpatient beds. This work describes the design and implementation of an "open block" strategy: operating room (OR) blocks were reserved for nonelective patients during regular working hours (prime time) and their management centralized. Discrete event simulation showed that 5 rooms would decrease the percentage of delayed patients from 30% to 2%, assuming that OR availability was the only reason for preoperative delay. Implementation began in January 2012. We compare metrics for June through December of 2012 against the same months of 2011. The average preoperative wait time of all nonelective surgical patients decreased by 25.5% (P < 0.001), even with a volume increase of 9%. The number of bed-days occupied by nonurgent patients before surgery declined by 13.3% whereas the volume increased by 4.5%. The large-scale application of an open-block strategy significantly improved the flow of nonelective patients at MGH when OR availability was a major reason for delay. Rigorous metrics were developed to evaluate its performance. Strong managerial leadership was crucial to enact the new practices and turn them into organizational change.

A quality improvement intervention to increase access to pediatric subspecialty practice.

PubMed

Heptulla, Rubina A; Choi, Steven J; Belamarich, Peter F

2013-02-01

To improve access to new pediatric endocrinology appointments in an urban academic hospital faculty-based practice. Three strategies were implemented to increase the number of appointment slots: new patient appointments were protected from conversion to follow-up appointments; all physicians, including senior faculty, were scheduled to see 3 to 4 new patients per session; and sessions devoted exclusively to follow-up appointments were added based on demand. The main outcomes for this quality improvement activity were waiting times for new and follow-up appointments, monthly visit volume, the per-provider visit volume, differences in the proportion of new visits, and clinic arrival rates pre- and postintervention. Thirteen months after the intervention, average wait for a new patient appointment decreased from 11.4 to 1.7 weeks (P < .001) and follow-up appointment wait time decreased from 8.2 to 2.9 weeks (P < .001). Mean monthly total visit volume increased from 284 to 366 patient visits (P < .01) and mean monthly visit volume per provider increased from 36.8 to 41.0 patients (P = .08). New patients were 27% of the visit volume and 35% after the intervention. Access to our pediatric specialty care clinic was improved without increasing the number of providers by improved scheduling.

Impact of increased patient choice of providers in Sweden: cataract surgery.

PubMed

Hanning, Marianne; Åhs, Annika; Winblad, Ulrika; Lundström, Mats

2012-04-01

Choice of provider was introduced in Sweden in 2001. Our aim was to describe the scope and character of patient flows and to analyze any differences between patients who chose to move outside of their home county (movers) and those who did not (non-movers) with regard to age, sex, waiting time and level of need. Use of cataract operations between 2005 and 2008 based on data from the National Cataract Register. Data were analysed using descriptive statistics, odds ratios and multivariate regression analysis to compare movers and non-movers. Information on contracting between county councils and providers in other counties was obtained from a survey. Only 4% of cataract patients were treated by a provider outside their home county. Patient flows were mainly determined by contracts between county councils and providers, and only 1% were considered to be 'true' movers (i.e. patients who were not part of any special contracting agreement). Movers differed from non-movers in that they were on average younger, had less serious visual problems and had shorter waiting times. Though patient flows are minor in scope, the possibility of changing provider has probably been important in tackling long waits in some counties. However, the reform may threaten the equity of health care use.

Ex vivo lung perfusion: a comprehensive review of the development and exploration of future trends.

PubMed

Roman, Marius A; Nair, Sukumaran; Tsui, Steven; Dunning, John; Parmar, Jasvir S

2013-09-01

There is a critical mismatch between the number of donor lungs available and the demand for lungs for transplantation. This has created unacceptably high waiting-list mortality for lung transplant recipients. Currently (2012) in the United Kingdom, there are 216 patients on the lung transplant waiting list and 17 on heart and lung transplant list. The waiting times for suitable lungs average 412 days, with an increasing mortality and morbidity among the patients on the lung transplant list. Ex vivo lung perfusion (EVLP) has emerged as a technique for the assessment, resuscitation, and potential repair of suboptimal donor lungs. This is a rapidly developing field with significant clinical implications. In this review article, we critically appraise the background developments that have led to our current clinical practice. In particular, we focus on the human and animal experience, the different perfusion-ventilation strategies, and the impact of different perfusates and leukocyte filters. Finally, we examine EVLP as a potential research tool. This will provide insight into EVLP and its future development in the field of clinical lung transplantation.

Delays in Prior Living Kidney Donors Receiving Priority on the Transplant Waiting List

PubMed Central

Klassen, David K.; Kucheryavaya, Anna Y.; Stewart, Darren E.

2016-01-01

Background and objectives Prior living donors (PLDs) receive very high priority on the Organ Procurement and Transplantation Network (OPTN) kidney waiting list. Program delays in adding PLDs to the waiting list, setting their status to active, and submitting requests for PLD priority can affect timely access to transplantation. Design, setting, participants, & measurements We used the OPTN and the Centers for Medicare and Medicaid Services data to examine timing of (1) listing relative to start of dialysis, (2) activation on the waiting list, and (3) requests for PLD priority relative to listing date. There were 210 PLDs (221 registrations) added to the OPTN kidney waiting list between January 1, 2010 and July 31, 2015. Results As of September 4, 2015, 167 of the 210 PLDs received deceased donor transplants, six received living donor transplants, two died, five were too sick to transplant, and 29 were still waiting. Median waiting time to deceased donor transplant for PLDs was 98 days. Only 40.7% of 221 PLD registrations (n=90) were listed before they began dialysis; 68.3% were in inactive status for <90 days, 17.6% were in inactive status for 90–365 days, 8.6% were in inactive status for 1–2 years, and 5.4% were in inactive status for >2 years. Median time of PLDs waiting in active status before receiving PLD priority was 2 days (range =0–1450); 67.4% of PLDs received PLD priority within 7 days after activation, but 15.4% waited 8–30 days, 8.1% waited 1–3 months, 4.1% waited 3–12 months, and 5.0% waited >1 year in active status for PLD priority. After receiving priority, most were transplanted quickly. Median time in active status with PLD priority before deceased donor transplant was 23 days. Conclusions Fewer than one half of listed PLDs were listed before starting dialysis. Most listed PLDs are immediately set to active status and receive PLD priority quickly, but a substantial number spends time in active status without PLD priority or a large amount of time in inactive status, which affects access to timely transplants. PMID:27591296

Retrospective comparison of mechanical percutaneous thrombectomy of hemodialysis arteriovenous grafts with the Arrow-Trerotola device and the lyse and wait technique.

PubMed

Vashchenko, Natalia; Korzets, Asher; Neiman, Chaim; Bachar, Gil N; Ori, Yaacov; Belenky, Alexander; Atar, Eli

2010-06-01

The purpose of our study was to determine whether pharmacologic thrombolysis with urokinase in the lyse and wait (L&W) technique compared with mechanical declotting using the Arrow-Trerotola percutaneous thrombectomy device is more efficient, safer, or less expensive in treating thrombosed hemodialysis grafts. The files of 157 patients who underwent arteriovenous graft declotting from 2000 to 2007 at one tertiary care center were reviewed. The study group included 83 women and 74 men with a mean age of 68 +/- 12 years (range, 27-95 years). A total of 563 procedures were performed: 427 with the L&W technique and 136 with mechanical percutaneous thrombectomy using the percutaneous thrombectomy device. The two types of procedures were compared for success rate, complications, average patency time, and cost. There were no statistically significant differences between the pharmacologic and mechanical procedures in immediate success rate (99% and 98%, respectively) or average patency time (5.44 months and 5.40 months, respectively). The L&W technique was considerably less expensive. Given its lower cost and equal efficacy and safety, L&W appears to be preferable to mechanical thrombolysis with a percutaneous thrombectomy device for initial arteriovenous hemodialysis graft declotting.

Optimal Server Scheduling to Maintain Constant Customer Waiting Times

DTIC Science & Technology

1988-12-01

I I• I I I I I LCn CN OPTIMAL SERVER SCHEDUUNG TO MAINTAIN CONSTANT CUSTOMER WAITING TIMES THESIS Thomas J. Frey Captain UISAF AFIT/GOR/ENS/88D-7...hw bees appsewlf in ple rtan. cd = , ’ S 087 AFIT/GORMENS/8D-7 OPTIMAL SERVER SCHEDUUNG TO MAINTAIN~ CONSTANT CUSTOMER WAITING TIMES THESIS Thomas j...CONSTANT CUSTOMER WAITING TIMES THESIS Presented to the Faculty of the School of Engineering of the Air Force Institute of Technology Air University In

Effect of emergency physician burnout on patient waiting times.

PubMed

De Stefano, Carla; Philippon, Anne-Laure; Krastinova, Evguenia; Hausfater, Pierre; Riou, Bruno; Adnet, Frederic; Freund, Yonathan

2018-04-01

Burnout is common in emergency physicians. This syndrome may negatively affect patient care and alter work productivity. We seek to assess whether burnout of emergency physicians impacts waiting times in the emergency department. Prospective study in an academic ED. All patients who visited the main ED for a 4-month period in 2016 were included. Target waiting times are assigned by triage nurse to patients on arrival depending on their severity. The primary endpoint was an exceeded target waiting time for ED patients. All emergency physicians were surveyed by a psychologist to assess their level of burnout using the Maslach Burnout Inventory. We defined the level of burnout of the day in the ED as the mean burnout level of the physicians working that day (8:30 to the 8:30 the next day). A logistic regression model was performed to assess whether burnout level of the day was independently associated with prolonged waiting times, along with previously reported predictors. Target waiting time was exceeded in 7524 patients (59%). Twenty-six emergency physicians were surveyed. Median burnout score was 35 [Interquartile (24-49)]. A burnout level of the day higher than 35 was independently associated with an exceeded target waiting time (adjusted odds ratio 1.54, 95% confidence interval 1.39-1.70), together with previously reported predictors (i.e., day of the week, time of the day, trauma, age and daily census). Burnout of emergency physicians was independently associated with a prolonged waiting time for patients visiting the ED.

Outcome in patients admitted outside regular hospital working hours: does time until regular working hours matter?

PubMed

Nakajima, Makoto; Inatomi, Yuichiro; Yonehara, Toshiro; Watanabe, Masaki; Ando, Yukio

2015-01-01

The aim of this study was to investigate whether stratifying patients according to the time period from admission to the start of regular working hours would help detect a weekend effect in acute stroke patients. Ischemic stroke patients admitted between October 2002 and March 2012 were analyzed. Working hours were defined as 9:00-17:00 on weekdays. Patients were divided into those admitted during working hours (no-wait group) and three other groups according to the time from admission to working hours: ≤24 h (short-wait group), 24-48 h (medium-wait group), and >48 h (long-wait group). The modified Rankin Scale score and mortality at three-months were compared among the groups. Of 5625 patients, 3323 (59%) were admitted outside working hours. The proportion of patients with an mRS score 0-1 at three-months showed a decreasing trend with the time period before working hours: 47% (no-wait group), 42% (short-wait group), 42% (medium-wait group), and 38% (long-wait group), respectively (P < 0·001). When the no-wait group was used as a reference, the odds ratio for modified Rankin Scale score 0-1 was 0·88 (95% confidence interval, 0·75-1·04) in the short-wait group, 0·86 (0·69-1·07) in the medium-wait group, and 0·67 (0·53-0·85) in the long-wait group after adjusting for sex, age, premorbid mRS score, previous morbidity, stroke severity, and vascular risk factors. Mortality at three-months was not different between the no-wait group and the other groups. A weekend effect might be evident if patients were stratified according to the time period from admission until working hours. © 2014 World Stroke Organization.

Assessment of Heart Transplant Waitlist Time and Pre- and Post-transplant Failure: A Mixed Methods Approach.

PubMed

Goldstein, Benjamin A; Thomas, Laine; Zaroff, Jonathan G; Nguyen, John; Menza, Rebecca; Khush, Kiran K

2016-07-01

Over the past two decades, there have been increasingly long waiting times for heart transplantation. We studied the relationship between heart transplant waiting time and transplant failure (removal from the waitlist, pretransplant death, or death or graft failure within 1 year) to determine the risk that conservative donor heart acceptance practices confer in terms of increasing the risk of failure among patients awaiting transplantation. We studied a cohort of 28,283 adults registered on the United Network for Organ Sharing heart transplant waiting list between 2000 and 2010. We used Kaplan-Meier methods with inverse probability censoring weights to examine the risk of transplant failure accumulated over time spent on the waiting list (pretransplant). In addition, we used transplant candidate blood type as an instrumental variable to assess the risk of transplant failure associated with increased wait time. Our results show that those who wait longer for a transplant have greater odds of transplant failure. While on the waitlist, the greatest risk of failure is during the first 60 days. Doubling the amount of time on the waiting list was associated with a 10% (1.01, 1.20) increase in the odds of failure within 1 year after transplantation. Our findings suggest a relationship between time spent on the waiting list and transplant failure, thereby supporting research aimed at defining adequate donor heart quality and acceptance standards for heart transplantation.

Wait times to rheumatology care for patients with rheumatic diseases: a data linkage study of primary care electronic medical records and administrative data.

PubMed

Widdifield, Jessica; Bernatsky, Sasha; Thorne, J Carter; Bombardier, Claire; Jaakkimainen, R Liisa; Wing, Laura; Paterson, J Michael; Ivers, Noah; Butt, Debra; Lyddiatt, Anne; Hofstetter, Catherine; Ahluwalia, Vandana; Tu, Karen

2016-01-01

The Wait Time Alliance recently established wait time benchmarks for rheumatology consultations in Canada. Our aim was to quantify wait times to primary and rheumatology care for patients with rheumatic diseases. We identified patients from primary care practices in the Electronic Medical Record Administrative data Linked Database who had referrals to Ontario rheumatologists over the period 2000-2013. To assess the full care pathway, we identified dates of symptom onset, presentation in primary care and referral from electronic medical records. Dates of rheumatologist consultations were obtained by linking with physician service claims. We determined the duration of each phase of the care pathway (symptom onset to primary care encounter, primary care encounter to referral, and referral to rheumatologist consultation) and compared them with established benchmarks. Among 2430 referrals from 168 family physicians, 2015 patients (82.9%) were seen by 146 rheumatologists within 1 year of referral. Of the 2430 referrals, 2417 (99.5%) occurred between 2005 and 2013. The main reasons for referral were osteoarthritis (32.4%) and systemic inflammatory rheumatic diseases (30.6%). Wait times varied by diagnosis and geographic region. Overall, the median wait time from referral to rheumatologist consultation was 74 (interquartile range 27-101) days; it was 66 (interquartile range 18-84) days for systemic inflammatory rheumatic diseases. Wait time benchmarks were not achieved, even for the most urgent types of referral. For systemic inflammatory rheumatic diseases, most of the delays occurred before referral. Rheumatology wait times exceeded established benchmarks. Targeted efforts are needed to promote more timely access to both primary and rheumatology care. Routine linkage of electronic medical records with administrative data may help fill important gaps in knowledge about waits to primary and specialty care.

Delays in Referral and Enrolment Are Associated With Mitigated Benefits of Cardiac Rehabilitation After Coronary Artery Bypass Surgery.

PubMed

Marzolini, Susan; Blanchard, Chris; Alter, David A; Grace, Sherry L; Oh, Paul I

2015-11-01

Cardiac rehabilitation (CR) is recommended after coronary artery bypass graft surgery; however, the consequences of longer wait times to start CR have not been elucidated. Cardiopulmonary, demographic, and anthropometric assessments were conducted before and after 6 months of CR in consecutively enrolled patients from January 1995 to October 2012. Wait times were ascertained from referral forms and charts. Neighborhood characteristics were ascertained using census data and cross-referencing with patients' home geographic location. Among 6497 post- coronary artery bypass graft participants, mean and median total wait time (time from surgery to first exercise session) was 101.1±47.9 and 80 days, respectively. In multiple linear regression, correlates of longer total wait time and the 2 wait-time phases, time from surgery to CR referral and time from CR referral to first exercise session, were determined. Factors influencing longer wait times included female sex, greater age, being employed, less social support, longer drive time to CR, lower neighborhood socioeconomic status, higher systolic blood pressure, abdominal obesity, and a complex medical history. After adjusting for correlates of delayed entry, longer wait time for each of the total and 2 wait-time phases was significantly associated with less improvement in cardiopulmonary fitness (VO2peak; β=-0.165, P<0.001), body fat percentage (β=0.032, P<0.02), resting heart rate (β=0.066, P<0.001), and poorer attendance to CR classes (β=-0.081, P<0.001) and completion rate (β=2.741, P<0.001). Strategies for timely access to CR at each phase of the process are important given the negative impact that wait time has on key clinical outcomes. This is relevant because optimizing VO2peak and attendance to CR has been shown to confer a mortality advantage. © 2015 American Heart Association, Inc.

Patient satisfaction with nursing care in an urban and suburban emergency department.

PubMed

Wright, Greg; Causey, Sherry; Dienemann, Jacqueline; Guiton, Paula; Coleman, Frankie Sue; Nussbaum, Marcy

2013-10-01

Patient satisfaction is an important outcome measurement in the emergency department (ED). When unavoidable, the negative effect of patient wait time may be lessened by communicating expected wait time, affective support, health information, decisional control, and competent providers. This controlled quasi-experimental design used a convenience sample. The patient questionnaire included demographics, expected and perceived wait time, receiving of comfort items, information and engaging activities and their perceived helpfulness for coping with waiting, and the Consumer Emergency Care Satisfaction Scale measure of patient satisfaction with nursing. Systematic offering of comfort items, clinical information, and engaging activities were statistically analyzed for impact on perceived wait times, helpfulness in waiting, and satisfaction with nursing care. Interventions were supported by the data as helpful for coping with waiting and were significantly related to nursing care satisfaction. Interventions were less helpful for suburban patients who were also less satisfied. Nurses can influence patient satisfaction in the ED through communication and caring behaviors.

FAST TRACK COMMUNICATION: Suppressing anomalous diffusion by cooperation

NASA Astrophysics Data System (ADS)

Dybiec, Bartłomiej

2010-08-01

Within a continuous time random walk scenario we consider a motion of a complex of particles which moves coherently. The motion of every particle is characterized by the waiting time and jump length distributions which are of the power-law type. Due to the interactions between particles it is assumed that the waiting time is adjusted to the shortest or to the longest waiting time. Analogously, the jump length is adjusted to the shortest or to the longest jump length. We show that adjustment to the shortest waiting time can suppress the subdiffusive behavior even in situations when the exponent characterizing the waiting time distribution assures subdiffusive motion of a single particle. Finally, we demonstrate that the characteristic of the motion depends on the number of particles building a complex.

The Impact of Patient-to-Patient Interaction in Health Facility Waiting Rooms on Their Perception of Health Professionals.

PubMed

Willis, William Kent; Ozturk, Ahmet Ozzie; Chandra, Ashish

2015-01-01

Patients have to wait in waiting rooms prior to seeing the physician. But there are few studies that demonstrate what they are actually doing in the waiting room. This exploratory study was designed to investigate the types of discussions that patients in the waiting room typically engage in with other patients and how the conversations affected their opinion on general reputation of the clinic, injections/blocks as treatment procedures, waiting time, time spent with the caregiver, overall patient satisfaction, and the pain medication usage policy. The study demonstrates that patient interaction in the waiting room has a positive effect on patient opinion of the pain clinic and the caregivers.

Continuous-Time Finance and the Waiting Time Distribution: Multiple Characteristic Times

NASA Astrophysics Data System (ADS)

Fa, Kwok Sau

2012-09-01

In this paper, we model the tick-by-tick dynamics of markets by using the continuous-time random walk (CTRW) model. We employ a sum of products of power law and stretched exponential functions for the waiting time probability distribution function; this function can fit well the waiting time distribution for BUND futures traded at LIFFE in 1997.

Quality improvement intervention to increase adherence to ART prescription policy at HIV treatment clinics in Lusaka, Zambia: A cluster randomized trial

PubMed Central

Subramaniam, Hamsa L.; Prust, Margaret L.; Prescott, Marta R.; Mpasela, Felton; Mwango, Albert; Namonje, Leah; Moyo, Crispin; Chibuye, Benjamin; van den Broek, Jan Willem; Hehman, Lindsey; Moberley, Sarah

2017-01-01

Introduction In urban areas, crowded HIV treatment facilities with long patient wait times can deter patients from attending their clinical appointments and picking up their medications, ultimately disrupting patient care and compromising patient retention and adherence. Methods Formative research at eight facilities in Lusaka revealed that only 46% of stable HIV treatment patients were receiving a three-month refill supply of antiretroviral drugs, despite it being national policy for stable adult patients. We designed a quality improvement intervention to improve the operationalization of this policy. We conducted a cluster-randomized controlled trial in sixteen facilities in Lusaka with the primary objective of examining the intervention’s impact on the proportion of stable patients receiving three-month refills. The secondary objective was examining whether the quality improvement intervention reduced facility congestion measured through two proxy indicators: daily volume of clinic visits and average clinic wait times for services. Results The mean change in the proportion of three-month refills among control facilities from baseline to endline was 10% (from 38% to 48%), compared to a 25% mean change (an increase from 44% to 69%) among intervention facilities. This represents a significant 15% mean difference (95% CI: 2%-29%; P = 0.03) in the change in proportion of patients receiving three-month refills. On average, control facilities had 15 more visits per day in the endline than in the baseline, while intervention facilities had 20 fewer visits per day in endline than in baseline, a mean difference of 35 fewer visits per day (P = 0.1). The change in the mean facility total wait time for intervention facilities dropped 19 minutes between baseline and endline when compared to control facilities (95% CI: -10.2–48.5; P = 0.2). Conclusion A more patient-centred service delivery schedule of three-month prescription refills for stable patients is viable. We encourage the expansion of this sustainable intervention in Zambia’s urban clinics. PMID:28419106

Quality improvement intervention to increase adherence to ART prescription policy at HIV treatment clinics in Lusaka, Zambia: A cluster randomized trial.

PubMed

McCarthy, Elizabeth A; Subramaniam, Hamsa L; Prust, Margaret L; Prescott, Marta R; Mpasela, Felton; Mwango, Albert; Namonje, Leah; Moyo, Crispin; Chibuye, Benjamin; van den Broek, Jan Willem; Hehman, Lindsey; Moberley, Sarah

2017-01-01

In urban areas, crowded HIV treatment facilities with long patient wait times can deter patients from attending their clinical appointments and picking up their medications, ultimately disrupting patient care and compromising patient retention and adherence. Formative research at eight facilities in Lusaka revealed that only 46% of stable HIV treatment patients were receiving a three-month refill supply of antiretroviral drugs, despite it being national policy for stable adult patients. We designed a quality improvement intervention to improve the operationalization of this policy. We conducted a cluster-randomized controlled trial in sixteen facilities in Lusaka with the primary objective of examining the intervention's impact on the proportion of stable patients receiving three-month refills. The secondary objective was examining whether the quality improvement intervention reduced facility congestion measured through two proxy indicators: daily volume of clinic visits and average clinic wait times for services. The mean change in the proportion of three-month refills among control facilities from baseline to endline was 10% (from 38% to 48%), compared to a 25% mean change (an increase from 44% to 69%) among intervention facilities. This represents a significant 15% mean difference (95% CI: 2%-29%; P = 0.03) in the change in proportion of patients receiving three-month refills. On average, control facilities had 15 more visits per day in the endline than in the baseline, while intervention facilities had 20 fewer visits per day in endline than in baseline, a mean difference of 35 fewer visits per day (P = 0.1). The change in the mean facility total wait time for intervention facilities dropped 19 minutes between baseline and endline when compared to control facilities (95% CI: -10.2-48.5; P = 0.2). A more patient-centred service delivery schedule of three-month prescription refills for stable patients is viable. We encourage the expansion of this sustainable intervention in Zambia's urban clinics.

Waiting times for cancer patients in Sweden: A nationwide population-based study.

PubMed

Robertson, Stephanie; Adolfsson, Jan; Stattin, Pär; Sjövall, Annika; Winnersjö, Rocio; Hanning, Marianne; Sandelin, Kerstin

2017-05-01

The reported long waiting times for cancer patients have mostly been related to prognostic outcome and less to patient-related experience to outcome. We assessed waiting times for patients with cancer of the breast, prostate, colon or rectum in Sweden. The median time from referral to start of treatment was assessed using data from clinical cancer registers for patients who received curative treatment during 2011, 2012 and 2013. The median overall waiting time in different counties ranged from 7 to 28 days for breast cancer, from 117 to 280 days for prostate cancer, from 27 to 64 days for colon cancer and from 48 to 80 days for rectal cancer. For the entire nation, the median time from referral to start of treatment remained unchanged from 2011 to 2013 for each cancer diagnosis. Large variations were found in waiting times between different counties in Sweden and between different types of cancer. The long waiting times identified in this study emphasize the need to improve national programmes for more rapid diagnosis and treatment.

The First View Concept: introduction of industrial flow techniques into emergency medicine organization.

PubMed

Hogan, Barbara; Rasche, Christoph; von Reinersdorff, Andrea Braun

2012-06-01

The number of patients seeking treatment in emergency departments is rising, although many governments are seeking to reduce expenditure on health. Emergency departments must achieve more with the same resources or perform the same functions with fewer resources. Patients demand higher emergency clinical care quality, with low waiting times viewed as a key quality criterion by many patients. The objective of this study was to create an improved working system in emergency departments that cuts patient waiting times for first specialty physician contact. Techniques from industrial flow management were applied to the working process of an emergency department and the concept was named 'First View.' A total of 3269 patient contacts using the First View Concept during a treatment month showed statistical significance. Before introduction, a total 3230 patients in a comparative treatment month had a median waiting time before the first doctor contact of 47.6 min, a first quartile waiting time of 36.1 min, and a third quartile waiting time of 62.7 min. After introduction, 3269 patients had a median waiting time before first specialty physician contact of 11.2 min, a first quartile waiting time of 9.1 min, and a third quartile waiting time of 15.2 min. Industrial flow concepts can achieve significant improvements in emergency department workflows in countries in which sufficient numbers of specialty physicians are available. More attention to the organization of emergency department working processes is needed, especially involving lean management.

Lean techniques for the improvement of patients’ flow in emergency department

PubMed Central

Chan, HY; Lo, SM; Lee, LLY; Lo, WYL; Yu, WC; Wu, YF; Ho, ST; Yeung, RSD; Chan, JTS

2014-01-01

BACKGROUND: Emergency departments (EDs) face problems with overcrowding, access block, cost containment, and increasing demand from patients. In order to resolve these problems, there is rising interest to an approach called “lean” management. This study aims to (1) evaluate the current patient flow in ED, (2) to identify and eliminate the non-valued added process, and (3) to modify the existing process. METHODS: It was a quantitative, pre- and post-lean design study with a series of lean management work implemented to improve the admission and blood result waiting time. These included structured re-design process, priority admission triage (PAT) program, enhanced communication with medical department, and use of new high sensitivity troponin-T (hsTnT) blood test. Triage waiting time, consultation waiting time, blood result time, admission waiting time, total processing time and ED length of stay were compared. RESULTS: Among all the processes carried out in ED, the most time consuming processes were to wait for an admission bed (38.24 minutes; SD 66.35) and blood testing result (mean 52.73 minutes, SD 24.03). The triage waiting time and end waiting time for consultation were significantly decreased. The admission waiting time of emergency medical ward (EMW) was significantly decreased from 54.76 minutes to 24.45 minutes after implementation of PAT program (P<0.05). CONCLUSION: The application of lean management can improve the patient flow in ED. Acquiescence to the principle of lean is crucial to enhance high quality emergency care and patient satisfaction. PMID:25215143

[Gender and age differences in waiting time on hospital waiting list.].

PubMed

Thornórðardóttir, Steinunn; Halldórsson, Matthías; Guðmundsson, Sigurður

2002-09-01

The size of waiting lists has traditionally been viewed as a fairly good measure of the quality of health care services. No statistical analysis exists in Iceland of the length of waiting times and the potential variation between groups of patients. This study was conducted within the office of the Directorate of Health in Iceland. This location was convenient since standardized information on waiting lists is collected by the office three times a year. Variations in waiting times were studied based on gender on the one hand and on age on the other. Data from the largest waiting lists, those amounting to 400 or more patients, were included in the study. The most frequently awaited operations were identified and the groups of people waiting for them analyzed. The departments and prospective operations included in the study were: Dept. of General Surgery at the University Hospital (UH) (laparoscopic gastro-oesophageal antireflux operation), Opthalmology at UH (phakoemulsification with implantation of artificial lens in posterior chamber), Orthopedic Surgery at UH (primary total prosthetic replacement of hip joint using sement), The Rehabilitation Center at Reykjalundur (rehabilitation, not specified), Ear, Nose and Throat (ENT) at UH (tonsillectomy), and Reconstructive Surgery at UH (reduction mammoplasty with transposition of areola). The lists were sorted by gender and age, with the latter consisting of two categories, older and younger patients. Every attempt was made as to ensure similar sample sizes for both age groups within each department. Finally, the median waiting time was determined and a Mann-Whitney test conducted in order to test for significance. The median waiting time for males at the General Surgery Dept. was 73 weeks as compared to 60 weeks for females. This was the only department where the median waiting time was significantly longer for males than for females (p<0.05). At three of the departments the older group had a longer median waiting time than the younger group, 18 weeks compared to 14 at Opthalmology (p<0.001), 26 versus 17 weeks at Reykjalundur (p<0.025) and 33 versus 21 weeks at ENT (p<0.01). Waiting times for females was significantly longer than for males at two departments, Reykjalundur (21 vs. 17 weeks, p<0.05) and ENT (33 vs. 29 weeks, p<0.05). This study revealed age and gender differences in median waiting times at Icelandic hospitals. These differences were in many cases marked and statistically significant. Various explanations have been put forward, however, further research is needed in order to determine if it these differences are due to actual clinical needs assessments or to age or gender discrimination.

Evaluation of supply-side initiatives to improve access to coronary bypass surgery.

PubMed

Sobolev, Boris G; Fradet, Guy; Kuramoto, Lisa; Sobolyeva, Rita; Rogula, Basia; Levy, Adrian R

2012-09-11

Guided by the evidence that delaying coronary revascularization may lead to symptom worsening and poorer clinical outcomes, expansion in cardiac surgery capacity has been recommended in Canada. Provincial governments started providing one-time and recurring increases in budgets for additional open heart surgeries to reduce waiting times. We sought to determine whether the year of decision to proceed with non-emergency coronary bypass surgery had an effect on time to surgery. Using records from a population-based registry, we studied times between decision to operate and the procedure itself. We estimated changes in the length of time that patients had to wait for non-emergency operation over 14 calendar periods that included several years when supplementary funding was available. We studied waiting times separately for patients who access surgery through a wait list and through direct admission. During two periods when supplementary funding was available, 1998-1999 and 2004-2005, the weekly rate of undergoing surgery from a wait list was, respectively, 50% and 90% higher than in 1996-1997, the period with the longest waiting times. We also observed a reduction in the difference between 90th and 50th percentiles of the waiting-time distributions. Forty percent of patients in the 1998, 1999, 2004 and 2005 cohorts (years when supplementary funding was provided) underwent surgery within 16 to 20 weeks following the median waiting time, while it took between 27 and 37 weeks for the cohorts registered in the years when supplementary funding was not available. Times between decision and surgery were shorter for direct admissions than for wait-listed patients. Among patients who were directly admitted to hospital, time between decision and surgery was longest in 1992-1993 and then has been steadily decreasing through the late nineties. The rate of surgery among these patients was the highest in 1998-1999, and has not changed afterwards, even for years when supplementary funding was provided. Waiting times for non-emergency coronary bypass surgery shortened after supplementary funding was granted to increase volume of cardiac surgical care in a health system with publicly-funded universal coverage for the procedure. The effect of the supplementary funding was not uniform for patients that access the services through wait lists and through direct admission.

The effect of waiting times from general practitioner referral to MRI or orthopaedic consultation for the knee on patient-based outcomes.

PubMed

Brealey, S; Andronis, L; Dale, V; Gibbon, A J; Gilbert, F J; Hendry, M; Hood, K; King, D; Wilkinson, C

2012-11-01

The purpose of this study was to test for the effect of waiting time from general practitioner (GP) referral to MRI or to orthopaedic consultation on outcomes of patients with knee problems, and to test whether any characteristics of trial participants predicted waiting time to MRI or orthopaedics. We undertook secondary analyses of data on 553 participants from a randomised trial who were recruited from 163 general practices during November 2002 to October 2004. Of the patients allocated to MRI, 263 (94%) had an MRI, and of those referred to orthopaedics, 236 (86%) had an orthopaedic consultation. The median (interquartile range) waiting time in days from randomisation to MRI was 41.0 (21.0-71.0) and to orthopaedic appointment was 78.5 (54.5-167.5). Waiting time was found to have no significant effect on patient outcome for both the Short Form 36-item (SF-36) physical functioning score (p=0.570) and the Knee Quality of Life 26-item (KQoL-26) physical functioning score (p=0.268). There was weak evidence that males waited less time for their MRI (p=0.049) and older patients waited longer for their orthopaedic referral (p=0.049). For patients who resided in the catchment areas of some centres there were significantly longer waiting times for both MRI and orthopaedic appointment. Where patients reside is a strong predictor of waiting time for access to services such as MRI or orthopaedics. There is no evidence to suggest, however, that this has a significant effect on physical well-being in the short term for patients with knee problems.

Fluorescence correlation spectroscopy: the case of subdiffusion.

PubMed

Lubelski, Ariel; Klafter, Joseph

2009-03-18

The theory of fluorescence correlation spectroscopy is revisited here for the case of subdiffusing molecules. Subdiffusion is assumed to stem from a continuous-time random walk process with a fat-tailed distribution of waiting times and can therefore be formulated in terms of a fractional diffusion equation (FDE). The FDE plays the central role in developing the fluorescence correlation spectroscopy expressions, analogous to the role played by the simple diffusion equation for regular systems. Due to the nonstationary nature of the continuous-time random walk/FDE, some interesting properties emerge that are amenable to experimental verification and may help in discriminating among subdiffusion mechanisms. In particular, the current approach predicts 1), a strong dependence of correlation functions on the initial time (aging); 2), sensitivity of correlation functions to the averaging procedure, ensemble versus time averaging (ergodicity breaking); and 3), that the basic mean-squared displacement observable depends on how the mean is taken.

Clinical and epidemiological aspects of cornea transplant patients of a reference hospital 1

PubMed Central

Cruz, Giovanna Karinny Pereira; de Azevedo, Isabelle Campos; Carvalho, Diana Paula de Souza Rego Pinto; Vitor, Allyne Fortes; Santos, Viviane Euzébia Pereira; Ferreira, Marcos Antonio

2017-01-01

ABSTRACT Objective: clinically characterizing cornea transplant patients and their distribution according to indicated and post-operative conditions of cornea transplantation, as well as estimating the average waiting time. Method: a cross-sectional, descriptive and analytical study performed for all cornea transplants performed at a reference service (n=258). Data were analyzed using Statistical Package for the Social Sciences, version 20.0. Results: the main indicator for cornea transplant was keratoconus. The mean waiting time for the transplant was approximately 5 months and 3 weeks for elective transplants and 9 days for urgent cases. An association between the type of corneal disorder with gender, age, previous surgery, eye classification, glaucoma and anterior graft failure were found. Conclusion: keratoconus was the main indicator for cornea transplant. Factors such as age, previous corneal graft failure (retransplantation), glaucoma, cases of surgeries prior to cornea transplant (especially cataract surgery) may be related to the onset corneal endothelium disorders. PMID:28614429

Analysis and Relative Evaluation of Connectivity of a Mobile Multi-Hop Network

NASA Astrophysics Data System (ADS)

Nakano, Keisuke; Miyakita, Kazuyuki; Sengoku, Masakazu; Shinoda, Shoji

In mobile multi-hop networks, a source node S and a destination node D sometimes encounter a situation where there is no multi-hop path between them when a message M, destined for D, arrives at S. In this situation, we cannot send M from S to D immediately; however, we can deliver M to D after waiting some time with the help of two capabilities of mobility. One of the capabilities is to construct a connected multi-hop path by changing the topology of the network during the waiting time (Capability 1), and the other is to move M closer to D during the waiting time (Capability 2). In this paper, we consider three methods to deliver M from S to D by using these capabilities in different ways. Method 1 uses Capability 1 and sends M from S to D after waiting until a connected multi-hop path appears between S and D. Method 2 uses Capability 2 and delivers M to D by allowing a mobile node to carry M from S to D. Method 3 is a combination of Methods 1 and 2 and minimizes the waiting time. We evaluate and compare these three methods in terms of the mean waiting time, from the time when M arrives at S to the time when D starts receiving M, as a new approach to connectivity evaluation. We consider a one-dimensional mobile multi-hop network consisting of mobile nodes flowing in opposite directions along a street. First, we derive some approximate equations and propose an estimation method to compute the mean waiting time of Method 1. Second, we theoretically analyze the mean waiting time of Method 2, and compute a lower bound of that of Method 3. By comparing the three methods under the same assumptions using results of the analyses and some simulation results, we show relations between the mean waiting times of these methods and show how Capabilities 1 and 2 differently affect the mean waiting time.

Non-renewal statistics for electron transport in a molecular junction with electron-vibration interaction

NASA Astrophysics Data System (ADS)

Kosov, Daniel S.

2017-09-01

Quantum transport of electrons through a molecule is a series of individual electron tunneling events separated by stochastic waiting time intervals. We study the emergence of temporal correlations between successive waiting times for the electron transport in a vibrating molecular junction. Using the master equation approach, we compute the joint probability distribution for waiting times of two successive tunneling events. We show that the probability distribution is completely reset after each tunneling event if molecular vibrations are thermally equilibrated. If we treat vibrational dynamics exactly without imposing the equilibration constraint, the statistics of electron tunneling events become non-renewal. Non-renewal statistics between two waiting times τ1 and τ2 means that the density matrix of the molecule is not fully renewed after time τ1 and the probability of observing waiting time τ2 for the second electron transfer depends on the previous electron waiting time τ1. The strong electron-vibration coupling is required for the emergence of the non-renewal statistics. We show that in the Franck-Condon blockade regime, extremely rare tunneling events become positively correlated.

An Estimation Method of Waiting Time for Health Service at Hospital by Using a Portable RFID and Robust Estimation

NASA Astrophysics Data System (ADS)

Ishigaki, Tsukasa; Yamamoto, Yoshinobu; Nakamura, Yoshiyuki; Akamatsu, Motoyuki

Patients that have an health service by doctor have to wait long time at many hospitals. The long waiting time is the worst factor of patient's dissatisfaction for hospital service according to questionnaire for patients. The present paper describes an estimation method of the waiting time for each patient without an electronic medical chart system. The method applies a portable RFID system to data acquisition and robust estimation of probability distribution of the health service and test time by doctor for high-accurate waiting time estimation. We carried out an health service of data acquisition at a real hospital and verified the efficiency of the proposed method. The proposed system widely can be used as data acquisition system in various fields such as marketing service, entertainment or human behavior measurement.

Waiting time care guarantees: necessity or nemesis?

PubMed

Joshi, N P; Noseworthy, F T; Noseworthy, T W

2006-01-01

One of the priorities of governments in Canada is to reduce long waiting times for health services. This has raised the prospect of introducing waiting time care guarantees. Such guarantees affirm the healthcare system's social contract with the public and provide an entitlement to Canadians to receive timely care. There are clinical, legal and political implications, which must be considered and well managed before introduction. Other countries have ventured down this path. They teach us that waiting time care guarantees are good policy and make good sense. Correspondingly, they remind us not to make a promise we are not ready to keep.

[Has the time arrived for the management of waiting lists?].

PubMed

Bernal, E

2002-01-01

Individuals on the waiting list frequently suffer an additional risk caused by the mean time until they receive treatment; however, other individuals do not need the treatment for which they are waiting.Both arguments, which can be contrasted with empirical evidence, would be sufficient to affirm that waiting list management should be implemented, leaving aside policies that are more of less opportunistic. Opportunistic policies are understood as those providing misinformation on waiting lists or their "manipulation", and using programs of auto-coordination with the sole aim of reaching the end of the year without a waiting list of not more than six months, etc. The panorama is not completely bleak. Some management initiatives (and even Politics with a capital P) are opening the way forward and may enter the Agenda in the next few years. In this context, the application of guaranteed times of medical care or the prioritization of waiting lists according to explicit criteria should be highlighted. It is worth remembering that, except for the queues in the waiting rooms of health centers and emergency departments, waiting lists are mediated by the decision of the physician. Therefore, an essential strategy for managing waiting lists consists of attenuating the problems caused by uncertainty (or ignorance) of the patient's diagnosis or prognosis.

Lowering transit crime may save energy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

Shifting travelers from less-energy-efficient automobiles to more-energy-efficient transit vehicles is an essential energy conservation measure. During peak travel periods the average auto carries 1.4 persons and consumes 16 times more fuel per passenger mile than an urban bus carrying an average of 75 passengers. Today's travelers are using transit for less than 3 percent of their urban trips. Travelers reject transit because its costs--in terms of time, money, and quality of service--are higher than those for the auto. One element of the higher cost of using transit is the increased exposure to crime which occurs when a traveler shifts frommore » his private car to mass transit. The increased exposure is the result of the additional time transit travelers spend getting to and waiting at transit stops, as well as the additional time spent riding, and the lack of privacy while on transit. Furthermore, transit travelers have no control over their route, which may go through high-crime areas. In contrast, traveling by auto not only eliminates the time getting to and waiting at transit stops, but it also provides a secure compartment which can be locked. Traveling companions can be chosen to limit exposure to crime. In addition, auto travel provides the opportunity to select the safest and shortest route. Between the two extremes of high exposure to crime presented by public transit and low exposure to crime offered by private autos lies para-transit, such as taxis, carpools, and jitneys (small buses that carry passengers over a regular route according to a flexible schedule). (MCW)« less

[Women's satisfaction with waiting times for further investigation in breast cancer screening].

PubMed

Molina-Barceló, Ana; Salas Trejo, Dolores; Miranda García, Josefa

2011-01-01

To determine the factors associated with satisfaction with waiting times for further investigation in breast cancer screening. We carried out a cross-sectional study by telephone survey of a representative sample of women (N=316) participating in the breast cancer screening program of the autonomous region of Valencia (Spain) who required additional tests to confirm the diagnosis. Descriptive analysis was performed by contingency tables (p<0.05) and multivariate association by odds ratios (OR) of logistic regression models (95%CI). Satisfaction with the waiting time was 78.6%. A higher risk of dissatisfaction was found in women from a "high" social class (OR=3.17; 95% CI: 1.10-9.14), those who perceived that the waiting time was "more than 2 weeks", both "since the notification of the need for further investigation until completion of the first test" (OR=15,54; 95%CI: 5,87-41,12) and "since the completion of the last test until notification of the final result" (OR=11.57; 95% CI: 2.96-45.19), and in women who experienced the attention as "worse than expected" (OR=15.40; 95% CI: 1.41-168.64). The maximum waiting time acceptable to the highest percentage of women was "up to 1 week" for each waiting period (n=47, 73.5%; n=14, 45.2%). Waiting times of no more than 1 week and never more than 2 weeks for each waiting period are recommended. Women should be given an approximate waiting time, paying special attention to women aged 45 to 54 years attending their initial screening. 2010 SESPAS. Published by Elsevier Espana. All rights reserved.

Longer wait times affect future use of VHA primary care.

PubMed

Wong, Edwin S; Liu, Chuan-Fen; Hernandez, Susan E; Augustine, Matthew R; Nelson, Karin; Fihn, Stephan D; Hebert, Paul L

2017-07-29

Improving access to the Veterans Health Administration (VHA) is a high priority, particularly given statutory mandates of the Veterans Access, Choice and Accountability Act. This study examined whether patient-reported wait times for VHA appointments were associated with future reliance on VHA primary care services. This observational study examined 13,595 VHA patients dually enrolled in fee-for-service Medicare. Data sources included VHA administrative data, Medicare claims and the Survey of Healthcare Experiences of Patients (SHEP). Primary care use was defined as the number of face-to-face visits from VHA and Medicare in the 12 months following SHEP completion. VHA reliance was defined as the number of VHA visits divided by total visits (VHA+Medicare). Wait times were derived from SHEP responses measuring the usual number of days to a VHA appointment with patients' primary care provider for those seeking immediate care. We defined appointment wait times categorically: 0 days, 1day, 2-3 days, 4-7 days and >7 days. We used fractional logistic regression to examine the relationship between wait times and reliance. Mean VHA reliance was 88.1% (95% CI = 86.7% to 89.5%) for patients reporting 0day waits. Compared with these patients, reliance over the subsequent year was 1.4 (p = 0.041), 2.8 (p = 0.001) and 1.6 (p = 0.014) percentage points lower for patients waiting 2-3 days, 4-7 days and >7 days, respectively. Patients reporting longer usual wait times for immediate VHA care exhibited lower future reliance on VHA primary care. Longer wait times may reduce care continuity and impact cost shifting across two federal health programs. Copyright © 2017. Published by Elsevier Inc.

Anxiety prior to breast biopsy: Relationships with length of time from breast biopsy recommendation to biopsy procedure and psychosocial factors.

PubMed

Hayes Balmadrid, Melissa A; Shelby, Rebecca A; Wren, Anava A; Miller, Lauren S; Yoon, Sora C; Baker, Jay A; Wildermann, Liz A; Soo, Mary Scott

2017-04-01

This study investigated how time from breast biopsy recommendation to biopsy procedure affected pre-biopsy anxiety ( N = 140 women), and whether the relationship between wait time and anxiety was affected by psychosocial factors (chronic life stress, traumatic events, social support). Analyses showed a significant interaction between wait time and chronic life stress. Increased time from biopsy recommendation was associated with greater anxiety in women with low levels of life stress. Women with high levels of life stress experienced increased anxiety regardless of wait time. These results suggest that women may benefit from shorter wait times and receiving strategies for managing anxiety.

Wait-Time and Multiple Representation Levels in Chemistry Lessons

ERIC Educational Resources Information Center

Li, Winnie Sim Siew; Arshad, Mohammad Yusof

2014-01-01

Wait-time is an important aspect in a teaching and learning process, especially after the teacher has posed questions to students, as it is one of the factors in determining quality of students' responses. This article describes the practices of wait-time one after teacher's questions at multiple representation levels among twenty three chemistry…

Improving Patient Satisfaction with Waiting Time

ERIC Educational Resources Information Center

Eilers, Gayleen M.

2004-01-01

Waiting times are a significant component of patient satisfaction. A patient satisfaction survey performed in the author's health center showed that students rated waiting time lowest of the listed categories--A ratings of 58% overall, 63% for scheduled appointments, and 41% for the walk-in clinic. The center used a quality improvement process and…

DOE Office of Scientific and Technical Information (OSTI.GOV)

Feldman, Steven; Valera-Leon, Carlos; Dechev, Damian

The vector is a fundamental data structure, which provides constant-time access to a dynamically-resizable range of elements. Currently, there exist no wait-free vectors. The only non-blocking version supports only a subset of the sequential vector API and exhibits significant synchronization overhead caused by supporting opposing operations. Since many applications operate in phases of execution, wherein each phase only a subset of operations are used, this overhead is unnecessary for the majority of the application. To address the limitations of the non-blocking version, we present a new design that is wait-free, supports more of the operations provided by the sequential vector,more » and provides alternative implementations of key operations. These alternatives allow the developer to balance the performance and functionality of the vector as requirements change throughout execution. Compared to the known non-blocking version and the concurrent vector found in Intel’s TBB library, our design outperforms or provides comparable performance in the majority of tested scenarios. Over all tested scenarios, the presented design performs an average of 4.97 times more operations per second than the non-blocking vector and 1.54 more than the TBB vector. In a scenario designed to simulate the filling of a vector, performance improvement increases to 13.38 and 1.16 times. This work presents the first ABA-free non-blocking vector. Finally, unlike the other non-blocking approach, all operations are wait-free and bounds-checked and elements are stored contiguously in memory.« less

A study of dynamic data placement for ATLAS distributed data management

NASA Astrophysics Data System (ADS)

Beermann, T.; Stewart, G. A.; Maettig, P.

2015-12-01

This contribution presents a study on the applicability and usefulness of dynamic data placement methods for data-intensive systems, such as ATLAS distributed data management (DDM). In this system the jobs are sent to the data, therefore having a good distribution of data is significant. Ways of forecasting workload patterns are examined which then are used to redistribute data to achieve a better overall utilisation of computing resources and to reduce waiting time for jobs before they can run on the grid. This method is based on a tracer infrastructure that is able to monitor and store historical data accesses and which is used to create popularity reports. These reports provide detailed summaries about data accesses in the past, including information about the accessed files, the involved users and the sites. From this past data it is possible to then make near-term forecasts for data popularity in the future. This study evaluates simple prediction methods as well as more complex methods like neural networks. Based on the outcome of the predictions a redistribution algorithm deletes unused replicas and adds new replicas for potentially popular datasets. Finally, a grid simulator is used to examine the effects of the redistribution. The simulator replays workload on different data distributions while measuring the job waiting time and site usage. The study examines how the average waiting time is affected by the amount of data that is moved, how it differs for the various forecasting methods and how that compares to the optimal data distribution.

Effects of communication burstiness on consensus formation and tipping points in social dynamics

NASA Astrophysics Data System (ADS)

Doyle, C.; Szymanski, B. K.; Korniss, G.

2017-06-01

Current models for opinion dynamics typically utilize a Poisson process for speaker selection, making the waiting time between events exponentially distributed. Human interaction tends to be bursty though, having higher probabilities of either extremely short waiting times or long periods of silence. To quantify the burstiness effects on the dynamics of social models, we place in competition two groups exhibiting different speakers' waiting-time distributions. These competitions are implemented in the binary naming game and show that the relevant aspect of the waiting-time distribution is the density of the head rather than that of the tail. We show that even with identical mean waiting times, a group with a higher density of short waiting times is favored in competition over the other group. This effect remains in the presence of nodes holding a single opinion that never changes, as the fraction of such committed individuals necessary for achieving consensus decreases dramatically when they have a higher head density than the holders of the competing opinion. Finally, to quantify differences in burstiness, we introduce the expected number of small-time activations and use it to characterize the early-time regime of the system.

Impact of a national system for waitlist prioritization: the experience with NIKE and cataract surgery in Sweden.

PubMed

Ng, Jonathon Q; Lundström, Mats

2014-06-01

  To evaluate waiting times for first-eye cataract surgery in Sweden following widespread adoption of the Nationell Indikationsmodell for Kataraktextraktion (NIKE) tool for prioritizing patients for cataract surgery.   Waiting times for all first-eye cataract surgeries in Sweden in 2009-2011 were identified from the Swedish National Cataract Register. Waiting times were compared according to demographic, clinical and NIKE indication group for surgery. Multivariate logistic regression modelling was used to determine factors associated with waiting times less than the 3-month Government guarantee period.   There were 141,070 first-eye cataract surgeries in 2009 to 2011; an annual increase of around 6%. Over the study period, mean waiting times decreased across all NIKE groups. The proportion waiting <3 months for surgery also increased across all NIKE groups. Surgery within 3 months of waitlisting was more likely for patients with a NIKE 1 indication classification (most need for surgery), in later years, male patients, younger patients and patients with a preoperative visual acuity in the better eye worse than 6/24.   Prioritizing patients for cataract surgery using NIKE reduces waiting times for those with the greatest need. © 2013 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Building a sustainable system: the making of the WTIS.

PubMed

Hall, Steve; Thabet, Rami; Dummett, Mark

2009-01-01

Building Ontario's Wait Time Information System (WTIS) was one of the largest and most complex technology projects Cancer Care Ontario (CCO) had ever taken on. Increasing public concern about wait times and the lack of adequate tools to provide a clear or accurate picture of provincial wait times had led to a sense of urgency for the province to report wait time data. While healthcare providers and the Ministry of Health and Long-term Care (MOHLTC) sought to address timely access to care, the challenges to develop a suitable information management/information technology (IM/IT) solution within aggressive timelines were significant. For the WTIS project, success was defined by the ability to deliver a tool to capture wait time data that addressed business and clinical needs and by providing individuals with the ability to use the tool and its data to improve access to care.

Factors that affect the flow of patients through triage.

PubMed

Lyons, Melinda; Brown, Ruth; Wears, Robert

2007-02-01

To use observational methods to objectively evaluate the organisation of triage and what issues may affect the effectiveness of the process. A two-phase study comprising observation of 16 h of triage in a London hospital emergency department and interviews with the triage staff to build a qualitative task analysis and study protocol for phase 2; observation and timing in triage for 1870 min including 257 patients and for 16 different members of the triage staff. No significant difference was found between grades of staff for the average triage time or the fraction of time absent from triage. In all, 67% of the time spent absent from triage was due to escorting patients into the department. The average time a patient waited in the reception before triage was 13 min 34 s; the average length of time to triage for a patient was 4 min 17 s. A significant increase in triage time was found when patients were triaged to a specialty, expected by a specialty, or were actively "seen and treated" in triage. Protocols to prioritise patients with potentially serious conditions to the front of the queue had a significantly positive effect on their waiting time. Supplementary tasks and distractions had varying effects on the timely assessment and triage of patients. The human factors method is applicable to the triage process and can identify key factors that affect the throughput at triage. Referring a patient to a specialty at triage affects significantly the triage workload; hence, alternative methods or management should be suggested. The decision to offer active treatment at triage increases the time taken, and should be based on clinical criteria and the workload determined by staffing levels. The proportion of time absent from triage could be markedly improved by support from porters or other non-qualified staff, as well as by proceduralised handovers from triage to the main clinical area. Triage productivity could be improved by all staff by becoming aware of the effect of the number of interruptions on the throughput of patients.

[Waiting list in general and digestive surgery: patient expectations, quality of life during waiting time and overall satisfaction].

PubMed

Parés, D; Duran, E; Hermoso, J; Comajuncosas, J; Gris, P; Lopez-Negre, J L; Urgellés, J; Orbeal, R; Vallverdú, H; Jimeno, J

2013-01-01

The structural resources of the National Health system are limited, and therefore early surgery cannot be performed on all patients. The objective was to analyse the satisfaction perceived by the patient as regards the delay of treatment by waiting list of three types of surgery. The influence of expectations on waiting times, and impaired quality of life due to the clinical symptoms during the delay, were studied. A prospective study was conducted using a postal questionnaire. We compared the expectations (scale of 1 to 5), the impact on quality of life for symptoms (scale of 1 to 5) and the level of patient satisfaction (scale of 1 to 5) with respect to time on the waitng list for cholelithiasis, inguinal hernia and haemorrhoids. The predictors of patient dissatisfaction were analysed. A total of 57 patients were included. When comparing the characteristics of patients with and without satisfaction over time on the waiting list, days on the waiting list (P=.044), the change in the quality of life due to the symptoms (P=.028), and expectations (P<.001) were significantly different between the two groups. In the multivariate analysis, the expectation was associated with patient dissatisfaction as regards the time on waiting list (OR: 3.14 95% CI: 5.91 to 220.73, P<.001). The level of patient dissatisfaction is associated with expectations about time in waiting list. Copyright © 2012 SECA. Published by Elsevier Espana. All rights reserved.

Gender and socioeconomic status as determinants of waiting time for inpatient surgery in a system with implicit queue management.

PubMed

Arnesen, Kjell E; Erikssen, Jan; Stavem, Knut

2002-12-01

In a system with implicit queue management, to examine gender and socioeconomic status as determinants of waiting time for inpatient surgery, after adjusting for other potential predictors. A cohort of 452 subjects was examined in outpatient clinics of a general hospital and referred to inpatient surgery. They were followed until scheduled hospital admission (n=396) or until the requested procedure no longer was relevant (n=56). We compared waiting time between groups from referral date until hospital admission, using Kaplan-Meier estimates of waiting times and log rank test. A Cox proportional hazards model was used for assessing the risk ratio (RR) of hospital admission for scheduled surgery. Gender and socioeconomic status could not explain variations in waiting time. However, patients with suspected/verified neoplastic disease or a risk of serious deterioration without treatment had markedly shorter waiting times than the reference groups, with adjusted RR (95% confidence intervals (95%CI)) of time to receiving in-patient surgery of 2.3 (1.7-3.0) and 2.0 (1.3-3.0), respectively. Being on sick leave was associated with shorter waiting time, adjusted RR of 1.7 (1.2-2.5). Referrals from within the hospital or other hospitals had also shorter waiting times than referrals from primary health care physicians, adjusted RR=1.4 (1.1-1.8). There was no evidence of bias against women or people in lower socioeconomic classes in this implicit queue management system. However, patients' access to inpatient surgery was associated with malignancy, prognosis, sick leave status, physician experience, referral pattern and the major diagnosis category.

Why wait so long for child care? An analysis of waits, queues and work in a South African urban health centre.

PubMed

Bachmann, M O; Barron, P

1997-01-01

Long waits at large urban clinics obstruct primary care delivery, imposing time costs on patients, deterring appropriate utilization and causing patient dissatisfaction. This paper reports on an innovative attempt by staff in a large South African urban health centre to analyse a system of queues and preventive and curative services for pre-school children, and thereafter to evaluate changes. The study had a cross-sectional work study design, with repeated measurement of waiting times after 13 months. At baseline the preventive clinic was found to have several inessential processes and waits; these were eliminated or overlapped, and clinic sessions per week were increased. A year later median waiting times had decreased substantially in the preventive clinic, but had increased in the curative clinic. Simple research can explain long waits, inform and measure changes, and provide evidence to justify primary care integration and would be useful in health centres and hospital outpatient departments in developing countries.

Community Care Administration of Spinal Deformities in the Brazilian Public Health System.

PubMed

Bressan-Neto, Mario; da Silva Herrero, Carlos Fernando Pereira; Pacola, Lilian Maria; Nunes, Altacílio Aparecido; Defino, Helton Luiz Aparecido

2017-08-01

Underfunding of the surgical treatment of complex spinal deformities has been an important reason for the steadily growing waiting lists in publicly funded healthcare systems. The aim of this study is to characterize the management of the treatment of spinal deformities in the public healthcare system. A cross-sectional study of 60 patients with complex pediatric spinal deformities waiting for treatment in December 2013 was performed. The evaluated parameters were place of origin, waiting time until first assessment at a specialized spine care center, waiting time for the surgical treatment, and need for implants not reimbursed by the healthcare system. Ninety-one percent of the patients lived in São Paulo State (33% from Ribeirão Preto - DRS XIII). Patients waited for 0.5 to 48.0 months for referral, and the waiting times for surgery ranged from 2 to 117 months. Forty-five percent of the patients required implants for the surgical procedure that were not available. The current management of patients with spinal deformities in the public healthcare system does not provide adequate treatment for these patients in our region. They experience long waiting periods for referral and prolonged waiting times to receive surgical treatment; additionally, many of the necessary procedures are not reimbursed by the public healthcare system.

Real time processor for array speckle interferometry

NASA Astrophysics Data System (ADS)

Chin, Gordon; Florez, Jose; Borelli, Renan; Fong, Wai; Miko, Joseph; Trujillo, Carlos

1989-02-01

The authors are constructing a real-time processor to acquire image frames, perform array flat-fielding, execute a 64 x 64 element two-dimensional complex FFT (fast Fourier transform) and average the power spectrum, all within the 25 ms coherence time for speckles at near-IR (infrared) wavelength. The processor will be a compact unit controlled by a PC with real-time display and data storage capability. This will provide the ability to optimize observations and obtain results on the telescope rather than waiting several weeks before the data can be analyzed and viewed with offline methods. The image acquisition and processing, design criteria, and processor architecture are described.

Real time processor for array speckle interferometry

NASA Technical Reports Server (NTRS)

Chin, Gordon; Florez, Jose; Borelli, Renan; Fong, Wai; Miko, Joseph; Trujillo, Carlos

1989-01-01

The authors are constructing a real-time processor to acquire image frames, perform array flat-fielding, execute a 64 x 64 element two-dimensional complex FFT (fast Fourier transform) and average the power spectrum, all within the 25 ms coherence time for speckles at near-IR (infrared) wavelength. The processor will be a compact unit controlled by a PC with real-time display and data storage capability. This will provide the ability to optimize observations and obtain results on the telescope rather than waiting several weeks before the data can be analyzed and viewed with offline methods. The image acquisition and processing, design criteria, and processor architecture are described.

Prioritizing public- private partnership models for public hospitals of iran based on performance indicators.

PubMed

Gholamzadeh Nikjoo, Raana; Jabbari Beyrami, Hossein; Jannati, Ali; Asghari Jaafarabadi, Mohammad

2012-01-01

The present study was conducted to scrutinize Public- Private Partnership (PPP) models in public hospitals of different countries based on performance indicators in order to se-lect appropriated models for Iran hospitals. In this mixed (quantitative-qualitative) study, systematic review and expert panel has been done to identify varied models of PPP as well as performance indicators. In the second step we prioritized performance indicator and PPP models based on selected performance indicators by Analytical Hierarchy process (AHP) technique. The data were analyzed by Excel 2007 and Expert Choice11 software's. In quality - effectiveness area, indicators like the rate of hospital infections (100%), hospital accidents prevalence rate (73%), pure rate of hospital mortality (63%), patient satisfaction percentage (53%), in accessibility equity area indicators such as average inpatient waiting time (100%) and average outpatient waiting time (74%), and in financial - efficiency area, indicators including average length of stay (100%), bed occupation ratio (99%), specific income to total cost ratio (97%) have been chosen to be the most key performance indicators. In the pri¬oritization of the PPP models clinical outsourcing, management, privatization, BOO (build, own, operate) and non-clinical outsourcing models, achieved high priority for various performance in¬dicator areas. This study had been provided the most common PPP options in the field of public hospitals and had gathered suitable evidences from experts for choosing appropriate PPP option for public hospitals. Effect of private sector presence in public hospital performance, based on which PPP options undertaken, will be different.

Prioritizing Public- Private Partnership Models for Public Hospitals of Iran Based on Performance Indicators

PubMed Central

Gholamzadeh Nikjoo, Raana; Jabbari Beyrami, Hossein; Jannati, Ali; Asghari Jaafarabadi, Mohammad

2012-01-01

Background: The present study was conducted to scrutinize Public- Private Partnership (PPP) models in public hospitals of different countries based on performance indicators in order to se-lect appropriated models for Iran hospitals. Methods: In this mixed (quantitative-qualitative) study, systematic review and expert panel has been done to identify varied models of PPP as well as performance indicators. In the second step we prioritized performance indicator and PPP models based on selected performance indicators by Analytical Hierarchy process (AHP) technique. The data were analyzed by Excel 2007 and Expert Choice11 software’s. Results: In quality – effectiveness area, indicators like the rate of hospital infections (100%), hospital accidents prevalence rate (73%), pure rate of hospital mortality (63%), patient satisfaction percentage (53%), in accessibility equity area indicators such as average inpatient waiting time (100%) and average outpatient waiting time (74%), and in financial – efficiency area, indicators including average length of stay (100%), bed occupation ratio (99%), specific income to total cost ratio (97%) have been chosen to be the most key performance indicators. In the pri¬oritization of the PPP models clinical outsourcing, management, privatization, BOO (build, own, operate) and non-clinical outsourcing models, achieved high priority for various performance in¬dicator areas. Conclusion: This study had been provided the most common PPP options in the field of public hospitals and had gathered suitable evidences from experts for choosing appropriate PPP option for public hospitals. Effect of private sector presence in public hospital performance, based on which PPP options undertaken, will be different. PMID:24688942

Variations in the service quality of medical practices.

PubMed

Ly, Dan P; Glied, Sherry A

2013-11-01

To examine regional variation in the service quality of physician practices and to assess the association of this variation with the supply and organization of physicians. Secondary analyses of the Community Tracking Study (CTS) household and physician surveys. A total of 40,339 individuals who had seen a primary care physician because of an illness or injury and 17,345 generalist physicians across 4 survey time periods in 60 CTS sites were included. Service quality measures used were lag between making an appointment and seeing a physician, and wait time at the physician's office. Our supply measure was the physician-to-population ratio. Our organizational measure was the percentage of physicians in group practices. Multivariate regressions were performed to examine the relationship between service quality and the supply and organization of physicians. There was substantial variation in the service quality of physician visits across the country. For example, in 2003, the average wait time to see a doctor was 16 minutes in Milwaukee but more than 41 minutes in Miami; the average appointment lag for a sick visit in 2003 was 1.2 days in west-central Alabama but almost 6 days in Northwestern Washington. Service quality was not associated with the primary care physician-to-population ratio and had varying associations with the organization of practices. Cross-site variation in service quality of care in primary care has been large, persistent, and associated with the organization of practices. Areas with higher primary care physician-to-population ratios had longer, not shorter, appointment lags.

Client satisfaction and quality of health care in rural Bangladesh.

PubMed Central

Mendoza Aldana, J.; Piechulek, H.; al-Sabir, A.

2001-01-01

OBJECTIVE: To assess user expectations and degree of client satisfaction and quality of health care provided in rural Bangladesh. METHODS: A total of 1913 persons chosen by systematic random sampling were successfully interviewed immediately after having received care in government health facilities. FINDINGS: The most powerful predictor for client satisfaction with the government services was provider behaviour, especially respect and politeness. For patients this aspect was much more important than the technical competence of the provider. Furthermore, a reduction in waiting time (on average to 30 min) was more important to clients than a prolongation of the quite short (from a medical standpoint) consultation time (on average 2 min, 22 sec), with 75% of clients being satisfied. Waiting time, which was about double at outreach services than that at fixed services, was the only element with which users of outreach services were dissatisfied. CONCLUSIONS: This study underscores that client satisfaction is determined by the cultural background of the people. It shows the dilemma that, though optimally care should be capable of meeting both medical and psychosocial needs, in reality care that meets all medical needs may fail to meet the client's emotional or social needs. Conversely, care that meets psychosocial needs may leave the clients medically at risk. It seems important that developing countries promoting client-oriented health services should carry out more in-depth research on the determinants of client satisfaction in the respective culture. PMID:11436472

The impact of waiting for intervention on costs and effectiveness: the case of transcatheter aortic valve replacement.

PubMed

Ribera, Aida; Slof, John; Ferreira-González, Ignacio; Serra, Vicente; García-Del Blanco, Bruno; Cascant, Purificació; Andrea, Rut; Falces, Carlos; Gutiérrez, Enrique; Del Valle-Fernández, Raquel; Morís-de laTassa, César; Mota, Pedro; Oteo, Juan Francisco; Tornos, Pilar; García-Dorado, David

2017-11-23

The economic crisis in Europe might have limited access to some innovative technologies implying an increase of waiting time. The purpose of the study is to evaluate the impact of waiting time on the costs and benefits of transcatheter aortic valve replacement (TAVR) for the treatment of severe aortic stenosis. This is a cost-utility analysis from the perspective of the Spanish National Health Service. Results of two prospective hospital registries (158 and 273 consecutive patients) were incorporated into a probabilistic Markov model to compare quality adjusted life years (QALYs) and costs for TAVR after waiting for 3-12 months, relative to immediate TAVR. We simulated a cohort of 1000 patients, male, and 80 years old; other patient profiles were assessed in sensitivity analyses. As waiting time increased, costs decreased at the expense of lower survival and loss of QALYs, leading to incremental cost-effectiveness ratios for eliminating waiting lists of about 12,500 € per QALY. In subgroup analyses prioritization of patients for whom higher benefit was expected led to a smaller loss of QALYs. Concerning budget impact, long waiting lists reduced spending considerably and permanently. A shorter waiting time is likely to be cost-effective (considering commonly accepted willingness-to-pay thresholds in Europe) relative to 3 months or longer waiting periods. If waiting lists are nevertheless seen as unavoidable due to severe but temporary budgetary restrictions, prioritizing patients for whom higher benefit is expected appears to be a way of postponing spending without utterly sacrificing patients' survival and quality of life.

Methodology for Analysis, Modeling and Simulation of Airport Gate-waiting Delays

NASA Astrophysics Data System (ADS)

Wang, Jianfeng

This dissertation presents methodologies to estimate gate-waiting delays from historical data, to identify gate-waiting-delay functional causes in major U.S. airports, and to evaluate the impact of gate operation disruptions and mitigation strategies on gate-waiting delay. Airport gates are a resource of congestion in the air transportation system. When an arriving flight cannot pull into its gate, the delay it experiences is called gate-waiting delay. Some possible reasons for gate-waiting delay are: the gate is occupied, gate staff or equipment is unavailable, the weather prevents the use of the gate (e.g. lightning), or the airline has a preferred gate assignment. Gate-waiting delays potentially stay with the aircraft throughout the day (unless they are absorbed), adding costs to passengers and the airlines. As the volume of flights increases, ensuring that airport gates do not become a choke point of the system is critical. The first part of the dissertation presents a methodology for estimating gate-waiting delays based on historical, publicly available sources. Analysis of gate-waiting delays at major U.S. airports in the summer of 2007 identifies the following. (i) Gate-waiting delay is not a significant problem on majority of days; however, the worst delay days (e.g. 4% of the days at LGA) are extreme outliers. (ii) The Atlanta International Airport (ATL), the John F. Kennedy International Airport (JFK), the Dallas/Fort Worth International Airport (DFW) and the Philadelphia International Airport (PHL) experience the highest gate-waiting delays among major U.S. airports. (iii) There is a significant gate-waiting-delay difference between airlines due to a disproportional gate allocation. (iv) Gate-waiting delay is sensitive to time of a day and schedule peaks. According to basic principles of queueing theory, gate-waiting delay can be attributed to over-scheduling, higher-than-scheduled arrival rate, longer-than-scheduled gate-occupancy time, and reduced gate availability. Analysis of the worst days at six major airports in the summer of 2007 indicates that major gate-waiting delays are primarily due to operational disruptions---specifically, extended gate occupancy time, reduced gate availability and higher-than-scheduled arrival rate (usually due to arrival delay). Major gate-waiting delays are not a result of over-scheduling. The second part of this dissertation presents a simulation model to evaluate the impact of gate operational disruptions and gate-waiting-delay mitigation strategies, including building new gates, implementing common gates, using overnight off-gate parking and adopting self-docking gates. Simulation results show the following effects of disruptions: (i) The impact of arrival delay in a time window (e.g. 7 pm to 9 pm) on gate-waiting delay is bounded. (ii) The impact of longer-than-scheduled gate-occupancy times in a time window on gate-waiting delay can be unbounded and gate-waiting delay can increase linearly as the disruption level increases. (iii) Small reductions in gate availability have a small impact on gate-waiting delay due to slack gate capacity, while larger reductions have a non-linear impact as slack gate capacity is used up. Simulation results show the following effects of mitigation strategies: (i) Implementing common gates is an effective mitigation strategy, especially for airports with a flight schedule not dominated by one carrier, such as LGA. (ii) The overnight off-gate rule is effective in mitigating gate-waiting delay for flights stranded overnight following departure cancellations. This is especially true at airports where the gate utilization is at maximum overnight, such as LGA and DFW. The overnight off-gate rule can also be very effective to mitigate gate-waiting delay due to operational disruptions in evenings. (iii) Self-docking gates are effective in mitigating gate-waiting delay due to reduced gate availability.

Obesity Surgery Score (OSS) for Prioritization in the Bariatric Surgery Waiting List: a Need of Public Health Systems and a Literature Review.

PubMed

Casimiro Pérez, José Antonio; Fernández Quesada, Carlos; Del Val Groba Marco, María; Arteaga González, Iván; Cruz Benavides, Francisco; Ponce, Jaime; de Pablos Velasco, Pedro; Marchena Gómez, Joaquín

2018-04-01

In the last decades, we have experienced an increase in the prevalence of obesity in western countries with a higher demand for bariatric surgery and consequently prolonged waiting times. Currently, in many public hospitals, the only criterion that establishes priority for bariatric surgery is waiting time regardless of obesity severity. We propose a new, simple, and homogeneous clinical prioritization system, the Obesity Surgery Score (OSS), which takes into account simultaneously and equitably the time on surgical waiting list and the obesity severity based on three variables: body mass index, obesity-related comorbidities, and functional limitations. We have reviewed the current literature related to obesity clinical staging systems, and we have carried out an analysis of our patients in waiting list and divided their characteristics according to their degree of severity (A, B, or C) in the OSS. Patients with OSS grade C have a higher mean BMI, greater severity in comorbidities, and greater socio-labor impact. The current surgery waiting time of our series is of 26 months. Currently, 27 patients (51.9%) with OSS grade B and 15 patients (51.7%) with OSS grade C have been on our waiting list for more than 1 year. Since the obesity severity, the waiting time and its clinical consequences are associated with an increase in morbidity and mortality, it is important to apply a structured prioritization system for bariatric surgery waiting list. This allows prioritization of patients at greater risk, improves patient prognosis, and optimizes costs and available health resources.

Waiting time distributions in financial markets

NASA Astrophysics Data System (ADS)

Sabatelli, L.; Keating, S.; Dudley, J.; Richmond, P.

2002-05-01

We study waiting time distributions for data representing two completely different financial markets that have dramatically different characteristics. The first are data for the Irish market during the 19th century over the period 1850 to 1854. A total of 10 stocks out of a database of 60 are examined. The second database is for Japanese yen currency fluctuations during the latter part of the 20th century (1989-1992). The Irish stock activity was recorded on a daily basis and activity was characterised by waiting times that varied from one day to a few months. The Japanese yen data was recorded every minute over 24 hour periods and the waiting times varied from a minute to a an hour or so. For both data sets, the waiting time distributions exhibit power law tails. The results for Irish daily data can be easily interpreted using the model of a continuous time random walk first proposed by Montroll and applied recently to some financial data by Mainardi, Scalas and colleagues. Yen data show a quite different behaviour. For large waiting times, the Irish data exhibit a cut off; the Yen data exhibit two humps that could arise as result of major trading centres in the World.

A Sarsa(λ)-based control model for real-time traffic light coordination.

PubMed

Zhou, Xiaoke; Zhu, Fei; Liu, Quan; Fu, Yuchen; Huang, Wei

2014-01-01

Traffic problems often occur due to the traffic demands by the outnumbered vehicles on road. Maximizing traffic flow and minimizing the average waiting time are the goals of intelligent traffic control. Each junction wants to get larger traffic flow. During the course, junctions form a policy of coordination as well as constraints for adjacent junctions to maximize their own interests. A good traffic signal timing policy is helpful to solve the problem. However, as there are so many factors that can affect the traffic control model, it is difficult to find the optimal solution. The disability of traffic light controllers to learn from past experiences caused them to be unable to adaptively fit dynamic changes of traffic flow. Considering dynamic characteristics of the actual traffic environment, reinforcement learning algorithm based traffic control approach can be applied to get optimal scheduling policy. The proposed Sarsa(λ)-based real-time traffic control optimization model can maintain the traffic signal timing policy more effectively. The Sarsa(λ)-based model gains traffic cost of the vehicle, which considers delay time, the number of waiting vehicles, and the integrated saturation from its experiences to learn and determine the optimal actions. The experiment results show an inspiring improvement in traffic control, indicating the proposed model is capable of facilitating real-time dynamic traffic control.

Effects of Wait Time When Communicating with Children Who Have Sensory and Additional Disabilities

ERIC Educational Resources Information Center

Johnson, Nicole; Parker, Amy T.

2013-01-01

Introduction: This study utilized wait-time procedures to determine if they are effective in helping children with deafblindness or multiple disabilities that include a visual impairment communicate in their home. Methods: A single subject with an alternating treatment design was used for the study. Zero- to one-second wait time was utilized…

Initial condition of stochastic self-assembly

NASA Astrophysics Data System (ADS)

Davis, Jason K.; Sindi, Suzanne S.

2016-02-01

The formation of a stable protein aggregate is regarded as the rate limiting step in the establishment of prion diseases. In these systems, once aggregates reach a critical size the growth process accelerates and thus the waiting time until the appearance of the first critically sized aggregate is a key determinant of disease onset. In addition to prion diseases, aggregation and nucleation is a central step of many physical, chemical, and biological process. Previous studies have examined the first-arrival time at a critical nucleus size during homogeneous self-assembly under the assumption that at time t =0 the system was in the all-monomer state. However, in order to compare to in vivo biological experiments where protein constituents inherited by a newly born cell likely contain intermediate aggregates, other possibilities must be considered. We consider one such possibility by conditioning the unique ergodic size distribution on subcritical aggregate sizes; this least-informed distribution is then used as an initial condition. We make the claim that this initial condition carries fewer assumptions than an all-monomer one and verify that it can yield significantly different averaged waiting times relative to the all-monomer condition under various models of assembly.

[Surgery for colorectal cancer since the introduction of the Netherlands national screening programmeInvestigations into changes in number of resections and waiting times for surgery].

PubMed

de Neree Tot Babberich, M P M; van der Willik, E M; van Groningen, J T; Ledeboer, M; Wiggers, T; Wouters, M W J M

2017-01-01

To investigate the impact of the Netherlands national colorectal cancer screening programme on the number of surgical resections for colorectal carcinoma and on waiting times for surgery. Descriptive study. Data were extracted from the Dutch Surgical Colorectal Audit. Patients with primary colorectal cancer surgery between 2011-2015 were included. The volume and median waiting times for the years 2011-2015 are described. Waiting times from first tumor positive biopsy until the operation (biopsy-operation) and first preoperative visit to the surgeon until the operation (visit-operation) are analyzed with a univariate and multivariate linear regression analysis. Separate analysis was done for visit-operation for academic and non-academic hospitals and for screening compared to non-screening patients. In 2014 there was an increase of 1469 (15%) patients compared to 2013. In 2015 this increase consisted of 1168 (11%) patients compared to 2014. In 2014 and 2015, 1359 (12%) and 3111 (26%) patients were referred to the surgeon through screening, respectively. The median waiting time of biopsy-operation significantly decreased (ß: 0.94, 95%BI) over the years 2014-2015 compared to 2011-2013. In non-academic hospitals, the waiting time visit-operation also decreased significantly (ß: 0.89, 95%BI 0.87-0.90) over the years 2014-2015 compared to 2011-2013. No difference was found in waiting times between patients referred to the surgeon through screening compared to non-screening. There is a clear increase in volume since the introduction of the colorectal cancer screening programme without an increase in waiting time until surgery.

Heart Surgery Waiting Time: Assessing the Effectiveness of an Action.

PubMed

Badakhshan, Abbas; Arab, Mohammad; Gholipour, Mahin; Behnampour, Naser; Saleki, Saeid

2015-08-01

Waiting time is an index assessing patient satisfaction, managerial effectiveness and horizontal equity in providing health care. Although heart surgery centers establishment is attractive for politicians. They are always faced with the question of to what extent they solve patient's problems. The objective of this study was to evaluate factors influencing waiting time in patients of heart surgery centers, and to make recommendations for health-care policy-makers for reducing waiting time and increasing the quality of services from this perspective. This cross-sectional study was performed in 2013. After searching articles on PubMed, Elsevier, Google Scholar, Ovid, Magiran, IranMedex, and SID, a list of several criteria, which relate to waiting time, was provided. Afterwards, the data on waiting time were collected by a researcher-structured checklist from 156 hospitalized patients. The data were analyzed by SPSS 16. The Kolmogorov Smirnov and Shapiro tests were used for determination of normality. Due to the non-normal distribution, non-parametric tests, such as Kruskal-Wallis and Mann-Whitney were chosen for reporting significance. Parametric tests also used reporting medians. Among the studied variables, just economic status had a significant relation with waiting time (P = 0.37). Fifty percent of participants had diabetes, whereas this estimate was 43.58% for high blood pressure. As the cause of delay, 28.2% of patients reported financial problems, 18.6% personal problem and 13.5% a delay in providing equipment by the hospital. It seems the studied hospital should review its waiting time arrangements and detach them, as far as possible, from subjective and personal (specialists) decisions. On the other hand, ministries of health and insurance companies should consider more financial support. It is also recommend that hospitals should arrange preoperational psychiatric consultation for increasing patients' emotionally readiness.

A research on motion design for APP's loading pages based on time perception

NASA Astrophysics Data System (ADS)

Cao, Huai; Hu, Xiaoyun

2018-04-01

Due to restrictions caused by objective reasons like network bandwidth, hardware performance and etc., waiting is still an inevitable phenomenon that appears in our using mobile-terminal products. Relevant researches show that users' feelings in a waiting scenario can affect their evaluations on the whole product and services the product provides. With the development of user experience and inter-facial design subjects, the role of motion effect in the interface design has attracted more and more scholars' attention. In the current studies, the research theory of motion design in a waiting scenario is imperfect. This article will use the basic theory and experimental research methods of cognitive psychology to explore the motion design's impact on user's time perception when users are waiting for loading APP pages. Firstly, the article analyzes the factors that affect waiting experience of loading APP pages based on the theory of time perception, and then discusses motion design's impact on the level of time-perception when loading pages and its design strategy. Moreover, by the operation analysis of existing loading motion designs, the article classifies the existing loading motions and designs an experiment to verify the impact of different types of motions on the user's time perception. The result shows that the waiting time perception of mobile's terminals' APPs is related to the loading motion types, the combination type of loading motions can effectively shorten the waiting time perception as it scores a higher mean value in the length of time perception.

Waiting for coronary angiography: is there a clinically ordered queue?

PubMed

Hemingway, H; Crook, A M; Feder, G; Dawson, J R; Timmis, A

2000-03-18

Among over 3000 patients undergoing coronary angiography in the absence of a formal queue-management system, we found that a-priori urgency scores were strongly associated with waiting times, prevalence of coronary-artery disease, rate of revascularisation, and mortality. These data challenge the widely held assumption that such waiting lists are not clinically ordered; however, the wide variation in waiting times within urgency categories suggests the need for further improvements in clinical queueing.

The corneal transplant score: a simple corneal graft candidate calculator.

PubMed

Rosenfeld, Eldar; Varssano, David

2013-07-01

Shortage of corneas for transplantation has created long waiting lists in most countries. Transplant calculators are available for many organs. The purpose of this study is to describe a simple automatic scoring system for keratoplasty recipient candidates, based on several parameters that we consider most relevant for tissue allocation, and to compare the system's accuracy in predicting decisions made by a cornea specialist. Twenty pairs of candidate data were randomly created on an electronic spreadsheet. A single priority score was computed from the data of each candidate. A cornea surgeon and the automated system then decided independently which candidate in each pair should have surgery if only a single cornea was available. The scoring system can calculate values between 0 (lowest priority) and 18 (highest priority) for each candidate. Average score value in our randomly created cohort was 6.35 ± 2.38 (mean ± SD), range 1.28 to 10.76. Average score difference between the candidates in each pair was 3.12 ± 2.10, range 0.08 to 8.45. The manual scoring process, although theoretical, was mentally and emotionally demanding for the surgeon. Agreement was achieved between the human decision and the calculated value in 19 of 20 pairs. Disagreement was reached in the pair with the lowest score difference (0.08). With worldwide donor cornea shortage, waiting for transplantation can be long. Manual sorting of priority for transplantation in a long waiting list is difficult, time-consuming and prone to error. The suggested system may help achieve a justified distribution of available tissue.

Heterogeneous nucleation of aspartame from aqueous solutions

NASA Astrophysics Data System (ADS)

Kubota, Noriaki; Kinno, Hiroaki; Shimizu, Kenji

1990-03-01

Waiting times, the time from the instant of quenching needed for a first nucleus to appear, were measured at constant supercoolings for primary nucleation of aspartame (α-L-aspartyl-L-phenylalanine methylester) from aqueous solutions, which were sealed into glass ampoules (solution volume = 3.16 cm 3). Since the waiting time became shorter by filtering the solution prior to quenching, the nucleation was concluded to be heterogeneously induced. The measured waiting time consisted of two parts: time needed for the nucleus to grow to a detactable size (growth time) and stochastic time needed for nucleation (true waiting time). The distribution of the true waiting time, is well explained by a stochastic model, in which nucleation is regarded to occur heterogeneously and in a stochastic manner by two kinds of active sites. The active sites are estimated to be located on foreign particles in which such elements as Si, Al and Mg were contained. The amount of each element is very small in the order of magnitude of ppb (mass basis) of the whole solution. The growth time was correlated with the degree of supercooling.

Factors Associated with Waiting Time for Access to Mental Health Services for Children and Adolescents in Norway

ERIC Educational Resources Information Center

Andersson, Helle Wessel

2004-01-01

The present study addresses the question of equality of access, as it relates to waiting time for specialised mental health treatment for children and adolescents. The aim was to investigate whether demographic, clinical factors and service-related factors were associated with waiting time. Data was based on a documentation system in which all…

Discrimination in a universal health system: explaining socioeconomic waiting time gaps.

PubMed

Johar, Meliyanni; Jones, Glenn; Keane, Micheal P; Savage, Elizabeth; Stavrunova, Olena

2013-01-01

One of the core goals of a universal health care system is to eliminate discrimination on the basis of socioeconomic status. We test for discrimination using patient waiting times for non-emergency treatment in public hospitals. Waiting time should reflect patients' clinical need with priority given to more urgent cases. Using data from Australia, we find evidence of prioritisation of the most socioeconomically advantaged patients at all quantiles of the waiting time distribution. These patients also benefit from variation in supply endowments. These results challenge the universal health system's core principle of equitable treatment. Copyright © 2012 Elsevier B.V. All rights reserved.

Waiting time as a competitive device: an example from general medical practice.

PubMed

Iversen, Tor; Lurås, Hilde

2002-09-01

From a theoretical model we predict that only physicians with quality characteristics perceived as inferior by patients are willing to embark on waiting time reductions. Because of variation in these quality characteristics among physicians, market equilibrium is likely to show a range of waiting times for physician services. This hypothesis is supported by results from a study of Norwegian general practitioners. Since the waiting time offered by a physician influences the number of patient-initiated consultations, a policy implication of our study is that the distinction between patient-initiated and physician-initiated consultations may be less clear-cut than often assumed in the literature.

Are seismic waiting time distributions universal?

NASA Astrophysics Data System (ADS)

Davidsen, Jörn; Goltz, Christian

2004-11-01

We show that seismic waiting time distributions in California and Iceland have many features in common as, for example, a power-law decay with exponent α ~ 1.1 for intermediate and with exponent γ ~ 0.6 for short waiting times. While the transition point between these two regimes scales proportionally with the size of the considered area, the full distribution is not universal and depends in a non-trivial way on the geological area under consideration and its size. This is due to the spatial distribution of epicenters which does not form a simple mono-fractal. Yet, the dependence of the waiting time distributions on the threshold magnitude seems to be universal.

Cumulative incidence for wait-list death in relation to length of queue for coronary-artery bypass grafting: a cohort study.

PubMed

Sobolev, Boris G; Kuramoto, Lisa; Levy, Adrian R; Hayden, Robert

2006-08-24

In deciding where to undergo coronary-artery bypass grafting, the length of surgical wait lists is often the only information available to cardiologists and their patients. Our objective was to compare the cumulative incidence for death on the wait list according to the length of wait lists at the time of registration for the operation. The study cohort included 8966 patients who registered to undergo isolated coronary-artery bypass grafting (82.4% men; 71.9% semi-urgent; 22.4% non-urgent). The patients were categorized according to wait-list clearance time at registration: either "1 month or less" or "more than 1 month". Cumulative incidence for wait-list death was compared between the groups, and the significance of difference was tested by means of regression models. Urgent patients never registered on a wait list with a clearance time of more than 1 month. Semi-urgent patients registered on shorter wait lists more often than non-urgent patients (79.1% vs. 44.7%). In semi-urgent and non-urgent patients, the observed proportion of wait-list deaths by 52 weeks was lower in category "1 month or less" than in category "more than 1 month" (0.8% [49 deaths] vs. 1.6% [39 deaths], P < 0.005). After adjustment, the odds of death before surgery were 64% higher in patients on longer lists, odds ratio [OR] = 1.64 (95% confidence interval [CI] 1.02-2.63). The observed death rate was higher in category "more than 1 month" than in category "1 month or less", 0.79 (95%CI 0.54-1.04) vs. 0.58 (95% CI 0.42-0.74) per 1000 patient-weeks, the adjusted OR = 1.60 (95%CI 1.01-2.53). Longer wait times (log-rank test = 266.4, P < 0.001) and higher death rates contributed to a higher cumulative incidence for death on the wait list with a clearance time of more than 1 month. Long wait lists for coronary-artery bypass grafting are associated with increased probability that a patient dies before surgery. Physicians who advise patients where to undergo cardiac revascularization should consider the risk of pre-surgical death that is associated with the length of a surgical wait list.

Using Queuing Theory and Simulation Modelling to Reduce Waiting Times in An Iranian Emergency Department

PubMed Central

Haghighinejad, Hourvash Akbari; Kharazmi, Erfan; Hatam, Nahid; Yousefi, Sedigheh; Hesami, Seyed Ali; Danaei, Mina; Askarian, Mehrdad

2016-01-01

Background: Hospital emergencies have an essential role in health care systems. In the last decade, developed countries have paid great attention to overcrowding crisis in emergency departments. Simulation analysis of complex models for which conditions will change over time is much more effective than analytical solutions and emergency department (ED) is one of the most complex models for analysis. This study aimed to determine the number of patients who are waiting and waiting time in emergency department services in an Iranian hospital ED and to propose scenarios to reduce its queue and waiting time. Methods: This is a cross-sectional study in which simulation software (Arena, version 14) was used. The input information was extracted from the hospital database as well as through sampling. The objective was to evaluate the response variables of waiting time, number waiting and utilization of each server and test the three scenarios to improve them. Results: Running the models for 30 days revealed that a total of 4088 patients left the ED after being served and 1238 patients waited in the queue for admission in the ED bed area at end of the run (actually these patients received services out of their defined capacity). The first scenario result in the number of beds had to be increased from 81 to179 in order that the number waiting of the “bed area” server become almost zero. The second scenario which attempted to limit hospitalization time in the ED bed area to the third quartile of the serving time distribution could decrease the number waiting to 586 patients. Conclusion: Doubling the bed capacity in the emergency department and consequently other resources and capacity appropriately can solve the problem. This includes bed capacity requirement for both critically ill and less critically ill patients. Classification of ED internal sections based on severity of illness instead of medical specialty is another solution. PMID:26793727

Lung cancer care trajectory at a Canadian centre: an evaluation of how wait times affect clinical outcomes.

PubMed

Kasymjanova, G; Small, D; Cohen, V; Jagoe, R T; Batist, G; Sateren, W; Ernst, P; Pepe, C; Sakr, L; Agulnik, J

2017-10-01

Lung cancer continues to be one of the most common cancers in Canada, with approximately 28,400 new cases diagnosed each year. Although timely care can contribute substantially to quality of life for patients, it remains unclear whether it also improves patient outcomes. In this work, we used a set of quality indicators that aim to describe the quality of care in lung cancer patients. We assessed adherence with existing guidelines for timeliness of lung cancer care and concordance with existing standards of treatment, and we examined the association between timeliness of care and lung cancer survival. Patients with lung cancer diagnosed between 2010 and 2015 were identified from the Pulmonary Division Lung Cancer Registry at our centre. We demonstrated that the interdisciplinary pulmonary oncology service successfully treated most of its patients within the recommended wait times. However, there is still work to be done to decrease variation in wait time. Our results demonstrate a significant association between wait time and survival, supporting the need for clinicians to optimize the patient care trajectory. It would be helpful for Canadian clinicians treating patients with lung cancer to have wait time guidelines for all treatment modalities, together with standard definitions for all time intervals. Any reductions in wait times should be balanced against the need for thorough investigation before initiating treatment. We believe that our unique model of care leads to an acceleration of diagnostic steps. Avoiding any delay associated with referral to a medical oncologist for treatment could be an acceptable strategy with respect to reducing wait time.

Queueing system analysis of multi server model at XYZ insurance company in Tasikmalaya city

NASA Astrophysics Data System (ADS)

Muhajir, Ahmad; Binatari, Nikenasih

2017-08-01

Queueing theory or waiting line theory is a theory that deals with the queue process from the customer comes, queue to be served, served and left on service facilities. Queue occurs because of a mismatch between the numbers of customers that will be served with the available number of services, as an example at XYZ insurance company in Tasikmalaya. This research aims to determine the characteristics of the queue system which then to optimize the number of server in term of total cost. The result shows that the queue model can be represented by (M/M/4):(GD/∞/∞), where the arrivals are Poisson distributed while the service time is following exponential distribution. The probability of idle customer service is 2,39% of the working time, the average number of customer in the queue is 3 customers, the average number of customer in a system is 6 customers, the average time of a customer spent in the queue is 15,9979 minutes, the average time a customer spends in the system is 34,4141 minutes, and the average number of busy customer servicer is 3 server. The optimized number of customer service is 5 servers, and the operational cost has minimum cost at Rp 4.323.

Impact of waiting time on the quality of life of patients awaiting coronary artery bypass grafting.

PubMed

Sampalis, J; Boukas, S; Liberman, M; Reid, T; Dupuis, G

2001-08-21

A lack of resources has created waiting lists for many elective surgical procedures within Canada's universal health care system. Coronary artery bypass grafting (CABG) for the treatment of atherosclerotic ischemic heart disease is one of these affected surgical procedures. We studied the impact of waiting times on the quality of life of patients awaiting CABG. A prospective cohort of 266 patients from 3 hospitals in Montreal was used. Patients who gave informed consent were followed from the time they were registered for CABG until 6 months after surgery; recruitment began in November 1993, and the last follow-up was completed in July 1995. Patient groups were classified according to the duration of the wait for CABG (< or = 97 days or > 97 days). We measured the following outcomes: quality of life (using the Medical Outcomes Study 36-item Short Form [SF-36]), incidence of chest pain (using the New York Heart Association angina classification), frequency of symptoms (using the Cardiac Symptom Inventory) and rates of complications and death before and after surgery. There were no differences in quality of life at baseline between the 2 groups. Immediately before surgery, compared with patients who waited 97 days or less, those who waited longer had significantly reduced physical functioning (change from baseline SF-36 score 0 v. -4 respectively, p = 0.001), vitality (change from baseline score -0.1 v. -1.3, p = 0.01), social functioning (change from baseline score 0.4 v. -0.4, p = 0.03) and general health (change from baseline score 1.1 v. -1.7, p = 0.001). At 6 months after surgery, compared with patients who waited 97 days or less for CABG, those who waited longer had reduced physical functioning (change from baseline SF-36 score 4.0 v. -0.1 respectively, p = 0.001), physical role (change from baseline score 0.8 v. 0.0, p = 0.001), vitality (change from baseline score 2.2 v. 0.9, p = 0.001), mental health (change from baseline score 1.2 v. 0.0, p = 0.001) and general health (change from baseline score 1.8 v. -0.3, p = 0.001). The incidence of postoperative adverse events was significantly greater among the patients with longer waits for CABG than among those with shorter waits (32 v. 14 events respectively, p = 0.005). Longer waits before CABG were associated with an increased likelihood of not returning to work after surgery (p = 0.08): 10 (53%) of the 19 patients with longer waiting times remained employed after CABG, as compared with 17 (85%) of the 20 with shorter waiting times. The significant decrease in physical and social functioning, both before and after surgery, for patients waiting more than 3 months for CABG is an important observation. Longer waiting times were also associated with increased postoperative adverse events. By decreasing waiting times for CABG, we may improve patients' quality of life and decrease the psychological morbidity associated with CABG.

The effect of medical trainees on pediatric emergency department flow: a discrete event simulation modeling study.

PubMed

Genuis, Emerson D; Doan, Quynh

2013-11-01

Providing patient care and medical education are both important missions of teaching hospital emergency departments (EDs). With medical school enrollment rising, and ED crowding becoming an increasing prevalent issue, it is important for both pediatric EDs (PEDs) and general EDs to find a balance between these two potentially competing goals. The objective was to determine how the number of trainees in a PED affects patient wait time, total ED length of stay (LOS), and rates of patients leaving without being seen (LWBS) for PED patients overall and stratified by acuity level as defined by the Pediatric Canadian Triage and Acuity Scale (CTAS) using discrete event simulation (DES) modeling. A DES model of an urban tertiary care PED, which receives approximately 40,000 visits annually, was created and validated. Thirteen different trainee schedules, which ranged from averaging zero to six trainees per shift, were input into the DES model and the outcome measures were determined using the combined output of five model iterations. An increase in LOS of approximately 7 minutes was noted to be associated with each additional trainee per attending emergency physician working in the PED. The relationship between the number of trainees and wait time varied with patients' level of acuity and with the degree of PED utilization. Patient wait time decreased as the number of trainees increased for low-acuity visits and when the PED was not operating at full capacity. With rising numbers of trainees, the PED LWBS rate decreased in the whole department and in the CTAS 4 and 5 patient groups, but it rose in patients triaged CTAS 3 or higher. A rising numbers of trainees was not associated with any change to flow outcomes for CTAS 1 patients. The results of this study demonstrate that trainees in PEDs have an impact mainly on patient LOS and that the effect on wait time differs between patients presenting with varying degrees of acuity. These findings will assist PEDs in finding a balance between providing high-quality medical education and timely patient care. © 2013 by the Society for Academic Emergency Medicine.

[Improving the CMP appointment waiting time for children and adolescents].

PubMed

Cani, Pascale

2014-01-01

The increasing activity of mental health centres for children and adolescents and longer waiting times in obtaining a first appointment have led an area of child psychiatry to question the organisation of new consultation applications. Two CMP in the sector had a waiting period of over 40 days for half of the patients. Two improvement actions were implemented:the implementation of organisation and reception nurses and the development of a new applications management process. The evaluation after one year showed a decrease of half of the appointment waiting time without changing the non showed up rate.

Continuous time random walk model with asymptotical probability density of waiting times via inverse Mittag-Leffler function

NASA Astrophysics Data System (ADS)

Liang, Yingjie; Chen, Wen

2018-04-01

The mean squared displacement (MSD) of the traditional ultraslow diffusion is a logarithmic function of time. Recently, the continuous time random walk model is employed to characterize this ultraslow diffusion dynamics by connecting the heavy-tailed logarithmic function and its variation as the asymptotical waiting time density. In this study we investigate the limiting waiting time density of a general ultraslow diffusion model via the inverse Mittag-Leffler function, whose special case includes the traditional logarithmic ultraslow diffusion model. The MSD of the general ultraslow diffusion model is analytically derived as an inverse Mittag-Leffler function, and is observed to increase even more slowly than that of the logarithmic function model. The occurrence of very long waiting time in the case of the inverse Mittag-Leffler function has the largest probability compared with the power law model and the logarithmic function model. The Monte Carlo simulations of one dimensional sample path of a single particle are also performed. The results show that the inverse Mittag-Leffler waiting time density is effective in depicting the general ultraslow random motion.

Differential Effects of Wait-Time on Textually Explicit and Implicit Responding: Interactional Explanation.

ERIC Educational Resources Information Center

Pond, Marlene R.; Newman, Isadore

The effects of wait-time, the pause following a teacher question and the pause after a student response, on the length and number of student responses were analyzed at different cognitive levels. Data were obtained from 95 students in grade 4 and from 5 teachers using a wait-time of 5 seconds. Four oral discussion sessions by teachers and students…

Waiting Time: The De-Subjectification of Children in Danish Asylum Centres

ERIC Educational Resources Information Center

Vitus, Kathrine

2010-01-01

This article analyses the relationship between time and subjectification, focusing on the temporal structures created within Danish asylum centres and politics, and on children's experiences of and reactions to open-ended waiting. Such waiting leads to existential boredom which manifests in the children as restlessness, fatigue and despair. The…

[Reducing patient waiting time for the outpatient phlebotomy service using six sigma].

PubMed

Kim, Yu Kyung; Song, Kyung Eun; Lee, Won Kil

2009-04-01

One of the challenging issues of the outpatient phlebotomy services at most hospitals is that patients have a long wait. The outpatient phlebotomy team of Kyungpook National University Hospital applied six sigma breakthrough methodologies to reduce the patient waiting time. The DMAIC (Define, Measure, Analyze, Improve, and Control) model was employed to approach the project. Two hundred patients visiting the outpatient phlebotomy section were asked to answer the questionnaires at inception of the study to ascertain root causes. After correction, we surveyed 285 patients for same questionnaires again to follow-up the effects. A defect was defined as extending patient waiting time so long and at the beginning of the project, the performance level was 2.61 sigma. Using fishbone diagram, all the possible reasons for extending patient waiting time were captured, and among them, 16 causes were proven to be statistically significant. Improvement plans including a new receptionist, automatic specimen transport system, and adding one phlebotomist were put into practice. As a result, the number of patients waited more than 5 min significantly decreased, and the performance level reached 3.0 sigma in December 2007 and finally 3.35 sigma in July 2008. Applying the six sigma, the performance level of waiting times for blood drawing exceeding five minutes were improved from 2.61 sigma to 3.35 sigma.

Not all waits are equal: an exploratory investigation of emergency care patient pathways.

PubMed

Swancutt, Dawn; Joel-Edgar, Sian; Allen, Michael; Thomas, Daniel; Brant, Heather; Benger, Jonathan; Byng, Richard; Pinkney, Jonathan

2017-06-24

Increasing pressure in the United Kingdom (UK) urgent care system has led to Emergency Departments (EDs) failing to meet the national requirement that 95% of patients are admitted, discharged or transferred within 4-h of arrival. Despite the target being the same for all acute hospitals, individual Trusts organise their services in different ways. The impact of this variation on patient journey time and waiting is unknown. Our study aimed to apply the Lean technique of Value Stream Mapping (VSM) to investigate care processes and delays in patient journeys at four contrasting hospitals. VSM timing data were collected for patients accessing acute care at four hospitals in South West England. Data were categorised according to waits and activities, which were compared across sites to identify variations in practice from the patient viewpoint. We included Public and Patient Involvement (PPI) to fully interpret our findings; observations and initial findings were considered in a PPI workshop. One hundred eight patients were recruited, comprising 25,432 min of patient time containing 4098 episodes of care or waiting. The median patient journey was 223 min (3 h, 43 min); just within the 4-h target. Although total patient journey times were similar between sites, the stage where the greatest proportion of waiting occurred varied. Reasons for waiting were dominated by waits for beds, investigations or results to be available. From our sample we observed that EDs without a discharge/clinical decision area exhibited a greater proportion of waiting time following an admission or discharge decision. PPI interpretation indicated that patients who experience waits at the beginning of their journey feel more anxious because they are 'not in the system yet'. The novel application of VSM analysis across different hospitals, coupled with PPI interpretation, provides important insight into the impact of care provision on patient experience. Measures that could reduce patient waiting include automatic notification of test results, and the option of discharge/clinical decision areas for patients awaiting results or departure. To enhance patient experience, good communication with patients and relatives about reasons for waits is essential.

Real-time OHT Dispatching Mechanism for the Interbay Automated Material Handling System with Shortcuts and Bypasses

NASA Astrophysics Data System (ADS)

Pan, Cong; Zhang, Jie; Qin, Wei

2017-05-01

As a key to improve the performance of the interbay automated material handling system (AMHS) in 300 mm semiconductor wafer fabrication system, the real-time overhead hoist transport (OHT) dispatching problem has received much attention. This problem is first formulated as a special form of assignment problem and it is proved that more than one solution will be obtained by Hungarian algorithm simultaneously. Through proposing and strictly proving two propositions related to the characteristics of these solutions, a modified Hungarian algorithm is designed to distinguish these solutions. Finally, a new real-time OHT dispatching method is carefully designed by implementing the solution obtained by the modified Hungarian algorithm. The experimental results of discrete event simulations show that, compared with conventional Hungarian algorithm dispatching method, the proposed dispatching method that chooses the solution with the maximum variance respectively reduces on average 4 s of the average waiting time and average lead time of wafer lots, and its performance is rather stable in multiple different scenarios of the interbay AMHS with different quantities of shortcuts. This research provides an efficient real-time OHT dispatching mechanism for the interbay AMHS with shortcuts and bypasses.

Improving spine surgical access, appropriateness and efficiency in metropolitan, urban and rural settings

PubMed Central

Zarrabian, Mohammad; Bidos, Andrew; Fanti, Caroline; Young, Barry; Drew, Brian; Puskas, David; Rampersaud, Raja

2017-01-01

Background The Inter-professional Spine Assessment and Education Clinics (ISAEC) were developed to improve primary care assessment, education and management of patients with persistent or recurrent low back pain–related symptoms. This study aims to determine the effect of ISAEC on access for surgical assessment, referral appropriateness and efficiency for patients meeting a priori referral criteria in rural, urban and metropolitan settings. Methods We conducted a retrospective review of prospective data from networked ISAEC clinics in Thunder Bay, Hamilton and Toronto, Ontario. For patients meeting surgical referral criteria, wait times for surgical assessment, surgical referral–related magnetic resonance imaging (MRI) scans and appropriateness of referral were recorded. Results Overall 422 patients, representing 10% of all ISAEC patients in the study period, were referred for surgical assessment. The average wait times for surgical assessment were 5.4, 4.3 and 2.2 weeks at the metropolitan, urban and rural centres, respectively. Referral MRI usage for the group decreased by 31%. Of the patients referred for formal surgical assessment, 80% had leg-dominant pain and 96% were deemed appropriate surgical referrals. Conclusion Contrary to geographic concentration of health care resources in metropolitan settings, the greatest decrease in wait times was achieved in the rural setting. A networked, shared-cared model of care for patients with low back pain–related symptoms significantly improved access for surgical assessment despite varying geographic practice settings and barriers. The greatest reductions were noted in the rural setting. In addition, significant improvements in referral appropriateness and efficiency were achieved compared with historical reports across all sites.

Do People with Disabilities Have Difficulty Finding a Family Physician?

PubMed Central

McColl, Mary Ann; Aiken, Alice; Schaub, Michael

2015-01-01

Primary care has been ideally characterized as the medical home for all citizens, and yet recent data shows that approximately 6% do not have a family physician, and only 17.5% of family practices are open to new patients. Given acknowledged shortages of family physicians, this research asks the question: Do people with disabilities have particular difficulty finding a family physician? Health Care Connect (HCC) is a government-funded agency in Ontario Canada, designed to “help Ontarians who are without a family health care provider to find one”. Using data from HCC, supplemented by interviews with HCC staff, the study explores the average wait time for patients with disabilities to be linked with a primary care physician, and the challenges faced by agency staff in doing so. The study found that disabled registrants with the program are only slightly disadvantaged in terms of wait times to find a family physician, and success rates are ultimately comparable; however, agency staff report that there are a number of significant challenges associated with placing disabled patients. PMID:25927477

A prospective audit of the impact of additional staff on the care of diabetic patients in a community podiatry service

PubMed Central

Ryan, Alexandra; Uppal, Meenakshi; Cunning, Imelda; Buckley, Claire M.

2015-01-01

Objective The purpose of this study was to evaluate the impact of the employment of additional podiatry staff on patients with diabetes attending a community-based podiatry service. Methods An audit was conducted to evaluate the intervention of two additional podiatry staff. All patients with diabetes referred to and attending community podiatry services in a specified area in the Republic of Ireland between June 2011 and June 2012 were included. The service was benchmarked against the UK gold standard outlined in the ‘Guidelines on prevention & management of foot problems in Type 2 Diabetes’ by the National Institute of Clinical Excellence (NICE). Process of care measures addressed were the number of patients with diabetes receiving treatment and the waiting times of patients with diabetes from referral to initial review. Results An increase in the number of patients with diabetes receiving treatment was seen in all risk categories (ranging from low risk to the emergency foot). Waiting times for patients with diabetes decreased post-intervention but did not reach the targets outlined in the NICE guidelines. The average time from referral to initial review of patients with an emergency diabetic foot was 37 weeks post-intervention. NICE guidelines recommend that these patients are seen within 24 hours. Discussion During the life cycle of this audit, increased numbers of patients were treated and waiting times for patients with diabetes were reduced. An internal re-organisation of the services coincided with the commencement of the additional staff. The improvements observed were due to the effects of a combination of additional staff and service re-organisation. Efficient organisation of services is key to optimal performance. Continued efforts to improve services are required to reach the standards outlined in the NICE guidelines. PMID:26048860

A prospective audit of the impact of additional staff on the care of diabetic patients in a community podiatry service.

PubMed

Ryan, Alexandra; Uppal, Meenakshi; Cunning, Imelda; Buckley, Claire M

2015-01-01

The purpose of this study was to evaluate the impact of the employment of additional podiatry staff on patients with diabetes attending a community-based podiatry service. An audit was conducted to evaluate the intervention of two additional podiatry staff. All patients with diabetes referred to and attending community podiatry services in a specified area in the Republic of Ireland between June 2011 and June 2012 were included. The service was benchmarked against the UK gold standard outlined in the 'Guidelines on prevention & management of foot problems in Type 2 Diabetes' by the National Institute of Clinical Excellence (NICE). Process of care measures addressed were the number of patients with diabetes receiving treatment and the waiting times of patients with diabetes from referral to initial review. An increase in the number of patients with diabetes receiving treatment was seen in all risk categories (ranging from low risk to the emergency foot). Waiting times for patients with diabetes decreased post-intervention but did not reach the targets outlined in the NICE guidelines. The average time from referral to initial review of patients with an emergency diabetic foot was 37 weeks post-intervention. NICE guidelines recommend that these patients are seen within 24 hours. During the life cycle of this audit, increased numbers of patients were treated and waiting times for patients with diabetes were reduced. An internal re-organisation of the services coincided with the commencement of the additional staff. The improvements observed were due to the effects of a combination of additional staff and service re-organisation. Efficient organisation of services is key to optimal performance. Continued efforts to improve services are required to reach the standards outlined in the NICE guidelines.

Waiting time for cataract surgery and its influence on patient attitudes.

PubMed

Chan, Frank Wan-kin; Fan, Alex Hoi; Wong, Fiona Yan-yan; Lam, Philip Tsze-ho; Yeoh, Eng-kiong; Yam, Carrie Ho-kwan; Griffiths, Sian; Lam, Dennis Shun-chiu; Congdon, Nathan

2009-08-01

To characterize willingness to pay for private operations and preferred waiting time among patients awaiting cataract surgery in Hong Kong. This was a cross-sectional survey. Subjects randomly selected from cataract surgical waiting lists in Hong Kong (n = 467) underwent a telephone interview based on a structured, validated questionnaire. Data were collected on private insurance coverage, preferred waiting time, amount willing to pay for surgery, and self-reported visual function and health status. Among 300 subjects completing the interview, 144 (48.2%) were 76 years of age or older, 177 (59%) were women, and mean time waiting for surgery was 17 +/- 15 months. Among 220 subjects (73.3%) willing to pay anything for surgery, the mean amount was US$552 +/- 443. With adjustment for age, education, and monthly household income, subjects willing to pay anything were less willing to wait 12 months for surgery (OR = 4.34; P = 0.002), more likely to know someone having had cataract surgery (OR = 2.20; P = 0.03), and more likely to use their own savings to pay for the surgery (OR = 2.21; P = 0.04). Subjects considering private cataract surgery, knowing people who have had cataract surgery, using nongovernment sources to pay for surgery, and having lower visual function were willing to pay more. Many patients wait significant periods for cataract surgery in Hong Kong, and are willing to pay substantial amounts for private operations. These results may have implications for other countries with cataract waiting lists.

Emergency medicine: an operations management view.

PubMed

Soremekun, Olan A; Terwiesch, Christian; Pines, Jesse M

2011-12-01

Operations management (OM) is the science of understanding and improving business processes. For the emergency department (ED), OM principles can be used to reduce and alleviate the effects of crowding. A fundamental principle of OM is the waiting time formula, which has clear implications in the ED given that waiting time is fundamental to patient-centered emergency care. The waiting time formula consists of the activity time (how long it takes to complete a process), the utilization rate (the proportion of time a particular resource such a staff is working), and two measures of variation: the variation in patient interarrival times and the variation in patient processing times. Understanding the waiting time formula is important because it presents the fundamental parameters that can be managed to reduce waiting times and length of stay. An additional useful OM principle that is applicable to the ED is the efficient frontier. The efficient frontier compares the performance of EDs with respect to two dimensions: responsiveness (i.e., 1/wait time) and utilization rates. Some EDs may be "on the frontier," maximizing their responsiveness at their given utilization rates. However, most EDs likely have opportunities to move toward the frontier. Increasing capacity is a movement along the frontier and to truly move toward the frontier (i.e., improving responsiveness at a fixed capacity), we articulate three possible options: eliminating waste, reducing variability, or increasing flexibility. When conceptualizing ED crowding interventions, these are the major strategies to consider. © 2011 by the Society for Academic Emergency Medicine.

Fairness in the coronary angiography queue.

PubMed

Alter, D A; Basinski, A S; Cohen, E A; Naylor, C D

1999-10-05

Since waiting lists for coronary angiography are generally managed without explicit queuing criteria, patients may not receive priority on the basis of clinical acuity. The objective of this study was to examine clinical and nonclinical determinants of the length of time patients wait for coronary angiography. In this single-centre prospective cohort study conducted in the autumn of 1997, 357 consecutive patients were followed from initial triage until a coronary angiography was performed or an adverse cardiac event occurred. The referring physicians' hospital affiliation (physicians at Sunnybrook & Women's College Health Sciences Centre, those who practice at another centre but perform angiography at Sunnybrook and those with no previous association with Sunnybrook) was used to compare processes of care. A clinical urgency rating scale was used to assign a recommended maximum waiting time (RMWT) to each patient retrospectively, but this was not used in the queuing process. RMWTs and actual waiting times for patients in the 3 referral groups were compared; the influence clinical and nonclinical variables had on the actual length of time patients waited for coronary angiography was assessed; and possible predictors of adverse events were examined. Of 357 patients referred to Sunnybrook, 22 (6.2%) experienced adverse events while in the queue. Among those who remained, 308 (91.9%) were in need of coronary angiography; 201 (60.0%) of those patients received one within the RMWT. The length of time to angiography was influenced by clinical characteristics similar to those specified on the urgency rating scale, leading to a moderate agreement between actual waiting times and RMWTs (kappa = 0.53). However, physician affiliation was a highly significant (p < 0.001) and independent predictor of waiting time. Whereas 45.6% of the variation in waiting time was explained by all clinical factors combined, 9.3% of the variation was explained by physician affiliation alone. Informal queuing practices for coronary angiography do reflect clinical acuity, but they are also influenced by nonclinical factors, such as the nature of the physicians' association with the catheterization facility.

The willingness to pay for wait reduction: the disutility of queues for cataract surgery in Canada, Denmark, and Spain.

PubMed

Bishai, D M; Lang, H C

2000-03-01

We estimate demand curves for a one month reduction in waiting time for cataract surgery based on survey data collected in 1992 in Manitoba, Barcelona, and Denmark. Patients answered, "Would you be willing to pay [Bid, B] to reduce your waiting time for cataract surgery to less than one month?" Controlling for SES and visual status, Barcelonan patients have greater WTP for shortened waiting time than the Danes and Manitobans. We estimate the value (in 1992 $) of lost consumer surplus due to the cataract surgery queue at $128 per patient in Manitoba, $160 in Denmark, and $243 in Barcelona.

Rational snacking: young children's decision-making on the marshmallow task is moderated by beliefs about environmental reliability.

PubMed

Kidd, Celeste; Palmeri, Holly; Aslin, Richard N

2013-01-01

Children are notoriously bad at delaying gratification to achieve later, greater rewards (e.g., Piaget, 1970)-and some are worse at waiting than others. Individual differences in the ability-to-wait have been attributed to self-control, in part because of evidence that long-delayers are more successful in later life (e.g., Shoda, Mischel, & Peake, 1990). Here we provide evidence that, in addition to self-control, children's wait-times are modulated by an implicit, rational decision-making process that considers environmental reliability. We tested children (M=4;6, N=28) using a classic paradigm-the marshmallow task (Mischel, 1974)-in an environment demonstrated to be either unreliable or reliable. Children in the reliable condition waited significantly longer than those in the unreliable condition (p<0.0005), suggesting that children's wait-times reflected reasoned beliefs about whether waiting would ultimately pay off. Thus, wait-times on sustained delay-of-gratification tasks (e.g., the marshmallow task) may not only reflect differences in self-control abilities, but also beliefs about the stability of the world. Copyright © 2012 Elsevier B.V. All rights reserved.

The “jaundice hotline” for the rapid assessment of patients with jaundice

PubMed Central

Mitchell, Jonathan; Hussaini, Hyder; McGovern, Dermot; Farrow, Richard; Maskell, Giles; Dalton, Harry

2002-01-01

Problem Patients with jaundice require rapid diagnosis and treatment, yet such patients are often subject to delay. Design An open referral, rapid access jaundice clinic was established by reorganisation of existing services and without the need for significant extra resources. Background and setting A large general hospital in a largely rural and geographically isolated area. Key measures for improvement Waiting times for referral, consultation, diagnosis, and treatment, length of stay in hospital, and general practitioners' and patients' satisfaction with the service. Strategies for change Referrals were made through a 24 hour telephone answering machine and fax line. Initial assessment of patients was carried out by junior staff as part of their working week. Dedicated ultrasonography appointments were made available. Effects of change Of 107 patients seen in the first year of the service, 62 had biliary obstruction. The mean time between referral and consultation was 2.5 days. Patients who went on to endoscopic retrograde cholangiopancreatography waited 5.7 days on average. The mean length of stay in hospital in the 69 patients who were admitted was 6.1 days, compared with 11.5 days in 1996, as shown by audit data. Nearly all the 36 general practices (95%) and the 30 consecutive patients (97%) that were surveyed rated the service as above average or excellent. Lessons learnt An open referral, rapid access service for patients with jaundice can shorten time to diagnosis and treatment and length of stay in hospital. These improvements can occur through the reorganisation of existing services and with minimal extra cost. PMID:12142314

Overcrowding of accident & emergency units: is it a growing concern in Nigeria?

PubMed

Makama, Jerry G; Iribhogbe, Pius; Ameh, Emmanuel A

2015-06-01

The inability of the Nigeria's Accident and Emergency Departments (AED) to meet current demands is growing among the public and health care professionals. The data supporting perceptions of insufficient capacity are limited. Therefore, this study was intended to determine the prevalence, causes, and effects of overcrowding AEDs in Nigeria. This was a cross sectional, descriptive study carried out among AED staff of 3 referral teaching hospitals in Nigeria, using a pre-tested and validated structured questionnaire. The analysis of the 267 AED staff revealed 20-56 years (36.40+5.1 mean) age range. One hundred and twenty eight (47.9%) were males, 139 (52.1%) females. Two hundred and fifty nine (97%) agreed that an AED should have a bed capacity of 21-30. Agreement to AED overcrowding in Nigeria was quite considerable. The frequency of AED overcrowding per week was 4-7 times. The average bed occupancy level was 3.25. Agreed common causes of prolonged AED admissions were to be a high volume of critically ill patients, Delayed transfer of patients to the wards, delay in theatre operation, delay in radiological investigations and exceptionally high proportion of patients requiring admission in AED. Also, long pre-review waiting time and haematological delays were more causes. The average waiting time for victims to be seen was 29.7 minutes. There are many causes of AED overcrowding in this environment. However, improving AED bed management, better organized and diligent discharge planning, and reducing access block should be a priority to reduce AED overcrowding.

Water Triple-Point Comparisons: Plateau Averaging or Peak Value?

NASA Astrophysics Data System (ADS)

Steur, P. P. M.; Dematteis, R.

2014-04-01

With a certain regularity, national metrology institutes conduct comparisons of water triple-point (WTP) cells. The WTP is the most important fixed point for the International Temperature Scale of 1990 (ITS-90). In such comparisons, it is common practice to simply average all the single measured temperature points obtained on a single ice mantle. This practice is quite reasonable whenever the measurements show no time dependence in the results. Ever since the first Supplementary Information for the International Temperature Scale of 1990, published by the Bureau International des Poids et Mesures in Sèvres, it was strongly suggested to wait at least 1 day before taking measurements (now up to 10 days), in order for a newly created ice mantle to stabilize. This stabilization is accompanied by a change in temperature with time. A recent improvement in the sensitivity of resistance measurement enabled the Istituto Nazionale di Ricerca Metrologica to detect more clearly the (possible) change in temperature with time of the WTP on a single ice mantle, as for old borosilicate cells. A limited investigation was performed where the temperature of two cells was monitored day-by-day, from the moment of mantle creation, where it was found that with (old) borosilicate cells it may be counterproductive to wait the usual week before starting measurements. The results are presented and discussed, and it is suggested to adapt the standard procedure for comparisons of WTP cells allowing for a different data treatment with (old) borosilicate cells, because taking the temperature dependence into account will surely reduce the reported differences between cells.

The U.S. Pediatric Dermatology Workforce: An Assessment of Productivity and Practice Patterns.

PubMed

Fogel, Alexander L; Teng, Joyce M C

2015-01-01

Pediatric dermatology has always played an important role in children's healthcare, but there has been a shortage of pediatric dermatologists nationwide for more than a decade, and few metrics of productivity and practice patterns exist. This study sought to provide insight into these and other factors of the pediatric dermatology workforce. Electronic surveys were distributed to all 226 U.S. board-certified pediatric dermatologists. A total of 108/226 (48%) of the electronic surveys were returned. Sixty percent of respondents were employed full- or part-time in academic environments and 81% were salaried. Respondents reported that children constituted 79.5% of their practice, and the average respondent spent 3.8 days/week treating 92.6 patients, considerably lower than the 136.3 patients/week that the average general dermatologist sees. The academic practice environment was associated with children constituting a larger proportion of the practice (p < 0.001), fewer patients seen per week (85.9, p < 0.001), and longer median new patient wait times (60 vs 15 days) than in other practice environments. Private practitioners saw significantly more patients per week than those in academic environments (112.7, p = 0.005). Male and female practitioners reported approximately equal patient care days per week, similar wait times, and similar proportions of children in their practices. This assessment revealed productivity and practice pattern differences between the various pediatric dermatology practice environments and between pediatric and general dermatology. This study provides important information for workforce planning and care availability assessments and baseline information for future studies. © 2015 Wiley Periodicals, Inc.

A Sarsa(λ)-Based Control Model for Real-Time Traffic Light Coordination

PubMed Central

Zhu, Fei; Liu, Quan; Fu, Yuchen; Huang, Wei

2014-01-01

Traffic problems often occur due to the traffic demands by the outnumbered vehicles on road. Maximizing traffic flow and minimizing the average waiting time are the goals of intelligent traffic control. Each junction wants to get larger traffic flow. During the course, junctions form a policy of coordination as well as constraints for adjacent junctions to maximize their own interests. A good traffic signal timing policy is helpful to solve the problem. However, as there are so many factors that can affect the traffic control model, it is difficult to find the optimal solution. The disability of traffic light controllers to learn from past experiences caused them to be unable to adaptively fit dynamic changes of traffic flow. Considering dynamic characteristics of the actual traffic environment, reinforcement learning algorithm based traffic control approach can be applied to get optimal scheduling policy. The proposed Sarsa(λ)-based real-time traffic control optimization model can maintain the traffic signal timing policy more effectively. The Sarsa(λ)-based model gains traffic cost of the vehicle, which considers delay time, the number of waiting vehicles, and the integrated saturation from its experiences to learn and determine the optimal actions. The experiment results show an inspiring improvement in traffic control, indicating the proposed model is capable of facilitating real-time dynamic traffic control. PMID:24592183

An Integrated Model of Patient and Staff Satisfaction Using Queuing Theory

PubMed Central

Mousavi, Ali; Clarkson, P. John; Young, Terry

2015-01-01

This paper investigates the connection between patient satisfaction, waiting time, staff satisfaction, and service time. It uses a variety of models to enable improvement against experiential and operational health service goals. Patient satisfaction levels are estimated using a model based on waiting (waiting times). Staff satisfaction levels are estimated using a model based on the time spent with patients (service time). An integrated model of patient and staff satisfaction, the effective satisfaction level model, is then proposed (using queuing theory). This links patient satisfaction, waiting time, staff satisfaction, and service time, connecting two important concepts, namely, experience and efficiency in care delivery and leading to a more holistic approach in designing and managing health services. The proposed model will enable healthcare systems analysts to objectively and directly relate elements of service quality to capacity planning. Moreover, as an instrument used jointly by healthcare commissioners and providers, it affords the prospect of better resource allocation. PMID:27170899

An Integrated Model of Patient and Staff Satisfaction Using Queuing Theory.

PubMed

Komashie, Alexander; Mousavi, Ali; Clarkson, P John; Young, Terry

2015-01-01

This paper investigates the connection between patient satisfaction, waiting time, staff satisfaction, and service time. It uses a variety of models to enable improvement against experiential and operational health service goals. Patient satisfaction levels are estimated using a model based on waiting (waiting times). Staff satisfaction levels are estimated using a model based on the time spent with patients (service time). An integrated model of patient and staff satisfaction, the effective satisfaction level model, is then proposed (using queuing theory). This links patient satisfaction, waiting time, staff satisfaction, and service time, connecting two important concepts, namely, experience and efficiency in care delivery and leading to a more holistic approach in designing and managing health services. The proposed model will enable healthcare systems analysts to objectively and directly relate elements of service quality to capacity planning. Moreover, as an instrument used jointly by healthcare commissioners and providers, it affords the prospect of better resource allocation.

Looking for Lithotripsy: Accessibility and Portability of Canadian Healthcare

PubMed Central

Piggott, Katrina L.; Bell, Chaim M.

2013-01-01

Background: Extracorporeal shock wave lithotripsy (ESWL) is a definitive, ambulatory and non-invasive modality for treating kidney stones. ESWL is not available in all urban centres and many Canadians must either travel, sometimes out of province, or wait to have this procedure performed. We sought to evaluate the variability in access to ESWL treatment. Method: We compiled a comprehensive list of ESWL centres in Canada and contacted all centres in 2011 to assess their wait times, out-of-province patient fees, and roles and responsibilities of the referring physician. Results: We contacted all 23 ESWL facilities across Canada (100% response rate). Wait times for elective ESWL procedures ranged from one day to over one year, with a mean of 8.4 weeks (SD, 16.76 weeks). No centres refused out-of-province patients, although five discouraged travel to their centre owing to their prolonged wait times. No facilities charged extra fees for out-of-province patients. Ten (43%) facilities required a secondary consultation by a urolo-gist at the centre before booking. Twelve (52%) of the centres indicated the waiting time could be shortened if the referring physician were to advocate on the patient's behalf. Contact was repeated one year later in 2012 with five centres, and the results were similar. Interpretation: There is marked variation in wait times across Canada for ESWL but there are few barriers to care. Patients' waits may be shortened by physician advocacy. PMID:24359718

Rationing in the emergency department: the good, the bad, and the unacceptable.

PubMed

Cross, E; Goodacre, S; O'Cathain, A; Arnold, J

2005-03-01

Waiting times in emergency departments (EDs) are an important government priority. Although substantial efforts are currently being made to reduce waiting times, little attention has been paid to the patients' view. We used qualitative methods to explore patients' perspectives on waiting times and other approaches to rationing and prioritisation. Face to face, in depth, qualitative interviews (n = 11) explored how patients valued waiting times for non-urgent ED care. The framework approach (identifying a thematic framework through repeated re-reading) was used to analyse transcripts. Interviewees found some forms of rationing and prioritisation acceptable. They expected rationing by delay, but required explanations or information on the reason for their wait. They valued prioritisation by triage (rationing by selection) and thought that this role could be expanded for the re-direction of non-urgent patients elsewhere (rationing by deflection). Interviewees were mainly unwilling or unable to engage in prioritisation of different types of patients, openly prioritising only those with obvious clinical need, and children. However, some interviewees were willing to ration implicitly, labelling some attenders as inappropriate, such as those causing a nuisance. Others felt it was unacceptable to blame "inappropriate" attenders, as their attendance may relate to lack of information or awareness of service use. Explicit rationing between services was not acceptable, although some believed there were more important priorities for NHS resources than ED waiting times. Interviewees disagreed with the hypothetical notion of paying to be seen more quickly in the ED (rationing by charging). Interviewees expected to wait and accepted the need for prioritisation, although they were reluctant to engage in judgements regarding prioritisation. They supported the re-direction of patients with certain non-urgent complaints. However, they perceived a need for more explanation and information about their wait, the system, and alternative services.

Disparities in Attention to HIV-Prevention Information

PubMed Central

Crause, Candi; Vaid, Awais; Albarracín, Dolores

2016-01-01

Compared to European-Americans, African-Americans have greater probability of becoming infected with HIV, as well as worse outcomes when they become infected. Therefore, adequate health communications should ensure that they capture the attention of African-Americans and do not perpetuate disadvantages relative to European-Americans. The objective of this report was to examine if racial disparities in attention to health information parallel racial disparities in health outcomes. Participants were clients of a public health clinic (Study 1 n = 64; Study 2 n = 55). Unobtrusive observation in a public health waiting room, message reading times, and response-time on a modified flanker task were used to examine attention to HIV- and flu-information across racial groups. In Study 1, participants were observed for the duration of their time in a public health clinic waiting room (average duration 31 minutes). In Study 2, participants completed tasks in a private room at the public health clinic (average duration 21 minutes). Across all attention measures, results suggest an interaction between race and information type on attention to health information. In particular, African-Americans differentially attended to information as a function of information type, with decreased attention to HIV versus flu information. In contrast, European-Americans attended equally to both HIV and flu information. As such, disparities in attention yielded less access to certain health information for African- than European-Americans in a health setting. The identified disparities in attention are particularly problematic because they disadvantage African-Americans at a time of great effort to correct racial disparities. Modifying the framing of health information in ways that ensure attention by all racial groups may be a strategy to increase attention, and thereby reduce disparities in health outcomes. Future research should find solutions that increase attentional access to health communications for all groups. PMID:26279308

Disparities in attention to HIV-prevention information.

PubMed

Earl, Allison; Crause, Candi; Vaid, Awais; Albarracín, Dolores

2016-01-01

Compared to European-Americans, African-Americans have greater probability of becoming infected with HIV, as well as worse outcomes when they become infected. Therefore, adequate health communications should ensure that they capture the attention of African-Americans and do not perpetuate disadvantages relative to European-Americans. The objective of this report was to examine if racial disparities in attention to health information parallel racial disparities in health outcomes. Participants were clients of a public health clinic (Study 1 n = 64; Study 2 n = 55). Unobtrusive observation in a public health waiting room, message reading times, and response-time on a modified flanker task were used to examine attention to HIV- and flu-information across racial groups. In Study 1, participants were observed for the duration of their time in a public health clinic waiting room (average duration: 31 min). In Study 2, participants completed tasks in a private room at the public health clinic (average duration: 21 min). Across all attention measures, results suggest an interaction between race and information type on attention to health information. In particular, African-Americans differentially attended to information as a function of information type, with decreased attention to HIV- versus flu-information. In contrast, European-Americans attended equally to both HIV- and flu-information. As such, disparities in attention yielded less access to certain health information for African- than European-Americans in a health setting. The identified disparities in attention are particularly problematic because they disadvantage African-Americans at a time of great effort to correct racial disparities. Modifying the framing of health information in ways that ensure attention by all racial groups may be a strategy to increase attention, and thereby reduce disparities in health outcomes. Future research should find solutions that increase attentional access to health communications for all groups.

The impact of travel distance, travel time and waiting time on health-related quality of life of diabetes patients: An investigation in six European countries.

PubMed

Konerding, Uwe; Bowen, Tom; Elkhuizen, Sylvia G; Faubel, Raquel; Forte, Paul; Karampli, Eleftheria; Mahdavi, Mahdi; Malmström, Tomi; Pavi, Elpida; Torkki, Paulus

2017-04-01

The effects of travel distance and travel time to the primary diabetes care provider and waiting time in the practice on health-related quality of life (HRQoL) of patients with type 2 diabetes are investigated. Survey data of 1313 persons with type 2 diabetes from six regions in England (274), Finland (163), Germany (254), Greece (165), the Netherlands (354), and Spain (103) were analyzed. Various multiple linear regression analyses with four different EQ-5D-3L indices (English, German, Dutch and Spanish index) as target variables, with travel distance, travel time, and waiting time in the practice as focal predictors and with control for study region, patient's gender, patient's age, patient's education, time since diagnosis, thoroughness of provider-patient communication were computed. Interactions of regions with the remaining five control variables and the three focal predictors were also tested. There are no interactions of regions with control variables or focal predictors. The indices decrease with increasing travel time to the provider and increasing waiting time in the provider's practice. HRQoL of patients with type 2 diabetes might be improved by decreasing travel time to the provider and waiting time in the provider's practice. Copyright © 2017 Elsevier B.V. All rights reserved.

Decreasing laboratory turnaround time and patient wait time by implementing process improvement methodologies in an outpatient oncology infusion unit.

PubMed

Gjolaj, Lauren N; Gari, Gloria A; Olier-Pino, Angela I; Garcia, Juan D; Fernandez, Gustavo L

2014-11-01

Prolonged patient wait times in the outpatient oncology infusion unit indicated a need to streamline phlebotomy processes by using existing resources to decrease laboratory turnaround time and improve patient wait time. Using the DMAIC (define, measure, analyze, improve, control) method, a project to streamline phlebotomy processes within the outpatient oncology infusion unit in an academic Comprehensive Cancer Center known as the Comprehensive Treatment Unit (CTU) was completed. Laboratory turnaround time for patients who needed same-day lab and CTU services and wait time for all CTU patients was tracked for 9 weeks. During the pilot, the wait time from arrival to CTU to sitting in treatment area decreased by 17% for all patients treated in the CTU during the pilot. A total of 528 patients were seen at the CTU phlebotomy location, representing 16% of the total patients who received treatment in the CTU, with a mean turnaround time of 24 minutes compared with a baseline turnaround time of 51 minutes. Streamlining workflows and placing a phlebotomy station inside of the CTU decreased laboratory turnaround times by 53% for patients requiring same day lab and CTU services. The success of the pilot project prompted the team to make the station a permanent fixture. Copyright © 2014 by American Society of Clinical Oncology.

Developments in pediatric liver transplantation since implementation of the new allocation rules in Eurotransplant.

PubMed

Herden, Uta; Grabhorn, Enke; Briem-Richter, Andrea; Ganschow, Rainer; Nashan, Björn; Fischer, Lutz

2014-09-01

Liver allocation in the Eurotransplant (ET) region has changed from a waiting time to an urgency-based system using the model of end-stage liver disease (MELD) score in 2006. To allow timely transplantation, pediatric recipients are allocated by an assigned pediatric MELD independent of severity of illness. Consequences for children listed at our center were evaluated by retrospective analysis of all primary pediatric liver transplantation (LTX) from deceased donors between 2002 and 2010 (110 LTX before/50 LTX after new allocation). Of 50 children transplanted in the MELD era, 17 (34%) underwent LTX with a high-urgent status that was real in five patients (median lab MELD 22, waiting time five d) and assigned in 12 patients (lab MELD 7, waiting time 35 d). Thirty-three children received a liver by their assigned pediatric MELD (lab MELD 15, waiting time 255 d). Waiting time in the two periods was similar, whereas the wait-list mortality decreased (from about four children/yr to about one child/yr). One- and three-yr patient survival showed no significant difference (94.5/97.7%; p = 0.385) as did one- and three-yr graft survival (80.7/75.2%; and 86.5/82%; p = 0.436 before/after). Introduction of a MELD-based allocation system in ET with assignment of a granted score for pediatric recipients has led to a clear priorization of children resulting in a low wait-list mortality and good clinical outcome. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Reading and Television Viewing Habits of American Adults during Time Spent in Waiting Rooms.

ERIC Educational Resources Information Center

Spirn, Sharon L.

In order to determine the reading and television viewing habits of American adults during time spent in waiting rooms, a study observed 100 adults waiting outside the Emergency Treatment Room of John F. Kennedy Hospital in Edison, New Jersey, over a four-week period. Results revealed that more of these adults chose to watch television as an…

Reward Sensitivity and Waiting Impulsivity: Shift towards Reward Valuation away from Action Control

PubMed Central

Mechelmans, Daisy J; Strelchuk, Daniela; Doñamayor, Nuria; Banca, Paula; Robbins, Trevor W; Baek, Kwangyeol

2017-01-01

Abstract Background Impulsivity and reward expectancy are commonly interrelated. Waiting impulsivity, measured using the rodent 5-Choice Serial Reaction Time task, predicts compulsive cocaine seeking and sign (or cue) tracking. Here, we assess human waiting impulsivity using a novel translational task, the 4-Choice Serial Reaction Time task, and the relationship with reward cues. Methods Healthy volunteers (n=29) performed the monetary incentive delay task as a functional MRI study where subjects observe a cue predicting reward (cue) and wait to respond for high (£5), low (£1), or no reward. Waiting impulsivity was tested with the 4-Choice Serial Reaction Time task. Results For high reward prospects (£5, no reward), greater waiting impulsivity on the 4-CSRT correlated with greater medial orbitofrontal cortex and lower supplementary motor area activity to cues. In response to high reward cues, greater waiting impulsivity was associated with greater subthalamic nucleus connectivity with orbitofrontal cortex and greater subgenual cingulate connectivity with anterior insula, but decreased connectivity with regions implicated in action selection and preparation. Conclusion These findings highlight a shift towards regions implicated in reward valuation and a shift towards compulsivity away from higher level motor preparation and action selection and response. We highlight the role of reward sensitivity and impulsivity, mechanisms potentially linking human waiting impulsivity with incentive approach and compulsivity, theories highly relevant to disorders of addiction. PMID:29020291

Patient satisfaction with wait times at an emergency ophthalmology on-call service.

PubMed

Chan, Brian J; Barbosa, Joshua; Moinul, Prima; Sivachandran, Nirojini; Donaldson, Laura; Zhao, Lily; Mullen, Sarah J; McLaughlin, Christopher R; Chaudhary, Varun

2018-04-01

To assess patient satisfaction with emergency ophthalmology care and determine the effect provision of anticipated appointment wait time has on scores. Single-centre, randomized control trial. Fifty patients triaged at the Hamilton Regional Eye Institute (HREI) from November 2015 to July 2016. Fifty patients triaged for next-day appointments at the HREI were randomly assigned to receive standard-of-care preappointment information or standard-of-care information in addition to an estimated appointment wait time. Patient satisfaction with care was assessed postvisit using the modified Judgements of Hospital Quality Questionnaire (JHQQ). In determining how informing patients of typical wait times influenced satisfaction, the Mann-Whitney U test was performed. As secondary study outcomes, we sought to determine patient satisfaction with the intervention material using the Fisher exact test and the effect that wait time, age, sex, education, mobility, and number of health care providers seen had on satisfaction scores using logistic regression analysis. The median JHQQ response was "very good" (4/5) and between "very good" and "excellent" (4.5/5) in the intervention and control arms, respectively. There was no difference in patient satisfaction between the cohorts (Mann-Whitney U = 297.00, p = 0.964). Logistic regression analysis demonstrated that wait times influenced patient satisfaction (OR = 0.919, 95% CI 0.864-0.978, p = 0.008). Of the intervention arm patients, 92.0% (N = 23) found the preappointment information useful, whereas only 12.5% (N = 3) of the control cohort patients noted the same (p < 0.001). Provision of anticipated wait time information to patients in an emergency on-call ophthalmology clinic did not influence satisfaction with care as captured by the JHQQ. Copyright © 2018 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

Burst wait time simulation of CALIBAN reactor at delayed super-critical state

DOE Office of Scientific and Technical Information (OSTI.GOV)

Humbert, P.; Authier, N.; Richard, B.

2012-07-01

In the past, the super prompt critical wait time probability distribution was measured on CALIBAN fast burst reactor [4]. Afterwards, these experiments were simulated with a very good agreement by solving the non-extinction probability equation [5]. Recently, the burst wait time probability distribution has been measured at CEA-Valduc on CALIBAN at different delayed super-critical states [6]. However, in the delayed super-critical case the non-extinction probability does not give access to the wait time distribution. In this case it is necessary to compute the time dependent evolution of the full neutron count number probability distribution. In this paper we present themore » point model deterministic method used to calculate the probability distribution of the wait time before a prescribed count level taking into account prompt neutrons and delayed neutron precursors. This method is based on the solution of the time dependent adjoint Kolmogorov master equations for the number of detections using the generating function methodology [8,9,10] and inverse discrete Fourier transforms. The obtained results are then compared to the measurements and Monte-Carlo calculations based on the algorithm presented in [7]. (authors)« less

Effect of socioeconomic deprivation on waiting time for cardiac surgery: retrospective cohort study

PubMed Central

Pell, Jill P; Pell, Alastair C H; Norrie, John; Ford, Ian; Cobbe, Stuart M

2000-01-01

Objective To determine whether the priority given to patients referred for cardiac surgery is associated with socioeconomic status. Design Retrospective study with multivariate logistic regression analysis of the association between deprivation and classification of urgency with allowance for age, sex, and type of operation. Multivariate linear regression analysis was used to determine association between deprivation and waiting time within each category of urgency, with allowance for age, sex, and type of operation. Setting NHS waiting lists in Scotland. Participants 26 642 patients waiting for cardiac surgery, 1 January 1986 to 31 December 1997. Main outcome measures Deprivation as measured by Carstairs deprivation category. Time spent on NHS waiting list. Results Patients who were most deprived tended to be younger and were more likely to be female. Patients in deprivation categories 6 and 7 (most deprived) waited about three weeks longer for surgery than those in category 1 (mean difference 24 days, 95% confidence interval 15 to 32). Deprived patients had an odds ratio of 0.5 (0.46 to 0.61) for having their operations classified as urgent compared with the least deprived, after allowance for age, sex, and type of operation. When urgent and routine cases were considered separately, there was no significant difference in waiting times between the most and least deprived categories. Conclusions Socioeconomically deprived patients are thought to be more likely to develop coronary heart disease but are less likely to be investigated and offered surgery once it has developed. Such patients may be further disadvantaged by having to wait longer for surgery because of being given lower priority. PMID:10617517

The association between an electric pump loan program and the timing of requests for formula by working mothers in WIC.

PubMed

Meehan, Karen; Harrison, Gail G; Afifi, Abdelmonem A; Nickel, Nathan; Jenks, Eloise; Ramirez, Anthony

2008-05-01

An electric pump loan program designed to facilitate breastfeeding for low-income mothers returning to full-time work was evaluated. All mothers were WIC participants in the Los Angeles area. Electric pump loans were made until the infant's first birthday or until the mother requested formula from WIC. Information was provided to employers on supporting breastfeeding in the workplace. A subsample of mothers who received an electric pump on return to full-time work was compared with counterparts in a wait list control group. Mothers who received an electric pump as soon as requested did not request formula until 8.8 months on average, whereas those who did not receive an electric pump requested formula on average at 4.8 months (P < .0001). Mothers who received an electric pump when requested were 5.5 (95% CI 2.0-15.1) times as likely as mothers who did not receive an electric pump to not request formula at 6 months.

Ramsey waits: allocating public health service resources when there is rationing by waiting.

PubMed

Gravelle, Hugh; Siciliani, Luigi

2008-09-01

The optimal allocation of a public health care budget across treatments must take account of the way in which care is rationed within treatments since this will affect their marginal value. We investigate the optimal allocation rules for public health care systems where user charges are fixed and care is rationed by waiting. The optimal waiting time is higher for treatments with demands more elastic to waiting time, higher costs, lower charges, smaller marginal welfare loss from waiting by treated patients, and smaller marginal welfare losses from under-consumption of care. The results hold for a wide range of welfarist and non-welfarist objective functions and for systems in which there is also a private health care sector. They imply that allocation rules based purely on cost effectiveness ratios are suboptimal because they assume that there is no rationing within treatments.

A Model to Study: Cannibalization, FMC, and Customer Waiting Time

DTIC Science & Technology

2002-02-01

4825 Mark Center Drive • Alexandria, Virginia 22311-1850 CRM D0005957.A2/Final February 2002 A Model to Study: Cannibalization, FMC, and Customer ...numerical example In this section, we will derive the relationship between cannibaliza- tion rates, customer waiting time (CWT) for needed spare parts... relationships between the FMC given by equation 1, the mean customer wait time for spare parts, denoted µ, and the 5. According to [19], not every part can be

Influence of Waiting Time on the Levitation Force Between a Permanent Magnet and a Superconductor

NASA Astrophysics Data System (ADS)

Zhang, Xing-Yi; Zhou, You-He; Zhou, Jun

This paper describes the experimental results of the levitation force of single-grained YBaCuO bulk superconductors preparing by the top-seeded melt-growth method with different waiting time tw below an NdFeB permanent magnet. It was found that waiting time has large effects on the zero-field-cooled (ZFC) and field-cooled (FC) levitation force, and the levitation force shows aging characteristics at the liquid nitrogen temperature.

Emergency Department Waiting Times (EDWaT): A Patient Flow Management and Quality of Care Rating mHealth Application.

PubMed

Househ, Mowafa; Yunus, Faisel

2014-01-01

Saudi hospital emergency departments (ED) have suffered from long waiting times, which have led to a delay in emergency patient care. The increase in the population of Saudi Arabia is likely to further stretch the healthcare services due to overcrowding leading to decreased healthcare quality, long patient waits, patient dissatisfaction, ambulance diversions, decreased physician productivity, and increased frustration among medical staff. This will ultimately put patients at risk for poor health outcomes. Time is of the essence in emergencies and to get to an ED that has the shortest waiting time can mean life or death for a patient, especially in cases of stroke and myocardial infarction. In this paper, we present our work on the development of a mHealth Application - EDWaT - that will: provide patient flow information to the emergency medical services staff, help in quick routing of patients to the nearest hospital, and provide an opportunity for patients to review and rate the quality of care received at an ED, which will then be forwarded to ED services administrators. The quality ratings will help patients to choose between two EDs with the same waiting time and distance from their location. We anticipate that the use of EDWaT will help improve ED wait times and the quality of care provision in Saudi hospitals EDs.

Using the Integration of Discrete Event and Agent-Based Simulation to Enhance Outpatient Service Quality in an Orthopedic Department.

PubMed

Kittipittayakorn, Cholada; Ying, Kuo-Ching

2016-01-01

Many hospitals are currently paying more attention to patient satisfaction since it is an important service quality index. Many Asian countries' healthcare systems have a mixed-type registration, accepting both walk-in patients and scheduled patients. This complex registration system causes a long patient waiting time in outpatient clinics. Different approaches have been proposed to reduce the waiting time. This study uses the integration of discrete event simulation (DES) and agent-based simulation (ABS) to improve patient waiting time and is the first attempt to apply this approach to solve this key problem faced by orthopedic departments. From the data collected, patient behaviors are modeled and incorporated into a massive agent-based simulation. The proposed approach is an aid for analyzing and modifying orthopedic department processes, allows us to consider far more details, and provides more reliable results. After applying the proposed approach, the total waiting time of the orthopedic department fell from 1246.39 minutes to 847.21 minutes. Thus, using the correct simulation model significantly reduces patient waiting time in an orthopedic department.

Using the Integration of Discrete Event and Agent-Based Simulation to Enhance Outpatient Service Quality in an Orthopedic Department

PubMed Central

Kittipittayakorn, Cholada

2016-01-01

Many hospitals are currently paying more attention to patient satisfaction since it is an important service quality index. Many Asian countries' healthcare systems have a mixed-type registration, accepting both walk-in patients and scheduled patients. This complex registration system causes a long patient waiting time in outpatient clinics. Different approaches have been proposed to reduce the waiting time. This study uses the integration of discrete event simulation (DES) and agent-based simulation (ABS) to improve patient waiting time and is the first attempt to apply this approach to solve this key problem faced by orthopedic departments. From the data collected, patient behaviors are modeled and incorporated into a massive agent-based simulation. The proposed approach is an aid for analyzing and modifying orthopedic department processes, allows us to consider far more details, and provides more reliable results. After applying the proposed approach, the total waiting time of the orthopedic department fell from 1246.39 minutes to 847.21 minutes. Thus, using the correct simulation model significantly reduces patient waiting time in an orthopedic department. PMID:27195606

RFID-based information visibility for hospital operations: exploring its positive effects using discrete event simulation.

PubMed

Asamoah, Daniel A; Sharda, Ramesh; Rude, Howard N; Doran, Derek

2016-10-12

Long queues and wait times often occur at hospitals and affect smooth delivery of health services. To improve hospital operations, prior studies have developed scheduling techniques to minimize patient wait times. However, these studies lack in demonstrating how such techniques respond to real-time information needs of hospitals and efficiently manage wait times. This article presents a multi-method study on the positive impact of providing real-time scheduling information to patients using the RFID technology. Using a simulation methodology, we present a generic scenario, which can be mapped to real-life situations, where patients can select the order of laboratory services. The study shows that information visibility offered by RFID technology results in decreased wait times and improves resource utilization. We also discuss the applicability of the results based on field interviews granted by hospital clinicians and administrators on the perceived barriers and benefits of an RFID system.

Posted wait times an added advantage to multi-facility systems?

PubMed

2011-04-01

Methodist Le Bonheur Healthcare in Memphis, TN, is investigating whether posting ED wait times via the internet can positively impact patient flow in the six EDs the health system operates in the Memphis region. The health system began posting wait times in August 2010, resulting in increases in ED volume ranging from 6% to 10%. The health system is monitoring ED arrivals by zip code to assess any impact on load balancing between its busy EDs. One marketing challenge is that a competitor is posting ED wait times as well, but it is posting the time it takes for a patient to be placed in a bed as opposed to the door-to-provider time that Methodist Le Bonheur is posting. The approach has the most impact on lower-acuity patients, but experts worry that in the future, payers may not be reimbursed for ED care for these patients.

Price Changes in Regulated Healthcare Markets: Do Public Hospitals Respond and How?

PubMed

Verzulli, Rossella; Fiorentini, Gianluca; Lippi Bruni, Matteo; Ugolini, Cristina

2017-11-01

This paper examines the behaviour of public hospitals in response to the average payment incentives created by price changes for patients classified in different diagnosis-related groups (DRGs). Using panel data on public hospitals located within the Italian region of Emilia-Romagna, we test whether a 1-year increase in DRG prices induced public hospitals to increase their volume of activity and whether a potential response is associated with changes in waiting times and/or length of stay. We find that public hospitals reacted to the policy change by increasing the number of patients with surgical treatments. This effect was smaller in the 2 years after the policy change than in later years, and for providers with a lower excess capacity in the pre-policy period, whereas it did not vary significantly across hospitals according to their degree of financial and administrative autonomy. For patients with medical DRGs, instead, there appeared to be no effect on inpatient volumes. Our estimates also suggest that an increase in DRG prices had no impact on the proportion of patients waiting more than 6 months. Finally, we find no evidence of a significant effect on patients' average length of stay. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Organ Type and Waiting Time

MedlinePlus

... but each organ type has its own individual distribution policy reflects reflect factors that are unique to each organ type: Kidney Waiting time Donor/recipient immune system compatibility Prior living donor ...

Optimizing the arrival, waiting, and NPO times of children on the day of pediatric endoscopy procedures.

PubMed

Smallman, Bettina; Dexter, Franklin

2010-03-01

Research in predictive variability of operating room (OR) times has been performed using data from multidisciplinary, tertiary hospitals with mostly adult patients. In this article, we discuss case-duration prediction for children receiving general anesthesia for endoscopy. We critique which of the several types of OR management decisions dependent on accuracy of prediction are relevant to series (lists) of brief pediatric anesthetics. OR information system data were obtained for all children (aged 18 years and younger) undergoing a gastroenterology procedure with an anesthesiologist over 21 months. Summaries of data were used for a qualitative, systematic review of prior studies to learn which apply to brief pediatric cases. Patient arrival times were changed to be based on the statistical method relating actual and scheduled start times (Wachtel and Dexter, Anesth Analg 2007;105:127-40). Even perfect case-duration prediction would not affect whether a brief case was performed on a certain date and/or in a certain OR. There was no evidence of usefulness in calculating the probability that one case would last longer than another or in resequencing cases to influence postanesthesia care unit staffing or patient waiting from scheduled start times. The only decision for which the accuracy of case-duration prediction mattered was for the shortest time that preceding cases in the OR may take. Knowledge of the preceding procedures in the OR was not useful for that purpose because there were hundreds of combinations of preceding procedures and some cases cancelled. Instead, patient ready times were chosen based on 5% lower prediction bounds for ratios of actual to scheduled OR times. The approach was useful based on a 30% reduction in patient waiting times from scheduled start times with corresponding expected reductions in average and peak numbers of patients in the holding area. For brief pediatric OR anesthetics, predictive variability of case durations matters principally to the extent that it affects appropriate patient ready times. Such times should not be chosen by having patients start fasting, arrive, and be ready fixed numbers of hours before their scheduled start times.

Socioeconomic status and waiting times for health services: An international literature review and evidence from the Italian National Health System.

PubMed

Landi, Stefano; Ivaldi, Enrico; Testi, Angela

2018-04-01

In the absence of priority criteria, waiting times are an implicit rationing instrument where the absence or limited use of prices creates an excess of demand. Even in the presence of priority criteria, waiting times may be unfair because they reduce health care demand of patients in lower socio-economic conditions due to high opportunity costs of time or a decay in their health level. Significant evidence has shown a relationship between socioeconomic status and the length of waiting time. The first phase of the study involved an extensive review of the existent literature for the period of 2002-2016 in the main databases (Scopus, PubMed and Science Direct). Twenty-eight met the eligibility criteria. The 27 papers were described and classified. The e mpirical objective of this study was to determine whether socioeconomic characteristics affect waiting time for different health services in the Italian national health system. The services studied were specialist visits, diagnostics tests and elective surgeries. A classification tree and logistic regression models were implemented. Data from the 2013 Italian Health National Survey were used. The analysis found heterogeneous results for different types of service. Individuals with lower education and economic resources have a higher risk of experiencing excessive waiting times for diagnostic and specialist visits. For elective surgery, socioeconomic inequalities are present but appear to be lower. Copyright © 2018 Elsevier B.V. All rights reserved.

Veterans Health Administration

MedlinePlus

... and Quality in VA Health Care Wait times, satisfaction scores, and quality comparisons for VA health care ... assessment flowchart . ACCESS and QUALITY DATA Wait times, satisfaction scores, and quality comparisons for VA health care ...

Transmembrane protein CD93 diffuses by a continuous time random walk.

NASA Astrophysics Data System (ADS)

Goiko, Maria; de Bruyn, John; Heit, Bryan

Molecular motion within the cell membrane is a poorly-defined process. In this study, we characterized the diffusion of the transmembrane protein CD93. By careful analysis of the dependence of the ensemble-averaged mean squared displacement (EA-MSD, r2) on time t and the ensemble-averaged, time-averaged MSD (EA-TAMSD, δ2) on lag time τ and total measurement time T, we showed that the motion of CD93 is well-described by a continuous-time random walk (CTRW). CD93 tracks were acquired using single particle tracking. The tracks were classified as confined or free, and the behavior of the MSD analyzed. EA-MSDs of both populations grew non-linearly with t, indicative of anomalous diffusion. Their EA-TAMSDs were found to depend on both τ and T, indicating non-ergodicity. Free molecules had r2 tα and δ2 (τ /T 1 - α) , with α 0 . 5 , consistent with a CTRW. Mean maximal excursion analysis supported this result. Confined CD93 had r2 t0 and δ2 (τ / T) α , with α 0 . 3 , consistent with a confined CTRW. CTRWs are described by a series of random jumps interspersed with power-law distributed waiting times, and may arise due to the interactions of CD93 with the endocytic machinery. NSERC.

Discrimination in waiting times by insurance type and financial soundness of German acute care hospitals.

PubMed

Schwierz, Christoph; Wübker, Achim; Wübker, Ansgar; Kuchinke, Björn A

2011-10-01

This paper shows that patients with private health insurance (PHI) are being offered significantly shorter waiting times than patients with statutory health insurance (SHI) in German acute hospital care. This behavior may be driven by the higher expected profitability of PHI relative to SHI holders. Further, we find that hospitals offering private insurees shorter waiting times when compared with SHI holders have a significantly better financial performance than those abstaining from or with less discrimination.

A Study to Determine Patient Waiting Time at the Outpatient Pharmacy at Wilford Hall USAF Medical Center

DTIC Science & Technology

1988-06-01

at Wilford Hall USAF Medical Center significantly reduced the patient wait time at the main outpatient pharmacy. Satellite pharmacies have been ).’l...PRESENTING TO WINDOW 1, 19 MAR 88. 47 C:. A’.’E-:A: -ESCRIRTIONS PER PATIENT ...........48 H. WILFORD HALL MEDICAL CENTER OUTPATIENT QUESTIONNAIRE...that wait times at tne outpatient pharmacy were excessive. It was this concern that motivated the Medical Center Administrator to request that patient

Deficient neural activity subserving decision-making during reward waiting time in intertemporal choice in adult attention-deficit hyperactivity disorder.

PubMed

Todokoro, Ayako; Tanaka, Saori C; Kawakubo, Yuki; Yahata, Noriaki; Ishii-Takahashi, Ayaka; Nishimura, Yukika; Kano, Yukiko; Ohtake, Fumio; Kasai, Kiyoto

2018-04-24

Impulsivity, which significantly affects social adaptation, is an important target behavioral characteristic in interventions for attention-deficit hyperactivity disorder (ADHD). Typically, people are willing to wait longer to acquire greater rewards. Impulsivity in ADHD may be associated with brain dysfunction in decision-making involving waiting behavior under such situations. We tested the hypothesis that brain circuitry during a period of waiting (i.e., prior to the acquisition of reward) is altered in adults with ADHD. The participants included 14 medication-free adults with ADHD and 16 healthy controls matched for age, sex, IQ, and handedness. The behavioral task had participants choose between a delayed, larger monetary reward and an immediate, smaller monetary reward, where the reward waiting time actually occurred during functional magnetic resonance imaging measurement. We tested for group differences in the contrast values of blood-oxygen-level dependent signals associated with the length of waiting time, calculated using the parametric modulation method. While the two groups did not differ in the time discounting rate, the delay-sensitive contrast values were significantly lower in the caudate and visual cortex in individuals with ADHD. The higher impulsivity scores were significantly associated with lower delay-sensitive contrast values in the caudate and visual cortex. These results suggest that deficient neural activity affects decision-making involving reward waiting time during intertemporal choice tasks, and provide an explanation for the basis of impulsivity in adult ADHD. © 2018 The Author. Psychiatry and Clinical Neurosciences © 2018 Japanese Society of Psychiatry and Neurology.

Does Wait-List Size at Registration Influence Time to Surgery? Analysis of a Population-Based Cardiac Surgery Registry

PubMed Central

Sobolev, Boris; Levy, Adrian; Hayden, Robert; Kuramoto, Lisa

2006-01-01

Objective To determine whether the probability of undergoing coronary bypass surgery within a certain time was related to the number of patients on the wait list at registration for the operation in a publicly funded health system. Methods A prospective cohort study comparing waiting times among patients registered on wait lists at the hospitals delivering adult cardiac surgery. For each calendar week, the list size, the number of new registrations, and the number of direct admissions immediately after angiography characterized the demand for surgery. Results The length of delay in undergoing treatment was associated with list size at registration, with shorter times for shorter lists (log-rank test 1,198.3, p<.0001). When the list size at registration required clearance time over 1 week patients had 42 percent lower odds of undergoing surgery compared with lists with clearance time less than 1 week (odds ratio [OR] 0.58 percent, 95 percent, confidence interval [CI] 0.53–0.63), after adjustment for age, sex, comorbidity, period, and hospital. The weekly number of new registrations exceeding weekly service capacity had an independent effect toward longer service delays when the list size at registration required clearance time less than 1 week (OR 0.56 percent, 95 percent CI 0.45–0.71), but not for longer lists. Every time the operation was performed for a patient requiring surgery without registration on wait lists, the odds of surgery for listed patients were reduced by 6 percent (OR 0.94, CI 0.93–0.95). Conclusion For wait-listed patients, time to surgery depends on the list size at registration, the number of new registrations, as well as on the weekly number of patients who move immediately from angiography to coronary bypass surgery without being registered on a wait list. Hospital managers may use these findings to improve resource planning and to reduce uncertainty when providing advice on expected treatment delays. PMID:16430599

Can a senior house officer's time be used more effectively?

PubMed

Mitchell, J; Hayhurst, C; Robinson, S M

2004-09-01

To determine the amount of time senior house officers (SHO) spent performing tasks that could be delegated to a technician or administrative assistant and therefore to quantify the expected benefit that could be obtained by employing such physicians' assistants (PA). SHOs working in the emergency department were observed for one week by pre-clinical students who had been trained to code and time each task performed by SHOs. Activity was grouped into four categories (clinical, technical, administrative, and other). Those activities in the technical and administrative categories were those we believed could be performed by a PA. The SHOs worked 430 hours in total, of which only 25 hours were not coded due to lack of an observer. Of the 405 hours observed 86.2% of time was accounted for by the various codes. The process of taking a history and examining patients accounted for an average of 22% of coded time. Writing the patient's notes accounted for an average of 20% of coded time. Discussion with relatives and patients accounted for 4.7% of coded time and performing procedures accounted for 5.2% of coded time. On average across all shifts, 15% of coded time was spent doing either technical or administrative tasks. In this department an average of 15% of coded SHOs working time was spent performing administrative and technical tasks, rising to 17% of coded time during a night shift. This is equivalent to an average time of 78 minutes per 10 hour shift/SHO. Most tasks included in these categories could be performed by PAs thus potentially decreasing patient waiting times, improving risk management, allowing doctors to spend more time with their patients, and possibly improving doctors' training.

Factors associated with psychological distress amongst outpatient chemotherapy patients: An analysis of depression, anxiety and stress using the DASS-21.

PubMed

McMullen, Michelle; Lau, Peter K H; Taylor, Scott; McTigue, Joseph; Cook, Angus; Bamblett, Marion; Hasani, Arman; Johnson, Claire E

2018-04-01

This study sought to identify clinical, demographic and service-related factors associated with psychological distress amongst outpatient chemotherapy patients. Distress in cancer patients leads to increased risk of psychological comorbidity, contributing to sub-optimal treatment adherence and potentially leading to poorer health outcomes. Screening and recognition of distress and risk factors is an important aspect of holistic care within a multidisciplinary team environment. Data were obtained via survey and chart review of ambulatory chemotherapy patients at three public tertiary referral hospitals in Perth, Western Australia. The DASS-21 was used to screen for psychological distress. Regression analyses were used to assess the relationship between distress and a range of cancer, socioeconomic and treatment factors. Patients with a Karnofsky Performance Score≤80 (OR 3.8, 95% CI [1.7, 78.7]) and average waiting time (between oncology outpatient appointment and commencement of chemotherapy infusion) >60min (OR 2.4, 95% CI [1.04, 5.5]) were at increased risk of moderate-severe distress. Patients with a household income between $AU 50-75,000 p.a. had a lower risk of distress compared to <$25,000 p.a. (OR 0.05, 95% CI [0.01, 0.52]). On sub-scale analysis, depression and anxiety contributed more to overall distress than the stress subscales. Performance status, waiting times and household income were key predictors of distress. Findings could assist clinicians to identify higher-risk population subsets that could benefit from targeted screening and additional psychological and social work support. Findings could also assist administrators to consider the contribution of modifiable factors such as waiting times to patient distress. Copyright © 2017 Elsevier Inc. All rights reserved.

Radio pulsar glitches as a state-dependent Poisson process

NASA Astrophysics Data System (ADS)

Fulgenzi, W.; Melatos, A.; Hughes, B. D.

2017-10-01

Gross-Pitaevskii simulations of vortex avalanches in a neutron star superfluid are limited computationally to ≲102 vortices and ≲102 avalanches, making it hard to study the long-term statistics of radio pulsar glitches in realistically sized systems. Here, an idealized, mean-field model of the observed Gross-Pitaevskii dynamics is presented, in which vortex unpinning is approximated as a state-dependent, compound Poisson process in a single random variable, the spatially averaged crust-superfluid lag. Both the lag-dependent Poisson rate and the conditional distribution of avalanche-driven lag decrements are inputs into the model, which is solved numerically (via Monte Carlo simulations) and analytically (via a master equation). The output statistics are controlled by two dimensionless free parameters: α, the glitch rate at a reference lag, multiplied by the critical lag for unpinning, divided by the spin-down rate; and β, the minimum fraction of the lag that can be restored by a glitch. The system evolves naturally to a self-regulated stationary state, whose properties are determined by α/αc(β), where αc(β) ≈ β-1/2 is a transition value. In the regime α ≳ αc(β), one recovers qualitatively the power-law size and exponential waiting-time distributions observed in many radio pulsars and Gross-Pitaevskii simulations. For α ≪ αc(β), the size and waiting-time distributions are both power-law-like, and a correlation emerges between size and waiting time until the next glitch, contrary to what is observed in most pulsars. Comparisons with astrophysical data are restricted by the small sample sizes available at present, with ≤35 events observed per pulsar.

Is physiotherapy self-referral with telephone triage viable, cost-effective and beneficial to musculoskeletal outpatients in a primary care setting?

PubMed

Mallett, Ross; Bakker, Edward; Burton, Maria

2014-12-01

The aim of the present study was to establish if physiotherapy self-referral (SR) is viable, cost effective and beneficial to musculoskeletal outpatients in a primary care setting. In an urban National Health Service (NHS) primary care physiotherapy service, waiting times, attendance rates and treatment ratios (thus, episode-of-care costs) were deemed unsustainable. The introduction of 'Any Qualified Provider' is imminent and will drive NHS physiotherapy services to compete directly with private counterparts. Current literature, healthcare policy and the Chartered Society of Physiotherapy strongly advocate SR to promote value for money and improve the patient experience. A repeated measure prospective cohort study introduced an SR pathway parallel to existing general practice (GP) referrals and compared costs, attendance and data relating to the patient experience across groups. SR referral groups were found to have a higher proportion of female patients presenting with acute conditions. Cost minimization analysis indicated an average 32.3% reduction in episode-of-care cost with an SR-initiated intervention. An estimated cost minimization of between £84,387.80 and £124,472.06 was calculated if SR were to be expanded service-wide. SR referral reduced waiting times and improved patient satisfaction relating to waiting times and communication compared with traditional pathways. The results of the present study showed that the introduction of the described SR pathway was feasible, cost-effective and offered comparable care. Certain aspects of the SR patient experience compared more favourably than those studied in traditional GP referral routes. They also added to an existing body of evidence supporting SR with a variety of administrative processes in various socioeconomic settings. Copyright © 2014 John Wiley & Sons, Ltd.

Association between the Medicare Modernization Act of 2003 and patient wait times and travel distance for chemotherapy.

PubMed

Shea, Alisa M; Curtis, Lesley H; Hammill, Bradley G; DiMartino, Lisa D; Abernethy, Amy P; Schulman, Kevin A

2008-07-09

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) altered reimbursements for outpatient chemotherapy drugs and drug administration services. Anecdotal reports suggest that these adjustments may have negatively affected access to chemotherapy for Medicare beneficiaries. To compare patient wait times and travel distances for chemotherapy before and after the enactment of the MMA. Analysis of a nationally representative 5% sample of claims from the Centers for Medicare & Medicaid Services for the period 2003 through 2006. Patients were Medicare beneficiaries with incident breast cancer, colorectal cancer, leukemia, lung cancer, or lymphoma who received chemotherapy in inpatient hospital, institutional outpatient, or physician office settings. Days from incident diagnosis to first chemotherapy visit and distance traveled for treatment, controlling for age, sex, race/ethnicity, cancer type, geographic region, comorbid conditions, and year of diagnosis and treatment. There were 5082 incident cases of breast cancer, colorectal cancer, leukemia, lung cancer, or lymphoma in 2003; 5379 cases in 2004; 5116 cases in 2005; and 5288 cases in 2006. Approximately 70% of patients received treatment in physician office settings in each year. Although the distribution of treatment settings in 2004 and 2005 was not significantly different from 2003 (P = .24 and P = .72, respectively), there was a small but significant change from 2003 to 2006 (P = .02). The proportion of patients receiving chemotherapy in inpatient settings decreased from 10.2% in 2003 to 8.8% in 2006 (P = .03), and the proportion in institutional outpatient settings increased from 21.1% to 22.5% (P = .004). The proportion in physician offices remained at 68.7% (P = .29). The median time from diagnosis to initial chemotherapy visit was 28 days in 2003, 27 days in 2004, 29 days in 2005, and 28 days in 2006. In multivariate analyses, average wait times for chemotherapy were 1.96 days longer in 2005 than in 2003 (95% confidence interval [CI], 0.11-3.80 days; P = .04) but not significantly different in 2006 (0.88 days; 95% CI, -0.96 to 2.71 days; P = .35). Median travel distance was 7 miles (11.2 km) in 2003 and 8 miles (12.8 km) in 2004 through 2006. After adjustment, average travel distance remained slightly longer in 2004 (1.47 miles [2.35 km]; 95% CI, 0.87-2.07 miles [1.39-3.31 km]; P < .001), 2005 (1.19 miles [1.90 km]; 95% CI, 0.58-1.80 miles [0.93-2.88 km]; P < .001), and 2006 (1.30 miles [2.08 km]; 95% CI, 0.69-1.90 miles [1.10-3.04 km]; P < .001) compared with 2003. There have not been major changes in travel distance and patient wait times for chemotherapy in the Medicare population since 2003, the year before MMA-related changes in reimbursement.

Interventions to reduce waiting times for elective procedures.

PubMed

Ballini, Luciana; Negro, Antonella; Maltoni, Susanna; Vignatelli, Luca; Flodgren, Gerd; Simera, Iveta; Holmes, Jane; Grilli, Roberto

2015-02-23

Long waiting times for elective healthcare procedures may cause distress among patients, may have adverse health consequences and may be perceived as inappropriate delivery and planning of health care. To assess the effectiveness of interventions aimed at reducing waiting times for elective care, both diagnostic and therapeutic. We searched the following electronic databases: Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1946-), EMBASE (1947-), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), ABI Inform, the Canadian Research Index, the Science, Social Sciences and Humanities Citation Indexes, a series of databases via Proquest: Dissertations & Theses (including UK & Ireland), EconLit, PAIS (Public Affairs International), Political Science Collection, Nursing Collection, Sociological Abstracts, Social Services Abstracts and Worldwide Political Science Abstracts. We sought related reviews by searching the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effectiveness (DARE). We searched trial registries, as well as grey literature sites and reference lists of relevant articles. We considered randomised controlled trials (RCTs), controlled before-after studies (CBAs) and interrupted time series (ITS) designs that met EPOC minimum criteria and evaluated the effectiveness of any intervention aimed at reducing waiting times for any type of elective procedure. We considered studies reporting one or more of the following outcomes: number or proportion of participants whose waiting times were above or below a specific time threshold, or participants' mean or median waiting times. Comparators could include any type of active intervention or standard practice. Two review authors independently extracted data from, and assessed risk of bias of, each included study, using a standardised form and the EPOC 'Risk of bias' tool. They classified interventions as follows: interventions aimed at (1) rationing and/or prioritising demand, (2) expanding capacity, or (3) restructuring the intake assessment/referral process.For RCTs when available, we reported preintervention and postintervention values of outcome for intervention and control groups, and we calculated the absolute change from baseline or the effect size with 95% confidence interval (CI). We reanalysed ITS studies that had been inappropriately analysed using segmented time-series regression, and obtained estimates for regression coefficients corresponding to two standardised effect sizes: change in level and change in slope. Eight studies met our inclusion criteria: three RCTs and five ITS studies involving a total of 135 general practices/primary care clinics, seven hospitals and one outpatient clinic. The studies were heterogeneous in terms of types of interventions, elective procedures and clinical conditions; this made meta-analysis unfeasible.One ITS study evaluating prioritisation of demand through a system for streamlining elective surgery services reduced the number of semi-urgent participants waiting longer than the recommended time (< 90 days) by 28 participants/mo, while no effects were found for urgent (< 30 days) versus non-urgent participants (< 365 days).Interventions aimed at restructuring the intake assessment/referral process were evaluated in seven studies. Four studies (two RCTs and two ITSs) evaluated open access, or direct booking/referral: One RCT, which showed that open access to laparoscopic sterilisation reduced waiting times, had very high attrition (87%); the other RCT showed that open access to investigative services reduced waiting times (30%) for participants with lower urinary tract syndrome (LUTS) but had no effect on waiting times for participants with microscopic haematuria. In one ITS study, same-day scheduling for paediatric health clinic appointments reduced waiting times (direct reduction of 25.2 days, and thereafter a decrease of 3.03 days per month), while another ITS study showed no effect of a direct booking system on proportions of participants receiving a colposcopy appointment within the recommended time. One RCT and one ITS showed no effect of distant consultancy (instant photography for dermatological conditions and telemedicine for ear nose throat (ENT) conditions) on waiting times; another ITS study showed no effect of a pooled waiting list on the number of participants waiting for uncomplicated spinal surgery.Overall quality of the evidence for all outcomes, assessed using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) tool, ranged from low to very low.We found no studies evaluating interventions to increase capacity or to ration demand. As only a handful of low-quality studies are presently available, we cannot draw any firm conclusions about the effectiveness of the evaluated interventions in reducing waiting times. However, interventions involving the provision of more accessible services (open access or direct booking/referral) show some promise.

Electron Waiting Times in Mesoscopic Conductors

NASA Astrophysics Data System (ADS)

Albert, Mathias; Haack, Géraldine; Flindt, Christian; Büttiker, Markus

2012-05-01

Electron transport in mesoscopic conductors has traditionally involved investigations of the mean current and the fluctuations of the current. A complementary view on charge transport is provided by the distribution of waiting times between charge carriers, but a proper theoretical framework for coherent electronic systems has so far been lacking. Here we develop a quantum theory of electron waiting times in mesoscopic conductors expressed by a compact determinant formula. We illustrate our methodology by calculating the waiting time distribution for a quantum point contact and find a crossover from Wigner-Dyson statistics at full transmission to Poisson statistics close to pinch-off. Even when the low-frequency transport is noiseless, the electrons are not equally spaced in time due to their inherent wave nature. We discuss the implications for renewal theory in mesoscopic systems and point out several analogies with level spacing statistics and random matrix theory.

Waiting time distribution in public health care: empirics and theory.

PubMed

Dimakou, Sofia; Dimakou, Ourania; Basso, Henrique S

2015-12-01

Excessive waiting times for elective surgery have been a long-standing concern in many national healthcare systems in the OECD. How do the hospital admission patterns that generate waiting lists affect different patients? What are the hospitals characteristics that determine waiting times? By developing a model of healthcare provision and analysing empirically the entire waiting time distribution we attempt to shed some light on those issues. We first build a theoretical model that describes the optimal waiting time distribution for capacity constraint hospitals. Secondly, employing duration analysis, we obtain empirical representations of that distribution across hospitals in the UK from 1997-2005. We observe important differences on the 'scale' and on the 'shape' of admission rates. Scale refers to how quickly patients are treated and shape represents trade-offs across duration-treatment profiles. By fitting the theoretical to the empirical distributions we estimate the main structural parameters of the model and are able to closely identify the main drivers of these empirical differences. We find that the level of resources allocated to elective surgery (budget and physical capacity), which determines how constrained the hospital is, explains differences in scale. Changes in benefits and costs structures of healthcare provision, which relate, respectively, to the desire to prioritise patients by duration and the reduction in costs due to delayed treatment, determine the shape, affecting short and long duration patients differently. JEL Classification I11; I18; H51.

Timed Transfer : An Evaluation of Its Structure, Performance and Cost

DOT National Transportation Integrated Search

1983-08-01

Timed transfer is a transit operating strategy in which vehicles from different routes are routed and scheduled to meet simultaneously at common stops to facilitate no-wait or minimum-wait passenger transfers. Timed transfers are being used primarily...

What Are We Waiting For Customer Wait Time, Fill Rate, And Marine Corps Equipment Operational Availability

DTIC Science & Technology

2016-12-01

managed by an RIP. SECREPs are typically critical repair assemblies that require consistently high fill- rates to satisfy maintenance customers ...fill-rate is potentially misreporting performance and areas where short customer wait times could potentially suffice for inventory management . A...supply. Inventory forecasting and management should focus on parts with CWTs that do not satisfy the maintenance customer and 100% fill-rates should

Adaptive allocation of decisionmaking responsibility between human and computer in multitask situations

NASA Technical Reports Server (NTRS)

Chu, Y.-Y.; Rouse, W. B.

1979-01-01

As human and computer come to have overlapping decisionmaking abilities, a dynamic or adaptive allocation of responsibilities may be the best mode of human-computer interaction. It is suggested that the computer serve as a backup decisionmaker, accepting responsibility when human workload becomes excessive and relinquishing responsibility when workload becomes acceptable. A queueing theory formulation of multitask decisionmaking is used and a threshold policy for turning the computer on/off is proposed. This policy minimizes event-waiting cost subject to human workload constraints. An experiment was conducted with a balanced design of several subject runs within a computer-aided multitask flight management situation with different task demand levels. It was found that computer aiding enhanced subsystem performance as well as subjective ratings. The queueing model appears to be an adequate representation of the multitask decisionmaking situation, and to be capable of predicting system performance in terms of average waiting time and server occupancy. Server occupancy was further found to correlate highly with the subjective effort ratings.

Consumer behaviour in the waiting area.

PubMed

Mobach, Mark P

2007-02-01

To determine consumer behaviour in the pharmacy waiting area. The applied methods for data-collection were direct observations. Three Dutch community pharmacies were selected for the study. The topics in the observation list were based on available services at each waiting area (brochures, books, illuminated new trailer, children's play area, etc.). Per patient each activity was registered, and at each pharmacy the behaviour was studied for 2 weeks. Most patients only waited during the waiting time at the studied pharmacies. Few consumers obtained written information during their wait. The waiting area may have latent possibilities to expand the information function of the pharmacy and combine this with other activities that distract the consumer from the wait. Transdisciplinary research, combining knowledge from pharmacy practice research with consumer research, has been a useful approach to add information on queueing behaviour of consumers.

Crash and Wait? The impact of the Great Recession on Retirement Planning of Older Americans

PubMed Central

McFall, Brooke Helppie

2012-01-01

This study uses data from pre- and post-crash surveys from the Cognitive Economics study to examine the impact of recent stock and labor market wealth losses on the planned retirement ages of older Americans. Regression estimates imply that the average wealth loss between July 2008 and May/June 2009 is associated with an increase in planned retirement age of approximately 2.5 months. Furthermore, pessimism about future stock market returns is found to amplify the impact of wealth losses on retirement timing. PMID:23413315

[Software-based visualization of patient flow at a university eye clinic].

PubMed

Greb, O; Abou Moulig, W; Hufendiek, K; Junker, B; Framme, C

2017-03-01

This article presents a method for visualization and navigation of patient flow in outpatient eye clinics with a high level of complexity. A network-based software solution was developed targeting long-term process optimization by structural analysis and temporal coordination of process navigation. Each examination unit receives a separate waiting list of patients in which the patient flow for every patient is recorded in a timeline. Time periods and points in time can be executed by mouse clicks and the desired diagnostic procedure can be entered. Recent progress in any of these diagnostic requests, as well as a variety of information on patient progress are collated and drawn into the corresponding timeline which can be viewed by any of the personnel involved. The software called TimeElement has been successfully tested in the practical implemenation for several months. As an example the patient flow regarding time stamps of defined events for intravitreous injections on 250 patients was recorded and an average attendance time of 169.71 min was found, whereby the time was also automatically recorded for each individual stage. Recording of patient flow data is a fundamental component of patient flow management, waiting time reduction, patient flow navigation with time and coordination in particular regarding timeline-based visualization for each individual patient. Long-term changes in process management can be planned and evaluated by comparing patient flow data. As using the software itself causes structural changes within the organization, a questionnaire is being planned for appraisal by the personnel involved.

7 CFR 56.46 - On a fee basis.

Code of Federal Regulations, 2011 CFR

2011-01-01

... required to perform the grading, waiting time, travel time, and any clerical costs involved in issuing a... required to perform the audit, waiting time, travel time, travel expenses and any clerical costs involved... services will be based on the time required to perform the services. The hourly charge shall be $74.08...

7 CFR 70.71 - On a fee basis.

Code of Federal Regulations, 2011 CFR

2011-01-01

... required to perform the work, waiting time, travel time, and any clerical costs involved in issuing a... perform the audit, waiting time, travel time, travel expenses and any clerical costs involved in issuing a... specified in this section. (b) Fees for grading services will be based on the time required to perform such...

7 CFR 70.71 - On a fee basis.

Code of Federal Regulations, 2013 CFR

2013-01-01

... required to perform the work, waiting time, travel time, and any clerical costs involved in issuing a... perform the audit, waiting time, travel time, travel expenses and any clerical costs involved in issuing a... specified in this section. (b) Fees for grading services will be based on the time required to perform such...

7 CFR 70.71 - On a fee basis.

Code of Federal Regulations, 2012 CFR

2012-01-01

... required to perform the work, waiting time, travel time, and any clerical costs involved in issuing a... perform the audit, waiting time, travel time, travel expenses and any clerical costs involved in issuing a... specified in this section. (b) Fees for grading services will be based on the time required to perform such...

7 CFR 56.46 - On a fee basis.

Code of Federal Regulations, 2014 CFR

2014-01-01

... required to perform the grading, waiting time, travel time, and any clerical costs involved in issuing a... required to perform the audit, waiting time, travel time, travel expenses and any clerical costs involved... services will be based on the time required to perform the services. The hourly charge shall be $74.08...

7 CFR 56.46 - On a fee basis.

Code of Federal Regulations, 2013 CFR

2013-01-01

... required to perform the grading, waiting time, travel time, and any clerical costs involved in issuing a... required to perform the audit, waiting time, travel time, travel expenses and any clerical costs involved... services will be based on the time required to perform the services. The hourly charge shall be $74.08...

7 CFR 56.46 - On a fee basis.

Code of Federal Regulations, 2012 CFR

2012-01-01

... required to perform the grading, waiting time, travel time, and any clerical costs involved in issuing a... required to perform the audit, waiting time, travel time, travel expenses and any clerical costs involved... services will be based on the time required to perform the services. The hourly charge shall be $74.08...

7 CFR 70.71 - On a fee basis.

Code of Federal Regulations, 2010 CFR

2010-01-01

... required to perform the work, waiting time, travel time, and any clerical costs involved in issuing a... perform the audit, waiting time, travel time, travel expenses and any clerical costs involved in issuing a... specified in this section. (b) Fees for grading services will be based on the time required to perform such...

7 CFR 70.71 - On a fee basis.

Code of Federal Regulations, 2014 CFR

2014-01-01

... required to perform the work, waiting time, travel time, and any clerical costs involved in issuing a... perform the audit, waiting time, travel time, travel expenses and any clerical costs involved in issuing a... specified in this section. (b) Fees for grading services will be based on the time required to perform such...

7 CFR 56.46 - On a fee basis.

Code of Federal Regulations, 2010 CFR

2010-01-01

... required to perform the grading, waiting time, travel time, and any clerical costs involved in issuing a... required to perform the audit, waiting time, travel time, travel expenses and any clerical costs involved... services will be based on the time required to perform the services. The hourly charge shall be $74.08...

Monitoring trends in waiting periods in Canada for elective surgery: validation of a method using administrative data.

PubMed

Shortt, Samuel E D; Shaw, Ralph A; Elliott, David; Mackillop, William J

2004-06-01

Provincial governments require timely, economical methods to monitor surgical waiting periods. Although use of prospective procedure-specific registers would be the ideal method, a less elaborate system has been proposed that is based on physician billing data. This study assessed the validity of using the date of the last service billed prior to surgery as a proxy for the beginning of the post-referral, pre-surgical waiting period. We examined charts for 31,824 elective surgical encounters between 1992 and 1996 at an Ontario teaching hospital. The date of the last service before surgery (the last billing date) was compared with the date of the consultant's letter indicating a decision to book surgery (i.e., to begin waiting). Several surgical specialties (but excluding cardiac, orthopedic and gynecologic) had a close correlation between the dates of the last pre-surgery visit and those of the actual decision to place the patient on the waiting list. Similar results were found for 12 of 15 individually studied procedures, including some orthopedic and gynecological procedures. Used judiciously, billing data is a timely, inexpensive and generally accurate method by which provincial governments could monitor trends in waiting times for appropriately selected surgical procedures.

The Effect of 5S-Continuous Quality Improvement-Total Quality Management Approach on Staff Motivation, Patients’ Waiting Time and Patient Satisfaction with Services at Hospitals in Uganda

PubMed Central

Take, Naoki; Byakika, Sarah; Tasei, Hiroshi; Yoshikawa, Toru

2015-01-01

This study aimed at analyzing the effect of 5S practice on staff motivation, patients’ waiting time and patient satisfaction with health services at hospitals in Uganda. Double-difference estimates were measured for 13 Regional Referral Hospitals and eight General Hospitals implementing 5S practice separately. The study for Regional Referral Hospitals revealed 5S practice had the effect on staff motivation in terms of commitment to work in the current hospital and waiting time in the dispensary in 10 hospitals implementing 5S, but significant difference was not identified on patient satisfaction. The study for General Hospitals indicated the effect of 5S practice on patient satisfaction as well as waiting time, but staff motivation in two hospitals did not improve. 5S practice enables the hospitals to improve the quality of services in terms of staff motivation, waiting time and patient satisfaction and it takes as least four years in Uganda. The fourth year since the commencement of 5S can be a threshold to move forward to the next step, Continuous Quality Improvement. PMID:28299136

The Effect of 5S-Continuous Quality Improvement-Total Quality Management Approach on Staff Motivation, Patients' Waiting Time and Patient Satisfaction with Services at Hospitals in Uganda.

PubMed

Take, Naoki; Byakika, Sarah; Tasei, Hiroshi; Yoshikawa, Toru

2015-03-31

This study aimed at analyzing the effect of 5S practice on staff motivation, patients' waiting time and patient satisfaction with health services at hospitals in Uganda. Double-difference estimates were measured for 13 Regional Referral Hospitals and eight General Hospitals implementing 5S practice separately. The study for Regional Referral Hospitals revealed 5S practice had the effect on staff motivation in terms of commitment to work in the current hospital and waiting time in the dispensary in 10 hospitals implementing 5S, but significant difference was not identified on patient satisfaction. The study for General Hospitals indicated the effect of 5S practice on patient satisfaction as well as waiting time, but staff motivation in two hospitals did not improve. 5S practice enables the hospitals to improve the quality of services in terms of staff motivation, waiting time and patient satisfaction and it takes as least four years in Uganda. The fourth year since the commencement of 5S can be a threshold to move forward to the next step, Continuous Quality Improvement.

Creation of a diagnostic wait times measurement framework based on evidence and consensus.

PubMed

Gilbert, Julie E; Dobrow, Mark J; Kaan, Melissa; Dobranowski, Julian; Srigley, John R; Jusko Friedman, Audrey; Irish, Jonathan C

2014-09-01

Public reporting of wait times worldwide has to date focused largely on treatment wait times and is limited in its ability to capture earlier parts of the patient journey. The interval between suspicion and diagnosis or ruling out of cancer is a complex phase of the cancer journey. Diagnostic delays and inefficient use of diagnostic imaging procedures can result in poor patient outcomes, both physical and psychosocial. This study was designed to develop a framework that could be adopted for multiple disease sites across different jurisdictions to enable the measurement of diagnostic wait times and diagnostic delay. Diagnostic benchmarks and targets in cancer systems were explored through a targeted literature review and jurisdictional scan. Cancer system leaders and clinicians were interviewed to validate the information found in the jurisdictional scan. An expert panel was assembled to review and, through a modified Delphi consensus process, provide feedback on a diagnostic wait times framework. The consensus process resulted in agreement on a measurement framework that identified suspicion, referral, diagnosis, and treatment as the main time points for measuring this critical phase of the patient journey. This work will help guide initiatives designed to improve patient access to health services by developing an evidence-based approach to standardization of the various waypoints during the diagnostic pathway. The diagnostic wait times measurement framework provides a yardstick to measure the performance of programs that are designed to manage and expedite care processes between referral and diagnosis or ruling out of cancer. Copyright © 2014 by American Society of Clinical Oncology.

Treating the right patient at the right time: Access to specialist consultation and noninvasive testing

PubMed Central

Knudtson, Merril L; Beanlands, Rob; Brophy, James M; Higginson, Lyall; Munt, Brad; Rottger, John

2006-01-01

The Council of the Canadian Cardiovascular Society commissioned working groups to examine issues of access to, and wait times for, various aspects of cardiovascular care. The present article summarizes the deliberations on targets for medically acceptable wait times for access to cardiovascular specialist evaluation and on the performance of non-invasive testing needed to complete this evaluation. Three categories of referral indications were identified: those requiring hospitalization due to substantial ongoing risk of mortality and morbidity; those requiring an expedited early review in an ambulatory setting; and, finally, a larger category in which delays of two to six weeks can be justified. The proposed wait time targets will provide guidance on the timeliness of care to busy clinicians charged with the care of patients with cardiovascular disease, help policy makers appreciate the clinical challenges in providing access to high quality care, and highlight the critical need for a thoughtful review of cardiology human resource requirements. Wait time implementation suggestions are also included, such as the innovative use of disease management and special need clinics. The times proposed assume that available clinical practice guidelines are followed for clinical coronary syndrome management and for treatment of associated conditions such as hypertension, diabetes, renal disease, smoking cessation and lipid disorders. Although media attention tends to focus on wait times for higher profile surgical procedures and high technology imaging, it is likely that patients face the greatest wait-related risk at the earlier phases of care, before the disease has been adequately characterized. PMID:16957798

Geographic determinants of access to pediatric deceased donor kidney transplantation.

PubMed

Reese, Peter P; Hwang, Hojun; Potluri, Vishnu; Abt, Peter L; Shults, Justine; Amaral, Sandra

2014-04-01

Children receive priority in the allocation of deceased donor kidneys for transplantation in the United States, but because allocation begins locally, geographic differences in population and organ supply may enable variation in pediatric access to transplantation. We assembled a cohort of 3764 individual listings for pediatric kidney transplantation in 2005-2010. For each donor service area, we assigned a category of short (<180 days), medium (181-270 days), or long (>270 days) median waiting time and calculated the ratio of pediatric-quality kidneys to pediatric candidates and the percentage of these kidneys locally diverted to adults. We used multivariable Cox regression analyses to examine the association between donor service area characteristics and time to deceased donor kidney transplantation. The Kaplan-Meier estimate of median waiting time to transplantation was 284 days (95% confidence interval, 263 to 300 days) and varied from 14 to 1313 days across donor service areas. Overall, 29% of pediatric-quality kidneys were locally diverted to adults. Compared with areas with short waiting times, areas with long waiting times had a lower ratio of pediatric-quality kidneys to candidates (3.1 versus 5.9; P<0.001) and more diversions to adults (31% versus 27%; P<0.001). In multivariable regression, a lower kidney to candidate ratio remained associated with longer waiting time (hazard ratio, 0.56 for areas with <2:1 versus reference areas with ≥5:1 kidneys/candidates; P<0.01). Large geographic variation in waiting time for pediatric deceased donor kidney transplantation exists and is highly associated with local supply and demand factors. Future organ allocation policy should address this geographic inequity.

Evaluation of a New Equation for Calculating the Maximum Wait Time for Pilots That Have Used an Impairing Medication

DTIC Science & Technology

2013-08-01

were treating pre-existing medical conditions using over-the-counter (OTC) medications ( Aspirin ™, Tylenol™, antihistamines, etc.), provided blood...time would decrease to 45 hours for a 150-lb person taking the same dose; a 300 -lb individual taking a 25-mg dose would only need to wait 31 hours...If the 300 -lb person mentioned above had taken a 50- mg dose, the wait time would have been 45 hours, which is approximately the same as the 49

Access to specialist gastroenterology care in Canada: Comparison of wait times and consensus targets

PubMed Central

Leddin, Desmond; Armstrong, David; Barkun, Alan NG; Chen, Ying; Daniels, Sandra; Hollingworth, Roger; Hunt, Richard H; Paterson, William G

2008-01-01

BACKGROUND: Monitoring wait times and defining targets for care have been advocated to improve health care delivery related to cancer, heart, diagnostic imaging, joint replacements and sight restoration. There are few data on access to care for digestive diseases, although they pose a greater economic burden than cancer or heart disease in Canada. The present study compared wait times for specialist gastroenterology care with recent, evidence-based, consensus-defined benchmark wait times for a range of digestive diseases. METHODS: Total wait times from primary care referral to investigation were measured for seven digestive disease indications by using the Practice Audit in Gastroenterology program, and were benchmarked against consensus recommendations. RESULTS: Total wait times for 1903 patients who were undergoing investigation exceeded targets for those with probable cancer (median 26 days [25th to 75th percentiles eight to 56 days] versus target of two weeks); probable inflammatory bowel disease (101 days [35 to 209 days] versus two weeks); documented iron deficiency anemia (71 days [19 to 142 days] versus two months); positive fecal occult blood test (73 days [36 to 148 days] versus two months); dyspepsia with alarm symptoms (60 days [23 to 140 days] versus two months); refractory dyspepsia without alarm symptoms (126 days [42 to 225 days] versus two months); and chronic constipation and diarrhea (141 days [68 to 264 days] versus two months). A minority of patients were seen within target times: probable cancer (33% [95% CI 20% to 47%]); probable inflammatory bowel disease (12% [95% CI 1% to 23%]); iron deficiency anemia (46% [95% CI 37% to 55%]); positive occult blood test (41% [95% CI 28% to 54%]); dyspepsia with alarm symptoms (51% [95% CI 41% to 60%]); refractory dyspepsia without alarm symptoms (33% [95% CI 19% to 47%]); and chronic constipation and diarrhea (21% [95% CI 14% to 29%]). DISCUSSION: Total wait times for the seven indications exceeded the consensus targets; 51% to 88% of patients were not seen within the target wait time. Multiple interventions, including adoption of evidence-based management guidelines and provision of economic and human resources, are needed to ensure appropriate access to digestive health care in Canada. Outcomes can be evaluated by the ‘point-of-care’, practice audit methodology used for the present study. PMID:18299735

Effect of Lean Processes on Surgical Wait Times and Efficiency in a Tertiary Care Veterans Affairs Medical Center.

PubMed

Valsangkar, Nakul P; Eppstein, Andrew C; Lawson, Rick A; Taylor, Amber N

2017-01-01

There are an increasing number of veterans in the United States, and the current delay and wait times prevent Veterans Affairs institutions from fully meeting the needs of current and former service members. Concrete strategies to improve throughput at these facilities have been sparse. To identify whether lean processes can be used to improve wait times for surgical procedures in Veterans Affairs hospitals. Databases in the Veterans Integrated Service Network 11 Data Warehouse, Veterans Health Administration Support Service Center, and Veterans Information Systems and Technology Architecture/Dynamic Host Configuration Protocol were queried to assess changes in wait times for elective general surgical procedures and clinical volume before, during, and after implementation of lean processes over 3 fiscal years (FYs) at a tertiary care Veterans Affairs medical center. All patients evaluated by the general surgery department through outpatient clinics, clinical video teleconferencing, and e-consultations from October 2011 through September 2014 were included. Patients evaluated through the emergency department or as inpatient consults were excluded. The surgery service and systems redesign service held a value stream analysis in FY 2013, culminating in multiple rapid process improvement workshops. Multidisciplinary teams identified systemic inefficiencies and strategies to improve interdepartmental and patient communication to reduce canceled consultations and cases, diagnostic rework, and no-shows. High-priority triage with enhanced operating room flexibility was instituted to reduce scheduling wait times. General surgery department pilot projects were then implemented mid-FY 2013. Planned outcome measures included wait time, clinic and telehealth volume, number of no-shows, and operative volume. Paired t tests were used to identify differences in outcome measures after the institution of reforms. Following rapid process improvement workshop project rollouts, mean (SD) patient wait times for elective general surgical procedures decreased from 33.4 (8.3) days in FY 2012 to 26.0 (9.5) days in FY 2013 (P = .02). In FY 2014, mean (SD) wait times were half the value of the previous FY at 12.0 (2.1) days (P = .07). This was a 3-fold decrease from wait times in FY 2012 (P = .02). Operative volume increased from 931 patients in FY 2012 to 1090 in FY 2013 and 1072 in FY 2014. Combined clinic, telehealth, and e-consultation encounters increased from 3131 in FY 2012 to 3460 in FY 2013 and 3517 in FY 2014, while the number of no-shows decreased from 366 in FY 2012 to 227 in FY 2014 (P = .02). Improvement in the overall surgical patient experience can stem from multidisciplinary collaboration among systems redesign personnel, clinicians, and surgical staff to reduce systemic inefficiencies. Monitoring and follow-up of system efficiency measures and the employment of lean practices and process improvements can have positive short- and long-term effects on wait times, clinical throughput, and patient care and satisfaction.

Wait times in the emergency department for patients with mental illness

PubMed Central

Atzema, Clare L.; Schull, Michael J.; Kurdyak, Paul; Menezes, Natasja M.; Wilton, Andrew S.; Vermuelen, Marian J.; Austin, Peter C.

2012-01-01

Background: It has been suggested that patients with mental illness wait longer for care than other patients in the emergency department. We determined wait times for patients with and without mental health diagnoses during crowded and noncrowded periods in the emergency department. Methods: We conducted a population-based retrospective cohort analysis of adults seen in 155 emergency departments in Ontario between April 2007 and March 2009. We compared wait times and triage scores for patients with mental illness to those for all other patients who presented to the emergency department during the study period. Results: The patients with mental illness (n = 51 381) received higher priority triage scores than other patients, regardless of crowding. The time to assessment by a physician was longer overall for patients with mental illness than for other patients (median 82, interquartile range [IQR] 41–147 min v. median 75 [IQR 36–140] min; p < 0.001). The median time from the decision to admit the patient to hospital to ward transfer was markedly shorter for patients with mental illness than for other patients (median 74 [IQR 15–215] min v. median 152 [IQR 45–605] min; p < 0.001). After adjustment for other variables, patients with mental illness waited 10 minutes longer to see a physician compared with other patients during noncrowded periods (95% confidence interval [CI] 8 to 11), but they waited significantly less time than other patients as crowding increased (mild crowding: −14 [95% CI −12 to −15] min; moderate crowding: −38 [95% CI −35 to −42] min; severe crowding: −48 [95% CI −39 to −56] min; p < 0.001). Interpretation: Patients with mental illness were triaged appropriately in Ontario’s emergency departments. These patients waited less time than other patients to see a physician under crowded conditions and only slightly longer under noncrowded conditions. PMID:23148052

Practical solutions for reducing container ships' waiting times at ports using simulation model

NASA Astrophysics Data System (ADS)

Sheikholeslami, Abdorreza; Ilati, Gholamreza; Yeganeh, Yones Eftekhari

2013-12-01

The main challenge for container ports is the planning required for berthing container ships while docked in port. Growth of containerization is creating problems for ports and container terminals as they reach their capacity limits of various resources which increasingly leads to traffic and port congestion. Good planning and management of container terminal operations reduces waiting time for liner ships. Reducing the waiting time improves the terminal's productivity and decreases the port difficulties. Two important keys to reducing waiting time with berth allocation are determining suitable access channel depths and increasing the number of berths which in this paper are studied and analyzed as practical solutions. Simulation based analysis is the only way to understand how various resources interact with each other and how they are affected in the berthing time of ships. We used the Enterprise Dynamics software to produce simulation models due to the complexity and nature of the problems. We further present case study for berth allocation simulation of the biggest container terminal in Iran and the optimum access channel depth and the number of berths are obtained from simulation results. The results show a significant reduction in the waiting time for container ships and can be useful for major functions in operations and development of container ship terminals.

Time interval between endometrial biopsy and surgical staging for type I endometrial cancer: association between tumor characteristics and survival outcome.

PubMed

Matsuo, Koji; Opper, Neisha R; Ciccone, Marcia A; Garcia, Jocelyn; Tierney, Katherine E; Baba, Tsukasa; Muderspach, Laila I; Roman, Lynda D

2015-02-01

To examine whether wait time between endometrial biopsy and surgical staging correlates with tumor characteristics and affects survival outcomes in patients with type I endometrial cancer. A retrospective study was conducted to examine patients with grade 1 and 2 endometrioid adenocarcinoma diagnosed by preoperative endometrial biopsy who subsequently underwent hysterectomy-based surgical staging between 2000 and 2013. Patients who received neoadjuvant chemotherapy or hormonal treatment were excluded. Time interval and grade change between endometrial biopsy and hysterectomy were correlated to demographics and survival outcomes. Median wait time was 57 days (range 1-177 days) among 435 patients. Upgrading of the tumor to grade 3 in the hysterectomy specimen was seen in 4.7% of 321 tumors classified as grade 1 and 18.4% of 114 tumors classified as grade 2 on the endometrial biopsy, respectively. Wait time was not associated with grade change (P>.05). Controlling for age, ethnicity, body habitus, medical comorbidities, CA 125 level, and stage, multivariable analysis revealed that wait time was not associated with survival outcomes (5-year overall survival rates, wait time 1-14, 15-42, 43-84, and 85 days or more; 62.5%, 93.6%, 95.2%, and 100%, respectively, P>.05); however, grade 1 to 3 on the hysterectomy specimen remained as an independent prognosticator associated with decreased survival (5-year overall survival rates, grade 1 to 3 compared with grade change 1 to 1, 82.1% compared with 98.5%, P=.01). Among grade 1 preoperative biopsies, grade 1 to 3 was significantly associated with nonobesity (P=.039) and advanced stage (P=.019). Wait time for surgical staging was not associated with decreased survival outcome in patients with type I endometrial cancer.

Performance Contracting and Quality Improvement in Outpatient Treatment: Effects on Waiting Time and Length of Stay

PubMed Central

Stewart, Maureen T.; Horgan, Constance M.; Garnick, Deborah W.; Ritter, Grant; McLellan, A. Thomas

2012-01-01

We evaluate effects of a performance contract (PC) implemented in Delaware in 2001 and participation in quality improvement (QI) programs on waiting time for treatment and length of stay (LOS) using client treatment episode level data from Delaware (n = 12,368) and Maryland (n = 147,151) for 1998 – 2006. Results of difference-in-difference analyses indicate waiting time declined 13 days following the PC, after controlling for client characteristics and historical trends. Participation in the PC and a formal QI program was associated with a decrease of 20 days. LOS increased 22 days under the PC and 24 days under the PC and QI programs, after controlling for client characteristics. The PC and QI program were associated with improvements in LOS and waiting time, although we cannot determine which aspects of the programs (incentives, training, monitoring) resulted in these changes. PMID:22445031

Concordance between partners in desired waiting time to birth for newlyweds in India

PubMed Central

Singh, Abhishek; Becker, Stan

2014-01-01

Examining waiting time to birth among newlywed couples is likely to provide insights into the desire for spacing births among newlywed husbands and wives. Data from the Indian National Family Health Survey of 2005-06 is used to examine the desired waiting time (DWT) to birth among newlywed couples. The dependent variable is spousal concordance on desired times. Overall 65 % of couples have concordant DWTs. Among discordant couples, wives were more likely to want to wait longer than their husbands. Couples from richer wealth quintiles were more likely than couples from poorest quintile to have a concordant DWTs. Muslims were less likely than Hindus to have concordant desires. There is a need for spacing methods among newlyweds. This may have implications for the Indian Family Planning Programme which to date has largely focused on sterilization. Programmes need to include newlywed husbands to promote use of spacing methods. PMID:21933466

Public health care and private insurance demand: the waiting time as a link.

PubMed

Jofre-Bonet, M

2000-01-01

This paper analyzes the effect of waiting times in the Spanish public health system on the demand for private health insurance. Expected utility maximization determines whether or not individuals buy a private health insurance. The decision depends not only on consumer's covariates such as income, socio-demographic characteristics and health status, but also on the quality of the treatment by the public provider. We interpret waiting time as a qualitative attribute of the health care provision. The empirical analysis uses the Spanish Health Survey of 1993. We cope with the absence of income data by using the Spanish Family Budget Survey of 1990-91 as a complementary data set, following the Arellano-Meghir method [4]. Results indicate that a reduction in the waiting time lowers the probability of buying private health insurance. This suggests the existence of a crowd-out in the health care provision market.

Addition of long-distance heart procurement promotes changes in heart transplant waiting list status.

PubMed

Atik, Fernando Antibas; Couto, Carolina Fatima; Tirado, Freddy Ponce; Moraes, Camila Scatolin; Chaves, Renato Bueno; Vieira, Nubia W; Reis, João Gabbardo

2014-01-01

Evaluate the addition of long-distance heart procurement on a heart transplant program and the status of heart transplant recipients waiting list. Between September 2006 and October 2012, 72 patients were listed as heart transplant recipients. Heart transplant was performed in 41 (57%), death on the waiting list occurred in 26 (36%) and heart recovery occurred in 5 (7%). Initially, all transplants were performed with local donors. Long-distance, interstate heart procurement initiated in February 2011. Thirty (73%) transplants were performed with local donors and 11 (27%) with long-distance donors (mean distance=792 km±397). Patients submitted to interstate heart procurement had greater ischemic times (212 min ± 32 versus 90 min±18; P<0.0001). Primary graft dysfunction (distance 9.1% versus local 26.7%; P=0.23) and 1 month and 12 months actuarial survival (distance 90.1% and 90.1% versus local 90% and 86.2%; P=0.65 log rank) were similar among groups. There were marked incremental transplant center volume (64.4% versus 40.7%, P=0.05) with a tendency on less waiting list times (median 1.5 month versus 2.4 months, P=0.18). There was a tendency on reduced waiting list mortality (28.9% versus 48.2%, P=0.09). Incorporation of long-distance heart procurement, despite being associated with longer ischemic times, does not increase morbidity and mortality rates after heart transplant. It enhances viable donor pool, and it may reduce waiting list recipient mortality as well as waiting time.

Non-Poissonian Distribution of Tsunami Waiting Times

NASA Astrophysics Data System (ADS)

Geist, E. L.; Parsons, T.

2007-12-01

Analysis of the global tsunami catalog indicates that tsunami waiting times deviate from an exponential distribution one would expect from a Poisson process. Empirical density distributions of tsunami waiting times were determined using both global tsunami origin times and tsunami arrival times at a particular site with a sufficient catalog: Hilo, Hawai'i. Most sources for the tsunamis in the catalog are earthquakes; other sources include landslides and volcanogenic processes. Both datasets indicate an over-abundance of short waiting times in comparison to an exponential distribution. Two types of probability models are investigated to explain this observation. Model (1) is a universal scaling law that describes long-term clustering of sources with a gamma distribution. The shape parameter (γ) for the global tsunami distribution is similar to that of the global earthquake catalog γ=0.63-0.67 [Corral, 2004]. For the Hilo catalog, γ is slightly greater (0.75-0.82) and closer to an exponential distribution. This is explained by the fact that tsunamis from smaller triggered earthquakes or landslides are less likely to be recorded at a far-field station such as Hilo in comparison to the global catalog, which includes a greater proportion of local tsunamis. Model (2) is based on two distributions derived from Omori's law for the temporal decay of triggered sources (aftershocks). The first is the ETAS distribution derived by Saichev and Sornette [2007], which is shown to fit the distribution of observed tsunami waiting times. The second is a simpler two-parameter distribution that is the exponential distribution augmented by a linear decay in aftershocks multiplied by a time constant Ta. Examination of the sources associated with short tsunami waiting times indicate that triggered events include both earthquake and landslide tsunamis that begin in the vicinity of the primary source. Triggered seismogenic tsunamis do not necessarily originate from the same fault zone, however. For example, subduction-thrust and outer-rise earthquake pairs are evident, such as the November 2006 and January 2007 Kuril Islands tsunamigenic pair. Because of variations in tsunami source parameters, such as water depth above the source, triggered tsunami events with short waiting times are not systematically smaller than the primary tsunami.

Interior effects on comfort in healthcare waiting areas.

PubMed

Bazley, C; Vink, P; Montgomery, J; Hedge, A

2016-07-21

This study compared the effects of pre-experience and expectations on participant comfort upon waking, arrival to, and after an appointment, as well as the assessment of properly placed Feng Shui elements in three healthcare waiting rooms. Participants assessed comfort levels using self-report surveys. The researcher conducted 'intention interviews' with each doctor to assess the goals of each waiting area design, and conducted a Feng Shui assessment of each waiting area for properly placed Feng Shui elements. The waiting area designed by the Feng Shui expert rated 'most comfortable', followed by the waiting area design by a doctor, and the lowest comfort rating for the conventional waiting room design. Results show a sufficiently strong effect to warrant further research. Awareness of the external environment, paired with pre-experience and expectation, influences comfort for people over time. Fostering and encouraging a holistic approach to comfort utilizing eastern and western concepts and ergonomic principles creates a sense of "placeness" and balance in the design for comfort in built environments. This is new research information on the influences of the comfort experience over time, to include pre-experience, expectations and the placement of elements in the external environment.

Email triage is an effective, efficient and safe way of managing new referrals to a neurologist.

PubMed

Patterson, Victor; Humphreys, Jenny; Henderson, Mark; Crealey, Grainne

2010-10-01

Patients referred to secondary care in the UK often wait many months to be seen, and the UK government has announced various initiatives to address this issue. Since 2002, we have developed an email referral system which allows some neurological referrals to be managed by advice and investigations rather than by a conventional hospital clinic appointment. This system has previously been shown to reduce clinic attendances and to be acceptable to patients and their general practitioners (GPs). To analyse the effects of an email triage system on waiting times, cost of care and safety over 5 years. Referral numbers and waiting times for clinics using this system were analysed. Cost was determined by comparing detailed costs with those of conventional care. Safety was analysed by examining the GP records of all patients referred from a single practice who had been dealt with by advice or investigation, noting deaths, re-referrals and changes in diagnosis. Waiting times fell from 72 to 4 weeks, despite an increase in referrals. The cost per patient of email referral was about £100, compared with £152 for conventional care, a 35% reduction. Safety data on 120 individuals showed a minor change in diagnosis in three. This system is safe, effective (in reducing waiting times) and efficient. It enables neurologists to focus on patients with significant neurological disease and, if applied more widely, could reduce costs and waiting times for neurology services in the UK.

Waiting Online: A Review and Research Agenda.

ERIC Educational Resources Information Center

Ryan, Gerard; Valverde, Mireia

2003-01-01

Reviews 21 papers based on 13 separate empirical studies on waiting on the Internet, drawn from the areas of marketing, system response time, and quality of service studies. The article proposes an agenda for future research, including extending the range of research methodologies, broadening the definition of waiting on the Internet, and…

Improving patient experience in a pediatric ambulatory clinic: a mixed method appraisal of service delivery.

PubMed

Soeteman, Marijn; Peters, Vera; Busari, Jamiu O

2015-01-01

In 2013, customer satisfaction surveys showed that patients were unhappy with the services provided at our ambulatory clinic. In response, we performed an appraisal of our services, which resulted in the development of a strategy to reduce waiting time and improve quality of service. Infrastructural changes to our clinic's waiting room, consultation rooms, and back offices were performed, and schedules were redesigned to reduce wait time to 10 minutes and increase consultation time to 20 minutes. Our objective was to identify if this would improve 1) accessibility to caregivers and 2) quality of service and available amenities. We conducted a multi-method survey using 1) a patient flow analysis to analyze the flow of service and understand the impact of our interventions on patient flow and 2) specially designed questionnaires to investigate patients' perceptions of our wait time and how to improve our services. The results showed that 79% of our respondents were called in to see a doctor within 20 minutes upon arrival. More patients (55%) felt that 10-20 minutes was an acceptable wait time. We also observed a perceived increase in satisfaction with wait time (94%). Finally, a large number of patients (97%) were satisfied with the quality of service and with the accessibility to caregivers (94%). The majority of our patients were satisfied with the accessibility to our ambulatory clinics and with the quality of services provided. The appraisal of our operational processes using a patient flow analysis also demonstrated how this strategy could effectively be applied to investigate and improve quality of service in patients.

Care Situation for Female Victims of Sexual Violence in Metropolitan Emergency Departments with Charité/Berlin as an Example

PubMed Central

Hoffmann-Walbeck, H.; Möckel, M.; Etzold, S.; David, M.

2016-01-01

of the perpetrators were friends or relations; 17 % were (ex-)partners. The waiting time in the Charité emergency departments amounted to 58 minutes on average, the medical treatment time 55 minutes. About 80 % of the personnel evaluated the “stuprum kit” as being altogether good or very good. More than ⅓ considered the time and room conditions as being unsuitable or rather unsuitable for the situation. Two thirds expressed the desire for further training and supervision. Conclusion: The structured procedure by means of the “stuprum kit” has proved its value. A need for optimisation was seen especially for the examination facilities in the emergency departments. PMID:27904168

Wait Time for Treatment in Hospital Emergency Departments: 2009

MedlinePlus

... on Vital and Health Statistics Annual Reports Health Survey Research Methods Conference Reports from the National Medical Care ... SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care ... with previous research, longer wait time for treatment was associated with ...

Make Each Five Minutes Count

ERIC Educational Resources Information Center

Hunter, Madeline

1973-01-01

Every day contains those unavoidable waiting periods, but they need not be unproductive. You can convert waiting time to learning with the help of sponge activities---learning activities which "sop up" those precious droplets of time that would otherwise be lost. (Author)

The Influence of Prior Choices on Current Choice

PubMed Central

de la Piedad, Xochitl; Field, Douglas; Rachlin, Howard

2006-01-01

Three pigeons chose between random-interval (RI) and tandem, continuous-reinforcement, fixed-interval (crf-FI) reinforcement schedules by pecking either of two keys. As long as a pigeon pecked on the RI key, both keys remained available. If a pigeon pecked on the crf-FI key, then the RI key became unavailable and the crf-FI timer began to time out. With this procedure, once the RI key was initially pecked, the prospective value of both alternatives remained constant regardless of time spent pecking on the RI key without reinforcement (RI waiting time). Despite this constancy, the rate at which pigeons switched from the RI to the crf-FI decreased sharply as RI waiting time increased. That is, prior choices influenced current choice—an exercise effect. It is argued that such influence (independent of reinforcement contingencies) may serve as a sunk-cost commitment device in self-control situations. In a second experiment, extinction was programmed if RI waiting time exceeded a certain value. Rate of switching to the crf-FI first decreased and then increased as the extinction point approached, showing sensitivity to both prior choices and reinforcement contingencies. In a third experiment, crf-FI availability was limited to a brief window during the RI waiting time. When constrained in this way, switching occurred at a high rate regardless of when, during the RI waiting time, the crf-FI became available. PMID:16602373

A model of return intervals between earthquake events

NASA Astrophysics Data System (ADS)

Zhou, Yu; Chechkin, Aleksei; Sokolov, Igor M.; Kantz, Holger

2016-06-01

Application of the diffusion entropy analysis and the standard deviation analysis to the time sequence of the southern California earthquake events from 1976 to 2002 uncovered scaling behavior typical for anomalous diffusion. However, the origin of such behavior is still under debate. Some studies attribute the scaling behavior to the correlations in the return intervals, or waiting times, between aftershocks or mainshocks. To elucidate a nature of the scaling, we applied specific reshulffling techniques to eliminate correlations between different types of events and then examined how it affects the scaling behavior. We demonstrate that the origin of the scaling behavior observed is the interplay between mainshock waiting time distribution and the structure of clusters of aftershocks, but not correlations in waiting times between the mainshocks and aftershocks themselves. Our findings are corroborated by numerical simulations of a simple model showing a very similar behavior. The mainshocks are modeled by a renewal process with a power-law waiting time distribution between events, and aftershocks follow a nonhomogeneous Poisson process with the rate governed by Omori's law.

Impact of the single point of access referral system to reduce waiting times and improve clinical outcomes in an assistive technology service.

PubMed

Hosking, Jonathan; Gibson, Colin

2016-07-01

The introduction of a single point referral system that prioritises clients depending on case complexity and overcomes the need for re-admittance to a waiting list via a review system has been shown to significantly reduce maximum waiting times for a Posture and Mobility (Special Seating) Service from 102.0 ± 24.33 weeks to 19.2 ± 8.57 weeks (p = 0.015). Using this service model linear regression revealed a statistically significant improvement in the performance outcome of prescribed seating solutions with shorter Episode of Care completion times (p = 0.023). In addition, the number of Episodes of Care completed per annum was significantly related to the Episode of Care completion time (p = 0.019). In conclusion, it is recommended that it may be advantageous to apply this service model to other assistive technology services in order to reduce waiting times and to improve clinical outcomes.

Determining delayed admission to intensive care unit for mechanically ventilated patients in the emergency department.

PubMed

Hung, Shih-Chiang; Kung, Chia-Te; Hung, Chih-Wei; Liu, Ber-Ming; Liu, Jien-Wei; Chew, Ghee; Chuang, Hung-Yi; Lee, Wen-Huei; Lee, Tzu-Chi

2014-08-23

The adverse effects of delayed admission to the intensive care unit (ICU) have been recognized in previous studies. However, the definitions of delayed admission varies across studies. This study proposed a model to define "delayed admission", and explored the effect of ICU-waiting time on patients' outcome. This retrospective cohort study included non-traumatic adult patients on mechanical ventilation in the emergency department (ED), from July 2009 to June 2010. The primary outcomes measures were 21-ventilator-day mortality and prolonged hospital stays (over 30 days). Models of Cox regression and logistic regression were used for multivariate analysis. The non-delayed ICU-waiting was defined as a period in which the time effect on mortality was not statistically significant in a Cox regression model. To identify a suitable cut-off point between "delayed" and "non-delayed", subsets from the overall data were made based on ICU-waiting time and the hazard ratio of ICU-waiting hour in each subset was iteratively calculated. The cut-off time was then used to evaluate the impact of delayed ICU admission on mortality and prolonged length of hospital stay. The final analysis included 1,242 patients. The time effect on mortality emerged after 4 hours, thus we deduced ICU-waiting time in ED > 4 hours as delayed. By logistic regression analysis, delayed ICU admission affected the outcomes of 21 ventilator-days mortality and prolonged hospital stay, with odds ratio of 1.41 (95% confidence interval, 1.05 to 1.89) and 1.56 (95% confidence interval, 1.07 to 2.27) respectively. For patients on mechanical ventilation at the ED, delayed ICU admission is associated with higher probability of mortality and additional resource expenditure. A benchmark waiting time of no more than 4 hours for ICU admission is recommended.

Access to Care for Youth in a State Mental Health System: A Simulated Patient Approach.

PubMed

Olin, Su-Chin Serene; O'Connor, Briannon C; Storfer-Isser, Amy; Clark, Lisa J; Perkins, Matthew; Hudson Scholle, Sarah; Whitmyre, Emma D; Hoagwood, Kimberly; Horwitz, Sarah McCue

2016-05-01

To examine access to psychiatric care for adolescents with depression in outpatient specialty clinics within a state mental health system, using a simulated patient approach. Trained callers posed as the mother of a 14-year-old girl with depression, following a script. A stratified random sample (n = 264) of 340 state-licensed outpatient mental health clinics that serve youth was selected. Clinics were randomly assigned to season and insurance condition. We examined whether access varied by season, clinic characteristics, and caller insurance type. Weighted logistic and linear mixed effects regression models were fitted to examine associations with appointment availability and wait times. Among clinics at which a treatment appointment could be scheduled, appointment availability differed by season. Clinics that had participated in state-sponsored trainings targeting access were more available. Wait times for treatment appointments varied by season and region. Wait times in New York City were shorter than in some other regions. Although callers were 4.1 times more likely to be able to schedule a psychiatry appointment in the spring, wait times for psychiatry appointments were significantly longer in the spring than in the summer (49.9 vs. 36.7 days). Wait times for therapy appointments were significantly shorter in community than in hospital clinics (19.1 days vs. 35.3 days). Access to psychiatric care for youth with depression was found to be variable in a state system. State-sponsored trainings on strategies to reduce wait times appear to improve care access. The simulated patient approach has promise for monitoring the impact of health care policy reforms on care quality measures. Published by Elsevier Inc.

Access to Care for Youth in a State Mental Health System: A Simulated Patient Approach

PubMed Central

Olin, Su-chin Serene; O'Connor, Briannon C.; Storfer-Isser, Amy; Clark, Lisa J.; Perkins, Matthew; Scholle, Sarah Hudson; Whitmyre, Emma D.; Hoagwood, Kimberly; Horwitz, Sarah McCue

2016-01-01

Objective To examine access to psychiatric care for adolescents with depression in outpatient specialty clinics within a state mental health system, using a simulated patient approach. Method Trained callers posed as the mother of a 14-year-old female with depression, following a script. A stratified random sample (n = 264) of 340 state-licensed outpatient mental health clinics that serve youth was selected. Clinics were randomly assigned to season and insurance condition. We examined if access varied by season, clinic characteristics, and caller insurance type. Weighted logistic and linear mixed effects regression models were fitted to examine associations with appointment availability and wait times. Results Among clinics where a treatment appointment could be scheduled, appointment availability differed by season. Clinics who had participated in state-sponsored trainings targeting access were more available. Wait times for treatment appointments varied by season and region. Wait times in New York City were shorter than in some other regions. Although callers were 4.1 times more likely to be able to schedule a psychiatry appointment in the spring, wait times for psychiatry appointments were significantly longer in the spring than in the summer (49.9 vs. 36.7 days). Wait times for therapy appointments were significantly shorter in community than hospital clinics (19.1 days vs. 35.3 days). Conclusion Access to psychiatric care for youth with depression was found to be variable in a state system. State-sponsored trainings on strategies to reduce wait times appear to improve care access. The simulated patient approach has promise for monitoring the impact of healthcare policy reforms on care quality measures. PMID:27126853

Poster - 26: Electronic Waiting Room Management for a busy Cancer Centre

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kildea, John; Hijal, Tarek

We describe an electronic waiting room management system that we have developed and deployed in our cancer centre. Our system connects with our electronic medical records systems, gathers data for a machine learning algorithm to predict future patient waiting times, and is integrated with a mobile phone app. The system has been in operation for over nine months and has led to reduced lines, calmer waiting rooms and overwhelming patient and staff satisfaction.

Examining Passenger Flow Choke Points at Airports Using Discrete Event Simulation

NASA Technical Reports Server (NTRS)

Brown, Jeremy R.; Madhavan, Poomima

2011-01-01

The movement of passengers through an airport quickly, safely, and efficiently is the main function of the various checkpoints (check-in, security. etc) found in airports. Human error combined with other breakdowns in the complex system of the airport can disrupt passenger flow through the airport leading to lengthy waiting times, missing luggage and missed flights. In this paper we present a model of passenger flow through an airport using discrete event simulation that will provide a closer look into the possible reasons for breakdowns and their implications for passenger flow. The simulation is based on data collected at Norfolk International Airport (ORF). The primary goal of this simulation is to present ways to optimize the work force to keep passenger flow smooth even during peak travel times and for emergency preparedness at ORF in case of adverse events. In this simulation we ran three different scenarios: real world, increased check-in stations, and multiple waiting lines. Increased check-in stations increased waiting time and instantaneous utilization. while the multiple waiting lines decreased both the waiting time and instantaneous utilization. This simulation was able to show how different changes affected the passenger flow through the airport.

Anomalous diffusion for bed load transport with a physically-based model

NASA Astrophysics Data System (ADS)

Fan, N.; Singh, A.; Foufoula-Georgiou, E.; Wu, B.

2013-12-01

Diffusion of bed load particles shows both normal and anomalous behavior for different spatial-temporal scales. Understanding and quantifying these different types of diffusion is important not only for the development of theoretical models of particle transport but also for practical purposes, e.g., river management. Here we extend a recently proposed physically-based model of particle transport by Fan et al. [2013] to further develop an Episodic Langevin equation (ELE) for individual particle motion which reproduces the episodic movement (start and stop) of sediment particles. Using the proposed ELE we simulate particle movements for a large number of uniform size particles, incorporating different probability distribution functions (PDFs) of particle waiting time. For exponential PDFs of waiting times, particles reveal ballistic motion in short time scales and turn to normal diffusion at long time scales. The PDF of simulated particle travel distances also shows a change in its shape from exponential to Gamma to Gaussian with a change in timescale implying different diffusion scaling regimes. For power-law PDF (with power - μ) of waiting times, the asymptotic behavior of particles at long time scales reveals both super-diffusion and sub-diffusion, however, only very heavy tailed waiting times (i.e. 1.0 < μ < 1.5) could result in sub-diffusion. We suggest that the contrast between our results and previous studies (for e.g., studies based on fractional advection-diffusion models of thin/heavy tailed particle hops and waiting times) results could be due the assumption in those studies that the hops are achieved instantaneously, but in reality, particles achieve their hops within finite times (as we simulate here) instead of instantaneously, even if the hop times are much shorter than waiting times. In summary, this study stresses on the need to rethink the alternative models to the previous models, such as, fractional advection-diffusion equations, for studying the anomalous diffusion of bed load particles. The implications of these results for modeling sediment transport are discussed.

Monitoring trends in waiting periods in Canada for elective surgery: validation of a method using administrative data

PubMed Central

Shortt, Samuel E.D.; Shaw, Ralph A.; Elliott, David; Mackillop, William J.

2004-01-01

Background Provincial governments require timely, economical methods to monitor surgical waiting periods. Although use of prospective procedure-specific registers would be the ideal method, a less elaborate system has been proposed that is based on physician billing data. This study assessed the validity of using the date of the last service billed prior to surgery as a proxy for the beginning of the post-referral, pre-surgical waiting period. Method We examined charts for 31 824 elective surgical encounters between 1992 and 1996 at an Ontario teaching hospital. The date of the last service before surgery (the last billing date) was compared with the date of the consultant's letter indicating a decision to book surgery (i.e., to begin waiting). Results Several surgical specialties (but excluding cardiac, orthopedic and gynecologic) had a close correlation between the dates of the last pre-surgery visit and those of the actual decision to place the patient on the waiting list. Similar results were found for 12 of 15 individually studied procedures, including some orthopedic and gynecological procedures. Conclusion Used judiciously, billing data is a timely, inexpensive and generally accurate method by which provincial governments could monitor trends in waiting times for appropriately selected surgical procedures. PMID:15264378

Applying Lean/Toyota production system principles to improve phlebotomy patient satisfaction and workflow.

PubMed

Melanson, Stacy E F; Goonan, Ellen M; Lobo, Margaret M; Baum, Jonathan M; Paredes, José D; Santos, Katherine S; Gustafson, Michael L; Tanasijevic, Milenko J

2009-12-01

Our goals were to improve the overall patient experience and optimize the blood collection process in outpatient phlebotomy using Lean principles. Elimination of non-value-added steps and modifications to operational processes resulted in increased capacity to handle workload during peak times without adding staff. The result was a reduction of average patient wait time from 21 to 5 minutes, with the goal of drawing blood samples within 10 minutes of arrival at the phlebotomy station met for 90% of patients. In addition, patient satisfaction increased noticeably as assessed by a 5-question survey. The results have been sustained for 10 months with staff continuing to make process improvements.

[Work schedule management in the health institutions of Abomey-Calavi (Benin)].

PubMed

Makoutodé, M; Kassanga, N N; Ouendo, E M; Agueh, V D; Diallo, P M

1999-12-01

Work time management of the health personnel of the health institutions in the sub-prefecture of Abomey-Calavi (Benin) This study was carried out with a sample size of 130, comprising health personnel, patients, members of management committees and twelve health institutions of the subprefecture of Abomey-Calavi. The survey was carried out through observation, one-on-one interviews and consultation of documents. The results reveal that work time is poorly managed in almost all of the programmes surveyed. There exist long waiting lines in almost all the health programmes. On average, the traffic report per service is 82 and 10 out of 12 of the programmes investigated do not have an agenda of activities.

The unethical focus on access: a study of medical ethics and the waiting-time guarantee.

PubMed

Karlberg, H I; Brinkmo, B-M

2009-03-01

All civilized societies favour ethical principles of equity. In healthcare, these principles generally focus on needs for medical care. Methods for establishing priorities among such needs are instrumental in this process. In this study, we analysed whether rules on access to healthcare, waiting-time guarantees, conflict with ethical principles of distributive justice. We interviewed directors, managers and other decision-makers of various healthcare providers of hospitals, primary care organizations and purchasing offices. We also conducted focus group interviews with professionals from a number of distinct medical areas. Our informants and their co-workers were reasonably familiar with the ethical platforms for priority-setting established by the Swedish parliament, giving the sickest patients complete priority. However, to satisfy the waiting-time guarantees, the informants often had to make priority decisions contrary to the ethical principles by favouring access before needs to keep waiting times within certain limits. The common opinion was that the waiting-time guarantee leads to crowding-out effects, overruling the ethical principles based on needs. For more than a decade, the interpretation in Sweden of the equitable principle based on medical needs has been distorted through political decisions, leading to healthcare providers giving priority to access rather than needs for care.

Availability of Maintained Systems

DTIC Science & Technology

1983-03-01

o -4 >1 w Administrative0 and Logistic Time 0 -4W 0 E-44 4q Operating Time ( > .1 Preventive Maintenance | 04 SOperating Time t Ready Time Operatinf...point in time. It excludes ready time, preventive-maintenance downtime, logistic time, and waiting or administrative downtime. It may be expressed as: A...satisfactorily at a given point in time. It excludes logistic tim-3 and waiting or administrative downtime. It includes active preventive and

DIVISION OF MOTOR VEHICLES

Science.gov Websites

Appointment at Palmer Appointment at Fairbanks Schedule My Road Test Road Test Wait List DRIVERS Get My Card Track My ID or License Practice Knowledge Test Register to Vote VEHICLES Renew My Registration Road Test Road Test Wait List Locations & Hours Office Hours Check Wait Times Dealer and Fleet

Strategic Attention Deployment for Delay of Gratification in Working and Waiting Situations.

ERIC Educational Resources Information Center

Peake, Philip K.; Hebl, Michelle; Mischel, Walter

2002-01-01

Two studies examined whether effects of attention to rewards during a delay of gratification task in waiting situations affects preschoolers' ability to delay gratification in working situations. Findings show that when work provides distraction, attention on rewards reduces delay time whether working or waiting; when work is not engaging,…

Impact of visual art on patient behavior in the emergency department waiting room.

PubMed

Nanda, Upali; Chanaud, Cheryl; Nelson, Michael; Zhu, Xi; Bajema, Robyn; Jansen, Ben H

2012-07-01

Wait times have been reported to be one of the most important concerns for people visiting emergency departments (EDs). Affective states significantly impact perception of wait time. There is substantial evidence that art depicting nature reduces stress levels and anxiety, thus potentially impacting the waiting experience. To analyze the effect of visual art depicting nature (still and video) on patients' and visitors' behavior in the ED. A pre-post research design was implemented using systematic behavioral observation of patients and visitors in the ED waiting rooms of two hospitals over a period of 4 months. Thirty hours of data were collected before and after new still and video art was installed at each site. Significant reduction in restlessness, noise level, and people staring at other people in the room was found at both sites. A significant decrease in the number of queries made at the front desk and a significant increase in social interaction were found at one of the sites. Visual art has positive effects on the ED waiting experience. Copyright © 2012 Elsevier Inc. All rights reserved.

A Time Study of Plastic Surgery Residents.

PubMed

Lau, Frank H; Sinha, Indranil; Jiang, Wei; Lipsitz, Stuart R; Eriksson, Elof

2016-05-01

Resident work hours are under scrutiny and have been subject to multiple restrictions. The studies supporting these changes have not included data on surgical residents. We studied the workday of a team of plastic surgery residents to establish prospective time-study data of plastic surgery (PRS) residents at a single tertiary-care academic medical center. Five trained research assistants observed all residents (n = 8) on a PRS service for 10 weeks and produced minute-by-minute activity logs. Data collection began when the team first met in the morning and continued until the resident being followed completed all non-call activities. We analyzed our data from 3 perspectives: 1) time spent in direct patient care (DPC), indirect patient care, and didactic activities; 2) time spent in high education-value activities (HEAs) versus low education-value activities; and 3) resident efficiency. We defined HEAs as activities that surgeons must master; other activities were LEAs. We quantified resident efficiency in terms of time fragmentation and time spent waiting. A total of 642.4 hours of data across 50 workdays were collected. Excluding call, residents worked an average of 64.2 hours per week. Approximately 50.7% of surgical resident time was allotted to DPC, with surgery accounting for the largest segment of this time (34.8%). Time spent on HEAs demonstrated trended upward with higher resident level (P = 0.086). Time in spent in surgery was significantly associated with higher resident levels (P < 0.0001); 57.7% of activities require 4 minutes or less, suggesting that resident work was highly fragmented. Residents spent 10.7% of their workdays waiting for other services. In this first-time study of PRS residents, we found that compared with medicine trainees, surgical residents spent 3.23 times more time on DPC. High education-value activities comprised most of our residents' workdays. Surgery was the leading component of both DPC and HEAs. Our residents were highly efficient and fragmented, with the majority of all activities requiring 4 minutes or less. Residents spent a large portion of their time waiting for other services. In light of these data, we suggest that future changes to residency programs be pilot tested, with preimplantation and postimplementation time studies performed to quantify the changes' impact.

[Do physicians' gender and workload affect patients?].

PubMed

Finnvold, Jon Erik

2008-10-23

The article discusses the effect of general practitioners' gender and workload on patients' experience with consultation time, waiting hours, use of out-of-hours services and planned health visits. Data were retrieved from the 2003 version of Statistics Norway's household panel study (5000 persons) and the National Insurance administration's register of regular general practitioners. Health condition was the most important factor related to patient experiences. A high workload was neither associated with more frequent use of out-of-hours services nor satisfaction with time spent in consultation. These results apply to physicians of both genders. Patients who used a female physician with a large workload had to wait longer for an appointment and more often reported dissatisfaction with the waiting time; this was not the case for male physicians. However, male physicians with a low workload had shorter waiting times. Patients who use practitioners with a high workload may have chosen their doctor more deliberately than others, which may be an explanation for few negative outcomes for physicians with a high workload. It is unlikely that these physicians would be as popular if the patients had fewer appointments, shorter consultations or more often had to use the out-of-hours services. Longer waiting time for appointments with female doctors may be related to more part time work, and the fact that female physicians more often are engaged in group practices.

Impact of pharmacy automation on patient waiting time: an application of computer simulation.

PubMed

Tan, Woan Shin; Chua, Siang Li; Yong, Keng Woh; Wu, Tuck Seng

2009-06-01

This paper aims to illustrate the use of computer simulation in evaluating the impact of a prototype automated dispensing system on waiting time in an outpatient pharmacy and its potential as a routine tool in pharmacy management. A discrete event simulation model was developed to investigate the impact of a prototype automated dispensing system on operational efficiency and service standards in an outpatient pharmacy. The simulation results suggest that automating the prescription-filing function using a prototype that picks and packs at 20 seconds per item will not assist the pharmacy in achieving the waiting time target of 30 minutes for all patients. Regardless of the state of automation, to meet the waiting time target, 2 additional pharmacists are needed to overcome the process bottleneck at the point of medication dispense. However, if the automated dispensing is the preferred option, the speed of the system needs to be twice as fast as the current configuration to facilitate the reduction of the 95th percentile patient waiting time to below 30 minutes. The faster processing speed will concomitantly allow the pharmacy to reduce the number of pharmacy technicians from 11 to 8. Simulation was found to be a useful and low cost method that allows an otherwise expensive and resource intensive evaluation of new work processes and technology to be completed within a short time.

Wait times for physical and occupational therapy in the public system for people with arthritis in quebec.

PubMed

Delaurier, Ashley; Bernatsky, Sasha; Raymond, Marie-Hélène; Feldman, Debbie Ehrmann

2013-01-01

Although arthritis is the leading cause of pain and disability in Canada, and physical therapy (PT) and occupational therapy (OT) are beneficial both for chronic osteoarthritis (OA) and for inflammatory arthritis such as rheumatoid arthritis (RA), there appear to be problems with access to such services. The aim of this study was to document wait times from referral by physician to consultation with PT or OT in the public health care system for people with arthritis in Quebec, Canada. Appointments were requested by telephone, using hypothetical case scenarios; wait times were defined as the time between initial request and appointment date. Descriptive statistics were used to examine the wait times in relation to diagnosis, service provider and geographic area. For both scenarios (OA and RA) combined, 13% were offered an appointment within 6 months, 13% offered given an appointment within 6-12 months, 24% were told they would need to wait longer than 12 months, and 22% were refused services. The remaining 28% were told they would require an evaluation appointment for functional assessment before being given an appointment for therapy. No difference was found between RA and OA diagnoses. Our study suggests that most people with arthritis living in the province of Quebec are not receiving publicly accessible PT or OT intervention in a timely manner.

Efficiency of colorectal cancer care among veterans: analysis of treatment wait times at Veterans Affairs Medical Centers.

PubMed

Merkow, Ryan P; Bilimoria, Karl Y; Sherman, Karen L; McCarter, Martin D; Gordon, Howard S; Bentrem, David J

2013-07-01

Timeliness of cancer treatment is an important aspect of health care quality. Veterans Affairs Medical Centers (VAMCs) are expected to treat a growing number of patients with cancer. Our objectives were to examine treatment times from diagnosis to first-course therapy for patients with colon and rectal cancers and assess factors associated with prolonged wait times. From the VA Central Cancer Registry, patients who underwent colon or rectal resection for cancer from 1998 to 2008 were identified. Time from diagnosis to definitive cancer-directed therapy was measured, and multivariable regression methods were used to determine predictors of prolonged wait times for colon (≥ 45 days) and rectal (≥ 60 days) cancers. From 124 VAMCs, 14,097 patients underwent colectomy, and 3,390 underwent rectal resection for cancer. For colon cancer, the median time to treatment increased by 68% over time (P < .001). From 2007 to 2008, the median time to colectomy was 32 days. Predictors of prolonged wait times included age ≥ 55 years (v < 55 years), time period (2007 to 2008 v 1998 to 2000), black race (v white), marriage status (married v unmarried), high-volume center status (v low volume), and treatment at a different hospital (v same hospital as initial diagnosis; all P < .05). For rectal cancer, the overall median time to first-course treatment increased by 74% (P < .001). From 2007 to 2008, the median time to proctectomy was 47 days. Similar predictors of prolonged wait times were identified for rectal cancer. Time to first treatment has increased for patients with colon and rectal cancers at VAMCs. Patient, tumor, and hospital factors are associated with prolonged time to treatment.

Spontaneous activity in the waiting brain: a marker of impulsive choice in attention-deficit/hyperactivity disorder?

PubMed

Hsu, Chia-Fen; Benikos, Nicholas; Sonuga-Barke, Edmund J S

2015-04-01

Spontaneous very low frequency oscillations (VLFO), seen in the resting brain, are attenuated when individuals are working on attention demanding tasks or waiting for rewards (Hsu et al., 2013). Individuals with attention-deficit/hyperactivity disorder (ADHD) display excess VLFO when working on attention tasks. They also have difficulty waiting for rewards. Here we examined the waiting brain signature in ADHD and its association with impulsive choice. DC-EEG from 21 children with ADHD and 21 controls (9-15 years) were collected under four conditions: (i) resting; (ii) choosing to wait; (iii) being "forced" to wait; and (iv) working on a reaction time task. A questionnaire measured two components of impulsive choice. Significant VLFO reductions were observed in controls within anterior brain regions in both working and waiting conditions. Individuals with ADHD showed VLFO attenuation while working but to a reduced level and none at all when waiting. A closer inspection revealed an increase of VLFO activity in temporal regions during waiting. Excess VLFO activity during waiting was associated with parents' ratings of temporal discounting and delay aversion. The results highlight the potential role for waiting-related spontaneous neural activity in the pathophysiology of impulsive decision-making of ADHD. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Waiting time for coronal preparation and the influence of different cements on tensile strength of metal posts.

PubMed

Oliveira, Ilione Kruschewsky Costa Sousa; Arsati, Ynara Bosco de Oliveira Lima; Basting, Roberta Tarkany; França, Fabiana Mantovani Gomes

2012-01-01

This study aimed to assess the effect of post-cementation waiting time for core preparation of cemented cast posts and cores had on retention in the root canal, using two different luting materials. Sixty extracted human canines were sectioned 16 mm from the root apex. After cast nickel-chromium metal posts and cores were fabricated and luted with zinc phosphate (ZP) cement or resin cement (RC), the specimens were divided into 3 groups (n = 10) according to the waiting time for core preparation: no preparation (control), 15 minutes, or 1 week after the core cementation. At the appropriate time, the specimens were subjected to a tensile load test (0.5 mm/min) until failure. Two-way ANOVA (time versus cement) and the Tukey tests (P < 0.05) showed significantly higher (P < 0.05) tensile strength values for the ZP cement groups than for the RC groups. Core preparation and post-cementation waiting time for core recontouring did not influence the retention strength. ZP was the best material for intraradicular metal post cementation.

Improving patient experience in a pediatric ambulatory clinic: a mixed method appraisal of service delivery

PubMed Central

Soeteman, Marijn; Peters, Vera; Busari, Jamiu O

2015-01-01

Objective In 2013, customer satisfaction surveys showed that patients were unhappy with the services provided at our ambulatory clinic. In response, we performed an appraisal of our services, which resulted in the development of a strategy to reduce waiting time and improve quality of service. Infrastructural changes to our clinic’s waiting room, consultation rooms, and back offices were performed, and schedules were redesigned to reduce wait time to 10 minutes and increase consultation time to 20 minutes. Our objective was to identify if this would improve 1) accessibility to caregivers and 2) quality of service and available amenities. Design We conducted a multi-method survey using 1) a patient flow analysis to analyze the flow of service and understand the impact of our interventions on patient flow and 2) specially designed questionnaires to investigate patients’ perceptions of our wait time and how to improve our services. Results The results showed that 79% of our respondents were called in to see a doctor within 20 minutes upon arrival. More patients (55%) felt that 10–20 minutes was an acceptable wait time. We also observed a perceived increase in satisfaction with wait time (94%). Finally, a large number of patients (97%) were satisfied with the quality of service and with the accessibility to caregivers (94%). Conclusion The majority of our patients were satisfied with the accessibility to our ambulatory clinics and with the quality of services provided. The appraisal of our operational processes using a patient flow analysis also demonstrated how this strategy could effectively be applied to investigate and improve quality of service in patients. PMID:25848303

Reducing Wait Time for Lung Cancer Diagnosis and Treatment: Impact of a Multidisciplinary, Centralized Referral Program.

PubMed

Common, Jessica L; Mariathas, Hensley H; Parsons, Kaylah; Greenland, Jonathan D; Harris, Scott; Bhatia, Rick; Byrne, SuzanneC

2018-06-04

A multidisciplinary, centralized referral program was established at our institution in 2014 to reduce delays in lung cancer diagnosis and treatment following diagnostic imaging observed with the traditional, primary care provider-led referral process. The main objectives of this retrospective cohort study were to determine if referral to a Thoracic Triage Panel (TTP): 1) expedites lung cancer diagnosis and treatment initiation; and 2) leads to more appropriate specialist consultation. Patients with a diagnosis of lung cancer and initial diagnostic imaging between March 1, 2015, and February 29, 2016, at a Memorial University-affiliated tertiary care centre in St John's, Newfoundland, were identified and grouped according to whether they were referred to the TTP or managed through a traditional referral process. Wait times (in days) from first abnormal imaging to biopsy and treatment initiation were recorded. Statistical analysis was performed using the Wilcoxon rank-sum test. A total of 133 patients who met inclusion criteria were identified. Seventy-nine patients were referred to the TTP and 54 were managed by traditional means. There was a statistically significant reduction in median wait times for patients referred to the TTP. Wait time from first abnormal imaging to biopsy decreased from 61.5 to 36.0 days (P < .0001). Wait time from first abnormal imaging to treatment initiation decreased from 118.0 to 80.0 days (P < .001). The percentage of specialist consultations that led to treatment was also greater for patients referred to the TTP. A collaborative, centralized intake and referral program helps to reduce wait time for diagnosis and treatment of lung cancer. Copyright © 2018 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.

Contribution of spontaneous improvement to placebo response in depression: a meta-analytic review.

PubMed

Rutherford, Bret R; Mori, Shoko; Sneed, Joel R; Pimontel, Monique A; Roose, Steven P

2012-06-01

It is unknown to what degree spontaneous improvement accounts for the large placebo response observed in antidepressant trials for Major Depressive Disorder (MDD). The purpose of this study was to estimate the spontaneous improvement observed in treatment-seeking individuals with acute MDD by determining the symptom change in depressed patients assigned to wait-list controls in psychotherapy studies. The databases PubMed and PsycINFO were searched to identify randomized, prospective studies randomizing outpatients to psychotherapy or a wait-list control condition for the treatment of acute MDD. Standardized effect sizes calculated from each identified study were aggregated in a meta-analysis to obtain a summary statistic for the change in depression scores during participation in a wait-list control. Ten trials enrolling 340 participants in wait-list control conditions were identified. The estimated effect size for the change in depression scores during wait-list control was 0.505 (95% CI 0.271-0.739, p < 0.001), representing an average improvement of 4 points on the Hamilton Rating Scale for Depression. Depressed patients acutely experience improvement even without treatment, but spontaneous improvement is unlikely to account for the magnitude of placebo response typically observed in antidepressant trials. These findings must be interpreted in light of the small number wait-list control participants available for analysis as well as certain methodological heterogeneity in the psychotherapy studies analyzed. Copyright © 2012 Elsevier Ltd. All rights reserved.

Advertising emergency department wait times.

PubMed

Weiner, Scott G

2013-03-01

Advertising emergency department (ED) wait times has become a common practice in the United States. Proponents of this practice state that it is a powerful marketing strategy that can help steer patients to the ED. Opponents worry about the risk to the public health that arises from a patient with an emergent condition self-triaging to a further hospital, problems with inaccuracy and lack of standard definition of the reported time, and directing lower acuity patients to the higher cost ED setting instead to primary care. Three sample cases demonstrating the pitfalls of advertising ED wait times are discussed. Given the lack of rigorous evidence supporting the practice and potential adverse effects to the public health, caution about its use is advised.

On the gap between an empirical distribution and an exponential distribution of waiting times for price changes in a financial market

NASA Astrophysics Data System (ADS)

Sazuka, Naoya

2007-03-01

We analyze waiting times for price changes in a foreign currency exchange rate. Recent empirical studies of high-frequency financial data support that trades in financial markets do not follow a Poisson process and the waiting times between trades are not exponentially distributed. Here we show that our data is well approximated by a Weibull distribution rather than an exponential distribution in the non-asymptotic regime. Moreover, we quantitatively evaluate how much an empirical data is far from an exponential distribution using a Weibull fit. Finally, we discuss a transition between a Weibull-law and a power-law in the long time asymptotic regime.

24 CFR 982.204 - Waiting list: Administration of waiting list.

Code of Federal Regulations, 2010 CFR

2010-04-01

... size (number of bedrooms for which family qualifies under PHA occupancy standards); (3) Date and time... list. (d) Family size. (1) The order of admission from the waiting list may not be based on family size, or on the family unit size for which the family qualifies under the PHA occupancy policy. (2) If the...

WAITING TIME DISTRIBUTION OF SOLAR ENERGETIC PARTICLE EVENTS MODELED WITH A NON-STATIONARY POISSON PROCESS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Li, C.; Su, W.; Fang, C.

2014-09-10

We present a study of the waiting time distributions (WTDs) of solar energetic particle (SEP) events observed with the spacecraft WIND and GOES. The WTDs of both solar electron events (SEEs) and solar proton events (SPEs) display a power-law tail of ∼Δt {sup –γ}. The SEEs display a broken power-law WTD. The power-law index is γ{sub 1} = 0.99 for the short waiting times (<70 hr) and γ{sub 2} = 1.92 for large waiting times (>100 hr). The break of the WTD of SEEs is probably due to the modulation of the corotating interaction regions. The power-law index, γ ∼more » 1.82, is derived for the WTD of the SPEs which is consistent with the WTD of type II radio bursts, indicating a close relationship between the shock wave and the production of energetic protons. The WTDs of SEP events can be modeled with a non-stationary Poisson process, which was proposed to understand the waiting time statistics of solar flares. We generalize the method and find that, if the SEP event rate λ = 1/Δt varies as the time distribution of event rate f(λ) = Aλ{sup –α}exp (– βλ), the time-dependent Poisson distribution can produce a power-law tail WTD of ∼Δt {sup α} {sup –3}, where 0 ≤ α < 2.« less

Effect of self-triage on waiting times at a walk-in sexual health clinic.

PubMed

Hitchings, Samantha; Barter, Janet

2009-10-01

Lengthy waiting times can be a major problem in walk-in sexual health clinics. They are stressful for both patients and staff and may lead to clients with significant health issues leaving the department before being seen by a clinician. A self-triage system may help reduce waiting times and duplication of work, improve patient pathways and decrease wasted visits. This paper describes implementation of a self-triage system in two busy sexual and reproductive health clinics. Patients were asked to complete a self-assessment form on registration to determine the reason for attendance. This then enabled patients to be directed to the most appropriate specialist or clinical service. The benefits of this approach were determined by measuring patient waiting times, reduction in unnecessary specialist review together with patient acceptability as tested by a patient satisfaction survey. The ease of comprehension of the triage form was also assessed by an independent readers' panel. A total of 193 patients were recruited over a 4-month period from November 2004 to February 2005. Patients from the November and December clinics were assigned to the 'traditional treatment' arm, with patients at subsequent clinics being assigned to the 'self-triage' system. Waiting times were collected by the receptionist and clinic staff. Ninety six patients followed the traditional route, 97 the new self-triage system. Sixty-nine (35.8%) patients completed the satisfaction survey. The self-triage system significantly reduced waiting time from 40 (22, 60) to 23 (10, 40) minutes [results expressed as median (interquartile range)]. There was a non-significant reduction in the proportion of patients seeing two clinicians from 21% to 13% (p = 0.17). Satisfaction levels were not significantly altered (95% compared to 97% satisfied, p = 0.64). The readers' panel found the triage form both easy to understand and to complete. Self-triage can effectively reduce clinic waiting times and allow better organisation of resources. Urgent cases can be prioritised. This process appears to be acceptable to and understandable by patients.

Waiting for the right time: how and why young Thai women manage to avoid heterosexual intercourse.

PubMed

Supametaporn, Pinhatai; Stern, Phyllis Noerager; Rodcumdee, Branom; Chaiyawat, Waraporn

2010-08-01

Nineteen young Thai women were purposively selected from networks of nongovernmental organizations involving children and youths in Bangkok. Our grounded theory findings indicated that these young women used the basic social process they called "waiting for the right time" in order to maintain heterosexual abstinence. Waiting for the right time involved one overarching condition, honoring parental love, and included three overlapping properties: learning rules, planning life path, and ways of preserving virginity. The findings provide information that may lead to the development of culturally competent interventions for middle-class Thai youths to remain healthy and avoid pregnancy.

Evaluation of a new equation for calculating the maximum wait time for pilots that have used an impairing medication.

DOT National Transportation Integrated Search

2013-08-01

Pilots thatuse an impairing medication to treat a medicalcondition are required to wait an appropriate amount of time after completing the treatment before returning to duty.However, toxicology findings for pilots involved in fatal aviation accidents...

Waiting time for radiotherapy in women with cervical cancer

PubMed Central

do Nascimento, Maria Isabel; Azevedo e Silva, Gulnar

2016-01-01

ABSTRACT OBJECTIVE To describe the waiting time for radiotherapy for patients with cervical cancer. METHODS This descriptive study was conducted with 342 cervical cancer cases that were referred to primary radiotherapy, in the Baixada Fluminense region, RJ, Southeastern Brazil, from October 1995 to August 2010. The waiting time was calculated using the recommended 60-day deadline as a parameter to obtaining the first cancer treatment and considering the date at which the diagnosis was confirmed, the date of first oncological consultation and date when the radiotherapy began. Median and proportional comparisons were made using the Kruskal Wallis and Chi-square tests. RESULTS Most of the women (72.2%) began their radiotherapy within 60 days from the diagnostic confirmation date. The median of this total waiting time was 41 days. This median worsened over the time period, going from 11 days (1995-1996) to 64 days (2009-2010). The median interval between the diagnostic confirmation and the first oncological consultation was 33 days, and between the first oncological consultation and the first radiotherapy session was four days. The median waiting time differed significantly (p = 0.003) according to different stages of the tumor, reaching 56 days, 35 days and 30 days for women whose cancers were classified up to IIA; from IIB to IIIB, and IVA-IVB, respectively. CONCLUSIONS Despite most of the women having had access to radiotherapy within the recommended 60 days, the implementation of procedures to define the stage of the tumor and to reestablish clinical conditions took a large part of this time, showing that at least one of these intervals needs to be improved. Even though the waiting times were ideal for all patients, the most advanced cases were quickly treated, which suggests that access to radiotherapy by women with cervical cancer has been reached with equity. PMID:26786473

The impact of diagnostic imaging wait times on the prognosis of lung cancer.

PubMed

Byrne, Suzanne C; Barrett, Brendan; Bhatia, Rick

2015-02-01

This study was performed to determine whether gaps in patient flow from initial lung imaging to computed tomography (CT) guided lung biopsy in patients with non-small cell lung cancer (NSCLC) was associated with a change in tumour size, stage, and thus prognosis. All patients who had a CT-guided lung biopsy in 2009 (phase I) and in 2011 (phase II) with a pathologic diagnosis of primary lung cancer (NSCLC) at Eastern Health, Newfoundland, were identified. Dates of initial abnormal imaging, confirmatory CT (if performed), and CT-guided biopsy were recorded, along with tumour size and resulting T stage at each time point. In 2010, wait times for diagnostic imaging at Eastern Health were reduced. The stage and prognosis of NSCLC in 2009 was compared with 2011. In phase 1, there was a statistically significant increase in tumour size (mean difference, 0.67 cm; P < .0001) and stage (P < .0001) from initial image to biopsy. There was a moderate correlation between the time (in days) between the images and change in size (r = 0.33, P = .008) or stage (r = 0.26, P = .036). In phase II, the median wait time from initial imaging to confirmatory CT was reduced to 7.5 days (from 19 days). At this reduced wait time, there was no statistically significant increase in tumour size (mean difference, 0.02; P > .05) or stage (P > .05) from initial imaging to confirmatory CT. Delays in patient flow through diagnostic imaging resulted in an increase in tumour size and stage, with a negative impact on prognosis of NSCLC. This information contributed to the hiring of additional CT technologists and extended CT hours to decrease the wait time for diagnostic imaging. With reduced wait times, the prognosis of NSCLC was not adversely impacted as patients navigated through diagnostic imaging. Copyright © 2015 Canadian Association of Radiologists. All rights reserved.

Walking Clinic in ambulatory surgery--A patient based concept: A Portuguese pioneer project.

PubMed

Vinagreiro, M; Valverde, J N; Alves, D; Costa, M; Gouveia, P; Guerreiro, E

2015-06-01

Walking Clinic is an innovative, efficient and easily reproducible concept adapted to ambulatory surgery. It consists of a preoperative single day work-up, with a surgeon, an anesthetist and a nurse. The aim of this study was to evaluate patient satisfaction and its determinants. A survey was applied to 171 patients (101 of the Walking Clinic group and 70 not engaged in this new concept). Patient satisfaction was assessed evaluating five major questionnaire items: secretariat (quality of the information and support given), physical space (overall comfort and cleanliness), nurses and medical staff (willingness and expertise), and patients (waiting time until pre-operative consults and exams, waiting time until being scheduled for surgery, surgery day waiting time and postoperative pain control). Furthermore, overall assessment of the received treatment, and probability of patient recommending or returning to our ambulatory unit were also analyzed. Walking Clinic group had overall better results in the five major questionnaire items assessed, with statistical significance, except for the physical space. It also showed better results regarding the sub-items postoperative pain control, waiting time until being scheduled for surgery and surgery day waiting time. The results confirm better patient satisfaction with this new concept. The Walking Clinic concept complements all the tenets of ambulatory surgery, in a more efficient manner. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

Intervention for children with word-finding difficulties: a parallel group randomised control trial.

PubMed

Best, Wendy; Hughes, Lucy Mari; Masterson, Jackie; Thomas, Michael; Fedor, Anna; Roncoli, Silvia; Fern-Pollak, Liory; Shepherd, Donna-Lynn; Howard, David; Shobbrook, Kate; Kapikian, Anna

2017-07-31

The study investigated the outcome of a word-web intervention for children diagnosed with word-finding difficulties (WFDs). Twenty children age 6-8 years with WFDs confirmed by a discrepancy between comprehension and production on the Test of Word Finding-2, were randomly assigned to intervention (n = 11) and waiting control (n = 9) groups. The intervention group had six sessions of intervention which used word-webs and targeted children's meta-cognitive awareness and word-retrieval. On the treated experimental set (n = 25 items) the intervention group gained on average four times as many items as the waiting control group (d = 2.30). There were also gains on personally chosen items for the intervention group. There was little change on untreated items for either group. The study is the first randomised control trial to demonstrate an effect of word-finding therapy with children with language difficulties in mainstream school. The improvement in word-finding for treated items was obtained following a clinically realistic intervention in terms of approach, intensity and duration.

An improved global dynamic routing strategy for scale-free network with tunable clustering

NASA Astrophysics Data System (ADS)

Sun, Lina; Huang, Ning; Zhang, Yue; Bai, Yannan

2016-08-01

An efficient routing strategy can deliver packets quickly to improve the network capacity. Node congestion and transmission path length are inevitable real-time factors for a good routing strategy. Existing dynamic global routing strategies only consider the congestion of neighbor nodes and the shortest path, which ignores other key nodes’ congestion on the path. With the development of detection methods and techniques, global traffic information is readily available and important for the routing choice. Reasonable use of this information can effectively improve the network routing. So, an improved global dynamic routing strategy is proposed, which considers the congestion of all nodes on the shortest path and incorporates the waiting time of the most congested node into the path. We investigate the effectiveness of the proposed routing for scale-free network with different clustering coefficients. The shortest path routing strategy and the traffic awareness routing strategy only considering the waiting time of neighbor node are analyzed comparatively. Simulation results show that network capacity is greatly enhanced compared with the shortest path; congestion state increase is relatively slow compared with the traffic awareness routing strategy. Clustering coefficient increase will not only reduce the network throughput, but also result in transmission average path length increase for scale-free network with tunable clustering. The proposed routing is favorable to ease network congestion and network routing strategy design.

Correlated continuous time random walk and option pricing

NASA Astrophysics Data System (ADS)

Lv, Longjin; Xiao, Jianbin; Fan, Liangzhong; Ren, Fuyao

2016-04-01

In this paper, we study a correlated continuous time random walk (CCTRW) with averaged waiting time, whose probability density function (PDF) is proved to follow stretched Gaussian distribution. Then, we apply this process into option pricing problem. Supposing the price of the underlying is driven by this CCTRW, we find this model captures the subdiffusive characteristic of financial markets. By using the mean self-financing hedging strategy, we obtain the closed-form pricing formulas for a European option with and without transaction costs, respectively. At last, comparing the obtained model with the classical Black-Scholes model, we find the price obtained in this paper is higher than that obtained from the Black-Scholes model. A empirical analysis is also introduced to confirm the obtained results can fit the real data well.

Cardiac EASE (Ensuring Access and Speedy Evaluation) – the impact of a single-point-of-entry multidisciplinary outpatient cardiology consultation program on wait times in Canada

PubMed Central

Bungard, Tammy J; Smigorowsky, Marcie J; Lalonde, Lucille D; Hogan, Terry; Doliszny, Katharine M; Gebreyesus, Ghirmay; Garg, Sipi; Archer, Stephen L

2009-01-01

BACKGROUND: Universal access to health care is valued in Canada but increasing wait times for services (eg, cardiology consultation) raise safety questions. Observations suggest that deficiencies in the process of care contribute to wait times. Consequently, an outpatient clinic was designed for Ensuring Access and Speedy Evaluation (Cardiac EASE) in a university group practice, providing cardiac consultative services for northern Alberta. Cardiac EASE has two components: a single-point-of-entry intake service (prospective testing using physician-approved algorithms and previsit triage) and a multidisciplinary clinic (staffed by cardiologists, nurse practitioners and doctoral-trained pharmacists). OBJECTIVES: It was hypothesized that Cardiac EASE would reduce the time to initial consultation and a definitive diagnosis, and also increase the referral capacity. METHODS: The primary and secondary outcomes were time from referral to initial consultation, and time to achieve a definitive diagnosis and management plan, respectively. A conventionally managed historical control group (three-month pre-EASE period in 2003) was compared with the EASE group (2004 to 2006). The conventional referral mechanism continued concurrently with EASE. RESULTS: A comparison between pre-EASE (n=311) and EASE (n=3096) revealed no difference in the mean (± SD) age (60±16 years), sex (55% and 52% men, respectively) or reason for referral, including chest pain (31% and 40%, respectively) and arrhythmia (27% and 29%, respectively). Cardiac EASE reduced the time to initial cardiac consultation (from 71±45 days to 33±19 days) and time to a definitive diagnosis (from 120±86 days to 51±58 days) (P<0.0001). The annual number of new referrals increased from 1512 in 2002 to 2574 in 2006 due to growth in the Cardiac EASE clinic. The number of patients seen through the conventional referral mechanism and their wait times remained constant during the study period. CONCLUSIONS: Cardiac EASE reduced wait times, increased capacity and shortened time to achieve a diagnosis. The EASE model could shorten wait times for consultative services in Canada. PMID:19960130

Waiting for hip arthroplasty: economic costs and health outcomes.

PubMed

Fielden, Jann M; Cumming, J M; Horne, J G; Devane, P A; Slack, A; Gallagher, L M

2005-12-01

This prospective cohort study of 153 patients aimed to determine the economic and health costs of waiting for total hip arthroplasty (THA). Health-related quality of life, using self-completed WOMAC and EQ-5D questionnaires, was assessed monthly from enrolment preoperatively to 6 months postsurgery. Monthly cost diaries were used to record costs. The mean waiting time was 5.1 months and mean total cost of waiting for surgery was NZ 4305 dollars(US 2876 dollars) per person (pp) (NZ 1 dollar = US 0.668 dollar). Waiting more than 6 months was associated with a higher total mean cost (NZ 4278 dollars/US 2858 dollars pp) than waiting less than 6 months (NZ 2828 dollars/US 1889 dollars pp; P < .01). Improvements from preoperative to postoperative WOMAC and EQ-5D scores were identified (P < or = .01). Waiting longer led to poorer physical function preoperatively (P < or = .01). Those with poor initial health status showed greater improvement in WOMAC (P = .0001) and EQ-5D (P = .003) measures by 6 months after surgery. Longer waits for total hip arthroplasty incur greater economic costs and deterioration in physical function while waiting.

Modernizing an ambulatory care pharmacy in a large multi-clinic institution.

PubMed

Miller, R F; Herrick, J D

1979-03-01

The steps involved in modernizing an outdated outpatient pharmacy, including the functional planning process, development of a work-flow pattern which makes the patient an integral part of the system, budget considerations and evaluation of the new pharmacy, are described. Objectives of the modernization were to: (1) provide a facility conductive to efficient and high quality services to the ambulatory patient; (2) provide an attractive and comfortable area for patients and staff; (3) provide a work flow which keeps the patient in the system and allows the pharmacist time for instruction and patient education; and (4) establish a patient medication record system. After one year of operation, average overall prescription volume increased by 50%, while average waiting time declined by 74%. Facility and procedural changes allowed the pharmacist to substantially increase patient counseling activity. The application of functional planning and facility design to the renovation and restructuring of an outpatient pharmacy allowed pharmacists to provide efficient, patient-oriented service.

Improvements in medical quality and patient safety through implementation of a case bundle management strategy in a large outpatient blood collection center.

PubMed

Zhao, Shuzhen; He, Lujia; Feng, Chenchen; He, Xiaoli

2018-06-01

Laboratory errors in blood collection center (BCC) are most common in the preanalytical phase. It is, therefore, of vital importance for administrators to take measures to improve healthcare quality and patient safety.In 2015, a case bundle management strategy was applied in a large outpatient BCC to improve its medical quality and patient safety.Unqualified blood sampling, complications, patient waiting time, largest number of patients waiting during peak hours, patient complaints, and patient satisfaction were compared over the period from 2014 to 2016.The strategy reduced unqualified blood sampling, complications, patient waiting time, largest number of patients waiting during peak hours, and patient complaints, while improving patient satisfaction.This strategy was effective in improving BCC healthcare quality and patient safety.

Analysis of bluetooth and wi-fi technology to measure wait times of personal vehicles at Arizona-Mexico ports of entry : [executive summary].

DOT National Transportation Integrated Search

2015-11-01

The Arizona Department of Transportation (ADOT), Office of P3 Initiatives and International : Affairs selected Lee Engineering to analyze the penetration rate of Anonymous Re-Identification : (ARID) technology to measure wait time of U.S. and Mexico ...

Poisson-process generalization for the trading waiting-time distribution in a double-auction mechanism

NASA Astrophysics Data System (ADS)

Cincotti, Silvano; Ponta, Linda; Raberto, Marco; Scalas, Enrico

2005-05-01

In this paper, empirical analyses and computational experiments are presented on high-frequency data for a double-auction (book) market. Main objective of the paper is to generalize the order waiting time process in order to properly model such empirical evidences. The empirical study is performed on the best bid and best ask data of 7 U.S. financial markets, for 30-stock time series. In particular, statistical properties of trading waiting times have been analyzed and quality of fits is evaluated by suitable statistical tests, i.e., comparing empirical distributions with theoretical models. Starting from the statistical studies on real data, attention has been focused on the reproducibility of such results in an artificial market. The computational experiments have been performed within the Genoa Artificial Stock Market. In the market model, heterogeneous agents trade one risky asset in exchange for cash. Agents have zero intelligence and issue random limit or market orders depending on their budget constraints. The price is cleared by means of a limit order book. The order generation is modelled with a renewal process. Based on empirical trading estimation, the distribution of waiting times between two consecutive orders is modelled by a mixture of exponential processes. Results show that the empirical waiting-time distribution can be considered as a generalization of a Poisson process. Moreover, the renewal process can approximate real data and implementation on the artificial stocks market can reproduce the trading activity in a realistic way.

Advertising Emergency Department Wait Times

PubMed Central

Weiner, Scott G.

2013-01-01

Advertising emergency department (ED) wait times has become a common practice in the United States. Proponents of this practice state that it is a powerful marketing strategy that can help steer patients to the ED. Opponents worry about the risk to the public health that arises from a patient with an emergent condition self-triaging to a further hospital, problems with inaccuracy and lack of standard definition of the reported time, and directing lower acuity patients to the higher cost ED setting instead to primary care. Three sample cases demonstrating the pitfalls of advertising ED wait times are discussed. Given the lack of rigorous evidence supporting the practice and potential adverse effects to the public health, caution about its use is advised. PMID:23599836

Survey of reproduction management on Canadian dairy farms.

PubMed

Denis-Robichaud, J; Cerri, R L A; Jones-Bitton, A; LeBlanc, S J

2016-11-01

The objectives of this study were to (1) quantify current reproduction management practices, and (2) assess the association between these practices and herd reproductive performance on dairy farms in Canada. A bilingual survey was developed, validated, and administered from March to May 2014 to collect general and reproduction management and performance measures [annual 21-d pregnancy rate (PR), 21-d insemination rate (IR), and conception risk (CR)]. Associations between management practices and reproductive performance measures were tested using linear regression models. A total of 832 questionnaires were completed online and by mail, representing a response rate of 9%. On average, farms had 77 lactating cows (median=50) and 13 dry cows (median=10), and Holstein was the most common breed (92% of herds). Lactating cow housing was tiestall on 61% of the farms, freestall on 37%, and bedded pack on 2%. The average voluntary waiting period was 58 d in milk (DIM). The main reproduction management practice per farm was defined as the means employed for >50% of inseminations. Farms reported their main reproduction management practice for first and subsequent inseminations, respectively, as visual estrus detection (51 and 44% of herds), timed AI (21 and 23% of herds), automated activity monitoring (AAM; 10 and 10% of herds), other management practice (bulls; 2 and 2% of herds), and a combination of management practices (16 and 21% of herds). On farms using visual estrus detection, cows were observed for signs of estrus on average 3.5 times per day, for an average total of 36 min/d. The most common use of reproductive hormones was to synchronize ovulation using Ovsynch (58% of the farms). Average PR, IR, and CR were 17.6, 44.1, and 40.5%, respectively. In linear regression analyses adjusted for confounders, pregnancy rate was significantly associated with geographic region, housing (tiestall: PR=15.4%, freestall: PR=17.6%), herd size (<50 lactating cows: PR=16.2%, 50-100 cows: PR=16.5%, >100 cows: PR=17.8%), voluntary waiting period (≤60 DIM: PR=17.6%, >60 DIM: PR=15.9%), and frequency of insemination per day (once daily: PR=16.6%, twice or more daily: PR=18.1%). The main reproduction management practice at first and subsequent inseminations was divergently associated with IR and CR, but not with PR (visual heat detection: PR=17.4%, timed AI: PR=18.4%, AAM: PR=17.1%, combined practices: PR=18.2%). Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Optogenetic activation of dorsal raphe serotonin neurons enhances patience for future rewards.

PubMed

Miyazaki, Kayoko W; Miyazaki, Katsuhiko; Tanaka, Kenji F; Yamanaka, Akihiro; Takahashi, Aki; Tabuchi, Sawako; Doya, Kenji

2014-09-08

Serotonin is a neuromodulator that is involved extensively in behavioral, affective, and cognitive functions in the brain. Previous recording studies of the midbrain dorsal raphe nucleus (DRN) revealed that the activation of putative serotonin neurons correlates with the levels of behavioral arousal [1], rhythmic motor outputs [2], salient sensory stimuli [3-6], reward, and conditioned cues [5-8]. The classic theory on serotonin states that it opposes dopamine and inhibits behaviors when aversive events are predicted [9-14]. However, the therapeutic effects of serotonin signal-enhancing medications have been difficult to reconcile with this theory [15, 16]. In contrast, a more recent theory states that serotonin facilitates long-term optimal behaviors and suppresses impulsive behaviors [17-21]. To test these theories, we developed optogenetic mice that selectively express channelrhodopsin in serotonin neurons and tested how the activation of serotonergic neurons in the DRN affects animal behavior during a delayed reward task. The activation of serotonin neurons reduced the premature cessation of waiting for conditioned cues and food rewards. In reward omission trials, serotonin neuron stimulation prolonged the time animals spent waiting. This effect was observed specifically when the animal was engaged in deciding whether to keep waiting and was not due to motor inhibition. Control experiments showed that the prolonged waiting times observed with optogenetic stimulation were not due to behavioral inhibition or the reinforcing effects of serotonergic activation. These results show, for the first time, that the timed activation of serotonin neurons during waiting promotes animals' patience to wait for a delayed reward. Copyright © 2014 Elsevier Ltd. All rights reserved.

An agent-based simulation combined with group decision-making technique for improving the performance of an emergency department.

PubMed

Yousefi, M; Ferreira, R P M

2017-03-30

This study presents an agent-based simulation modeling in an emergency department. In a traditional approach, a supervisor (or a manager) allocates the resources (receptionist, nurses, doctors, etc.) to different sections based on personal experience or by using decision-support tools. In this study, each staff agent took part in the process of allocating resources based on their observation in their respective sections, which gave the system the advantage of utilizing all the available human resources during the workday by being allocated to a different section. In this simulation, unlike previous studies, all staff agents took part in the decision-making process to re-allocate the resources in the emergency department. The simulation modeled the behavior of patients, receptionists, triage nurses, emergency room nurses and doctors. Patients were able to decide whether to stay in the system or leave the department at any stage of treatment. In order to evaluate the performance of this approach, 6 different scenarios were introduced. In each scenario, various key performance indicators were investigated before and after applying the group decision-making. The outputs of each simulation were number of deaths, number of patients who leave the emergency department without being attended, length of stay, waiting time and total number of discharged patients from the emergency department. Applying the self-organizing approach in the simulation showed an average of 12.7 and 14.4% decrease in total waiting time and number of patients who left without being seen, respectively. The results showed an average increase of 11.5% in total number of discharged patients from emergency department.

An agent-based simulation combined with group decision-making technique for improving the performance of an emergency department

PubMed Central

Yousefi, M.; Ferreira, R.P.M.

2017-01-01

This study presents an agent-based simulation modeling in an emergency department. In a traditional approach, a supervisor (or a manager) allocates the resources (receptionist, nurses, doctors, etc.) to different sections based on personal experience or by using decision-support tools. In this study, each staff agent took part in the process of allocating resources based on their observation in their respective sections, which gave the system the advantage of utilizing all the available human resources during the workday by being allocated to a different section. In this simulation, unlike previous studies, all staff agents took part in the decision-making process to re-allocate the resources in the emergency department. The simulation modeled the behavior of patients, receptionists, triage nurses, emergency room nurses and doctors. Patients were able to decide whether to stay in the system or leave the department at any stage of treatment. In order to evaluate the performance of this approach, 6 different scenarios were introduced. In each scenario, various key performance indicators were investigated before and after applying the group decision-making. The outputs of each simulation were number of deaths, number of patients who leave the emergency department without being attended, length of stay, waiting time and total number of discharged patients from the emergency department. Applying the self-organizing approach in the simulation showed an average of 12.7 and 14.4% decrease in total waiting time and number of patients who left without being seen, respectively. The results showed an average increase of 11.5% in total number of discharged patients from emergency department. PMID:28380196

Use of the SONET score to evaluate Urgent Care Center overcrowding: a prospective pilot study

PubMed Central

Wang, Hao; Robinson, Richard D; Cowden, Chad D; Gorman, Violet A; Cook, Christopher D; Gicheru, Eugene K; Schrader, Chet D; Jayswal, Rani D; Zenarosa, Nestor R

2015-01-01

Objectives To derive a tool to determine Urgent Care Center (UCC) crowding and investigate the association between different levels of UCC overcrowding and negative patient care outcomes. Design Prospective pilot study. Setting Single centre study in the USA. Participants 3565 patients who registered at UCC during the 21-day study period were included. Patients who had no overcrowding statuses estimated due to incomplete collection of operational variables at the time of registration were excluded in this study. 3139 patients were enrolled in the final data analysis. Primary and secondary outcome measures A crowding estimation tool (SONET: Severely overcrowded, Overcrowded and Not overcrowded Estimation Tool) was derived using the linear regression analysis. The average length of stay (LOS) in UCC patients and the number of left without being seen (LWBS) patients were calculated and compared under the three different levels of UCC crowding. Results Four independent operational variables could affect the UCC overcrowding score including the total number of patients, the number of results pending for patients, the number of patients in the waiting room and the longest time a patient was stationed in the waiting room. In addition, UCC overcrowding was associated with longer average LOS (not overcrowded: 133±76 min, overcrowded: 169±79 min, and severely overcrowded: 196±87 min, p<0.001) and an increased number of LWBS patients (not overcrowded: 0.28±0.69 patients, overcrowded: 0.64±0.98, and severely overcrowded: 1.00±0.97). Conclusions The overcrowding estimation tool (SONET) derived in this study might be used to determine different levels of crowding in a high volume UCC setting. It also showed that UCC overcrowding might be associated with negative patient care outcomes. PMID:25872940

Assessing the performance of centralized waiting lists for patients without a regular family physician using clinical-administrative data.

PubMed

Breton, Mylaine; Smithman, Mélanie Ann; Brousselle, Astrid; Loignon, Christine; Touati, Nassera; Dubois, Carl-Ardy; Nour, Kareen; Boivin, Antoine; Berbiche, Djamal; Roberge, Danièle

2017-01-05

With 4.6 million patients who do not have a regular family physician, Canada performs poorly compared to other OECD countries in terms of attachment to a family physician. To address this issue, several provinces have implemented centralized waiting lists to coordinate supply and demand for attachment to a family physician. Although significant resources are invested in these centralized waiting lists, no studies have measured their performance. In this article, we present a performance assessment of centralized waiting lists for unattached patients implemented in Quebec, Canada. We based our approach on the Balanced Scorecard method. A committee of decision-makers, managers, healthcare professionals, and researchers selected five indicators for the performance assessment of centralized waiting lists, including both process and outcome indicators. We analyzed and compared clinical-administrative data from 86 centralized waiting lists (GACOs) located in 14 regions in Quebec, from April 1, 2013, to March 31, 2014. During the study period, although over 150,000 patients were attached to a family physician, new requests resulted in a 30% median increase in patients on waiting lists. An inverse correlation of average strength was found between the rates of patients attached to a family physician and the proportion of vulnerable patients attached to a family physician meaning that as more patients became attached to an FP through GACOs, the proportion of vulnerable patients became smaller (r = -0.31, p < 0.005). The results showed very large performance variations both among GACOs of different regions and among those of a same region for all performance indicators. Centralized waiting lists for unattached patients in Quebec seem to be achieving their twofold objective of attaching patients to a family physician and giving priority to vulnerable patients. However, the demand for attachment seems to exceed the supply and there appears to be a tension between giving priority to vulnerable patients and attaching of a large number of patients. Results also showed heterogeneity in the performance of centralized waiting lists across Quebec. Finally, our findings suggest it is critical that similar mechanisms should use available data to identify the best strategies for reducing variations and improving performance.

Who breaches the four-hour emergency department wait time target? A retrospective analysis of 374,000 emergency department attendances between 2008 and 2013 at a type 1 emergency department in England.

PubMed

Bobrovitz, Niklas; Lasserson, Daniel S; Briggs, Adam D M

2017-11-02

The four-hour target is a key hospital emergency department performance indicator in England and one that drives the physical and organisational design of the ED. Some studies have identified time of presentation as a key factor affecting waiting times. Few studies have investigated other determinants of breaching the four-hour target. Therefore, our objective was to describe patterns of emergency department breaches of the four-hour wait time target and identify patients at highest risk of breaching. This was a retrospective cohort study of a large type 1 Emergency department at an NHS teaching hospital in Oxford, England. We analysed anonymised individual level patient data for 378,873 emergency department attendances, representing all attendances between April 2008 and April 2013. We examined patient characteristics and emergency department presentation circumstances associated with the highest likelihood of breaching the four-hour wait time target. We used 374,459 complete cases for analysis. In total, 8.3% of all patients breached the four-hour wait time target. The main determinants of patients breaching the four-hour wait time target were hour of arrival to the ED, day of the week, patient age, ED referral source, and the types of investigations patients receive (p < 0.01 for all associations). Patients most likely to breach the four-hour target were older, presented at night, presented on Monday, received multiple types of investigation in the emergency department, and were not self-referred (p < 0.01 for all associations). Patients attending from October to February had a higher odds of breaching compared to those attending from March to September (OR 1.63, 95% CI 1.59 to 1.66). There are a number of independent patient and circumstantial factors associated with the probability of breaching the four-hour ED wait time target including patient age, ED referral source, the types of investigations patients receive, as well as the hour, day, and month of arrival to the ED. Efforts to reduce the number of breaches could explore late-evening/overnight staffing, access to diagnostic tests, rapid discharge facilities, and early assessment and input on diagnostic and management strategies from a senior practitioner.

Time Spent in Indirect Nursing Care

DTIC Science & Technology

1983-09-01

divisions of labor by nursing personnel: a) direct patient care (28-35%); b) indirect care (50-62%); and c) personal time (10-15%). In comparing the... personal time (13-18%) (Kuhn, 1983). It must be noted that, in the VA data, wait time (time waiting to render care) has been subsumed under personal time...interval during the entire eight-hour shift. The first task observed being performed by the monitored person was the activity documented. 5 U. ,. 1 -V

A comparison of control modes for time-delayed remote manipulation

NASA Technical Reports Server (NTRS)

Starr, G. P.

1982-01-01

Transmission time delay in the communication channel of a manual control system is investigated. A time delay can exist in remote manipulation systems, caused by long communication distances or bandwidth limitations. Ferrell 1 conducted the first research in time-delayed manipulation using a two degree-of-freedom manipulator. His subjects, working at time delays of 1.0, 2.1, and 3.2 s, could accomplish tasks even requiring great accuracy. The subjects spontaneously adopted a pattern of moving cautiously, then waiting to see the results of their actions. In experiments with a six degree-of-freedom master-slave manipulator system and time delays of 1.0 to 6 s, Black 2 saw that subjects tried to use the move-and-wait strategy; but there were often difficulties. The subjects seemed to have a problem in holding the master arm stationary while waiting for feedback. Any undesired drifting of the master arm introduced a discrepancy between the positions of the master and slave. This discrepancy was not perceived because of the time delay. The subject would then begin his next move with an inherent error. The difficulty of effectively using the move-and-wait strategy with a master-slave manipulator suggested that rate control might be a more effective control mode with time delay.

Development of an Information Model for Kidney Transplant Wait List.

PubMed

Bircan, Hüseyin Yüce; Özçelik, Ümit; Uysal, Nida; Demirağ, Alp; Haberal, Mehmet

2015-11-01

Deceased-donor kidney transplant is unique among surgical procedures that are an urgent procedure performed in an elective population. It has not been possible to accurately determine when a given patient will be called for transplant. Patients on the active transplant list can be called for a transplant at any time. As a result, every effort must be made to optimize their health according to best practices and published clinical practice guidelines. Once the patient is placed on the transplant wait list after undergoing an initial extensive evaluation, continued surveillance is required. Therefore, we developed a kidney transplant wait list surveillance software program that alerts organ transplant coordinator on time regarding which patients need a work-up. The new designed software has a database of our waiting patients with their completed and pending controls. The software also has built-in functions to warn the responsible staff with an E-mail. If one of the controls of a recipient delayed, the software sends an automated E-mail to the staff regarding the patients delayed controls. The software is a Web application that works on any platform with a Web browser and Internet connection and allows access by multiple users. The software has been developed with NET platform. The database is SQL server. The software has the following functions: patient communication info, search, alert list, alert E-mail, control entry, and system management. As of January 2014, a total of 21 000 patients were registered on the National Kidney Transplant wait list in Turkey and the kidney transplant wait list had been expanding by 2000 to 3000 patients each year. Therefore computerized wait list programs are crucial to help to transplant centers to keep their patients up-to-date on time.

The effect of waiting: A meta-analysis of wait-list control groups in trials for tinnitus distress.

PubMed

Hesser, Hugo; Weise, Cornelia; Rief, Winfried; Andersson, Gerhard

2011-04-01

The response rates and effects of being placed on a wait-list control condition are well documented in psychiatric populations. Despite the usefulness of such estimates and the frequent use of no-treatment controls in clinical trials for tinnitus, the effect of waiting in a tinnitus trial has not been investigated systematically. The aim of the present study was to quantify the overall effect of wait-list control groups on tinnitus distress. Studies were retrieved via a systematic review of randomised controlled trials of cognitive behaviour therapy for tinnitus distress. Outcomes of psychometrically robust tinnitus-specific measures (Tinnitus Handicap Inventory, Tinnitus Questionnaire, Tinnitus Reaction Questionnaire) from wait-list control groups were quantified using meta-analytic techniques. Percentage of change and standard mean difference effect sizes were calculated using the pre and post wait period. Eleven studies involving 314 wait-list subjects with tinnitus were located. The analysis for a waiting period of 6 to 12 weeks revealed a mean decrease in scores on tinnitus-specific measures of 3% to 8%. Across studies, a statically significant small mean within-group effect size was obtained (Hedges' g=.17). The effects were moderated by methodological quality of the trial, sample characteristics (i.e., age, tinnitus duration), time of the wait-list and how diagnosis was established. Subjects in a tinnitus trial improve in tinnitus distress over a short waiting phase. The effects of waiting are highly variable and depend on the characteristics of the sample and of the trial. Copyright © 2011 Elsevier Inc. All rights reserved.

Traffic pollutant exposures experienced by pedestrians waiting to enter the U.S. at a major U.S.-Mexico border crossing

NASA Astrophysics Data System (ADS)

Galaviz, V. E.; Yost, M. G.; Simpson, C. D.; Camp, J. E.; Paulsen, M. H.; Elder, J. P.; Hoffman, L.; Flores, D.; Quintana, P. J. E.

2014-05-01

Pedestrians waiting to cross into the US from Mexico at Ports of Entry experience long wait times near idling vehicles. The near-road environment is associated with elevated pollutant levels and adverse health outcomes. This is the first exposure assessment conducted to quantify northbound pedestrian commuter exposure to traffic-related air pollutants at the U.S.-Mexico border San Ysidro Port of Entry (SYPOE). Seventy-three persons who regularly crossed the SYPOE in the pedestrian line and 18 persons who did not cross were recruited to wear personal air monitors for 24-h to measure traffic pollutants particulate matter less than 2.5 μm (PM2.5), 1-nitropyrene (1-NP) - a marker for diesel exhaust - and carbon monoxide (CO). Fixed site concentrations were collected at SYPOE and occurred during the time subjects were crossing northbound to approximate their exposure to 1-NP, ultrafine particles (UFP), PM2.5, CO, and black carbon (BC) while standing in line during their border wait. Subjects who crossed the border in pedestrian lanes had a 6-fold increase in exposure to 1-NP, a 3-fold increase in exposure to CO, and a 2-fold increase in exposure to gravimetric PM2.5, vs. non-border commuters. Univariate regression analysis for UFP (median 40,000 # cm-3) found that border wait time for vehicles explained 21% of variability and relative humidity 13%, but when modeled together neither predictor remained significant. Concentrations at the SYPOE of UFP, PM2.5, CO, and BC are similar to those in other near-roadway studies that show associations with acute and chronic adverse health effects. Although results are limited by small sample numbers, these findings warrant concern for adverse health effects experienced by pedestrian commuters waiting in a long northbound queue at SYPOE and demonstrates a potential health benefit of reduced wait times at the border.

Hidden scaling patterns and universality in written communication

NASA Astrophysics Data System (ADS)

Formentin, M.; Lovison, A.; Maritan, A.; Zanzotto, G.

2014-07-01

The temporal statistics exhibited by written correspondence appear to be media dependent, with features which have so far proven difficult to characterize. We explain the origin of these difficulties by disentangling the role of spontaneous activity from decision-based prioritizing processes in human dynamics, clocking all waiting times through each agent's "proper time" measured by activity. This unveils the same fundamental patterns in written communication across all media (letters, email, sms), with response times displaying truncated power-law behavior and average exponents near -3/2. When standard time is used, the response time probabilities are theoretically predicted to exhibit a bimodal character, which is empirically borne out by our newly collected years-long data on email. These perspectives on the temporal dynamics of human correspondence should aid in the analysis of interaction phenomena in general, including resource management, optimal pricing and routing, information sharing, and emergency handling.

Community care for the Elderly: Needs and Service Use Study (CENSUS): Who receives home care packages and what are the outcomes?

PubMed

Low, Lee-Fay; Fletcher, Jennifer; Gresham, Meredith; Brodaty, Henry

2015-09-01

Investigate factors associated with waiting times for home care packages and outcomes for care recipients and carers. Analyses of data collected every four months for 12 months from 55 community-dwelling older adults eligible for government-subsidised packaged care and their carers. Thirty of fifty-five participants were offered a package; they waited from one to 237 days. Baseline quality of life was higher for those offered a package than those not. Baseline care needs and unmet needs, neuropsychiatric symptoms, and cognitive decline did not predict offers. Package receipt compared to non-package receipt was associated with decreased carer burden over time but did not affect levels of unmet care needs, care needs or quality of life. Being offered a home care package was not based on waiting time or unmet care needs. Reforms should include a transparent system of wait listing and prioritisation. © 2014 ACOTA.

A hazard-based duration model for analyzing crossing behavior of cyclists and electric bike riders at signalized intersections.

PubMed

Yang, Xiaobao; Huan, Mei; Abdel-Aty, Mohamed; Peng, Yichuan; Gao, Ziyou

2015-01-01

This paper presents a hazard-based duration approach to investigate riders' waiting times, violation hazards, associated risk factors, and their differences between cyclists and electric bike riders at signalized intersections. A total of 2322 two-wheeled riders approaching the intersections during red light periods were observed in Beijing, China. The data were classified into censored and uncensored data to distinguish between safe crossing and red-light running behavior. The results indicated that the red-light crossing behavior of most riders was dependent on waiting time. They were inclined to terminate waiting behavior and run against the traffic light with the increase of waiting duration. Over half of the observed riders cannot endure 49s or longer. 25% of the riders can endure 97s or longer. Rider type, gender, waiting position, conformity tendency and crossing traffic volume were identified to have significant effects on riders' waiting times and violation hazards. Electric bike riders were found to be more sensitive to the external risk factors such as other riders' crossing behavior and crossing traffic volume than cyclists. Moreover, unobserved heterogeneity was examined in the proposed models. The finding of this paper can explain when and why cyclists and electric bike riders run against the red light at intersections. The results of this paper are useful for traffic design and management agencies to implement strategies to enhance the safety of riders. Copyright © 2014 Elsevier Ltd. All rights reserved.

WAITING TIMES OF QUASI-HOMOLOGOUS CORONAL MASS EJECTIONS FROM SUPER ACTIVE REGIONS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang Yuming; Liu Lijuan; Shen Chenglong

Why and how do some active regions (ARs) frequently produce coronal mass ejections (CMEs)? These are key questions for deepening our understanding of the mechanisms and processes of energy accumulation and sudden release in ARs and for improving our space weather prediction capability. Although some case studies have been performed, these questions are still far from fully answered. These issues are now being addressed statistically through an investigation of the waiting times of quasi-homologous CMEs from super ARs in solar cycle 23. It is found that the waiting times of quasi-homologous CMEs have a two-component distribution with a separation atmore » about 18 hr. The first component is a Gaussian-like distribution with a peak at about 7 hr, which indicates a tight physical connection between these quasi-homologous CMEs. The likelihood of two or more occurrences of CMEs faster than 1200 km s{sup -1} from the same AR within 18 hr is about 20%. Furthermore, the correlation analysis among CME waiting times, CME speeds, and CME occurrence rates reveals that these quantities are independent of each other, suggesting that the perturbation by preceding CMEs rather than free energy input is the direct cause of quasi-homologous CMEs. The peak waiting time of 7 hr probably characterizes the timescale of the growth of the instabilities triggered by preceding CMEs. This study uncovers some clues from a statistical perspective for us to understand quasi-homologous CMEs as well as CME-rich ARs.« less

The relationship between waiting times and 'adherence' to the Scottish Intercollegiate Guidelines Network 98 guideline in autism spectrum disorder diagnostic services in Scotland.

PubMed

McKenzie, Karen; Forsyth, Kirsty; O'Hare, Anne; McClure, Iain; Rutherford, Marion; Murray, Aja; Irvine, Linda

2016-05-01

The aim of this study was to explore the extent to which the Scottish Intercollegiate Guidelines Network 98 guidelines on the assessment and diagnosis of autism spectrum disorder were adhered to in child autism spectrum disorder diagnostic services in Scotland and whether there was a significant relationship between routine practice which more closely reflected these recommendations (increased adherence) and increased waiting times. Retrospective, cross-sectional case note analysis was applied to data from 80 case notes. Adherence ranged from a possible 0 (no adherence) to 19 (full adherence). Overall, 17/22 of the recommendations were adhered to in over 50 of the 80 cases and in 70 or more cases for 11/22 of the recommendations, with a mean adherence score of 16 (standard deviation = 1.9). No significant correlation was found between adherence and total wait time for untransformed (r = 0.15, p = 0.32) or transformed data (r = 0.12, p = 0.20). The results indicated that the assessment and diagnostic practices were consistent with the relevant Scottish Intercollegiate Guidelines Network 98 guideline recommendations. Increased adherence to the 19 included recommendations was not significantly related to increased total waiting times, indicating that the Scottish Intercollegiate Guidelines Network 98 recommendations have generally been integrated into practice, without a resultant increase in patient waits. © The Author(s) 2015.

The timing of life history events in the presence of soft disturbances.

PubMed

Bertacchi, Daniela; Zucca, Fabio; Ambrosini, Roberto

2016-01-21

We study a model for the evolutionarily stable strategy (ESS) used by biological populations for choosing the time of life-history events, such as arrival from migration and breeding. In our model we account for both intra-species competition (early individuals have a competitive advantage) and a disturbance which strikes at a random time, killing a fraction 1-p of the population. Disturbances include spells of bad weather, such as freezing or heavily raining days. It has been shown by Iwasa and Levin (1995) that when the disturbance is so strong that it kills any individual present when it strikes (hard disturbance, p=0), then the ESS is a mixed strategy (individuals choose their arrival date in an interval of possible dates, according to a certain probability distribution). In this case, individuals wait for a certain time and afterwards start arriving (or breeding) every day. In this paper we explore a biologically more realistic situation whereby the disturbance kills only a fraction of the individuals (soft disturbance, p>0). We also remove some technical assumptions which Iwasa and Levin made on the distribution of the disturbance. We prove that the ESS is still a mixed choice of times, however with respect to the case of hard disturbance, a new phenomenon arises: whenever the disturbance is soft, if the competition is sufficiently strong, the waiting time disappears and a fraction of the population arrives at the earliest day possible, while the rest will arrive throughout the whole period during which the disturbance may occur. This means that under strong competition, the payoff of early arrival balances the increased risk of being killed by the disturbance. We study the behaviour of the ESS and of the average fitness of the population, depending on the parameters involved. We also investigate how the population may be affected by climate change: namely the occurrence of more extreme weather events, which may kill a larger fraction of the population, and time shifts of the distribution of the disturbance. We show how the ESS and the average fitness change under the new climate and discuss which is the impact of the new climate on a population that still follows the old strategy. In particular, we show that, at least under some conditions, extreme weather events imply a temporary decrease of the average fitness of the population due to an increased mortality. In addition, if the population adapts to the new climate, the population may have a larger fitness. Copyright © 2015 Elsevier Ltd. All rights reserved.

Wait time management strategies for total joint replacement surgery: sustainability and unintended consequences.

PubMed

Pomey, Marie-Pascale; Clavel, Nathalie; Amar, Claudia; Sabogale-Olarte, Juan Carlos; Sanmartin, Claudia; De Coster, Carolyn; Noseworthy, Tom

2017-09-07

In Canada, long waiting times for core specialized services have consistently been identified as a key barrier to access. Governments and organizations have responded with strategies for better access management, notably for total joint replacement (TJR) of the hip and knee. While wait time management strategies (WTMS) are promising, the factors which influence their sustainable implementation at the organizational level are understudied. Consequently, this study examined organizational and systemic factors that made it possible to sustain waiting times for TJR within federally established limits and for at least 18 months or more. The research design is a multiple case study of WTMS implementation. Five cases were selected across five Canadian provinces. Three success levels were pre-defined: 1) the WTMS maintained compliance with requirements for more than 18 months; 2) the WTMS met requirements for 18 months but could not sustain the level thereafter; 3) the WTMS never met requirements. For each case, we collected documents and interviewed key informants. We analyzed systemic and organizational factors, with particular attention to governance and leadership, culture, resources, methods, and tools. We found that successful organizations had specific characteristics: 1) management of the whole care continuum, 2) strong clinical leadership; 3) dedicated committees to coordinate and sustain strategy; 4) a culture based on trust and innovation. All strategies led to relatively similar unintended consequences. The main negative consequence was an initial increase in waiting times for TJR and the main positive consequence was operational enhancement of other areas of specialization based on the TJR model. This study highlights important differences in factors which help to achieve and sustain waiting times. To be sustainable, a WTMS needs to generate greater synergies between contextual-level strategy (provincial or regional) and organizational objectives and constraints. Managers at the organizational level should be vigilant with regard to unintended consequences that a WTMS in one area can have for other areas of care. A more systemic approach to sustainability can help avoid or mitigate undesirable unintended consequences.

Pre- Versus Posttransplant Treatment of Hepatitis C Virus With Direct-Acting Antivirals in Liver Transplant Recipients: More Issues to be Solved.

PubMed

Abdelqader, Abdelhai; Kabacam, Gokhan; Woreta, Tinsay A; Hamilton, James P; Luu, Harry; Al Khalloufi, Kawtar; Saberi, Behnam; Philosophe, Benjamin; Cameron, Andrew M; Gurakar, Ahmet

2017-02-01

Our goal was to investigate wait times related to hepatitis C virus treatment with direct acting antivirals before versus after liver transplant at a single center as well as wait times for insurance approval for preemptive treatment with these agents after liver transplant. We retrospectively evaluated hepatitis C virus infections in transplant recipients of deceased liver donations in 2014 and 2015. Demographics, hepatocellular carcinoma incidence, Model for End-Stage Liver Disease scores, and transplant wait times were compared between patients treated before or after liver transplant. Wait times to approval of direct-acting antiviral treatment were evaluated in those untreated before transplant. During our study period, of 67 deceased-donor liver transplants, 21 patients received hepatitis C virus treatment pretransplant (treated group) and 46 patients were not treated pretransplant (untreated group). Twenty-five patients in the untreated group received hepatitis C virus-positive donations, with all in this group treated with direct-acting antivirals. We found no statistically significant differences regarding age, sex, race, donation after cardiac death, or incidence of hepatocellular carcinoma between groups. The treated group had a longer median wait time (287 vs 172 days; P = .02). Twelve of the 46 untreated patients (26.1%) developed biopsy-proven hepatitis C virus-related relapse (median 87 days; range, 55-383 days). Preemptive direct-acting antiviral therapy was initiated at a median of 81 days in the untreated group. Although treatment of hepatitis C virus before liver transplant is an attractive option to eliminate the risk of complications, it can limit the donor pool for recipients to uninfected donors, significantly increasing wait times in regions with large hepatitis C virus-positive donor pools. Allocation of Model for End-Stage Liver Disease score was not different between the treated and untreated groups. Insurance companies should revise their policies for rapid approval of preemptive direct-acting antiviral treatment after liver transplant.

Constructing an episode of care from acute hospitalization records for studying effects of timing of hip fracture surgery.

PubMed

Sheehan, Katie J; Sobolev, Boris; Guy, Pierre; Bohm, Eric; Hellsten, Erik; Sutherland, Jason M; Kuramoto, Lisa; Jaglal, Susan

2016-02-01

Episodes of care defined by the event of hip fracture surgery are widely used for the assessment of surgical wait times and outcomes. However, this approach does not consider nonoperative deaths, implying that survival time begins at the time of procedure. This approach makes treatment effect implicitly conditional on surviving to treatment. The purpose of this article is to describe a novel conceptual framework for constructing an episode of hip fracture care to fully evaluate the incidence of adverse events related to time after admission for hip fracture. This admission-based approach enables the assessment of the full harm of delay by including deaths while waiting for surgery, not just deaths after surgery. Some patients wait until their conditions are optimized for surgery, whereas others have to wait until surgical service becomes available. We provide definitions, linkage rules, and algorithms to capture all hip fracture patients and events other than surgery. Finally, we discuss data elements for stratifying patients according to administrative factors for delay to allow researchers and policymakers to determine who will benefit most from expedited access to surgery. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

[Patients' satisfaction and waiting time in oncology day care centers in Champagne-Ardenne].

PubMed

Debreuve-Theresette, A; Jovenin, N; Stona, A C; Kraïem-Leleu, M; Burde, F; Parent, D; Hettler, D; Rey, J B

2015-12-01

Quality of life of patients suffering from cancer may be influenced by the way healthcare is organized and by patient experiences. Nowadays, chemotherapy is often provided in day care centers. This study aimed to assess patient waiting time and satisfaction in oncology day care centers in Champagne-Ardenne, France. This cross-sectional survey involved all patients receiving ambulatory chemotherapy during a one-week period in day care centers of Champagne-Ardenne public and private healthcare institutions participating in the study. Sociodemographic, medical and outpatient data were collected. Patient satisfaction was measured using the Out-Patsat35 questionnaire. Eleven (out of 16) oncology day care centers and 441 patients participated in the study. Most of the patients were women (n=252, 57.1%) and the mean age was 61±12 years. The mean satisfaction score was 82±14 (out of 100) and the mean waiting time between the assigned appointment time and administration of chemotherapy was 97±60 min. This study has shown that waiting times are important. However, patients are satisfied with the healthcare organization, especially regarding nursing support. Early preparation of chemotherapy could improve these parameters. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Managing patients' wait time in specialist out-patient clinic using real-time data from existing queue management and ADT systems.

PubMed

Ju, John Chen; Gan, Soon Ann; Tan Siew Wee, Justine; Huang Yuchi, Peter; Mei Mei, Chan; Wong Mei Mei, Sharon; Fong, Kam Weng

2013-01-01

In major cancer centers, heavy patients load and multiple registration stations could cause significant wait time, and can be result in patient complains. Real-time patient journey data and visual display are useful tools in hospital patient queue management. This paper demonstrates how we capture patient queue data without deploying any tracing devices; and how to convert data into useful patient journey information to understand where interventions are likely to be most effective. During our system development, remarkable effort has been spent on resolving data discrepancy and balancing between accuracy and system performances. A web-based dashboard to display real-time information and a framework for data analysis were also developed to facilitate our clinics' operation. Result shows our system could eliminate more than 95% of data capturing errors and has improved patient wait time data accuracy since it was deployed.

Comparison of public and private bariatric surgery services in Canada.

PubMed

Martin, Allan R; Klemensberg, Jason; Klein, Laz V; Urbach, David; Bell, Chaim M

2011-06-01

Surgical treatment of obesity is cost-effective and improves life expectancy. Roux-en-Y gastric bypass (RYGB) and adjustable gastric banding (AGB) are dominant surgical techniques, but RYGB is the only publicly insured procedure in all Canadian provinces. Private clinics currently offer AGB with minimal wait times. We sought to compare RYGB in public facilities with AGB in private clinics in terms of cost, wait times and certain aspects of patient care. We conducted telephone interviews of all bariatric surgery providers across Canada (100% response rate). We asked about various aspects of care, such as wait time, cost, pre- and postoperative care and surgeon experience. The median out-of-pocket cost for AGB at private facilities is $16,000 (range $13,160-$18,375). Private clinics have much shorter wait times for AGB than public facilities do for RYGB (1 v. 21 mo, p < 0.001). Private clinics provide significantly fewer preoperative visits with multidisciplinary health professionals (2.7 v. 4.3, p = 0.045), and 5 of 12 (42%) private clinics conduct AGB surgeries without on-site critical care for high-risk (based on the respondents' definitions) patients. Private clinics performing AGB offer short wait times, but the cost is high. We found a great deal of variation between pre- and postoperative care among bariatric surgery facilities, and in some cases patient care appears to be less comprehensive. Our findings suggest that further research on obesity treatment is needed to inform policy so that all Canadians can have equitable and timely access to proven, evidence-based care.

Reducing Bottlenecks to Improve the Efficiency of the Lung Cancer Care Delivery Process: A Process Engineering Modeling Approach to Patient-Centered Care.

PubMed

Ju, Feng; Lee, Hyo Kyung; Yu, Xinhua; Faris, Nicholas R; Rugless, Fedoria; Jiang, Shan; Li, Jingshan; Osarogiagbon, Raymond U

2017-12-01

The process of lung cancer care from initial lesion detection to treatment is complex, involving multiple steps, each introducing the potential for substantial delays. Identifying the steps with the greatest delays enables a focused effort to improve the timeliness of care-delivery, without sacrificing quality. We retrospectively reviewed clinical events from initial detection, through histologic diagnosis, radiologic and invasive staging, and medical clearance, to surgery for all patients who had an attempted resection of a suspected lung cancer in a community healthcare system. We used a computer process modeling approach to evaluate delays in care delivery, in order to identify potential 'bottlenecks' in waiting time, the reduction of which could produce greater care efficiency. We also conducted 'what-if' analyses to predict the relative impact of simulated changes in the care delivery process to determine the most efficient pathways to surgery. The waiting time between radiologic lesion detection and diagnostic biopsy, and the waiting time from radiologic staging to surgery were the two most critical bottlenecks impeding efficient care delivery (more than 3 times larger compared to reducing other waiting times). Additionally, instituting surgical consultation prior to cardiac consultation for medical clearance and decreasing the waiting time between CT scans and diagnostic biopsies, were potentially the most impactful measures to reduce care delays before surgery. Rigorous computer simulation modeling, using clinical data, can provide useful information to identify areas for improving the efficiency of care delivery by process engineering, for patients who receive surgery for lung cancer.

Learning to wait: A laboratory investigation

USGS Publications Warehouse

Oprea, R.; Friedman, D.; Anderson, S.T.

2009-01-01

Human subjects decide when to sink a fixed cost C to seize an irreversible investment opportunity whose value V is governed by Brownian motion. The optimal policy is to invest when V first crosses a threshold V* = (1 + w*) C, where the wait option premium w* depends on drift, volatility, and expiration hazard parameters. Subjects in the Low w* treatment on average invest at values quite close to optimum. Subjects in the two Medium and the High w* treatments invested at values below optimum, but with the predicted ordering, and values approached the optimum by the last block of 20 periods. ?? 2009 The Review of Economic Studies Limited.

Factors affecting medication-order processing time.

PubMed

Beaman, M A; Kotzan, J A

1982-11-01

The factors affecting medication-order processing time at one hospital were studied. The order processing time was determined by directly observing the time to process randomly selected new drug orders on all three work shifts during two one-week periods. An order could list more than one drug for an individual patient. The observer recorded the nature, location, and cost of the drugs ordered, as well as the time to process the order. The time and type of interruptions also were noted. The time to process a drug order was classified as six dependent variables: (1) total time, (2) work time, (3) check time, (4) waiting time I--time from arrival on the dumbwaiter until work was initiated, (5) waiting time II--time between completion of the work and initiation of checking, and (6) waiting time III--time after the check was completed until the order left on the dumbwaiter. The significant predictors of each of the six dependent variables were determined using stepwise multiple regression. The total time to process a prescription order was 58.33 +/- 48.72 minutes; the urgency status of the order was the only significant determinant of total time. Urgency status also significantly predicted the three waiting-time variables. Interruptions and the number of drugs on the order were significant determinants of work time and check time. Each telephone interruption increased the work time by 1.72 minutes. While the results of this study cannot be generalized to other institutions, pharmacy managers can use the method of determining factors that affect medication-order processing time to identify problem areas in their institutions.

[Morbidity and hospital cost reduction in cardiac surgery using a presurgery ambulatory strategy].

PubMed

Ávila-Vanzzini, Nydia; Kuri-Alfaro, Jorge; Rodríguez-Chávez, Laura Leticia; Meléndez-Ramírez, Gabriela; Trevethan-Cravioto, Sergio; Quiroz-Martínez, Alejandro; Herrera-Bello, Héctor; Herrera-Alarcón, Valentín; Martínez-Hernández, Humberto; Martínez-Ríos, Marco Antonio

2010-01-01

In our hospital, the patients that need an elective cardiac surgery are admitted through the admission department on the basis of a waiting list. Since 1999, a fast track to hospitalization program has existed in the National Institute of Cardiology Ignacio Chavez for patients with low surgical risk. Later, in 2004, this program was extended to patients to moderate risk, based on rules accepted worldwide, and our own experience. 1) To compare two ways of admission that are used currently: fast track to hospitalization, against admission department waiting list. We compared major events: death or events that increased the hospital stay by more than 14 days (infections, alterations of rhythm and conduction, reoperations and others), 2) To compare the days of hospitalization and money spent by the hospital. We conformed 2 groups of 347 patients. The admission department waiting list group was admitted before doing their preoperative studies, which is the customary form for hospitalization by our admissions department, while the group of fast track to hospitalization was obligated to have their laboratory exams complete and any other diseases resolved or controlled previously. The monetary cost per patient for the hospital was calculated based on the patient's socioeconomic classification. Student t test was conduncted on independent samples and numerical variables, and Chi square for categorical variables. We considered a p <0.05 to be statistically significant. In average in both groups, 75% underwent valve operation and 25% underwent congenital heart disease repair, 49% were women, age 47 15 years. The comparison between the groups fast track to hospitalization and admission department waiting list group were: Mortality: 4.3% vs. 5.8% (p=0.38). Major events that needed a hospital stay of more than 14 days: 73 vs. 97 cases respectively (p = 0.032). Infections: 22 vs. 29 (p = 0.14). Mediastinitis: 2 vs. 9 respectively (p = 0.033). In-hospital stay: were 11 days vs. 20 days (p = 0.0001), the biggest difference was found in the pre-surgical time: 2 vs. 9 days respectively (p = 0.0001). The postoperative morbidity in general was lower in fast track to hospitalization group, and the mediastinitis showed a decrease with statistical significance. The time interval between hospital admission an operation in fast track to hospitalization group was significantly shorter. We believe that the decrease in the exposure time to nosocomial pathogens present in the hospital environment was directly related to the low number of mediastinitis. Finally, the decrease in time of hospital stay represented a 32% monetary savings for the hospital.

Toward a joint health and disease management program. Toronto hospitals partner to provide system leadership.

PubMed

Macleod, Anne Marie; Gollish, Jeffrey; Kennedy, Deborah; McGlasson, Rhona; Waddell, James

2009-01-01

The Joint Health and Disease Management Program in the Toronto Central Local Health Integration Network (TC LHIN) is envisioned as a comprehensive model of care for patients with hip and knee arthritis. It includes access to assessment services, education, self-management programs and other treatment programs, including specialist care as needed. As the first phase of this program, the hospitals in TC LHIN implemented a Hip and Knee Replacement Program to focus on improving access and quality of care, coordinating services and measuring wait times for patients waiting for hip or knee replacement surgery. The program involves healthcare providers, consumers and constituent hospitals within TC LHIN. The approach used for this program involved a definition of governance structure, broad stakeholder engagement to design program elements and plans for implementation and communication to ensure sustainability. The program and approach were designed to provide a model that is transferrable in its elements or its entirety to other patient populations and programs. Success has been achieved in creating a single wait list, developing technology to support referral management and wait time reporting, contributing to significant reductions in waits for timely assessment and treatment, building human resource capacity and improving patient and referring physician satisfaction with coordination of care.

The Preemptive Stocker Dispatching Rule of Automatic Material Handling System in 300 mm Semiconductor Manufacturing Factories

NASA Astrophysics Data System (ADS)

Wang, C. N.; Lin, H. S.; Hsu, H. P.; Wang, Yen-Hui; Chang, Y. P.

2016-04-01

The integrated circuit (IC) manufacturing industry is one of the biggest output industries in this century. The 300mm wafer fabs is the major fab size of this industry. The automatic material handling system (AMHS) has become one of the most concerned issues among semiconductor manufacturers. The major lot delivery of 300mm fabs is used overhead hoist transport (OHT). The traffic jams are happened frequently due to the wide variety of products and big amount of OHTs moving in the fabs. The purpose of this study is to enhance the delivery performance of automatic material handling and reduce the delay and waiting time of product transportation for both hot lots and normal lots. Therefore, this study proposes an effective OHT dispatching rule: preemptive stocker dispatching (PSD). Simulation experiments are conducted and one of the best differentiated preemptive rule, differentiated preemptive dispatching (DPD), is used for comparison. Compared with DPD, The results indicated that PSD rule can reduce average variable delivery time of normal lots by 13.15%, decreasing average variable delivery time of hot lots by 17.67%. Thus, the PSD rule can effectively reduce the delivery time and enhance productivity in 300 mm wafer fabs.

A Streamlined Western Blot Exercise: An Efficient and Greener Approach in the Laboratory Classroom

ERIC Educational Resources Information Center

Ness, Traci L.; Robinson, Rebekah L.; Mojadedi, Wais; Peavy, Lydia; Weiland, Mitch H.

2015-01-01

SDS-PAGE and western blotting are two commonly taught protein detection techniques in biochemistry and molecular biology laboratory classrooms. A pitfall associated with incorporating these techniques into the laboratory is the significant wait times that do not allow students to obtain timely results. The waiting associated with SDS-PAGE comes…

Improving Efficiency and Quality of the Children's ASD Diagnostic Pathway: Lessons Learned from Practice

ERIC Educational Resources Information Center

Rutherford, Marion; Burns, Morag; Gray, Duncan; Bremner, Lynne; Clegg, Sarah; Russell, Lucy; Smith, Charlie; O'Hare, Anne

2018-01-01

The 'autism diagnosis crisis' and long waiting times for assessment are as yet unresolved, leading to undue stress and limiting access to effective support. There is therefore a significant need for evidence to support practitioners in the development of efficient services, delivering acceptable waiting times and effectively meeting guideline…

A modelling framework for mitigating customers' waiting time at a vehicle inspection centre

NASA Astrophysics Data System (ADS)

Ahmad, Norazura; Abidin, Norhaslinda Zainal; Ilyas, Khibtiyah; Abduljabbar, Waleed Khalid

2017-11-01

In Malaysia, an agency that is entrusted by the Government to perform mandatory vehicle inspection for public, commercial and private vehicles, receive many customers daily. Often complaints of problems received from the customers are associated with waiting time that leads to lost of business and dissatisfied customers. To address this issue, we propose a framework for modelling a vehicle inspection system using an integration of simulation and optimization approaches. The strengths of simulation and optimization are reviewed briefly that is hoped to reveal the synergy between the established methods in determining an appropriate customer's waiting time for inspection at a vehicle inspection centre. Relevant concepts and preliminary results are also presented and discussed in this paper.

The effects of a lean transition on process times, patients and employees.

PubMed

Simons, Pascale; Backes, Huub; Bergs, Jochen; Emans, Davy; Johannesma, Madelon; Jacobs, Maria; Marneffe, Wim; Vandijck, Dominique

2017-03-13

Purpose Treatment delays must be avoided, especially in oncology, to assure sustainable high-quality health care and increase the odds of survival. The purpose of this paper is to hypothesize that waiting times would decrease and patients and employees would benefit, when specific lean interventions are incorporated in an organizational improvement approach. Design/methodology/approach In 2013, 15 lean interventions were initiated to improve flow in a single radiotherapy institute. Process/waiting times, patient satisfaction, safety, employee satisfaction, and absenteeism were evaluated using a mixed methods methodology (2010-2014). Data from databases, surveys, and interviews were analyzed by time series analysis, χ 2 , multi-level regression, and t-tests. Findings Median waiting/process times improved from 20.2 days in 2012 to 16.3 days in 2014 ( p<0.001). The percentage of palliative patients for which waiting times had exceeded Dutch national norms (ten days) improved from 35 (six months in 2012: pre-intervention) to 16 percent (six months in 2013-2014: post-intervention; p<0.01), and the percentage exceeding national objectives (seven days) from 22 to 17 percent ( p=0.44). For curative patients, exceeding of norms (28 days) improved from 17 (2012) to 8 percent (2013-2014: p=0.05), and for the objectives (21 days) from 18 to 10 percent ( p<0.01). Reported safety incidents decreased 47 percent from 2009 to 2014, whereas safety culture, awareness, and intention to solve problems improved. Employee satisfaction improved slightly, and absenteeism decreased from 4.6 (2010) to 2.7 percent (2014; p<0.001). Originality/value Combining specific lean interventions with an organizational improvement approach improved waiting times, patient safety, employee satisfaction, and absenteeism on the short term. Continuing evaluation of effects should study the improvements sustainability.

[Relevance of five core aspects of the pre-anesthesia visit: results of a patient survey].

PubMed

Aust, H; Eberhart, L H J; Kalmus, G; Zoremba, M; Rüsch, D

2011-05-01

Due to a variety of reasons (e.g. increase in outpatient surgery and legal restrictions related to working hours) it has become increasingly more difficult to have the pre-anesthesia visit and the anesthesia carried out by the same anesthetist. In the light of these organizational changes as well as increasing economical pressure it has become common practice to implement pre-anesthesia assessment clinics. It is unclear, however, if these changes in anesthetic patient care respect patient needs. By means of a survey using the willingness to pay method, the relative significance of five quality aspects (location of pre-anesthesia visit, waiting time, patient-physician relationship, use of multimedia and ambience) were studied. Participation during a 12-month study period was on a voluntary basis. Of the 1,058 questionnaires, 1,014 were eligible for analysis. A pre-anesthesia visit performed by the anesthetist who would deliver anesthesia was the most important aspect for almost two thirds (624 out of 1,014) of the patients with on average more than one third of the money available spent on this item. Waiting time was the second most important factor with about one third of the patients rating this item as the most relevant factor and on average approximately one quarter of the total money available spent on it. Location of the pre-anesthesia visit, use of multimedia and ambience were considered least important. The order of these preferences was regardless of age and gender of subjects. However, there was a trend to age and gender-specific differences concerning the amount of money spent on these five items. For instance, with increasing age, patient-physician relationship and location of the pre-anesthesia visit become more important. These results suggest that the integration of a pre-anesthesia assessment clinic in anesthetic patient care is not favorable from the patients' point of view because getting to know the anesthetist who will deliver anesthesia is of paramount importance to most patients. In cases where a pre-anesthetic assessment clinic is indispensable, other measures to build up confidence compensating for the lack of personal patient-physician relationship should be developed. In this respect, the promotion of a corporate identity of the whole anesthesia department may be beneficial. Furthermore, keeping the waiting time as short as possible should be a high priority as this item was rated the second most important factor.

Efficient priority queueing routing strategy on networks of mobile agents

NASA Astrophysics Data System (ADS)

Wu, Gan-Hua; Yang, Hui-Jie; Pan, Jia-Hui

2018-03-01

As a consequence of their practical implications for communications networks, traffic dynamics on complex networks have recently captivated researchers. Previous routing strategies for improving transport efficiency have paid little attention to the orders in which the packets should be forwarded, just simply used first-in-first-out queue discipline. Here, we apply a priority queuing discipline and propose a shortest-distance-first routing strategy on networks of mobile agents. Numerical experiments reveal that the proposed scheme remarkably improves both the network throughput and the packet arrival rate and reduces both the average traveling time and the rate of waiting time to traveling time. Moreover, we find that the network capacity increases with an increase in both the communication radius and the number of agents. Our work may be helpful for the design of routing strategies on networks of mobile agents.

Waiting for transplant: physical, psychosocial, and nutritional status considerations for pediatric candidates and implications for care.

PubMed

Anthony, Samantha J; Annunziato, Rachel A; Fairey, Elise; Kelly, Vicky L; So, Stephanie; Wray, Jo

2014-08-01

The waiting period for an organ transplant has been described as a time of tremendous uncertainty and vulnerability, posing unique challenges and stressors for pediatric transplant candidates and their families. It has been identified as the most stressful stage of the transplant journey, yet little attention has been given to the physical, psychological, or social impact of the waiting period in the literature. In this review, we discuss the physical, nutritional, and psychosocial implications of the waiting period for child and adolescent transplant candidates and the impact on their parents and siblings. We identify areas for future research and provide recommendations for clinical practice to support children, adolescents, and families during the waiting period. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Improving Aircraft Refueling Procedures at Naval Air Station Oceana

DTIC Science & Technology

2012-06-01

Station (NAS) Oceana, VA, using aircraft waiting time for fuel as a measure of performance. We develop a computer-assisted discrete-event simulation to...Station (NAS) Oceana, VA, using aircraft waiting time for fuel as a measure of performance. We develop a computer-assisted discrete-event simulation...server queue, with general interarrival and service time distributions gpm Gallons per minute JDK Java development kit M/M/1 Single-server queue

Self-organized criticality in type I X-ray bursts

NASA Astrophysics Data System (ADS)

Wang, J. S.; Wang, F. Y.; Dai, Z. G.

2017-11-01

Type I X-ray bursts in a low-mass X-ray binary are caused by unstable nuclear burning of accreted materials. Semi-analytical and numerical studies of unstable nuclear burning have successfully reproduced the partial properties of this kind of burst. However, some other properties (e.g. the waiting time) are not well explained. In this paper, we find that the probability distributions of fluence, peak count, rise time, duration and waiting time can be described as power-law-like distributions. This indicates that type I X-ray bursts may be governed by a self-organized criticality (SOC) process. The power-law index of the waiting time distribution (WTD) is around -1, which is not predicted by any current waiting time model. We propose a physical burst rate model, in which the mean occurrence rate is inversely proportional to time: λ ∝ t-1. In this case, the WTD is explained well by a non-stationary Poisson process within the SOC theory. In this theory, the burst size is also predicted to follow a power-law distribution, which requires that the emission area covers only part of the neutron star surface. Furthermore, we find that the WTDs of some astrophysical phenomena can also be described by similar occurrence rate models.

Two Hour Evaluation and Referral Model for Shorter Turnaround Times in the emergency department.

PubMed

Burke, John A; Greenslade, Jaimi; Chabrowska, Jadwiga; Greenslade, Katherine; Jones, Sally; Montana, Jacqueline; Bell, Anthony; O'Connor, Alan

2017-06-01

The objective of this study was to assess the implementation of a novel ED model of care, which combines clinical streaming, team-based assessment and early senior consultation to reduce length of stay. A pre-post-intervention study was used to compare ED performance following an extensive clinical redesign programme. Clinical teams and work sequences were reconfigured to promote the role of the staff specialist, with a focus on earlier decisions regarding disposition. Primary outcome measures were ED length of stay and National Emergency Access Target (NEAT) compliance. Secondary outcomes included referral and workup times, wait times by triage category, ambulance offload times, ward discharges and unit transfers within 24 h of admission, representation within 48 h, and Medical Emergency Response Team (MERT) calls within 24 h of admission. Two seasonally matched 26 week intervals were compared with adjustment for demographics, triage category and arrival by ambulance. Overall, there was an 18.4% rise in NEAT performance (95% confidence interval (CI): 17.7-19.1) while ED length of stay decreased by a total of 86.8 min (95% CI: 83.6-90.1). Time series analysis did not suggest any preexisting trends to explain these results. The average time to referral decreased by 74.7 min (95% CI: 69.8-79.6) and waiting times decreased across all triage categories. Rates of MERT activation and unplanned representation were unchanged. A facilitated team leader role for senior doctors can help to reduce length of stay by via early disposition, without significant risks to the patient. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Impact of a psychiatric unit's daily discharge rates on emergency department flow.

PubMed

Bastiampillai, Tarun; Schrader, Geoffrey; Dhillon, Rohan; Strobel, Jörg; Bidargaddi, Niranjan

2012-04-01

To investigate relationships between time spent in the emergency department (ED) in patients requiring admission to the psychiatric ward, the day of the week of presentation and the daily number of discharges from the psychiatric ward. Retrospective analysis of patient flow as a function of day of week, time of day (a.m., p.m.), number of patients requiring admission and number of ward discharges over a one-year period, for all mental health related presentations to the ED of the Queen Elizabeth Hospital in Adelaide, South Australia, before their admission to the psychiatric inpatient facility. The time spent by patients in the ED waiting for admission to the psychiatric ward was significantly greater on weekends. There were significantly fewer discharges from the psychiatric ward during weekends compared with weekdays. The average time spent by patients in the ED requiring admission to the psychiatric ward for those days when there were vacant beds was 17.9 hours (SD=14.5). More people presented to the ED with a psychiatric diagnosis in the afternoons. There was a significant inverse correlation between the time spent by patients in the ED requiring admission to the psychiatric ward per day and the number of discharges from the psychiatric ward per day. These findings demonstrate that patient flow is significantly slower on weekends because of fewer discharges from the ward, leading to longer times spent in the ED before ward transfer. Waiting times in the ED were very substantially greater than the proposed 4-hour target even when vacant beds were available, raising considerable doubt about that target being realistic for psychiatric patients.

Strategic attention deployment for delay of gratification in working and waiting situations.

PubMed

Peake, Philip K; Mischel, Walter; Hebl, Michelle

2002-03-01

Two studies examined whether the detrimental effects of attention to rewards on delay of gratification in waiting situations holds-or reverses-in working situations. In Study 1, preschoolers waited or worked for desired delayed rewards. Delay times increased when children worked in the presence of rewards but, as predicted, this increase was due to the distraction provided by the work itself. not because attention to rewards motivated children to sustain work. Analysis of spontaneous attention deployment showed that attending to rewards reduces delay time regardless of the working or waiting nature of the task. Fixing attention on rewards was a particularly detrimental strategy regardless of the type of task. Study 2 showed that when the work is not engaging, however, attention to rewards can motivate instrumental work and facilitate delay of gratification as long as attention deployment does not become fixed on the rewards.

The fully actuated traffic control problem solved by global optimization and complementarity

NASA Astrophysics Data System (ADS)

Ribeiro, Isabel M.; de Lurdes de Oliveira Simões, Maria

2016-02-01

Global optimization and complementarity are used to determine the signal timing for fully actuated traffic control, regarding effective green and red times on each cycle. The average values of these parameters can be used to estimate the control delay of vehicles. In this article, a two-phase queuing system for a signalized intersection is outlined, based on the principle of minimization of the total waiting time for the vehicles. The underlying model results in a linear program with linear complementarity constraints, solved by a sequential complementarity algorithm. Departure rates of vehicles during green and yellow periods were treated as deterministic, while arrival rates of vehicles were assumed to follow a Poisson distribution. Several traffic scenarios were created and solved. The numerical results reveal that it is possible to use global optimization and complementarity over a reasonable number of cycles and determine with efficiency effective green and red times for a signalized intersection.

Simulation and Analysis of EXPRESS Run Frequency

DTIC Science & Technology

2013-12-01

indicator, Customer Wait Time ( CWT ), is a measure of total wait time for a customer from the time they submit a need until it is fulfilled...Department of Defense 2000). MICAP hours is a special subset of CWT reserved for requirements that represent a mission capability need (i.e. an aircraft is...performance is tracked by total CWT and MICAP days, which are convertible to hours by multiplying by 24. CWT is tracked by measuring the total time

Improving the quality of palliative care for ambulatory patients with lung cancer

PubMed Central

von Plessen, Christian; Aslaksen, Aslak

2005-01-01

Problem Most patients with advanced lung cancer currently receive much of their health care, including chemotherapy, as outpatients. Patients have to deal with the complex and time consuming logistics of ambulatory cancer care. At the same time, members of staff often waste considerable time and energy in organisational aspects of care that could be better used in direct interaction with patients. Design Quality improvement study using direct observation and run and flow charts, and focus group meetings with patients and families regarding perceptions of the clinic and with staff regarding satisfaction with working conditions. Setting Thoracic oncology outpatient clinic at a Norwegian university hospital where patients receive chemotherapy and complementary palliative care. Key measures for improvement Waiting time and time wasted during consultations; calmer working situation at the clinic; satisfaction among patients. Strategies for change Rescheduled patients' appointments, automated retrieval of blood test results, systematic reporting in patients' files, design of an information leaflet, and refurnishing of the waiting area at the clinic. Effects of change Interventions resulted in increased satisfaction for patients and staff, reduced waiting time, and reduced variability of waiting time. Lessons learnt Direct observation, focus groups, questionnaires on patients' satisfaction, and measurement of process time were useful in systematically improving care in this outpatient clinic. The description of this experience can serve as an example for the improvement of a microsystem, particularly in other settings with similar problems. PMID:15933354

Mary Budd Rowe: a storyteller of science

NASA Astrophysics Data System (ADS)

Bianchini, Julie A.

2008-12-01

This article examines Mary Budd Rowe's groundbreaking and far-reaching contributions to science education. Rowe is best known for her research on wait-time: the idea that teachers can improve the quality and length of classroom discussions by waiting at least 3 s before and after student responses. Her wait-time research grew from and helped inform her staunch advocacy of science education as inquiry; Rowe saw wonder and excitement as central to the teaching and learning of science. She spent much of her professional life designing professional development experiences and innovative curriculum materials to help teachers, particularly elementary school teachers, enact inquiry in their classrooms.

Act-and-wait time-delayed feedback control of autonomous systems

NASA Astrophysics Data System (ADS)

Pyragas, Viktoras; Pyragas, Kestutis

2018-02-01

Recently an act-and-wait modification of time-delayed feedback control has been proposed for the stabilization of unstable periodic orbits in nonautonomous dynamical systems (Pyragas and Pyragas, 2016 [30]). The modification implies a periodic switching of the feedback gain and makes the closed-loop system finite-dimensional. Here we extend this modification to autonomous systems. In order to keep constant the phase difference between the controlled orbit and the act-and-wait switching function an additional small-amplitude periodic perturbation is introduced. The algorithm can stabilize periodic orbits with an odd number of real unstable Floquet exponents using a simple single-input single-output constraint control.

Optimizing the admission time of outbound trucks entering a cross-dock with uniform arrival time by considering a queuing model

NASA Astrophysics Data System (ADS)

Motaghedi-Larijani, Arash; Aminnayeri, Majid

2017-03-01

Cross-docking is a supply-chain strategy that can reduce transportation and inventory costs. This study is motivated by a fruit and vegetable distribution centre in Tehran, which has cross-docks and a limited time to admit outbound trucks. In this article, outbound trucks are assumed to arrive at the cross-dock with a single outbound door with a uniform distribution (0,L). The total number of assigned trucks is constant and the loading time is fixed. A queuing model is modified for this situation and the expected waiting time of each customer is calculated. Then, a curve for the waiting time is calculated. Finally, the length of window time L is optimized to minimize the total cost, which includes the waiting time of the trucks and the admission cost of the cross-dock. Some illustrative examples of cross-docking are presented and solved using the proposed method.

Quality of life in patients with unilateral vestibular schwannoma on wait and see - strategy.

PubMed

Klersy, P C; Arlt, F; Hofer, M; Meixensberger, J

2018-01-01

A 'wait and see' strategy is an option when managing patients with small vestibular schwannomas (VS). A risk of growth and worsening of hearing may influence a patient's daily quality of life (QOL). Therefore, the present study focused on QOL parameters in patients who are on a 'wait and see' strategy following magnetic resonance imaging (MRI)-based diagnosis of small unilateral VS. Sixty-five patients (mean age 64.4 years; male:female, 32:33) who suffered from a small unilateral VS (9.34 mm, range 1.5-23 mm) between 2013 and 2016 were included in a prospective single center study. During follow-up, in addition to clinical and neurological examinations and MRI imaging, all patients answered the Short Form 36 questionnaire once to characterize QOL. Additionally, the severity of tinnitus was determined by the Mini-TQ-12 from Hiller and Goebel. It was found during follow-up that there was no lowering of QOL in patients with small VS who were on 'wait and see' strategy compared with Germany's general population and no tumor growth was detected in 53 patients (81.5%). Patients with a tumor diameter larger than 10 mm did not suffer from stronger tinnitus, vertigo or unsteadiness than the group with an average tumor size, which is smaller than 10 mm. Sixty-two patients (95.4%) showed ipsilateral hearing loss and three of these reported deafness (4.6%). Severe vertigo or tinnitus is connected with lower levels of mental component scale and physical component scale. These findings reduced the QOL (p = 0.05). In our series, QOL is not influenced in patients with unilateral untreated small VS in comparison to Germany's general population. This is helpful information when advising patients during follow-up and finding out the optimal timing of individual treatment.

Effect of a Brief Video Intervention on Incident Infection among Patients Attending Sexually Transmitted Disease Clinics

PubMed Central

Warner, Lee; Klausner, Jeffrey D; Rietmeijer, Cornelis A; Malotte, C. Kevin; O'Donnell, Lydia; Margolis, Andrew D; Greenwood, Gregory L; Richardson, Doug; Vrungos, Shelley; O'Donnell, Carl R; Borkowf, Craig B

2008-01-01

Background Sexually transmitted disease (STD) prevention remains a public health priority. Simple, practical interventions to reduce STD incidence that can be easily and inexpensively administered in high-volume clinical settings are needed. We evaluated whether a brief video, which contained STD prevention messages targeted to all patients in the waiting room, reduced acquisition of new infections after that clinic visit. Methods and Findings In a controlled trial among patients attending three publicly funded STD clinics (one in each of three US cities) from December 2003 to August 2005, all patients (n = 38,635) were systematically assigned to either a theory-based 23-min video depicting couples overcoming barriers to safer sexual behaviors, or the standard waiting room environment. Condition assignment alternated every 4 wk and was determined by which condition (intervention or control) was in place in the clinic waiting room during the patient's first visit within the study period. An intent-to-treat analysis was used to compare STD incidence between intervention and control patients. The primary endpoint was time to diagnosis of incident laboratory-confirmed infections (gonorrhea, chlamydia, trichomoniasis, syphilis, and HIV), as identified through review of medical records and county STD surveillance registries. During 14.8 mo (average) of follow-up, 2,042 patients (5.3%) were diagnosed with incident STD (4.9%, intervention condition; 5.7%, control condition). In survival analysis, patients assigned to the intervention condition had significantly fewer STDs compared with the control condition (hazard ratio [HR], 0.91; 95% confidence interval [CI], 0.84 to 0.99). Conclusions Showing a brief video in STD clinic waiting rooms reduced new infections nearly 10% overall in three clinics. This simple, low-intensity intervention may be appropriate for adoption by clinics that serve similar patient populations. Trial registration: http://www.ClinicalTrials.gov (#NCT00137670). PMID:18578564

Modeling of waiting times and price changes in currency exchange data

NASA Astrophysics Data System (ADS)

Repetowicz, Przemysław; Richmond, Peter

2004-11-01

A theory which describes the share price evolution at financial markets as a continuous-time random walk (Physica A 287 (2000) 468, Physica A 314 (2002) 749, Eur. Phys. J. B 27 (2002) 273, Physica A 376 (2000) 284) has been generalized in order to take into account the dependence of waiting times t on price returns x. A joint probability density function (pdf) φ(x,t) which uses the concept of a Lévy stable distribution is worked out. The theory is fitted to high-frequency US $/Japanese Yen exchange rate and low-frequency 19th century Irish stock data. The theory has been fitted both to price return and to waiting time data and the adherence to data, in terms of the χ2 test statistic, has been improved when compared to the old theory.

What's in a wait? Contrasting management science and economic perspectives on waiting for emergency care.

PubMed

Morton, Alec; Bevan, Gwyn

2008-02-01

The current paper reviews and contrasts a management science view of waiting for healthcare, which centres on queues as devices for buffering demand, with an economic view, which stresses the role of the incentive structure, in the context of English Accident and Emergency Departments. We demonstrate that the management science view provides insight into waiting time performance within a single facility but is limited in its ability to shed light on variations in performance across facilities. We argue, with reference to supporting data, that such variations may be explainable by a proper understanding of the incentive structure in A&E Departments.

Quality-of-Life Assessment of Fibroid Treatment Options and Outcomes

PubMed Central

Kong, Chung Yin; Tempany, Clare M.; Swan, J. Shannon

2011-01-01

Purpose: To obtain utilities (a unit of measure of a person’s relative preferences for different health states compared with death or worst possible outcome) for uterine fibroids before and after treatment and to measure short-term utilities for the following uterine fibroid treatments: abdominal hysterectomy, magnetic resonance (MR) imaging–guided focused ultrasound surgery, and uterine artery embolization (UAE). Materials and Methods: This retrospective study was approved by the institutional review board and was HIPAA compliant. The waiting trade-off (WTO) method, a variation on the time trade-off (TTO) method, is used to obtain utilities for diagnostic procedures on the basis of the fact that people wait longer to avoid noxious tests and/or procedures. The WTO method provides short-term quality of life tolls in terms of quality-adjusted life-weeks by scaling wait times with pre- and posttreatment utilities. Utilities for uterine fibroids before and after treatment were obtained with the TTO method and a visual analog scale (VAS) by using a questionnaire administered by means of a phone interview. WTO wait times were adjusted for quality of life with VAS and TTO utilities and a transformation of VAS. Wait times were compared by using nonparametric tests. The study participants included 62 patients who had undergone abdominal hysterectomy, 74 who had undergone UAE, and 61 who had undergone MR imaging–guided focused ultrasound surgery. Results: Quality of life increased with all treatments. The median WTO wait time was higher for hysterectomy (21.6 weeks) than for UAE or MR imaging–guided focused ultrasound surgery (14.1 weeks for both) (P < .05). Quality-adjusted life-week tolls were smaller when scaled according to TTO than when scaled according to VAS or transformation of VAS. Conclusion: Quality of life increased after all fibroid treatments. WTO is feasible for assessing the quality-adjusted morbidity of treatment procedures. © RSNA, 2011 Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11100704/-/DC1 PMID:21364084

Enhanced hip fracture management: use of statistical methods and dataset to evaluate a fractured neck of femur fast track pathway-pilot study.

PubMed

Gilchrist, Nigel; Dalzell, Kristian; Pearson, Scott; Hooper, Gary; Hoeben, Kit; Hickling, Jeremy; McKie, John; Yi, Ma; Chamberlain, Sandra; McCullough, Caroline; Gutenstein, Marc

2017-05-12

The increasing elderly population and subsequent rise in total hip fracture(s) in this group means more effective management strategies are necessary to improve efficiency. We have changed our patient care strategy from the emergency department (ED), acute orthopaedic wards, operating theatre, post-operation and rehabilitation, and called it Fracture Neck of Femur Fast Track Pathway. All clinical data and actions were captured, integrated and displayed on a weekly basis using 'signalfromnoise' (SFN) software. The initial four months analysis of this project showed significant improvement in patient flow within the hospitals. The overall length of stay was reduced by four days. Time in ED was reduced by 30 minutes, and the wait for rehabilitation reduced by three days. Overall time in rehabilitation reduced by 3-7 days depending on facility. On average, fast track patients spent 95 less hours in hospital, resulting in 631 bed days saved in this period, with projected savings of NZD700,000. No adverse effects were seen in mortality, readmission and functional improvement status. Fractured neck of femur has increasing clinical demand in a busy tertiary hospital. Length of stay, co-morbidities and waiting time for theatres are seen as major barriers to treatment for these conditions. Wait for rehabilitation can significantly lengthen hospital stay; also poor communication between the individual hospital management facets of this condition has been an ongoing issue. Lack of instant and available electronic information on this patient group has also been seen as a major barrier to improvement. This paper demonstrates how integration of service components that are involved in fractured neck of femur can be achieved. It also shows how the use of electronic data capture and analysis can give a very quick and easily interpretable data trend that will enable change in practice. This paper indicates that cooperation between health professionals and practitioners can significantly improve the length of stay and the time in which patients can be returned home. Full interdisciplinary involvement was the key to this approach. The use of electronic data capture and analysis can be used in many other health pathways within the health system.

Cost-effectiveness of Wait Time Reduction for Intensive Behavioral Intervention Services in Ontario, Canada.

PubMed

Piccininni, Caroline; Bisnaire, Lise; Penner, Melanie

2017-01-01

Earlier access to intensive behavioral intervention (IBI) is associated with improved outcomes for children with severe autism spectrum disorder (ASD); however, there are long waiting times for this program. No analyses have been performed modeling the cost-effectiveness of wait time reduction for IBI. To model the starting age for IBI with reduced wait time (RWT) (by half) and eliminated wait time (EWT), and perform a cost-effectiveness analysis comparing RWT and EWT with current wait time (CWT) from government and societal perspectives. Published waiting times were used to model the mean starting age for IBI for CWT, RWT, and EWT in children diagnosed with severe ASD who were treated at Ontario's Autism Intervention Program. Inputs were loaded into a decision analytic model, with an annual discount rate of 3% applied. Incremental cost-effectiveness ratios (ICERs) were determined. One-way and probabilistic sensitivity analyses were performed to assess the effect of model uncertainty. We used data from the year 2012 (January 1 through December 31) provided from the Children's Hospital of Eastern Ontario IBI center for the starting ages. Data analysis was done from May through July 2015. The outcome was independence measured in dependency-free life-years (DFLYs) to 65 years of age. To derive this, expected IQ was modeled based on probability of early (age <4 years) or late (age ≥4 years) access to IBI. Probabilities of having an IQ in the normal (≥70) or intellectual disability (<70) range were calculated. The IQ strata were assigned probabilities of achieving an independent (60 DFLYs), semidependent (30 DFLYs), or dependent (0 DFLYs) outcome. Costs were calculated for provincial government and societal perspectives in Canadian dollars (Can$1 = US$0.78). The mean starting ages for IBI were 5.24 years for CWT, 3.89 years for RWT, and 2.71 years for EWT. From the provincial government perspective, EWT was the dominant strategy, generating the most DFLYs for Can$53 000 less per individual to 65 years of age than CWT. From the societal perspective, EWT produced lifetime savings of Can$267 000 per individual compared with CWT. The ICERs were most sensitive to uncertainty in the starting age for IBI and in achieving a normal IQ based on starting age. This study predicts the long-term effect of the current disparity between IBI service needs and the amount of IBI being delivered in the province of Ontario. The results suggest that providing timely access optimizes IBI outcomes, improves future independence, and lessens costs from provincial and societal perspectives.

Reconciling quality and cost: A case study in interventional radiology.

PubMed

Zhang, Li; Domröse, Sascha; Mahnken, Andreas

2015-10-01

To provide a method to calculate delay cost and examine the relationship between quality and total cost. The total cost including capacity, supply and delay cost for running an interventional radiology suite was calculated. The capacity cost, consisting of labour, lease and overhead costs, was derived based on expenses per unit time. The supply cost was calculated according to actual procedural material use. The delay cost and marginal delay cost derived from queueing models was calculated based on waiting times of inpatients for their procedures. Quality improvement increased patient safety and maintained the outcome. The average daily delay costs were reduced from 1275 € to 294 €, and marginal delay costs from approximately 2000 € to 500 €, respectively. The one-time annual cost saved from the transfer of surgical to radiological procedures was approximately 130,500 €. The yearly delay cost saved was approximately 150,000 €. With increased revenue of 10,000 € in project phase 2, the yearly total cost saved was approximately 290,000 €. Optimal daily capacity of 4.2 procedures was determined. An approach for calculating delay cost toward optimal capacity allocation was presented. An overall quality improvement was achieved at reduced costs. • Improving quality in terms of safety, outcome, efficiency and timeliness reduces cost. • Mismatch of demand and capacity is detrimental to quality and cost. • Full system utilization with random demand results in long waiting periods and increased cost.

Analysis of Trajectory Parameters for Probe and Round-Trip Missions to Venus

NASA Technical Reports Server (NTRS)

Dugan, James F., Jr.; Simsic, Carl R.

1960-01-01

For one-way transfers between Earth and Venus, charts are obtained that show velocity, time, and angle parameters as functions of the eccentricity and semilatus rectum of the Sun-focused vehicle conic. From these curves, others are obtained that are useful in planning one-way and round-trip missions to Venus. The analysis is characterized by circular coplanar planetary orbits, successive two-body approximations, impulsive velocity changes, and circular parking orbits at 1.1 planet radii. For round trips the mission time considered ranges from 65 to 788 days, while wait time spent in the parking orbit at Venus ranges from 0 to 467 days. Individual velocity increments, one-way travel times, and departure dates are presented for round trips requiring the minimum total velocity increment. For both single-pass and orbiting Venusian probes, the time span available for launch becomes appreciable with only a small increase in velocity-increment capability above the minimum requirement. Velocity-increment increases are much more effective in reducing travel time for single-pass probes than they are for orbiting probes. Round trips composed of a direct route along an ellipse tangent to Earth's orbit and an aphelion route result in the minimum total velocity increment for wait times less than 100 days and mission times ranging from 145 to 612 days. Minimum-total-velocity-increment trips may be taken along perihelion-perihelion routes for wait times ranging from 300 to 467 days. These wait times occur during missions lasting from 640 to 759 days.

A Critical Analysis of the Role of Wait Time in Classroom Interactions and the Effects on Student and Teacher Interactional Behaviours

ERIC Educational Resources Information Center

Ingram, Jenni; Elliott, Victoria

2016-01-01

Extending the pauses between teachers' and students' turns (wait time) has been recommended as a way of improving classroom learning. Drawing on the Conversation Analysis literature on classroom interactions alongside extracts of classroom interactions, the relationship between these pauses and the interactional behaviour of teachers and students…

Factors Associated with Waiting Time for Breast Cancer Treatment in a Teaching Hospital in Ghana

ERIC Educational Resources Information Center

Dedey, Florence; Wu, Lily; Ayettey, Hannah; Sanuade, Olutobi A.; Akingbola, Titilola S.; Hewlett, Sandra A.; Tayo, Bamidele O.; Cole, Helen V.; de-Graft Aikins, Ama; Ogedegbe, Gbenga; Adanu, Richard

2016-01-01

Background: Breast cancer is the leading cause of cancer-related mortality among women in Ghana. Data are limited on the predictors of poor outcomes in breast cancer patients in low-income countries; however, prolonged waiting time has been implicated. Among breast cancer patients who received treatment at Korle Bu Teaching Hospital, this study…

Perception of randomness: On the time of streaks.

PubMed

Sun, Yanlong; Wang, Hongbin

2010-12-01

People tend to think that streaks in random sequential events are rare and remarkable. When they actually encounter streaks, they tend to consider the underlying process as non-random. The present paper examines the time of pattern occurrences in sequences of Bernoulli trials, and shows that among all patterns of the same length, a streak is the most delayed pattern for its first occurrence. It is argued that when time is of essence, how often a pattern is to occur (mean time, or, frequency) and when a pattern is to first occur (waiting time) are different questions and bear different psychological relevance. The waiting time statistics may provide a quantitative measure to the psychological distance when people are expecting a probabilistic event, and such measure is consistent with both of the representativeness and availability heuristics in people's perception of randomness. We discuss some of the recent empirical findings and suggest that people's judgment and generation of random sequences may be guided by their actual experiences of the waiting time statistics. Published by Elsevier Inc.

Late-night hours draw busy patients.

PubMed

1999-10-01

Planned Parenthood of Houston and southeast Texas is currently implementing a reproductive health care clinic with night-time hours. The clinic provides for the reproductive health care needs of college students with after-class jobs, women with two jobs or with night-shift employment, and all other women who do not have time to go to a daytime clinic. The clinic operates twice a month on Fridays and was initially open 10:30 p.m. - 7 a.m., but now it has changed its hours to 7:30 p.m. - 3:30 a.m. The clinic is staffed by one clinician and two clinic assistants, which attend to an average of 17-22 patients per night's schedule. Women who use the clinic keep their appointments better and do not have to wait so long for care.

Refining paracervical block techniques for pain control in first trimester surgical abortion: a randomized controlled noninferiority trial.

PubMed

Renner, Regina-Maria; Edelman, Alison B; Nichols, Mark D; Jensen, Jeffrey T; Lim, Jeong Y; Bednarek, Paula H

2016-11-01

Our objective was to evaluate two different aspects of the paracervical block (PCB) technique for first trimester surgical abortion, to compare a 3-min wait prior to cervical dilation to no wait and to compare four-site with two-site injection. We conducted two consecutive randomized, single-blinded noninferiority trials. In the first trial, women <11 weeks gestational age received a 20-mL 1% buffered lidocaine four-site PCB with either a 3-min wait between PCB injection and dilation or no wait. In the second trial, we compared a four-site with a two-site PCB. We evaluated dilation pain [100-mm visual analogue scale (VAS)] as the primary outcome. Secondary outcomes included pain at additional time points, anxiety, satisfaction and adverse events. Both trials fully enrolled (total n=332). Results were inconclusive as to whether no wait was noninferior to waiting 3-min prior to cervical dilation for dilation pain [VAS: 63 mm (SD, 24 mm) vs. 56 mm (SD, 32mm)] and as to whether a two-site PCB was noninferior to a four-site block [VAS: 68 mm (SD, 21 mm) vs. 60 mm (SD, 30 mm)]. Noninferiority analysis was inconclusive because the confidence interval of the mean pain score difference between groups included the predefined inferiority margin of 13-mm pain difference. Superiority analysis showed the four-site PCB to be superior to the two-site PCB. It remained inconclusive whether a 3-min wait time between PCB and cervical dilation provides noninferior pain control for first trimester surgical abortion. However, a four-site PCB appeared to be superior to a two-site PCB. It remained inconclusive whether a 3-min wait time between PCB and cervical dilation or using a two-site instead of a four-site PCB provided noninferior pain control for first trimester surgical abortion. This study did not assess whether the combination of the two separate factors provides additive benefit. Copyright © 2016 Elsevier Inc. All rights reserved.

Covert checks by standardised patients of general practitioners' delivery of new periodic health examinations: clustered cross-sectional study from a consumer organisation

PubMed Central

Thaler, Kylie; Harris, Mark F

2012-01-01

Objective To assess if data collected by a consumer organisation are valid for a health service research study on physicians' performance in preventive care. To report first results of the analysis of physicians performance like consultation time and guideline adherence in history taking. Design Secondary data analysis of a clustered cross-sectional direct observation survey. Setting General practitioners (GPs) in Vienna, Austria, visited unannounced by mystery shoppers (incognito standardised patients (ISPs)). Participants 21 randomly selected GPs were visited by two different ISPs each. 40 observation protocols were realised. Main outcome measures Robustness of sampling and data collection by the consumer organisation. GPs consultation and waiting times, guideline adherence in history taking. Results The double stratified random sampling method was robust and representative for the private and contracted GPs mix of Vienna. The clinical scenarios presented by the ISPs were valid and believable, and no GP realised the ISPs were not genuine patients. The average consultation time was 46 min (95% CI 37 to 54 min). Waiting times differed more than consultation times between private and contracted GPs. No differences between private and contracted GPs in terms of adherence to the evidence-based guidelines regarding history taking including questions regarding alcohol use were found. According to the analysis, 20% of the GPs took a perfect history (95% CI 9% to 39%). Conclusions The analysis of secondary data collected by a consumer organisation was a valid method for drawing conclusions about GPs preventive practice. Initial results, like consultation times longer than anticipated, and the moderate quality of history taking encourage continuing the analysis on available clinical data. PMID:22872721

Transformation of a Pediatric Primary Care Waiting Room: Creating a Bridge to Community Resources.

PubMed

Henize, Adrienne W; Beck, Andrew F; Klein, Melissa D; Morehous, John; Kahn, Robert S

2018-06-01

Introduction Children and families living in poverty frequently encounter social risks that significantly affect their health and well-being. Physicians' near universal access to at-risk children and their parents presents opportunities to address social risks, but time constraints frequently interfere. We sought to redesign our waiting room to create a clinic-to-community bridge and evaluate the impact of that redesign on family-centered outcomes. Methods We conducted a pre-post study of a waiting room redesign at a large, academic pediatric primary care center. Design experts sought input about an optimal waiting room from families, community partners and medical providers. Family caregivers were surveyed before and after redesign regarding perceived availability of help with social needs and access to community resources, and hospitality and feelings of stress. Pre-post differences were assessed using the Chi square or Wilcoxon rank sum test. Results The key redesign concepts that emerged included linkages to community organizations, a welcoming environment, and positive distractions for children. A total of 313 caregiver surveys were completed (pre-160; post-153). Compared to pre-redesign, caregivers surveyed post-redesign were significantly more likely to perceive the waiting room as a place to obtain help connecting to community resources and find information about clinical and educational resources (both p < 0.05). Families were also significantly more likely to report the waiting room as more welcoming and relaxing, with sufficient privacy and space (all p < 0.05). Discussion Waiting rooms, typically a place of wasted time and space, can be redesigned to enhance families' engagement and connection to community resources.

Built spaces and features associated with user satisfaction in maternity waiting homes in Malawi.

PubMed

McIntosh, Nathalie; Gruits, Patricia; Oppel, Eva; Shao, Amie

2018-07-01

To assess satisfaction with maternity waiting home built spaces and features in women who are at risk for underutilizing maternity waiting homes (i.e. residential facilities that temporarily house near-term pregnant mothers close to healthcare facilities that provide obstetrical care). Specifically we wanted to answer the questions: (1) Are built spaces and features associated with maternity waiting home user satisfaction? (2) Can built spaces and features designed to improve hygiene, comfort, privacy and function improve maternity waiting home user satisfaction? And (3) Which built spaces and features are most important for maternity waiting home user satisfaction? A cross-sectional study comparing satisfaction with standard and non-standard maternity waiting home designs. Between December 2016 and February 2017 we surveyed expectant mothers at two maternity waiting homes that differed in their design of built spaces and features. We used bivariate analyses to assess if built spaces and features were associated with satisfaction. We compared ratings of built spaces and features between the two maternity waiting homes using chi-squares and t-tests to assess if design features to improve hygiene, comfort, privacy and function were associated with higher satisfaction. We used exploratory robust regression analysis to examine the relationship between built spaces and features and maternity waiting home satisfaction. Two maternity waiting homes in Malawi, one that incorporated non-standardized design features to improve hygiene, comfort, privacy, and function (Kasungu maternity waiting home) and the other that had a standard maternity waiting home design (Dowa maternity waiting home). 322 expectant mothers at risk for underutilizing maternity waiting homes (i.e. first-time mothers and those with no pregnancy risk factors) who had stayed at the Kasungu or Dowa maternity waiting homes. There were significant differences in ratings of built spaces and features between the two differently designed maternity waiting homes, with the non-standard design having higher ratings for: adequacy of toilets, and ratings of heating/cooling, air and water quality, sanitation, toilets/showers and kitchen facilities, building maintenance, sleep area, private storage space, comfort level, outdoor spaces and overall satisfaction (p = <.0001 for all). The final regression model showed that built spaces and features that are most important for maternity waiting home user satisfaction are toilets/showers, guardian spaces, safety, building maintenance, sleep area and private storage space (R 2  = 0.28). The design of maternity waiting home built spaces and features is associated with user satisfaction in women at risk for underutilizing maternity waiting homes, especially related to toilets/showers, guardian spaces, safety, building maintenance, sleep area and private storage space. Improving maternity waiting home built spaces and features may offer a promising area for improving maternity waiting home satisfaction and reducing barriers to maternity waiting home use. Copyright © 2018 Elsevier Ltd. All rights reserved.

Generalized priority-queue network dynamics: Impact of team and hierarchy

NASA Astrophysics Data System (ADS)

Cho, Won-Kuk; Min, Byungjoon; Goh, K.-I.; Kim, I.-M.

2010-06-01

We study the effect of team and hierarchy on the waiting-time dynamics of priority-queue networks. To this end, we introduce generalized priority-queue network models incorporating interaction rules based on team-execution and hierarchy in decision making, respectively. It is numerically found that the waiting-time distribution exhibits a power law for long waiting times in both cases, yet with different exponents depending on the team size and the position of queue nodes in the hierarchy, respectively. The observed power-law behaviors have in many cases a corresponding single or pairwise-interacting queue dynamics, suggesting that the pairwise interaction may constitute a major dynamic consequence in the priority-queue networks. It is also found that the reciprocity of influence is a relevant factor for the priority-queue network dynamics.

Improving Efficiency While Improving Patient Care in a Student-Run Free Clinic.

PubMed

Lee, Jason S; Combs, Kristen; Pasarica, Magdalena

2017-01-01

Student-run free clinics (SRFCs) have the capacity to decrease health care inequity in underserved populations. These facilities can benefit from improved patient experience and outcomes. We implemented a series of quality improvement interventions with the objectives to decrease patient wait times and to increase the variety of services provided. A needs assessment was performed. Problems related to time management, communication between staff and providers, clinic resources, and methods for assessing clinic performance were identified as targets to reduce wait times and improve the variety of services provided. Seventeen interventions were designed and implemented over a 2-month period. The interventions resulted in improved efficiency for clinic operations and reduced patient wait times. The number of specialty providers, patient visits for specialty care, lifestyle education visits for disease prevention and treatment, free medications, and free laboratory investigations increased to achieve the goal of improving the availability and the variety of services provided. We demonstrated that it is feasible to implement successful quality improvement interventions in SRFCs to decrease patient wait times and to increase the variety of services provided. We believe that the changes we implemented can serve as a model for other SRFCs to improve their performance. © Copyright 2017 by the American Board of Family Medicine.

Evaluation of customer satisfaction at the Department of Paediatric Dentistry of "Sapienza" University of Rome.

PubMed

Ierardo, G; Luzzi, V; Vestri, A; Sfasciotti, G L; Polimeni, A

2008-03-01

Healthcare facility management requires the optimisation of the quality of services offered. The Authors adopted a questionnaire as a means to assess customer satisfaction and needs. The Questionnaire has been designed to address adults, i.e., parents or guardians of children attending the Paediatric unit as patients. To estimate their degree of satisfaction, either regarding the environment where children are treated or about the direct interactions between the parents and the structure (waiting room, waiting time, treatment time and time needed to make the payments, costs, etc.), the questionnaire was submitted to a sample of approximately 600 customers, between March and June of 2005. On one hand results provide a pleasant confirmation on customers' perception of the service, especially regarding the direct relationship between the parties; on the other, they highlight aspects that could be improved (waiting room, optimisation of waiting time), distinguishing between factors that need extra funding to be implemented, and those that, instead, could be simply improved through a better and more efficient organisation of labour and time. The present analysis and previous experiences confirm that appraisal of the degree of customers' satisfaction by means of questionnaires is a valid and necessary instrument for the quality improvement of a healthcare service. Doing so, economic and human resources can be more efficiently allocated.

Cholelithiasis in patients on the kidney transplant waiting list

PubMed Central

Brito, André Thiago Scandiuzzi; Azevedo, Luiz Sergio; Nahas, Willian Carlos; Matheus, André Siqueira; Jukemura, José

2010-01-01

OBJECTIVES To evaluate the prevalence of cholecystopathy in chronic renal patients awaiting kidney transplants. INTRODUCTION The prevalence and management of cholelithiasis in renal transplant patients is not well established. METHODS A total of 342 chronic renal failure patients on the waiting list for a kidney transplant were studied. Patients were evaluated for the presence of cholelithiasis and related symptoms, previous cholecystectomies and other abdominal surgeries, time on dialysis, and general data (gender, age, number of pregnancies, and body mass index). RESULTS Cholelithiasis was found in 41 out of 342 patients (12%). Twelve of these patients, all symptomatic, had previously undergone cholecystectomies. Five out of 29 patients who had not undergone surgery were symptomatic. Overall, 17 patients (41.5%) were symptomatic. Their mean age was 54 (range 32–74) years old; 61% were female, and their mean body mass index was 25.4. Nineteen (76%) out of 25 women had previously been pregnant, with an average of 3.6 pregnancies per woman. CONCLUSIONS The frequency of cholelithiasis was similar to that reported in the literature for the general population. However, the high frequency of symptomatic patients points toward an indication of routine pre-transplant cholecystectomy to avoid serious post-transplant complications. PMID:20454496