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Sample records for equity waiting times

  1. Equity in waiting times for major joint arthroplasty

    PubMed Central

    Kelly, Karen D.; Voaklander, Donald C.; Johnston, D. William C.; Suarez-Almazor, Maria E.

    2002-01-01

    Objective To ascertain whether waiting lists are managed in an equitable fashion in a universal health system by examining demographic, socioeconomic and clinical factors, along with 2 health systems variables. Design A prospective survey by questionnaire. Setting The Capital Health Region of Edmonton, Alta. Patients and methods A cohort of 553 patients, who were waiting for either total hip or total knee replacement surgery, seen between Dec. 18, 1995, and Jan. 24, 1997. Interventions A home visit was made when the patient was first placed on the waiting list and again just before surgery to complete the questionnaires. The Western Ontario and McMaster Universities (WOMAC) instrument and the Medication Quantification Score were administered at the time the patient was placed on the waiting list. Main outcome measure The length of waiting time, defined as the date the patient was put on the waiting list to the date the patient was operated on. Results There were no biases in waiting time with respect to age, gender, education or work status. Although pain and function were not related to waiting time, multivariate analyses found that marital status, primary language, body mass index, pain medication use and the size of the surgeons’ major joint replacement practice determined waiting time for surgery. However, this model explained only 10% of the variance in waiting time. Conclusion Waiting lists were managed unfairly in terms of clinical equity (clinical severity) but managed fairly in terms of social equity. PMID:12174981

  2. 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.

  3. Feedback control of waiting times

    NASA Astrophysics Data System (ADS)

    Brandes, Tobias; Emary, Clive

    2016-04-01

    Feedback loops are known as a versatile tool for controlling transport in small systems, which usually have large intrinsic fluctuations. Here we investigate the control of a temporal correlation function, the waiting-time distribution, under active and passive feedback conditions. We develop a general formalism and then specify to the simple unidirectional transport model, where we compare costs of open-loop and feedback control and use methods from optimal control theory to optimize waiting-time distributions.

  4. 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. ...

  5. 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. ...

  6. 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. ...

  7. 46 CFR 9.10 - Waiting time.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 1 2014-10-01 2014-10-01 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....

  8. 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.

  9. 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

  10. Mathematical Models of Waiting Time.

    ERIC Educational Resources Information Center

    Gordon, Sheldon P.; Gordon, Florence S.

    1990-01-01

    Considered are several mathematical models that can be used to study different waiting situations. Problems involving waiting at a red light, bank, restaurant, and supermarket are discussed. A computer program which may be used with these problems is provided. (CW)

  11. Factors influencing waiting times for elective laparoscopic cholecystectomy

    PubMed Central

    Lau, Richard; Vair, Brock A.; Porter, Geoffrey A.

    2007-01-01

    Introduction Health Canada states that waiting list information and management systems in Canada are woefully inadequate, especially for elective surgical procedures. Understanding the reasons for waiting is paramount to achieving fairness and equity. The objective of this study was to examine the impact of demographic and clinical factors and surgeon volume on waiting times for laparoscopic cholecystectomy (LC). Methods We comprehensively applied a wait-list database for all surgical procedures across a division of general surgery and performed a chart review of all patients undergoing LC in 2002 to collect additional demographic and clinical data. We excluded patients undergoing LC on an emergent basis or as a secondary procedure. For each patient, we calculated 2 time intervals: time from the receipt of consult to the surgical consult (interval A) and time from the surgical consult to the LC (interval B). Surgeons were categorized a priori into low-and high-volume groups, based on the median number of procedures they had performed. All analyses examining waiting times were performed with nonparametric methods. Results The study cohort included 294 patients; most (94.6%) underwent LC for biliary colic. The median waiting times for interval A and interval B were 22 days and 50 days, respectively. No associations were identified between any of the examined waiting times, sex, diagnosis or Charlston Comorbidity Index. High surgeon volume was associated with longer waiting times for interval A (median 26 v. 19 d; p = 0.04) and interval B (median 58 v. 35 d; p = 0.003) and was also associated with a greater number of episodes of biliary colic (2.7 v. 2.0; p = 0.03). Conclusion There is significant variability in specific waiting times for LC, which appears to be associated with surgeon volume. Better prioritization of patients undergoing nonemergent LC is required to improve patient care. PMID:17391614

  12. Decreasing extremes in patient waiting time.

    PubMed

    Groome, Lynn J; Mayeaux, E J

    2010-01-01

    We present a conceptual framework for approaching reducing excessive patient wait time in an outpatient setting. We hypothesized that statistical process control techniques can be used to identify extremes in waiting time; root cause analysis can be used to identify specific delay causes; and minimizing the contribution of the root causes will lead to an improvement in system performance. We conducted a prospective study of waiting times in a private outpatient clinic providing high-risk obstetrical care. The baseline period consisted of 55 clinic sessions, and the intervention period consisted of 101 clinic sessions. Mean waiting time was prolonged during 9 (16.4%) baseline clinic sessions. The root cause analysis determined that appointment schedule, physician tardiness, and patient complexity contributed to clinic delays. After making changes to minimize root causes, there was a significant reduction in prolonged waiting times (16.4% vs 4.9%, Yates chi(2) = 4.37, P = .037); a significant decrease in mean waiting time (32.7 +/- 23.6 minutes vs 29.3 +/- 21.2 minutes, t = 3.42, P < .001); and a significant improvement in the waiting time distribution (Kruskal-Wallis test of homogeneity, P = .003). Our methodology was successful in identifying and reducing factors associated with prolonged wait times. However, although system operation was improved, as defined by a decrease in the occurrence of excessive clinic delays, effecting a large and sustained decrease in patient waiting times was challenging.

  13. 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…

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

    PubMed Central

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

    2015-01-01

    Background: 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. Objectives: 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. Patients and Methods: 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. Results: 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. Conclusions: 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

  15. Electron waiting times for the mesoscopic capacitor

    NASA Astrophysics Data System (ADS)

    Hofer, Patrick P.; Dasenbrook, David; Flindt, Christian

    2016-08-01

    We evaluate the distribution of waiting times between electrons emitted by a driven mesoscopic capacitor. Based on a wave packet approach we obtain analytic expressions for the electronic waiting time distribution and the joint distribution of subsequent waiting times. These semi-classical results are compared to a full quantum treatment based on Floquet scattering theory and good agreement is found in the appropriate parameter ranges. Our results provide an intuitive picture of the electronic emissions from the driven mesoscopic capacitor and may be tested in future experiments.

  16. Waiting time and socioeconomic status--an individual-level analysis.

    PubMed

    Monstad, Karin; Engesaeter, Lars Birger; Espehaug, Birgitte

    2014-04-01

    Waiting time is a rationing mechanism that is used in publicly funded healthcare systems. From an equity viewpoint, it is regarded as preferable to co-payments. However, long waits are an indication of poor quality of service. To our knowledge, this analysis is the first to benefit from individual-level data from administrative registers to investigate the relationship between waiting time, income, and education. Furthermore, it makes use of an extensive set of medical information that serves as indicators of patient need. Differences in waiting time by socioeconomic status are detected. For men, there is a statistically highly significant negative association between income and waiting time, driven by men in the highest income group, which constitutes 12% of all men. More educated women, that is, those having an education above compulsory schooling, experience lower waiting time than their fellow sisters with the lowest level of education. Copyright © 2013 John Wiley & Sons, Ltd.

  17. 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

  18. Waiting times and generalized Fibonacci sequences

    SciTech Connect

    Uppuluri, V.R.R.; Patil, S.A.

    1982-06-01

    Suppose we have a multinormal population with k possible outcomes E/sub 1/, E/sub 2/, ..., E/sub k/ and associated probabilities ..pi../sub 1/, ..pi../sub 2/, ..., ..pi../sub k/. At each of the independent trials, one of the outcomes is observed. One may be interested in the waiting time for the occurrence of a specified event, which consists of a succession of outcomes. In this paper, we consider the probability distribution of the waiting times associated with specified events, and show how they generalize the Fibonacci, Tribonacci, ..., sequences in different ways. This is possible, since the probability generating functions of the associated waiting time random variables can be utilized to derive the probability distributions.

  19. Managing waiting times in diagnostic medical imaging

    PubMed Central

    Nuti, Sabina; Vainieri, Milena

    2012-01-01

    Objective This paper aims to analyse the variation in the delivery of diagnostic imaging services in order to suggest possible solutions for the reduction of waiting times, increase the quality of services and reduce financial costs. Design This study provides a logic model to manage waiting times in a regional context. Waiting times measured per day were compared on the basis of the variability in the use rates of CT and MRI examinations in Tuscany for the population, as well as on the basis of the capacity offered with respect to the number of radiologists available. The analysis was performed at the local health authority level to support the decision-making process of local managers. Setting Diagnostic imaging services, in particular the CT and MRI examinations. The study involved all the 12 local health authorities that provide services for 3.7 million inhabitants of the Italian Tuscany Region. Primary and secondary outcome measures Participants: the study uses regional administrative data on outpatients and survey data on inpatient diagnostic examinations in order to measure productivity. Primary and secondary outcome measures The study uses the volumes per 1000 inhabitants, the days of waiting times and the number of examinations per radiologist. Variability was measured using the traditional SD measures. Results A significant variation in areas considered homogeneous in terms of age, gender or mortality may indicate that the use of radiological services is not optimal and underuse or overuse occurs and that there is room for improvement in the service organisation. Conclusions Considering that there is a high level of variability among district use rates and waiting times, this study provides managers with a specific tool to find the cause of the problem, identify a possible solution, assess the financial impact and initiate the eventual reduction of waste. PMID:23242480

  20. Time to wait: a systematic review of strategies that affect out-patient waiting times.

    PubMed

    Naiker, Ugenthiri; FitzGerald, Gerry; Dulhunty, Joel M; Rosemann, Michael

    2017-03-30

    Objective Out-patient waiting times pose a significant challenge for public patients in need of specialist evaluation and intervention. The aim of the present study was to identify and categorise effective strategies to reduce waiting times for specialist out-patient services with a focus on the Australian healthcare system.Methods A systematic review of major health databases was conducted using the key terms 'outpatient*' AND 'waiting time', 'process*' AND 'improvement in outpatient clinics'. Identified articles were assessed for their relevance by sequential review of the title, abstract and full text. References of the selected manuscripts were scanned for additional relevant articles. Selected articles were evaluated for consistent and emerging themes.Results In all, 152 articles were screened, of which 38 were included in the present review. Numerous strategies identified in the articles were consolidated into 26 consistent approaches. Three overarching themes were identified as significantly affecting waiting times: resource realignment, operational efficiency and process improvement.Conclusions Strategies to align resources, increase operational efficiency and improve processes provide a comprehensive approach that may reduce out-patient waiting times.What is known about the topic? Out-patient waiting times are a challenge in most countries that seek to provide universal access to health care for all citizens. Although there has been extensive research in this area, many patients still experience extensive delays accessing specialist care, particularly in the public health sector. The multiple factors that contribute to bottlenecks and inefficiencies in the referral process and affect patient waiting times are often poorly understood.What does this paper add? This paper reviews the published healthcare literature to identify strategies that affect specialist out-patient waiting times for patients. The findings suggest that there are numerous operational

  1. The acceptability of waiting times for elective general surgery and the appropriateness of prioritising patients

    PubMed Central

    Oudhoff, Jurriaan P; Timmermans, Danielle RM; Rietberg, Martin; Knol, Dirk L; van der Wal, Gerrit

    2007-01-01

    Background Problematic waiting lists in public health care threaten the equity and timeliness of care provision in several countries. This study assesses different stakeholders' views on the acceptability of waiting lists in health care, their preferences for priority care of patients, and their judgements on acceptable waiting times for surgical patients. Methods A questionnaire survey was conducted among 257 former patients (82 with varicose veins, 86 with inguinal hernia, and 89 with gallstones), 101 surgeons, 95 occupational physicians, and 65 GPs. Judgements on acceptable waiting times were assessed using vignettes of patients with varicose veins, inguinal hernia, and gallstones. Results Participants endorsed the prioritisation of patients based on clinical need, but not on ability to benefit. The groups had significantly different opinions (p < 0.05) on the use of non-clinical priority criteria and on the need for uniformity in the prioritisation process. Acceptable waiting times ranged between 2 and 25 weeks depending on the type of disorder (p < 0.001) and the severity of physical and psychosocial problems of patients (p < 0.001). Judgements were similar between the survey groups (p = 0.3) but responses varied considerably within each group depending on the individual's attitude towards waiting lists in health care (p < 0.001). Conclusion The explicit prioritisation of patients seems an accepted means for reducing the overall burden from waiting lists. The disagreement about appropriate prioritisation criteria and the need for uniformity, however, raises concern about equity when implementing prioritisation in daily practice. Single factor waiting time thresholds seem insufficient for securing timely care provision in the presence of long waiting lists as they do not account for the different consequences of waiting between patients. PMID:17328816

  2. 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.

  3. Correlated continuous time random walk with time averaged waiting time

    NASA Astrophysics Data System (ADS)

    Lv, Longjin; Ren, Fu-Yao; Wang, Jun; Xiao, Jianbin

    2015-03-01

    In this paper, we study the dynamics of a correlated continuous time random walk with time averaged waiting time. The mean square displacement (MSD) shows this process is subdiffusive and generalized Einstein relation holds. We also get the asymptotic behavior of the probability density function (PDF) of this process is stretched Gaussian. At last, by computing the time averaged MSD, we find ergodicity breaking occurs in this process.

  4. Sustainability: orthopaedic surgery wait time management strategies.

    PubMed

    Amar, Claudia; Pomey, Marie-Pascale; SanMartin, Claudia; De Coster, Carolyn; Noseworthy, Tom

    2015-01-01

    The purpose of this paper is to examine Canadian organizational and systemic factors that made it possible to keep wait times within federally established limits for at least 18 months. The research design is a multiple cases study. The paper selected three cases: Case 1 - staff were able to maintain compliance with requirements for more than 18 months; Case 2 - staff were able to meet requirements for 18 months, but unable to sustain this level; Case 3 - staff were never able to meet the requirements. For each case the authors interviewed persons involved in the strategies and collected documents. The paper analysed systemic and organizational-level factors; including governance and leadership, culture, resources, methods and tools. Findings indicate that the hospital that was able to maintain compliance with the wait time requirements had specific characteristics: an exclusive mandate to do only hip and knee replacement surgery; motivated staff who were not distracted by other concerns; and a strong team spirit. The authors' research highlights an important gradient between three cases regarding the factors that sustain waiting times. The paper show that the hospital factory model seems attractive in a super-specialized surgery context. However, patients are selected for simple surgeries, without complications, and so this cannot be considered a unique model.

  5. Expectantly waiting: a survey of thyroid surgery wait times among Canadian Otolaryngologists

    PubMed Central

    2013-01-01

    Background Our objective is to highlight discrepancies between actual wait times and perceived appropriate wait times for various thyroid pathologies among Otolaryngology- Head and Neck Surgeons in Canada; and to identify specific diagnoses/pathologies where wait times could be improved. Methods A questionnaire was distributed to all practicing CSO-HNS members. Questions focused on actual wait times for initial consults and surgery within individual practices, in the setting of various thyroid pathologies. Respondents were also asked to state wait times that they felt were appropriate for each scenario. Wilcoxon signed-rank tests were performed to determine statistically significant differences between actual and appropriate wait times. Results For most scenarios, the actual wait times were significantly longer than most physicians felt were appropriate; these scenarios included time to initial consult for undiagnosed nodules, time to surgery for confirmed malignancies, and time to completion thyroidectomy for surgically confirmed malignancies. Conclusions Wait times for thyroid consults and surgeries in Canada are longer than physicians feel are appropriate. The authors hope that this survey may spur a move towards a national consensus on appropriate wait times for the treatment of thyroid pathology. PMID:24025587

  6. Measuring and comparing health care waiting times in OECD countries.

    PubMed

    Siciliani, Luigi; Moran, Valerie; Borowitz, Michael

    2014-12-01

    Waiting times for elective treatments are a key health-policy concern in several OECD countries. This study describes common measures of waiting times from administrative data across OECD countries. It focuses on common elective procedures, such as hip and knee replacement, and cataract surgery, where waiting times are notoriously long. It provides comparative data on waiting times across 12 OECD countries and presents trends in waiting times over the last decade. Waiting times appear to be low in the Netherlands and Denmark. In the last decade the United Kingdom (in particular England), Finland and the Netherlands have witnessed large reductions in waiting times which can be attributed to a range of policy initiatives, including higher spending, waiting-times target schemes and incentive mechanisms, which reward higher levels of activity. The negative trend in these countries has, however, halted or reversed in recent years. The analysis also emphasizes systematic differences across different waiting-time measures, in particular between the distribution of waiting times of patients treated versus that of patients on the list. Mean waiting times are systematically higher than median waiting times and the difference can be quantitatively large. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  7. Waiting time information services: an evaluation of how well clearance time statistics can forecast a patient's wait.

    PubMed

    Cromwell, David A

    2004-11-01

    Governments in some countries have created web-based information services so that patients requiring elective surgery can compare the waiting times of surgical units. This study investigated how accurately the waiting times of patients about to join a waiting list can be forecast by various clearance time statistics. It used 3 years of elective surgical activity data that covered 46 surgeons in 10 specialties within a public hospital. Six clearance time functions were tested, and the best function was compared with average waiting time statistics derived from census and throughput data. The forecast accuracy of the clearance time functions was found to be greatly affected by the characteristics and behaviour of a surgeon's waiting list. Although there was less difference in performance among the six functions, systematic differences between them were also found. The best of these performed better than the statistics derived from waiting time data, especially where waiting times exceeded 6 months. Yet, its accuracy was still poor. For each surgeon with an average waiting time of more than 6 months, at least 20% of patients waited more than 90 days beyond the clearance time forecast. Consequently, while waiting time information services should consider adopting the clearance time approach, they need to be explicit about its statistical limitations.

  8. Quantum theory of an electron waiting time clock

    NASA Astrophysics Data System (ADS)

    Dasenbrook, David; Flindt, Christian

    2016-06-01

    The electron waiting time is the time that passes between two subsequent charge transfers in an electronic conductor. Recently, theories of electron waiting times have been devised for quantum transport in Coulomb-blockade structures and for mesoscopic conductors; however, so far a proper description of a detector has been missing. Here we develop a quantum theory of a waiting time clock capable of measuring the distribution of waiting times between electrons above the Fermi sea in a mesoscopic conductor. The detector consists of a mesoscopic capacitor coupled to a quantum two-level system whose coherent precession we monitor. Under ideal operating conditions our waiting time clock recovers the results of earlier theories without a detector. We investigate possible deviations due to an imperfect waiting time clock. As specific applications we consider a quantum point contact with a constant voltage and Lorentzian voltage pulses applied to an electrode.

  9. Patient-expressed perceptions of wait-time causes and wait-related satisfaction

    PubMed Central

    Mathews, M.; Ryan, D.; Bulman, D.

    2015-01-01

    Background This study set out to identify patterns in the causes of waits and wait-related satisfaction. Methods We conducted qualitative interviews with urban, semi-urban, and rural patients (n = 60) to explore their perceptions of the waits they experienced in the detection and treatment of their breast, prostate, lung, or colorectal cancer. We asked participants to describe their experiences from the onset of symptoms to the start of treatment at the cancer clinic and their satisfaction with waits at various intervals. Interview transcripts were coded using a thematic approach. Results Patients identified five groups of wait-time causes: Patient-related (beliefs, preferences, and non-cancer health issues)Treatment-related (natural consequences of treatment)System-related (the organization or functioning of groups, workforce, institution, or infrastructure in the health care system)Physician-related (a single physician responsible for a specific element in the patient’s care)Other causes (disruptions to normal operations of a city or community as a whole) With the limited exception of physician-related absences, the nature of the cause was not linked to overall satisfaction or dissatisfaction with waits. Conclusions Causes in themselves do not explain wait-related satisfaction. Further work is needed to explore the underlying reasons for wait-related satisfaction or dissatisfaction. Although our findings shed light on patient experiences with the health system and identify where interventions could help to inform the expectations of patients and the public with respect to wait time, more research is needed to understand wait-related satisfaction among cancer patients. PMID:25908909

  10. Waiting time to infectious disease emergence

    PubMed Central

    2016-01-01

    Emerging diseases must make a transition from stuttering chains of transmission to sustained chains of transmission, but this critical transition need not coincide with the system becoming supercritical. That is, the introduction of infection to a supercritical system results in a significant fraction of the population becoming infected only with a certain probability. Understanding the waiting time to the first major outbreak of an emerging disease is then more complicated than determining when the system becomes supercritical. We treat emergence as a dynamic bifurcation, and use the concept of bifurcation delay to understand the time to emergence after a system becomes supercritical. Specifically, we consider an SIR model with a time-varying transmission term and random infections originating from outside the population. We derive an analytic density function for the delay times and find it to be, in general, in agreement with stochastic simulations. We find the key parameters to be the rate of introduction of infection and the rate of change of the basic reproductive ratio. These findings aid our understanding of real emergence events, and can be incorporated into early-warning systems aimed at forecasting disease risk. PMID:27798277

  11. Urgent care clinics post wait times on web.

    PubMed

    2007-10-01

    Posting wait times in an urgent care center certainly can make patients happier--but don't expect it to shorten the waiting times in your ED. Patient populations in EDs and urgent care centers are entirely different, and they rarely will overlap in terms of where they seek care. Some EDs post waiting times in their lobbies, but this can be a two-edged sword as patients will take those times literally. With technology advancing and more patients becoming Internet-savvy, web postings of ED waits may be just a matter of time.

  12. The extent and predictors of waiting time geographic disparity in kidney transplantation in the United States.

    PubMed

    Davis, Ashley E; Mehrotra, Sanjay; McElroy, Lisa M; Friedewald, John J; Skaro, Anton I; Lapin, Brittany; Kang, Raymond; Holl, Jane L; Abecassis, Michael M; Ladner, Daniela P

    2014-05-27

    Waiting time to deceased donor kidney transplant varies greatly across the United States. This variation violates the final rule, a federal mandate, which demands geographic equity in organ allocation for transplantation. Retrospective analysis of the United States Renal Data System and United Network for Organ Sharing database from 2000 to 2009. Median waiting time was calculated for each of the 58 donor service areas (DSA) in the United States. Multivariate regression was performed to identify DSA predictors for long waiting times to kidney transplantation. The median waiting time varied between the 58 DSAs from 0.61 to 4.57 years, ranging from 0.59 to 5.17 years for standard criteria donor kidneys and 0.41 to 4.69 years for expanded criteria donor kidneys. The disparity in waiting time between the DSAs grew from 3.26 years (range, 0.41-3.67) in 2000 to 4.72 years (range, 0.50-5.22) in 2009. In DSAs with longer waiting times, there were significantly more patients suffering from end-stage renal disease and more patients listed for kidney transplant, lower kidney procurement rates, and higher transplant center competition. Patients were more likely black, sensitized, with lower educational attainment and less likely to waitlist outside of their DSA of residence. Donor organs used in DSAs with long waiting times were more likely hepatitis C positive and had a higher kidney donor profile index. Graft and patient survival at 5 years was worse for deceased donor kidney transplant, but rates for living donor kidney transplant were higher. Our analysis demonstrates significant and worsening geographic disparity in waiting time for kidney transplant across the DSAs. Increase in living donor kidney transplant and use of marginal organs has not mitigated the disparity. Changes to the kidney allocation system might be required to resolve this extensive geographic disparity in kidney allocation.

  13. Waiting time distribution for continuous stochastic systems.

    PubMed

    Gernert, Robert; Emary, Clive; Klapp, Sabine H L

    2014-12-01

    The waiting time distribution (WTD) is a common tool for analyzing discrete stochastic processes in classical and quantum systems. However, there are many physical examples where the dynamics is continuous and only approximately discrete, or where it is favourable to discuss the dynamics on a discretized and a continuous level in parallel. An example is the hindered motion of particles through potential landscapes with barriers. In the present paper we propose a consistent generalization of the WTD from the discrete case to situations where the particles perform continuous barrier crossing characterized by a finite duration. To this end, we introduce a recipe to calculate the WTD from the Fokker-Planck (Smoluchowski) equation. In contrast to the closely related first passage time distribution (FPTD), which is frequently used to describe continuous processes, the WTD contains information about the direction of motion. As an application, we consider the paradigmatic example of an overdamped particle diffusing through a washboard potential. To verify the approach and to elucidate its numerical implications, we compare the WTD defined via the Smoluchowski equation with data from direct simulation of the underlying Langevin equation and find full consistency provided that the jumps in the Langevin approach are defined properly. Moreover, for sufficiently large energy barriers, the WTD defined via the Smoluchowski equation becomes consistent with that resulting from the analytical solution of a (two-state) master equation model for the short-time dynamics developed previously by us [Phys. Rev. E 86, 061135 (2012)]. Thus, our approach "interpolates" between these two types of stochastic motion. We illustrate our approach for both symmetric systems and systems under constant force.

  14. 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…

  15. Effect of fundholding on waiting times: database study.

    PubMed Central

    Dowling, B.

    1997-01-01

    OBJECTIVES: To determine whether fundholding patients have shorter waiting times for surgery than non-fundholding patients and to establish if any such differences resulted from practices attaining fundholding status. DESIGN: Comparison of waiting times of fundholding and non-fundholding patients for elective surgery covered by the fundholding scheme at four providers over four years. Comparison of the waiting times for patients of practices in their last year outside and first year inside the fundholding scheme with those for patients of practices remaining non-fundholding. SETTING: West Sussex. SUBJECTS: Over 57,000 patients on the elective waiting list who had operations purchased by a health authority or fundholding practice during 1992-6. Patients with booked or planned elective admissions were excluded. MAIN OUTCOME MEASURES: Waiting times for patients of fundholding and non-fundholding patients. RESULTS: Patients of fundholding practices had significantly shorter waiting times than those of non-fundholders for all four providers and over all four years. Waiting times for patients did not fall until the year that the practices joined the fundholding scheme. CONCLUSIONS: Fundholding shortens waiting times. This may be because purchasing of elective surgery is best done at a practice level or because fundholding practices are funded overgenerously. PMID:9274551

  16. 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.

  17. Reducing Outpatient Waiting Time: A Simulation Modeling Approach

    PubMed Central

    Aeenparast, Afsoon; Tabibi, Seyed Jamaleddin; Shahanaghi, Kamran; Aryanejhad, Mir Bahador

    2013-01-01

    Objectives The objective of this study was to provide a model for reducing outpatient waiting time by using simulation. Materials and Methods A simulation model was constructed by using the data of arrival time, service time and flow of 357 patients referred to orthopedic clinic of a general teaching hospital in Tehran. The simulation model was validated before constructing different scenarios. Results In this study 10 scenarios were presented for reducing outpatient waiting time. Patients waiting time was divided into three levels regarding their physicians. These waiting times for all scenarios were computed by simulation model. According to the final scores the 9th scenario was selected as the best way for reducing outpatient's waiting time. Conclusions Using the simulation as a decision making tool helps us to decide how we can reduce outpatient's waiting time. Comparison of outputs of this scenario and the based- case scenario in simulation model shows that combining physician's work time changing with patient's admission time changing (scenario 9) would reduce patient waiting time about 73.09%. Due to dynamic and complex nature of healthcare systems, the application of simulation for the planning, modeling and analysis of these systems has lagged behind traditional manufacturing practices. Rapid growth in health care system expenditures, technology and competition has increased the complexity of health care systems. Simulation is a useful tool for decision making in complex and probable systems. PMID:24616801

  18. Reducing outpatient waiting time: a simulation modeling approach.

    PubMed

    Aeenparast, Afsoon; Tabibi, Seyed Jamaleddin; Shahanaghi, Kamran; Aryanejhad, Mir Bahador

    2013-09-01

    The objective of this study was to provide a model for reducing outpatient waiting time by using simulation. A simulation model was constructed by using the data of arrival time, service time and flow of 357 patients referred to orthopedic clinic of a general teaching hospital in Tehran. The simulation model was validated before constructing different scenarios. In this study 10 scenarios were presented for reducing outpatient waiting time. Patients waiting time was divided into three levels regarding their physicians. These waiting times for all scenarios were computed by simulation model. According to the final scores the 9th scenario was selected as the best way for reducing outpatient's waiting time. Using the simulation as a decision making tool helps us to decide how we can reduce outpatient's waiting time. Comparison of outputs of this scenario and the based- case scenario in simulation model shows that combining physician's work time changing with patient's admission time changing (scenario 9) would reduce patient waiting time about 73.09%. Due to dynamic and complex nature of healthcare systems, the application of simulation for the planning, modeling and analysis of these systems has lagged behind traditional manufacturing practices. Rapid growth in health care system expenditures, technology and competition has increased the complexity of health care systems. Simulation is a useful tool for decision making in complex and probable systems.

  19. 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.

  20. 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.

  1. [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.

  2. The Origin of the Solar Flare Waiting-Time Distribution.

    PubMed

    Wheatland

    2000-06-20

    It was recently pointed out that the distribution of times between solar flares (the flare waiting-time distribution) follows a power law for long waiting times. Based on 25 years of soft X-ray flares observed by Geostationary Operational Environmental Satellite instruments, it is shown that (1) the waiting-time distribution of flares is consistent with a time-dependent Poisson process and (2) the fraction of time the Sun spends with different flaring rates approximately follows an exponential distribution. The second result is a new phenomenological law for flares. It is shown analytically how the observed power-law behavior of the waiting times originates in the exponential distribution of flaring rates. These results are argued to be consistent with a nonstationary avalanche model for flares.

  3. Voluntary versus involuntary waiting for joint replacements: new Alberta wait times rules for hip and knee arthroplasties, with provincial consensus.

    PubMed

    Marshall, Deborah; Christiansen, Tanya; Smith, Christopher; Howden, Jane Squire; Werle, Jason; Fyie, Ken; Frank, Cy

    2012-01-01

    Despite various health system improvements across Alberta, the wait times benchmark was not being met for all patients requiring hip or knee arthroplasty. Alberta Health Services Bone and Joint Clinical Network working groups, in collaboration with other provincial organizations, gained consensus on the development and implementation of a set of provincial Wait Times Rules. These rules standardize the definition and measurement of data elements specific to joint replacement and distinguish between voluntary (patient-related) versus involuntary (healthcare system-related) wait times. Collectively, this information will help identify trends in wait times and more accurately show where wait times can be reduced.

  4. Waiting Time Distribution of Emissions in Complex Coronal Mass Ejections

    NASA Astrophysics Data System (ADS)

    Méndez Berhondo, Adolfo L.; Rodríguez Taboada, Ramón E.; Larralde, Liliana Alfonso

    2006-04-01

    The waiting time distribution of emissions in Coronal Mass Ejections (CMEs) with several emissions is examined. We define the waiting time as the time interval between the commencement of an emission and the commencement of the next emission considered as parts of a unique CME. The distribution seems to follow a power-law. Two classes of CMEs several emissions are considered: “close” and “separate” depending on angular distance between emissions.

  5. Waiting time distribution of emissions in complex coronal mass ejections

    NASA Astrophysics Data System (ADS)

    Méndez Berhondo, A. L.; Rodríguez Taboada, R. E.; Larralde, L. Alfonso

    The waiting time distribution of emissions in Coronal Mass Ejections (CMEs) with several emissions is examined. We define the waiting time (?) as the time interval between the commencement of an emission and the commencement of the next emission considered as parts of a unique CME. The distribution seems to follow a power-law.Two classes of CMEs several emissions are considered: “close” and “separate” depending on angular distance between emissions.

  6. Wait Time for Treatment in Hospital Emergency Departments: 2009

    MedlinePlus

    ... on ambulance diversions, as well as the high percentage (71%) that also reported boarding admitted patients, suggest that these EDs may have been on ambulance diversion. There was no difference in mean wait time for patients triaged as ...

  7. 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

  8. What does satisfaction with wait times mean to cancer patients?

    PubMed

    Mathews, Maria; Ryan, Dana; Bulman, Donna

    2015-12-28

    Patient satisfaction is an important element of quality improvement and patient-centered care, and is an indicator of the public's confidence in the health care system. Although shorter wait times are believed intuitively to lead to higher satisfaction, studies have demonstrated the importance of many other factors which contribute to patients' satisfaction with their wait time experiences. The current study explores the factors that shape patients' satisfaction with their overall wait times (i.e. from symptom to treatment). We conducted qualitative interviews with 60 breast, prostate, lung, or colorectal cancer patients to examine the reasons behind patients' satisfaction or dissatisfaction with their wait time experiences. We purposefully recruited satisfied and unsatisfied participants from our larger survey sample. Using a semi-structured interview guide, patients were asked about their wait time experiences and the reasons behind their (dis)satisfaction. Interviews were transcribed verbatim and coded using a thematic approach. Patients' perceptions of satisfaction with wait times were influenced by three interrelated dimensions: the interpersonal skills of treating physicians (which included expressions/demonstrations of empathy and concern, quality of information exchange, accountability for errors), coordination (which included assistance navigating the health system, scheduling of appointments, sharing information between providers, coordination in scheduling appointments, and sharing of information ), and timeliness of care (which referred to providers' responsiveness to patients' symptoms, coverage during provider absences, and shared sense of urgency between patient and providers). Providers' willingness to "trouble shoot" and acknowledge errors/delays were particularly influential in patients' overall perception of their wait times. We described three dimensions of wait-related satisfaction: physicians' interpersonal skills, coordination of care, and

  9. 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.

  10. 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

    2017-07-04

    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.

  11. 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.

  12. Waiting time and doctor shopping in a mixed medical economy.

    PubMed

    Yeung, Raymond Y T; Leung, Gabriel M; McGhee, Sarah M; Johnston, Janice M

    2004-11-01

    Waiting time generally acts as a rationing mechanism in the public health care system. In theory, patients who have a higher valuation of time are more likely to seek alternative care (i.e. doctor shopping) if there is a parallel private sector than those who have weaker time preference. However, the existing settings of many health care systems do not allow patients to reveal their preference of such. The data presented in this study suggest a positive association between patients' expressed value of time and doctor shopping behaviour in Hong Kong. Patients who were assigned longer waiting times relative to their expected horizon were more likely to seek private alternative care.

  13. [Simulation of waiting time and effectiveness in hospitals].

    PubMed

    Tjoflot, Gunn Kristin; Waaler, Hans Th; Iversen, Tor

    2005-06-02

    Many Norwegian hospitals have to cancel elective surgery because of acute cases, and ring fencing of elective surgery is a frequently discussed measure. In this article we discuss advantages and disadvantages of ring fencing in relation to the results from a simulation model. Model simulations were done in the computer program Powersim Constructor 2.5. We found that combined acute and elective departments are expected to have shorter waiting time and less use of overtime compared with separate acute and elective departments, as more flexible use of capacity results in higher average capacity utilization. In a combined department, elective patients run the risk of having their operation cancelled, but they may expect a shorter waiting time before treatment. Our results indicate that ring fencing in itself is not beneficial, as total capacity utilization declines. On the other hand, separate departments may facilitate an increase in efficiency in the elective surgery department; this may shorten waiting time.

  14. Creating Time for Equity Together

    ERIC Educational Resources Information Center

    Renée, Michelle

    2015-01-01

    Iin urban communities across the nation, a broad range of partners have committed to reinventing educational time together to ensure equitable access to rich learning opportunities for all young people. Across the nation, education partners are using their creativity, commitment, and unique resources to create new school and system designs that…

  15. [Waiting time for treatment shall be calculated correctly].

    PubMed

    Pedersen, Jørgen Ejler

    2011-05-23

    Every system is perfectly designed to achieve the results it gets and in the Danish health care system there is a significant waiting time for the patients. If we want this result to change, we have to change something in the system, but before we do that, we need to understand the system. With queuing theory as a frame of reference, the anatomy and physiology of waiting time is illuminated in order to bring additional knowledge into the design of systems in health care.

  16. 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…

  17. The Identification, Definition, and Measurement of Key Variables in Wait Time Research.

    ERIC Educational Resources Information Center

    Gooding, C. Thomas; And Others

    Wait time, or the pauses between questions and responses, has been demonstrated to be an important factor influencing classroom learning. This paper reviews the key variables that have emerged in wait time research over the past 20 years. Progress in defining and measuring wait time has resulted in improved methodology for wait time research.…

  18. A model to prioritize access to elective surgery on the basis of clinical urgency and waiting time

    PubMed Central

    Valente, Roberto; Testi, Angela; Tanfani, Elena; Fato, Marco; Porro, Ivan; Santo, Maurizio; Santori, Gregorio; Torre, Giancarlo; Ansaldo, Gianluca

    2009-01-01

    covering the case mix of the patients referred to surgery. The software produced real time data and advanced parameters, providing patients and users useful tools to manage waiting lists and to schedule hospital admissions with ease and efficiency. The model protected patients from horizontal and vertical inequities, while positive changes in API were observed in the latest period, meaning that more patients were treated within their MTBT. Conclusion The SWALIS model achieves the purpose of providing useful data to monitor waiting lists appropriately. It allows homogeneous and standardized prioritization, enhancing transparency, efficiency and equity. Due to its applicability, it might represent a pragmatic approach towards surgical waiting lists, useful in both clinical practice and strategic resource management. PMID:19118494

  19. Satisfaction and Wait Time of Patients Visiting a Family Practice Clinic

    PubMed Central

    Bestvater, David; Dunn, Earl V.; Townsend, Connie; Nelson, Wendy

    1988-01-01

    Data relating to wait times and time spent with nurses and physicians were recorded for 656 patients visiting a large family-practice unit. Patients were asked to provide estimates of their wait times and ratings of the acceptability of these wait intervals. Actual wait times were usually longer than those estimated by the patient, and total wait times were considered reasonable. The results of the study show high levels of patient satisfaction and indicate that few patients are dissatisfied until total wait time exceeds forty-five minutes. Different age groups appear to have different expectations, however, and younger patients are more likely to be dissatisfied with their wait times. PMID:21264021

  20. Reducing waiting time at security checkpoints

    SciTech Connect

    Landauer, E.G.; Becker, L.C.

    1988-08-01

    The authors were asked to improve the time it took a queue of cars to go through a security gate every morning and afternoon. Each individual passing through the gate was required to show a security badge to a guard. The goal was to improve processing time and to eliminate a safety problem at the gate without increasing the required resources. This problem required quick resolution. The project was initiated using queuing theory. After collecting data, the authors determined that a simulation model would be more appropriate. The study demonstrated that a significant improvement could be seen when the same number of guards worked two parallel traffic lines leading to the single gate, in place of the security guards working in a serial process from a single line of traffic. 7 tabs., 4 figs.

  1. Waiting times in a tertiary paediatric nephrology clinic

    PubMed Central

    Filler, Guido; Sutandar, Marilyn; Poulin, Darlene

    2007-01-01

    BACKGROUND To the authors’ knowledge, paediatric nephrology waiting times have not been previously studied. Given the high incidence of new referrals each year, the evaluation of the current waiting times would be beneficial in the management and triaging of new appointments. PATIENTS AND METHODS Using descriptive statistics, data from all appropriate paediatric nephrology referrals to the Children’s Hospital of Eastern Ontario (Ottawa, Ontario) from 2003 to 2005 (n=1446) were retrospectively analyzed. RESULTS The median waiting time from receipt of initial request for referral to first appointment was 111 days (range zero to 364 days). No significant variation existed throughout the duration of the study, despite the variation in the number of paediatric nephrology staff. Infants were seen significantly sooner than older children. There were no assigned priority classification levels based on referral reason. Critical conditions, such as macrohematuria, were seen on an urgent basis; all other patients were seen at the next available appointment slot, which was usually four months away. A significant proportion of patients were referred for dysfunctional voiding and enuresis (25.9%). These diagnoses are not generally considered a part of core nephrology. CONCLUSION The waiting times for a paediatric nephrology appointment are long. Focusing on core nephrology business and appropriate triaging of consult would be necessary to implement a priority classification level-based appointment assignment. Additional resources would allow for more patients to be seen in a more timely fashion. PMID:19030333

  2. Waiting-time distributions in the photodetection of squeezed light

    SciTech Connect

    Vyas, R.; Singh, S.

    1988-09-01

    Distribution of waiting-time intervals between the arrivals of successive photons on a photocathode illuminated by a beam of light is discussed. Analytic expressions for the conditional and unconditional distributions for squeezed light are derived in the high degeneracy limit. Results for binomial and thermocoherent states are also given. Curves are presented to illustrate the behavior.

  3. Contract management of Ontario's cancer surgery wait times strategy.

    PubMed

    Cheng, Siu Mee; Irish, Jonathan C; Thompson, Leslee J

    2007-01-01

    The province of Ontario, as a result of the First Ministers' Meeting, was committed to addressing surgery wait times in Ontario. The Ministry of Health and Long-Term Care's response to this commitment was the Wait Times Strategy (WTS) initiative, which addressed access issues with the aim of positively impacting wait times in cancer surgery. Cancer Care Ontario (CCO) was tasked with managing the cancer surgery WTS. CCO engaged in accountability agreements with Ontario hospitals to provide incremental cancer surgery volumes, in return for one-time funding. Through the use of accountability agreements, CCO was able to tie service volume delivery, quality care initiatives and reporting requirements to funding. Other elements of the cancer surgery WTS implementation included the development of wait times definitions, guidelines and targets; the use of a performance management system; facilitation by existing regional cancer leads and continued development of regional cancer programs. Eight key lessons were learned: (1) baseline volume guarantees are critical to ensuring that wait times are positively impacted; (2) there is a need to create a balance between accountability and systems management; (3) clinical quality initiatives can be tied to funding initiatives; (4) allocations of services should be informed by many factors; (5) regional leadership is key to ensuring that local needs are met; (6) data are invaluable in improving performance; (7) there is regional disparity in service delivery, capacity and resources across the province; and (8) program sustainability is an underlying goal of the WTS for cancer surgery. The implication is that accountability agreements can be leveraged to create sustainable health management systems.

  4. Resource Selection Using Execution and Queue Wait Time Predictions

    NASA Technical Reports Server (NTRS)

    Warren, Smith; Wong, Parkson; Biegel, Bryan A. (Technical Monitor)

    2002-01-01

    Computational grids provide users with many possible places to execute their applications. We wish to help users select where to run their applications by providing predictions of the execution times of applications on space shared parallel computers and predictions of when scheduling systems for such parallel computers will start applications. Our predictions are based on instance based learning techniques and simulations of scheduling algorithms. We find that our execution time prediction techniques have an average error of 37 percent of the execution times for trace data recorded from SGI Origins at NASA Ames Research Center and that this error is 67 percent lower than the error of user estimates. We also find that the error when predicting how long applications will wait in scheduling queues is 95 percent of mean queue wait times when using our execution time predictions and this is 57 percent lower than if we use user execution time estimates.

  5. 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

  6. 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

  7. 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

  8. Time to Endoscopy in Patients with Colorectal Cancer: Analysis of Wait-Times

    PubMed Central

    Janssen, Renée M.; Takach, Oliver; Nap-Hill, Estello; Enns, Robert A.

    2016-01-01

    Objective. The Canadian Association of Gastroenterology Wait Time Consensus Group recommends that patients with symptoms associated with colorectal cancer (CRC) should have an endoscopic examination within 2 months. However, in a recent survey of Canadian gastroenterologists, wait-times for endoscopy were considerably longer than the current guidelines recommend. The purpose of this study was to evaluate wait-times for colonoscopy in patients who were subsequently found to have CRC through the Division of Gastroenterology at St. Paul's Hospital (SPH). Methods. This study was a retrospective chart review of outpatients seen for consultation and endoscopy ultimately diagnosed with CRC. Subjects were identified through the SPH pathology database for the inclusion period 2010 through 2013. Data collected included wait-times, subject characteristics, cancer characteristics, and outcomes. Results. 246 subjects met inclusion criteria for this study. The mean wait-time from primary care referral to first office visit was 63 days; the mean wait-time to first endoscopy was 94 days. Patients with symptoms waited a mean of 86 days to first endoscopy, considerably longer than the national recommended guideline of 60 days. There was no apparent effect of length of wait-time on node positivity or presence of distant metastases at the time of diagnosis. Conclusion. Wait-times for outpatient consultation and endoscopic evaluation at the St. Paul's Hospital Division of Gastroenterology exceed current guidelines. PMID:27446872

  9. Real waiting times for surgery. Proposal for an improved system for their management.

    PubMed

    Abásolo, Ignacio; Barber, Patricia; González López-Valcárcel, Beatriz; Jiménez, Octavio

    2014-01-01

    In Spain, official information on waiting times for surgery is based on the interval between the indication for surgery and its performance. We aimed to estimate total waiting times for surgical procedures, including outpatient visits and diagnostic tests prior to surgery. In addition, we propose an alternative system to manage total waiting times that reduces variability and maximum waiting times without increasing the use of health care resources. This system is illustrated by three surgical procedures: cholecystectomy, carpal tunnel release and inguinal/femoral hernia repair. Using data from two Autonomous Communities, we adjusted, through simulation, a theoretical distribution of the total waiting time assuming independence of the waiting times of each stage of the clinical procedure. We show an alternative system in which the waiting time for the second consultation is established according to the time previously waited for the first consultation. Average total waiting times for cholecystectomy, carpal tunnel release and inguinal/femoral hernia repair were 331, 355 and 137 days, respectively (official data are 83, 68 and 73 days, respectively). Using different negative correlations between waiting times for subsequent consultations would reduce maximum waiting times by between 2% and 15% and substantially reduce heterogeneity among patients, without generating higher resource use. Total waiting times are between two and five times higher than those officially published. The relationship between the waiting times at each stage of the medical procedure may be used to decrease variability and maximum waiting times. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

  10. Waiting time dynamics of priority-queue networks.

    PubMed

    Min, Byungjoon; Goh, K-I; Kim, I-M

    2009-05-01

    We study the dynamics of priority-queue networks, generalizations of the binary interacting priority-queue model introduced by Oliveira and Vazquez [Physica A 388, 187 (2009)]. We found that the original AND-type protocol for interacting tasks is not scalable for the queue networks with loops because the dynamics becomes frozen due to the priority conflicts. We then consider a scalable interaction protocol, an OR-type one, and examine the effects of the network topology and the number of queues on the waiting time distributions of the priority-queue networks, finding that they exhibit power-law tails in all cases considered, yet with model-dependent power-law exponents. We also show that the synchronicity in task executions, giving rise to priority conflicts in the priority-queue networks, is a relevant factor in the queue dynamics that can change the power-law exponent of the waiting time distribution.

  11. Improving wait times in primary care using the Dartmouth microsystem improvement curriculum.

    PubMed

    Malloy, Christine; Little, Barbara Battin; Michael, Melanie

    2013-01-01

    Wait times for medical care are a major factor in patient satisfaction with health care. The Dartmouth Microsystem Improvement Curriculum and Plan-Do-Study-Act improvement method were used to address patient dissatisfaction with wait times among patients receiving primary care in a Federally Qualified Health Center. Wait time data were collected for 406 patient visits during the pretest phase and 397 visits during the posttest phase. Improvements in patient satisfaction with waiting room wait time (P = .023) and examination room wait time (P = .009) were achieved.

  12. [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.

  13. [Identification of variables influencing waiting times for specialized care].

    PubMed

    Cano, J G; Medina, E; Custardoy, J; Orozco, D; Quince, F

    2003-01-01

    To identify the variables influencing waiting time for specialized care (waiting lists) through multiple regression analysis and to analyze the health districts with long waiting times according to these variables. Descriptive, cross sectional and retrospective study of waiting times for access to specialized care between 1997 and 1998. Area 20 of the Health Department of the Autonomous Community of Valencia (Spain) consisting of 12 health districts with 204,424 inhabitants. The following variables were gathered: variables influencing demand: type of municipality, aging and indexes of dependent population, and percentage of pensioners; variables influencing supply: age, sex, training and professional stability of the doctor, and size of the patient list; variables influencing resource consumption: percentage of referrals to specialized care per thousand inhabitants, mean WT for access to specialized care (in natural days) by district and year, number of consultations, and workload. A multiple regression model was constructed through (backward) elimination, taking the mean WT as the dependent variable and the remaining variables as independent variables. The resulting equation enabled calculation of the expected WT per health district and the deviation of the real WT from the expected WT. A district was considered to have a high WT when its deviation was above the mean plus one standard deviation of the distribution. The mean WT for access to specialized care was 37 days in 1997 and 34 days in 1998. A significant correlation (p < 0.005) was found between WT and the percentage of the population aged less than 14 years (r = 0.693), the percentage of the population aged between 14-65 years (r = 0.517), the number of consultations (r = 0.689), and coastal population (r = 0.470). Our final model included: percentage of the population aged less than 14 years, number of consultations, and coastal population (F = 41.803; p < 0.000; r = 0.945; r2 = 0.893). Three districts

  14. Probing Majorana and Andreev bound states with waiting times

    NASA Astrophysics Data System (ADS)

    Chevallier, D.; Albert, M.; Devillard, P.

    2016-10-01

    We consider a biased normal-superconducting junction with various types of superconductivity. Depending on the class of superconductivity, a Majorana bound state may appear at the interface. We show that this has important consequences on the statistical distribution of time delays between detection of consecutive electrons flowing out of such an interface, namely the waiting time distribution. Therefore, this quantity is shown to be a clear fingerprint of Majorana bound-state physics and may be considered as an experimental signature of its presence.

  15. An audit of travel and waiting times for outpatient radiotherapy.

    PubMed

    Junor, E J; Macbeth, F R; Barrett, A

    1992-05-01

    The object of this study was to assess the non-medical factors which detract from the quality of outpatient receiving service to a population of 2.7 million in a wide geographical area. We conducted a survey by patient questionnaire of all outpatients receiving radiotherapy in the West of Scotland on a single day in 1990. A total of 216 outpatients attended for radiotherapy with a 92% response rate to the questionnaire being achieved. Median values (and ranges) were: age 58 (4-85) years, number of daily treatments 20 (4-33), distance travelled in one direction 10 (1-60) miles, travelling time 45 (5-130) minutes, waiting time in the unit for treatment 60 (0-200) minutes, and a time away from home of 2 hours 50 minutes (35 minutes-7 hours). Sixteen per cent of patients had a relative who lost time from work by transporting the patient and only 12 of 60 patients who were away from home over a meal time were offered a hospital meal. Sixteen per cent of patients came by ambulance and 73% by motor car. Of 146 travelling by car 27% used a charity service and 20% a volunteer driver ambulance service car. It is concluded that long travelling distances, travelling times and treatment waiting times for many patients require revision of transport provision, a strict appointment system, more treatment machines and hostel accommodation.

  16. Investigating the Relationship between Customer Wait Time and Operational Availability through Simulation Modeling

    DTIC Science & Technology

    2012-12-01

    NAVAL POSTGRADUATE SCHOOL MONTEREY, CALIFORNIA MBA PROFESSIONAL REPORT Investigating the Relationship between Customer Wait Time...Investigating the Relationship between Customer Wait Time and Operational Availability through Simulation Modeling 5. FUNDING NUMBERS 6. AUTHOR(S... RELATIONSHIP BETWEEN CUSTOMER WAIT TIME AND OPERATIONAL AVAILABILITY THROUGH SIMULATION MODELING Dustin Thorn, Major, United States Marine Corps Matt

  17. An Investigation of the Teacher Behavior of Wait-Time During an Inquiry Science Lesson.

    ERIC Educational Resources Information Center

    Fowler, Thaddeus W.

    This study was designed to investigate the nonverbal teacher behavior of wait-time. Wait-time is the silence in a conversation following a teacher or student utterance. The primary purpose of the investigation was to document some of the behavioral and cognitive effects of wait-time and to delineate the interrelationships between the various forms…

  18. A directed continuous time random walk model with jump length depending on waiting time.

    PubMed

    Shi, Long; Yu, Zuguo; Mao, Zhi; Xiao, Aiguo

    2014-01-01

    In continuum one-dimensional space, a coupled directed continuous time random walk model is proposed, where the random walker jumps toward one direction and the waiting time between jumps affects the subsequent jump. In the proposed model, the Laplace-Laplace transform of the probability density function P(x, t) of finding the walker at position x at time t is completely determined by the Laplace transform of the probability density function φ(t) of the waiting time. In terms of the probability density function of the waiting time in the Laplace domain, the limit distribution of the random process and the corresponding evolving equations are derived.

  19. Joint optimisation of transmission and waiting times in cognitive radio

    NASA Astrophysics Data System (ADS)

    Amini, Mohammadreza; Samimi, Abouzar; Mirzavandi, Asra

    2016-04-01

    Transmission time optimisation is one of the key considerations of cognitive network design. There are many studies in cognitive radio networks (CRNs) focusing on finding the best transmission time for secondary users (SUs) to maximise transmission or energy efficiency. While longer sensing duration leads to a higher sensing accuracy and causes less interference, the SU spends less time for transmission and more energy on sensing spectrum. On the other hand, when the transmission duration becomes longer, although the SU has more opportunities to access the channel, it may encounter higher interference due to primary user (PU) returns and the probability of collision becomes higher. In this article, in a decentralised slotted protocol for CRN, the SU spectrum access is proved as a renewal process, then the interference due to PU return during SU transmission, the missed opportunities due to waiting for the channel to become idle and the energy consumed by the SU in the whole spectrum access process including idling energy, transmission energy and sensing energy consumption are formulated and integrated into newly defined efficiency to obtain the optimum transmission time and waiting time.

  20. Average waiting time profiles of uniform DQDB model

    SciTech Connect

    Rao, N.S.V.; Maly, K.; Olariu, S.; Dharanikota, S.; Zhang, L.; Game, D.

    1993-09-07

    The Distributed Queue Dual Bus (DQDB) system consists of a linear arrangement of N nodes that communicate with each other using two contra-flowing buses; the nodes use an extremely simple protocol to send messages on these buses. This simple, but elegant, system has been found to be very challenging to analyze. We consider a simple and uniform abstraction of this model to highlight the fairness issues in terms of average waiting time. We introduce a new approximation method to analyze the performance of DQDB system in terms of the average waiting time of a node expressed as a function of its position. Our approach abstracts the intimate relationship between the load of the system and its fairness characteristics, and explains all basic behavior profiles of DQDB observed in previous simulation. For the uniform DQDB with equal distance between adjacent nodes, we show that the system operates under three basic behavior profiles and a finite number of their combinations that depend on the load of the network. Consequently, the system is not fair at any load in terms of the average waiting times. In the vicinity of a critical load of 1 {minus} 4/N, the uniform network runs into a state akin to chaos, where its behavior fluctuates from one extreme to the other with a load variation of 2/N. Our analysis is supported by simulation results. We also show that the main theme of the analysis carries over to the general (non-uniform) DQDB; by suitably choosing the inter-node distances, the DQDB can be made fair around some loads, but such system will become unfair as the load changes.

  1. Average waiting time in FDDI networks with local priorities

    NASA Technical Reports Server (NTRS)

    Gercek, Gokhan

    1994-01-01

    A method is introduced to compute the average queuing delay experienced by different priority group messages in an FDDI node. It is assumed that no FDDI MAC layer priorities are used. Instead, a priority structure is introduced to the messages at a higher protocol layer (e.g. network layer) locally. Such a method was planned to be used in Space Station Freedom FDDI network. Conservation of the average waiting time is used as the key concept in computing average queuing delays. It is shown that local priority assignments are feasable specially when the traffic distribution is asymmetric in the FDDI network.

  2. Outpatient chemotherapy administration: decreasing wait times for patients and families.

    PubMed

    Hendershot, Eleanor; Murphy, Cory; Doyle, Sandra; Van-Clieaf, Judy; Lowry, Jane; Honeyford, Lisa

    2005-01-01

    Increasingly, there is a trend to deliver chemotherapy, where possible, in the outpatient ambulatory setting. In the few studies that have explored the setting of cancer care, long wait times are frequently linked to dissatisfaction. Several factors contribute to lengthy waiting times for patients and their families: long registration processes, lag times associated with obtaining laboratory results, time required for patient assessments and preparation of chemotherapeutic agents, adequacy of nursing resources, and physical space constraints in relation to patient volumes. With the goal of improving care delivery in the outpatient clinic, a fast-tracking system was established. Program planning included establishing patient eligibility criteria, protocol and treatment appropriateness, interdepartmental collaboration, development of a communication plan for families and staff, negotiation of physical space, and allocation of human resources. This was instituted by re-allocating existing resources and establishing an autonomous nurse-managed chemotherapy clinic. This fast-tracking program has enabled us to use our existing resources with greater efficiency and improve patient care from safety and quality-of-life perspectives for those included in the program.

  3. 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.

  4. Lean-driven solutions slash ED wait times, LOS.

    PubMed

    2012-12-01

    The ED at The Aroostook Medical Center (TAMC) in Presque Isle, ME, is a level II trauma center. It is the largest in the region, with only 89 beds. It has undergone a transformation in recent months, with average wait times to see a provider going from four to five hours down to less than five minutes, and the left-without-being-seen (LWBS) rate has been slashed from a high of 7% down to less than 1%. The hospital says the improvements are the result of lean-driven, staff-designed solutions, coupled with administrative engagement and oversight. And administrators say more improvements are on the way in 2013 when a hospital-wide workgroup will try to clear away obstacles and inefficiencies from the hospital admissions process. To tackle long wait times among patients with lower triage levels, the ED instituted a fast-track system, manned by mid-level providers and a tech or LPN. Responsibilities for charge nurses have been redesigned so that they have the power to monitor and facilitate patient flow. The ED has initiated more point-of-care testing so that nurses and techs can conduct many routine tests on their own. While the lean model relies on staff-driven solutions, administrators make the difference when it comes to sustaining changes and minimizing employee resistance.

  5. 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.

  6. Anomalous Processes with General Waiting Times: Functionals and Multipoint Structure

    NASA Astrophysics Data System (ADS)

    Cairoli, Andrea; Baule, Adrian

    2015-09-01

    Many transport processes in nature exhibit anomalous diffusive properties with nontrivial scaling of the mean square displacement, e.g., diffusion of cells or of biomolecules inside the cell nucleus, where typically a crossover between different scaling regimes appears over time. Here, we investigate a class of anomalous diffusion processes that is able to capture such complex dynamics by virtue of a general waiting time distribution. We obtain a complete characterization of such generalized anomalous processes, including their functionals and multipoint structure, using a representation in terms of a normal diffusive process plus a stochastic time change. In particular, we derive analytical closed form expressions for the two-point correlation functions, which can be readily compared with experimental data.

  7. Wait and consult times for primary healthcare services in central Mozambique: a time-motion study

    PubMed Central

    Wagenaar, Bradley H.; Gimbel, Sarah; Hoek, Roxanne; Pfeiffer, James; Michel, Cathy; Cuembelo, Fatima; Quembo, Titos; Afonso, Pires; Gloyd, Stephen; Lambdin, Barrot H.; Micek, Mark A.; Porthé, Victoria; Sherr, Kenneth

    2016-01-01

    Background We describe wait and consult times across public-sector clinics and identify health facility determinants of wait and consult times. Design We observed 8,102 patient arrivals and departures from clinical service areas across 12 public-sector clinics in Sofala and Manica Provinces between January and April 2011. Negative binomial generalized estimating equations were used to model associated health facility factors. Results Mean wait times (in minutes) were: 26.1 for reception; 43.5 for outpatient consults; 58.8 for antenatal visits; 16.2 for well-child visits; 8.0 for pharmacy; and 15.6 for laboratory. Mean consultation times (in minutes) were: 5.3 for outpatient consults; 9.4 for antenatal visits; and 2.3 for well-child visits. Over 70% (884/1,248) of patients arrived at the clinic to begin queuing for general reception prior to 10:30 am. Facilities with more institutional births had significantly longer wait times for general reception, antenatal visits, and well-child visits. Clinics in rural areas had especially shorter wait times for well-child visits. Outpatient consultations were significantly longer at the smallest health facilities, followed by rural hospitals, tertiary/quaternary facilities, compared with Type 1 rural health centers. Discussion The average outpatient consult in Central Mozambique lasts 5 min, following over 40 min of waiting, not including time to register at most clinics. Wait times for first antenatal visits are even longer at almost 1 h. Urgent investments in public-sector human resources for health alongside innovative operational research are needed to increase consult times, decrease wait times, and improve health system responsiveness. PMID:27580822

  8. Optimal spacecraft rendezvous by minimum velocity change and wait time

    NASA Astrophysics Data System (ADS)

    Oghim, Snyoll; Mok, Sung-Hoon; Leeghim, Henzeh

    2017-09-01

    An optimization problem is investigated in this paper to obtain a minimum velocity change, sometimes called as minimum-energy, to rendezvous a target spacecraft. The problem formulation starts with known initial positions and velocity vectors of two spacecraft, so-called target and chaser, respectively. The Kepler's time-of-flight equation in terms of the universal variables and the relationship between final position vectors of the two spacecraft are posed as constraints. Three-dimensional orbital information is obtained by using the f and g solution that called the Lagrange coefficients. One of advantages for the universal variables is that it provides total orbital information valid for all conic orbits without much numerical difficulty. The wait time concept is also employed to release the magnitude of velocity changes by minimizing the performance index. Finally, these techniques are demonstrated using numerical simulations.

  9. Waiting times for elective surgery and the decision to buy private health insurance.

    PubMed

    Johar, Meliyanni; Jones, Glenn; Keane, Michael; Savage, Elizabeth; Stavrunova, Olena

    2011-09-01

    More than 45% of Australians buy health insurance for private treatment in hospital. This is despite having access to universal and free public hospital treatment. Anecdotal evidence suggests that avoidance of long waits for public treatment is one possible explanation for the high rate of insurance coverage. In this study, we investigate the effect of waiting on individual decisions to buy private health insurance. Individuals are assumed to form an expectation of their own waiting time as a function of their demographics and health status. We model waiting times using administrative data on the population hospitalised for elective procedures in public hospitals and use the parameter estimates to impute the expected waiting time and the probability of a long wait for a representative sample of the population. We find that expected waiting time does not increase the probability of buying insurance but a high probability of experiencing a long wait does. On average, waiting time has no significant impact on insurance. In addition, we find that favourable selection into private insurance, measured by self-assessed health, is no longer significant once waiting time variables are included. This result suggests that a source of favourable selection may be aversion to waiting among healthier people. Copyright © 2011 John Wiley & Sons, Ltd.

  10. A stochastic model of waiting time for first conception.

    PubMed

    Pathak, K B; Pandey, R N

    1982-04-01

    This paper derives a probability model of the waiting time from marriage to 1st conception by using a mathematical function to show the variation of fecundability over a woman's reproductive span. The model is based on the assumptions that conception is a chance event, a woman begins her reproductive cycle after marrige in a fecundable and nonpregnant state, the age at marriage is a random variable with unknown distribution function, and all women are homogeneous with respect to fecundability. To test the validity of the model, it was fitted to the data of Singh. The proposed model described the observed data satisfactorily on the basis of age at marriage. Weaknesses in the fit of the data in some cells may reflect recall and adjustment errors. The advantage of this model over those that assume that the coition rate of couples is the same until conception is that it takes into account the effect of social customs regulating sexual activity after marriage.

  11. Turn to staff for dramatic improvement in wait times, productivity.

    PubMed

    2011-09-01

    Baylor Medical Center in Garland,TX, has been able to drastically reduce ED wait times, as well as the LWBS rate by streamlining the triage process and implementing a staff-driven improvement effort aimed at identifying inefficiencies and replacing them with solutions that work. The result is 11 beds of added capacity just from changes in patient flow. A cross section of volunteers from the ED staff reviewed metrics and devised solutions that they felt would work best to boost efficiency and eliminate bottlenecks. Solutions included letting low-acuity patients move themselves between care settings, freeing the charge nurse from patient care duties so that he or she could oversee patient flow, and empowering physician-nurse teams to see patients more quickly. ED managers say leadership is important, but letting staff drive the improvement process is key to their success.

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

    SciTech Connect

    Joseph, A; Herrera, D; Hijal, T; Kildea, J; Hendren, L; Leung, A; Wainberg, J; Sawaf, M; Gorshkov, M; Maglieri, R; Keshavarz, M

    2016-06-15

    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 of 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

  13. 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.

  14. 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.

  15. The impact of different prioritisation policies on waiting times: case studies of Norway and Scotland.

    PubMed

    Januleviciute, Jurgita; Askildsen, Jan Erik; Kaarboe, Oddvar; Holmås, Tor Helge; Sutton, Matt

    2013-11-01

    We investigate the distributional consequences of two different waiting times initiatives, one in Norway, and one in Scotland. The primary focus of Scotland's recent waiting time reforms, introduced in 2003, and modified in 2005 and 2007, has been on reducing maximum waiting times through the imposition of high profile national targets accompanied by increases in resources. In Norway, the focus of the reform introduced in September 2004, has been on assigning patients referred to hospital a maximum waiting time based on disease severity, the expected benefit and the cost-effectiveness of the treatment. We use large, national administrative datasets from before and after each of these reforms and assign priority groups based on the maximum waiting times stipulated in medical guidelines. The analysis shows that the lowest priority patients benefited most from both reforms. This was at the cost of longer waiting times for patients that should have been given higher priority in Norway, while Scotland's high priority patients remained unaffected.

  16. Patients' Waiting Time and Doctors' Idle Time in the Outpatient Setting

    PubMed Central

    Fetter, Robert B.; Thompson, John D.

    1966-01-01

    If outpatient care is to be made acceptable to the patient and still remain efficient, some balance between the patients' waiting time and the doctors' idle time must be achieved. Examination of the literature on the subject and of three specific waiting-time studies revealed that there are at least seven variables affecting this relationship: appointment interval, service time, patients' arrival pattern, number of no-shows, number of walk-ins, physicians' arrival pattern, and interruptions in patient services. An outpatient department simulator was constructed so that each of these variables could be manipulated and its effect on the doctors' idle time—patients' waiting time relation assessed. Specific experiments were conducted to determine the effect of patient loads, patients' early and late arrival times, physicians' promptness, and a combination of these variables on the operation of the clinic. Results of the simulation runs are presented. PMID:5915335

  17. 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

  18. [Effects of waiting times within simple problems: an analogy to waiting times in human-computer interaction].

    PubMed

    Kuhmann, W; Schaefer, F; Boucsein, W

    1990-01-01

    The impact of forced intra-task waiting periods was evaluated in a laboratory study designed in analogy to forced waiting periods in human-computer interaction. Each task consisted of two lines of grouped capital letters (so-called Sterzinger lines) that had to be processed individually, separated by the experimental waiting period. The final response to both lines was taken after removal of the second line. The experiment was conducted according to a within-subjects design with the order of the two factors "duration" (2 s vs. 8 s) and "variability of the waiting periods" (constant vs. variable) controlled. The dependent variables were performance indices, heart rate, electrodermal activity, and subjective measures of mood and physical complaints. The results showed effects of the duration of waiting periods for the performance and the physiological variables, and effects of the variability factor for the subjective variables. Shorter waiting periods were associated with higher scores of heart rate and skin resistance responses, variable waiting periods seemed to confuse the subjects more than constant ones. The results are discussed with respect to the effects of the two experimental factors. With respect to dialog structures in human-computer interaction, the results lead to the conclusion that response interference could be avoided by giving the user the possibility to immediately input problem solutions. Partial and preliminary inputs should be permanently kept visible during the whole task cycle by the software.

  19. Models of Emergency Departments for Reducing Patient Waiting Times

    PubMed Central

    Laskowski, Marek; McLeod, Robert D.; Friesen, Marcia R.; Podaima, Blake W.; Alfa, Attahiru S.

    2009-01-01

    In this paper, we apply both agent-based models and queuing models to investigate patient access and patient flow through emergency departments. The objective of this work is to gain insights into the comparative contributions and limitations of these complementary techniques, in their ability to contribute empirical input into healthcare policy and practice guidelines. The models were developed independently, with a view to compare their suitability to emergency department simulation. The current models implement relatively simple general scenarios, and rely on a combination of simulated and real data to simulate patient flow in a single emergency department or in multiple interacting emergency departments. In addition, several concepts from telecommunications engineering are translated into this modeling context. The framework of multiple-priority queue systems and the genetic programming paradigm of evolutionary machine learning are applied as a means of forecasting patient wait times and as a means of evolving healthcare policy, respectively. The models' utility lies in their ability to provide qualitative insights into the relative sensitivities and impacts of model input parameters, to illuminate scenarios worthy of more complex investigation, and to iteratively validate the models as they continue to be refined and extended. The paper discusses future efforts to refine, extend, and validate the models with more data and real data relative to physical (spatial–topographical) and social inputs (staffing, patient care models, etc.). Real data obtained through proximity location and tracking system technologies is one example discussed. PMID:19572015

  20. Waiting Time as a Barrier to Treatment Entry: Perceptions of Substance Users

    PubMed Central

    Redko, Cristina; Rapp, Richard C.; Carlson, Robert G.

    2007-01-01

    Many substance users report that they experience multiple barriers that produce significant challenges to linking with treatment services. Being on a waiting list is frequently mentioned as a barrier, leading some people to give up on treatment and to continue using, while prompting others to view sobriety during the waiting period as proof they do not need treatment. This ethnographic study examines the views that 52 substance users have of the waiting time before treatment and the strategies they created to overcome it. Understanding how substance users react to waiting time itself and in relation to other barriers can lead to services that are effective in encouraging treatment linkage. PMID:18509514

  1. 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.

  2. [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

  3. Spatial structure increases the waiting time for cancer

    PubMed Central

    Martens, Erik A.; Kostadinov, Rumen; Maley, Carlo C.; Hallatschek, Oskar

    2012-01-01

    Cancer results from a sequence of genetic and epigenetic changes which lead to a variety of abnormal phenotypes including increased proliferation and survival of somatic cells, and thus, to a selective advantage of pre-cancerous cells. The notion of cancer progression as an evolutionary process has been experiencing increasing interest in recent years. Many efforts have been made to better understand and predict the progression to cancer using mathematical models; these mostly consider the evolution of a well-mixed cell population, even though pre-cancerous cells often evolve in highly structured epithelial tissues. In this study, we propose a novel model of cancer progression that considers a spatially structured cell population where clones expand via adaptive waves. This model is used to assess two different paradigms of asexual evolution that have been suggested to delineate the process of cancer progression. The standard scenario of periodic selection assumes that driver mutations are accumulated strictly sequentially over time. However, when the mutation supply is sufficiently high, clones may arise simultaneously on distinct genetic backgrounds, and clonal adaptation waves interfere with each other. We find that in the presence of clonal interference, spatial structure increases the waiting time for cancer, leads to a patchwork structure of non-uniformly sized clones, decreases the survival probability of virtually neutral (passenger) mutations, and that genetic distance begins to increase over a characteristic length scale Lc. These characteristic features of clonal interference may help to predict the onset of cancers with pronounced spatial structure and to interpret spatially-sampled genetic data obtained from biopsies. Our estimates suggest that clonal interference likely occurs in the progression of colon cancer, and possibly other cancers where spatial structure matters. PMID:22707911

  4. Measurement of surgical wait times in a universal health care system

    PubMed Central

    Kawakami, Jun; Hopman, Wilma M.; Smith-Tryon, Rachael; Siemens, D. Robert

    2008-01-01

    Introduction Reported increases in surgical wait times for cancer have intensified the focus on this quality of health care indicator and have created a very public, concerted effort by providers to decrease wait times for cancer surgery in Ontario. Delays in access to health care are multifactorial and their measurement from existing administrative databases can lack pertinent detail. The purpose of our study was to use a real-time surgery-booking software program to examine surgical wait times at a single centre. Methods The real-time wait list management system Axcess.Rx has been used exclusively by the department of urology at the Kingston General Hospital to book all nonemergency surgery for 4 years. We reviewed the length of time from the decision to perform surgery to the actual date of surgery for patients in our group urological practice. Variables thought to be potentially important in predicting wait time were also collected, including the surgeon’s assessment of urgency, the type of procedure (i.e., diagnostic, minor cancer, major cancer, minor benign, major benign), age and sex of the patient, inpatient versus outpatient status and year of surgery. Analysis was planned a priori to determine factors that affected wait time by using multivariate analysis to analyze variables that were significant in univariate analysis. Results There were 960 operations for cancer and 1654 for benign conditions performed during the evaluation period. The overall mean wait time was 36 days for cancer and 47 days for benign conditions, respectively. The mean wait time for cancer surgery reached a nadir in 2004 at 29.9 days and subsequently increased every year, reaching 56 days in 2007. In comparison, benign surgery reached a nadir wait time of 33.7 days in 2004 and in 2007 reached 74 days at our institution. Multivariate analysis revealed that the year of surgery was still a significant predictor of wait time. Urgency score, type of procedure and inpatient versus

  5. 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

  6. 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…

  7. 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…

  8. 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.

  9. 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.

  10. Follow-up of recommendations for hostel care: some determinants of waiting times.

    PubMed

    Otis, N; Humphries, S

    1993-01-01

    This study explores the impact of client characteristics on waiting times for hostel admission. A sample of 116 clients recommended for hostel care by Victorian aged care assessment teams (ACATs) between April and June 1991 were tracked until they entered a hostel, cancelled their applications, died, or until the end of the study in April 1992. Survival analysis was used to identify possible relationships between specific client characteristics and waiting times. High dependency clients consistently entered more quickly than low dependency clients (p < .05), while cognitive impairment did not appear to have an impact on waiting times for either group. Similarly, client living arrangement did not have a clear impact on waiting time. Possible explanations for the longer waiting times include client preference for a particular hostel and the incentives of the payment system.

  11. Electron waiting times of a periodically driven single-electron turnstile

    NASA Astrophysics Data System (ADS)

    Potanina, Elina; Flindt, Christian

    2017-07-01

    We investigate the distribution of waiting times between electrons emitted from a periodically driven single-electron turnstile. To this end, we develop a scheme for analytic calculations of the waiting time distributions for arbitrary periodic driving protocols. We illustrate the general framework by considering a driven tunnel junction before moving on to the more involved single-electron turnstile. The waiting time distributions are evaluated at low temperatures for square-wave and harmonic driving protocols. In the adiabatic regime, the dynamics of the turnstile is synchronized with the external drive. As the nonadiabatic regime is approached, the waiting time distribution becomes dominated by cycle-missing events in which the turnstile fails to emit within one or several periods. We also discuss the influence of finite electronic temperatures. The waiting time distributions provide a useful characterization of the driven single-electron turnstile with complementary information compared to what can be learned from conventional current measurements.

  12. The effect of standardised cancer pathways on Danish cancer patients' dissatisfaction with waiting time.

    PubMed

    Dahl, Trine Louise; Vedsted, Peter; Jensen, Henry

    2017-01-01

    Standardised cancer patient pathways (CPPs) were implemented in Denmark in 2008 to reduce the waiting time during the diagnostic process and hereby improve patient satisfaction. The aim of this study was to investigate whether patient-reported dissatisfaction with long waiting times has changed from "before" to "after" the implementation of CPPs. We conducted a comparative cohort study by comparing the patient-reported dissatisfaction with long waiting time before (2004/2005) and after (2010) CPP implementation. Logistic regression was used to estimate the odds ratios (ORs) for patient-reported dissatisfaction after CPP implementation compared with before. Fewer patients reported dissatisfaction with long waiting time from the time of referral by their general practitioner (GP) to the first consultation at the hospital across the time of CPP implementation (p < 0.001) (adjusted OR = 0.6 (95% confidence interval (CI): 0.5-0.8)). More patients reported dissatisfaction with long waiting time to get an appointment with their GP across the time of CPP implementation (p < 0.001) (adjusted OR = 3.7 (95% CI: 2.5-5.3)). CPP implementation in Denmark was associated with a reduced level of patient-reported dissatisfaction with long waiting time from the time of referral to the first consultation at the hospital. This indicates that the CPP objective of increasing patient satisfaction may have been achieved. Nevertheless, more patients reported dissatisfaction with long waiting time to get an appointment with their GP. none. not relevant.

  13. 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…

  14. 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…

  15. Outpatient waiting time in health services and teaching hospitals: a case study in Iran.

    PubMed

    Mohebbifar, Rafat; Hasanpoor, Edris; Mohseni, Mohammad; Sokhanvar, Mobin; Khosravizadeh, Omid; Mousavi Isfahani, Haleh

    2013-11-10

    One of the most important indexes of the health care quality is patient's satisfaction and it takes place only when there is a process based on management. One of these processes in the health care organizations is the appropriate management of the waiting time process. The aim of this study is the systematic analyzing of the outpatient waiting time. This descriptive cross sectional study conducted in 2011 is an applicable study performed in the educational and health care hospitals of one of the medical universities located in the north west of Iran. Since the distributions of outpatients in all the months were equal, sampling stage was used. 160 outpatients were studied and the data was analyzed by using SPSS software. Results of the study showed that the waiting time for the outpatients of ophthalmology clinic with an average of 245 minutes for each patient allocated the maximum time among the other clinics for itself. Orthopedic clinic had the minimal waiting time including an average of 77 minutes per patient. The total average waiting time for each patient in the educational hospitals under this study was about 161 minutes. by applying some models, we can reduce the waiting time especially in the realm of time and space before the admission to the examination room. Utilizing the models including the one before admission, electronic visit systems via internet, a process model, six sigma model, queuing theory model and FIFO model, are the components of the intervention that reduces the outpatient waiting time.

  16. Wait time from primary to specialty care: a trend analysis from Edmonton, Canada.

    PubMed

    Thanh, Nguyen X; Wanke, Margaret; McGeachy, Leanne

    2013-05-01

    Medical wait time is a top health policy issue in canada. reliable data on the referral wait time from primary to specialty care are limited. Existing data on referral wait times are generally self-reported by specialists. In 2008, the edmonton north primary care network (PCN) developed a centralized referral program, including a specialist database that contains information on specialists' referral requirements, forms and protocols, and has the capability of tracking referrals that the PCN makes on behalf of its family physicians to specialty care. We performed a trend analysis of the referral wait time (defined as the time from referral by a family physician to an appointment date with a specialist) from 2009 to 2011 using the program database (n=33,281 referrals). The study provided a unique and comprehensive picture of wait times for 22 specialties. We identified a decrease in the overall wait time year over year, and improvement in the number of referrals that are accepted the first time. additionally, specific opportunities for further improvement in referral wait time were noted. Copyright © 2013 Longwoods Publishing.

  17. Wait Time from Primary to Specialty Care: A Trend Analysis from Edmonton, Canada

    PubMed Central

    Wanke, Margaret; McGeachy, Leanne

    2013-01-01

    Medical wait time is a top health policy issue in Canada. Reliable data on the referral wait time from primary to specialty care are limited. Existing data on referral wait times are generally self-reported by specialists. In 2008, the Edmonton North Primary Care Network (PCN) developed a Centralized Referral Program, including a specialist database that contains information on specialists' referral requirements, forms and protocols, and has the capability of tracking referrals that the PCN makes on behalf of its family physicians to specialty care. We performed a trend analysis of the referral wait time (defined as the time from referral by a family physician to an appointment date with a specialist) from 2009 to 2011 using the program database (n=33,281 referrals). The study provided a unique and comprehensive picture of wait times for 22 specialties. We identified a decrease in the overall wait time year over year, and improvement in the number of referrals that are accepted the first time. Additionally, specific opportunities for further improvement in referral wait time were noted. PMID:23968636

  18. Waiting for thyroid surgery: a study of psychological morbidity and determinants of health associated with long wait times for thyroid surgery.

    PubMed

    Eskander, Antoine; Devins, Gerald M; Freeman, Jeremy; Wei, Alice C; Rotstein, Lorne; Chauhan, Nitin; Sawka, Anna M; Brown, Dale; Irish, Jonathan; Gilbert, Ralph; Gullane, Patrick; Higgins, Kevin; Enepekides, Danny; Goldstein, David

    2013-02-01

    Patients with thyroid pathology tend have longer surgical wait times. Uncertainty during this wait can have negative psychologically impact. This study aims to determine the degree of psychological morbidity in patients waiting for thyroid surgery. Prospectively assessing patients pre- and postoperative psychological morbidity (level 2c). Patients waiting for thyroidectomy were mailed a sociodemographic and four psychological morbidity questionnaires: Impact of Events Scale-Revised (IES-R), Illness Intrusiveness Ratings Scale (IIRS), Perceived Stress Scale (PSS) and Hospital Anxiety and Depression Scale (HADS). We assessed whether anxiety was related to length of wait and a number of clinical/sociodemographic factors. We achieved a 53% response rate over a 3-year period, with 176 patients providing complete preoperative data; and 74 (42%) completed postoperative data. The average age was 53 (± 12) years; 82% were female. Respondents with a suspicious or known malignancy waited an average of 107 days while those with benign neoplastic biopsies waited an average of 218 days for thyroidectomy. Respondents reported substantial psychological morbidity with high IES-R, IIRS, PSS, and HADS scores. There was no significant association between psychological morbidity and wait times, clinical or sociodemographic factors. Postoperative anxiety decreased significantly in all psychological morbidity measures except for the IIRS. Patients waiting for thyroid surgery have mild to moderate psychological morbidity and long wait times for surgery. These appear not to be related. Psychological morbidity decreases after surgery. Reducing wait time can potentially reduce the time that patients have to live with unnecessary stress and anxiety. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

  19. Age Dating Fluvial Sediment Storage Reservoirs to Construct Sediment Waiting Time Distributions

    NASA Astrophysics Data System (ADS)

    Skalak, K.; Pizzuto, J. E.; Benthem, A.; Karwan, D. L.; Mahan, S.

    2015-12-01

    Suspended sediment transport is an important geomorphic process that can often control the transport of nutrients and contaminants. The time a particle spends in storage remains a critical knowledge gap in understanding particle trajectories through landscapes. We dated floodplain deposits in South River, VA, using fallout radionuclides (Pb-210, Cs-137), optically stimulated luminescence (OSL), and radiocarbon dating to determine sediment ages and construct sediment waiting time distributions. We have a total of 14 age dates in two eroding banks. We combine these age dates with a well-constrained history of mercury concentrations on suspended sediment in the river from an industrial release. Ages from fallout radionuclides document sedimentation from the early 1900s to the present, and agree with the history of mercury contamination. OSL dates span approximately 200 to 17,000 years old. We performed a standard Weibull analysis of nonexceedance to construct a waiting time distribution of floodplain sediment for the South River. The mean waiting time for floodplain sediment is 2930 years, while the median is approximately 710 years. When the floodplain waiting time distribution is combined with the waiting time distribution for in-channel sediment storage (available from previous studies), the mean waiting time shifts to approximately 680 years, suggesting that quantifying sediment waiting times for both channel and floodplain storage is critical in advancing knowledge of particle trajectories through watersheds.

  20. Adjusting patients streaming initiated by a wait time threshold in emergency department for minimizing opportunity cost.

    PubMed

    Kim, Byungjoon B J; Delbridge, Theodore R; Kendrick, Dawn B

    2017-07-10

    Purpose Two different systems for streaming patients were considered to improve efficiency measures such as waiting times (WTs) and length of stay (LOS) for a current emergency department (ED). A typical fast track area (FTA) and a fast track with a wait time threshold (FTW) were designed and compared effectiveness measures from the perspective of total opportunity cost of all patients' WTs in the ED. The paper aims to discuss these issues. Design/methodology/approach This retrospective case study used computerized ED patient arrival to discharge time logs (between July 1, 2009 and June 30, 2010) to build computer simulation models for the FTA and fast track with wait time threshold systems. Various wait time thresholds were applied to stream different acuity-level patients. National average wait time for each acuity level was considered as a threshold to stream patients. Findings The fast track with a wait time threshold (FTW) showed a statistically significant shorter total wait time than the current system or a typical FTA system. The patient streaming management would improve the service quality of the ED as well as patients' opportunity costs by reducing the total LOS in the ED. Research limitations/implications The results of this study were based on computer simulation models with some assumptions such as no transfer times between processes, an arrival distribution of patients, and no deviation of flow pattern. Practical implications When the streaming of patient flow can be managed based on the wait time before being seen by a physician, it is possible for patients to see a physician within a tolerable wait time, which would result in less crowded in the ED. Originality/value A new streaming scheme of patients' flow may improve the performance of fast track system.

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

    PubMed Central

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

    2015-01-01

    Background: 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. Methods: 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. Results: 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. Conclusion: 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. PMID:26188810

  2. The impact of surgical wait time on patient-based outcomes in posterior lumbar spinal surgery.

    PubMed

    Braybrooke, Jason; Ahn, Henry; Gallant, Aimee; Ford, Michael; Bronstein, Yigel; Finkelstein, Joel; Yee, Albert

    2007-11-01

    A prospective observational study was conducted on patients undergoing posterior lumbar spine surgery for degenerative spinal disorders. The study purpose was to evaluate the effect of wait time to surgery on patient derived generic and disease specific functional outcome following surgery. A prolonged wait to surgery may adversely affect surgical outcome. Although there is literature on the effect of wait time to surgery in surgical fields such as oncology, cardiac, opthamologic, and total joint arthroplasty, little is known regarding the effect of wait time to surgery as it pertains to the spinal surgical population. Consecutive patients undergoing elective posterior lumbar spinal surgery for degenerative disorders were recruited. Short-Form 36 and Oswestry disability questionnaires were administered (pre-operatively, and at 6 weeks, 6 months, and 1 year post-operatively). Patients completed a questionnaire regarding their experience with the wait time to surgery. The study cohort consisted of 70 patients with follow-up in 53/70 (76%). Time intervals from the onset of patient symptoms to initial consultation by family physician through investigations, spinal surgical consultation and surgery were quantified. Time intervals were compared to patient specific improvements in reported outcome following surgery using Cox Regression analysis. The effect of patient and surgical parameters on wait time was evaluated using the median time as a reference for those patients who had either a longer or shorter wait. Significant improvements in patient derived outcome were observed comparing post-operative to pre-operative baseline scores. The greatest improvements were observed in aspects relating to physical function and pain. A longer wait to surgery was associated with less improvement in outcome following surgery (SF-36 domains of BP, GH, RP, VT). A longer wait time to surgery negatively influences the results of posterior lumbar spinal surgery for degenerative conditions

  3. Wait-time, classroom discourse, and the influence of sociocultural factors in science teaching

    NASA Astrophysics Data System (ADS)

    Jegede, Olugbemiro J.; Olajide, Janet O.

    Wait-time, a variable related to questioning in a teaching-learning situation, has been found to have implications for the inquiry mode of science teaching especially in Western classroom environments. Aside from the fact that the literature is very sparse in this area about what obtains in developing countries, nothing appears to be available with regard to how wait-time interacts with the sociocultural factors within non-Western science classrooms. In a non-Western country such as Nigeria where most science programs in schools are inquiry-oriented, do teachers take notice of, and effectively use, wait-time in the teaching-learning process? Are science teachers able to effectively use the mediating role of sociocultural factors in science teaching in a traditional environment which expects children to be seen only and not heard? The main purpose of this study was to investigate the wait-time of Nigerian integrated science teachers in relation to the amount of students' participation in inquiry. This study also investigated the relationship between wait-time and sociocultural attitudinal factors prevalent in traditional societies. The instruments used for data collection were the Hough's Observational Schedule and a modified version of the Socio-Cultural Environment Scale (SCES); a stop-watch was used to measure the wait-time of audio-recorded integrated science lessons of 37 integrated science teachers from selected junior secondary schools in Kaduna State, Nigeria. The results showed that the average wait-time TT and wait-time ST of the integrated science teachers was 3.0 seconds and 0.7 seconds, respectively. The study reported the amount of student participation in the student-teacher classroom discourse to be very low. Wait-time was also shown to have a strong relationship with sociocultural factors of authoritarianism, goal structure, societal expectation, and traditional worldview. The pedagogical and curricular implications of the results have been

  4. General anesthetic versus light sedation: effect on pediatric endoscopy wait times.

    PubMed

    Edwards, Christine; Kapoor, Vikram; Samuel, Christopher; Issenman, Robert; Brill, Herbert

    2013-09-01

    Wait times are an important measure of health care system effectiveness. There are no studies describing wait times in pediatric gastroenterology for either outpatient visits or endoscopy. Pediatric endoscopy is performed under light sedation or general anesthesia. The latter is hypothesized to be associated with a longer wait time due to practical limits on access to anesthesia in the Canadian health care system. To identify wait time differences according to sedation type and measure adverse clinical outcomes that may arise from increased wait time to endoscopy in pediatric patients. The present study was a retrospective review of medical charts of all patients <18 years of age who had been assessed in the pediatric gastroenterology clinic and were scheduled for an elective outpatient endoscopic procedure at McMaster Children's Hospital (Hamilton, Ontario) between January 2006 and December 2007. The primary outcome measure was time between clinic visit and date of endoscopy. Secondary outcome measures included other defined waiting periods and complications while waiting, such as emergency room visits and hospital admissions. The median wait time to procedure was 64 days for general anesthesia patients and 22 days for patients who underwent light sedation (P<0.0001). There was no significant difference between the two groups with regard to the number of emergency room visits or hospital admissions, both pre- and postendoscopy. Due to the lack of pediatric anesthetic resources, patients who were administered general anesthesia experienced a longer wait time for endoscopy compared with patients who underwent light sedation. This did not result in adverse clinical outcomes in this population.

  5. Waiting-time solutions of a nonlinear diffusion equation: Experimental study of a creeping flow near a waiting front

    NASA Astrophysics Data System (ADS)

    Marino, B. M.; Thomas, L. P.; Gratton, R.; Diez, J. A.; Betelú, S.; Gratton, J.

    1996-09-01

    We investigate an unsteady plane viscous gravity current of silicone oil on a horizontal glass substrate. Within the lubrication approximation with gravity as the dominant force, this current is described by the nonlinear diffusion equation φt=(φmφx)x (φ is proportional to the liquid thickness h and m=3>0), which is of interest in many other physical processes. The solutions of this equation display a fine example of the competition between diffusive smoothening and nonlinear steepening. This work concerns the so-called waiting-time solutions, whose distinctive character is the presence of an interface or front, separating regions with h≠/0 and h=0, that remains motionless for a finite time interval tw meanwhile a redistribution of h takes place behind the interface. We start the experiments from an initial wedge-shape configuration [h(x)~=α'(x0-x)] with a small angle (α'<=0.12 rad). In this situation, the tip of the wedge, situated at x0 from the rear wall (15 cm<=x0<=75 cm), waits at least several seconds before moving. During this waiting stage, a region characterized by a strong variation of the free surface slope (corner layer) develops and propagates toward the front while it gradually narrows and ∂2h/∂x2 peaks. The stage ends when the corner layer overtakes the front. At this point, the liquid begins to spread over the uncovered substrate. We measure the slope of the free surface in a range ~=10 cm around x0, and, by integration, we determine the fluid thickness h(x) there. We find that the flow tends to a self-similar behavior when the corner layer position tends to x0; however, near the end of the waiting stage, it is perturbed by capillarity. Even if some significant effects are not included in the above equation, the main properties of its solutions are well displayed in the experiments

  6. 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.

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

    DTIC Science & Technology

    2016-12-01

    supply chain outcomes between 20–40% of the time. These findings support policies that balance inventory performance with supply chain...currently results in misreporting of supply chain outcomes between 20–40% of the time. These findings support policies that balance inventory performance...effects of CWT. 2. Recommendations Balance inventory performance with supply chain responsiveness. Both fill- rate and CWT are significant

  8. Chimpanzee (Pan troglodytes) anticipation of food return: coping with waiting time in an exchange task.

    PubMed

    Dufour, V; Pelé, M; Sterck, E H M; Thierry, B

    2007-05-01

    Despite controversial expectations that animals achieve reciprocal altruism, it is unclear if nonhuman species possess the necessary cognitive abilities. For reciprocal altruism, individuals must anticipate the loss of a commodity and accept a delay before some return. The authors investigated the abilities of 5 chimpanzees (Pan troglodytes) to cope with increasing waiting duration in exchange tasks. Subjects had to keep a small cookie before returning it to a human partner to obtain a larger piece. For a piece 2, 4, or 8 times the size of the small piece, 3 of the 5 subjects waited for up to 4 min. For a piece 40 times larger, 4 of the 5 subjects waited up to 8 min. At long time lag, renouncement to wait occurred earlier than predicted by subjects' general waiting capacity, suggesting that the decision to wait was based on a trade-off between reward quantity and expected costs of the waiting duration. Chimpanzees could anticipate a delayed reward at a time scale of several minutes. If this reflects a cognitive limit in chimpanzees' anticipation capacity, reciprocal altruism by keeping track of costs and benefits over extended periods may be unlikely in chimpanzees.

  9. Disparities in Emergency Department Wait Time Among Patients with Mental Health and Substance-Related Disorders.

    PubMed

    Opoku, Samuel T; Apenteng, Bettye A; Akowuah, Emmanuel A; Bhuyan, Soumitra

    2017-08-16

    This study examined disparities in emergency department (ED) wait time for patients with mental health and substance-related disorders (PwMHSDs), using data from the 2009-2011 National Hospital Ambulatory Medical Care Survey (NHAMCS). Wait time was defined as the time between arrival at ED and being seen by an ED provider. Results from multivariable regression models show racial disparities, with non-Hispanic Black PwMHSDs experiencing longer ED wait time, compared to non-Hispanic White PwMHSDs. A temporal decline in ED wait time was also observed over the study period. The findings of this study have implications for informing the development of policies tailored at facilitating the delivery of equitable emergency care services to all PwMHSDs.

  10. 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.

  11. Waiting time distribution for electron transport in a molecular junction with electron-vibration interaction

    NASA Astrophysics Data System (ADS)

    Kosov, Daniel S.

    2017-02-01

    On the elementary level, electronic current consists of individual electron tunnelling events that are separated by random time intervals. The waiting time distribution is a probability to observe the electron transfer in the detector electrode at time t +τ given that an electron was detected in the same electrode at an earlier time t. We study waiting time distribution for quantum transport in a vibrating molecular junction. By treating the electron-vibration interaction exactly and molecule-electrode coupling perturbatively, we obtain the master equation and compute the distribution of waiting times for electron transport. The details of waiting time distributions are used to elucidate microscopic mechanism of electron transport and the role of electron-vibration interactions. We find that as nonequilibrium develops in the molecular junction, the skewness and dispersion of the waiting time distribution experience stepwise drops with the increase of the electric current. These steps are associated with the excitations of vibrational states by tunnelling electrons. In the strong electron-vibration coupling regime, the dispersion decrease dominates over all other changes in the waiting time distribution as the molecular junction departs far away from the equilibrium.

  12. Reducing wait times through operations research: optimizing the use of surge capacity.

    PubMed

    Patrick, Jonathan; Puterman, Martin L

    2008-01-01

    Widespread public demand for improved access, political pressure for shorter wait times, a stretched workforce, an aging population and overutilized equipment and facilities challenge healthcare leaders to adopt new management approaches. This paper highlights the significant benefits that can be achieved by applying operations research (OR) methods to healthcare management. It shows how queuing theory provides managers with insights into the causes for excessive wait times and the relationship between wait times and capacity. It provides a case study of the use of several OR methods, including Markov decision processes, linear programming and simulation, to optimize the scheduling of patients with multiple priorities. The study shows that by applying this approach, wait time targets can be attained with the judicious use of surge capacity in the form of overtime. It concludes with some policy insights.

  13. Reducing Wait Times through Operations Research: Optimizing the Use of Surge Capacity.

    PubMed

    Patrick, Jonathan; Puterman, Martin L

    2008-02-01

    Widespread public demand for improved access, political pressure for shorter wait times, a stretched workforce, an aging population and overutilized equipment and facilities challenge healthcare leaders to adopt new management approaches. This paper highlights the significant benefits that can be achieved by applying operations research (OR) methods to healthcare management. It shows how queuing theory provides managers with insights into the causes for excessive wait times and the relationship between wait times and capacity. It provides a case study of the use of several OR methods, including Markov decision processes, linear programming and simulation, to optimize the scheduling of patients with multiple priorities. The study shows that by applying this approach, wait time targets can be attained with the judicious use of surge capacity in the form of overtime. It concludes with some policy insights.

  14. Wait times for publicly funded addiction and problem gambling treatment agencies in Ontario, Canada

    PubMed Central

    2013-01-01

    Background This study describes the definitions of wait times and intake processes used by drug and problem gambling treatment agencies in Ontario, Canada, as well as the various strategies employed to ameliorate client backlog. Methods An online survey was developed and distributed to 203 publicly-funded, provincial substance use and problem gambling treatment agencies from June to August, 2011. All aspects of the intake process were covered in the survey. Results Based on 139 responses, six different wait time periods were identified. Additional analyses were completed by type of service offered. Suggestions for effective interventions to shorten wait times and recommendations for future research are provided. Conclusion The results of this study highlight a need for standardized definitions of wait times across substance use and problem gambling treatment services. PMID:24252217

  15. Group Enrollment and Open Gym Format Decreases Cardiac Rehabilitation Wait Times.

    PubMed

    Bachmann, Justin M; Klint, Zachary W; Jagoda, Allison M; McNatt, Jeremy K; Abney, Lesa R; Huang, Shi; Liddle, David G; Frontera, Walter R; Freiberg, Matthew S

    2017-09-01

    Wait times for the first cardiac rehabilitation (CR) session are inversely related to CR participation rates. We hypothesized that changing from individually scheduled appointments to a group enrollment and open gym format, in which patients were enrolled during group intake sessions and could arrive for subsequent CR sessions any time during open gym periods, would decrease wait times. A total of 603 patients enrolled in CR at Vanderbilt University Medical Center from July 2012 to December 2014 were included in the study. We evaluated the effect of changing to a group enrollment and open gym format after adjusting for referral diagnosis, insurance status, seasonality, and other factors. We compared outcomes, including exercise capacity and quality of life, between the 2 groups. Patients in the group enrollment and open gym format had significantly lower average wait times than those receiving individual appointments (14.9 vs 19.5 days, P < .001). After multivariable adjustment, the new CR delivery model was associated with a 22% (3.7 days) decrease in average wait times (95% CI, 1.9-5.6, P < .001). Patients completing CR had equally beneficial changes in 6-minute walk distance and Patient Health Questionnaire scores between the 2 groups, although there was no significant difference in participation rates or the number of sessions attended. Implementation of a group enrollment and open gym format was associated with a significant decrease in wait times for first CR sessions. This CR delivery model may be an option for programs seeking to decrease wait times.

  16. Reconciliation of Waiting Time Statistics of Solar Flares Observed in Hard X-rays

    NASA Astrophysics Data System (ADS)

    Aschwanden, Markus J.; McTiernan, James M.

    2010-07-01

    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 (Δt ≈ 10-3-103 hr), can be reconciled with a single distribution function, N(Δt) vprop λ0(1 + λ0Δt)-2, which has a power-law slope of p ≈ 2.0 at large waiting times (Δt ≈ 1-1000 hr) and flattens out at short waiting times Δt <~ Δt 0 = 1/λ0. We find a consistent breakpoint at Δt 0 = 1/λ0 = 0.80 ± 0.14 hr from the WATCH, HXRBS, BATSE, and RHESSI data. The distribution of waiting times is invariant for sampling with different flux thresholds, while the mean waiting time scales reciprocically with the number of detected events, Δt 0 vprop 1/n det. This waiting time distribution can be modeled with a nonstationary Poisson process with a flare rate λ = 1/Δt that varies as f(λ) vprop λ-1exp - (λ/λ0). This flare rate distribution requires a highly intermittent flare productivity in short clusters with high rates, separated by relatively long quiescent intervals with very low flare rates.

  17. 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.

  18. The Effect of Preservice Laserdisc Presentation of Question Types and Wait-Time Use on Questioning and Wait-Time Use in Clinical Experiences.

    ERIC Educational Resources Information Center

    Wallace, Stephen R.; And Others

    This study explored whether the addition of visual examples through laser disc instruction influenced the learning and application of convergent and divergent questioning techniques and wait-time by preservice elementary education teachers during their clinical experience. The study compared the difference in the frequency of convergent and…

  19. 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.

  20. Waiting times for surgical and diagnostic procedures in public hospitals in Mexico.

    PubMed

    Contreras-Loya, David; Gómez-Dantés, Octavio; Puentes, Esteban; Garrido-Latorre, Francisco; Castro-Tinoco, Manuel; Fajardo-Dolci, Germán

    2015-01-01

    A retrospective evaluation of waiting times for elective procedures was conducted in a sample of Mexican public hospitals from the following institutions: the Mexican Institute for Social Security (IMSS), the Institute for Social Security and Social Services for Civil Servants (ISSSTE) and the Ministry of Health (MoH). Our aim was to describe current waiting times and identify opportunities to redistribute service demand among public institutions. We examined current waiting times and productivity for seven elective surgical and four diagnostic imaging procedures, selected on the basis of their relative frequency and comparability with other national health systems. Mean waiting time for the seven surgical procedures in the three institutions was 14 weeks. IMSS and ISSSTE hospitals showed better performance (12 and 13 weeks) than the MoH hospitals (15 weeks). Mean waiting time for the four diagnostic procedures was 11 weeks. IMSS hospitals (10 weeks) showed better average waiting times than ISSSTE (12 weeks) and MoH hospitals (11 weeks). Substantial variations were revealed, not only among institutions but also within the same institution. These variations need to be addressed in order to improve patient satisfaction.

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

    PubMed

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

    2016-01-01

    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. 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. 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. 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.

  2. Family physician access to and wait times for cancer diagnostic investigations

    PubMed Central

    Barisic, Andriana; Kish, Maxine; Gilbert, Julie; Mittmann, Nicole; Moineddin, Rahim; Sisler, Jeffrey; Vedsted, Peter; Grunfeld, Eva

    2016-01-01

    Abstract Objective To examine provincial and regional differences in FPs’ direct access to cancer diagnostic investigations and advice from other specialists regarding investigations and referrals, and to explore FPs’ perceptions about wait times for diagnostic investigations and receipt of results. Design A cross-sectional, online survey. Setting British Columbia, Manitoba, and Ontario. Participants A sample of FPs from participating provinces. Main outcome measures Direct FP access to various diagnostic investigations and advice from other specialists regarding investigations and referrals; FPs’ perceptions about wait times for diagnostic investigations ordered directly; and FPs’ perceptions about wait times for results. Results A total of 1054 surveys were completed by FPs from British Columbia (n = 229), Manitoba (n = 228), and Ontario (n = 597). Distance from a cancer centre was not significantly associated with direct access to or wait times for diagnostic investigations for most of the investigations studied; however, provincial differences were observed. Family physicians in Manitoba and British Columbia were 30% to 45% less likely to report having direct access to endoscopy and some imaging investigations compared with FPs in Ontario. Family physicians in Manitoba and British Columbia were also at increased odds of waiting longer than 12 weeks for endoscopy investigations and longer than 4 weeks for imaging investigations compared with FPs in Ontario. Most FPs reported wait times of less than 2 weeks for imaging results; however, the proportion of FPs who waited longer than 2 weeks for colonoscopy results ranged from 15% in Ontario to 96% in British Columbia. Conclusion Given the disparities observed among provinces, there is an opportunity for provinces to learn from one another to improve direct access to and shorten wait times for diagnostic investigations. This in turn has the potential to shorten the primary care interval for cancer diagnostic

  3. 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

  4. Discovering the Impact of Preceding Units' Characteristics on the Wait Time of Cardiac Surgery Unit from Statistic Data

    PubMed Central

    Liu, Jiming; Tao, Li; Xiao, Bo

    2011-01-01

    Introduction 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). Methods 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 Results show that: (i) wait time of CU has a direct positive impact on wait time of SU (); (ii) capacity of CU has a direct positive impact on demand of SU (); (iii) within each unit, there exist significant relationships among different characteristics (except for the effect of throughput on wait time in SU). Conclusion 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. PMID:21818282

  5. 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.

  6. [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.

  7. 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

  8. The Impact of Pre-Operative Breast MRI on Surgical Waiting Time

    PubMed Central

    Zhang, Michelle; Sun, Simon

    2017-01-01

    Purpose To assess the impact of pre-operative breast MRI on surgical waiting time, and to identify factors contributing to the delay. Materials and Methods A retrospective cohort study involving 1274 patients was conducted after obtaining institutional ethics review. Surgical candidates for newly diagnosed breast cancer from 2007 to 2013 at a tertiary center were divided into 2 groups: those who had pre-operative MRI and those who did not. Linear regression using matched populations was used to compare the surgical waiting times, defined as time from the date of the first positive biopsy to the date of surgery. Potential influences on surgical waiting time and subgroup analysis were obtained using median regression analysis and the Kruskal-Wallis test. Results Mean surgical waiting time was 57.9 days (95% CI: 55.6–60.1) for MRI patients, compared to 46.8 days (95% CI: 45.1–48.9) for the control group, after matching for potential confounding factors (p<0.0001). Increased surgical waiting time was associated with more favorable pathology, later year of diagnosis, older patient age, surgeon and summer time. Second-look ultrasound and subsequent biopsies were associated with increased waiting time (p = 0.001). Conclusions Pre-operative breast MRI increased surgical waiting time by 11 days using a conventional average of differences, and by 12 days after using a full matching statistical method (p<0.0001), with the main contributor being additional post-MRI procedures and imaging. PMID:28068382

  9. Outpatient Waiting Time in Health Services and Teaching Hospitals: A Case Study in Iran

    PubMed Central

    Mohebbifar, Rafat; Hasanpoor, Edris; Mohseni, Mohammad; Sokhanvar, Mobin; Khosravizadeh, Omid; Isfahani, Haleh Mousavi

    2014-01-01

    Background: One of the most important indexes of the health care quality is patient’s satisfaction and it takes place only when there is a process based on management. One of these processes in the health care organizations is the appropriate management of the waiting time process. The aim of this study is the systematic analyzing of the outpatient waiting time. Methods: This descriptive cross sectional study conducted in 2011 is an applicable study performed in the educational and health care hospitals of one of the medical universities located in the north west of Iran. Since the distributions of outpatients in all the months were equal, sampling stage was used. 160 outpatients were studied and the data was analyzed by using SPSS software. Results: Results of the study showed that the waiting time for the outpatients of ophthalmology clinic with an average of 245 minutes for each patient allocated the maximum time among the other clinics for itself. Orthopedic clinic had the minimal waiting time including an average of 77 minutes per patient. The total average waiting time for each patient in the educational hospitals under this study was about 161 minutes. Conclusion: by applying some models, we can reduce the waiting time especially in the realm of time and space before the admission to the examination room. Utilizing the models including the one before admission, electronic visit systems via internet, a process model, six sigma model, queuing theory model and FIFO model, are the components of the intervention that reduces the outpatient waiting time. PMID:24373277

  10. Evaluation of wait times for patients seeking cosmetic and reconstructive breast surgery.

    PubMed

    Silvestre, Jason; Bess, Christina R; Nguyen, John T; Ibrahim, Ahmed M S; Patel, Priti P; Lee, Bernard T

    2014-07-01

    Patients seeking cosmetic or reconstructive procedures in plastic surgery typically face significant wait times for consultations. Little attention has been given to potential disparities in wait times between elective cosmetic and reconstructive procedures. In this initial pilot study, we audited a broad sample of plastic surgery offices within a single state for wait times in initial consultations for both breast reconstruction and breast augmentation. A sample of board-certified plastic surgeons was audited from the American Society of Plastic Surgeons (ASPS) Web site that listed both cosmetic and reconstructive breast surgery. Scripted patient telephone calls were made to 67 plastic surgery clinics within a single state on May 2012. Two calls separated by 7 days were made to each office by the same actor seeking an initial appointment for either breast reconstruction or breast augmentation. Wait times were calculated from the date of the call until the date of appointment offered. There were 72 paired calls completed on 36 plastic surgery clinics. Significant disparities in appointment wait times existed between elective cosmetic versus reconstructive procedures (P = 0.02). Mean wait times for breast reconstruction consultation (26.1 days) were significantly longer than mean consultation wait times for breast augmentation (20.9 days). Interestingly, 17.9% of offices contacted no longer perform certain procedures currently advertised on the ASPS Web site. Disparities exist in access to care between patients seeking elective breast augmentation and reconstruction after mastectomy. Patients seeking breast augmentation have more rapid access to plastic surgeons. This study did not evaluate possible explanations for the observed differences. Potential causes may include physician preference and compensation benefits for cosmetic procedures.

  11. 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

  12. Socioeconomic differences in waiting times for elective surgery: a population-based retrospective study

    PubMed Central

    2012-01-01

    Background Widespread literature on inequity in healthcare access and utilization has been published, but research on socioeconomic differences in waiting times is sparse and the evidence is fragmentary and controversial. The objective of the present study is the analysis of the relationship between individual socioeconomic level and waiting times for in-hospital elective surgery. Methods We retrospectively studied the waiting times experienced by patients registered on hospital waiting lists for 6 important surgical procedures by using the Hospital Discharge Database (HDD) of the Piedmont Region (4,000,000 inhabitants in the North West of Italy) from 2006 to 2008. The surgical procedures analyzed were: coronary artery by-pass (CABG), angioplasty, coronarography, endarterectomy, hip replacement and cholecystectomy. Cox regression models were estimated to study the relationship between waiting times and educational level taking into account the confounding effect of the following factors: sex, age, comorbidity, registration period, and Local Health Authorities (LHA) as a proxy of supply. Results Median waiting times for low educational level were higher than for high educational level for all the selected procedures. Differences were particularly high for endarterectomy and hip replacement. For all considered procedures, except CABG, an inverse gradient between waiting times and educational level was observed: the conditional probabilities of undergoing surgery were lower among individuals with a low to middle level education than for individuals with a higher level of education after adjustment for sex, age, comorbidities, registration period, and LHAs. For most procedures the effect decreases over the follow up period. Conclusions The results of the study show evidence of inequalities in access to elective surgery in Italy. Implementation of policies aimed to promote national information initiatives that guarantee wider access to those with low socio

  13. Waiting Times in Emergency Department After Using the Emergency Severity Index Triage Tool

    PubMed Central

    Mahmoodian, Farzad; Eqtesadi, Razie; Ghareghani, Atefe

    2014-01-01

    Background: Hospital emergency departments (EDs) are as barometers of the health care system. Crowded EDs threaten delivery of timely care. Prolonged ED wait times reduce the quality of care and increase adverse and sometimes irreversible events. Objectives: The purpose of this study was to determine the patients' waiting time at Namazi and Shahid Faghihi hospitals in Shiraz, Iran. Patients and Methods: This analytical cross-sectional study was conducted in two phases from December 2012 to May 2013. First, the researcher attended the EDs of the two hospitals and recorded the information of 900 patients who entered the ED, including arrival time, level of triage, and time of first visit by physician. Then, among patients admitted to the ED units, 273 were followed and waiting times for the first physician order in the referral unit and the commencement of clinical interventions (defined as check time by the nurse) were recorded. Results: The median waiting time from arrival to first visit by physician for the 900 patients included in the study was 8 (5-14) minutes [median (interquartile range)]. For the patients admitted to referral units, waiting time was 84 (43-145) minutes for the physician order and 85 (45-147) minutes for the commencement of first clinical intervention; 75% of the patients in triage level I, 84.6% in triage level II, and 95.6% in triage level III were visited within the target time limit. Conclusions: Waiting time for commencement of clinical action in patients admitted to the EDs was considerably high for patients with higher priorities; so, rapid care of critically ill patients, identified during the triage process, should be emphasized. PMID:25738132

  14. Time is money: outpatient waiting times and health insurance choices of elderly veterans in the United States.

    PubMed

    Pizer, Steven D; Prentice, Julia C

    2011-07-01

    Growth in the number of days between an appointment request and the actual appointment reduces demand. Although such waiting times are relatively low in the US, current policy initiatives could cause them to increase. We estimate multiple-equation models of physician utilization and insurance plan choice for Medicare-eligible veterans. We find that a 10% increase in VA waiting times increases demand for Medigap insurance by 5%, implying that a representative patient would be indifferent between waiting an average of 5 more days for VA appointments and paying $300 more in annual premium. Published by Elsevier B.V.

  15. Innovative Strategies for Decreasing Blood Collection Wait Times for Patients in Early-Phase Cancer Clinical Trials.

    PubMed

    Mengistu, Bayabel; Ray, Dina; Lockett, Passion; Dorsey, Vivian; Phipps, Ron A; Subramanian, Harihara; Atkins, Johnique T; El Osta, Badi; Falchook, Gerald S; Karp, Daniel D

    2016-07-01

    Long wait times are a primary source of dissatisfaction among patients enrolled in early-phase clinical trials. We hypothesized that an automated patient check-in system with readily available display for increasing awareness of waiting intervals would improve patient flow and use of our rooms, with decreased turnover time and increased throughput. We recorded in-room wait times for patients seen in our clinic and observed the logistics involved in the blood collection process to delineate causes for delays. We then implemented a three-step strategy to alleviate the causes of these delays: (1) changing the collection of materials and the review of faxed orders, (2) improving our LabTracker automated database system that included wait time calculators and real-time information regarding patient status, and (3) streamlining lower complexity appointments. After our intervention, we observed a 19% decrease in mean wait times and a 30% decrease in wait times among patients waiting the longest (95th percentile). We also observed an increase in staff productivity during this process. Modifications in LabTracker provided the biggest reduction in mean wait times (17%). We observed a significant decrease in mean wait times after implementing our intervention. This decrease led to increased staff productivity and cost savings. Once wait times became a measurable metric, we were able to identify causes for delays and improve our operations, which can be performed in any patient care facility. Copyright © 2016 by American Society of Clinical Oncology.

  16. 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.

  17. Using a Time Timer to increase appropriate waiting behavior in a child with developmental disabilities.

    PubMed

    Grey, Ian; Healy, Olive; Leader, Geraldine; Hayes, Deirdre

    2009-01-01

    This study aimed to examine the use of a predictive stimulus (Time Timer) and delayed reinforcement to increase appropriate waiting behavior in a child with developmental disabilities and problem behavior maintained by access to tangible items and activities. The study employed a changing criterion design across settings to gradually increase reinforcement delay from 1s to 10 min. Firstly a baseline phase was conducted to measure the duration of appropriate waiting behavior to access tangible reinforcers/activities. Phase 2 involved the use of a red cue card and the verbal instruction "wait". Phase 3 involved the introduction of the Time Timer with the cue card attached, and the verbal instruction "wait". Finally, Phase 4 utilised the Time Timer without the cue card. This method was an effective strategy for increasing appropriate waiting behavior with this participant in a school setting. The role of adding a concurrent activity during the reinforcement delay, using cues to predict reinforcement, future generalization, maintenance and the teaching of functionally equivalent skills are discussed.

  18. 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

  19. Noise-induced rupture process: phase boundary and scaling of waiting time distribution.

    PubMed

    Pradhan, Srutarshi; Chandra, Anjan Kumar; Chakrabarti, Bikas K

    2013-07-01

    A bundle of fibers has been considered here as a model for composite materials, where breaking of the fibers occur due to a combined influence of applied load (stress) and external noise. Through numerical simulation and a mean-field calculation we show that there exists a robust phase boundary between continuous (no waiting time) and intermittent fracturing regimes. In the intermittent regime, throughout the entire rupture process avalanches of different sizes are produced and there is a waiting time between two consecutive avalanches. The statistics of waiting times follows a Γ distribution and the avalanche distribution shows power-law scaling, similar to what has been observed in the case of earthquake events and bursts in fracture experiments. We propose a prediction scheme that can tell when the system is expected to reach the continuous fracturing point from the intermittent phase.

  20. Impact of different discharge patterns on bed occupancy rate and bed waiting time: a simulation approach.

    PubMed

    Zhu, Zhecheng

    2011-01-01

    Beds are one of the most important resources in a healthcare system. How to manage beds efficiently is an important indicator of the efficiency of the healthcare system. Bed management is challenging to many healthcare service providers in many aspects. In recent years, population growth and aging society impose extra pressure on bed requirement. There are usually two key performance indicators of a bed management system: bed occupancy rate and bed waiting time. In this paper, different discharge patterns and their impacts on the bed occupancy rate and bed waiting time are studied. A discrete event simulation model is constructed to evaluate the existing discharge pattern in a Singapore regional hospital using actual hospital admission and discharge transaction data. Then different discharge patterns are tested in the same context. Simulation results show that a proper discharge pattern significantly smoothes the fluctuation of bed occupancy rate and reduce the bed waiting time.

  1. Doctor at triage - effect on waiting time and patient satisfaction in a Jamaican hospital.

    PubMed

    French, Simone; Lindo, Jascinth L M; Williams Jean, Eric W; Williams-Johnson, Jean

    2014-07-01

    Waiting time in the Emergency Departments is a major source of patient dissatisfaction in hospitals. Triage attempts to have the most critically ill patients seen first with an overall reduction in waiting time. Triage teams may include specially trained nurses or alternatively a specialist physician. The aim of this study was to determine if inclusion of a specialist physician on the triage team at the University Hospital of the West Indies (UHWI) in Kingston Jamaica reduced waiting time and improved patient satisfaction. A prospective, cross sectional survey of ambulatory care patients was undertaken in 2006. Triage was completed by a team consisting of a doctor and two nurses during the first week and by nurses only during the second week. The study showed that there was no significant difference in the length of time patients spent in the emergency department based on whether or not they were triaged by a physician led team or by a team of nurses only. Type of triage team did not affect the level of patient satisfaction. Waiting time was significantly influenced by factors which came into play after triage such as the wait for X-ray and laboratory services. There appears to be no reduction in waiting times experienced by patients at the UHWI emergency department as a result of inclusion of a specialist emergency physician in the triage process. This suggests that specialist emergency department nurses are adequately trained in triage, and that delays in the triage process at UHWI are due to other factors. Copyright © 2013 Elsevier Ltd. All rights reserved.

  2. 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.

  3. Impact of value added services on patient waiting time at the ambulatory pharmacy Queen Elizabeth Hospital.

    PubMed

    Loh, Benjamin C; Wah, Kheng F; Teo, Carolyn A; Khairuddin, Nadia M; Fairuz, Fairenna B; Liew, Jerry E

    2017-01-01

    Value added services (VAS) are an innovative dispensing system created to provide an alternative means of collecting partial drug supply from our hospital. This in turn was projected to reduce the necessity for patient to visit pharmacy counter and thus reduce the burden of prescription handling. To evaluate the impact of increased VAS uptake following promotional campaign towards patient waiting time and to explore factors that may affect patient waiting time at the Ambulatory Pharmacy, Queen Elizabeth Hospital. A quasi experimental study design was conducted from September 2014 till June 2015 at the Ambulatory Pharmacy. During pre-intervention phase, baseline parameters were collected retrospectively. Then, VAS promotional campaign was carried out for six months and whilst this was done, the primary outcome of patient waiting time was measured by percentage of prescription served less than 30 minutes. A linear regression analysis was used to determine the impact of increased VAS uptake towards patient waiting time. An increased in percentage of VAS registration (20.9% vs 35.7%, p<0.001) was observed after the promotional campaign. The mean percentage of prescription served less than 30 minutes increased from 83.2% SD=15.9 to 90.3% SD=11.5, p=0.001. After controlling for covariates, it was found that patient waiting time was affected by number of pharmacy technicians (b=-0.0349, 95%CI-0.0548 : -0.0150, p=0.001), number of pharmacy counters (b=0.1125, 95%CI 0.0631 : 0.1620, p<0.001), number of prescriptions (b=0.0008, 95%CI 0.0004 : 0.0011, p<0.001), and number of refill prescriptions (b=0.0004, 95%CI 0.0002 : 0.0007, p<0.001). The increased in percentage of VAS registration was associated with reduction in number of refill prescription (b=-2.9838, 95%CI -4.2289 : -1.7388, p<0.001). Patient waiting time at the Ambulatory Pharmacy improved with the increased in VAS registration. The impact of increased VAS uptake on patient waiting time resulted from reduction in

  4. Study: wait times continue to lengthen--visits increase as EDS disappear.

    PubMed

    2008-03-01

    Despite seemingly insurmountable odds, several ED managers have been able to reduce wait times--in many cases, quite dramatically. Here are some of the strategies they say will help you decrease those waiting times: Create a chest pain policy that focuses not only on getting patients back as quickly as possible, but also frontloads your work force. Encourage staff to bring EKG results to the ED doc as soon as they are obtained. When seeking important hospitalwide changes, remind your board of the political consequences of a poor ED image.

  5. Question Types and Wait-Time during Science Related Activities in Turkish Preschools

    ERIC Educational Resources Information Center

    Günay Bilaloglu, Raziye; Aktas Arnas, Yasare; Yasar, Mustafa

    2017-01-01

    The aim of the study is to investigate the types of questions that preschool teachers used during the science-related activities and preschool teachers' behaviors in terms of wait-time. Through this study, the types of questions (lower level and higher level), the time that teachers allocate to their students to respond, and the teachers'…

  6. Model for end-stage liver disease exceptions committee activity in Argentina: does it provide justice and equity among adult patients waiting for a liver transplant?

    PubMed Central

    McCormack, Lucas; Gadano, Adrián; Lendoire, Javrer; Quiñonez, Emilio; Imventarza, Oscar; Andriani, Oscar; Toselli, Lorenzo; Gil, Octavio; Gondolesi, Gabriel; Bisigniano, Liliana; de Santibañes, Eduardo

    2010-01-01

    Background In 2005, the model of end-stage liver disease (MELD)-based allocation system was adopted to assess potential liver transplant (LT) recipients in Argentina. The aim of the present study was to revise the activity of the MELD Exception Experts Committee. Methods Between 2005 and 2009, 1623 patients were listed for LT. Regulation provides extra-MELD points for amyloidosis, hepatopulmonary syndrome (HPS) and T2 hepatocellular carcinoma (T2 HCC). Centres could also request priority for other situations. Using a prospective database, we identified patients in whom priority points were requested. Pathology reports of explanted livers were analysed for patients with T2 HCC. Results From 234 out of 1623 (14.4%) requests, the overall approval rate was 60.2% including: 2 amyloidosis, 6 HPS, 111 T2 HCC and 22 non-regulated situations. Of the 111 patients with T2 HCC, 6 died (5.4%), 8 had tumour progression (7.2%), 94 were transplanted (84.2%) and 3 are still waiting. An explants correlation showed that presumed diagnosis of T2HCC was incorrect in 20/94 (22%) and was correct in only 41/94 (43%) cases being T1 HCC in 9 and T3 HCC in 23. Conclusions MELD exceptions are frequently requested in Argentina. Unfortunately, most receiving priority points for T2 HCC benefited by medical error or imaging limitations. An intense review process is urgently needed to maintain equity and justice in the allocation system. PMID:20887320

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

    SciTech Connect

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

    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 the 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)

  8. WAITING TIME DISTRIBUTION OF SOLAR ENERGETIC PARTICLE EVENTS MODELED WITH A NON-STATIONARY POISSON PROCESS

    SciTech Connect

    Li, C.; Su, W.; Fang, C.; Zhong, S. J.; Wang, L.

    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 ∼ 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.

  9. 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.

  10. 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…

  11. Minimizing patient waiting time in emergency department of public hospital using simulation optimization approach

    NASA Astrophysics Data System (ADS)

    Ibrahim, Ireen Munira; Liong, Choong-Yeun; Bakar, Sakhinah Abu; Ahmad, Norazura; Najmuddin, Ahmad Farid

    2017-04-01

    Emergency department (ED) is the main unit of a hospital that provides emergency treatment. Operating 24 hours a day with limited number of resources invites more problems to the current chaotic situation in some hospitals in Malaysia. Delays in getting treatments that caused patients to wait for a long period of time are among the frequent complaints against government hospitals. Therefore, the ED management needs a model that can be used to examine and understand resource capacity which can assist the hospital managers to reduce patients waiting time. Simulation model was developed based on 24 hours data collection. The model developed using Arena simulation replicates the actual ED's operations of a public hospital in Selangor, Malaysia. The OptQuest optimization in Arena is used to find the possible combinations of a number of resources that can minimize patients waiting time while increasing the number of patients served. The simulation model was modified for improvement based on results from OptQuest. The improvement model significantly improves ED's efficiency with an average of 32% reduction in average patients waiting times and 25% increase in the total number of patients served.

  12. WAITING TIMES OF QUASI-HOMOLOGOUS CORONAL MASS EJECTIONS FROM SUPER ACTIVE REGIONS

    SciTech Connect

    Wang Yuming; Liu Lijuan; Shen Chenglong; Liu Rui; Ye Pinzhong; Wang, S.

    2013-02-01

    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 at 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.

  13. The Relation of Wait-Time to Student Behaviors in Science Curriculum Improvement Study Lessons.

    ERIC Educational Resources Information Center

    Garigliano, Leonard Joseph

    Post studies have indicated the existence of a fast questioning pace with teachers allowing very little "think-space" as they ask questions, present materials, and respond to students. Descriptive studies indicate that the average wait-time in classrooms is between one and two seconds. The problem of this study was to determine the…

  14. Children's Mental Health Visits to the Emergency Department: Factors Affecting Wait Times and Length of Stay

    PubMed Central

    Newton, Amanda S.; Grewal, Simran; Dow, Nadia; Rosychuk, Rhonda J.

    2014-01-01

    Objective. This study explores the association of patient and emergency department (ED) mental health visit characteristics with wait time and length of stay (LOS). Methods. We examined data from 580 ED mental health visits made to two urban EDs by children aged ≤18 years from April 1, 2004, to March 31, 2006. Logistic regressions identified characteristics associated with wait time and LOS using hazard ratios (HR) with 95% confidence intervals (CIs). Results. Sex (male: HR = 1.48, 95% CI = 1.20–1.84), ED type (pediatric ED: HR = 5.91, 95% CI = 4.16–8.39), and triage level (Canadian Triage and Acuity Scale (CTAS) 2: HR = 3.62, 95% CI = 2.24–5.85) were statistically significant predictors of wait time. ED type (pediatric ED: HR = 1.71, 95% CI = 1.18–2.46), triage level (CTAS 5: HR = 2.00, 95% CI = 1.15–3.48), number of consultations (HR = 0.46, 95% CI = 0.31–0.69), and number of laboratory investigations (HR = 0.75, 95% CI = 0.66–0.85) predicted LOS. Conclusions. Based on our results, quality improvement initiatives to reduce ED waits and LOS for pediatric mental health visits may consider monitoring triage processes and the availability, access, and/or time to receipt of specialty consultations. PMID:24563785

  15. 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…

  16. Reducing waiting time and raising outpatient satisfaction in a Chinese public tertiary general hospital-an interrupted time series study.

    PubMed

    Sun, Jing; Lin, Qian; Zhao, Pengyu; Zhang, Qiongyao; Xu, Kai; Chen, Huiying; Hu, Cecile Jia; Stuntz, Mark; Li, Hong; Liu, Yuanli

    2017-08-22

    It is globally agreed that a well-designed health system deliver timely and convenient access to health services for all patients. Many interventions aiming to reduce waiting times have been implemented in Chinese public tertiary hospitals to improve patients' satisfaction. However, few were well-documented, and the effects were rarely measured with robust methods. We conducted a longitudinal study of the length of waiting times in a public tertiary hospital in Southern China which developed comprehensive data collection systems. Around an average of 60,000 outpatients and 70,000 prescribed outpatients per month were targeted for the study during Oct 2014-February 2017. We analyzed longitudinal time series data using a segmented linear regression model to assess changes in levels and trends of waiting times before and after the introduction of waiting time reduction interventions. Pearson correlation analysis was conducted to indicate the strength of association between waiting times and patient satisfactions. The statistical significance level was set at 0.05. The monthly average length of waiting time decreased 3.49 min (P = 0.003) for consultations and 8.70 min (P = 0.02) for filling prescriptions in the corresponding month when respective interventions were introduced. The trend shifted from baseline slight increasing to afterwards significant decreasing for filling prescriptions (P =0.003). There was a significant negative correlation between waiting time of filling prescriptions and outpatient satisfaction towards pharmacy services (r = -0.71, P = 0.004). The interventions aimed at reducing waiting time and raising patient satisfaction in Fujian Provincial Hospital are effective. A long-lasting reduction effect on waiting time for filling prescriptions was observed because of carefully designed continuous efforts, rather than a one-time campaign, and with appropriate incentives implemented by a taskforce authorized by the hospital managers. This

  17. [SPCCTV and SPC Recommendations Related to the Waiting Times for Cardiac Surgery].

    PubMed

    Neves, José Pedro; Pereira, Hélder; Sousa-Uva, Miguel; Gavina, Cristina; Leite Moreira, Adelino; Loureiro, Maria José; Silva Cardoso, José

    2014-01-01

    Appointed jointly by the Portuguese Society for Cardiothoracic and Vascular Surgery (SPCCTV) and by the Portuguese Society of Cardiology (SPC), the Working Group related to the Waiting Times for Cardiac Surgery was created with the aim of developing practical recommendations about clinically acceptable waiting times for the three critical phases of the care of adults with a cardiac disease that require surgery or an intervention: cardiology appointments; diagnostic process and invasive therapy. Cardiac surgery has its own characteristics, not comparable to other surgical specialties and, therefore, it is important to reduce its maximum waiting times and, also, increase the efficacy of the systems which are responsible to monitor and trace the patient. The information given in this document was based, mostly, in available clinical information. The methodology used to establish the criteria was based on studies regarding disease's natural history, clinical studies that compared medical treatment with intervention, retrospective and prospective analysis of patients included on a waiting list, and experts or working groups' opinions. After this first step, marked by this publication, the SPCCTV and the SPC PSC should be considered as natural interlocutors about this matter and they are committed to decisively contribute to the definition of operational strategies through the adaption of the clinical evidence with reality and with the available resources.

  18. The effect of waiting time on pain intensity after elective surgical lumbar discectomy.

    PubMed

    Quon, Jeffrey A; Sobolev, Boris G; Levy, Adrian R; Fisher, Charles G; Bishop, Paul B; Kopec, Jacek A; Dvorak, Marcel F; Schechter, Martin T

    2013-12-01

    Waitlists are commonly used in Canada to manage access to surgical procedures such as elective surgical lumbar discectomy (ESLD). The timing of enrollment onto the waitlist is important as this is a proxy measure for the concordance of preferences for surgery between a patient and surgeon. After enrollment, the waiting time to actual surgery extends the duration of preoperative symptoms, which possibly affects the outcome of ESLD. Waiting time also specifically reflects the delay in service delivery imposed by the limited capacity of the health-care system. To determine if a system-imposed delay in treatment, that is, longer waiting time, for ESLD is associated with a higher odds of experiencing residual postoperative pain. Ambidirectional cohort study with 2-year retrospective and 3-year prospective components, conducted at a major tertiary care center serving a metropolitan area in Canada. Patients aged 16 years or older with sciatica because of herniated lumbar disc, confirmed on advanced imaging, were recruited at the time of waitlist enrollment for ESLD. Patients with significant comorbidity or emergency indications for surgery were excluded. Of 391 participants, 291 had complete follow-up information at 6 months postoperatively. Intensity of the predominant symptom (worse of either back or leg pain) was assessed on the 11-point numerical rating scale at waitlist enrollment and 6 months postoperatively. Pain scores were highly skewed and therefore categorized into four ordinal levels defined by quartiles. For the primary analysis, time to surgery from waitlist enrollment was dichotomized based on a predetermined clinically meaningful cut-point of 12 weeks. Ordinal logistic regression was used to compare the odds of experiencing higher pain intensity between wait groups. Control of confounders was achieved using both propensity scores and conventional multivariable modeling. In unadjusted analyses, long-wait patients were 80% more likely than short-wait

  19. Improving patient waiting times: a simulation study of an obesity care service

    PubMed Central

    Tako, Antuela A; Kotiadis, Kathy; Vasilakis, Christos; Miras, Alexander; le Roux, Carel W

    2014-01-01

    Background Obesity care services are often faced with the need to adapt their resources to rising levels of demand. The main focus of this study was to help prioritise planned investments in new capacity allowing the service to improve patient experience and meet future anticipated demand. Methods We developed computer models of patient flows in an obesity service in an Academic Health Science Centre that provides lifestyle, pharmacotherapy and surgery treatment options for the UK's National Health Service. Using these models we experiment with different scenarios to investigate the likely impact of alternative resource configurations on patient waiting times. Results Simulation results show that the timing and combination of adding extra resources (eg, surgeons and physicians) to the service are important. For example, increasing the capacity of the pharmacotherapy clinics equivalent to adding one physician reduced the relevant waiting list size and waiting times, but it then led to increased waiting times for surgical patients. Better service levels were achieved when the service operates with the resource capacity of two physicians and three surgeons. The results obtained from this study had an impact on the planning and organisation of the obesity service. Conclusions Resource configuration combined with demand management (reduction in referral rates) along the care service can help improve patient waiting time targets for obesity services, such as the 18 week target of UK's National Health Service. The use of simulation models can help stakeholders understand the interconnectedness of the multiple microsystems (eg, clinics) comprising a complex clinical service for the same patient population, therefore, making stakeholders aware of the likely impact of resourcing decisions on the different microsystems. PMID:24050985

  20. 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

  1. 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

  2. Impact of adjustment measures on reducing outpatient waiting time in a community hospital: application of a computer simulation.

    PubMed

    Chen, Bai-lian; Li, En-dong; Yamawuchi, Kazunobu; Kato, Ken; Naganawa, Shinji; Miao, Wei-jun

    2010-03-05

    As an important determinant of patient satisfaction, waiting time, has gained increasing attention in the field of health care services. The present study aimed to illustrate the distribution characteristics of waiting time in a community hospital and explore the impact of potential measures to reduce outpatient waiting time based on a computer simulation approach. During a one-month study period in 2006, a cross-sectional study was conducted in a community hospital located in Shanghai, China. Baseline data of outpatient waiting time were calculated according to the records of registration time and payment time. A simulation technique was adopted to investigate the impact of perspective reform methods on reducing waiting time. Data from a total of 10,092 patients and 26,816 medical consultations were collected in the study and 19,947 medical consultations were included. The average of the total visit time for outpatients in this hospital was 43.6 minutes in the morning, 19.1 minutes in the afternoon, and 34.3 minutes for the whole day studied period. The simulation results suggested that waiting time for outpatients could be greatly reduced through the introduction of appointment system and flexible demand-orientated doctor scheduling according to the numbers of patients waiting at different time of the workday. Adoption of an appointment system and flexible management of doctor scheduling may be effective way to achieve decreased waiting time.

  3. 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.

  4. Leveraging Time for School Equity: Indicators to Measure More and Better Learning Time

    ERIC Educational Resources Information Center

    Del Razo, Jaime L.; Saunders, Marisa; Renée, Michelle; López, Ruth M.; Ullucci, Kerri

    2014-01-01

    Using standardized test scores as the main measure of educational achievement is not enough to capture the complexity of a student's or school's needs, challenges, and successes. "Leveraging Time for School Equity: Indicators to Measure More and Better Learning Time" presents a new set of comprehensive, rich, and meaningful…

  5. 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.

  6. Waiting time before release increases the motivation to home in homing pigeons (Columba livia).

    PubMed

    Dell'Ariccia, Gaia; Costantini, David; Dell'Omo, Giacomo; Lipp, Hans-Peter

    2009-10-01

    When performing homing experiments with individual releases, pigeons have to wait in a transport box for a certain amount of time before being released and hence perceive the departure of companions. Quite often, the last pigeons disappear straightforward from the release site. The question is whether this reflects improved orientation because of prolonged exposure to the release place or whether it reflects increased homing motivation. By releasing pigeons from a familiar site, we investigated the effects of the time spent at the release site on homing performance, recording pigeons' flights with GPS loggers. Our results show that, despite individual peculiarities of flight patterns, the waiting time at release site had a positive effect on homing speed and time, and reduced the time spent circling around the release point. However, the overall path efficiency as derived from GPS tracking was not influenced. These results suggest that a longer waiting time before release improves homing performance and this is related not only to increased navigational abilities but also to increased homing motivation.

  7. 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.

  8. Anomalous transport in fluid field with random waiting time depending on the preceding jump length

    NASA Astrophysics Data System (ADS)

    Zhang, Hong; Li, Guo-Hua

    2016-11-01

    Anomalous (or non-Fickian) transport behaviors of particles have been widely observed in complex porous media. To capture the energy-dependent characteristics of non-Fickian transport of a particle in flow fields, in the present paper a generalized continuous time random walk model whose waiting time probability distribution depends on the preceding jump length is introduced, and the corresponding master equation in Fourier-Laplace space for the distribution of particles is derived. As examples, two generalized advection-dispersion equations for Gaussian distribution and lévy flight with the probability density function of waiting time being quadratic dependent on the preceding jump length are obtained by applying the derived master equation. Project supported by the Foundation for Young Key Teachers of Chengdu University of Technology, China (Grant No. KYGG201414) and the Opening Foundation of Geomathematics Key Laboratory of Sichuan Province, China (Grant No. scsxdz2013009).

  9. A Customer Wait Time Analysis of Medical Supplies and Equipment for Operations Enduring and Iraqi Freedom

    DTIC Science & Technology

    2005-06-15

    Supply Chain Management , Supply Chain Performance. 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF 18. NUMBER 19a. NAME OF RESPONSIBLE PERSON a. REPORT...equipment to the OEF and OIF theaters. Customer Wait Time Analysis 8 Literature review Effective supply chain management is paramount to an organization’s...the last several decades the Army has made continuous improvements in supply chain management that coincide with changes in the strategic objectives

  10. Impact of Surgical Waiting-List Times on Scoliosis Surgery: The Surgeon's Perspective.

    PubMed

    Miyanji, Firoz; Newton, Peter O; Samdani, Amer F; Shah, Suken A; Varghese, Ranjit A; Reilly, Christopher W; Mulpuri, Kishore

    2015-06-01

    Survey. The aim of this study was to evaluate the surgeon's perspective on the potential impact of prolonged surgical waitlists on the surgical care and perioperative management of patients with scoliosis. The long waits for surgical treatment of scoliosis found in some countries may have serious implications for the complexity of surgery and perioperative care required if the curve progresses while waiting. The surgeon's perspective on this problem provides important information that needs to be taken into account during resource allocation. Radiographs from 13 patients who had waited more than 6 months for scoliosis surgery were selected. Each patient had radiographs from the time of surgical booking and immediately preoperatively. The radiographs and a questionnaire were sent to 3 surgeons to canvass their surgical and postoperative plan. The surgeons were blinded to the fact that the radiographs were of the same patients at 2 time points. The patients' actual course of treatment was documented. Data for 11 patients were available for analysis. The average wait for surgery was 24 months (range, 17-30 mo). The mean curve progression was 25.3° while on the waitlist, from an average of 52° to 77°. By the time the patients had to undergo surgery, more anterior releases were added to posterior instrumentation alone in the surgical plan. Mean estimated operative time increased by 2.2 hours, mean estimated length of hospital stay increased by 1 day, and the estimated level of difficulty of surgery increased 2.33 grades. The predicted estimated blood loss also increased. From the surgeon's perspective, lengthy waitlists have a significant negative impact on the perioperative and postoperative care of patients with scoliosis by increasing the complexity of surgery. The actual course of treatment corresponded to the responses from these different surgeons. N/A.

  11. Radical radiotherapy for cervix cancer: The effect of waiting time on outcome

    SciTech Connect

    Choan, E. . E-mail: ce@ottawahospital.on.ca; Dahrouge, Simone; Samant, Rajiv; Mirzaei, Ameneh; Price, Julie

    2005-03-15

    Purpose: To assess the effect of treatment waiting time on clinical outcome for patients with cervix cancers treated with radical radiotherapy. Methods and materials: A retrospective analysis was conducted on all cervix cancer patients treated with radical radiotherapy between 1990 and 2001 at the Ottawa Regional Cancer Centre. Analyses were performed according to the three following separate definitions of waiting times: interval from start of radiotherapy to (1) date of initial biopsy (2) date of examination under anesthesia, and (3) date of radiation oncology consultation. Associations between waiting times and patient characteristics and disease control were investigated using t-tests, analyses of variance, and Cox regression analyses. Results: A total of 195 patients were studied. The vast majority of patients were treated within 5, 6, and 8 weeks of their consultation (91%), examination under anesthesia (88%), and biopsy (81%), respectively. On average, delays between initial biopsy and treatment start were greater for older patients (p = 0.025) (5.8 weeks for <40 years old vs. 6.6 weeks for >70 years old) and those with smaller tumors (p < 0.001) (5.0 weeks for >4 cm vs. 6.3 weeks for {<=}4 cm). Univariate analysis revealed no adverse effect of treatment delay on tumor control. Multivariate analysis, with the inclusion of multiple prognostic tumor and treatment parameters, revealed an adverse effect of treatment delay on survival outcomes. Conclusions: Longer radiotherapy waiting times were found to be associated with diminished survival outcomes for patients treated radically for cervix cancer. The significance of this observed association requires further investigation.

  12. 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

  13. The effect of superfluid hydrodynamics on pulsar glitch sizes and waiting times

    NASA Astrophysics Data System (ADS)

    Haskell, B.

    2016-09-01

    Pulsar glitches, sudden jumps in frequency observed in many radio pulsars, may be the macroscopic manifestation of superfluid vortex avalanches on the microscopic scale. Small-scale quantum mechanical simulations of vortex motion in a decelerating container have shown that such events are possible and predict power-law distributions for the size of the events, and exponential distributions for the waiting time. Despite a paucity of data, this prediction is consistent with the size and waiting time distributions of most glitching pulsars. Nevertheless, a few object appear to glitch quasi-periodically, and exhibit many large glitches, while a recent study of the Crab pulsar has suggested deviations from a power-law distribution for smaller glitches. In this Letter, we incorporate the results of quantum mechanical simulations in a macroscopic superfluid hydrodynamics simulation. We show that the effect of vortex coupling to the neutron and proton fluids in the star naturally leads to deviations from power-law distributions for sizes, and from exponential distributions for waiting times, and we predict a cutoff in the size distribution for small glitches.

  14. Patient and operational factors affecting wait times in a bariatric surgery program in Toronto: a retrospective cohort study.

    PubMed

    Diamant, Adam; Cleghorn, Michelle C; Milner, Joseph; Sockalingam, Sanjeev; Okrainec, Allan; Jackson, Timothy D; Quereshy, Fayez A

    2015-01-01

    Increasing rates of obesity have led to growing demand for bariatric surgery. This has implications for wait times, particularly in publicly funded programs. This study examined the impact of patient and operational factors on wait times in a multidisciplinary bariatric surgery program. A retrospective study was conducted involving patients who were referred to a tertiary care centre (University Health Network, Toronto Western Hospital, Toronto) for bariatric surgery between June 2008 and July 2011. Patient characteristics, dates of clinical assessments and records describing operational changes were collected. Univariable analysis and multivariable log-linear and parametric time-to-event regressions were performed to determine whether patient and operational covariates were associated with the wait time for bariatric surgery (i.e., length of preoperative evaluation). Of the 1664 patients included in the analysis, 724 underwent surgery with a mean wait time of 440 (standard deviation 198) days and a median wait time of 445 (interquartile range 298-533) days. Wait times ranged from 3 months to 4 years. Univariable and multivariable analyses showed that patients with active substance use (β = 0.3482, p = 0.02) and individuals who entered the program in more recent operational periods (β = 0.2028, p < 0.001) had longer wait times. Additionally, the median time-to-surgery increased over 3 discrete operational periods (characterized by specific program changes related to scheduling and staffing levels, and varying referral rates and defined surgical targets; p < 0.001). Some patients could be identified at referral as being at risk for longer wait times. We also found that previous operational decisions significantly increased the wait time in the program since its inception. Therefore, careful consideration must be devoted to process-level decision-making for multistage bariatric surgical programs, because managerial and procedural changes can affect timely

  15. 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.

  16. Toward systematic reviews to understand the determinants of wait time management success to help decision-makers and managers better manage wait times

    PubMed Central

    2013-01-01

    Background Long waits for core specialized services have consistently been identified as a key barrier to access. Governments and organizations at all levels have responded with strategies for better wait list management. While these initiatives are promising, insufficient attention has been paid to factors influencing the implementation and sustainability of wait time management strategies (WTMS) implemented at the organizational level. Methods A systematic review was conducted using the main electronic databases, such as CINAHL, MEDLINE, and Cochrane Database of Systematic Reviews, to identify articles published between 1990 and 2011 on WTMS for scheduled care implemented at the organizational level or higher and on frameworks for analyzing factors influencing their success. Data was extracted on governance, culture, resources, and tools. We organized a workshop with Canadian healthcare policy-makers and managers to compare our initial findings with their experience. Results Our systematic review included 47 articles: 36 related to implementation and 11 to sustainability. From these, we identified a variety of WTMS initiated at the organizational level or higher, and within these, certain factors that were specific to either implementation or sustainability and others common to both. The main common factors influencing success at the contextual level were stakeholder engagement and strong funding, and at the organizational level, physician involvement, human resources capacity, and information management systems. Specific factors for successful implementation at the contextual level were consultation with front-line actors and common standards and guidelines, and at the organizational level, financial incentives and dedicated staffing. For sustainability, we found no new factors. The workshop participants identified the same major factors as found in the articles and added others, such as information sharing between physicians and managers. Conclusions Factors

  17. Determinants of patient satisfaction with cataract surgery and length of time on the waiting list

    PubMed Central

    Conner-Spady, B L; Sanmugasunderam, S; Courtright, P; McGurran, J J; Noseworthy, T W

    2004-01-01

    Aims: To assess determinants of patient satisfaction with their waiting time (WT) and cataract surgery outcome. Methods: A prospective cohort of consecutive patients waiting for cataract surgery were assessed by their ophthalmologist. Satisfaction, maximum acceptable waiting time (MAWT), urgency, visual function, visual acuity (VA), and health related quality of life (EQ-5D) were assessed using mailed questionnaires before surgery and 8–10 weeks after surgery. Ordinal logistic regression was used to build explanatory models. Results: 166 patients (61.9% female, mean age 73.4 years) had a mean WT of 16 weeks. Patients whose actual WT was shorter than their MAWT had greater odds of being satisfied with their WT than those whose WT was longer (adjusted OR 3.86, 95% CI 1.38 to 10.74). Improvement in visual function (OR 3.19, 95% CI 1.78 to 5.73), and VA (OR 4.27, 95% CI 1.70 to 10.68) significantly predicted satisfaction with surgery. Models were adjusted for age and sex. Conclusion: Patient perspectives on MAWT and satisfaction with WT are important inputs to the process of determining WT standards for levels of patient priority. Patient expectation of WT may mediate satisfaction with actual WT. PMID:15377556

  18. 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.

  19. Hunger, waiting time and transport costs: time to confront challenges to ART adherence in Africa.

    PubMed

    Hardon, A P; Akurut, D; Comoro, C; Ekezie, C; Irunde, H F; Gerrits, T; Kglatwane, J; Kinsman, J; Kwasa, R; Maridadi, J; Moroka, T M; Moyo, S; Nakiyemba, A; Nsimba, S; Ogenyi, R; Oyabba, T; Temu, F; Laing, R

    2007-05-01

    Adherence levels in Africa have been found to be better than those in the US. However around one out of four ART users fail to achieve optimal adherence, risking drug resistance and negative treatment outcomes. A high demand for 2nd line treatments (currently ten times more expensive than 1st line ART) undermines the sustainability of African ART programs. There is an urgent need to identify context-specific constraints to adherence and implement interventions to address them. We used rapid appraisals (involving mainly qualitative methods) to find out why and when people do not adhere to ART in Uganda, Tanzania and Botswana. Multidisciplinary teams of researchers and local health professionals conducted the studies, involving a total of 54 semi-structured interviews with health workers, 73 semi-structured interviews with ARTusers and other key informants, 34 focus group discussions, and 218 exit interviews with ART users. All the facilities studied in Botswana, Tanzania and Uganda provide ARVs free of charge, but ART users report other related costs (e.g. transport expenditures, registration and user fees at the private health facilities, and lost wages due to long waiting times) as main obstacles to optimal adherence. Side effects and hunger in the initial treatment phase are an added concern. We further found that ART users find it hard to take their drugs when they are among people to whom they have not disclosed their HIV status, such as co-workers and friends. The research teams recommend that (i) health care workers inform patients better about adverse effects; (ii) ART programmes provide transport and food support to patients who are too poor to pay; (iii) recurrent costs to users be reduced by providing three-months, rather than the one-month refills once optimal adherence levels have been achieved; and (iv) pharmacists play an important role in this follow-up care.

  20. Conceptualising time before surgery: the experience of patients waiting for hip replacement.

    PubMed

    Johnson, Emma C; Horwood, Jeremy; Gooberman-Hill, Rachael

    2014-09-01

    Interpretations of time underlie patients' experiences of illness and the way in which the National Health Service (NHS) is organised. In the NHS, achieving short waiting times for treatment is seen as important, and this is particularly evident in relation to chronic conditions where the time waiting in care from onset of symptoms to successful management can last months and years. One example of a chronic condition with high prevalence is osteoarthritis, estimated to affect 10% of people aged over 55 years in the UK. Osteoarthritis of the hip is particularly common, and treatments include exercise and medication. If these options do not provide enough relief from pain and functional difficulties, then joint replacement may be considered. With over 70,000 such operations conducted every year in England and Wales, processes relating to waiting times impact on many patients. This article explores how 24 patients with osteoarthritis experience time during the lead up to hip replacement surgery. We draw on data collected during longitudinal in-depth interviews with patients a median of 9.5 days before surgery and at two to four weeks post-operatively. Transcripts of audio-recorded interviews were imported into Atlas.ti(®) and inductive thematic analysis undertaken. Increasing pain and deterioration in function altered the experience of time during the journey towards hip replacement. Patients made essential changes to how they filled their days. They experienced lost and wasted time and faced disruption to the temporal order of their lives. A surgical date marked in the calendar became their focus. However, this date was not static, moving because of changing perceptions of duration and real-time alterations by the healthcare system. Findings highlight that patients' experience of time is complex and multi-dimensional and does not reflect the linear, monochronic conceptualisation of time embedded in the healthcare system. Copyright © 2014 The Authors. Published by

  1. Does socioeconomic status affect lengthy wait time in Canada? Evidence from Canadian Community Health Surveys.

    PubMed

    Hajizadeh, Mohammad

    2017-04-07

    Reasonable access to health services without financial or other barriers is a primary objective of the Canadian health system. Notwithstanding such concern about accessibility of services, long waiting times for health services have been a prominent health policy issue in recent years. Using pooled data from four nationally representative Canadian Community Health Surveys (CCHSs, 2000/01, 2003, 2005 and 2010; n = 266,962) we examine socioeconomic inequality in lengthy wait time (LWT) to health care among adults (aged 18-65) in Canada. The relative and absolute concentration indices (RC and AC, respectively) are used to quantify income-related inequality in LWT in Canada and for its provinces. Additionally, we decompose the RC and AC indices to identify factors affecting income-related inequality in LWT. Our descriptive results show that, on average, 5% of Canadian adults experienced LWT to access health services in the past 12 months. While 3% of the residents of British Columbia and Saskatchewan reported LWT to access health care services, this figure was 7% in Quebec. Our findings also demonstrated that LWT was mainly concentrated among the poor in Canada [RC = -0.039; 95% confidence interval (CI) -0.049 to -0.028 and AC = -0.067; CI -0.086 to -0.049]. The RC and AC suggested statistically significant pro-rich inequality of LWT in Nova Scotia, New Brunswick, Quebec, Manitoba, Saskatchewan and British Columbia. Decomposition analyses indicate that, besides income itself, health status (measured by a set of 15 chronic condition indicators), immigration status and geographical factors were the most important factors contributing to the concentration of LWT among the poor in Canada. These results provide some evidence that low-income individuals tend to have lengthier wait times for publicly-funded health care in Canada in comparison to their high-income counterparts. The observed negative gradient between income and long waiting time may be interpreted as

  2. Medical Team Evaluation: Effect on Emergency Department Waiting Time and Length of Stay

    PubMed Central

    Lauks, Juliane; Mramor, Blaz; Baumgartl, Klaus; Maier, Heinrich; Nickel, Christian H.; Bingisser, Roland

    2016-01-01

    Emergency Departments (ED) are trying to alleviate crowding using various interventions. We assessed the effect of an alternative model of care, the Medical Team Evaluation (MTE) concept, encompassing team triage, quick registration, redesign of triage rooms and electronic medical records (EMR) on door-to-doctor (waiting) time and ED length of stay (LOS). We conducted an observational, before-and-after study at an urban academic tertiary care centre. On July 17th 2014, MTE was initiated from 9:00 a.m. to 10 p.m., 7 days a week. A registered triage nurse was teamed with an additional senior ED physician. Data of the 5-month pre-MTE and the 5-month MTE period were analysed. A matched comparison of waiting times and ED LOS of discharged and admitted patients pertaining to various Emergency Severity Index (ESI) triage categories was performed based on propensity scores. With MTE, the median waiting times improved from 41.2 (24.8–66.6) to 10.2 (5.7–18.1) minutes (min; P < 0.01). Though being beneficial for all strata, the improvement was somewhat greater for discharged, than for admitted patients. With a reduction from 54.3 (34.2–84.7) to 10.5 (5.9–18.4) min (P < 0.01), in terms of waiting times, MTE was most advantageous for ESI4 patients. The overall median ED LOS increased for about 15 min (P < 0.01), increasing from 3.4 (2.1–5.3) to 3.7 (2.3–5.6) hours. A significant increase was observed for all the strata, except for ESI5 patients. Their median ED LOS dropped by 73% from 1.2 (0.8–1.8) to 0.3 (0.2–0.5) hours (P < 0.01). In the same period the total orders for diagnostic radiology increased by 1,178 (11%) from 10,924 to 12,102 orders, with more imaging tests being ordered for ESI 2, 3 and 4 patients. Despite improved waiting times a decrease of ED LOS was only seen in ESI level 5 patients, whereas in all the other strata ED LOS increased. We speculate that this was brought about by the tendency of triage physicians to order more diagnostic radiology

  3. 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.

  4. Parallel-batch scheduling and transportation coordination with waiting time constraint.

    PubMed

    Gong, Hua; Chen, Daheng; Xu, Ke

    2014-01-01

    This paper addresses a parallel-batch scheduling problem that incorporates transportation of raw materials or semifinished products before processing with waiting time constraint. The orders located at the different suppliers are transported by some vehicles to a manufacturing facility for further processing. One vehicle can load only one order in one shipment. Each order arriving at the facility must be processed in the limited waiting time. The orders are processed in batches on a parallel-batch machine, where a batch contains several orders and the processing time of the batch is the largest processing time of the orders in it. The goal is to find a schedule to minimize the sum of the total flow time and the production cost. We prove that the general problem is NP-hard in the strong sense. We also demonstrate that the problem with equal processing times on the machine is NP-hard. Furthermore, a dynamic programming algorithm in pseudopolynomial time is provided to prove its ordinarily NP-hardness. An optimal algorithm in polynomial time is presented to solve a special case with equal processing times and equal transportation times for each order.

  5. 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.

  6. Transitioning from Health Disparities to a Health Equity Research Agenda: The Time Is Now

    PubMed Central

    Williams, Shanita D.

    2014-01-01

    Health disparities are real. The evidence base is large and irrefutable. As such, the time is now to shift the research emphasis away from solely documenting the pervasiveness of the health disparities problem and begin focusing on health equity, the highest level of health possible. The focus on health equity research will require investigators to propose projects that develop and evaluate evidence-based solutions to health differences that are driven largely by social, economic, and environmental factors. This article highlights ongoing research and programmatic efforts underway at the National Institutes of Health that hold promise for advancing population health and improving health equity. PMID:24385668

  7. Transitioning from health disparities to a health equity research agenda: the time is now.

    PubMed

    Srinivasan, Shobha; Williams, Shanita D

    2014-01-01

    Health disparities are real. The evidence base is large and irrefutable. As such, the time is now to shift the research emphasis away from solely documenting the pervasiveness of the health disparities problem and begin focusing on health equity, the highest level of health possible. The focus on health equity research will require investigators to propose projects that develop and evaluate evidence-based solutions to health differences that are driven largely by social, economic, and environmental factors. This article highlights ongoing research and programmatic efforts underway at the National Institutes of Health that hold promise for advancing population health and improving health equity.

  8. Delay decomposition at a single server queue with constant service time and multiple inputs. [Waiting time on computer network

    NASA Technical Reports Server (NTRS)

    Ziegler, C.; Schilling, D. L.

    1977-01-01

    Two networks consisting of single server queues, each with a constant service time, are considered. The external inputs to each network are assumed to follow some general probability distribution. Several interesting equivalencies that exist between the two networks considered are derived. This leads to the introduction of an important concept in delay decomposition. It is shown that the waiting time experienced by a customer can be decomposed into two basic components called self delay and interference delay.

  9. Delay decomposition at a single server queue with constant service time and multiple inputs. [Waiting time on computer network

    NASA Technical Reports Server (NTRS)

    Ziegler, C.; Schilling, D. L.

    1977-01-01

    Two networks consisting of single server queues, each with a constant service time, are considered. The external inputs to each network are assumed to follow some general probability distribution. Several interesting equivalencies that exist between the two networks considered are derived. This leads to the introduction of an important concept in delay decomposition. It is shown that the waiting time experienced by a customer can be decomposed into two basic components called self delay and interference delay.

  10. Modified cumulative distribution function in application to waiting time analysis in the continuous time random walk scenario

    NASA Astrophysics Data System (ADS)

    Połoczański, Rafał; Wyłomańska, Agnieszka; Maciejewska, Monika; Szczurek, Andrzej; Gajda, Janusz

    2017-01-01

    The continuous time random walk model plays an important role in modelling of the so-called anomalous diffusion behaviour. One of the specific properties of such model is the appearance of constant time periods in the trajectory. In the continuous time random walk approach they are realizations of the sequence called waiting times. In this work we focus on the analysis of waiting time distribution by introducing novel methods of parameter estimation and statistical investigation of such a distribution. These methods are based on the modified cumulative distribution function. In this paper we consider three special cases of waiting time distributions, namely α-stable, tempered stable and gamma. However, the proposed methodology can be applied to broad set of distributions—in general it may serve as a method of fitting any distribution function if the observations are rounded. The new statistical techniques are applied to the simulated data as well as to the real data of \\text{C}{{\\text{O}}2} concentration in indoor air.

  11. Kramers' escape problem for fractional Klein-Kramers equation with tempered α-stable waiting times.

    PubMed

    Gajda, Janusz; Magdziarz, Marcin

    2011-08-01

    In this paper we extend the subdiffusive Klein-Kramers model, in which the waiting times are modeled by the α-stable laws, to the case of waiting times belonging to the class of tempered α-stable distributions. We introduce a generalized version of the Klein-Kramers equation, in which the fractional Riemman-Liouville derivative is replaced with a more general integro-differential operator. This allows a transition from the initial subdiffusive character of motion to the standard diffusion for long times to be modeled. Taking advantage of the corresponding Langevin equation, we study some properties of the tempered dynamics, in particular, we approximate solutions of the tempered Klein-Kramers equation via Monte Carlo methods. Also, we study the distribution of the escape time from the potential well and compare it to the classical results in the Kramers escape theory. Finally, we derive the analytical formula for the first-passage-time distribution for the case of free particles. We show that the well-known Sparre Andersen scaling holds also for the tempered subdiffusion.

  12. Reducing waiting times for GU medicine appointments: the impact of a new appointment system.

    PubMed

    Tayal, S C; Opaneye, A A; Crinion, Susan; Hildreth, A J

    2006-03-01

    Our objective was to reduce the 'did not attend' (DNA) rates and waiting times by introducing a new confirmatory appointment system prior to their attendance at both Hartlepool and Middlesbrough genitourinary (GU) medicine departments. In Middlesbrough it was previous day appointment confirmation, whereas at Hartlepool it was 10 days. Both systems achieved significant attendance rates of 83.4% and 79.1% at Hartlepool and Middlesbrough, in comparison to 68.7% and 75.0% prior to the new system. The new system will improve the departmental capacity.

  13. Application of Queuing Analytic Theory to Decrease Waiting Times in Emergency Department: Does it Make Sense?

    PubMed

    Alavi-Moghaddam, Mostafa; Forouzanfar, Reza; Alamdari, Shahram; Shahrami, Ali; Kariman, Hamid; Amini, Afshin; Pourbabaee, Shokooh; Shirvani, Armin

    2012-01-01

    Patients who receive care in an emergency department (ED), are usually unattended while waiting in queues. This study was done to determine, whether the application of queuing theory analysis might shorten the waiting times of patients admitted to emergency wards. This was an operational study to use queuing theory analysis in the ED. In the first phase, a field study was conducted to delineate the performance of the ED and enter the data obtained into simulator software. In the second phase, "ARENA" software was used for modeling, analysis, creating a simulation and improving the movement of patients in the ED. Validity of the model was confirmed through comparison of the results with the real data using the same instrument. The third phase of the study concerned modeling in order to assess the effect of various operational strategies, on the queue waiting time of patients who were receiving care in the ED. In the first phase, it was shown that 47.7% of the 3000 patient records were cases referred for trauma treatment, and the remaining 52.3% were referred for non-trauma services. A total of 56% of the cases were male and 44% female. Maximum input was 4.5 patients per hour and the minimum input was 0.5 per hour. The average length of stay for patients in the trauma section was three hours, while for the non-trauma section it was four hours. In the second phase, modeling was tested with common scenarios. In the third phase, the scenario with the addition of one or more senior emergency resident(s) on each shift resulted in a decreased length of stay from 4 to 3.75 hours. Moreover, the addition of one bed to the Intensive Care Unit (ICU) and/or Critical Care Unit (CCU) in the study hospital, reduced the occupancy rate of the nursing service from 76% to 67%. By adding another clerk to take electrocardiograms (ECG) in the ED, the average time from a request to performing the procedure is reduced from 26 to 18 minutes. Furthermore, the addition of 50% more staff to the

  14. Application of Queuing Analytic Theory to Decrease Waiting Times in Emergency Department: Does it Make Sense?

    PubMed Central

    Alavi-Moghaddam, Mostafa; Forouzanfar, Reza; Alamdari, Shahram; Shahrami, Ali; Kariman, Hamid; Amini, Afshin; Pourbabaee, Shokooh; Shirvani, Armin

    2012-01-01

    Background Patients who receive care in an emergency department (ED), are usually unattended while waiting in queues. Objectives This study was done to determine, whether the application of queuing theory analysis might shorten the waiting times of patients admitted to emergency wards. Patients and Methods This was an operational study to use queuing theory analysis in the ED. In the first phase, a field study was conducted to delineate the performance of the ED and enter the data obtained into simulator software. In the second phase, "ARENA" software was used for modeling, analysis, creating a simulation and improving the movement of patients in the ED. Validity of the model was confirmed through comparison of the results with the real data using the same instrument. The third phase of the study concerned modeling in order to assess the effect of various operational strategies, on the queue waiting time of patients who were receiving care in the ED. Results In the first phase, it was shown that 47.7% of the 3000 patient records were cases referred for trauma treatment, and the remaining 52.3% were referred for non-trauma services. A total of 56% of the cases were male and 44% female. Maximum input was 4.5 patients per hour and the minimum input was 0.5 per hour. The average length of stay for patients in the trauma section was three hours, while for the non-trauma section it was four hours. In the second phase, modeling was tested with common scenarios. In the third phase, the scenario with the addition of one or more senior emergency resident(s) on each shift resulted in a decreased length of stay from 4 to 3.75 hours. Moreover, the addition of one bed to the Intensive Care Unit (ICU) and/or Critical Care Unit (CCU) in the study hospital, reduced the occupancy rate of the nursing service from 76% to 67%. By adding another clerk to take electrocardiograms (ECG) in the ED, the average time from a request to performing the procedure is reduced from 26 to 18 minutes

  15. Functional Status, Time to Transplantation, and Survival Benefit of Kidney Transplantation Among Wait-Listed Candidates

    PubMed Central

    Reese, Peter P.; Shults, Justine; Bloom, Roy D.; Mussell, Adam; Harhay, Meera N.; Abt, Peter; Levine, Matthew; Johansen, Kirsten L.; Karlawish, Jason T.; Feldman, Harold I.

    2015-01-01

    Background In the context of an aging end-stage renal disease population with multiple comorbidities, transplantation professionals face challenges in evaluating the global health of patients awaiting kidney transplantation. Functional status might be useful for identifying which patients will derive a survival benefit from transplantation versus dialysis. Study Design Retrospective cohort study of wait-listed patients using data on functional status from a national dialysis provider linked to United Network for Organ Sharing registry data. Setting & Participants Adult kidney transplant candidates added to the waiting list between the years 2000 and 2006. Predictor Physical function scale of the Medical Outcomes Study 36-Item Short Form Healthy Survey, analyzed as a time-varying covariate. Outcomes Kidney transplantation; Survival benefit of transplantation versus remaining wait-listed. Measurements We used multivariable Cox regression to assess the association between physical function with study outcomes. In survival benefit analyses, transplant status was modeled as a time-varying covariate. Results The cohort comprised 19,242 kidney transplant candidates (median age, 51 years; 36% black race) receiving maintenance dialysis. Candidates in the lowest baseline physical function quartile were more likely to be inactivated (adjusted HR vs. highest quartile, 1.30; 95% CI, 1.21-1.39) and less likely to undergo transplantation (adjusted HR vs. highest quartile, 0.64; 95% CI, 0.61-0.68). After transplantation, worse physical function was associated with shorter 3-year survival (84% vs. 92% for the lowest vs. highest function quartiles). However, compared to dialysis, transplantation was associated with a statistically significant survival benefit by 9 months for patients in every function quartile. Limitations Functional status is self-reported. Conclusions Even patients with low function appear to live longer with kidney transplantation versus dialysis. For waitlisted

  16. Single centre experience with prolonged waiting time on transplant list with "high-urgency" status.

    PubMed

    Heim, Christian; Nooh, Ehab; Kondruweit, Markus; Weyand, Michael; Tandler, Rene

    2013-04-01

    The waiting list for heart transplantation (HTx) in Eurotransplant area has grown to a record size of nearly 1,300 patients, whereas only around 600 hearts were transplanted last year. The prolonged time for patients awaiting HTx on the high-urgency (HU) status leads mostly to serious medical complications. The aim of this study was to study the trend of changes in the frequency of ventricular assist device (VAD) implantation in patients on the HU status. A total of 22 adult patients awaiting transplantation on the HU status at our hospital between January 2011 and December 2011 were analyzed, assessing risk profile, blood group, and complication rates in terms of VAD implantation or death. Results were compared with 16 consecutive patients who were on transplant list with the HU status between January 2010 and December 2010 at our institution. Mean age was 49.5 ± 12.1 (2010 group) years and 51.4 ± 10.7 years (2011 group; p = 0.62). Mean logEuroSCORES raised not significantly from 9.1 ± 6.3% (2010 group) to 10.7 ± 14.7% (2011 group; p = 0.68). Six patients died on the HU status and seven patients had to be supplied with a VAD in 2011. In comparison with the preceding year, only two patients died in 2010 and none of our patients on the HU status had to be provided with mechanical circulatory support. Because of the prolonged waiting time on the HU list, the earlier-mentioned data demonstrate a negative trend in transplant medicine. Especially when taking into consideration that five of seven patients who needed a VAD implantation during the HU waiting period had blood group O. Furthermore, the data derived from Eurotransplant show that the waiting period for patients with blood group O was considerably longer when compared with patients of the same average body height and weight but with other blood groups. Georg Thieme Verlag KG Stuttgart · New York.

  17. An audit of waiting times in the diabetic outpatient clinic: role of patients' punctuality and level of medical staffing.

    PubMed

    Perros, P; Frier, B M

    1996-07-01

    A survey of patients' waiting times was performed in the follow-up clinics of a large hospital outpatient diabetic department (approximately 6500 patients). Over a period of 1 week, 138 patients attended 5 review outpatient clinics. The overall patient:doctor ratio was 11.1:1. Only 18.8% of patients were seen by the doctor, and 86% by the nurse within 30 min of their appointment time. A policy of strict adherence to the formal appointment times was implemented but had no effect on the waiting time (20% of patients were seen by the doctor, and 82.2% by the nurse within 30 min of their appointment time). The combined effects of adherence to actual appointment times and increasing the number of doctors (lowering the patient:doctor ratio to 7.7:1), reduced the total waiting times, and increased the proportion of patients seen by the doctor or nurse within 30 min of their appointment time, to 31% and 100%, respectively. Strict adherence to appointment times was difficult to implement and ineffective but the patient:doctor ratio was important in determining waiting times in the diabetic clinic. Inadequate medical staffing of diabetic outpatient clinics is a major cause of prolonged waiting time for patients. This approach may be useful in assessing and improving the organizational efficiency of a diabetes service.

  18. Waiting time reduction in intravitreal clinics by optimization of appointment scheduling: balancing demand and supply.

    PubMed

    Ugarte, Marta

    2015-01-01

    This study was designed guided by the Model for Improvement framework to reduce waiting times and visit duration in the intravitreal therapy clinic, while improving patient and staff experience. In our aim to provide good quality, patient-centred care and constantly improve, we optimised the appointment profile and patient flow. We involved a multidisciplinary team (one consultant, junior doctors, staff nurses, technicians, and receptionist), as well as patients and relatives, to try to understand the main delays in the clinic. Process mapping, a fishbone diagram, run charts, together with feedback from patients and staff, provided an insight on the possible roots of the delays experienced by our patients. The results of the inquiry led us to take actions focused on optimising appointment scheduling. After implementing the new scheduling profile (with a gap in the middle of the session), various cycles of plan-do-study-act and a comparative, qualitative study by interviewing 10 patients demonstrated that the waiting times decreased, and patients and staff experience improved.

  19. Waiting time reduction in intravitreal clinics by optimization of appointment scheduling: balancing demand and supply

    PubMed Central

    Ugarte, Marta

    2015-01-01

    This study was designed guided by the Model for Improvement framework to reduce waiting times and visit duration in the intravitreal therapy clinic, while improving patient and staff experience. In our aim to provide good quality, patient-centred care and constantly improve, we optimised the appointment profile and patient flow. We involved a multidisciplinary team (one consultant, junior doctors, staff nurses, technicians, and receptionist), as well as patients and relatives, to try to understand the main delays in the clinic. Process mapping, a fishbone diagram, run charts, together with feedback from patients and staff, provided an insight on the possible roots of the delays experienced by our patients. The results of the inquiry led us to take actions focused on optimising appointment scheduling. After implementing the new scheduling profile (with a gap in the middle of the session), various cycles of plan-do-study-act and a comparative, qualitative study by interviewing 10 patients demonstrated that the waiting times decreased, and patients and staff experience improved. PMID:26734454

  20. 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

  1. 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.

  2. Advancing health equity to improve health: the time is now.

    PubMed

    Jackson, B; Huston, P

    2016-02-01

    Health inequities, or avoidable inequalities in health between groups of people, are increasingly recognized and tackled to improve public health. Canada's interest in health inequities goes back over 40 years, with the landmark 1974 Lalonde report, and continues with the 2011 Rio Political Declaration on Social Determinants of Health, which affirmed a global political commitment to implementing a social determinants of health approach to reducing health inequities. Research in this area includes documenting and tracking health inequalities, exploring their multidimensional causes, and developing and evaluating ways to address them. Inequalities can be observed in who is vulnerable to infectious and chronic diseases, the impact of health promotion and disease prevention efforts, how disease progresses, and the outcomes of treatment. Many programs, policies and projects with potential impacts on health equity and determinants of health have been implemented across Canada. Recent theoretical and methodological advances in the areas of implementation science and population health intervention research have strengthened our capacity to develop effective interventions. With the launch of a new health equity series this month, the journals Canada Communicable Disease Report and Health Promotion and Chronic Disease Prevention in Canada will continue to reflect and foster analysis of social determinants of health and focus on intervention studies that advance health equity.

  3. Advancing health equity to improve health: the time is now

    PubMed Central

    Jackson, B.; Huston, P.

    2016-01-01

    Abstract Health inequities, or avoidable inequalities in health between groups of people, are increasingly recognized and tackled to improve public health. Canada’s interest in health inequities goes back over 40 years, with the landmark 1974 Lalonde report, and continues with the 2011 Rio Political Declaration on Social Determinants of Health, which affirmed a global political commitment to implementing a social determinants of health approach to reducing health inequities. Research in this area includes documenting and tracking health inequalities, exploring their multidimensional causes, and developing and evaluating ways to address them. Inequalities can be observed in who is vulnerable to infectious and chronic diseases, the impact of health promotion and disease prevention efforts, how disease progresses, and the outcomes of treatment. Many programs, policies and projects with potential impacts on health equity and determinants of health have been implemented across Canada. Recent theoretical and methodological advances in the areas of implementation science and population health intervention research have strengthened our capacity to develop effective interventions. With the launch of a new health equity series this month, the journals Canada Communicable Disease Report and Health Promotion and Chronic Disease Prevention in Canada will continue to reflect and foster analysis of social determinants of health and focus on intervention studies that advance health equity. PMID:26878490

  4. Predictive event modelling in multicenter clinical trials with waiting time to response.

    PubMed

    Anisimov, Vladimir V

    2011-01-01

    A new analytic statistical technique for predictive event modeling in ongoing multicenter clinical trials with waiting time to response is developed. It allows for the predictive mean and predictive bounds for the number of events to be constructed over time, accounting for the newly recruited patients and patients already at risk in the trial, and for different recruitment scenarios. For modeling patient recruitment, an advanced Poisson-gamma model is used, which accounts for the variation in recruitment over time, the variation in recruitment rates between different centers and the opening or closing of some centers in the future. A few models for event appearance allowing for 'recurrence', 'death' and 'lost-to-follow-up' events and using finite Markov chains in continuous time are considered. To predict the number of future events over time for an ongoing trial at some interim time, the parameters of the recruitment and event models are estimated using current data and then the predictive recruitment rates in each center are adjusted using individual data and Bayesian re-estimation. For a typical scenario (continue to recruit during some time interval, then stop recruitment and wait until a particular number of events happens), the closed-form expressions for the predictive mean and predictive bounds of the number of events at any future time point are derived under the assumptions of Markovian behavior of the event progression. The technique is efficiently applied to modeling different scenarios for some ongoing oncology trials. Case studies are considered. Copyright © 2011 John Wiley & Sons, Ltd.

  5. Improving equitable access to imaging under universal-access medicine: the ontario wait time information program and its impact on hospital policy and process.

    PubMed

    Kielar, Ania Z; El-Maraghi, Robert H; Schweitzer, Mark E

    2010-08-01

    In Canada, equal access to health care is the goal, but this is associated with wait times. Wait times should be fair rather than uniform, taking into account the urgency of the problem as well as the time an individual has already waited. In November 2004, the Ontario government began addressing this issue. One of the first steps was to institute benchmarks reflecting "acceptable" wait times for CT and MRI. A public Web site was developed indicating wait times at each Local Health Integration Network. Since starting the Wait Time Information Program, there has been a sustained reduction in wait times for Ontarians requiring CT and MRI. The average wait time for a CT scan went from 81 days in September 2005 to 47 days in September 2009. For MRI, the resulting wait time was reduced from 120 to 105 days. Increased patient scans have been achieved by purchasing new CT and MRI scanners, expanding hours of operation, and improving patient throughput using strategies learned from the Lean initiative, based on Toyota's manufacturing philosophy for car production. Institution-specific changes in booking procedures have been implemented. Concurrently, government guidelines have been developed to ensure accountability for monies received. The Ontario Wait Time Information Program is an innovative first step in improving fair and equitable access to publicly funded imaging services. There have been reductions in wait times for both CT and MRI. As various new processes are implemented, further review will be necessary for each step to determine their individual efficacy.

  6. Evaluation of an Advanced-Practice Physical Therapist in a Specialty Shoulder Clinic: Diagnostic Agreement and Effect on Wait Times

    PubMed Central

    Robarts, Susan; Kennedy, Deborah; McKnight, Cheryl; MacLeod, Anne Marie; Holtby, Richard

    2013-01-01

    ABSTRACT Purpose: To examine the role of an advanced-practice physiotherapist (APP) with respect to (1) agreement with an orthopaedic surgeon on diagnosis and management of patients with shoulder problems; (2) wait times; and (3) satisfaction with care. Methods: This prospective study involved patients with shoulder complaints who were referred to a shoulder specialist in a tertiary care centre. Agreement was examined on seven major diagnostic categories, need for further examination and surgery, and type of surgical procedure. Wait times were compared between the APP- and surgeon-led clinics from referral date to date of initial consultation, date of final diagnostic test, and date of confirmed diagnosis and planned treatment. A modified and validated version of the Visit-Specific Satisfaction Instrument assessed satisfaction in seven domains. Kappa (κ) coefficients and bias- and prevalence-adjusted kappa (PABAK) values were calculated, and strength of agreement was categorized. Wait time and satisfaction data were examined using non-parametric statistics. Results: Agreement on major diagnostic categories varied from 0.68 (good) to 0.96 (excellent). Agreement with respect to indication for surgery was κ=0.75, p<0.001; 95% CI, 0.62–0.88 (good). Wait time for APP assessment was significantly shorter than wait time for surgeon consultation at all time points (p<0.001); the surgeon's wait time was significantly reduced over 3 years. High satisfaction was reported in all components of care received from both health care providers. Conclusions: Using experienced physiotherapists in an extended role reduces wait times without compromising patient clinical management and overall satisfaction. PMID:24381382

  7. Reduction of admit wait times: the effect of a leadership-based program.

    PubMed

    Patel, Pankaj B; Combs, Mary A; Vinson, David R

    2014-03-01

    Prolonged admit wait times in the emergency department (ED) for patients who require hospitalization lead to increased boarding time in the ED, a significant cause of ED congestion. This is associated with decreased quality of care, higher morbidity and mortality, decreased patient satisfaction, increased costs for care, ambulance diversion, higher numbers of patients who leave without being seen (LWBS), and delayed care with longer lengths of stay (LOS) for other ED patients. The objective was to assess the effect of a leadership-based program to expedite hospital admissions from the ED. This before-and-after observational study was undertaken from 2006 through 2011 at one community hospital ED. A team of ED and hospital leaders implemented a program to reduce admit wait times, using a computerized hospital-wide tracking system to monitor inpatient and ED bed status. The team collaboratively and consistently moved ED patients to their inpatient beds within an established goal of 60 minutes after an admission decision was reached. Top leadership actively intervened in real time by contacting staff whenever delays occurred to expedite immediate solutions to achieve the 60-minute goal. The primary outcome measures were the percentage of ED patients who were admitted to inpatient beds within 60 minutes from the time the beds were requested and ED boarding time. LOS, patient satisfaction, LWBS rate, and ambulance diversion hours were also measured. After ED census, hospital admission rates, and ED bed capacity were controlled for using a multivariable linear regression analysis, the admit wait time reduction program contributed to an increase in patients being admitted to the hospital within 60 minutes by 16 percentage points (95% confidence intervals [CI] = 10 to 22 points; p < 0.0001) and a decrease in boarding time per admission of 46 minutes (95% CI = 63 to 82 minutes; p < 0.0001). LOS decreased for admitted patients by 79 minutes (95% CI = 55 to 104 minutes; p < 0

  8. Reducing radiotherapy waiting times for palliative patients: The role of the Advanced Practice Radiation Therapist.

    PubMed

    Job, Mary; Holt, Tanya; Bernard, Anne

    2017-08-29

    Palliative radiotherapy is effective in reducing symptom burden and improving quality of life in patients with symptomatic metastatic cancer and should be delivered in a timely manner. The aim of this study was to determine whether referring patients directly to a Palliative Advanced Practice Radiation Therapist (APRT) improves access to palliative radiotherapy and reduces time from referral to treatment. At Radiation Oncology Mater Center (ROMC) in Brisbane, Australia a new referral pathway was developed which involved patients requiring palliative radiotherapy, being referred directly to the APRT from a single external hospital medical oncology and palliative care departments. Over a 5 months period, patient demographics and time in working days from referral to treatment were compared for consecutive palliative patients seen within our department. Patients were stratified by method of referral i.e. via the new referral pathway (NP) or via standard referral pathway (SP). Between October 2014 and March 2015, a total of 150 patients were referred for palliative radiotherapy. Of these patients, 48 were referred and processed via the NP. There was a significant reduction in the number of days from referral to treatment for patients referred through the NP. Patients referred through the NP via the APRT had a mean and median wait time of 3.5 and 3 days respectively compared with 8.1 and 5 days for patients referred through the SP (P = <0.001). Patients were also more likely to have the treatment completed with less visits to the hospital (P < 0.001). The new referral pathway utilising a dedicated palliative APRT decreased waiting times for patients receiving palliative radiotherapy and improved timely access to the radiotherapy service for both referrers and patients. © 2017 The Authors and State of Queensland. Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy

  9. The assessment of patients' waiting and nursing consultation times at urban clinics in the National Capital District, Papua New Guinea.

    PubMed

    Benjamin, Amos L

    2003-01-01

    This study was conducted in the National Capital District during the months of August, September and October 2000. The study sites were the 3 urban clinics situated in the suburbs of Six Mile, Hohola and Konedobu. The aim of the study was to determine the patients' waiting times and nursing consultation times in the urban clinics. A total of 1075 patients were surveyed, including 264 children under 5 years of age. 58% of patients were males. 24% of patients were able to see a nurse within 30 minutes and 70% within 2 hours. 47% had to wait 1-3 hours to see a consulting nurse and a further 9.5% had to wait 3-5 hours. 67% of nursing consultations were 5 minutes or less, which is too short to interview, examine and prescribe treatment for the patients and to use the Paediatric 10 Steps. The short consultations of 5 minutes or less did not involve children under 5 years of age. There were only one to two nurses seeing the patients when 79% of patients were seen. This explains why the patients' waiting time was long. After consultations many patients (71%) were able to get their treatment within 30 minutes but 28% had to wait from 30 minutes to 2 hours for their treatment. The small number of nurses giving treatment leads to long waiting times. From the time of entry to exit out of the clinic, only 11% of patients spent 30 minutes or less in the clinic while 51% spent between 1 and 3 hours. The patients' waiting times and the short nursing consultation times are directly related to the insufficient number of nursing officers working in the clinics.

  10. Wait Times for Publicly Funded Outpatient and Community Physiotherapy and Occupational Therapy Services: Implications for the Increasing Number of Persons with Chronic Conditions in Ontario, Canada

    PubMed Central

    Passalent, Laura A.; Landry, Michel D.

    2009-01-01

    ABSTRACT Background: Timely access to publicly funded health services has emerged as a priority policy issue across the continuum of care from hospitals to the home and community sector. The purpose of this study was to examine wait lists and wait times for publicly funded outpatient and community occupational therapy (OT) and physical therapy (PT) services. Methods: A mailed self-administered questionnaire was sent in December 2005 to all publicly funded sites across Ontario that deliver outpatient or community OT or PT services (N = 374). Descriptive statistics were used to describe the study sample and to examine wait lists and wait times by setting and client condition. Results: Overall response rate was 57.2% (n = 214). More than 10,000 people were reported to be waiting for OT or PT services across Ontario. Of these, 16% (n = 1,664) were waiting for OT and 84% (n = 8,842) for PT. Of those waiting for OT, 59% had chronic conditions and half were waiting for home care rehabilitation services. Of those waiting for PT, 73% had chronic conditions and 81% were waiting at hospital outpatient departments. Conclusions: Individuals with chronic conditions experience excessive wait times for outpatient and community OT and PT services in Ontario, particularly if they are waiting for services in hospital outpatient departments. PMID:20145747

  11. Waiting times before dental care under general anesthesia in children with special needs in the Children's Hospital of Casablanca

    PubMed Central

    Badre, Bouchra; Serhier, Zineb; El Arabi, Samira

    2014-01-01

    Introduction Oral diseases may have an impact on quality of children's life. The presence of severe disability requires the use of care under general anesthesia (GA). However, because of the limited number of qualified health personnel, waiting time before intervention can be long. Aim: To evaluate the waiting time before dental care under general anesthesia for children with special needs in Morocco. Methods A retrospective cohort study was carried out in pediatric dentistry unit of the University Hospital of Casablanca. Data were collected from records of patients seen for the first time between 2006 and 2011. The waiting time was defined as the time between the date of the first consultation and intervention date. Results 127 children received dental care under general anesthesia, 57.5% were male and the average age was 9.2 (SD = 3.4). Decay was the most frequent reason for consultation (48%), followed by pain (32%). The average waiting time was 7.6 months (SD = 4.2 months). The average number of acts performed per patient was 13.5. Conclusion Waiting times were long, it is necessary to take measures to reduce delays and improve access to oral health care for this special population. PMID:25328594

  12. Waiting times before dental care under general anesthesia in children with special needs in the Children's Hospital of Casablanca.

    PubMed

    Badre, Bouchra; Serhier, Zineb; El Arabi, Samira

    2014-01-01

    Oral diseases may have an impact on quality of children's life. The presence of severe disability requires the use of care under general anesthesia (GA). However, because of the limited number of qualified health personnel, waiting time before intervention can be long. To evaluate the waiting time before dental care under general anesthesia for children with special needs in Morocco. A retrospective cohort study was carried out in pediatric dentistry unit of the University Hospital of Casablanca. Data were collected from records of patients seen for the first time between 2006 and 2011. The waiting time was defined as the time between the date of the first consultation and intervention date. 127 children received dental care under general anesthesia, 57.5% were male and the average age was 9.2 (SD = 3.4). Decay was the most frequent reason for consultation (48%), followed by pain (32%). The average waiting time was 7.6 months (SD = 4.2 months). The average number of acts performed per patient was 13.5. Waiting times were long, it is necessary to take measures to reduce delays and improve access to oral health care for this special population.

  13. Role of the advanced practice physiotherapist in decreasing surgical wait times.

    PubMed

    Aiken, Alice B; Harrison, Mark M; Hope, John

    2009-01-01

    The role of the advanced practice physiotherapist (APP) in outpatient orthopedic clinics has been present in Ontario for over five years. These professionals have additional duties beyond those of a regular physiotherapist in order to screen patients pre- and post-operatively, triage patients for surgery, prescribe conservative management and monitor patients on an ongoing basis. The purpose of this role is to improve patient access to timely surgical care by reducing wait times for hip and knee replacement surgeries. Several positive outcomes have been reported in the literature. It has been established that an APP can effectively manage over 30% of the patients referred to a surgeon for hip or knee replacement surgery because these patients do not require surgery; rather, they require conservative management.

  14. 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.

  15. Did waiting times really decrease following a service reorganization? Results from a retrospective study in a pediatric rehabilitation program in Québec.

    PubMed

    Camden, Chantal; Swaine, Bonnie; Levasseur, Mélanie

    2013-05-01

    To examine changes in waiting times and types of services received before, during and after a pediatric rehabilitation service reorganization including new admission procedures; To compare waiting time data available in the program's administrative database and children's medical files. Waiting time was defined as the time elapsed between referral and accessing a service provided by any clinician in the program (program waiting time) or by any clinician within a discipline (discipline-specific waiting time). Services were categorized as individual, group treatment, or other. ANOVAs and χ(2) tests were used to examine changes in waiting times and type of services, respectively. Paired T-tests compared the program waiting times from the two databases. Data were collected on 188 children (mean age: 4 years and 1 month). The program and occupational therapy waiting times were shorter following the service reorganization. For two disciplines, the proportion of children receiving individual treatment diminished over time, while group and other types of interventions increased. Program waiting times calculated using the two data sources did not differ significantly but differences in the available data highlighted administrative issues. Service reorganization can decrease waiting times and change the type of services offered over time.

  16. Waiting time to pregnancy and pregnancy outcome among Danish workers in the textile, clothing, and footwear industries.

    PubMed

    Schaumburg, I; Boldsen, J L

    1992-06-01

    The relationship between time from planned to achieved pregnancy and pregnancy outcome has been studied in a group of 18,658 workers in the textile, clothing and footwear industries. Information on pregnancy outcome and delay in conception in the period 1979-84 was collected by self administered questionnaires in 1985. The response rate was 70.3%. During the study period there had been 5,171 live births and 708 spontaneous abortions. Information on delay in conception was collected in broad categories. The data were analysed by means of a newly developed statistical parametric model in order to collect all possible information from the highly grouped data. Median waiting time before a pregnancy which ended in spontaneous abortion was 1.68 times longer than median waiting time before a pregnancy leading to a live birth. There seems to be a correlation between the length of the waiting time and abortion.

  17. Clinical intake of child and adolescent consumers in a rural community mental health center: does wait-time predict attendance?

    PubMed

    Sherman, Marne L; Barnum, David D; Buhman-Wiggs, Adam; Nyberg, Erik

    2009-02-01

    This study examines the clinic variable of wait-time as a predictor of intake attendance in a rural community mental health center (CMHC) serving child and adolescent consumers. Data from 1,317 contacts seeking services for a child or adolescent (ages 2-17) were examined. In logistic regression analysis, wait-time between initial consumer contact and intake appointment was identified as a significant predictor of appointment attendance, even after accounting for consumer variables. The impact of wait-time on the likelihood of intake appointment attendance was not moderated by the urgency of consumer need. Findings elucidate the odds of intake attendance versus non-attendance associated with each day of wait-time and clarify the impact of this clinic variable on pre-intake attrition above and beyond more often studied consumer variables. These results provide information that can assist rural CMHCs in assessing the costs and benefits of steps to reduce wait-time or its impact.

  18. 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.

  19. Optimizing computed tomography simulation wait times in a busy radiation medicine program.

    PubMed

    Roussos, Jerry; Zahedi, Payam; Spence, Tara; Swanson, Lue-Ann; Li-Cheung, Fionna; Cops, Fred; Darcy, Patrick; Chhin, Veng; Moyo, Elen; Warde, Padraig; Foxcroft, Sophie; Liu, Fei-Fei

    An audit was conducted of patient schedules for computed tomography simulation (CT-Sim) scans within the Radiation Medicine Program at the Princess Margaret Cancer Centre to investigate opportunities for improved efficiencies, enhancing process, reducing rescanning rates, and decreasing wait times. A 3-phased approach was undertaken to evaluate the current practice in the CT-Sim facility with a view toward implementing improvements. The first phase involved a review and assessment of the validity of current guidelines and protocols associated with 16 different disease sites. The second phase incorporated the use of a patient record and verification program MOSAIQ to capture the duration of each appointment. The last phase allocated additional time for patient-centered care and staff engagement. The audit revealed that efficiency could be achieved through staff training, updating protocols, and improving process coordination. With the exception of sarcoma, pediatric, and palliative patients who require unique management approaches, the duration for each CT-Sim appointment was successfully shortened for all disease sites by 22% to 33%, corresponding to a reduction of 10 to 15 minutes per appointment. Rescanning rates for patients requiring self-administered preparations before CT-Sim procedures were also significantly reduced by enhancing processes to increase patient compliance. Implementation of procedural changes resulted in an overall net gain of 3060 minutes, equivalent to 102 additional 30-minute CT-Sim appointment slots available for each month. This retrospective evaluation, review, and optimization of CT-Sim guidelines and practices identified opportunities to shorten appointment timeslots, and reduce rescanning rates for CT-Sim procedures, thereby significantly shortening wait times and improving access to service for our patients. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

  20. 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

  1. Lean-driven improvements slash wait times, drive up patient satisfaction scores.

    PubMed

    2012-07-01

    Administrators at LifePoint Hospitals, based in Brentwood, TN, used lean manufacturing techniques to slash wait times by as much as 30 minutes and achieve double-digit increases in patient satisfaction scores in the EDs at three hospitals. In each case, front-line workers took the lead on identifying opportunities for improvement and redesigning the patient-flow process. As a result of the new efficiencies, patient volume is up by about 25% at all three hospitals. At each hospital, the improvement process began with Kaizen, a lean process that involves bringing personnel together to flow-chart the current system, identify problem areas, and redesign the process. Improvement teams found big opportunities for improvement at the front end of the flow process. Key to the approach was having a plan up front to deal with non-compliance. To sustain improvements, administrators gather and disseminate key metrics on a daily basis.

  2. Upper Bounds on Waiting Times for the Thin-Film Equation: The Case of Weak Slippage

    NASA Astrophysics Data System (ADS)

    Fischer, Julian

    2014-03-01

    We derive upper bounds on the waiting time of solutions to the thin-film equation in the regime of weak slippage . In particular, we give sufficient conditions on the initial data for instantaneous forward motion of the free boundary. For , our estimates are sharp, for n = 2, they are sharp up to a logarithmic correction term. Note that the case n = 2 corresponds—with a grain of salt—to the assumption of the Navier slip condition at the fluid-solid interface. We also obtain results in the regime of strong slippage ; however, in this regime we expect them not to be optimal. Our method is based on weighted backward entropy estimates, Hardy's inequality and singular weight functions; we deduce a differential inequality which would enforce blowup of the weighted entropy if the contact line were to remain stationary for too long.

  3. Wait Time Management Strategies for Scheduled Care: What Makes Them Succeed?

    PubMed Central

    Pomey, Marie-Pascale; Forest, Pierre-Gerlier; Sanmartin, Claudia; De Coster, Carolyn; Drew, Madeleine

    2010-01-01

    Objectives: To assess experts' perceptions of the contextual and local factors that promote or inhibit the implementation of waiting time management strategies (WTMS) in Canadian healthcare organizations. Methods: We conducted 16 semi-structured interviews and one focus group with individuals involved in WTMS at the federal, provincial or organizational level. Results: The most frequently cited local factor was physicians' participation. Physicians' leadership made the greatest difference in bringing resistant physicians on board. To be effective, however, local leadership had to be supported by senior management. Alignment of financial incentives between the contextual and local levels was also frequently cited, and interviewees stressed the importance of tools used to design, monitor, evaluate and prioritize WTMS. Conclusions: Finding the right balance between supportive resources and tools and an effective management system is a tough challenge. But achieving this balance will help reconcile contradictions between top-down and bottom-up WTMS. PMID:21286269

  4. Anxiety and fear in patients with short waiting times before coronary artery bypass surgery--a qualitative study.

    PubMed

    Feuchtinger, Johanna; Burbaum, Christina; Heilmann, Claudia; Imbery, Claudia; Siepe, Matthias; Stotz, Ulrike; Fritzsche, Kurt; Beyersdorf, Friedhelm

    2014-07-01

    To obtain qualitative information on fears and anxieties of coronary artery bypass grafting patients with short waiting periods (up to a maximum of four weeks) before surgery. Coronary artery bypass grafting is a standard procedure in cardiac surgery. However, many patients suffer significant anxiety and fear before the operation. Preoperative anxiety and fear correlate with adverse outcomes, but there is a lack of data on the emotional stressors for patients with short waiting periods as applicable in Germany. This knowledge would be a prerequisite for the development of in-hospital interventions to reduce patients' anxieties and fears. An exploratory study was chosen to learn about patients' anxieties and fears. The day before coronary artery bypass grafting, 24 patients were examined with respect to their emotional experience using semi-structured interviews. The results were categorised by inductive content analysis. The overall waiting time for coronary artery bypass grafting was 6 ± 6 days. According to the analysis, the patients' statements were grouped in 'fears', 'negation of fears' and 'other emotional and physical conditions'. The interviews could cover all categories simultaneously. Eighteen patients mentioned fears, and most of them referred to specific issues. However, 16 of the 18 patients also named nonspecific fears and uncertainties. Fifteen patients negated fear. Twenty-three patients described their emotions and/or somatic conditions. Patients with short waiting periods before coronary artery bypass grafting experience specific as well as nonspecific fears on the day before surgery. In contrast to patients with long waiting (longer than four weeks), uncertainty and frustration about waiting time and feelings of disability are no concerns. The detailed insight into the emotional experiences of patients with a short waiting time before coronary artery bypass grafting surgery is a basis for targeted anxiety-reducing interventions. © 2013 John

  5. Models for Flare Statistics and the Waiting-time Distribution of Solar Flare Hard X-ray Bursts

    NASA Astrophysics Data System (ADS)

    Wheatland, M. S.; Edney, S. D.

    1999-12-01

    In a previous study (Wheatland, Sturrock, McTiernan 1998), a waiting-time distribution was constructed for solar flare hard X-ray bursts observed by the ICE/ISEE-3 spacecraft. A comparison of the observed distribution with that of a time-dependent Poisson process indicated an overabundance of short waiting times (10~s -- 10~min), implying that the hard X-ray bursts are not independent events. Models for flare statistics assume or predict that flares are independent events -- in particular the avalanche model makes this specific prediction. The results of the previous study may be reconciled with the avalanche picture if individual flares produce several distinct bursts of hard X-ray emission. A detailed comparison of the avalanche model and the ICE/ISEE-3 waiting-time distribution is presented here.

  6. Wait times for breast cancer surgery: effect of magnetic resonance imaging and preoperative investigations on the diagnostic pathway.

    PubMed

    Nessim, Carolyn; Winocour, Julian; Holloway, Diana P M; Saskin, Refik; Holloway, Claire M B

    2015-03-01

    Women with breast cancer often require an extensive diagnostic work-up. We sought to determine the overall wait time, from the patient's perspective, from identification of an imaging abnormality to definitive treatment. The objective was to identify which factors contribute to overall wait time in women with breast cancer. A retrospective chart review in a tertiary care center was performed to identify all women who had breast surgery for invasive carcinoma and ductal carcinoma in situ. We recorded the dates of first imaging abnormality, first biopsy, subsequent imaging and biopsy, first consultation with any physician at the cancer center, first surgical consultation, and date of surgery. Clinical data that might influence these dates were then extracted. Wait times were calculated and factors associated with wait times were described. Eligible consecutive women with a cancer diagnosis (n = 264) were identified. The median time between first imaging abnormality and definitive surgery was 79 days. The median time from first surgical consultation to surgery was significantly longer in women who underwent magnetic resonance imaging and in women who underwent initial imaging outside of our tertiary care center (P < .05). On multivariable analysis, the modifiable factors associated with prolonged wait times included number of preoperative clinic visits, number of visits to radiology, and initial imaging outside of our center (P < .05). Extensive diagnostic work-up is an important factor that affects the time to definitive surgery. A more integrated approach using a rapid diagnostic clinic for tissue diagnosis initially, followed by facilitated preoperative evaluation, may potentially decrease wait times in breast evaluation. Copyright © 2015 by American Society of Clinical Oncology.

  7. Waiting times for diagnosis and treatment of head and neck cancer in Denmark in 2010 compared to 1992 and 2002.

    PubMed

    Lyhne, N M; Christensen, A; Alanin, M C; Bruun, M T; Jung, T H; Bruhn, M A; Jespersen, J B B; Kristensen, C A; Andersen, E; Godballe, C; Buchwald, C; Bundgaard, T; Johansen, J; Lambertsen, K; Primdahl, H; Toustrup, K; Sørensen, J A; Overgaard, J; Grau, C

    2013-05-01

    Significant tumour progression was observed during waiting time for treatment of head and neck cancer. To reduce waiting times, a Danish national policy of fast track accelerated clinical pathways was introduced in 2007. This study describes changes in waiting time and the potential influence of fast track by comparing waiting times in 2010 to 2002 and 1992. Charts of all new patients diagnosed with squamous cell carcinoma of the oral cavity, pharynx and larynx at the five Danish head and neck oncology centres from January to April 2010 (n=253) were reviewed and compared to similar data from 2002 (n=211) and 1992 (n=168). The median time to diagnosis was 13 days (2010) versus 17 days (2002; p<0.001) and 20 days (1992; p<0.001). Median days from diagnosis to treatment start were 25 (2010) versus 47 (2002; p<0.001) and 31 (1992; p<0.001). Total pre-treatment time was median 41 days in 2010 versus 69 days (2002) (p<0.001) and 50 days (1992; p<0.001). Significantly more diagnostic imaging was done in 2010 compared to 2002 and 1992. When compared to current fast track standards the adherence to diagnosis improved slightly from 47% (1992) to 51% (2002) and 64% (2010); waiting time for radiotherapy was within standards for 7%, 1% and 22% of cases, respectively; waiting time for surgery was within standards for 17%, 22% and 48%, respectively. The study showed a significant reduction in delay of diagnosis and treatment of head and neck cancer in 2010, but still less than half of all patients start treatment within the current standards. Copyright © 2012 Elsevier Ltd. All rights reserved.

  8. Arrival time pattern and waiting time distribution of patients in the emergency outpatient department of a tertiary level health care institution of North India

    PubMed Central

    Tiwari, Yogesh; Goel, Sonu; Singh, Amarjeet

    2014-01-01

    Background: Emergency Department (ED) of tertiary health care institute in India is mostly overcrowded, over utilized and inappropriately staffed. The challenges of overcrowded EDs and ill-managed patient flow and admission processes result in excessively long waits for patients. Aim: The objective of the present study was to analyze the patient flow system by assessing the arrival and waiting time distribution of patients in an Emergency out Patient Department (EOPD). Materials and Methods: This short cross-sectional descriptive study was conducted in the EOPD of a Tertiary level health care Institution in North India in the month of May, 2011. The data was obtained from 591 patients, who were present in the EOPD during the month of May, 2011. The waiting time, inter arrival time between two consecutive patients were calculated in addition to the daily census data (discharge rate, admission rate and transfer out rates etc.) of the emergency. Results: Arrival time pattern of patients in the EOPD was highly stochastic with the peak arrival hours to be 9.00-12.00 h in which around 26.3% patients arrived in the EOPD. The primary waiting areas of patients included patients under observation (29.6%); waiting for routine diagnostic tests (16.4%) and waiting for discharge (14.6%). Around 71% patients were waiting due to reasons within emergency complex. Conclusion: The patient flow of the ED could only be addressed by multifaceted, multidisciplinary and hospital wide approach. PMID:25114424

  9. Analyzing the waiting time pattern for non-critical patients in the emergency department using six sigma approach

    NASA Astrophysics Data System (ADS)

    Majid, Noriza; Mohd Suradi, Nur Riza; Ahmad Sabri, Safura

    2013-04-01

    This study was conducted to examine the waiting time of non-critical patients in the Emergency Department (ED) of Universiti Kebangsaan Malaysia Medical Centre (UKMMC) using the approach of six sigma (6σ). The define phase is completed by obtaining customers' critical to quality in UKMMC using survey. In measure phase, data on patients to the ED of UKMMC in May 2009 were gathered. Subsequently, analysis phase is performed using cause-and-effect diagram to identify root causes of the problems. Finally, improvements are proposed based on the identified problems. Results show that waiting time is critical to quality for health services in the ED.

  10. Prediction problem for target events based on the inter-event waiting time

    NASA Astrophysics Data System (ADS)

    Shapoval, A.

    2010-11-01

    In this paper we address the problem of forecasting the target events of a time series given the distribution ξ of time gaps between target events. Strong earthquakes and stock market crashes are the two types of such events that we are focusing on. In the series of earthquakes, as McCann et al. show [W.R. Mc Cann, S.P. Nishenko, L.R. Sykes, J. Krause, Seismic gaps and plate tectonics: seismic potential for major boundaries, Pure and Applied Geophysics 117 (1979) 1082-1147], there are well-defined gaps (called seismic gaps) between strong earthquakes. On the other hand, usually there are no regular gaps in the series of stock market crashes [M. Raberto, E. Scalas, F. Mainardi, Waiting-times and returns in high-frequency financial data: an empirical study, Physica A 314 (2002) 749-755]. For the case of seismic gaps, we analytically derive an upper bound of prediction efficiency given the coefficient of variation of the distribution ξ. For the case of stock market crashes, we develop an algorithm that predicts the next crash within a certain time interval after the previous one. We show that this algorithm outperforms random prediction. The efficiency of our algorithm sets up a lower bound of efficiency for effective prediction of stock market crashes.

  11. Comparison of Emergency Department Wait Times in Adults with Sickle Cell Disease Versus Other Painful Etiologies.

    PubMed

    Pulte, Dianne; Lovett, Paris B; Axelrod, David; Crawford, Albert; McAna, John; Powell, Rhea

    2016-09-01

    Sickle cell disease is characterized by intermittent painful crises often requiring treatment in the emergency department (ED). Past examinations of time-to-provider (TTP) in the ED for patients with sickle cell disease demonstrated that these patients may have longer TTP than other patients. Here, we examine TTP for patients presenting for emergency care at a single institution, comparing patients with sickle cell disease to both the general population and to those with other painful conditions, with examination of both institutional and patient factors that might affect wait times. Our data demonstrated that at our institution patients with sickle cell disease have a slightly longer average TTP compared to the general ED population (+16 min.) and to patients with other painful conditions (+4 min.) However, when confounding factors were considered, there was no longer a significant difference between TTP of patients with sickle cell disease and the general population nor between patients with sickle cell disease and those with other painful conditions. Multivariate analyses demonstrated that gender, race, age, high utilizer status, fast track use, time of presentation, acuity and insurance type, were all independently associated with TTP, with acuity, time of presentation and use of fast track having the greatest influence. We concluded that the longer TTP observed in patients with sickle cell disease can at least partially be explained by institutional factors such as the use of fast track protocols. Further work to reduce TTP for sickle cell disease and other patients is needed to optimize care.

  12. Wait times for breast surgical operations, 2003-2011: a report from the National Cancer Data Base.

    PubMed

    Liederbach, Erik; Sisco, Mark; Wang, Chihsiung; Pesce, Catherine; Sharpe, Susan; Winchester, David J; Yao, Katharine

    2015-03-01

    Few large-scale multicenter studies have examined wait times for breast surgery and no benchmarks exist. Using the National Cancer Data Base, we analyzed time from diagnosis to first surgery for 819,175 non-neoadjuvant AJCC stage 0-III breast cancer patients treated from 2003 to 2011. Chi-square tests and logistic regression models were used to examine factors associated with delays to surgery and adjuvant chemotherapy. Seventy percent of patients underwent an initial lumpectomy (LP), 22% a mastectomy (MA), and 8% a mastectomy with reconstruction (MR). The median time from diagnosis to first surgery significantly increased by approximately 1 week for all three procedures over the study period. In a multivariate analysis, the following variables were independent predictors of a longer wait time to first surgery: increasing age, black or Hispanic race, Medicaid or no insurance, low-education communities and metropolitan areas, increasing comorbidities, stage 0 and grade 1 disease, academic/research facilities, high-volume facilities, and facilities located in the New England, Mid-Atlantic, and Pacific regions. In 2010-2011, patients who waited >30 days for surgery were 1.36 times more likely (OR = 1.36, 95% CI 1.30-1.43) to experience a delay to adjuvant chemotherapy >60 days compared with patients who were surgically treated within 30 days of diagnosis. Facility and socioeconomic factors are most strongly associated with longer wait times for breast operations, and delays to surgery are associated with delays to adjuvant chemotherapy initiation.

  13. Wait Times for Physical and Occupational Therapy in the Public System for People with Arthritis in Quebec

    PubMed Central

    Bernatsky, Sasha; Raymond, Marie-Hélène; Feldman, Debbie Ehrmann

    2013-01-01

    ABSTRACT Purpose: 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. Method: 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. Results: 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. Conclusions: 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. PMID:24403693

  14. 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.

  15. A Physiotherapy Triage Service for Orthopaedic Surgery: An Effective Strategy for Reducing Wait Times

    PubMed Central

    McCormack, Robert G.; Hunt, Michael A.; Brooks-Hill, Alexandra

    2013-01-01

    ABSTRACT Purpose: To investigate the effectiveness of a physiotherapy triage service for orthopaedic surgery referrals from primary-care physicians. Methods: A prospective, observational design was used with patients referred to an orthopaedic surgeon based out of two small urban centres in British Columbia. The level of agreement between the physiotherapist and surgeon was determined using a weighted kappa statistic (κw) with 95% CI. A patient satisfaction questionnaire was administered, and the surgical conversion rate (SCR) was calculated to assess the level of appropriate referrals. Results: The analysis found substantial agreement (κw=0.77; 95% CI, 0.60–0.94) between surgeon and physiotherapist for surgical management decisions. All patients reported being “satisfied” or “very satisfied” with the overall care they received from the physiotherapist. The SCR of patients referred by the physiotherapist to the surgeon was 91%, versus 22% among patients referred by a general practitioner or emergency physician. Conclusion: More than three-fourths of patients referred by primary-care physicians did not need to see a surgeon and were able to be managed by an experienced orthopaedic physiotherapist. This triage model could have considerable impact on orthopaedic wait times in Canada by minimizing unnecessary referrals; the model could also promote timely and conservative management of non-surgical conditions by physiotherapists. PMID:24396164

  16. Scaling in Omori law Waiting Time Distributions and Implications for Earthquakes as a Self-Organized Critical Phenomena

    NASA Astrophysics Data System (ADS)

    Jonsdottir, K.; Lindman, M.; Roberts, R.; Lund, B.

    2006-12-01

    Observed power law distributions of earthquake magnitudes, locations and aftershock waiting time distributions are often taken as a support for earthquakes being a phenomena of self-organized criticality (SOC), implying that earthquakes cannot be predicted. Here we study the scaling behaviour of waiting time distributions for aftershock sequences obeying the Omori law (dn/dt=K/(c+t)^p) in order to investigate the implications for the SOC hypothesis. We show that the Omori waiting time distribution is constant in the range [0, (2c)^p/K], exhibit power law decay with exponent 2-1/p in the range [(2c)^p/K, (c+T)^p/K] and falls off rapidly for waiting times larger than (c+T)^p/K, where K, c and p are the Omori law parameters and T the length of the aftershock sequence. The bounded range of the power law regime implies that we cannot immediately regard empirical Omori waiting time distributions as evidence of SOC. For a given value of K and p the scaling of the upper bound is essentially an effect of a finite time series and does not contradict SOC. The scaling of the lower bound controlled by c, however, implies that a non-zero c cannot support SOC as the power law regime is bounded at short waiting times. It is therefore important to deduce whether c, reflecting a roughly constant rate in the beginning of aftershock sequences, only represents incomplete detection of earthquakes, or, is a true description of the physics of the aftershock process. For a given aftershock sequence, we can estimate the number of missed events if the true value of c is zero. Removing the number of missed events from a simulation of the sequence with c=0 results in a sequence deviating significantly from that described by a non-zero c. We illustrate this using simulations and investigations of real aftershock sequences. We can show, for the aftershock sequences we have studied, that it is highly probable that the roughly constant rate during the initial c seconds do not represent incomplete

  17. COMPARATIVE STUDY ON LIVER TRANSPLANTATION WITH AND WITHOUT HEPATOCELLULAR CARCINOMA WITH CIRRHOSIS: ANALYSIS OF MELD, WAITING TIME AND SURVIVAL

    PubMed Central

    de FREITAS, Alexandre Coutinho Teixeira; SHIGUIHARA, Rafael Shinmi; MONTEIRO, Ruan Teles; PAZETO, Thiago Linck; COELHO, Júlio Cezar Uili

    2016-01-01

    Background : Liver transplantation is the usual treatment for hepatocellular carcinoma. Aim: To analyze the MELD score, waiting time and three month and one year survival for liver transplantation in cirrhotic patients affected by hepatocellular carcinoma or not. Methods : This was a retrospective, observational and analytical study of 93 patients submitted to liver transplantation. Results : There were 28 hepatocellular carcinoma and 65 non-hepatocellular carcinoma patients with no differences related to age and sex distribution. The main causes of cirrhosis on hepatocellular carcinoma were hepatitis C virus (57.1%) and hepatitis B virus (28.5%), more frequent than non-hepatocellular carcinoma patients, which presented 27.7% and 4.6% respectively. The physiological and exception MELD score on hepatocellular carcinoma were 11.9 and 22.3 points. On non-hepatocellular carcinoma, it was 19.4 points, higher than the physiological MELD and lower than the exception MELD on hepatocellular carcinoma. The waiting time for transplantation was 96.2 days for neoplasia, shorter than the waiting time for non-neoplasia patients, which was 165.6 days. Three month and one year survival were 85.7% and 78.6% for neoplasia patients, similar to non-neoplasia, which were 77% and 75.4%. Conclusion: Hepatocellular carcinoma patients presented lower physiological MELD score, higher exception MELD score and shorter waiting time for transplantation when compared to non-hepatocellular carcinoma patients. Three month and one year survival were the same between the groups. PMID:27120734

  18. Waiting cycle times and generalized Haldane equality in the steady-state cycle kinetics of single enzymes.

    PubMed

    Ge, Hao

    2008-01-10

    Enzyme kinetics are cyclic. A more realistic reversible three-step mechanism of the Michaelis-Menten kinetics is investigated in detail, and three kinds of waiting cycle times T, T+, T- are defined. It is shown that the mean waiting cycle times T, T+, and T- are the reciprocal of the steady-state cycle flux Jss, the forward steady-state cycle flux Jss+ and the backward steady-state cycle flux Jss, respectively. We also show that the distribution of T+ conditioned on T+waiting cycle time of T+ conditioned on T+waiting cycle times. Furthermore, we extend the same results to the n-step cycle, and finally, experimental and theoretically based evidence are also included.

  19. Attrition after Intake at a University Counseling Center: Relationship among Client Race, Problem Type, and Time on a Waiting List

    ERIC Educational Resources Information Center

    Levy, Jacob J.; Thompson-Leonardelli, Kenya; Smith, Nathan Grant; Coleman, M. Nicole

    2005-01-01

    The present study examined the relationship between attrition after intake and the length of time that clients spent on a waiting list by client race and problem type. Participants were 1,461 clients who completed an initial intake evaluation at a large, Mid-Atlantic counseling center over a 6-year period. Fullfactorial hierarchical logistic…

  20. Using a Time Timer[TM] to Increase Appropriate Waiting Behavior in a Child with Developmental Disabilities

    ERIC Educational Resources Information Center

    Grey, Ian; Healy, Olive; Leader, Geraldine; Hayes, Deirdre

    2009-01-01

    This study aimed to examine the use of a predictive stimulus (Time Timer[TM]) and delayed reinforcement to increase appropriate waiting behavior in a child with developmental disabilities and problem behavior maintained by access to tangible items and activities. The study employed a changing criterion design across settings to gradually increase…

  1. Using a Time Timer[TM] to Increase Appropriate Waiting Behavior in a Child with Developmental Disabilities

    ERIC Educational Resources Information Center

    Grey, Ian; Healy, Olive; Leader, Geraldine; Hayes, Deirdre

    2009-01-01

    This study aimed to examine the use of a predictive stimulus (Time Timer[TM]) and delayed reinforcement to increase appropriate waiting behavior in a child with developmental disabilities and problem behavior maintained by access to tangible items and activities. The study employed a changing criterion design across settings to gradually increase…

  2. Portuguese Society of Cardiothoracic and Vascular Surgery/Portuguese Society of Cardiology recommendations for waiting times for cardiac surgery.

    PubMed

    Neves, José; Pereira, Hélder; Sousa Uva, Miguel; Gavina, Cristina; Leite Moreira, Adelino; Loureiro, Maria José

    2015-11-01

    Appointed jointly by the Portuguese Society of Cardiothoracic and Vascular Surgery (SPCCTV) and the Portuguese Society of Cardiology (SPC), the Working Group on Waiting Times for Cardiac Surgery was established with the aim of developing practical recommendations for clinically acceptable waiting times for the three critical phases of the care of adults with heart disease who require surgery or other cardiological intervention: cardiology appointments; the diagnostic process; and invasive treatment. Cardiac surgery has specific characteristics that are not comparable to other surgical specialties. It is important to reduce maximum waiting times and to increase the efficacy of systems for patient monitoring and tracking. The information in this document is mainly based on available clinical information. The methodology used to establish the criteria was based on studies on the natural history of heart disease, clinical studies comparing medical treatment with intervention, retrospective and prospective analyses of patients on waiting lists, and the opinions of experts and working groups. Following the first step, represented by publication of this document, the SPCCTV and SPC, as the bodies best suited to oversee this process, are committed to working together to define operational strategies that will reconcile the clinical evidence with the actual situation and with available resources. Copyright © 2015 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  3. Improving Customer Waiting Time at a DMV Center Using Discrete-Event Simulation

    NASA Technical Reports Server (NTRS)

    Arnaout, Georges M.; Bowling, Shannon

    2010-01-01

    Virginia's Department of Motor Vehicles (DMV) serves a customer base of approximately 5.6 million licensed drivers and ID card holders and 7 million registered vehicle owners. DMV has more daily face-to-face contact with Virginia's citizens than any other state agency [1]. The DMV faces a major difficulty in keeping up with the excessively large customers' arrival rate. The consequences are queues building up, stretching out to the entrance doors (and sometimes even outside) and customers complaining. While the DMV state employees are trying to serve at their fastest pace, the remarkably large queues indicate that there is a serious problem that the DMV faces in its services, which must be dealt with rapidly. Simulation is considered as one of the best tools for evaluating and improving complex systems. In this paper, we use it to model one of the DMV centers located in Norfolk, VA. The simulation model is modeled in Arena 10.0 from Rockwell systems. The data used is collected from experts of the DMV Virginia headquarter located in Richmond. The model created was verified and validated. The intent of this study is to identify key problems causing the delays at the DMV centers and suggest possible solutions to minimize the customers' waiting time. In addition, two tentative hypotheses aiming to improve the model's design are tested and validated.

  4. Utilizing lean tools to improve value and reduce outpatient wait times in an Indian hospital.

    PubMed

    Miller, Richard; Chalapati, Nirisha

    2015-01-01

    This paper aims to demonstrate how lean tools were applied to some unique issues of providing healthcare in a developing country where many patients face challenges not found in developed countries. The challenges provide insight into how lean tools can be utilized to provide similar results across the world. This paper is based on a qualitative case study carried out by a master's student implementing lean at a hospital in India. This paper finds that lean tools such as value-stream mapping and root cause analysis can lead to dramatic reductions in waste and improvements in productivity. The problems of the majority of patients paying for their own healthcare and lacking transportation created scheduling problems that required patients to receive their diagnosis and pay for treatment within a single day. Many additional wastes were identified that were significantly impacting the hospital's ability to provide care. As a result of this project, average outpatient wait times were reduced from 1 hour to 15 minutes along with a significant increase in labor productivity. The results demonstrate how lean tools can increase value to the patients. It also provides are framework that can be utilized for healthcare providers in developed and developing countries to analyze their value streams to reduce waste. This paper is one of the first to address the unique issues of implementing lean to a healthcare setting in a developing country.

  5. System-wide flow initiative slashes patient wait times in the ED, boosts volume by 25%.

    PubMed

    2012-06-01

    Emergency department administrators at Cambridge Health Alliance, a three-hospital health care organization in Cambridge, MA, implemented a system-wide flow initiative that has reduced the average length-of-stay for rapid assessment patients from three hours to just over an hour. Under the approach, patients are immediately placed in a room, and providers and registration staff come to the patients rather than the traditional approach of having patients constantly move from place to place with wait times in between each interval of care. The approach relies on "patient partners," non-clinical personnel who are trained in customer service, to greet and quick-register patients who present to the ED for care. Administrators say 97% of patients who present to the ED are in a room within five minutes, and over 90% of them are seen by a provider within 14 minutes. The leave-without-being-seen (LWBS) rate has been slashed from 4.5% to 0.6%. System-wide ED volume, which was dropping before the new approach was implemented, has gone from 77,000 patients per year to nearly 100,000 patients per year.

  6. Dedicated Pediatricians in Emergency Department: Shorter Waiting Times and Lower Costs

    PubMed Central

    Melo, Manuel Rocha; Ferreira-Magalhães, Manuel; Flor-Lima, Filipa; Rodrigues, Mariana; Severo, Milton; Almeida-Santos, Luis; Caldas-Afonso, Alberto; Barros, Pedro Pita; Ferreira, António

    2016-01-01

    Background Dedicated pediatricians in emergency departments (EDs) may be beneficial, though no previous studies have assessed the related costs and benefits/harms. We aimed to evaluate the net benefits and costs of dedicated emergency pediatricians in a pediatric ED. Methods Cost-consequences analysis of visits to a pediatric ED of a tertiary hospital. Two pediatric ED Medical Teams (MT) were compared: MT-A (May–September 2012), with general pediatrics physicians only; and MT-B (May–September 2013), with emergency dedicated pediatricians. The main outcomes analyzed were relevant clinical outcomes, patient throughput time and costs. Results We included 8,694 children in MT-A and 9,417 in MT-B. Medication use in the ED increased from 42.3% of the children in MT-A to 49.6% in MT-B; diagnostic tests decreased from 24.2% in MT-A to 14.3% in MT-B. Hospitalization increased from 1.3% in MT-A to 3.0% in MT-B; however, there was no significant difference in diagnosis-related group relative weight of hospitalized children in MT-A and MT-B (MT-A, 0.979; MT-B, 1.075). No differences were observed in ED readmissions or in patients leaving without being seen by a physician. The patient throughput time was significantly shorter in MT-B, with faster times to first medical observation. Within the cost domains analyzed, the total expenditures per children observed in the ED were 16% lower in MT-B: 37.87 euros in MT-A; 31.97 euros in MT-B. Conclusion The presence of dedicated emergency pediatricians in a pediatric ED was associated with significantly lower waiting times in the ED, reduced costs, and similar clinical outcomes. PMID:27564093

  7. Dedicated Pediatricians in Emergency Department: Shorter Waiting Times and Lower Costs.

    PubMed

    Melo, Manuel Rocha; Ferreira-Magalhães, Manuel; Flor-Lima, Filipa; Rodrigues, Mariana; Severo, Milton; Almeida-Santos, Luis; Caldas-Afonso, Alberto; Barros, Pedro Pita; Ferreira, António

    2016-01-01

    Dedicated pediatricians in emergency departments (EDs) may be beneficial, though no previous studies have assessed the related costs and benefits/harms. We aimed to evaluate the net benefits and costs of dedicated emergency pediatricians in a pediatric ED. Cost-consequences analysis of visits to a pediatric ED of a tertiary hospital. Two pediatric ED Medical Teams (MT) were compared: MT-A (May-September 2012), with general pediatrics physicians only; and MT-B (May-September 2013), with emergency dedicated pediatricians. The main outcomes analyzed were relevant clinical outcomes, patient throughput time and costs. We included 8,694 children in MT-A and 9,417 in MT-B. Medication use in the ED increased from 42.3% of the children in MT-A to 49.6% in MT-B; diagnostic tests decreased from 24.2% in MT-A to 14.3% in MT-B. Hospitalization increased from 1.3% in MT-A to 3.0% in MT-B; however, there was no significant difference in diagnosis-related group relative weight of hospitalized children in MT-A and MT-B (MT-A, 0.979; MT-B, 1.075). No differences were observed in ED readmissions or in patients leaving without being seen by a physician. The patient throughput time was significantly shorter in MT-B, with faster times to first medical observation. Within the cost domains analyzed, the total expenditures per children observed in the ED were 16% lower in MT-B: 37.87 euros in MT-A; 31.97 euros in MT-B. The presence of dedicated emergency pediatricians in a pediatric ED was associated with significantly lower waiting times in the ED, reduced costs, and similar clinical outcomes.

  8. Patients' Perspectives on Wait Times and the Referral-Consultation Process While Attending a Tertiary Diabetes and Endocrinology Centre: Is Econsultation an Acceptable Option?

    PubMed

    Keely, Erin; Traczyk, Lara; Liddy, Clare

    2015-08-01

    The goal of this study was to establish patients' perspectives on the acceptability of wait times, the impact of wait times on their health and the possibility of using electronic consultations (eConsultations) to avoid visits to specialists. A 2-stage patient survey (self-administered and with a follow-up telephone call) and a chart audit was conducted on a sequential sample of patients attending their initial consultations in a tertiary diabetes and endocrinology centre. Patients' perspectives on actual and ideal wait times, the impact of waiting for access, the effectiveness of the referral-consultation process and attitudes toward eConsultations as an alternative to traditional referral-consultations were collected. The study involved 101 patients (22% for diabetes, 78% for endocrinologic conditions), whose comments were collated and categorized. Of the 101 patients who completed the survey, 61 also completed telephone interviews. The average wait time was 19 weeks; the median 10 weeks. More than 30% of patients waited longer than 6 months and 6% waited longer than 1 year. Overall, 90% of patients thought that the maximum wait time should be less than 3 months. While waiting, 58% of patients worried about a serious undiagnosed disease, 30% found their symptoms had affected their daily activities and 24% had to miss work or school due to symptoms. Of the patients, 46% considered eConsultation a viable alternative to face-to-face visits. Excessive wait times for specialist care remain barriers and have negative impacts on patients. Wait times significantly exceeded times patients considered acceptable. eConsultations provide acceptable alternatives for many patients, and they reduced the number of patients requiring traditional consultations. Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

  9. Quality management: reduction of waiting time and efficiency enhancement in an ENT-university outpatients' department.

    PubMed

    Helbig, Matthias; Helbig, Silke; Kahla-Witzsch, Heike A; May, Angelika

    2009-01-31

    Public health systems are confronted with constantly rising costs. Furthermore, diagnostic as well as treatment services become more and more specialized. These are the reasons for an interdisciplinary project on the one hand aiming at simplification of planning and scheduling patient appointments, on the other hand at fulfilling all requirements of efficiency and treatment quality. As to understanding procedure and problem solving activities, the responsible project group strictly proceeded with four methodical steps: actual state analysis, analysis of causes, correcting measures, and examination of effectiveness. Various methods of quality management, as for instance opinion polls, data collections, and several procedures of problem identification as well as of solution proposals were applied. All activities were realized according to the requirements of the clinic's ISO 9001:2000 certified quality management system. The development of this project is described step by step from planning phase to inauguration into the daily routine of the clinic and subsequent control of effectiveness. Five significant problem fields could be identified. After an analysis of causes the major remedial measures were: installation of a patient telephone hotline, standardization of appointment arrangements for all patients, modification of the appointments book considering the reason for coming in planning defined working periods for certain symptoms and treatments, improvement of telephonic counselling, and transition to flexible time planning by daily updates of the appointments book. After implementation of these changes into the clinic's routine success could be demonstrated by significantly reduced waiting times and resulting increased patient satisfaction. Systematic scrutiny of the existing organizational structures of the outpatients' department of our clinic by means of actual state analysis and analysis of causes revealed the necessity of improvement. According to rules of

  10. 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

  11. Estimating the time needed for induction of anaesthesia and its importance in balancing anaesthetists' and surgeons' waiting times around the start of surgery.

    PubMed

    Koenig, T; Neumann, C; Ocker, T; Kramer, S; Spies, C; Schuster, M

    2011-07-01

    After the anaesthetist has induced anaesthesia, it is desirable that the surgeon is present and ready to start surgery, otherwise the team needs to wait for the surgeon. From another perspective, however, the surgeon does not necessarily wish to be present from the start of induction, since that process can take a variable time and the surgeon might be otherwise occupied in productive activity rather than waiting for the patient to be ready. Waiting times in the morning can therefore be a source of constant friction between anaesthetists and surgeons. In this prospective study we used the data from 718 first cases of the day, during a 4-week study period at two university hospitals, to develop a simple spreadsheet-based method to analyse the interaction of anaesthesia and surgical start time, anaesthesia technique and the probability of waiting time for anaesthetist or surgeon, respectively. This method can be used to determine the best surgical or anaesthesia start time for each case, so that the waiting time for anaesthetists and surgeons can be minimised. © 2011 The Authors. Anaesthesia © 2011 The Association of Anaesthetists of Great Britain and Ireland.

  12. Diffusion entropy and waiting time statistics of hard-x-ray solar flares.

    PubMed

    Grigolini, Paolo; Leddon, Deborah; Scafetta, Nicola

    2002-04-01

    We show at work a technique of scaling detection based on evaluating the Shannon entropy of the diffusion process obtained by converting the time series under study into trajectories. This method, called diffusion entropy, affords information that cannot be derived from the direct evaluation of waiting times. We apply this method to the analysis of the distribution of time distance tau between two nearest-neighbor solar flares. This traditional part of the analysis is based on the direct evaluation of the distribution function psi(tau), or of the probability Psi(tau), that no time distance smaller than a given tau is found. We adopt the paradigm of the inverse power-law behavior, and we focus on the determination of the inverse power index mu, without ruling out different asymptotic properties that might be revealed, at larger scales, with the help of richer statistics. We then use the DE method, with three different walking rules, and we focus on the regime of transition to scaling. This regime of transition and the value of the scaling parameter itself, delta, depends on the walking rule adopted, a property of interest to shed light on the slow process of transition from dynamics to thermodynamics often occurring under anomalous statistical conditions. With the first two rules the transition regime occurs throughout a large time interval, and the information contained in the time series is transmitted, to a great extent, to it, as well as to the scaling regime. By using the third rule, on the contrary, the same information is essentially conveyed to the scaling regime, which, in fact, emerges very quickly after a fast transition process. We show that the DE method not only causes to emerge the long-range correlation with a given mu < 3, and so a basin of attraction different from the ordinary Gaussian one, but it also reveals the presence of memory effects induced by the time dependence of the solar flare rate. When this memory is annihilated by shuffling, the

  13. Effect of different waiting time processes with memory to anomalous diffusion dynamics in an external force fields

    NASA Astrophysics Data System (ADS)

    Ren, Fu-Yao; Wang, Jun; Lv, Long-Jin; Pan, Hua; Qiu, Wei-Yuan

    2015-01-01

    In this paper, we study the anomalous diffusion of a particle in an external force field whose motion is governed by nonrenewal continuous time random walks with memory. In our models, the waiting time involves Riemann-Liouville fractional derivative or Riemann-Liouville fractional integral. We obtain the systematic observation on the mean squared displacement, the Fokker-Planck-type dynamic equations and their stationary solutions. These processes obey a generalized Einstein-Stokes-Smoluchowski relation, and observe the second Einstein relation. The asymptotic behavior of waiting times and subordinations are of stretched Gaussian distributions. We also discuss the time averaged in the case of an external force field, and show that the process exhibits aging and ergodicity breaking.

  14. Patients' satisfaction and wait times at Guelph General Hospital Emergency Department before and after implementation of a process improvement project.

    PubMed

    Preyde, Michèle; Crawford, Kim; Mullins, Laura

    2012-05-01

    A process improvement program (PIP) was implemented in the emergency department (ED) at Guelph General Hospital in July 2009. The purpose of this study was to examine patients' satisfaction and wait times by level of Canadian Triage and Acuity Scale (CTAS) score before and 6 months after implementation of this program. Two samples were recruited: one was recruited before implementation of the PIP, January to June 2009 (T1), and one was recruited 6 months after implementation, January to June 2010 (T2). Patients were contacted by telephone to administer a survey including patient satisfaction with quality of care. Time to physician initial assessment, numbers left without being seen, and length of stay (LOS) were obtained from hospital records to compare wait times before and 6 months after implementation of the PIP. Patients (n = 301) reported shorter wait times after implementation (e.g., 12% reported seeing a physician right away at T1 compared to 29% at T2). Time to physician initial assessment improved for patients with CTAS scores of III, IV, and V (average decrease from 2.1 to 1.7 hours), fewer patients (n = 425) left without being seen after implementation, and the mean and 90th percentile of LOS decreased for all patients except the mean LOS for discharged patients with a CTAS score of I. Total time spent in the ED for admitted patients decreased from 11.11 hours in the 2009 period to 9.95 in the 2010 period, and for nonadmitted patients, the total time decreased from 3.94 to 3.29 hours. The overall satisfaction score improved from a mean of 3.17 to 3.4 (of 4; p < 0.001). Implementation of the ED PIP corresponded with decreased wait times, increased patient satisfaction, and improved patient flow for patients with CTAS scores of III, IV, and V.

  15. Resolving the impact of waiting time distributions on the persistence of measles

    PubMed Central

    Conlan, Andrew J. K.; Rohani, Pejman; Lloyd, Alun L.; Keeling, Matthew; Grenfell, Bryan T.

    2010-01-01

    Measles epidemics in human populations exhibit what is perhaps the best empirically characterized, and certainly the most studied, stochastic persistence threshold in population biology. A critical community size (CCS) of around 250 000–500 000 separates populations where measles is predominantly persistent from smaller communities where there are frequent extinctions of measles between major epidemics. The fundamental mechanisms contributing to this pattern of persistence, which are long-lasting immunity to re-infection, recruitment of susceptibles, seasonality in transmission, age dependence of transmission and the spatial coupling between communities, have all been quantified and, to a greater or lesser level of success, captured by theoretical models. Despite these successes there has not been a consensus over whether simple models can successfully predict the value of the CCS, or indeed which mechanisms determine the persistence of measles over a broader range of population sizes. Specifically, the level of the CCS has been thought to be particularly sensitive to the detailed stochastic dynamics generated by the waiting time distribution (WTD) in the infectious and latent periods. We show that the relative patterns of persistence between models with different WTDs are highly sensitive to the criterion of comparison—in particular, the statistical measure of persistence that is employed. To this end, we introduce two new statistical measures of persitence—fade-outs post epidemic and fade-outs post invasion. Contrary to previous reports, we demonstrate that, no matter the choice of persistence measure, appropriately parametrized models of measles demonstrate similar predictions for the level of the CCS. PMID:19793743

  16. 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.

  17. Waiting Time for Coronal Preparation and the Influence of Different Cements on Tensile Strength of Metal Posts

    PubMed Central

    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. PMID:22291705

  18. Prototype of a Questionnaire and Quiz System for Supporting Increase of Health Awareness During Wait Time in Dispensing Pharmacy

    NASA Astrophysics Data System (ADS)

    Toda, Takeshi; Chen, Poa-Min; Ozaki, Shinya; Ideguchi, Naoko; Miyaki, Tomoko; Nanbu, Keiko; Ikeda, Keiko

    For quit-smoking clinic and its campaign, there was a need for pharmacists to investigate pediatric patient's parent consciousness to tobacco harm utilizing wait time in a pediatric dispensing pharmacy. In this research, we developed the questionnaire and quiz total system using the tablet for user interface, in which people can easily answer the questionnaire/quiz and quickly see the total results on the spot in order to enhance their consciousness to the tobacco harm. The system also provides their tobacco dependence level based on the questionnaire results and some advice for their health and dietary habits due to the tobacco dependence level. From a field trial with one hundred four examinees in the pediatric dispensing pharmacy, the user interface was useful compared to conventional questionnaire form. The system could enhance their consciousness to tobacco harm and make their beneficial use of waiting time in dispensing pharmacy. Some interesting suggestions for improvement and new services were also obtained.

  19. Quality management: reduction of waiting time and efficiency enhancement in an ENT-university outpatients' department

    PubMed Central

    Helbig, Matthias; Helbig, Silke; Kahla-Witzsch, Heike A; May, Angelika

    2009-01-01

    Background Public health systems are confronted with constantly rising costs. Furthermore, diagnostic as well as treatment services become more and more specialized. These are the reasons for an interdisciplinary project on the one hand aiming at simplification of planning and scheduling patient appointments, on the other hand at fulfilling all requirements of efficiency and treatment quality. Methods As to understanding procedure and problem solving activities, the responsible project group strictly proceeded with four methodical steps: actual state analysis, analysis of causes, correcting measures, and examination of effectiveness. Various methods of quality management, as for instance opinion polls, data collections, and several procedures of problem identification as well as of solution proposals were applied. All activities were realized according to the requirements of the clinic's ISO 9001:2000 certified quality management system. The development of this project is described step by step from planning phase to inauguration into the daily routine of the clinic and subsequent control of effectiveness. Results Five significant problem fields could be identified. After an analysis of causes the major remedial measures were: installation of a patient telephone hotline, standardization of appointment arrangements for all patients, modification of the appointments book considering the reason for coming in planning defined working periods for certain symptoms and treatments, improvement of telephonic counselling, and transition to flexible time planning by daily updates of the appointments book. After implementation of these changes into the clinic's routine success could be demonstrated by significantly reduced waiting times and resulting increased patient satisfaction. Conclusion Systematic scrutiny of the existing organizational structures of the outpatients' department of our clinic by means of actual state analysis and analysis of causes revealed the necessity

  20. Increased wait-list time predicts dropout from outpatient enhanced cognitive behaviour therapy (CBT-E) for eating disorders.

    PubMed

    Carter, Olivia; Pannekoek, Louise; Fursland, Anthea; Allen, Karina L; Lampard, Amy M; Byrne, Susan M

    2012-08-01

    Between 30 and 70% of patients with eating disorders drop out from outpatient treatment. However, research has been unable to identify factors that consistently predict dropout from eating disorder treatment. Most studies have exclusively investigated the role that individual patient characteristics play in dropout and have ignored more process-based factors such as expectations about treatment, the therapeutic alliance, or time spent on a treatment waiting list. This study aimed to investigate the roles of both individual patient characteristics and process-based factors in dropout from outpatient treatment for eating disorders. The study involved data collected from consecutive eating disorder referrals to the only public specialist eating disorder service for youth and adults in Perth, Western Australia. The standard treatment provided at this service is Enhanced Cognitive Behaviour Therapy on an individual basis. The study involved 189 patients referred to the service between 2005 and 2010. Forty five percent of this sample dropped out of treatment. Results showed that, in this sample, two individual factors, lowest reported weight and the tendency to avoid affect, and one process-based factor, time spent on the wait list for treatment, were significant predictors of dropout. These findings are valuable because a process-based factor, such as wait-list time, may be easier to address and modify than a patient's weight history or the trait of mood intolerance. Increased resources for eating disorder services may reduce waiting list times which would help to reduce dropout and maximize treatment outcomes. Copyright © 2012 Elsevier Ltd. All rights reserved.

  1. Impact of clinical urgency, physician supply and procedural capacity on regional variations in wait times for coronary angiography

    PubMed Central

    2010-01-01

    Background Despite universal health care, there continues to be regional access disparities to coronary angiography in Canada. Our objective was to evaluate the extent to which demand-side factors such as clinical urgency/need, and supply-side factors, as reflected by differences in physician and procedural supply account for these inequalities. Methods Our cohort consisted of 74,254 consecutive patients referred for coronary angiography in Ontario, Canada between April 1st 2005 and March 31st 2006, divided into three urgency strata based on a clinical urgency scale. Cox-proportional hazard models were developed, adjusting for age, gender, socioeconomic status (SES), region, and urgency score, with greater hazard ratios (HR) indicating shorter wait times. To evaluate mediators of any residual wait-time differences, we examined the influence of the regional supply of cath lab facilities, invasive cardiologists and general practitioners (GP). Results We found that the urgency score was a significant predictor of wait time in all three strata (urgent patients: HR 1.61 for each unit increase in patient urgency (95% Confidence interval (CI) 1.55-1.67); semi-urgent patients: HR 1.55 (95% CI 1.44-1.68); elective patients: HR 1.13 (95% CI 1.08-1.18)). After accounting for clinical need/urgency, regional wait time differences persisted; these were most consistently associated with variation in cath lab supply. The impact of invasive cardiologist supply was restricted to urgent patients while that of GP supply was confined to semi-urgent and elective patients. Conclusion We found that there remained significant regional disparities in access to coronary angiography after accounting for clinical need. These disparities are partially explained by variations in supply of both procedural capacity and physician services, most notably in elective and semi-urgent patients. PMID:20051136

  2. 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.

  3. Evaluation of the effect of different enamel surface treatments and waiting times on the staining prevention after bleaching

    PubMed Central

    Moreira, Allyson; Cornacchia, Tulimar; Magalhães, Cláudia

    2017-01-01

    Background Bleached dental enamel can be more susceptible to staining than the enamel that has never been bleached, especially right after tooth bleaching. The aim of this study is to evaluate the effect of surface treatments and waiting time prior to contact with dye on bleached enamel staining susceptibility. Material and Methods One hundred teeth were bleached with 35% hydrogen peroxide (Whiteness HP, FGM) and randomly assigned to G1 artificial saliva, G2 2% sodium fluoride (Flugel, Nova DFL), G3 casein phosphopeptide-amorphous calcium phosphate fluoride paste (CPP-ACPF, MI Paste Plus, GC America), G4 rinse for color maintenance after bleaching (Keep White Rinse, DMC) and G5 polishing with aluminum oxide-impregnated disks (Super Buff Disk, Shofu). Fifty specimens were immersed in red wine for 15 minutes, immediately after treatment, and the others one hour after. Color difference (∆E) was evaluated with a spectrophotometer (Vita EasyShade). Surface treatments and waiting time effects were analyzed with Kruskal-Wallis and Mann Whitney tests (p<0.05). Results Surface treatments (p>0.05) and waiting time (p>0.05) were not significant to decrease bleached enamel susceptibility to red wine staining. Conclusions Surface treatments were similar to artificial saliva for bleached enamel susceptibility to red wine staining. Immediate or one-hour-postponed contact with red wine did not affect bleached enamel color. Key words:Tooth bleaching, color, dental enamel, hydrogen peroxide, pigmentation. PMID:28512546

  4. Do new workforce roles reduce waiting times in ED? A difference-in-difference evaluation using hospital administrative data.

    PubMed

    Scott, Anthony; Yong, Jongsay

    2015-04-01

    This paper evaluates the effect of introducing two new workforce roles under a pilot program conducted in Victoria, Australia. The trial took place at a regional hospital's emergency department (ED) between 1 July 2008 and 30 June 2009. The evaluation is based on three outcome measures: waiting time (in minutes) at ED before treatment; proportion of presentations with waiting time on target; and length of stay (in days), for ED presentations that led to in-patient admissions. The technique of difference-in-differences analysis is used. A total of 142,980 patient records from the pilot hospital and three comparison hospitals were extracted from the Victorian Emergency Minimum Dataset (VEMD). Further, 21,925 records of patients whose ED presentations led to in-patient admissions were extracted from the Victorian Admitted Episodes Dataset (VAED). The evaluation finds the piloted roles have lowered waiting time and raised the proportion of on-target presentations. These effects were found to be the strongest for less urgent triage categories. However, the evidence on in-patient length of stay was mixed. The results provide positive evidence that new workforce roles can be effective in improving the efficiency of emergency care delivery. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  5. Does Extending the Waiting Time of Low-Rectal Cancer Surgery after Neoadjuvant Chemoradiation Increase the Perioperative Complications?

    PubMed Central

    Timudom, Kittinut; Phothong, Natthawut; Akaraviputh, Thawatchai; Chinswangwatanakul, Vitoon; Pongpaibul, Ananya; Petsuksiri, Janjira; Ithimakin, Suthinee

    2016-01-01

    Background. Traditionally, rectal cancer surgery is recommended 6 to 8 weeks after completing neoadjuvant chemoradiation. Extending the waiting time may increase the tumor response rate. However, the perioperative complication rate may increase. The purpose of this study was to determine the association between extending the waiting time of surgery after neoadjuvant chemoradiation and perioperative outcomes. Methods. Sixty patients with locally advanced rectal cancer who underwent neoadjuvant chemoradiation followed by radical resection at Siriraj hospital between June 2012 and January 2015 were retrospectively analyzed. Demographic data and perioperative outcomes were compared between the two groups. Results. The two groups were comparable in term of demographic parameters. The mean time interval from neoadjuvant chemoradiation to surgery was 6.4 weeks in Group A and 11.7 weeks in Group B. The perioperative outcomes were not significantly different between Groups A and B. Pathologic examination showed a significantly higher rate of circumferential margin positivity in Group A than in Group B (30% versus 9.3%, resp.; P = 0.04). Conclusions. Extending the waiting to >8 weeks from neoadjuvant chemoradiation to surgery did not increase perioperative complications, whereas the rate of circumferential margin positivity decreased. PMID:27738430

  6. Customer service in dental offices: analyses of service orientations and waiting time in telephone interactions with a potential new customer.

    PubMed

    Ford, W S; Snyder, O J

    2000-01-01

    Increasing competition among health care organizations has prompted greater concern for the quality of "customer service" in brief encounters with patients. This study examined service practices engaged by dental office staff interacting over the telephone with a potential new customer. The goals of the study were to determine whether the staff displayed customer-oriented and control-oriented service communication behaviors and to examine the relation between these service behaviors and waiting time required of customers. Structured observational data were collected in phone encounters with staff in 84 dental offices. Approximately 40% of the staff engaged in the customer-oriented behavior of inviting the customer to share questions or concerns, and 31% exhibited the control-oriented behavior of reciting promotional pitches on behalf of the dental office. Six other communication behaviors were observed with less frequency. Staff who made customers wait on the line longer were more likely to use promotional pitches. Analyses revealed no significant relation between waiting time and other service communication behaviors.

  7. Interest of waiting time for spontaneous early reconnection after cavo-tricuspid isthmus ablation: A monocentric randomized trial.

    PubMed

    Marchandise, Sébastien; Scavée, Christophe; Barbraud, Cynthia; de Meester de Ravenstein, Christophe; Bagalwa, Mittérand Balola; Goesaert, Cédric; Reis-Pinheiro, Yvone; le Polain de Waroux, Jean-Benoit

    2017-10-04

    The aim of this study was to determine the rate of recurrent Atrial Flutter (AFl) after isolated cavotricuspid isthmus (CTI) ablation and to evaluate the impact of a waiting period with the search for early resumption of the CTI block on the long-term outcome. 319 consecutive patients referred for typical AFl ablation were randomly assigned to CTI ablation with continuous re-evaluation of the CTI block during 30 minutes and early re-ablation if needed (WT+ group, n = 155) or to CTI ablation with no waiting period after proven bi-directional CTI block (WT- group, n = 164). All patients were regularly followed-up. In the WT+ group, 10 patients (6%) presented a recovery across the CTI (time to recovery: 17 ± 7') and were re-ablated at the end of the waiting period. After a median follow-up of 21 months, the rate of recurrent AFl was significantly higher in the WT- group as compared to the WT+ group (11.6% (19/164) vs. 2.5% (4/155) respectively; p = 0.007). However, no significant differences in the subsequent rate of AF were observed between the 2 groups (29% (WT-) vs. 32% (WT+), p = 0.66). During the follow-up, 28 patients from the WT- group underwent a second ablation procedure (16 AFl redo and 12 AF ablation) versus 10 patients form the WT+ group (3 AFl redo and 7 AF ablation). Waiting 30 minutes after CTI ablation to check for early resumption and early re-ablation allows for decreasing significantly the rate of recurrent atrial flutter. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  8. No More Waits and Delays: Streamlining Workflow to Decrease Patient Time of Stay for Image-guided Musculoskeletal Procedures.

    PubMed

    Cheung, Yvonne Y; Goodman, Eric M; Osunkoya, Tomiwa O

    2016-01-01

    Long wait times limit our ability to provide the right care at the right time and are commonly products of inefficient workflow. In 2013, the demand for musculoskeletal (MSK) procedures increased beyond our department's ability to provide efficient and timely service. We initiated a quality improvement (QI) project to increase efficiency and decrease patient time of stay. Our project team included three MSK radiologists, one senior resident, one technologist, one administrative assistant/scheduler, and the lead technologist. We adopted and followed the Lean Six Sigma DMAIC (define, measure, analyze, improve, and control) approach. The team used tools such as voice of the customer (VOC), along with affinity and SIPOC (supplier, input, process, output, customer) diagrams, to understand the current process, identify our customers, and develop a project charter in the define stage. During the measure stage, the team collected data, created a detailed process map, and identified wastes with the value stream mapping technique. Within the analyze phase, a fishbone diagram helped the team to identify critical root causes for long wait times. Scatter plots revealed relationships among time variables. Team brainstorming sessions generated improvement ideas, and selected ideas were piloted via plan, do, study, act (PDSA) cycles. The control phase continued to enable the team to monitor progress using box plots and scheduled reviews. Our project successfully decreased patient time of stay. The highly structured and logical Lean Six Sigma approach was easy to follow and provided a clear course of action with positive results. (©)RSNA, 2016.

  9. Interactive effects of musical and visual cues on time perception: an application to waiting lines in banks.

    PubMed

    Chebat, J C; Gelinas-Chebat, C; Filiatrault, P

    1993-12-01

    This study explores the interactive effects of musical and visual cues on time perception in a specific situation, that of waiting in a bank. Videotapes are employed to stimulate the situation; a 2 x 3 factorial design (N = 427) is used: 2 (high vs low) amounts of visual information and 2 (fast vs slow) levels of musical tempo in addition to a no-music condition. Two mediating variables are tested in the relation between the independent variables (musical and visual ones) and the dependent variable (perceived waiting time), mood and attention. Results of multivariate analysis of variance and a system of simultaneous equations show that musical cues and visual cues have no symmetrical effects: the musical tempo has a global (moderating) effect on the whole structure of the relations between dependent, independent, and mediating variables but has no direct influence on time perception. The visual cues affect time perception, the significance of which depends on musical tempo. Also, the "Resource Allocation Model of Time Estimation" predicts the attention-time relation better than Ornstein's "storage-size theory." Mood state serves as a substitute for time information with slow music, but its effects are cancelled with fast music.

  10. Pigeons' wait-time responses to transitions in interfood-interval duration: Another look at cyclic schedule performance

    PubMed Central

    Higa, Jennifer J.; Thaw, Jean M.; Staddon, John E. R.

    1993-01-01

    Recent developments reveal that animals can rapidly learn about intervals of time. We studied the nature of this fast-acting process in two experiments. In Experiment 1 pigeons were exposed to a modified fixed-time schedule, in which the time between food rewards (interfood interval) changed at an unpredictable point in each session, either decreasing from 15 to 5 s (step-down) or increasing from 15 to 45 s (step-up). The birds were able to track under both conditions by producing postreinforcement wait times proportional to the preceding interfood-interval duration. However, the time course of responding differed: Tracking was apparently more gradual in the step-up condition. Experiment 2 studied the effect of having both kinds of transitions within the same session by exposing pigeons to a repeating (cyclic) sequence of the interfood-interval values used in Experiment 1. Pigeons detected changes in the input sequence of interfood intervals, but only for a few sessions—discrimination worsened with further training. The dynamic effects we observed do not support a linear waiting process of time discrimination, but instead point to a timing mechanism based on the frequency and recency of prior interfood intervals and not the preceding interfood interval alone. PMID:16812693

  11. Reduction of client waiting time using task shifting in an anti-retroviral clinic at Specialist Hospital Bauchi, Nigeria

    PubMed Central

    Umar, Nisser Ali; Hajara, Moses John; Khalifa, Mohammed

    2010-01-01

    Aiming to assess the impact of the intervention in reducing the patients' waiting time in the clinic, two surveys were conducted before and after task shifting intervention in an anti-retroviral (ARV) clinic at the Specialist Hospital, Bauchi, Nigeria in November 2008 and April 2009, respectively. Before the task shifting, six nurses from the clinic were trained on integrated management of adolescent and adult illness, as well as on the principle and guidelines for the anti-retroviral therapy, after which their schedule in the clinic was broadened to include seeing HIV patients presenting for routine refill and follow-up visits. In this study, fifty-six and sixty patients, respectively out of 186 and 202 who attended the clinic on the days of the pre- and post-intervention surveys, were randomly sampled. Data on patients' sex, age and marital status, whether patient a first timer or follow up visitor and the time spent in the clinic on that day as well as the number and composition of staff and equipment in the clinic was collected. The difference in waiting time spent between the first group before task shifting and second group after task shifting was statistically analyzed and significance tested using unpaired t-test. There was a reduction in the average waiting time for patients attending the clinic from 6.48 h before task shifting to 4.35 h after task shifting. The difference of mean was -2.13 h, with 95% CI: -2.44:-1.82 hours and the test of significance by unpaired t-test P<0.0001. PMID:28299042

  12. Reduction of client waiting time using task shifting in an anti-retroviral clinic at Specialist Hospital Bauchi, Nigeria

    PubMed Central

    Umar, Nisser Ali; Hajara, Moses John; Khalifa, Mohammed

    2011-01-01

    Aiming to assess the impact of the intervention in reducing the patients' waiting time in the clinic, two surveys were conducted before and after task shifting intervention in an anti-retroviral (ARV) clinic at the Specialist Hospital, Bauchi, Nigeria in November 2008 and April 2009, respectively. Before the task shifting, six nurses from the clinic were trained on integrated management of adolescent and adult illness, as well as on the principle and guidelines for the anti-retroviral therapy, after which their schedule in the clinic was broadened to include seeing HIV patients presenting for routine refill and follow-up visits. In this study, fifty-six and sixty patients, respectively out of 186 and 202 who attended the clinic on the days of the pre- and post-intervention surveys, were randomly sampled. Data on patients' sex, age and marital status, whether patient a first timer or follow up visitor and the time spent in the clinic on that day as well as the number and composition of staff and equipment in the clinic was collected. The difference in waiting time spent between the first group before task shifting and second group after task shifting was statistically analyzed and significance tested using unpaired t-test. There was a reduction in the average waiting time for patients attending the clinic from 6.48 h before task shifting to 4.35 h after task shifting. The difference of mean was −2.13 h, with 95% CI: −2.44:−1.82 hours and the test of significance by unpaired t-test P<0.0001. PMID:28299044

  13. Applying the Lean principles of the Toyota Production System to reduce wait times in the emergency department.

    PubMed

    Ng, David; Vail, Gord; Thomas, Sophia; Schmidt, Nicki

    2010-01-01

    In recognition of patient wait times, and deteriorating patient and staff satisfaction, we set out to improve these measures in our emergency department (ED) without adding any new funding or beds. In 2005 all staff in the ED at Hôtel-Dieu Grace Hospital began a transformation, employing Toyota Lean manufacturing principles to improve ED wait times and quality of care. Lean techniques such as value-stream mapping, just-in-time delivery techniques, workplace organization, reduction of systemic wastes, use of the worker as the source of quality improvement and ongoing refinement of our process steps formed the basis of our project. Our ED has achieved major improvements in departmental flow without adding any additional ED or inpatient beds. The mean registration to physician time has decreased from 111 minutes to 78 minutes. The number of patients who left without being seen has decreased from 7.1% to 4.3%. The length of stay (LOS) for discharged patients has decreased from a mean of 3.6 to 2.8 hours, with the largest decrease seen in our patients triaged at levels 4 or 5 using the Canadian Emergency Department Triage and Acuity Scale. We noted an improvement in ED patient satisfaction scores following the implementation of Lean principles. Lean manufacturing principles can improve the flow of patients through the ED, resulting in greater patient satisfaction along with reduced time spent by the patient in the ED.

  14. 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.

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

    PubMed Central

    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

    Background: 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. Methods: 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. Results: 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. Interpretation: 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. PMID:27398365

  16. Waiting time distributions for the transport through a quantum-dot tunnel coupled to one normal and one superconducting lead.

    PubMed

    Rajabi, Leila; Pöltl, Christina; Governale, Michele

    2013-08-09

    We have studied the waiting time distributions (WTDs) for subgap transport through a single-level quantum-dot tunnel coupled to one normal and one superconducting lead. The WTDs reveal the internal dynamics of the system, in particular, the coherent transfer of Cooper pairs between the dot and the superconductor. The WTDs exhibit oscillations that can be directly associated to the coherent oscillation between the empty and doubly occupied dot. The oscillation frequency is equal to the energy splitting between the Andreev bound states. These effects are more pronounced when the empty state and double-occupied state are in resonance.

  17. 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.

  18. Design of appointment systems for preanesthesia evaluation clinics to minimize patient waiting times: a review of computer simulation and patient survey studies.

    PubMed

    Dexter, F

    1999-10-01

    Anesthesiologists can use the science of clinic scheduling to design appointment systems for preanesthesia evaluation clinics. The principal reasons reported for inappropriately [or arguably unethically] long patient waiting times are provider tardiness, lack of patient punctuality, patient no-shows, and improperly designed appointment systems. However, the fundamental reason why anesthesia clinics have such long patient waiting times is because of their relatively long mean (and consequently standard deviation) of consultation times. If commonly applied valuations of provider idle time to patient waiting time are used in anesthesia clinics, appointment intervals will be sufficiently brief that the mean patient waiting time will be at least the mean consultation time or half an hour. Patients will be dissatisfied with this level of service. Therefore, efforts to decrease the mean patient waiting time in anesthesia clinics should focus foremost on minimizing the mean consultation time and its variability, which can most likely be achieved by assuring that providers have rapid access to relevant clinical information, including external medical records, surgical dictations, etc. Anesthesiologists managing anesthesia clinics may find it valuable to apply other interventions to decrease patient waiting times. Scheduling of preanesthesia evaluation and surgical clinics should be coordinated to assure patient punctuality. Providers should be on time for the start of their sessions. If an add-on patient cannot be seen during a scheduled clinic session, because all appointment times have been assigned to other patients, the add-on patient should be seen by a different provider or at the end of the regularly scheduled clinic session. Mean consultation times should be measured accurately for each provider. Substantial provider idle time should be expected. Appropriate values for breaks, appointment intervals, and percentage no-shows should be determined by computer simulation

  19. 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.

  20. Using lean manufacturing principles to evaluate wait times for HIV-positive patients in an urban clinic in Kenya.

    PubMed

    Monroe-Wise, Aliza; Reisner, Elizabeth; Sherr, Kenneth; Ojakaa, David; Mbau, Lilian; Kisia, Paul; Muhula, Samuel; Farquhar, Carey

    2017-01-01

    As human immunodeficiency virus (HIV) treatment programs expand in Africa, delivery systems must be strengthened to support patient retention. Clinic characteristics may affect retention, but a relationship between clinic flow and attrition is not established. This project characterized HIV patient experience and flow in an urban Kenyan clinic to understand how these may affect retention. We used Toyota's lean manufacturing principles to guide data collection and analysis. Clinic flow was evaluated using value stream mapping and time and motion techniques. Clinic register data were analyzed. Two focus group discussions were held to characterize HIV patient experience. Results were shared with clinic staff. Wait times in the clinic were highly variable. We identified four main barriers to patient flow: inconsistent patient arrivals, inconsistent staffing, filing system defects, and serving patients out of order. Focus group participants explained how clinic operations affected their ability to engage in care. Clinic staff were eager to discuss the problems identified and identified numerous low-cost potential solutions. Lean manufacturing methodologies can guide efficiency interventions in low-resource healthcare settings. Using lean techniques, we identified bottlenecks to clinic flow and low-cost solutions to improve wait times. Improving flow may result in increased patient satisfaction and retention.

  1. The effectiveness of service delivery initiatives at improving patients' waiting times in clinical radiology departments: a systematic review.

    PubMed

    Olisemeke, B; Chen, Y F; Hemming, K; Girling, A

    2014-12-01

    We reviewed the literature for the impact of service delivery initiatives (SDIs) on patients' waiting times within radiology departments. We searched MEDLINE, EMBASE, CINAHL, INSPEC and The Cochrane Library for relevant articles published between 1995 and February, 2013. The Cochrane EPOC risk of bias tool was used to assess the risk of bias on studies that met specified design criteria. Fifty-seven studies met the inclusion criteria. The types of SDI implemented included extended scope practice (ESP, three studies), quality management (12 studies), productivity-enhancing technologies (PETs, 29 studies), multiple interventions (11 studies), outsourcing and pay-for-performance (one study each). The uncontrolled pre- and post-intervention and the post-intervention designs were used in 54 (95%) of the studies. The reporting quality was poor: many of the studies did not test and/or report the statistical significance of their results. The studies were highly heterogeneous, therefore meta-analysis was inappropriate. The following type of SDIs showed promising results: extended scope practice; quality management methodologies including Six Sigma, Lean methodology, and continuous quality improvement; productivity-enhancing technologies including speech recognition reporting, teleradiology and computerised physician order entry systems. We have suggested improved study design and the mapping of the definitions of patient waiting times in radiology to generic timelines as a starting point for moving towards a situation where it becomes less restrictive to compare and/or pool the results of future studies in a meta-analysis.

  2. Does rapid HIV testing result in an early diagnosis and reduce the waiting time for patients to receive medical care?

    PubMed

    Melo, Magaly Carvalho Vieira de; Ximenes, Ricardo Arraes de Alencar; Falcão, Ilka Veras; Miranda-Filho, Demócrito de Barros

    2017-08-01

    The implementation of rapid HIV testing in Brazil began in 2006 for specific groups, and from 2009 was extended to the Counseling and Testing Centers (CTC) in certain Brazilian capitals. The aim of this study was to compare two groups of individuals: those diagnosed with HIV infection by conventional testing and those diagnosed with rapid testing, with respect to: the waiting time before receiving medical care, the time of the first laboratory tests and the virological, immune and clinical status. This is a cross-sectional study to compare a group with individuals diagnosed by conventional testing (2006-2008) and another with those diagnosed by rapid testing (2010-2011).The median time between blood collection and diagnosis of HIV in the conventional test group was 76 days, while in the rapid test group 94.2% of the subjects received their results on the same day of blood collection (p < 0.001). In the conventional test group, the median period of time before the first consultation with an infectious disease specialist was 99 days, and for the rapid test group the time was 14 days (p < 0.001). The median time between the first blood sample and the first results of the CD4 count and viral load was approximately 2.5 times lower in the rapid test group (p < 0.001 for both). The median CD4 count in the rapid test group (472) was higher than in the conventional test group (397) (p = 0.01). The introduction of rapid HIV testing as a diagnostic strategy has reduced the waiting times for medical care and laboratory tests and also allowed earlier diagnosis of HIV infection than with the conventional test.

  3. Modeling the Impact of Integrating HIV and Outpatient Health Services on Patient Waiting Times in an Urban Health Clinic in Zambia

    PubMed Central

    Deo, Sarang; Topp, Stephanie M.; Garcia, Ariel; Soldner, Mallory; Yagci Sokat, Kezban; Chipukuma, Julien; Wamulume, Chibesa S.; Reid, Stewart E.; Swann, Julie

    2012-01-01

    Background Rapid scale up of HIV treatment programs in sub-Saharan Africa has refueled the long-standing health policy debate regarding the merits and drawbacks of vertical and integrated system. Recent pilots of integrating outpatient and HIV services have shown an improvement in some patient outcomes but deterioration in waiting times, which can lead to worse health outcomes in the long run. Methods A pilot intervention involving integration of outpatient and HIV services in an urban primary care facility in Lusaka, Zambia was studied. Data on waiting time of patients during two seven-day periods before and six months after the integration were collected using a time and motion study. Statistical tests were conducted to investigate whether the two observation periods differed in operational details such as staffing, patient arrival rates, mix of patients etc. A discrete event simulation model was constructed to facilitate a fair comparison of waiting times before and after integration. The simulation model was also used to develop alternative configurations of integration and to estimate the resulting waiting times. Results Comparison of raw data showed that waiting times increased by 32% and 36% after integration for OPD and ART patients respectively (p<0.01). Using simulation modeling, we found that a large portion of this increase could be explained by changes in operational conditions before and after integration such as reduced staff availability (p<0.01) and longer breaks between consecutive patients (p<0.05). Controlling for these differences, integration of services, per se, would have resulted in a significant decrease in waiting times for OPD and a moderate decrease for HIV services. Conclusions Integrating health services has the potential of reducing waiting times due to more efficient use of resources. However, one needs to ensure that other operational factors such as staff availability are not adversely affected due to integration. PMID:22545108

  4. Rationing scarce organs for transplantation: healthcare provider perspectives on wait-listing and organ allocation.

    PubMed

    Tong, Allison; Jan, Stephen; Wong, Germaine; Craig, Jonathan C; Irving, Michelle; Chadban, Steven; Cass, Alan; Howard, Kirsten

    2013-01-01

    Ongoing debate about how to maximize the benefit of scarce organs while maintaining equity of access to transplantation exists. This study aims to synthesize healthcare provider perspectives on wait-listing and organ allocation. MEDLINE, Embase, and PsycINFO were searched till February 21, 2011. Quantitative data were extracted, and a qualitative synthesis of the studies was conducted. Twenty studies involving 4254 respondents were included. We identified two goals underpinning healthcare provider preferences for organ allocation: (i) maximize clinical benefit (quality of life gains, patient survival, treatment adherence, and graft survival) and social outcomes (social support, productivity, and valuation); (ii) achieve equity (waiting time, patient preferences, access to live donation, and medical urgency). Maximizing clinical or social outcomes meant organs would be preferentially given to patients expected to achieve good transplant outcomes or wider social gain. Achieving equity meant all patients should have an equal chance of transplant, or patients deemed more urgent receive higher priority. A tension between equity and efficiency is apparent. Balanced against dimensions of efficiency were considerations to instill a degree of perceived fairness in organ allocation. Ongoing engagement with stakeholders is needed to enhance transparency, a reasonable balance between efficiency and equity, and avoid discrimination against specific populations.

  5. Evaluating wait times from screening to breast cancer diagnosis among women undergoing organised assessment vs usual care.

    PubMed

    Chiarelli, Anna M; Muradali, Derek; Blackmore, Kristina M; Smith, Courtney R; Mirea, Lucia; Majpruz, Vicky; O'Malley, Frances P; Quan, May Lynn; Holloway, Claire Mb

    2017-05-09

    Timely coordinated diagnostic assessment following an abnormal screening mammogram reduces patient anxiety and may optimise breast cancer prognosis. Since 1998, the Ontario Breast Screening Program (OBSP) has offered organised assessment through Breast Assessment Centres (BACs). For OBSP women seen at a BAC, an abnormal mammogram is followed by coordinated referrals through the use of navigators for further imaging, biopsy, and surgical consultation as indicated. For OBSP women seen through usual care (UC), further diagnostic imaging is arranged directly from the screening centre and/or through their physician; results must be communicated to the physician who is then responsible for arranging any necessary biopsy and/or surgical consultation. This study aims to evaluate factors associated with diagnostic wait times for women undergoing assessment through BAC and UC. Of the 2 147 257 women aged 50-69 years screened in the OBSP between 1 January 2002 and 31 December 2009, 155 866 (7.3%) had an abnormal mammogram. A retrospective design identified two concurrent cohorts of women diagnosed with screen-detected breast cancer at a BAC (n=4217; 47%) and UC (n=4827; 53%). Multivariable logistic regression analyses examined associations between wait times and assessment and prognostic characteristics by pathway. A two-sided 5% significance level was used. Screened women with breast cancer were two times more likely to be diagnosed within 7 weeks when assessed through a BAC vs UC (OR=1.91, 95% CI=1.73-2.10). In addition, compared with UC, women assessed through a BAC were significantly more likely to have their first assessment procedure within 3 weeks of their abnormal mammogram (OR=1.25, 95% CI=1.12-1.39), ⩽3 assessment procedures (OR=1.54, 95% CI=1.41-1.69), ⩽2 assessment visits (OR=1.86, 95% CI=1.70-2.05), and ⩾2 procedures per visit (OR=1.41, 95% CI=1.28-1.55). Women diagnosed through a BAC were also more likely than those in UC to have imaging (OR=1.99, 95

  6. Is it not time for health economists to rethink equity and access?

    PubMed

    Mooney, Gavin

    2009-04-01

    This article considers two key issues in health economics regarding the question of equity. First, why have health economists not resolved better the issue of what are equity and access? Second, the paper draws attention to the relative lack of analyses of equity concerns outside of health care. The question of whose values should prevail in equity is also addressed. On the first issue, there is an obsession with quantification in economics with the result that in analysing equity, in practice often 'use' has been substituted for 'access'. The problem of defining access has thereby been by-passed. This has taken the pressure off trying to research access per se. Second, what is meant by equity and access are in part culturally determined. The continued efforts of health economists to treat equity as some universal construct are misplaced. The lack of effort on the part of health economists to look at equity more broadly than health care equity is concerning. Certainly, to be pursued in practice, equity in both health and health care need a shift in resources, which will be opposed by those who exercise power over decision making in health care and in society more generally. Currently health economists' analyses say all too little about power and property rights in health care and in society. It is argued that the relevant citizens or communities which a health service serves are best placed to judge the access barriers they face and their relative heights. A useful definition of equity established by a citizens' jury in Perth, Australia is used to exemplify this point. It is concluded that the often all too simplistic equity goals adopted in health economics (and sometimes public health discourse) need to be challenged. For health economists, there is a need for more of us to get involved in the issues around inequalities, class and power and the impact of these on health.

  7. Cost-Effectiveness of Reduced Waiting Time for Head and Neck Cancer Patients due to a Lean Process Redesign.

    PubMed

    Simons, Pascale A M; Ramaekers, Bram; Hoebers, Frank; Kross, Kenneth W; Marneffe, Wim; Pijls-Johannesma, Madelon; Vandijck, Dominique

    2015-07-01

    Compared with new technologies, the redesign of care processes is generally considered less attractive to improve patient outcomes. Nevertheless, it might result in better patient outcomes, without further increasing costs. Because early initiation of treatment is of vital importance for patients with head and neck cancer (HNC), these care processes were redesigned. This study aimed to assess patient outcomes and cost-effectiveness of this redesign. An economic (Markov) model was constructed to evaluate the biopsy process of suspicious lesion under local instead of general anesthesia, and combining computed tomography and positron emission tomography for diagnostics and radiotherapy planning. Patients treated for HNC were included in the model stratified by disease location (larynx, oropharynx, hypopharynx, and oral cavity) and stage (I-II and III-IV). Probabilistic sensitivity analyses were performed. Waiting time before treatment start reduced from 5 to 22 days for the included patient groups, resulting in 0.13 to 0.66 additional quality-adjusted life-years. The new workflow was cost-effective for all the included patient groups, using a ceiling ratio of €80,000 or €20,000. For patients treated for tumors located at the larynx and oral cavity, the new workflow resulted in additional quality-adjusted life-years, and costs decreased compared with the regular workflow. The health care payer benefited €14.1 million and €91.5 million, respectively, when individual net monetary benefits were extrapolated to an organizational level and a national level. The redesigned care process reduced the waiting time for the treatment of patients with HNC and proved cost-effective. Because care improved, implementation on a wider scale should be considered. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  8. 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.

  9. "Kairos" and the Time of Gender Equity Policy in Australian Schooling

    ERIC Educational Resources Information Center

    Gannon, Susanne

    2016-01-01

    Almost 20 years ago the Australian government released "Gender Equity: A Framework for Australian Schools" (1997). It was adopted by all states but almost immediately disappeared from sight after a conservative change of government. This was followed by the dismantling of gender equity units in each state, and a turn to boys' education…

  10. "Kairos" and the Time of Gender Equity Policy in Australian Schooling

    ERIC Educational Resources Information Center

    Gannon, Susanne

    2016-01-01

    Almost 20 years ago the Australian government released "Gender Equity: A Framework for Australian Schools" (1997). It was adopted by all states but almost immediately disappeared from sight after a conservative change of government. This was followed by the dismantling of gender equity units in each state, and a turn to boys' education…

  11. [Times of gender equity: a description of the inequalities between autonomous communities, Spain 2006-2014].

    PubMed

    Fernández-Sáez, José; Ruiz-Cantero, María Teresa; Guijarro-Garvi, Marta; Rodenas-Calatayud, Carmen; Martí-Sempere, Mónica; Jiménez-Alegre, María Dolores

    2016-01-01

    Gender equity (GE) is a structural determinant of health inequalities. In this light, our objective is to show the evolution of gender equity in the Spanish autonomous communities since 2006, prior to the enactment of the Equality Act (2007) and the economic crisis (2008), until 2014. Ecological study of gender equity in the 17 Spanish autonomous communities from 2006-2011-2014. We have calculated: 1) modified gender equity index (MGEI) for the autonomous communities (0=equity, ±1=inequity); 2) interregional and temporal convergences in gender equity. The MGEI in the autonomous communities in 2014 has negative values close to 0 (inequity towards women). There is no interregional convergence due to the dispersion increase (2006: 0.1503; 2011: 0.2280; 2014: 0.4964), and no temporal convergence due to the lack of progress of the autonomous communities with poor gender equity. The gender gap in economic activity continues to be unfavourable to women, decreasing in all communities between 2006 and 2011 but increasing in six communities in 2014. The gender gap in education from 2006-2011-2014 has positive values close to 0 (unfavourable to men), while the gender gap in empowerment is unfavourable to women, representing the most significant gender equity disparity. Inter-community dispersion of economic activity and education did not change between 2006 and 2014, while inter-community dispersion of empowerment increased. The level of gender equity achieved in the Spanish autonomous communities in 2006 was lost during the economic crisis, as gender equity disparities between the communities had increased by 2014. Gender inequity continues to be unfavourable to women. Copyright © 2016 SESPAS. Published by Elsevier Espana. All rights reserved.

  12. Dynamics of waiting in pigeons

    PubMed Central

    Wynne, C. D. L.; Staddon, J. E. R.; Delius, J. D.

    1996-01-01

    Two experiments used response-initiated delay schedules to test the idea that when food reinforcement is available at regular intervals, the time an animal waits before its first operant response (waiting time) is proportional to the immediately preceding interfood interval (linear waiting; Wynne & Staddon, 1988). In Experiment 1 the interfood intervals varied from cycle to cycle according to one of four sinusoidal sequences with different amounts of added noise. Waiting times tracked the input cycle in a way which showed that they were affected by interfood intervals earlier than the immediately preceding one. In Experiment 2 different patterns of long and short interfood intervals were presented, and the results implied that waiting times are disproportionately influenced by the shortest of recent interfood intervals. A model based on this idea is shown to account for a wide range of results on the dynamics of timing behavior. PMID:16812811

  13. Effect of α-stable sorptive waiting times on microbial transport in microflow cells

    NASA Astrophysics Data System (ADS)

    Bonilla, F. Alejandro; Cushman, John H.

    2002-09-01

    The interaction of bacteria in the fluid phase with pore walls of a porous material involves a wide range of effective reaction times which obey a diversity of substrate-bacteria adhesion conditions, and adhesive mechanisms. For a transported species, this heterogeneity in sorption conditions occurs both in time and space. Modern experimental methods allow one to measure adhesive reaction times of individual bacteria. This detailed information may be incorporated into nonequilibrium transport-sorption models that capture the heterogeneity in reaction times caused by varying chemical conditions. We have carried out particle (Brownian dynamic) simulations of adhesive, self-motile bacteria convected between two infinite plates as a model for a microflow cell. The adhesive heterogeneity is included by introducing adhesive reaction time (understood as time spent at a solid boundary once the particle collides against it) as a random variable that can be infinite (irreversible sorption) or vary over a wide range of values. This is made possible by treating this reaction time random variable as having an α-stable probability distribution whose properties (e.g., infinite moments and long tails) are distinctive from the standard exponential distribution commonly used to model reversible sorption. In addition, the α-stable distribution is renormalizable and hence upscalable to complex porous media. Simulations are performed in a pressure-driven microflow cell. Bacteria motility (driven by an effective Brownian force) acts as a dispersive component in the convective field. Upon collision with the pore wall, bacteria attachment or detachment occurs. The time bacteria spend at the wall varies over a wide range of time scales. This model has the advantage of being parsimonious, that is, involving very few parameters to model complex irreversible or reversible adhesion in heterogeneous environments. It is shown that, as in Taylor dispersion, the ratio of the channel half width b

  14. Fecundity in Thai and European regions: results based on waiting time to pregnancy.

    PubMed

    Tuntiseranee, P; Olsen, J; Chongsuvivatwong, V; Limbutara, S

    1998-02-01

    Very little is known about the frequency of subfecundity in different cultures, ethnic groups and regions. To fill this gap, the European Study Group on Infertility and Subfecundity established data on the prevalence of infertility and subfecundity in five European regions. In this study, a comparison of fecundity was made between 4035 Caucasian women from five European countries and 1496 Asian women from southern Thailand. Fecundity was measured using 'time to pregnancy', i.e. the time women took to conceive after stopping contraceptive methods. The Thai primigravid women had a shorter time to pregnancy than European women, whereas time to pregnancy was found to be longer among Thai multigravidae, although this was not statistically significant. This study has illustrated that cross-culture comparison of subfecundity is difficult despite using a common protocol and questionnaire because of differences in the use of contraceptive methods and a different concept of pregnancy planning. The distribution of time to pregnancy for the Thai women was not outside the variation found within the European samples.

  15. A probabilistic model for estimating the waiting time until the simultaneous collapse of two contingencies

    SciTech Connect

    Barnett, C.S.

    1991-06-01

    The Double Contingency Principle (DCP) is widely applied to criticality safety practice in the United States. Most practitioners base their application of the principle on qualitative, intuitive assessments. The recent trend toward probabilistic safety assessments provides a motive to search for a quantitative, probabilistic foundation for the DCP. A Markov model is tractable and leads to relatively simple results. The model yields estimates of mean time to simultaneous collapse of two contingencies as a function of estimates of mean failure times and mean recovery times of two independent contingencies. The model is a tool that can be used to supplement the qualitative methods now used to assess effectiveness of the DCP. 3 refs., 1 fig.

  16. Factors related with the time to surgery in waiting-list patients for knee prostheses.

    PubMed

    Romero Jurado, Manuel; Enrique Fidalgo, Alejandro; Rodríguez Villar, Virginia; Mar Medina, Javier; Soler López, Begoña

    2013-01-01

    In the year 2006 the Hospital Complex of Jaén began a new model of attention for consultation of knee osteoarthritis (CMAR), to offer quality treatment to the patient based on clinical practice guidelines. The objective of this study was to analyse the efficiency of the unit, in terms of delaying the time until a knee prostheses is needed. An analysis of a retrospective cohort of patients seen at the CMAR was made, with a minimum available data set, and a Kaplan Meier analysis carried out in order to evaluate the time until the referral of the patient to surgery, as well as a Cox regression analysis in order to study the factors related with the time until the referral. 224 patients were included, with mean age of 65.7 years (95% CI 64 to 67), 67.9% women. 48.2% had a stage III affection (Kellgren-Lawrence), 27.5% stage 2, 15.3% stage 4, and 9% stage 1. 90.2% (202) received treatment with viscosupplementation (Hialuronic acid NASHA). Single joint affection (P<.0001; OR 0,267, 95% CI 0.130 to 0,549), a higher degree of osteoarthritis (P=.048; OR 0,410, 95% CI 0.169 to 0,992), and lower intensity of pain (P<.0001; OR 1,091, 95% CI 1.044 to 1,141), were the factors related with shorter time until surgery. Treatment with viscosupplementation increased the time until surgery in all patients. Factors like a lower age of the patient and the involvement of a single joint influenced the referral of the patient to surgery. The administration of viscosupplementation, delayed the time until the patient was finally referred to surgery. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  17. The optimization of the direct metro lines based on the waiting time and flow of people

    NASA Astrophysics Data System (ADS)

    Li, Yan; Li, Yuhe

    2017-04-01

    In this paper, author established an optimization mathematical framework on helping government optimize the choice of the end stations of the shuttle train and give a specific approach to explore the advantages of the direct metro line and to construct a detailed time schedule.

  18. Waiting for Paternity: An Observational Study of the Timing of Fatherhood.

    ERIC Educational Resources Information Center

    Neville, Brian

    The aim of this study was to examines the effects of life-span contextual variation on father-child relationships. Sixty families in which both parents were either younger than 26 or older than 29 when they began childbearing, and whose oldest or only child was between the ages of 3 and 5 at the time of the study participated. Questionnaires were…

  19. Speeding Products to Market: Waiting Time to First Product Introduction in New Firms.

    ERIC Educational Resources Information Center

    Schoonhoven, Claudia Bird; And Others

    1990-01-01

    Using event-history analysis techniques, a longitudinal study of the semiconductor industry found that substantial technological innovation lengthens development times and reduces the speed with which first products reach the marketplace. Organizations that undertook lower levels of technological innovation had relatively lower monthly…

  20. Changes in waiting-list patients over time: data on some commonly-used measures. Beware!

    PubMed

    Arrindell, W A

    2001-10-01

    When samples of psychiatric patients are assessed on 2 occasions on state and trait measures, without any formal intervention having yet taken place, a mean change in scores towards less psychopathology is often observed. This re-test effect, which is a potential threat to the validity of longitudinal studies, has not been given serious attention by researchers using repeated administrations. The present study addressed this issue by examining re-test effects in 2 independent clinical samples with the Symptom Check List-90-Revised and other widely-used state and trait measures. Time intervals between intake and re-take were 3 months and 11-350 days (M = 93 days, median = 81 days). Results indicated that the re-test effect occurred for most of the measures. Where significant testing effects were observed, 54-72% of the patients had time 2 scores that were lower than the average time I scores. The importance and practical and scientific implications of the findings are discussed. Eleven hypotheses concerning the nature of the re-test effect are offered, including mood-congruent associative processing, natural coping mechanisms, self-monitoring hypothesis and response-shift.

  1. Asymptotic solutions of decoupled continuous-time random walks with superheavy-tailed waiting time and heavy-tailed jump length distributions.

    PubMed

    Denisov, S I; Yuste, S B; Bystrik, Yu S; Kantz, H; Lindenberg, K

    2011-12-01

    We study the long-time behavior of decoupled continuous-time random walks characterized by superheavy-tailed distributions of waiting times and symmetric heavy-tailed distributions of jump lengths. Our main quantity of interest is the limiting probability density of the position of the walker multiplied by a scaling function of time. We show that the probability density of the scaled walker position converges in the long-time limit to a nondegenerate one only if the scaling function behaves in a certain way. This function as well as the limiting probability density are determined in explicit form. Also, we express the limiting probability density which has heavy tails in terms of the Fox H function and find its behavior for small and large distances.

  2. Using business process redesign to reduce wait times at a university hospital in the Netherlands.

    PubMed

    Elkhuizen, Sylvia G; Burger, Matthe P M; Jonkers, Rene E; Limburg, Martien; Klazinga, Niek; Bakker, Piet J M

    2007-06-01

    Business process redesign (BPR) has been applied to implement more customer-focused and cost-effective care. In 2002, two pilot projects to improve patient care processes for two specific patient groups were conducted at the Academic Medical Center, a 1,000-bed university hospital in Amsterdam. The BPR consisted of process analysis, identification of bottlenecks and goals for redesign, selection of interventions, and evaluation of effects. After identifying and selecting interventions with the greatest expected benefits, changes were implemented and effects were evaluated. For gynecologic oncology patients, access time (from telephone call to first visit) was reduced from 14 days to < 7 days, and the proportion of patients who completed all diagnostic examinations within 14 days increased from 49% to 83%. For dyspnea patients, access time was reduced to < 6 days, and the number of visits was halved. Despite the fact that we applied the same approach in these two projects, the interventions turned out to be quite different. Whereas changes in communication and planning were sufficient to eliminate bottlenecks in the gynecologic oncology project, the dyspnea project required a radical redesign of processes. Experience since these projects suggests that process redesign may have only marginal impact when the greatest bottleneck occurs, as was the case for the two BPR projects, at the point of access to central diagnostic facilities.

  3. 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…

  4. 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…

  5. Gaps in the Continuum of HIV Care: Long Pretreatment Waiting Time between HIV Diagnosis and Antiretroviral Therapy Initiation Leads to Poor Treatment Adherence and Outcomes

    PubMed Central

    Su, Shu; Li, Shifu; Li, Shunxiang; Gao, Liangmin; Cai, Ying; Fu, Jincui; Guo, Chunyuan; Jing, Jun; Mao, Limin

    2016-01-01

    Background. Criteria for antiretroviral treatment (ART) were adjusted to enable early HIV treatment for people living HIV/AIDS (PLHIV) in China in recent years. This study aims to determine how pretreatment waiting time after HIV confirmation affects subsequent adherence and outcomes over the course of treatment. Methods. A retrospective observational cohort study was conducted using treatment data from PLHIV in Yuxi, China, between January 2004 and December 2015. Results. Of 1,663 participants, 348 were delayed testers and mostly initiated treatment within 28 days. In comparison, 1,315 were nondelayed testers and the median pretreatment waiting time was 599 days, but it significantly declined over the study period. Pretreatment CD4 T-cell count drop (every 100 cells/mm3) contributed slowly in CD4 recovery after treatment initiation (8% less, P < 0.01) and increased the risk of poor treatment adherence by 15% (ARR = 1.15, 1.08–1.25). Every 100 days of extensive pretreatment waiting time increased rates of loss to follow-up by 20% (ARR = 1.20, 1.07–1.29) and mortality rate by 11% (ARR = 1.11, 1.06–1.21), based on multivariable Cox regression. Conclusion. Long pretreatment waiting time in PLHIV can lead to higher risk of poor treatment adherence and HIV-related mortality. Current treatment guidelines should be updated to provide ART promptly. PMID:28101505

  6. Managing patient pathways to achieve lung cancer waiting time targets: mixed methods study

    PubMed Central

    Ip, Hugh; Amer, Tarik; Dangoor, Michael; Zamir, Affan; Gibbings-Isaac, Darryl; Kochhar, Ranjeev; Heymann, Timothy

    2012-01-01

    Objectives England's National Health Service (NHS) introduced a 62-day target, from referral to treatment, to make lung cancer patient pathways more efficient. This study aims to understand pathway delays that lead to breaches of the target when patients need care in both secondary and tertiary setting, so more than one institution is involved. Design Mixed methods cross case analysis. Setting Two tertiary referral hospitals in London. Participants Database records of 53 patients were analysed. Nineteen sets of patient notes were used for pathway mapping. Seventeen doctors, four nurses, eight managers and administrators were interviewed. Main outcome measures Qualitative methods include pathway mapping and semi-structured interviews. Quantitative analysis of patient pathway times from cancer services records. Results The majority of the patient pathway (68.4%) is spent in secondary centres. There is more variability in the processes of secondary centres but tertiary centres do not have perfect processes either. Three themes emerged from discussions: information flows, pathway performance and the role of the multidisciplinary approach. Conclusions The actions of secondary centres have a greater influence on whether a patient breaches the 62-day target, compared with tertiary centres. Nevertheless variability exists in both, with potential for improvement. PMID:23162682

  7. The 'straight to test' initiative reduces both diagnostic and treatment waiting times for colorectal cancer: outcomes after 2 years.

    PubMed

    Mukherjee, S; Fountain, G; Stalker, M; Williams, J; Porrett, T R C; Lunniss, P J

    2010-10-01

    This study aimed to determine whether a 'straight to test'(STT) strategy for 2-week wait (2 wk) referrals for suspected colorectal cancer (CRC) reduced the time to diagnosis and treatment for patients with CRC. Consecutive 2-week referrals for suspected CRC over a period of 2 years from February 2007 were analysed. The times to the first diagnostic test and treatment and the cancers identified were analysed for those going to STT or the outpatient clinic. Of 662 patients having a 2 wk referral, 519 (78.4%) were suitable for the hospital colorectal telephone triage service, 121 (18.3%) patients went to STT and 502 (75.8%) were seen in the clinic. Of these 401 (79.8%) underwent diagnostic tests and 25 (6.2%) had CRC and in 12 (2.9%) patients other cancers were detected. In the STT group, 7 (5.8%) patients were diagnosed with CRC. The median time to first diagnostic test was 12 days (IQR 9-13) in the STT pathway, compared with 23 days (17-31) in those seen in the clinic (P < 0.0001). The median time to first treatment was 40 (32-48) days for those via STT, compared to 46 (28-55) days for those seen in the clinic (P = 0.004). A total of 162 CRC were diagnosed during the study period of whom 34 (20.9%) were 2 wk referrals (5.1% of all suspected CRC 2 wk referrals), and 14 (2.1%) other cancers were detected via this pathway. STT speeds up the patient pathway by reducing the time to diagnosis and treatment for patients with CRC. © 2010 The Authors. Colorectal Disease © 2010 The Association of Coloproctology of Great Britain and Ireland.

  8. 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.

  9. [Factors associated with waiting time and access to kidney transplants in Belo Horizonte, Minas Gerais State, Brazil'].

    PubMed

    Machado, Elaine Leandro; Gomes, Isabel Cristina; Acurcio, Francisco de Assis; César, Cibele Comini; Almeida, Maria Cristina de Mattos; Cherchiglia, Mariangela Leal

    2012-12-01

    The objective of this study was to analyze factors associated with access to kidney transplants from living and cadaver donors in Belo Horizonte, Minas Gerais State, Brazil. The authors conducted a non-concurrent cohort study of patients on the waiting list for kidney transplants from 2000 to 2004 and followed until transplantation, death, exclusion, or continued presence on the line at the end of the study on December 31, 2005. The Cox model was used for competing risks. Of the 835 patients, 22.7% were transplanted. Lower risk of transplantation from living donors and cadavers was observed in patients with more time on dialysis and blood type O. Lower risk of transplantation from living donors was observed in residents in a high health risk area and in recipients with diabetes. The greatest disparity in access was observed in transplants from living donors, since there were no significant socio-demographic differences in transplants from cadaver donors. One can infer that the organ allocation system contributed to mitigating socio-demographic inequalities, and that clinical issues were more relevant in access to transplants from cadaver donors.

  10. Variation in Additional Breast Imaging Orders and Impact on Surgical Wait Times at a Comprehensive Cancer Center

    PubMed Central

    Golshan, Mehra; Losk, Katya; Mallory, Melissa A.; Camuso, Kristen; Troyan, Susan; Lin, Nancy U.; Kadish, Sarah; Bunnell, Craig A.

    2015-01-01

    Background In the multidisciplinary care model, breast imagers frequently provide second opinion reviews of imaging studies performed at outside institutions. However, the need for additional imaging and timeliness of obtaining these studies has yet to be established. We sought to evaluate the frequency of additional imaging orders by breast surgeons and to evaluate the impact of this supplementary imaging on timeliness of surgery. Methods We identified 2,489 consecutive women with breast cancer who underwent first definitive surgery (FDS) at our comprehensive cancer center between 2011 and 2013. The number of breast-specific imaging studies performed for each patient between initial consultation and FDS was obtained. Chi-squared tests were used to quantify the proportion of patients undergoing additional imaging by surgeon. Interval time between initial consultation and additional imaging and/or biopsy was calculated. The delay of additional imaging on time to FDS was assessed by t-test. Results Of 2,489 patients, 615 (24.7%) had at least one additional breast-specific imaging study performed between initial consultation and FDS, with 222 patients undergoing additional biopsies (8.9%). The proportion of patients receiving imaging tests by breast surgeon ranged from 15% to 39% (p<0.0001). Patients receiving additional imaging had statistically longer wait times to FDS for BCT (21.4 to 28.5 days, p<0.0001). Conclusions Substantial variability exists in the utilization of additional breast-specific imaging and in the timeliness of obtaining these tests among breast surgeons. Further research is warranted to assess the sources and impact of this variation on patient care, cost and outcomes. PMID:26307233

  11. Forward waiting in theatre.

    PubMed

    Belbin, H

    2000-02-01

    Waiting to go into theatre on the day of your surgery is probably the most stressful time for patients. What happens to patients during this crucial time can make a tremendous difference to the whole experience of going to theatre. Heidi Belbin and her colleagues realised that there was a problem at Lincoln City Hospital with patients being kept waiting at theatre reception and were concerned that the quality of patient care in this respect was not acceptable. A plan was developed to improve this situation, and the story of what was done is told in this article. The project was entered for the 3M/NATN award, and earned a commendation from the judges.

  12. Allocating operating room resources to an acute care surgery service does not affect wait-times for elective cancer surgeries: a retrospective cohort study.

    PubMed

    Anantha, Ram Venkatesh; Paskar, Dave; Vogt, Kelly; Crawford, Silvie; Parry, Neil; Leslie, Ken

    2014-03-27

    Acute care surgical services provide timely comprehensive emergency general surgical care while optimizing the use of limited resources. At our institution, 50% of the daily dedicated operating room (OR) time allocated to the Acute Care Emergency Surgery Service (ACCESS) came from previous elective general surgery OR time. We assessed the impact of this change in resource allocation on wait-times for elective general surgery cancer cases. We retrospectively reviewed adult patients who underwent elective cancer surgeries in the pre-ACCESS (September 2009 to June 2010) and post-ACCESS (September 2010 to June 2011) eras. Wait-times, calculated as the time between booking and actual dates of surgery, were compared within assigned priority classifications. Categorical and continuous variables were compared using chi-square and Mann-Whitney U tests respectively. A total of 732 cases (367 pre-ACCESS and 365 post-ACCESS) were identified, with no difference in median wait-times (25 versus 23 days) between the eras. However, significantly fewer cases exceeded wait-time targets in the post-ACCESS era (p <0.0001). There was a significant change (p = 0.027) in the composition of cancer cases, with fewer breast cancer operations (22% versus 28%), and more colorectal (41% versus 32%) and hepatobiliary cancer cases (5% versus 2%) in the post-ACCESS era. These results suggest that shifting OR resources towards emergency surgery does not affect the timeliness of surgical cancer care. This study may encourage more centres to adopt acute care surgical services alongside their elective or subspecialty practices.

  13. Ambulatory health service users' experience of waiting time and expenditure and factors associated with the perception of low quality of care in Mexico.

    PubMed

    Sauceda-Valenzuela, Alma Lucila; Wirtz, Veronika J; Santa-Ana-Téllez, Yared; de la Luz Kageyama-Escobar, Maria

    2010-06-23

    A principal reason for low use of public health care services is the perception of inferior quality of care. Studying health service user (HSU) experiences with their care and their perception of health service quality is critical to understanding health service utilization. The aim of this study was to define reference points for some aspects of health care quality and to analyze which HSU experiences resulted in perceptions of overall low quality of care. Data from the National Health Survey 2006 were used to compare the experiences of HSUs with their ambulatory care at Ministry of Health and affiliated institutions (MOH), social security institutions (SSI) and private institutions (PrivI). Reference points of quality of care related to waiting time and expenditure were defined for each of the three types of institutions by analyzing HSU experiences rated as 'acceptable'. A multivariable logistic regression model was used to identify the principal factors associated with the general perception of low quality of care. A total of 11,959 HSUs were included in the analysis, of whom 37.6% (n = 4,500) HSUs received care at MOH facilities; 31.2% (n = 3,730) used SSI and 31.2% (n = 3,729) PrivI. An estimated travel and waiting time of 10 minutes respectively was rated as acceptable by HSUs from all institutions. The differences between the waiting time rated as acceptable and the actual waiting time were the largest for SSI (30 min) in comparison to MoH (20 min) and PrivI (5 min) users. The principal factors associated with an overall perception of low quality of care are type of institution (OR 4.36; 95% CI 2.95-6.44), waiting time (OR 3.20; 95% CI 2.35-4.35), improvement of health after consultation (OR 2.93; CI 2.29-3.76) and consultation length of less than 20 minutes (2.03; 95% CI 1.60-2.57). The reference points derived by the HSUs' own ratings are useful in identifying where quality improvements are required. Prioritizing the reduction of waiting times and

  14. Ambulatory health service users' experience of waiting time and expenditure and factors associated with the perception of low quality of care in Mexico

    PubMed Central

    2010-01-01

    Background A principal reason for low use of public health care services is the perception of inferior quality of care. Studying health service user (HSU) experiences with their care and their perception of health service quality is critical to understanding health service utilization. The aim of this study was to define reference points for some aspects of health care quality and to analyze which HSU experiences resulted in perceptions of overall low quality of care. Methods Data from the National Health Survey 2006 were used to compare the experiences of HSUs with their ambulatory care at Ministry of Health and affiliated institutions (MOH), social security institutions (SSI) and private institutions (PrivI). Reference points of quality of care related to waiting time and expenditure were defined for each of the three types of institutions by analyzing HSU experiences rated as 'acceptable'. A multivariable logistic regression model was used to identify the principal factors associated with the general perception of low quality of care. Results A total of 11,959 HSUs were included in the analysis, of whom 37.6% (n = 4,500) HSUs received care at MOH facilities; 31.2% (n = 3,730) used SSI and 31.2% (n = 3,729) PrivI. An estimated travel and waiting time of 10 minutes respectively was rated as acceptable by HSUs from all institutions. The differences between the waiting time rated as acceptable and the actual waiting time were the largest for SSI (30 min) in comparison to MoH (20 min) and PrivI (5 min) users. The principal factors associated with an overall perception of low quality of care are type of institution (OR 4.36; 95% CI 2.95-6.44), waiting time (OR 3.20; 95% CI 2.35-4.35), improvement of health after consultation (OR 2.93; CI 2.29-3.76) and consultation length of less than 20 minutes (2.03; 95% CI 1.60-2.57). Conclusions The reference points derived by the HSUs' own ratings are useful in identifying where quality improvements are required. Prioritizing the

  15. Willingness to wait and altered encoding of time-discounted reward in the orbitofrontal cortex with normal aging.

    PubMed

    Roesch, Matthew R; Bryden, Daniel W; Cerri, Domenic H; Haney, Zachary R; Schoenbaum, Geoffrey

    2012-04-18

    Normal aging has been associated with cognitive changes, including shifts in responding for time-discounted rewards. The orbitofrontal cortex, an area previously associated with aging-related cognitive changes, is critical for normal discounting. Previously we have shown in a choice task that rats prefer immediate over delayed reward and that neural representations of delayed reward in orbitofrontal cortex were attenuated, whereas immediate reward elicited strong responses. Changes in choice performance were correlated with changes in firing rate in orbitofrontal neurons, suggesting that these reward representations were critical to the rats' ability to wait for reward. Here we asked whether age-dependent changes in discounting behavior were related to changes in the representation of delayed reward in the orbitofrontal cortex. Young (3-6 months) and aged (22-26 months) rats were trained on the same discounting paradigm used previously. We found that aged rats showed less sensitivity to increasing delay preceding reward delivery, shifting behavior away from the delayed reward more slowly than younger rats. This sensitivity was specific to delay, since choice performance did not differ between the two groups when delay was held constant and reward size varied. Aged rats exhibited a corresponding increase in the prevalence of neurons that fired more strongly for delayed reward. Again this change was specific to delay; there was no change in encoding of different-sized rewards. These results suggest that natural aging results in altered representations of reward in orbitofrontal cortex. These changes may relate to the increased ability to delay gratification and reduced impulsivity associated with aging.

  16. [Evolution of waiting time and length of stay between 2005 and 2012 in an obstetric and gynaecologic emergency unit in a French teaching hospital].

    PubMed

    Coutin, A-S; Vaucel, E

    2014-05-01

    To compare and analyze waiting time and length of stay between 2005 and 2012 in the obstetric and gynaecologic emergency unit of Nantes teaching hospital, new unit opened in 2004. Descriptive study from the registers over 2months' periods in 2005 and 2012. Despite an increase of the daily average number of visits from 28 to 39 (P<0.0001), the waiting time increased in obstetrics from 15minutes to 18 in 2012, P<0.03. In gynaecology, waiting time decreased in 2012 on daytime weekdays (37minutes versus 44) and increased on weekend (41minutes versus 28) and at night (37minutes versus 23) P<0.01. The length of stay was similar in obstetrics (108minutes versus 104) but reduced on daytime weekdays (124minutes in 2005, 109 in 2012, P<0.05). In gynaecology duration was similar (108minutes versus 105), but decreased on daytime weekdays (110minutes in 2005, 101 in 2012) and increased on overnight weekend (94minutes in 2005, 121 in 2012) (P<0.05). Our organization enabled to improve some lengths of time despite an increased activity. Those lengths of time should be monitored as they reflect our organizations and are indicators of efficiency. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  17. 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

  18. Waiting for a hand: saccadic reaction time increases in proportion to hand reaction time when reaching under a visuomotor reversal

    PubMed Central

    Armstrong, Irene T.; Judson, Melissa; Munoz, Douglas P.; Johansson, Roland S.; Flanagan, J. Randall

    2013-01-01

    Although eye movement onset typically precedes hand movement onset when reaching to targets presented in peripheral vision, arm motor commands appear to be issued at around the same time, and possibly in advance, of eye motor commands. A fundamental question, therefore, is whether eye movement initiation is linked or yoked to hand movement. We addressed this issue by having participants reach to targets after adapting to a visuomotor reversal (or 180° rotation) between the position of the unseen hand and the position of a cursor controlled by the hand. We asked whether this reversal, which we expected to increase hand reaction time (HRT), would also increase saccadic reaction time (SRT). As predicted, when moving the cursor to targets under the reversal, HRT increased in all participants. SRT also increased in all but one participant, even though the task for the eyes—shifting gaze to the target—was unaltered by the reversal of hand position feedback. Moreover, the effects of the reversal on SRT and HRT were positively correlated across participants; those who exhibited the greatest increases in HRT also showed the greatest increases in SRT. These results indicate that the mechanisms underlying the initiation of eye and hand movements are linked. In particular, the results suggest that the initiation of an eye movement to a manual target depends, at least in part, on the specification of hand movement. PMID:23847494

  19. Reducing Patient Waiting Times for Radiation Therapy and Improving the Treatment Planning Process: a Discrete-event Simulation Model (Radiation Treatment Planning).

    PubMed

    Babashov, V; Aivas, I; Begen, M A; Cao, J Q; Rodrigues, G; D'Souza, D; Lock, M; Zaric, G S

    2017-06-01

    We analysed the radiotherapy planning process at the London Regional Cancer Program to determine the bottlenecks and to quantify the effect of specific resource levels with the goal of reducing waiting times. We developed a discrete-event simulation model of a patient's journey from the point of referral to a radiation oncologist to the start of radiotherapy, considering the sequential steps and resources of the treatment planning process. We measured the effect of several resource changes on the ready-to-treat to treatment (RTTT) waiting time and on the percentage treated within a 14 calendar day target. Increasing the number of dosimetrists by one reduced the mean RTTT by 6.55%, leading to 84.92% of patients being treated within the 14 calendar day target. Adding one more oncologist decreased the mean RTTT from 10.83 to 10.55 days, whereas a 15% increase in arriving patients increased the waiting time by 22.53%. The model was relatively robust to the changes in quantity of other resources. Our model identified sensitive and non-sensitive system parameters. A similar approach could be applied by other cancer programmes, using their respective data and individualised adjustments, which may be beneficial in making the most effective use of limited resources. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  20. 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.

  1. State Action on Sex Equity in Vocational Education. A Compilation of Selected States' Approaches to the Legislated Functions of Full-Time Sex Equity Personnel in Vocational Education.

    ERIC Educational Resources Information Center

    Ellis Associates, Inc., College Park, MD.

    Intended to aid the personnel hired by the states to coordinate and supervise their sex equity efforts in vocational education, this handbook contains brief descriptions of what fifteen states (which were chosen to participate in a workshop on the development of action models to eliminate sex stereotyping from vocational education) have done, and…

  2. Contraceptive Equity

    PubMed Central

    Temkin, Elizabeth

    2007-01-01

    The Equity in Prescription Insurance and Contraceptive Coverage Act, introduced in Congress in 1997 and still unpassed, seeks to redress health insurers’ failure to pay for birth control as they pay for other prescription drugs, most paradoxically Viagra. In 1936 the International Workers Order (IWO), a fraternal society, became the first insurer to include contraception in its benefits package. A forerunner in the movement for prepaid medical care, the IWO offered its members primary care and contraceptive services for annual flat fees. Founded at a time when the legal status of contraception was in flux, the IWO’s Birth Control Center was the only such clinic to operate on an insurance system. Recent state laws and judicial actions have revived the IWO’s groundbreaking view of contraception as a basic preventive service deserving of insurance coverage. PMID:17761562

  3. Breast cancer: diagnosis-to-treatment waiting times for elderly women at a reference hospital of São Paulo, Brazil.

    PubMed

    Souza, Camila Brandão; Fustinoni, Suzete Maria; Amorim, Maria Helena Costa; Zandonade, Eliana; Matos, Jéssica Carvalho; Schirmer, Janine

    2015-12-01

    This study compares waiting time from diagnosis of breast cancer to start of treatment with patients' social-demographic and clinical profiles in women aged 60 or more at the PérolaByington Hospital, São Paulo, over the years 2001-2006.It is a descriptive study based on secondary data in a sample of 1,299 cases. Social-demographic, clinical and temporal variables were collected. Patients were divided into two groups: those with period between diagnosis and start of treatment less than 60 days, and greater than 60 days. The average time between diagnosis and start of treatment was 74.7 days (SD = 212.6), and the median time was 45 days. This waiting time was lower for subjects without diagnosis and without prior treatment (p = 0.001), and also for those with tumors at Stage 0, in situ or Stage I(p = 0.001). Time was significant for the outcomes of relapse (p = 0.004) and metastasis (p = 0.038). Having established diagnosis and treatment also resulted in lower time to start of the required care. Improvement to the structuring and functioning of the health service is an essential need, for dealing with the cases of the disease in an efficient manner, an important challenge for Brazil's Unified Health System.

  4. SCREEN: A simple layperson administered screening algorithm in low resource international settings significantly reduces waiting time for critically ill children in primary healthcare clinics.

    PubMed

    Hansoti, Bhakti; Jenson, Alexander; Kironji, Antony G; Katz, Joanne; Levin, Scott; Rothman, Richard; Kelen, Gabor D; Wallis, Lee A

    2017-01-01

    In low resource settings, an inadequate number of trained healthcare workers and high volumes of children presenting to Primary Healthcare Centers (PHC) result in prolonged waiting times and significant delays in identifying and evaluating critically ill children. The Sick Children Require Emergency Evaluation Now (SCREEN) program, a simple six-question screening algorithm administered by lay healthcare workers, was developed in 2014 to rapidly identify critically ill children and to expedite their care at the point of entry into a clinic. We sought to determine the impact of SCREEN on waiting times for critically ill children post real world implementation in Cape Town, South Africa. This is a prospective, observational implementation-effectiveness hybrid study that sought to determine: (1) the impact of SCREEN implementation on waiting times as a primary outcome measure, and (2) the effectiveness of the SCREEN tool in accurately identifying critically ill children when utilised by the QM and adherence by the QM to the SCREEN algorithm as secondary outcome measures. The study was conducted in two phases, Phase I control (pre-SCREEN implementation- three months in 2014) and Phase II (post-SCREEN implementation-two distinct three month periods in 2016). In Phase I, 1600 (92.38%) of 1732 children presenting to 4 clinics, had sufficient data for analysis and comprised the control sample. In Phase II, all 3383 of the children presenting to the 26 clinics during the sampling time frame had sufficient data for analysis. The proportion of critically ill children who saw a professional nurse within 10 minutes increased tenfold from 6.4% to 64% (Phase I to Phase II) with the median time to seeing a professional nurse reduced from 100.3 minutes to 4.9 minutes, (p < .001, respectively). Overall layperson screening compared to Integrated Management of Childhood Illnesses (IMCI) designation by a nurse had a sensitivity of 94.2% and a specificity of 88.1%, despite large variance

  5. SCREEN: A simple layperson administered screening algorithm in low resource international settings significantly reduces waiting time for critically ill children in primary healthcare clinics

    PubMed Central

    Jenson, Alexander; Kironji, Antony G.; Katz, Joanne; Levin, Scott; Rothman, Richard; Kelen, Gabor D.; Wallis, Lee A.

    2017-01-01

    Background In low resource settings, an inadequate number of trained healthcare workers and high volumes of children presenting to Primary Healthcare Centers (PHC) result in prolonged waiting times and significant delays in identifying and evaluating critically ill children. The Sick Children Require Emergency Evaluation Now (SCREEN) program, a simple six-question screening algorithm administered by lay healthcare workers, was developed in 2014 to rapidly identify critically ill children and to expedite their care at the point of entry into a clinic. We sought to determine the impact of SCREEN on waiting times for critically ill children post real world implementation in Cape Town, South Africa. Methods and findings This is a prospective, observational implementation-effectiveness hybrid study that sought to determine: (1) the impact of SCREEN implementation on waiting times as a primary outcome measure, and (2) the effectiveness of the SCREEN tool in accurately identifying critically ill children when utilised by the QM and adherence by the QM to the SCREEN algorithm as secondary outcome measures. The study was conducted in two phases, Phase I control (pre-SCREEN implementation- three months in 2014) and Phase II (post-SCREEN implementation—two distinct three month periods in 2016). In Phase I, 1600 (92.38%) of 1732 children presenting to 4 clinics, had sufficient data for analysis and comprised the control sample. In Phase II, all 3383 of the children presenting to the 26 clinics during the sampling time frame had sufficient data for analysis. The proportion of critically ill children who saw a professional nurse within 10 minutes increased tenfold from 6.4% to 64% (Phase I to Phase II) with the median time to seeing a professional nurse reduced from 100.3 minutes to 4.9 minutes, (p < .001, respectively). Overall layperson screening compared to Integrated Management of Childhood Illnesses (IMCI) designation by a nurse had a sensitivity of 94.2% and a

  6. Gender equity.

    PubMed

    Shiva, M

    1999-01-01

    This paper focuses on gender equity. Gender equity is difficult to achieve when there is no economic, social, or political equity. The Gender Development Index evidenced this. There were a lot of instances where women are psychologically traumatized, whether it is through domestic rape, purchased sexual services in the red light area, and seduction or violation of neighbors, relatives, daughter or child. The economic changes linked with globalization and media's influence have worsened women's position. The policy for empowerment of women is an attempt toward ensuring equity. Furthermore, many women and women's organizations are trying to address these inequities; wherein they fight for strong acceptance of women's rights, social, economic, and political rights, as well as equities between gender and within gender.

  7. 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.

  8. Whittling Down the Wait Time: Exploring Models to Minimize the Delay from Initial Concern to Diagnosis and Treatment of Autism Spectrum Disorder.

    PubMed

    Gordon-Lipkin, Eliza; Foster, Jessica; Peacock, Georgina

    2016-10-01

    The process from initial concerns to diagnosis of autism spectrum disorder (ASD) can be a long and complicated process. The traditional model for evaluation and diagnosis of ASD often consists of long wait-lists and evaluations that result in a 2-year difference between the earliest signs of ASD and mean age of diagnosis. Multiple factors contribute to this diagnostic bottleneck, including time-consuming evaluations, cost of care, lack of providers, and lack of comfort of primary care providers to diagnose autism. This article explores innovative clinical models that have been implemented to address this as well as future directions and opportunities. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Waiting for care

    PubMed Central

    Goel, Ritika; Bloch, Gary; Caulford, Paul

    2013-01-01

    Abstract Objective To describe the experiences of a group of new immigrants and caregivers of new immigrants who were subject to the 3-month waiting period for the Ontario Health Insurance Plan and needed to access health care services during that time. Design Qualitative study using a phenomenologic framework. Setting Participants were recruited through the Scarborough Community Volunteer Clinic in Toronto, Ont. Interviews were conducted in person at the clinic or by telephone. Participants Seven participants were interviewed who themselves needed to access health care during the 3-month waiting period for the Ontario Health Insurance Plan or who were caring for someone who did. Methods Seven semistructured, in-depth interviews were conducted using an interview guide; these were recorded and transcribed verbatim. Data were analyzed for themes to arrive at the essence of the participants’ experiences. Main findings Participants believed that there was a lack of clear information and a lack of help from officials. Other common themes included poor social situations, financial loss or threat of financial loss related to health care, a choice to delay seeking care owing to cost, difficulty accessing alternative care, and appreciation for those who advocated on their behalf. Other themes that arose included emotional hardship, poor health outcomes or threat of poor health outcomes resulting from not seeking care, the importance and unpredictability of health, as well as negative impressions of Canada as a country as a result of the negative experience of seeking care. Conclusion New immigrants to Ontario who need to access health care services during the 3-month waiting period for provincial health insurance and the caregivers of such newcomers can have potentially very negative experiences. They might be unable to access care without financial barriers and might, therefore, choose to delay seeking health care until the end of the waiting period; this can lead to

  10. [The international adoption waiting period: waiting experience and coping strategies].

    PubMed

    Pedro-Viejo, Ana Berástegui

    2008-11-01

    The adoption waiting period is a powerful stressor that can affect the well-being and configuration of future family life. Adoption research and practice have not paid enough attention to this phase. The principal aim of this study is to address prospective adoptive parents' experience of and coping with this period. For this purpose, 63 families answered a feelings scale, a coping resources scale and a needs questionnaire, all elaborated for the study. Results show that a shorter length of waiting time, using cognitive and learning coping strategies and associative participation were related to a better general experience of adoption whereas process-centred strategies were related to a worse experience of adoption. Families would like to see more speed in the process, more warmth and humanity in their relation with institutions and better information about their expedients. We conclude by proposing some activities and services during the waiting period that could be useful for post adoption.

  11. G-quadruplex and G-rich sequence stimulate Pif1p-catalyzed downstream duplex DNA unwinding through reducing waiting time at ss/dsDNA junction.

    PubMed

    Zhang, Bo; Wu, Wen-Qiang; Liu, Na-Nv; Duan, Xiao-Lei; Li, Ming; Dou, Shuo-Xing; Hou, Xi-Miao; Xi, Xu-Guang

    2016-09-30

    Alternative DNA structures that deviate from B-form double-stranded DNA such as G-quadruplex (G4) DNA can be formed by G-rich sequences that are widely distributed throughout the human genome. We have previously shown that Pif1p not only unfolds G4, but also unwinds the downstream duplex DNA in a G4-stimulated manner. In the present study, we further characterized the G4-stimulated duplex DNA unwinding phenomenon by means of single-molecule fluorescence resonance energy transfer. It was found that Pif1p did not unwind the partial duplex DNA immediately after unfolding the upstream G4 structure, but rather, it would dwell at the ss/dsDNA junction with a 'waiting time'. Further studies revealed that the waiting time was in fact related to a protein dimerization process that was sensitive to ssDNA sequence and would become rapid if the sequence is G-rich. Furthermore, we identified that the G-rich sequence, as the G4 structure, equally stimulates duplex DNA unwinding. The present work sheds new light on the molecular mechanism by which G4-unwinding helicase Pif1p resolves physiological G4/duplex DNA structures in cells.

  12. G-quadruplex and G-rich sequence stimulate Pif1p-catalyzed downstream duplex DNA unwinding through reducing waiting time at ss/dsDNA junction

    PubMed Central

    Zhang, Bo; Wu, Wen-Qiang; Liu, Na-Nv; Duan, Xiao-Lei; Li, Ming; Dou, Shuo-Xing; Hou, Xi-Miao; Xi, Xu-Guang

    2016-01-01

    Alternative DNA structures that deviate from B-form double-stranded DNA such as G-quadruplex (G4) DNA can be formed by G-rich sequences that are widely distributed throughout the human genome. We have previously shown that Pif1p not only unfolds G4, but also unwinds the downstream duplex DNA in a G4-stimulated manner. In the present study, we further characterized the G4-stimulated duplex DNA unwinding phenomenon by means of single-molecule fluorescence resonance energy transfer. It was found that Pif1p did not unwind the partial duplex DNA immediately after unfolding the upstream G4 structure, but rather, it would dwell at the ss/dsDNA junction with a ‘waiting time’. Further studies revealed that the waiting time was in fact related to a protein dimerization process that was sensitive to ssDNA sequence and would become rapid if the sequence is G-rich. Furthermore, we identified that the G-rich sequence, as the G4 structure, equally stimulates duplex DNA unwinding. The present work sheds new light on the molecular mechanism by which G4-unwinding helicase Pif1p resolves physiological G4/duplex DNA structures in cells. PMID:27471032

  13. The New Articulation of Equity Education in Neoliberal Times: The Changing Conception of Social Justice in Ontario

    ERIC Educational Resources Information Center

    Rezai-Rashti, G.; Segeren, A.; Martino, W.

    2017-01-01

    In this paper, we draw attention to the impact of neoliberal globalisation in rearticulating conceptions of equity within the Ontario context. The Ontario education system has been hailed for its top performance on Programme for International Student Assessment (PISA) as a high-equity/high-quality education system and created "PISA envy"…

  14. 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…

  15. 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…

  16. History of Pay Equity Studies.

    ERIC Educational Resources Information Center

    Barbezat, Debra A.

    2002-01-01

    Traces the evolution of salary-equity studies over time, and how the findings have changed with regard to pay differences by gender and race/ethnicity. Reviews the literature on salary equity for both faculty and nonfaculty academic employees. (EV)

  17. An audit of waiting times at a district general hospital sexual health department--how far are we from the 48 hours target?

    PubMed

    Crowe, G

    2007-04-01

    The Government has stated that by 2008, anyone who wants an appointment at a genitourinary medicine clinic should be able to get one within 48 hours. We have performed an audit of waiting times for appointments in our clinic and compared this to the most recent Health Protection Agency (HPA) audit. Our audit showed that 75% of people were offered an appointment within 48 hours, but only 62% accepted - the rest wanted to be seen later. In contrast, the HPA audit suggests that only 63% of patients were offered an appointment within 48 hours, and 59% were seen within this time frame. Our audit highlights the fact that many people do not want to be seen within 48 hours and call in to question the validity of this as a target for all patients.

  18. Use of HCV+ Donors Does Not Affect HCV Clearance With Directly Acting Antiviral Therapy But Shortens the Wait Time to Kidney Transplantation.

    PubMed

    Sawinski, Deirdre; Patel, Nikunjkumar; Appolo, Brenda; Bloom, Roy

    2017-05-01

    Hepatitis C virus (HCV) infection is prevalent in the renal transplant population but direct acting antiviral agents (DAA) provide an effective cure of HCV infection without risk of allograft rejection. We report our experience treating 43 renal transplant recipients with 4 different DAA regimens. One hundred percent achieved a sustained viral response by 12 weeks after therapy, and DAA regimens were well tolerated. Recipients transplanted with a HCV+ donor responded equally well to DAA therapy those transplanted with a kidney from an HCV- donor, but recipients of HCV+ organs experienced significantly shorter wait times to transplantation, 485 days (interquartile range, 228-783) versus 969 days (interquartile range, 452-2008; P = 0.02). On this basis, we advocate for a strategy of early posttransplant HCV eradication to facilitate use of HCV+ organs whenever possible. Additional studies are needed to identify the optimal DAA regimen for kidney transplant recipients, accounting for efficacy, timing relative to transplant, posttransplant clinical outcomes, and cost.

  19. Waiting for surgery from the patient perspective

    PubMed Central

    Carr, Tracey; Teucher, Ulrich; Mann, Jackie; Casson, Alan G

    2009-01-01

    The aim of this study was to perform a systematic review of the impact of waiting for elective surgery from the patient perspective, with a focus on maximum tolerance, quality of life, and the nature of the waiting experience. Searches were conducted using Medline, PubMed, CINAHL, EMBASE, and HealthSTAR. Twenty-seven original research articles were identified which included each of these three themes. The current literature suggested that first, patients tend to state longer wait times as unacceptable when they experienced severe symptoms or functional impairment. Second, the relationship between length of wait and health-related quality of life depended on the nature and severity of proposed surgical intervention at the time of booking. Third, the waiting experience was consistently described as stressful and anxiety provoking. While many patients expressed anger and frustration at communication within the system, the experience of waiting was not uniformly negative. Some patients experienced waiting as an opportunity to live full lives despite pain and disability. The relatively unexamined relationship between waiting, illness and patient experience of time represents an area for future research. PMID:22110325

  20. Equity in health care.

    PubMed

    La Rosa-Salas, Virginia; Tricas-Sauras, Sandra

    2008-01-01

    It has long been known that a segment of the population enjoys distinctly better health status and higher quality of health care than others. To solve this problem, prioritization is unavoidable, and the question is how priorities should be set. Rational priority setting would seek equity amongst the whole population, the extent to which people receive equal care for equal needs. Equity in health care is an ethical imperative not only because of the intrinsic worth of good health, or the value that society places on good health, but because, without good health, people would be unable to enjoy life's other sources of happiness. This paper also argues the importance of the health care's efficiency, but at the same time, it highlights how any innovation and rationalization undertaken in the provision of the health system should be achieved from the consideration of human dignity, making the person prevail over economic criteria. Therefore, the underlying principles on which this health care equity paper is based are fundamental human rights. The main aim is to ensure the implementation of these essential rights by those carrying out public duties. Viewed from this angle, equity in health care means equality: equality in access to services and treatment, and equality in the quality of care provided. As a result, this paper attempts to address both human dignity and efficiency through the context of equity to reconcile them in the middle ground.

  1. Exploring implications of Medicaid participation and wait times for colorectal screening on early detection efforts in Connecticut--a secret-shopper survey.

    PubMed

    Patel, Vatsal B; Nahar, Richa; Murray, Betty; Salner, Andrew L

    2013-04-01

    Routine colorectal screening, decreases in incidence, and advances in treatment have lowered colorectal cancer mortality rates over the past three decades. Nevertheless, it remains the second most common cause of cancer death amongst men and women combined in U.S. Most cases of colon cancer are diagnosed at a late stage leading to poor survival outcomes for patients. After extensive research of publically available data, it would appear that the state of Connecticut does not have available state-wide data on patient wait times for routine colonoscopy screening. Furthermore, there are no publicly available, or Connecticut-specific, reports on Medicaid participation rates for colorectal screening amongst gastroenterologists (GI) in Connecticut. In 2012, the American Cancer Society report on Colorectal Cancer Screening Rates confirmed barriers to health-care access and disparities in health outcomes and survival rates for colon cancer patients based on race, ethnicity, and low socioeconomic status. Given this information, one could conjecture that low Medicaid participation rates among GIs could potentially have a more severe impact on health-care access and outcomes for underserved populations. At present, funding and human resources are being employed across the state of Connecticut to address bottlenecks in colorectal cancer screening. More specifically, patient navigation and outreach programs are emerging and expanding to address the gaps in services for hard-to-reach populations and the medically underserved. Low Medicaid participation rates and increased wait times for colonoscopy screening may impair the efficacy of colorectal cancer patient navigation and outreach efforts and potentially funding for future interventions. In this study, we report the results of our secret-shopper telephone survey comprising of 93 group and independent gastroenterologist (GI) practices in different counties of Connecticut. Reviewing online resources and yellow pages

  2. The process of family waiting during surgery.

    PubMed

    Trimm, Donna R; Sanford, Julie T

    2010-11-01

    In 2006, there were 46 million surgical procedures performed in the United States, all of which would have typically included waiting by the family and/or friends. A grounded-theory approach was used to examine the experiences of waiting family members during surgery of a loved one. A convenience sample of 32 family members of patients undergoing surgery were interviewed in two surgical waiting rooms. Constant comparison of the data was performed until saturation of categories was achieved. The resulting middle-range theory, maintaining balance during the wait, described the family member's struggle for balance during the surgical wait. Four domains were identified: focusing on the patient, passing the time, interplay of thoughts and feelings, and giving and/or receiving support. Study findings showed that understanding this struggle for balance during a surgery is imperative for nurses who often interact with family members and need to address their needs.

  3. 78 FR 41293 - Premerger Notification; Reporting and Waiting Period Requirements

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-10

    ... CFR Part 803 RIN 3084-AA91 Premerger Notification; Reporting and Waiting Period Requirements AGENCY... (``the Assistant Attorney General'') (collectively, ``the Agencies'') and to wait a specified period of time before consummating such transactions. The reporting and waiting period requirements are intended...

  4. Implementing wait-time reductions under Ontario government benchmarks (Pay-for-Results): a Cluster Randomized Trial of the Effect of a Physician-Nurse Supplementary Triage Assistance team (MDRNSTAT) on emergency department patient wait times

    PubMed Central

    2013-01-01

    Background Internationally, emergency departments are struggling with crowding and its associated morbidity, mortality, and decreased patient and health-care worker satisfaction. The objective was to evaluate the addition of a MDRNSTAT (Physician (MD)-Nurse (RN) Supplementary Team At Triage) on emergency department patient flow and quality of care. Methods Pragmatic cluster randomized trial. From 131 weekday shifts (8:00–14:30) during a 26-week period, we randomized 65 days (3173 visits) to the intervention cluster with a MDRNSTAT presence, and 66 days (3163 visits) to the nurse-only triage control cluster. The primary outcome was emergency department length-of-stay (EDLOS) for patients managed and discharged only by the emergency department. Secondary outcomes included EDLOS for patients initially seen by the emergency department, and subsequently consulted and admitted, patients reaching government-mandated thresholds, time to initial physician assessment, left-without being seen rate, time to investigation, and measurement of harm. Results The intervention’s median EDLOS for discharged, non-consulted, high acuity patients was 4:05 [95th% CI: 3:58 to 4:15] versus 4:29 [95th% CI: 4:19–4:38] during comparator shifts. The intervention’s median EDLOS for discharged, non-consulted, low acuity patients was 1:55 [95th% CI: 1:48 to 2:05] versus 2:08 [95th% CI: 2:02–2:14]. The intervention’s median physician initial assessment time was 0:55 [95th% CI: 0:53 to 0:58] versus 1:21 [95th% CI: 1:18 to 1:25]. The intervention’s left-without-being-seen rate was 1.5% versus 2.2% for the control (p = 0.06). The MDRNSTAT subgroup analysis resulted in significant decreases in median EDLOS for discharged, non-consulted high (4:01 [95th% CI: 3:43–4:16]) and low acuity patients (1:10 95th% CI: 0:58–1:19]), as well as physician initial assessment time (0:25 [95th% CI: 0:23–0:26]). No patients returned to the emergency department after being discharged by the

  5. Implementing wait-time reductions under Ontario government benchmarks (Pay-for-Results): a Cluster Randomized Trial of the Effect of a Physician-Nurse Supplementary Triage Assistance team (MDRNSTAT) on emergency department patient wait times.

    PubMed

    Cheng, Ivy; Lee, Jacques; Mittmann, Nicole; Tyberg, Jeffrey; Ramagnano, Sharon; Kiss, Alex; Schull, Michael; Kerr, Fergus; Zwarenstein, Merrick

    2013-11-11

    Internationally, emergency departments are struggling with crowding and its associated morbidity, mortality, and decreased patient and health-care worker satisfaction. The objective was to evaluate the addition of a MDRNSTAT (Physician (MD)-Nurse (RN) Supplementary Team At Triage) on emergency department patient flow and quality of care. Pragmatic cluster randomized trial. From 131 weekday shifts (8:00-14:30) during a 26-week period, we randomized 65 days (3173 visits) to the intervention cluster with a MDRNSTAT presence, and 66 days (3163 visits) to the nurse-only triage control cluster. The primary outcome was emergency department length-of-stay (EDLOS) for patients managed and discharged only by the emergency department. Secondary outcomes included EDLOS for patients initially seen by the emergency department, and subsequently consulted and admitted, patients reaching government-mandated thresholds, time to initial physician assessment, left-without being seen rate, time to investigation, and measurement of harm. The intervention's median EDLOS for discharged, non-consulted, high acuity patients was 4:05 [95th% CI: 3:58 to 4:15] versus 4:29 [95th% CI: 4:19-4:38] during comparator shifts. The intervention's median EDLOS for discharged, non-consulted, low acuity patients was 1:55 [95th% CI: 1:48 to 2:05] versus 2:08 [95th% CI: 2:02-2:14]. The intervention's median physician initial assessment time was 0:55 [95th% CI: 0:53 to 0:58] versus 1:21 [95th% CI: 1:18 to 1:25]. The intervention's left-without-being-seen rate was 1.5% versus 2.2% for the control (p = 0.06). The MDRNSTAT subgroup analysis resulted in significant decreases in median EDLOS for discharged, non-consulted high (4:01 [95th% CI: 3:43-4:16]) and low acuity patients (1:10 95th% CI: 0:58-1:19]), as well as physician initial assessment time (0:25 [95th% CI: 0:23-0:26]). No patients returned to the emergency department after being discharged by the MDRNSTAT at triage. The intervention reduced delays

  6. Co-movement of Africa's equity markets: Regional and global analysis in the frequency-time domains

    NASA Astrophysics Data System (ADS)

    Boako, Gideon; Alagidede, Paul

    2017-02-01

    This paper examines regional and global co-movement of Africa's stock markets using the three-dimensional continuous Morlet wavelet transform methodology. The analyses which are done in segments investigate co-movements with global markets; bilateral exchange rates expressed in US dollars and euro; and four regional markets in Africa. First, we find evidence of stronger co-movements broadly narrowed to short-run fluctuations. The co-movements are time-varying and commonly non-homogeneous - with phase difference arrow vectors implying lead-lag relationships. The presence of lead-lag effects and stronger co-movements at short-run fluctuations may induce arbitrage and diversification opportunities to both local and international investors with long-term investment horizons. The findings also reveal that some African equity markets are, to a degree, segmented from volatilities of the dollar and euro exchange rates. Thus, inferring that, ceteris paribus, international investors may diversify their portfolio investments across those markets without worrying about the effects of currency price volatility.

  7. Out-of-School-Time Academic Programs to Improve School Achievement: A Community Guide Health Equity Systematic Review.

    PubMed

    Knopf, John A; Hahn, Robert A; Proia, Krista K; Truman, Benedict I; Johnson, Robert L; Muntaner, Carles; Fielding, Jonathan E; Jones, Camara Phyllis; Fullilove, Mindy T; Hunt, Pete C; Qu, Shuli; Chattopadhyay, Sajal K; Milstein, Bobby

    2015-01-01

    Low-income and minority status in the United States are associated with poor educational outcomes, which, in turn, reduce the long-term health benefits of education. This systematic review assessed the extent to which out-of-school-time academic (OSTA) programs for at-risk students, most of whom are from low-income and racial/ethnic minority families, can improve academic achievement. Because most OSTA programs serve low-income and ethnic/racial minority students, programs may improve health equity. Methods of the Guide to Community Preventive Services were used. An existing systematic review assessing the effects of OSTA programs on academic outcomes (Lauer et al 2006; search period 1985-2003) was supplemented with a Community Guide update (search period 2003-2011). Standardized mean difference. Thirty-two studies from the existing review and 25 studies from the update were combined and stratified by program focus (ie, reading-focused, math-focused, general academic programs, and programs with minimal academic focus). Focused programs were more effective than general or minimal academic programs. Reading-focused programs were effective only for students in grades K-3. There was insufficient evidence to determine effectiveness on behavioral outcomes and longer-term academic outcomes. OSTA programs, particularly focused programs, are effective in increasing academic achievement for at-risk students. Ongoing school and social environments that support learning and development may be essential to ensure the longer-term benefits of OSTA programs.

  8. What are the real waiting times for therapeutic management of head and neck cancer: a study in the general population in the north-west of France.

    PubMed

    Guizard, Anne-Valerie; Dejardin, Olivier; Launay, Ludivine; Bara, Simona; Lapôtre-Ledoux, Bénédicte; Babin, Emmanuel; Launoy, Guy; Ligier, Karine

    2016-11-01

    Head and neck cancers (HNC) have a poor prognosis and a long treatment delay may have a negative impact on this. Some studies have investigated the determinants of this delay but not in the general population and rarely taking into account socio-economic factors. A high-resolution population-based study about cancer management was conducted, using registries in the north-west of France, on HNC diagnosed between 2008 and 2010. The median time between diagnosis and multidisciplinary team meeting (DMI) (N = 1631) was 14 days (Q1: 7 to Q3: 26). The median time between diagnosis and first treatment (DTI) (N = 1519) was 35 days (Q1: 21 to Q3: 54). When the first treatment was radiotherapy, the interval was 54.5 days (Q1: 40 to Q3: 71). In multivariate analysis, DTI was associated with the type of first treatment and place of treatment. For advanced stage HNC, DTI was associated with comorbidities, topography of the cancer and socio-economic status, underprivileged patients being treated later than privileged ones. Given the French governmental cancer plans which set out to coordinate care pathways via nursing coordinators and to improve the availability of radiotherapy, the waiting times observed in this study still seem long. The optimal care pathway should include adapted social management but the DTI was still longer for underprivileged patients.

  9. Increasing Time and Enriching Learning for Greater Equity in Schools: Perspective from Two Community Funders

    ERIC Educational Resources Information Center

    Lopez, Janet; Rivera, Peter

    2015-01-01

    Foundations across the country engage in grantmaking to eliminate the opportunity and achievement gaps in K-12 public schools. Many of the strategies and investments that funders have supported in recent years focus not only on "more time" but also on "better use of time" in schools. This better use of time centers on outcomes…

  10. The impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department: a systematic review.

    PubMed

    Jennings, Natasha; Clifford, Stuart; Fox, Amanda R; O'Connell, Jane; Gardner, Glenn

    2015-01-01

    To provide the best available evidence to determine the impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department for adult patients. The delivery of quality care in the emergency department is emerging as one of the most important service indicators in health delivery. Increasing service pressures in the emergency department have resulted in the adoption of service innovation models: the most common and rapidly expanding of these is emergency nurse practitioner services. The rapid uptake of emergency nurse practitioner service in Australia has outpaced the capacity to evaluate this service model in terms of outcomes related to safety and quality of patient care. Previous research is now outdated and not commensurate with the changing domain of delivering emergency care with nurse practitioner services. A comprehensive search of four electronic databases from 2006 to 2013 was conducted to identify research evaluating nurse practitioner service impact in the emergency department. English language articles were sought using MEDLINE, CINAHL, Embase and Cochrane and included two previous systematic reviews completed five and seven years ago. A three step approach was used. Following a comprehensive search, two reviewers assessed all identified studies against the inclusion criteria. From the original 1013 studies, 14 papers were retained for critical appraisal on methodological quality by two independent reviewers and data were extracted using standardised tools. Narrative synthesis was conducted to summarise and report the findings as insufficient data was available for meta-analysis of results. This systematic review has shown that emergency nurse practitioner service has a positive impact on quality of care, patient satisfaction and waiting times. There was insufficient evidence to draw conclusions regarding outcomes of a cost benefit analysis. Synthesis of the available research attempts to provide an

  11. The Relationship between Wait Time after Triage and Show Rate for Intake in a Nonurgent Student Population

    ERIC Educational Resources Information Center

    DiMino, John; Blau, Gary

    2012-01-01

    Ideally, students requesting services should be seen quickly at their university counseling center to increase the likelihood of a successful treatment outcome. However, in these times of ever-increasing demand for university counseling services and the challenges of securing resources to keep up with that demand, the reality of prompt…

  12. Waiting in Line: Low Income Families and the Search for Housing. Watching Out for Children in Changing Times.

    ERIC Educational Resources Information Center

    Philadelphia Citizens for Children and Youth, PA.

    The existing housing crisis for Philadelphia's low income families has been exacerbated by a decrease in the real income of these families over the past 10 years, a shortage of affordable housing during the same period, and the deterioration of much of the existing housing stock. "Watching Out for Children in Changing Times," a joint…

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

    DTIC Science & Technology

    2013-05-07

    5  3.  Information Technology ............................................................... 6  B.  LEAN SIX SIGMA APPLICATION...Control ICP Inventory Control Point IT Information Technology LRT Logistics Response Time LS Logistics Specialist MBA Master of Business...opportunity exists to leverage current technologies and practices in order to reduce the manpower involved or eliminate redundant steps in the process

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

    DTIC Science & Technology

    2013-06-01

    Information Technology ......................................................................6  B.  LEAN SIX SIGMA APPLICATION...Control ICP Inventory Control Point IT Information Technology LCPO Leading Chief Petty Officer LS Logistics Specialists MBA Masters of...time for the end user. Furthermore, we evaluate whether the opportunity exists to leverage current technologies and practices in order to reduce the

  15. Two-state theory of binned photon statistics for a large class of waiting time distributions and its application to quantum dot blinking

    SciTech Connect

    Volkán-Kacsó, Sándor

    2014-06-14

    A theoretical method is proposed for the calculation of the photon counting probability distribution during a bin time. Two-state fluorescence and steady excitation are assumed. A key feature is a kinetic scheme that allows for an extensive class of stochastic waiting time distribution functions, including power laws, expanded as a sum of weighted decaying exponentials. The solution is analytic in certain conditions, and an exact and simple expression is found for the integral contribution of “bright” and “dark” states. As an application for power law kinetics, theoretical results are compared with experimental intensity histograms from a number of blinking CdSe/ZnS quantum dots. The histograms are consistent with distributions of intensity states around a “bright” and a “dark” maximum. A gap of states is also revealed in the more-or-less flat inter-peak region. The slope and to some extent the flatness of the inter-peak feature are found to be sensitive to the power-law exponents. Possible models consistent with these findings are discussed, such as the combination of multiple charging and fluctuating non-radiative channels or the multiple recombination center model. A fitting of the latter to experiment provides constraints on the interaction parameter between the recombination centers. Further extensions and applications of the photon counting theory are also discussed.

  16. Intrapartum antibiotic prophylaxis for Group B Streptococcus: has the time come to wait more than 4 hours?

    PubMed

    Turrentine, Mark

    2014-07-01

    Despite progress in preventing infant group B streptococcal disease, group B streptococcus remains the leading cause of early-onset neonatal sepsis in the United States. Fortunately, most women who are colonized with group B streptococcus receive therapy and antibiotic prophylaxis is effective. However, the only factor associated with missed chemoprophylaxis is the short duration of time between hospital admission and delivery. Although antibiotic prophylaxis given for at least 2 hours shows some pharmacological benefit, the most effective method of preventing early-onset group B streptococcus disease is 4 hours of therapy. Intrapartum management strategies might be modified to improve the efficacy of antibiotic exposure. Obstetricians should consider strengthening the beneficial effect of intrapartum antibiotic prophylaxis for infants exposed to group B streptococcus by providing at least 4 hours of treatment coverage. Copyright © 2014 Mosby, Inc. All rights reserved.

  17. Wait Times Experienced by Lung Cancer Patients in the BC Southern Interior to Obtain Oncologic Care: Exploration of the Intervals from First Abnormal Imaging to Oncologic Treatment

    PubMed Central

    Chowdhury, Rezwan; Boyce, Andrew; Halperin, Ross

    2015-01-01

    Background: Lung cancer is associated with rapid disease progression, which can significantly progress over a duration of four to eight weeks. This study examines the time interval lung cancer patients from the interior of British Columbia (BC) experience while undergoing diagnostic evaluation, biopsy, staging, and preparation for treatment. Methods: A chart review of lung cancer patients (n=231) referred to the BC Cancer Agency Centre for the Southern Interior between January 1, 2010 and December 31, 2011 was performed. Time zero was defined as the date of the first abnormal chest imaging. Time intervals, expressed as median averages, to specialist consult, biopsy, oncologic referral, initial oncology consultation, and commencement of oncologic treatment were obtained. Results: The median time interval from first abnormal chest imaging to a specialist consultation was 18 days (interquartile range, IQR, 7-36). An additional nine days elapsed prior to biopsy in the form of bronchoscopy, CT-guided biopsy, or sputum cytology (median; IQR, 3-21); if lobectomy was required, 18 days elapsed (median; IQR, 9-28). Eight days were required for pathologic diagnosis and subsequent referral to the cancer centre (median; IQR, 3-16.5). Once referral was received, 10 days elapsed prior to consultation with either a medical or radiation oncologist (median, IQR 5-18). Finally, eight days was required for initiation of radiation and/or chemotherapy (median; IQR, 1-15). The median wait time from detection of lung cancer on imaging to oncologic treatment in the form of radiation and/or chemotherapy was 65.5 days (IQR, 41.5-104.3).  Interpretation: Patients in the BC Southern Interior experience considerable delays in accessing lung cancer care. During this time, the disease has the potential to significantly progress and it is possible that a subset of patients may lose their opportunity for curative intent treatment. PMID:26543688

  18. The Wait Calculation: The Broader Consequences of the Minimum Time from Now to Interstellar Destinations and its Significance to the Space Economy

    NASA Astrophysics Data System (ADS)

    Kennedy, A.

    This paper summarises the wait calculation [1] of interstellar voyagers which finds the minimum time to destination given exponential growth in the rate of travel available to a civilisation. The minimum time obliges stellar system colonisers to consider departure times a significant risk factor in their voyages since a departure then to a destination will beat a departure made at any other time before or after. Generalised conclusions will be drawn about the significant impact that departures to interstellar destinations before, at, or after the minimum time will have on the economic potential of missions and on the inevitability of competition between them. There will be no international law operating in interstellar space and an ability to escape predatory actions en route, or at the destination, can only be done by precise calculations of departure times. Social and economic forces affecting the factors in the growth equation are discussed with reference to the probability of accelerating growth reaching the technological Singularity and strengthening the growth incentive trap. Islamic banking practices are discussed as a credible alternative to compounding interest bearing paper for funding the space economy in the long term and for supporting stakeholder investment in such long term mission development. The paper considers the essential free productivity of the Earth's biosphere and the capital accumulations made possible by land productivity are essential components to a viable long term space economy and that research into re-creating the costless productivity of the biosphere at a destination will determine both the mission's ultimate success and provide means of returns for stakeholders during the long build up. Conclusions of these arguments suggest that the Icarus project should ignore a robotic interstellar mission concept and develop a manned colonising mission from now.

  19. 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

  20. 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.

  1. The study of waiting time to first pregnancy in the south of Iran: A parametric frailty model approach

    PubMed Central

    Zare, Najaf; Nouri, Bijan; Moradi, Fariba; Parvareh, Maryam

    2017-01-01

    Background: Time to first pregnancy (TTFP) has never been studied in an Iranian setting. Lifestyle, occupational and environmental factors have been suggested to affect the female reproduction. Objective: This study was conducted to measure TTFP in the south of Iran and survey the effects of several similar factors on TTFP by frailty models. Materials and Methods: The data on TTFP were available for 882 women who were randomly selected from the rural population (the south of Iran). Only the first and the planned pregnancies of every woman were included. The data were collected retrospectively by using self-administered questionnaires. Frailty and shared frailty models were used to determine which factors had the highest impact on TTFP. Results: The median TTFP was 6.4 months and several factors were surveyed. However, only the age of marriage, height, maternal education and regularity of menstruation prior to conception were selected in the multivariable models. Conclusion: Among the several factors which were included in the study, the result of frailty model showed that the height, age of marriage and regular menstruation seemed more notable predictors of TTFP. PMID:28280795

  2. The study of waiting time to first pregnancy in the south of Iran: A parametric frailty model approach.

    PubMed

    Zare, Najaf; Nouri, Bijan; Moradi, Fariba; Parvareh, Maryam

    2017-01-01

    Time to first pregnancy (TTFP) has never been studied in an Iranian setting. Lifestyle, occupational and environmental factors have been suggested to affect the female reproduction. This study was conducted to measure TTFP in the south of Iran and survey the effects of several similar factors on TTFP by frailty models. The data on TTFP were available for 882 women who were randomly selected from the rural population (the south of Iran). Only the first and the planned pregnancies of every woman were included. The data were collected retrospectively by using self-administered questionnaires. Frailty and shared frailty models were used to determine which factors had the highest impact on TTFP. The median TTFP was 6.4 months and several factors were surveyed. However, only the age of marriage, height, maternal education and regularity of menstruation prior to conception were selected in the multivariable models. Among the several factors which were included in the study, the result of frailty model showed that the height, age of marriage and regular menstruation seemed more notable predictors of TTFP.

  3. [A study on organ transplantation waiting lines in Brazil's Unified National Health System].

    PubMed

    Marinho, Alexandre

    2006-10-01

    This study analyzes the waiting lines for solid organ transplants in Brazil's Unified National Health System. By using a queuing theory model, we estimate the waiting times for different organs under alternative scenarios. The model reveals the elasticity of various waiting times with respect to arrival and service rates for organ transplantation within the system. Average waiting time for a solid organ transplant is very long and highly elastic in Brazil. The article discusses some important possibilities for reducing such waiting times.

  4. Evaluation of patients' attitudes to their care during oral and maxillofacial surgical outpatient consultations: the importance of waiting times and quality of interaction between patient and doctor.

    PubMed

    Dimovska, E O F; Sharma, S; Trebble, T M

    2016-06-01

    Knowing what patients think about their care is fundamental to the provision of an effective, quality service, and it can help to direct change and reduce costs. Much of the work in oral and maxillofacial departments concerns the treatment of outpatients, but as little is known about what they think about their care, we aimed to find out which aspects were associated with satisfaction. Consecutive patients (n=244) who attended the oral and maxillofacial outpatient department at Southampton University Hospital NHS Foundation Trust over a 7-day period were given a questionnaire to complete before and after their consultation. It included questions with Likert scale responses on environmental, procedural, and interactive aspects of the visit, and a 16-point scale to rank their priorities. A total of 187 patients (77%) completed the questionnaires. No association was found between expected (p=0.93) or actual (p=0.41) waiting times, and 90% of patients were satisfied with their visit. Seeing the doctor, having confidence in the treatment plan, being listened to, and the ability of the doctor to recognise their personal needs, were ranked as important. Environmental and procedural aspects were considered the least important. These findings may be of value in the development of services to improve patient-centred care. Copyright © 2016 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  5. Are disparities of waiting times for breast cancer care related to socio-economic factors? A regional population-based study (France).

    PubMed

    Ayrault-Piault, Stéphanie; Grosclaude, Pascale; Daubisse-Marliac, Laetitia; Pascal, Jean; Leux, Christophe; Fournier, Evelyne; Tagri, Anne-Delphine; Métais, Magali; Lombrail, Pierre; Woronoff, Anne-Sophie; Molinié, Florence

    2016-11-01

    The increasing number of breast cancer cases may induce longer waiting times (WT), which can be a source of anxiety for patients and may play a role in survival. The aim of this study was to examine the factors, in particular socio-economic factors, related to treatment delays. Using French Cancer Registry databases and self-administered questionnaires, we included 1,152 women with invasive non-metastatic breast cancer diagnosed in 2007. Poisson regression analysis was used to identify WTs' influencing factors. For 973 women who had a malignant tissue sampling, the median of overall WT between the first imaging procedure and the first treatment was 44 days (9 days for pathological diagnostic WT and 31 days for treatment WT). The medical factors mostly explained inequalities in WTs. Socio-economic and behavioral factors had a limited impact on WTs except for social support which appeared to be a key point. Better identifying the factors associated with increase in WTs will make it possible to develop further interventional or prospective studies to confirm their causal role in delay and at last reduce disparities in breast cancer management.

  6. Correlation analysis for energy losses, waiting times and durations of type I edge-localized modes in the Joint European Torus

    NASA Astrophysics Data System (ADS)

    Shabbir, A.; Verdoolaege, G.; Hornung, G.; Kardaun, O. J. W. F.; Zohm, H.; Contributors, JET

    2017-03-01

    Several important ELM control techniques are in large part motivated by the empirically observed inverse relationship between average ELM energy loss and ELM frequency in a plasma. However, to ensure a reliable effect on the energy released by the ELMs, it is important that this relation is verified for individual ELM events. Therefore, in this work the relation between ELM energy loss ≤ft({{W}\\text{ELM}}\\right) and waiting time ≤ft(Δ {{t}\\text{ELM}}\\right) is investigated for individual ELMs in a set of ITER-like wall plasmas in JET. A comparison is made with the results from a set of carbon-wall and nitrogen-seeded ITER-like wall JET plasmas. It is found that the correlation between W ELM and Δ {{t}\\text{ELM}} for individual ELMs varies from strongly positive to zero. Furthermore, the effect of the extended collapse phase often accompanying ELMs from unseeded JET ILW plasmas and referred to as the slow transport event (STE) is studied on the distribution of ELM durations, and on the correlation between W ELM and Δ {{t}\\text{ELM}} . A high correlation between W ELM and Δ {{t}\\text{ELM}} , comparable to CW plasmas is only found in nitrogen-seeded ILW plasmas. Finally, a regression analysis is performed using plasma engineering parameters as predictors for determining the region of the plasma operational space with a high correlation between W ELM and Δ {{t}\\text{ELM}} .

  7. Development of a minimization instrument for allocation of a hospital-level performance improvement intervention to reduce waiting times in Ontario emergency departments

    PubMed Central

    Leaver, Chad Andrew; Guttmann, Astrid; Zwarenstein, Merrick; Rowe, Brian H; Anderson, Geoff; Stukel, Therese; Golden, Brian; Bell, Robert; Morra, Dante; Abrams, Howard; Schull, Michael J

    2009-01-01

    Background Rigorous evaluation of an intervention requires that its allocation be unbiased with respect to confounders; this is especially difficult in complex, system-wide healthcare interventions. We developed a short survey instrument to identify factors for a minimization algorithm for the allocation of a hospital-level intervention to reduce emergency department (ED) waiting times in Ontario, Canada. Methods Potential confounders influencing the intervention's success were identified by literature review, and grouped by healthcare setting specific change stages. An international multi-disciplinary (clinical, administrative, decision maker, management) panel evaluated these factors in a two-stage modified-delphi and nominal group process based on four domains: change readiness, evidence base, face validity, and clarity of definition. Results An original set of 33 factors were identified from the literature. The panel reduced the list to 12 in the first round survey. In the second survey, experts scored each factor according to the four domains; summary scores and consensus discussion resulted in the final selection and measurement of four hospital-level factors to be used in the minimization algorithm: improved patient flow as a hospital's leadership priority; physicians' receptiveness to organizational change; efficiency of bed management; and physician incentives supporting the change goal. Conclusion We developed a simple tool designed to gather data from senior hospital administrators on factors likely to affect the success of a hospital patient flow improvement intervention. A minimization algorithm will ensure balanced allocation of the intervention with respect to these factors in study hospitals. PMID:19505308

  8. Length of stay, wait time to surgery and 30-day mortality for patients with hip fractures after the opening of a dedicated orthopedic weekend trauma room

    PubMed Central

    Taylor, Michel; Hopman, Wilma; Yach, Jeff

    2016-01-01

    Background In September 2011, Kingston General Hospital (KGH) opened a dedicated orthopedic weekend trauma room. Previously, 1 weekend operating room (OR) was used by all surgical services. We assessed the impact this dedicated weekend trauma room had on hospital length of stay (LOS), time to surgery and 30-day mortality for patients with hip fractures. Methods Patients admitted between Oct. 1, 2009, and Sept. 30, 2012, were identified through our trauma registry, representing the 2 years before and 1 year after the opening of the orthopedic weekend trauma room. We documented type of fracture, mode of fixation, age, sex, American Society of Anesthesiologists (ASA) score, time to OR, LOS, discharge disposition and 30-day mortality. We excluded patients with multiple fractures, open fractures and those requiring trauma team activation. Results Our study included 609 patients (405 pre- and 204 post–trauma room opening). Mean LOS decreased from 11.6 to 9.4 days (p = 0.005) and there was a decreasing trend in mean time to OR from 31.5 to 28.5 hours (p = 0.16). There was no difference in 30-day mortality (p = 0.24). The LOS decreased by an average of 2 days following opening of the weekend trauma room (p = 0.031) and by an average of 2.2 additional days if the patient was admitted on the weekend versus during the week (p = 0.024). Conclusion The weekend trauma OR at KGH significantly decreased the LOS and appears to have decreased wait times to surgery. Further analysis is needed to assess the cost-effectiveness of the current strategy, the long-term outcome of this patient population and the impact the additional orthopedic weekend trauma room has had on other surgical services (i.e., general surgery) and their patients. PMID:27668332

  9. Out-of-School-Time Academic Programs to Improve School Achievement: A Community Guide Health Equity Systematic Review

    PubMed Central

    Knopf, John A.; Hahn, Robert A.; Proia, Krista K.; Truman, Benedict I.; Johnson, Robert L.; Muntaner, Carles; Fielding, Jonathan E.; Jones, Camara Phyllis; Fullilove, Mindy T.; Hunt, Pete C.; Qu, Shuli; Chattopadhyay, Sajal K.; Milstein, Bobby

    2015-01-01

    Context Low-income and minority status in the United States are associated with poor educational outcomes, which, in turn, reduce the long-term health benefits of education. Objective This systematic review assessed the extent to which out-of-school-time academic (OSTA) programs for at-risk students, most of whom are from low-income and racial/ethnic minority families, can improve academic achievement. Because most OSTA programs serve low-income and ethnic/racial minority students, programs may improve health equity. Design Methods of the Guide to Community Preventive Services were used. An existing systematic review assessing the effects of OSTA programs on academic outcomes (Lauer et al 2006; search period 1985–2003) was supplemented with a Community Guide update (search period 2003–2011). Main Outcome Measure Standardized mean difference. Results Thirty-two studies from the existing review and 25 studies from the update were combined and stratified by program focus (ie, reading-focused, math-focused, general academic programs, and programs with minimal academic focus). Focused programs were more effective than general or minimal academic programs. Reading-focused programs were effective only for students in grades K-3. There was insufficient evidence to determine effectiveness on behavioral outcomes and longer-term academic outcomes. Conclusions OSTA programs, particularly focused programs, are effective in increasing academic achievement for at-risk students. Ongoing school and social environments that support learning and development may be essential to ensure the longer-term benefits of OSTA programs. PMID:26062096

  10. Colour Consideration for Waiting areas in hospitals

    NASA Astrophysics Data System (ADS)

    Zraati, Parisa

    2012-08-01

    Colour is one the most important factors in the nature that can have some affects on human behaviour. Many years ago, it was proven that using colour in public place can have some affect on the users. Depend of the darkness and lightness; it can be vary from positive to negative. The research will mainly focus on the colour and psychological influences and physical factors. The statement of problem in this research is what is impact of colour usually applied to waiting area? The overall aim of the study is to explore the visual environment of hospitals and to manage the colour psychological effect of the hospital users in the waiting area by creating a comfortable, pleasant and cozy environment for users while spend their time in waiting areas. The analysisconcentrate on satisfaction and their interesting regarding applied colour in two private hospital waiting area in Malaysia.

  11. Organ Type and Waiting Time

    MedlinePlus

    ... Liver Disease/Pediatric End-Stage Liver Disease). The system offers liver to candidates with the highest MELD/PELD scores first. Geographic factors are also taken into consideration. Please see ...

  12. Supply and demand: estimating the real need for care while meeting the 48 hour waiting time target in a genitourinary medicine clinic by a closed appointment system.

    PubMed

    Clarke, J; Christodoulides, H; Taylor, Y

    2006-02-01

    To attempt to assess demand for access to sexual health services in a community where a "closed" appointment system operates in the local genitourinary medicine (GUM) clinic. A large GUM clinic serving a provincial city in England. Appointments for new episodes are available only 1 or 2 days ahead. Service user complaints about repeated difficulty in getting through to book a visit prompted a review of all methods of access. A prospective review of all calls received in the departmental telephone booking service was performed. Temporary extra staff manned a cascade sequence of telephone lines and recorded all calls and caller characteristics such as age and declaration of symptoms. All attempts to book an appointment in person, by written referral, or by telephone in a period of 5 working days were also logged. This total demand was compared with the actual capacity and maximum theoretical capacity of the clinic during the same time period. 626 appointments would be required in the working week to accommodate all patients within 48 hours of requesting to be seen. 84% of all calls requested a new appointment, and 77% all new appointment requests were by phone. There were 181 new appointments available; 72% of those requesting an appointment could not be seen. The clinic was working at 103% capacity. To accommodate demand at this quiet time of the academic year, the GUM service would need to increase capacity by 3-4-fold. Closed appointment systems in GUM services may produce an apparent "improvement" in waiting times to 48 hours, but many callers are not able to book an appointment at all. Demand for GUM services outstrips capacity to an extent that internal efficiency savings cannot hope to address.

  13. Challenging "Waiting for Superman"

    ERIC Educational Resources Information Center

    Bruhn, Molle

    2014-01-01

    A group of New York City public school teachers, angry about the depiction of public schools in 'Waiting for Superman," decide to make their own film about the realities of the current education reform movement. They persevered even though they had no budget when they started and lacked a background in filmmaking. "The Inconvenient Truth…

  14. Waiting in the surgery.

    PubMed

    Fry, F

    1994-07-01

    The concise Oxford English Dictionary defines 'dilemma' as an argument forcing one to choose one of two alternatives, both of which are unfavourable. This is a situation that frequently confronts the general practitioner. This paper will present one practitioner's view on the subject of patients waiting to see the doctor.

  15. Straight-to-test colonoscopy for 2-week-wait referrals improves time to diagnosis of colorectal cancer and is feasible in a high-volume unit.

    PubMed

    Banerjea, A; Voll, J; Chowdhury, A; Siddika, A; Thomson, S; Briggs, R; Humes, D J

    2017-09-01

    We have introduced 'straight-to-test' (STT) colonoscopy as part of our 2-week-wait (2WW) pathway to address increasing numbers of urgent referrals for colorectal cancer (CRC) within the National Health Service. In this study we evaluated the ability of this initiative to shorten the time to diagnosis of CRC. We amended our 2WW referral form to include performance status and comorbidities. General practitioners were asked to provide data on estimated glomerular filtration rate and full blood count/ferritin. Our 2WW referrals were screened by a colorectal consultant and a nurse specialist. Those deemed unsuitable for STT were offered outpatient assessment (OPA). Of 553 2WW referrals screened, 352 were considered suitable, 65 of whom failed a telephone assessment or were uncontactable, and accordingly 287 were offered the STT pathway. The STT group was significantly younger than the OPA group (median 65.9 years vs 78.7 years; P < 0.0001). STT colonoscopy significantly reduced the time to first test (13 days vs 22 days; P < 0.0001) and tissue diagnosis from the referral date (17 days vs 24.5 days; P < 0.0001). Thirty-seven (6.8%) CRCs were detected. Proportionately fewer patients in the STT pathway were managed with 'best supportive care only' compared with patients attending OPA (one of 15 vs six of 22, respectively). STT colonoscopy obviated the need for clinic attendance before testing in 287 patients, representing a potential net cost benefit of at least £48 500 in 4 months. STT colonoscopy was safe and effective for selecting out a group of symptomatic patients who could proceed straight to endoscopic examination and receive a diagnosis more rapidly. Colorectal Disease © 2017 The Association of Coloproctology of Great Britain and Ireland.

  16. A wavelet-based evaluation of time-varying long memory of equity markets: A paradigm in crisis

    NASA Astrophysics Data System (ADS)

    Tan, Pei P.; Chin, Cheong W.; Galagedera, Don U. A.

    2014-09-01

    This study, using wavelet-based method investigates the dynamics of long memory in the returns and volatility of equity markets. In the sample of five developed and five emerging markets we find that the daily return series from January 1988 to June 2013 may be considered as a mix of weak long memory and mean-reverting processes. In the case of volatility in the returns, there is evidence of long memory, which is stronger in emerging markets than in developed markets. We find that although the long memory parameter may vary during crisis periods (1997 Asian financial crisis, 2001 US recession and 2008 subprime crisis) the direction of change may not be consistent across all equity markets. The degree of return predictability is likely to diminish during crisis periods. Robustness of the results is checked with de-trended fluctuation analysis approach.

  17. Waiting for Water

    ERIC Educational Resources Information Center

    Lamson-Nussbaum, Jorie

    2013-01-01

    The author waits in the hot and oppressive air while dust devils are born and die over the newly plowed field. It is a dry spring and she prays for rain. The lupine beans withered to dry threads last week and the corn that sprouted in a green haze over the north field is turning to brown paper. However, driving north, the author discovers the Rum…

  18. Waiting for Water

    ERIC Educational Resources Information Center

    Lamson-Nussbaum, Jorie

    2013-01-01

    The author waits in the hot and oppressive air while dust devils are born and die over the newly plowed field. It is a dry spring and she prays for rain. The lupine beans withered to dry threads last week and the corn that sprouted in a green haze over the north field is turning to brown paper. However, driving north, the author discovers the Rum…

  19. Civil Wrongs: Federal Equity Initiative Promotes Paperwork, Not Equality

    ERIC Educational Resources Information Center

    Melnick, R. Shep

    2016-01-01

    In October 2014, U.S. secretary of education Arne Duncan announced the Obama administration's new "education equity initiative," explaining that the president could not "continue to wait" for Congress to act "on behalf of vulnerable children." The centerpiece of this initiative was a 37-page "Dear Colleague"…

  20. Civil Wrongs: Federal Equity Initiative Promotes Paperwork, Not Equality

    ERIC Educational Resources Information Center

    Melnick, R. Shep

    2016-01-01

    In October 2014, U.S. secretary of education Arne Duncan announced the Obama administration's new "education equity initiative," explaining that the president could not "continue to wait" for Congress to act "on behalf of vulnerable children." The centerpiece of this initiative was a 37-page "Dear Colleague"…

  1. '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

  2. Japanese public long-term care insured: preferences for future long-term care facilities, including relocation, waiting times, and individualized care.

    PubMed

    Sawamura, Kanae; Sano, Hiroshi; Nakanishi, Miharu

    2015-04-01

    Expenditures on long-term care insurance (LTCI) in Japan have been increasing with the aging of the population, which has led to an increase in premiums. To optimize resource allocation, we aim to clarify the priorities of the functions of long-term care facilities from the viewpoint of future beneficiaries. The present study was conducted using a cross-sectional study design. We conducted a mail-in survey targeting 2400 adults aged 50-65 in 8 cities in Japan, and 371 persons responded. Conjoint analysis was applied to measure participants' preferences for long-term care facility services. Participants read 1 of 2 vignettes of an 80-year-old person with either dementia or a fracture, and were asked to envision it as a possible future scenario for themselves. Participants then completed 8 or 9 tasks to select suitable long-term care facilities for the person described. The questionnaire also contained common questions on participants' personal profiles: age, gender, family situation, education, approximate yearly family income, experience as a family caregiver, dwelling status, present health status, and possibility of requiring long-term care services in the future. The results focused mainly on (1) possibilities of individual choice for daily schedules/meals; (2) availability of regular care staff; (3) room; (4) main daily interactions; (5) necessity of relocation associated with medical deterioration; 6) Waiting time; 7) distance from present residence; and (8) monthly fees. Necessity of relocation associated with medical deterioration was consistently given the greatest importance. Participants with experience as a family caregiver showed significantly greater preference for individualized care and communication. The option of avoiding relocation was highly valued by participants compared with private rooms and individualized care. The present situation of high demand for intensive care homes for the elderly, provoked by anxiety about future residence, will not

  3. An equity dashboard to monitor vaccination coverage.

    PubMed

    Arsenault, Catherine; Harper, Sam; Nandi, Arijit; Rodríguez, José M Mendoza; Hansen, Peter M; Johri, Mira

    2017-02-01

    Equity monitoring is a priority for Gavi, the Vaccine Alliance, and for those implementing The2030 agenda for sustainable development. For its new phase of operations, Gavi reassessed its approach to monitoring equity in vaccination coverage. To help inform this effort, we made a systematic analysis of inequalities in vaccination coverage across 45 Gavi-supported countries and compared results from different measurement approaches. Based on our findings, we formulated recommendations for Gavi's equity monitoring approach. The approach involved defining the vulnerable populations, choosing appropriate measures to quantify inequalities, and defining equity benchmarks that reflect the ambitions of the sustainable development agenda. In this article, we explain the rationale for the recommendations and for the development of an improved equity monitoring tool. Gavi's previous approach to measuring equity was the difference in vaccination coverage between a country's richest and poorest wealth quintiles. In addition to the wealth index, we recommend monitoring other dimensions of vulnerability (maternal education, place of residence, child sex and the multidimensional poverty index). For dimensions with multiple subgroups, measures of inequality that consider information on all subgroups should be used. We also recommend that both absolute and relative measures of inequality be tracked over time. Finally, we propose that equity benchmarks target complete elimination of inequalities. To facilitate equity monitoring, we recommend the use of a data display tool - the equity dashboard - to support decision-making in the sustainable development period. We highlight its key advantages using data from Côte d'Ivoire and Haiti.

  4. Managing the kidney waiting list.

    PubMed

    Zarifian, April; O'Rourke, Marian

    2006-09-01

    Candidates on the kidney transplant list wait for longer periods and have increasing numbers of comorbid conditions. To ensure that these candidates are acceptable for transplantation when an organ becomes available, physical, psychosocial, and financial strategies are essential. The authors surveyed 68 transplant centers to determine current practices. Eighteen percent of centers did not reevaluate candidates. Other programs used time on the list, disease, age, or a combination of these factors as evaluation criteria. Initial cardiac evaluation was relied upon by 51.4% of centers, with varying criteria used to determine status. Social work evaluation was done by 42.6% of centers, usually annually. Annual financial reevaluation was performed in 57.4%. Data support reviewing candidates, especially those with diabetes, those who have been receiving dialysis for a long time, and those older than 60 years. The dedication of one coordinator to manage waitlisted candidates using age, diagnosis, and time receiving dialysis was effective in this study.

  5. Impact of MRI on a knee arthroscopy waiting list.

    PubMed Central

    Williams, R. L.; Williams, L. A.; Watura, R.; Fairclough, J. A.

    1996-01-01

    As part of a waiting list initiative, magnetic resonance imaging (MRI) scans were arranged for 69 patients waiting for knee arthroscopy. All patients had a clinical diagnosis of a meniscal tear. With 11 non-attenders, 58 scans were performed. Of the patients scanned, 35 had demonstrable meniscal tears, and five patients had other pathology on their scans. All patients were reviewed clinically after their scans, and 24 patients were removed from the waiting list. After a further 9 months, only one of the 24 patients removed had been re-listed for therapeutic arthroscopy. This initiative proved a cost-effective method of reducing waiting times for knee arthroscopy. PMID:8881730

  6. 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.

  7. The impact of rural hospital closures on equity of commuting time for haemodialysis patients: simulation analysis using the capacity-distance model

    PubMed Central

    2012-01-01

    Background Frequent and long-term commuting is a requirement for dialysis patients. Accessibility thus affects their quality of lives. In this paper, a new model for accessibility measurement is proposed in which both geographic distance and facility capacity are taken into account. Simulation of closure of rural facilities and that of capacity transfer between urban and rural facilities are conducted to evaluate the impacts of these phenomena on equity of accessibility among dialysis patients. Methods Post code information as of August 2011 of all the 7,374 patients certified by municipalities of Hiroshima prefecture as having first or third grade renal disability were collected. Information on post code and the maximum number of outpatients (capacity) of all the 98 dialysis facilities were also collected. Using geographic information systems, patient commuting times were calculated in two models: one that takes into account road distance (distance model), and the other that takes into account both the road distance and facility capacity (capacity-distance model). Simulations of closures of rural and urban facilities were then conducted. Results The median commuting time among rural patients was more than twice as long as that among urban patients (15 versus 7 minutes, p < 0.001). In the capacity-distance model 36.1% of patients commuted to the facilities which were different from the facilities in the distance model, creating a substantial gap of commuting time between the two models. In the simulation, when five rural public facilitiess were closed, Gini coefficient of commuting times among the patients increased by 16%, indicating a substantial worsening of equity, and the number of patients with commuting times longer than 90 minutes increased by 72 times. In contrast, closure of four urban public facilities with similar capacities did not affect these values. Conclusions Closures of dialysis facilities in rural areas have a substantially larger impact on

  8. Three Kinds of Equity.

    ERIC Educational Resources Information Center

    Arnold, Michael L.

    1998-01-01

    School-finance equity is deceivingly complex. Equity necessitates fair and just treatment, which might actually require unequal treatment of some individuals or groups. State governments face a tremendous challenge in developing school-finance systems that result in equity for children. Obstacles include finding the correct mix of taxes to…

  9. Schools Achieving Gender Equity.

    ERIC Educational Resources Information Center

    Revis, Emma

    This guide is designed to assist teachers presenting the Schools Achieving Gender Equity (SAGE) curriculum for vocational education students, which was developed to align gender equity concepts with the Kentucky Education Reform Act (KERA). Included in the guide are lesson plans for classes on the following topics: legal issues of gender equity,…

  10. Equity Assessment Study. Summary.

    ERIC Educational Resources Information Center

    Fadale, LaVerna M.; Zhao, Peisheng

    This assessment study is a culminating activity of an eight-year initiative to facilitate gender equity and more equitable campus environments - Mentoring Institutional Equity in New York State Two-Year Colleges. Eighteen two-year colleges participated in the application and implementation of an educational equity model designed to enhance gender…

  11. "Waiting and the waiting room: how do you experience them?" emotional implications and suggestions from patients with cancer.

    PubMed

    Catania, Chiara; De Pas, Tommaso; Minchella, Ida; De Braud, Filippo; Micheli, Daniela; Adamoli, Laura; Spitaleri, Gianluca; Noberasco, Cristina; Milani, Alessandra; Zampino, Maria Giulia; Toffalorio, Francesca; Radice, Davide; Goldhirsch, Aron; Nolè, Franco

    2011-06-01

    Waiting can increase discomfort. The goal of this study was to identify moods and fears of cancer patients while in a waiting room and to capture their concrete suggestions for an anthropocentric transformation of waiting itself. A 15-item questionnaire was given to 355 patients who came to our Out-patient Oncology Clinic. Eighty-three percent of patients felt that waiting has an emotional cost, 35% were upset by talking about their condition with others while waiting, and 26% suffered a major emotional impact seeing other sick people and witnessing their clinical decline. Eighty-nine percent of patients suggested that alternative activities, such as meetings with professionals, doctors, and psychologists, be organized during the waiting period; 65% suggested fun activities (music therapy, drawing courses, library, TV). Most patients asked to have the freedom to leave the waiting room. This option, feasibly by means of IMs/"beepers," would limit their sense of having a lack of freedom or being robbed of their time. This study highlighted the complexity and heterogeneity of emotional implications that waiting causes in patients with cancer and collected many patients' suggestions about how to create a constructive, free, and personalized waiting period, overcoming the boredom, distress, and psychological suffering it causes.

  12. The consequences of waiting for cataract surgery: a systematic review

    PubMed Central

    Hodge, William; Horsley, Tanya; Albiani, David; Baryla, Julia; Belliveau, Michel; Buhrmann, Ralf; O'Connor, Michael; Blair, Jason; Lowcock, Elizabeth

    2007-01-01

    Background Cataract surgery is the most common operative procedure performed in Canada, and how patients are affected by wait times for this surgery has important clinical, public health and health policy considerations. We conducted a systematic review to understand the relation between wait time for cataract surgery and patient outcomes and the variables that modify this relation. Methods We performed an electronic search of 11 databases and the proceedings of 4 conferences. The search was restricted to studies published after the transition to phacoemulsification (1990). We assessed the quality of the included studies using the Jadad Scale for randomized controlled trials and the Newcastle–Ottawa Scale for cohort and case–control studies. The data were found to be inappropriate for meta-analysis, thus we performed a qualitative synthesis. Results We found a total of 27 studies that met our inclusion criteria. When these studies were reviewed, a dichotomy was observed for the wait time–outcome relation: outcomes associated with wait times of ≤ 6 weeks were better than outcomes associated with wait times of ≥ 6 months. Patients who waited more than 6 months to receive cataract surgery experienced more vision loss, a reduced quality of life and had an increased rate of falls compared with patients who had wait times of less than 6 weeks. The outcomes associated with wait times between 6 weeks and 6 months remain unclear. Interpretation Patients who wait more than 6 months for cataract surgery may experience negative outcomes during the wait period, including vision loss, a reduced quality of life and an increased rate of falls. PMID:17452662

  13. Patients’ perceptions of waiting for bariatric surgery: a qualitative study

    PubMed Central

    2013-01-01

    Background In Canada waiting lists for bariatric surgery are common, with wait times on average > 5 years. The meaning of waiting for bariatric surgery from the patients’ perspective must be understood if health care providers are to act as facilitators in promoting satisfaction with care and quality care outcomes. The aims of this study were to explore patients’ perceptions of waiting for bariatric surgery, the meaning and experience of waiting, the psychosocial and behavioral impact of waiting for treatment and identify health care provider and health system supportive measures that could potentially improve the waiting experience. Methods Twenty-one women and six men engaged in in-depth interviews that were digitally recorded, transcribed verbatim and analysed using a grounded theory approach to data collection and analysis between June 2011 and April 2012. The data were subjected to re-analysis to identify perceived health care provider and health system barriers to accessing bariatric surgery. Results Thematic analysis identified inequity as a barrier to accessing bariatric surgery. Three areas of perceived inequity were identified from participants’ accounts: socioeconomic inequity, regional inequity, and inequity related to waitlist prioritization. Although excited about their acceptance as candidates for surgery, the waiting period was described as stressful, anxiety provoking, and frustrating. Anger was expressed towards the health care system for the long waiting times. Participants identified the importance of health care provider and health system supports during the waiting period. Recommendations on how to improve the waiting experience included periodic updates from the surgeon’s office about their position on the wait list; a counselor who specializes in helping people going through this surgery, dietitian support and further information on what to expect after surgery, among others. Conclusion Patients’ perceptions of accessing and

  14. Access & Equity Newsletter. Volume 6

    ERIC Educational Resources Information Center

    South Carolina Commission on Higher Education, 2004

    2004-01-01

    Included in this edition of the "In-the-Know" Access & Equity Newsletter are: (1) State Losing Black Instructors (Gina Smith); (2) Time to Join Together to Seek "Economic Rights" (Darla Moore); and (3) "Advancing Diversity in Higher Education--Diversity Digest" (Mark Giles, Ed.), which is a reprint of an article…

  15. Sick of waiting: Does waiting for elective treatment cause sickness absence?

    PubMed

    Dyrstad, Karin; Halvorsen, Thomas; Hem, Karl-Gerhard; Rohde, Tarald

    2016-12-01

    Sickness absence represents a substantial cost in most of Western Europe, whether the insurance scheme is public or private. The objective of this study was to analyse whether waiting time for elective treatment in specialist health care is associated with the length of individual sickness absence in Norway. To estimate the association between waiting time and the duration of sick leave, we used data from the working population aged 18-67 years in 2010-2012. The files combined register data from The Norwegian Patient Registry with individual characteristics and sickness absence data from Statistics Norway, and was analysed using zero-truncated negative binomial regression. We found that about one in four employees who had one or more spells of sick leave in the period, was also waiting for consultation or treatment in specialist health care. Yet, the length of the waiting period had no substantial effect on the length of sickness absence (i.e., less than 0.1% reduction). Therefore, while measures to reduce waiting times for hospital treatment in many instances could be beneficial for the individual patient, such policies would probably not have any substantial impact on the national sickness absence rate.

  16. Waiting for HAPO.

    PubMed

    Trujillo, Angelina L; Jovanovic, Lois

    2008-01-01

    The recent global increase in gestational diabetes has paralleled the increased prevalence of obesity and type 2 diabetes. The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study is an attempt to establish gestational diabetes diagnostic criteria as well as to clarify the accurate glucose threshold for the relationship between maternal hyperglycaemia and adverse perinatal outcomes. Although five international workshops have convened to address the importance of gestational diabetes, a resolution towards a general consensus for diagnosis and clinical management of gestational diabetes has not been achieved. Such a resolution may never appear, much like the outcome in the play Waiting for Godot, a character who in the end never arrives, and may not even exist. The accompanying article by Mathiesen and Vaz highlights the fetal, neonatal and maternal risks that accompany inadequate glycaemic control during pregnancies complicated by diabetes, even in the presence of only mild maternal hyperglycaemia. Diet, exercise and an optimised treatment regimen based on regular pre- and postprandial monitoring of blood glucose are essential throughout pregnancy. Pivotal to this goal is the recognition that insulin requirements in pregnancy are distinct from those of the prepregnancy state, and that these requirements change throughout gestation, labour and lactation.

  17. Family members' experiences of the intensive care unit waiting room.

    PubMed

    Kutash, Mary; Northrop, Linda

    2007-11-01

    This paper is a report of a study to explore family members' perspectives and experiences of waiting rooms in adult intensive care units. Waiting to visit family members who are hospitalized in intensive care units can be very stressful. Although flexible and or open visiting is practised in many hospitals, family members may spend a great deal of time in the waiting room. A qualitative design using semi-structured interviews was used and the data were collected in 2004. A convenience sample of six visitors was recruited from waiting rooms of three different adult intensive care units. Data collection and analysis were concurrent. Six categories emerged from the data that included structural and subjective aspects of waiting: 'close proximity' referred to the importance of a close physical distance to their family member; 'caring staff' captured the comfort family members felt when staff showed caring behaviours towards relative; 'need for a comfortable environment' represented the impact of the design of the waiting room on family members well-being; 'emotional support' referred to the waiting room as a place where comfort was found by sharing with others; 'rollercoaster of emotions' captured the range of emotions experienced by family members; 'information' referred to the importance of receiving information about their relative. Future research should focus on the impact of the interior design of waiting rooms on the comfort and welfare of family members and on identifying needs of family members across different cultures.

  18. Strategy as active waiting.

    PubMed

    Sull, Donald N

    2005-09-01

    Successful executives who cut their teeth in stable industries or in developed countries often stumble when they face more volatile markets. They falter, in part, because they assume they can gaze deep into the future and develop a long-term strategy that will confer a sustainable competitive advantage. But visibility into the future of volatile markets is sharply limited because so many different variables are in play. Factors such as technological innovation, customers' evolving needs, government policy, and changes in the capital markets interact with one another to create unexpected outcomes. Over the past six years, Donald Sull, an associate professor at London Business School, has led a research project examining some of the world's most volatile markets, from national markets like China and Brazil to industries like enterprise software, telecommunications, and airlines. One of the most striking findings from this research is the importance of taking action during comparative lulls in the storm. Huge business opportunities are relatively rare; they come along only once or twice in a decade. And, for the most part, companies can't manufacture those opportunities; changes in the external environment converge to make them happen. What managers can do is prepare for these golden opportunities by managing smart during the comparative calm of business as usual. During these periods of active waiting, leaders must probe the future and remain alert to anomalies that signal potential threats or opportunities; exercise restraint to preserve their war chests; and maintain discipline to keep the troops battle ready. When a golden opportunity or"sudden death"threat emerges, managers must have the courage to declare the main effort and concentrate resources to seize the moment.

  19. [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

  20. An equity dashboard to monitor vaccination coverage

    PubMed Central

    Harper, Sam; Nandi, Arijit; Rodríguez, José M Mendoza; Hansen, Peter M; Johri, Mira

    2017-01-01

    Abstract Equity monitoring is a priority for Gavi, the Vaccine Alliance, and for those implementing The 2030 agenda for sustainable development. For its new phase of operations, Gavi reassessed its approach to monitoring equity in vaccination coverage. To help inform this effort, we made a systematic analysis of inequalities in vaccination coverage across 45 Gavi-supported countries and compared results from different measurement approaches. Based on our findings, we formulated recommendations for Gavi’s equity monitoring approach. The approach involved defining the vulnerable populations, choosing appropriate measures to quantify inequalities, and defining equity benchmarks that reflect the ambitions of the sustainable development agenda. In this article, we explain the rationale for the recommendations and for the development of an improved equity monitoring tool. Gavi’s previous approach to measuring equity was the difference in vaccination coverage between a country’s richest and poorest wealth quintiles. In addition to the wealth index, we recommend monitoring other dimensions of vulnerability (maternal education, place of residence, child sex and the multidimensional poverty index). For dimensions with multiple subgroups, measures of inequality that consider information on all subgroups should be used. We also recommend that both absolute and relative measures of inequality be tracked over time. Finally, we propose that equity benchmarks target complete elimination of inequalities. To facilitate equity monitoring, we recommend the use of a data display tool – the equity dashboard – to support decision-making in the sustainable development period. We highlight its key advantages using data from Côte d’Ivoire and Haiti. PMID:28250513

  1. 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.

  2. Gender Equity Report.

    ERIC Educational Resources Information Center

    Washington State Higher Education Coordinating Board, Olympia.

    This document reports on the implementation of two bills adopted by the Washington State legislature in 1989 to achieve gender equity in higher education. The gender equity statute prohibits discrimination on the basis of gender against any student, and, in particular, it forbids discrimination in student assistance and services, academic…

  3. Science Education and Equity.

    ERIC Educational Resources Information Center

    Bates, Percy; And Others

    1994-01-01

    This double issue of "Equity Coalition" deals with issues related to the need for inclusive science training and encouraging the interest of women and minorities groups in science. The following articles are included: (1) "Say Yes to Science" (Percy Bates); (2) "Science and Equity: Why This Issue Is Important"…

  4. Gender Equity. IDRA Forum.

    ERIC Educational Resources Information Center

    IDRA Newsletter, 1994

    1994-01-01

    This newsletter contains six articles on issues of gender equity for Chicanas and other women. "Recognizing Chicana Contributions: Cultural History & Gender Equity on the Line" (Mikki Symonds) discusses the invisibility of Mexican Americans in general and of Chicanas in particular in U.S. history books, school curricula, and pop…

  5. Men, Women, and Equity

    ERIC Educational Resources Information Center

    Rapoport, Rhona; Rapoport, Robert N.

    1975-01-01

    The concept of equity is proposed as having advantages over that of equality. By equity, we mean a fair allocation both of opportunity and of constraints. It is put forward as a concept which goes beyond that of equality; it acknowledges differences between men and women and the need to think in terms of variations of patterns. Paper presented at…

  6. Equity in Higher Education.

    ERIC Educational Resources Information Center

    Bane, Mary Jo; Winston, Kenneth I.

    Equity within U.S. higher education is examined in three parts: Practices, Principles, and Policies. Public/private problems, attendance variables, and public subsidies to higher education are included in the Practices section. Part 2, Principles, discusses the place of philosophy, meanings of equity, remedying discrimination, and equality of…

  7. Melding Excellence and Equity.

    ERIC Educational Resources Information Center

    Bennett, David A.

    1983-01-01

    This document examines the issues of educational excellence and equity. The Milwaukee Public School System, Wisconsin, is cited as an example of a desegregation program that both exceeded court requirements of equity and also made a substantial contribution to the goals of excellence in education. The school effectiveness movement, like…

  8. Plastic surgery waiting list--the numbers game fact or fiction?

    PubMed

    McGregor, J C

    1998-10-01

    Previous studies have indicated the importance of work load and operating time in helping to manage a waiting list. While analysis of a waiting list based solely on numbers cannot give an accurate assessment it is only this and "the waiting time" to surgery (apparently irrespective of clinical priorities) that seem to matter to the government, the Trust Hospitals, and to the public. This study examines case numbers on a waiting list over a two year period and links this to the preceding six months elective operations. Further insight into a waiting list construction can be obtained because of the clinical need for some degree of prioritisation, particularly because of malignancies, it is obvious why the bare waiting list numbers and composition can give a false impression of the true situation. The secondary effect on waiting time for less urgent cases can thus be more readily explained. Some form of rationing may be the answer.

  9. How Long Are Patients Willing to Wait in the Emergency Department Before Leaving Without Being Seen?

    PubMed Central

    Shaikh, Sanober B.; Jerrard, David A.; Witting, Michael D.; Winters, Michael E.; Brodeur, Michael N.

    2012-01-01

    Introduction: Our goal was to evaluate patients’ threshold for waiting in an emergency department (ED) waiting room before leaving without being seen (LWBS). We analyzed whether willingness to wait was influenced by perceived illness severity, age, race, triage acuity level, or insurance status. Methods: We conducted this survey-based study from March to July 2010 at an urban academic medical center. After triage, patients were given a multiple-choice questionnaire, designed to ascertain how long they would wait for medical care. We collected data including age, gender, race, insurance status, and triage acuity level. We looked at the association between willingness to wait and these variables, using stratified analysis and logistic regression. Results: Of the 375 patients who were approached, 340 (91%) participated. One hundred seventy-one (51%) were willing to wait up to 2 hours before leaving, 58 (17%) would wait 2 to 8 hours, and 110 (32%) would wait indefinitely. No association was found between willingness to wait and race, gender, insurance status, or perceived symptom severity. Patients willing to wait >2 hours tended to be older than 25, have higher acuity, and prefer the study site ED. Conclusion: Many patients have a defined, limited period that they are willing to wait for emergency care. In our study, 50% of patients were willing to wait up to 2 hours before leaving the ED without being seen. This result suggests that efforts to reduce the percentage of patients who LWBS must factor in time limits. PMID:23359833

  10. Review of "Waiting for Superman"

    ERIC Educational Resources Information Center

    Dutro, Elizabeth

    2011-01-01

    "Waiting for Superman" offers what appear to be straightforward, commonsense solutions to inequities in schooling. The film argues that heroic action can be taken to fix what it portrays as the disaster of public schooling. The film disregards poverty as a factor in school performance and connection--and therefore never addresses anti-poverty…

  11. Waiting Impulsivity: The Influence of Acute Methylphenidate and Feedback

    PubMed Central

    Chang-Webb, Yee Chien; Morris, Laurel S.; Cooper, Ella; Sethi, Arjun; Baek, Kwangyeol; Grant, Jon; Robbins, Trevor W.; Harrison, Neil A

    2016-01-01

    Background: The ability to wait and to weigh evidence is critical to behavioral regulation. These behaviors are known as waiting and reflection impulsivity. In Study 1, we examined the effects of methylphenidate, a dopamine and norepinephrine reuptake inhibitor, on waiting and reflection impulsivity in healthy young individuals. In study 2, we assessed the role of learning from feedback in disorders of addiction. Methods: We used the recently developed 4-Choice Serial Reaction Time task and the Beads task. Twenty-eight healthy volunteers were tested twice in a randomized, double-blind, placebo-controlled cross-over trial with 20mg methylphenidate. In the second study, we analyzed premature responses as a function of prior feedback in disorders of addiction. Results: Study 1: Methylphenidate was associated with greater waiting impulsivity to a cue predicting reward along with faster responding to target onset without a generalized effect on reaction time or attention. Methylphenidate influenced reflection impulsivity based on baseline impulsivity. Study 2: More premature responses occurred after premature responses in stimulant-dependent subjects. Conclusions: We show that methylphenidate has dissociable effects on waiting and reflection impulsivity. Chronic stimulant exposure impairs learning from prior premature responses, suggesting a failure to learn that premature responding is suboptimal. These findings provide a greater mechanistic understanding of waiting impulsivity. PMID:26136351

  12. 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.

  13. Pay Equity for Coaches.

    ERIC Educational Resources Information Center

    Blum, Debra E.

    1994-01-01

    Some colleges are giving substantial raises to women's athletic team coaches, sometimes reducing mens' team coaches' salaries to provide equity. Court litigation, activism by several national coaches' organizations, and debate over federal laws keep the issue in high profile. (MSE)

  14. Achieving Salary Equity

    ERIC Educational Resources Information Center

    Nevill, Dorothy D.

    1975-01-01

    Three techniques are outlined for use by higher education institutions to achieve salary equity: salary prediction (using various statistical procedures), counterparting (comparing salaries of persons of similar rank), and grievance procedures. (JT)

  15. Spatial and socio-demographic predictors of time-to-immunization in a rural area in Kenya: Is equity attainable?

    PubMed Central

    Moïsi, Jennifer C.; Kabuka, Jonathan; Mitingi, Dorah; Levine, Orin S.; Scott, J. Anthony G.

    2010-01-01

    We conducted a vaccine coverage survey in Kilifi District, Kenya in order to identify predictors of childhood immunization. We calculated travel time to vaccine clinics and examined its relationship to immunization coverage and timeliness among the 2169 enrolled children (median age: 12.5 months). 86% had vaccine cards available, >95% had received three doses of DTP-HepB-Hib and polio vaccines and 88% of measles. Travel time did not affect vaccination coverage or timeliness. The Kenyan EPI reaches nearly all children in Kilifi and delays in vaccination are few, suggesting that vaccines will have maximal impact on child morbidity and mortality. PMID:20600489

  16. Evaluation of Waiting Times and Sonographic Findings in Patients with First Trimester Vaginal Bleeding at the University Hospital of the West Indies. Can Emergency Department Ultrasound Make a Difference?

    PubMed Central

    French, S; Henry, T; Williams, EW

    2014-01-01

    Background: Pregnant female patients with vaginal bleeding in the first trimester are seen commonly in the Emergency Department (ED) at the University Hospital of the West Indies (UHWI), Kingston, Jamaica. The protocol for the management of these patients requires that they have a sonographic evaluation performed for the purpose of localizing the pregnancy where possible, to assist with determining the risk for an ectopic pregnancy. The ultrasound examinations are performed in the radiology department. Objective: This retrospective study was conducted to evaluate how long patients wait for a pelvic ultrasound. We also sought to establish how many patients had ultrasound findings that would have allowed safe discharge home. Methods: The records of 150 patients seen in the six-month period from January 1 to July 30, 2008 were examined. Data were extracted pertaining to age, time to see an emergency room doctor, time taken for ultrasound examination to be obtained from the radiology department and the ultrasound findings. Result: Fifty-four per cent presented to the Emergency Department with a complaint of vaginal bleeding and abdominal pain, 29% with bleeding only, 16% with abdominal pain only and one with syncope. One hundred and sixteen of the patients enrolled had an ultrasound performed at UHWI. The average waiting time for an ultrasound was 3.8 ± 2.5 hours. The majority (66/116) of the patients had an intrauterine pregnancy (IUP) demonstrated on ultrasound. Twenty-nine had no IUP, free fluid or adnexal mass. These 95 patients would likely have been discharged home. Ten patients had an adnexal mass with or without free fluid, and ten had free fluid only on ultrasound. One patient was found to have a definite ectopic pregnancy. These 21 patients would have been referred for evaluation by the obstetrician on call for further management. Conclusion: The majority of patients had sonographic findings that would have allowed safe and timely discharge from the

  17. [Waiting lists management model based on timeliness and justice].

    PubMed

    Julio, Cristian; Wolff, Patricio; Vegoña Yarza, María

    2016-06-01

    Waiting lists for elective surgery are considered a major health policy concern in most countries of the world. The most common reason to explain this phenomenon is that demand exceeds supply. Traditionally, the management of waiting lists has been focused on timeliness of medical attention. The objective of this paper is to present a waiting lists management model that includes the concepts of timeliness and justice simultaneously. We designed a prioritization method based solely on medical criteria. We developed a computer software to register patients, to prioritize and monitor the waiting lists. The system was implemented in 2013 and is currently used in all surgical specialties at a public hospital. The results show that timeliness does not suffice to manage the waiting lists for elective surgery, and therefore it should be complemented with an indicator of justice. Under this management model, hospitals should attempt to balance justice with timeliness of care and prioritize initiatives that improve both indicators at the same time. In addition, we propose using this model to manage the waiting lists of other hospital processes.

  18. Association Between Mohs Surgery Wait Times and Surgical Defect Size in Patients With Squamous Cell or Basal Cell Carcinoma of the Skin.

    PubMed

    Diehl, Joseph; Choi, Young M; Liang, Li-Jung; Chiu, Melvin

    2015-07-01

    Consequences of delays in treatment of nonmelanoma skin cancers (NMSCA) are largely unstudied. To determine the relationship between Mohs micrographic surgery (MMS) delay time and final MMS defect size. A retrospective chart review was performed to identify patients who underwent MMS for biopsy-proven basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) between 2004 and 2006. Time delay between date of biopsy and date of surgery and lesion diameter increase between biopsy and surgical defect were calculated. Two hundred eighty-three lesions qualified for inclusion in the study. No significant difference in mean change of major diameter between primary and recurrent tumors (1.0 vs 1.1 cm, p = .67), between BCCs and SCCs (both were 1.0 cm, p = .99), and between tumor size at presentation <1.0 versus ≥1.0 cm (1.1 vs 0.8 cm, p = .11) were found. However, the mean number of MMS layers taken was significantly different between BCCs and SCCs (1.9 vs 1.5, respectively; p = .0022). Linear regression analysis of major diameter change versus time delay to MMS showed no significant increasing trend over time. No evidence was found that time delays of up to 1 year from biopsy to MMS impact the growth of NMSCA.

  19. Waiting for Unruh

    NASA Astrophysics Data System (ADS)

    Fewster, Christopher J.; Juárez-Aubry, Benito A.; Louko, Jorma

    2016-08-01

    How long does a uniformly accelerated observer need to interact with a quantum field in order to record thermality in the Unruh temperature? We address this question for a pointlike Unruh-DeWitt detector, coupled linearly to a real Klein-Gordon field of mass m≥slant 0 and treated within first order perturbation theory, in the limit of large detector energy gap {E}{gap}. We first show that when the interaction duration {{Δ }}T is fixed, thermality in the sense of detailed balance cannot hold as {E}{gap}\\to ∞ , and this property generalises from the Unruh effect to any Kubo-Martin-Schwinger state satisfying certain technical conditions. We then specialise to a massless field in four spacetime dimensions and show that detailed balance does hold when {{Δ }}T grows as a power-law in {E}{gap} as {E}{gap}\\to ∞ , provided the switch-on and switch-off intervals are stretched proportionally to {{Δ }}T and the switching function has sufficiently strong Fourier decay. By contrast, if {{Δ }}T grows by stretching a plateau in which the interaction remains at constant strength but keeping the duration of the switch-on and switch-off intervals fixed, detailed balance at {E}{gap}\\to ∞ requires {{Δ }}T to grow faster than any polynomial in {E}{gap}, under mild technical conditions. The results also hold for a static detector in a Minkowski heat bath. The results limit the utility of the large {E}{gap} regime as a probe of thermality in time-dependent versions of the Hawking and Unruh effects, such as an observer falling into a radiating black hole. They may also have implications on the design of prospective experimental tests of the Unruh effect.

  20. Equity and Efficiency of Minnesota Educational Expenditures with a Focus on English Learners, 2003-2011: A Retrospective Look in a Time of Accountability

    ERIC Educational Resources Information Center

    Alexander, Nicola A.; Jang, Sung Tae

    2017-01-01

    Policymakers and practitioners often must balance distributing resources equitably and efficiently while being accountable for high student achievement. This paper focuses on these concepts as they relate to English learners and examines equity and efficiency in Minnesota's educational funding from 2003 through 2011, the years spanning…

  1. After-School for All? Exploring Access and Equity in After-School Programs. Out-of-School Time Policy Commentary #4

    ERIC Educational Resources Information Center

    Pittman, Karen; Wilson-Ahlstrom, Alicia; Yohalem, Nicole

    2003-01-01

    While significant progress has occurred over the past several years regarding the expansion of the quantity and quality of after-school opportunities, the ambitious idea of "after-school for all" remains a distant goal. In this commentary, we push beyond some of the numbers to take a close look at questions related to access and equity,…

  2. The Phenomenon of Waiting in Class

    ERIC Educational Resources Information Center

    Peine, Marie E.; Coleman, Laurence J.

    2010-01-01

    Gifted children often complain about waiting in class to learn. A qualitative study of 16 children in elementary and middle school in grades 1-8 revealed that sitting and waiting was a universal ingredient of being gifted in those regular classrooms. Children experienced 3 kinds of waiting: school/classroom, instructional, and assignment. Grounded…

  3. University of Alaska 1983 Salary Equity Study: The Analytical Process.

    ERIC Educational Resources Information Center

    Gaylord, Thomas A.

    Results of a study of the equity of salaries of University of Alaska full-time, nonbargaining-unit employees are presented. The following questions were investigated: (1) whether salary differences exist between sexes and races, and (2) which individuals should be considered for salary equity committee review. After introducing salary equity…

  4. University of Alaska 1983 Salary Equity Study: The Analytical Process.

    ERIC Educational Resources Information Center

    Gaylord, Thomas A.

    Results of a study of the equity of salaries of University of Alaska full-time, nonbargaining-unit employees are presented. The following questions were investigated: (1) whether salary differences exist between sexes and races, and (2) which individuals should be considered for salary equity committee review. After introducing salary equity…

  5. The electronic health record audit file: the patient is waiting.

    PubMed

    Hirsch, Annemarie G; Jones, J B; Lerch, Virginia R; Tang, Xiaoqin; Berger, Andrea; Clark, Deserae N; Stewart, Walter F

    2017-04-01

    We describe how electronic health record (EHR) audit files can be used to understand how time is spent in primary care (PC). We used audit file data from the Geisinger Clinic to quantify elements of the clinical workflow and to determine how these times vary by patient and encounter factors. We randomly selected audit file records representing 36 437 PC encounters across 26 clinic locations. Audit file data were used to estimate duration and variance of: (1) time in the waiting room, (2) nurse time with the patient, (3) time in the exam room without a nurse or physician, and (4) physician time with the patient. Multivariate modeling was used to test for differences by patient and by encounter features. On average, a PC encounter took 54.6 minutes, with 5 minutes of nurse time, 15.5 minutes of physician time, and the remaining 62% of the time spent waiting to see a clinician or check out. Older age, female sex, and chronic disease were associated with longer wait times and longer time with clinicians. Level of service and numbers of medications, procedures, and lab orders were associated with longer time with clinicians. Late check-in and same-day visits were associated with shorter wait time and clinician time. This study provides insights on uses of audit file data for workflow analysis during PC encounters. Scalable ways to quantify clinical encounter workflow elements may provide the means to develop more efficient approaches to care and improve the patient experience.

  6. The Equity of Public Education Funding in Georgia, 1988-1996.

    ERIC Educational Resources Information Center

    Rubenstein, Ross; Doering, Dwight; Gess, Larry

    2000-01-01

    Employs school funding formulas enacted under Georgia's Quality Basic Education Act to explore changes in interdistrict equity over time. Regarding overall distribution of per-pupil resources across districts (horizontal equity) and for special- needs students (vertical equity), dispersion measures approach Odden and Picus' suggested equity…

  7. Health equity impact assessment.

    PubMed

    Povall, Susan L; Haigh, Fiona A; Abrahams, Debbie; Scott-Samuel, Alex

    2014-12-01

    The World Health Organization's Commission on Social Determinants of Health has called for 'health equity impact assessments' of all economic agreements, market regulation and public policies. We carried out an international study to clarify if existing health impact assessment (HIA) methods are adequate for the task of global health equity assessments. We triangulated data from a scoping review of the international literature, in-depth interviews with health equity and HIA experts and an international stakeholder workshop. We found that equity is not addressed adequately in HIAs for a variety of reasons, including inadequate guidance, absence of definitions, poor data and evidence, perceived lack of methods and tools and practitioner unwillingness or inability to address values like fairness and social justice. Current methods can address immediate, 'downstream' factors, but not the root causes of inequity. Extending HIAs to cover macro policy and global equity issues will require new tools to address macroeconomic policies, historical roots of inequities and upstream causes like power imbalances. More sensitive, participatory methods are also required. There is, however, no need for the development of a completely new methodology. © The Author (2013). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  8. Defining equity in health

    PubMed Central

    Braveman, P; Gruskin, S

    2003-01-01

    Study objective: To propose a definition of health equity to guide operationalisation and measurement, and to discuss the practical importance of clarity in defining this concept. Design: Conceptual discussion. Setting, Patients/Participants, and Main results: not applicable. Conclusions: For the purposes of measurement and operationalisation, equity in health is the absence of systematic disparities in health (or in the major social determinants of health) between groups with different levels of underlying social advantage/disadvantage—that is, wealth, power, or prestige. Inequities in health systematically put groups of people who are already socially disadvantaged (for example, by virtue of being poor, female, and/or members of a disenfranchised racial, ethnic, or religious group) at further disadvantage with respect to their health; health is essential to wellbeing and to overcoming other effects of social disadvantage. Equity is an ethical principle; it also is consonant with and closely related to human rights principles. The proposed definition of equity supports operationalisation of the right to the highest attainable standard of health as indicated by the health status of the most socially advantaged group. Assessing health equity requires comparing health and its social determinants between more and less advantaged social groups. These comparisons are essential to assess whether national and international policies are leading toward or away from greater social justice in health. PMID:12646539

  9. [Intervention to reduce variability in surgical indications and the waiting list of priority 1 patients. An experience in Galicia (Spain)].

    PubMed

    Domínguez González, M A Nieves; López-Pardo Pardo, M A Estrella; Rey Liste, M A Teresa; García Sixto, M A Montserrat

    2011-01-01

    The aims of this study were to homogenize priority 1 surgical indications in Galician hospitals and propose a methodology designed to ensure that that the waiting times of priority 1 patients do not exceed 30 days. The priority 1 surgical indications of the distinct surgical services in Galicia were obtained and reviewed and were then sent for validation to the scientific societies. To reduce waiting times to less than 30 days, a procedure of periodic patient monitoring was established, with allocation of tasks to all the parties involved. Comparison of the mean waiting times before and after the implantation of periodic monitoring showed that this procedure reduced the mean waiting time by 55.7%. The mean waiting time was reduced in all the surgical specialities except one. In almost all of the surgical specialities, the procedure established reduced the number of patients on the waiting lists and the mean waiting time to less than 30 days.

  10. The relationship between health locus of control, depression, and sociodemographic factors and amount of time breast cancer patients wait before seeking diagnosis and treatment.

    PubMed

    Marijanović, Inga; Pavleković, Gordana; Buhovac, Teo; Martinac, Marko

    2017-09-01

    In the Federation of Bosnia and Herzegovina, the prevalence and incidence of breast cancer has been increasing, and the national programme of early prevention, administered locally, is sporadic and without quality assurance. While many factors may influence women's decision to adopt prevention-oriented behaviours regarding breast cancer, this study has emphasised the importance of sociodemographic factors, psychological factors and mental wellbeing. Participants in the study were all patients who, during one year, were admitted for the first time for diagnosis and treatment in the biggest Clinical hospitals of the Herzegovina-Neretva region Patients were divided into two groups based on their TNM classification: "early stage" and "late stage". Three instruments were used in this study: an individual questionnaire about demographic and socioeconomic characteristics of the woman, the Multidimensional Health Locus of Control scales, and the Hamilton Depression Rating Scale. The majority of patients diagnosed with advanced disease were admitted to hospital in the late/advanced stages of the disease. Multi-variant analysis showed that the most statistically significant positive predictor for early admittance in hospital is living with family and marital status while religiosity has a negative predictive value. The results indicate that 59.7% of respondents do not have depression, while the remainder do have some degree of depression. There was no statistically significant difference in the degree of depression between women who were diagnosed and treated early and those who were not. The employment status of the respondents was the only significant factor related to degree of depression. Although health locus of control and depression are not statistically significant predictors of early hospital treatment, the recommendation is that further studies focus on the implementation of MHLC and HDRS scales within the community. This could be useful in planning appropriate and

  11. Individual Differences in Equity Models

    ERIC Educational Resources Information Center

    Hofmans, Joeri

    2012-01-01

    In the present paper, we (1) study whether people differ in the equity models they use, and (2) test whether individual differences in equity models relate to individual differences in equity sensitivity. To achieve this goal, an Information Integration experiment was performed in which participants were given information on the performance of two…

  12. Salary Equity: A Case Study.

    ERIC Educational Resources Information Center

    McConkey, Joan; And Others

    1993-01-01

    Describes a six-year effort to complete a salary equity review for librarians at the University of Colorado (Boulder) in the context of general salary equity for women and minority faculty. Recounts the difficulties before a male counterpart study was chosen to complete the process, and advises others seeking salary equity to be realistic,…

  13. Cross sectional survey on the concerns and anxiety of patients waiting for organ transplants.

    PubMed

    Li, Philip Kam-Tao; Chu, Kwok Hong; Chow, Kai Ming; Lau, Miu Fong; Leung, Chi Bon; Kwan, Bonnie Ching Ha; Tong, Yuen Fan; Szeto, Cheuk Chun; Ng, Maggie Miu Man

    2012-07-01

      We aimed to gain an understanding of patient concerns while on a transplantation waiting list in areas with long transplant waiting time.   The study population comprised patients with organ failure on the transplant waiting list in Hong Kong. They were invited to complete a questionnaire survey. Demographic data and waiting time were collected. Respondents rated their chance of getting transplanted, their subjective concerns and feelings, level of happiness and support received.   A total of 442 patients on the waiting list for kidney, liver, lung and heart-lung transplants completed the questionnaire survey. The majority of patients (93.0%) were waiting for kidney transplantation. More than half of the respondents (63.3%) had been waiting for more than 3 years. Patients with longer transplant waiting times had lower self-estimated chance of receiving a transplant (P = 0.004). Self-estimated chance of getting transplanted was positively associated with the happiness score (P < 0.0001). Issues of most concerns to the patients waiting for organ transplants were: inconvenience of therapy (48.2%), disease progression (47.9%), burden to family (59.5%) and financial difficulties (52.3%). More female patients on the waiting list (50.0% vs 25.7% in male) reported concerns about suffering associated with the illnesses. 21.7% of patients considered the level of support received inadequate.   Our patients had long waiting time for transplantation, which is associated with a lower perceived chance of getting a transplant. Attention to more psychosocial support to these patients waiting for organ transplant is important. Promoting and improving organ donation would be the ultimate way to help these patients. © 2012 The Authors. Nephrology © 2012 Asian Pacific Society of Nephrology.

  14. Psychosocial and Patient Education Needs of Prostate Cancers Selecting Watchful Waiting

    DTIC Science & Technology

    2008-11-01

    to report erectile dysfunction (80% vs. 45%) and urinary leakage (49% vs. 21%) than men treated with a radical prostatectomy. However, urinary...men selecting watchful waiting. Over time, men selecting watchful waiting have worse mental HRQoL than men treated with surgery but better HRQoL than...men treated with radiation.16 Men who select watchful waiting report substantial uncertainty and anxiety about their health status.17 Our

  15. How long should someone wait after CMV infection to start pregnancy?

    PubMed Central

    Moienafshari, R.; Bar-Oz, B.; Ford-Jones, L.; Koren, G.

    1998-01-01

    QUESTION: One of my patients contracted a primary cytomegalovirus (CMV) infection. What is the recommended waiting time between primary CMV infection and conception, and which tests are valid for determining whether infectivity is over? ANSWER: Although no data on the proper waiting period between primary CMV infection and conception are available, we suggest waiting until CMV-specific immunoglobulin G antibodies are present (at least 6 months). PMID:9839051

  16. Optimising waiting: a view from the English National Health Service.

    PubMed

    Harrison, Anthony J; Appleby, John

    2010-10-01

    Recent authors have proposed that waiting times for elective treatment should be reduced to the point where the costs of doing so exceed the benefits. This paper considers how this criterion could be put into effect. Taking benefits first it argues that these could be estimated in three different ways - social cost benefit, clinical and user valuation - that would not necessarily produce consistent results and hence a choice has to be made between them. It then considers the costs of reducing waits and argues, citing relevant evidence, that these may range widely according to whether or not reductions can be achieved through simple management measures or whether more long-term capacity is required. It concludes therefore that the apparently simple criterion proposed for defining the point where waiting times are optimal is hard to establish. Choice of criterion must be made in the light of the overall values that a given health care system is intended to promote.

  17. Waiting-time targets. Early learners.

    PubMed

    Moore, Alison

    2007-04-05

    Thirteen 'early achiever' sites have volunteered to deliver the new 18-week target ahead of schedule. The sites have highlighted recurring issues for trusts aiming for 18 weeks: orthopaedics, audiology, endoscopy and some smaller specialties have all proved challenging. The target should be seen as a vital step towards a 'no unnecessary delay' system of working and thinking.

  18. Supply and demand: estimating the real need for care while meeting the 48 hour waiting time target in a genitourinary medicine clinic by a closed appointment system

    PubMed Central

    Clarke, J; Christodoulides, H; Taylor, Y

    2006-01-01

    Aim To attempt to assess demand for access to sexual health services in a community where a “closed” appointment system operates in the local genitourinary medicine (GUM) clinic. Setting A large GUM clinic serving a provincial city in England. Appointments for new episodes are available only 1 or 2 days ahead. Service user complaints about repeated difficulty in getting through to book a visit prompted a review of all methods of access. Methods A prospective review of all calls received in the departmental telephone booking service was performed. Temporary extra staff manned a cascade sequence of telephone lines and recorded all calls and caller characteristics such as age and declaration of symptoms. All attempts to book an appointment in person, by written referral, or by telephone in a period of 5 working days were also logged. This total demand was compared with the actual capacity and maximum theoretical capacity of the clinic during the same time period. Results 626 appointments would be required in the working week to accommodate all patients within 48 hours of requesting to be seen. 84% of all calls requested a new appointment, and 77% all new appointment requests were by phone. There were 181 new appointments available; 72% of those requesting an appointment could not be seen. The clinic was working at 103% capacity. To accommodate demand at this quiet time of the academic year, the GUM service would need to increase capacity by 3–4‐fold. Conclusions Closed appointment systems in GUM services may produce an apparent “improvement” in waiting times to 48 hours, but many callers are not able to book an appointment at all. Demand for GUM services outstrips capacity to an extent that internal efficiency savings cannot hope to address. PMID:16461602

  19. Unmet Needs and Waiting List Prioritization for Knee Arthroplasty

    PubMed Central

    Comas, Mercè; Román, Rubén; Quintana, José Maria

    2009-01-01

    Background There is a high volume of unmet needs for knee arthroplasty in the population despite the increase in surgery rates. Given the long waiting times to have a knee arthroplasty, some governments have proposed prioritization systems for patients on waiting lists based on their level of need. Questions/Purposes We therefore estimated the needs and demand of knee arthroplasty in four regions of Spain during a 5-year period. Methods We developed a discrete event simulation model to reproduce the process of knee arthroplasty. The prioritization system was compared with the usual waiting list management strategy (by waiting time only). Results Under the prioritization system, patients saved an average of 4.5 months (95% confidence interval, 4.4–4.6 months) adjusted by level of need. The proportion of patients who experienced excessive waiting times was small and was associated with low levels of priority. The 5-year projection of the volume of unmet needs for knee arthroplasty remained stable; however, although the volume of need for the first knee arthroplasty decreased by 12%, the volume of need for an arthroplasty in the contralateral knee increased by 50%. Conclusions The data suggested the prioritization system was more beneficial than assigning surgery by waiting time only. The 5-year projection of the volume of unmet needs for knee arthroplasty remained stable, despite the increase in the need for contralateral knee arthroplasty. Level of Evidence Level II, economic and decision analyses. See Guidelines for Authors for a complete description of levels of evidence. PMID:19911242

  20. Equity Literacy for All

    ERIC Educational Resources Information Center

    Gorski, Paul C.; Swalwell, Katy

    2015-01-01

    If the authors have learned anything working with schools across the United States, they've learned this: When it comes to educational equity, the trouble is not a lack of multicultural programs or diversity initiatives in schools. Nor is it a lack of educators who appreciate and even champion diversity. The trouble lies in how so many diversity…

  1. Student Equity Policy.

    ERIC Educational Resources Information Center

    Guichard, Gus

    Following a decrease in minority student enrollment within the California Community Colleges (CCC), the Board of Governors (BOG) convened a special statewide symposium to examine issues of minority student enrollment, retention, and transfer, and established a standing Board Committee on Equity and Diversity. Over the past 2 years, a system policy…

  2. Equity Literacy for All

    ERIC Educational Resources Information Center

    Gorski, Paul C.; Swalwell, Katy

    2015-01-01

    If the authors have learned anything working with schools across the United States, they've learned this: When it comes to educational equity, the trouble is not a lack of multicultural programs or diversity initiatives in schools. Nor is it a lack of educators who appreciate and even champion diversity. The trouble lies in how so many diversity…

  3. Organizing Equity Exchanges

    NASA Astrophysics Data System (ADS)

    Schaper, Torsten

    In the last years equity exchanges have diversified their operations into business areas such as derivatives trading, post-trading services, and software sales. Securities trading and post-trading are subject to economies of scale and scope. The integration of these functions into one institution ensures efficiency by economizing on transactions costs.

  4. Teacher Communities for Equity

    ERIC Educational Resources Information Center

    Cochran-Smith, Marilyn

    2015-01-01

    Teachers working together in learning communities is a popular aspect of school reform projects in countries around the world. However, teacher communities vary greatly from one another. This article describes two communities whose purpose is to help teachers work for equity by focusing on questions that emerge from practice and from genuine…

  5. Computer Equity @ School.

    ERIC Educational Resources Information Center

    Equity Coalition for Race, Gender, and National Origin, 1999

    1999-01-01

    This edition of "Equity Coalition" is designed to be a resource to assist those who have responsibility for technology in the schools. The authors of these articles discuss a variety of issues related to computer uses in education and equal access to educational technology. The issue contains the following articles: (1) "Technology--A New Kind of…

  6. Gender Equity Report.

    ERIC Educational Resources Information Center

    Washington State Higher Education Coordinating Board, Olympia.

    Under a legislative mandate from the state of Washington, this report provides updated information on gender equity at each of the public institutions of higher education in Washington and at the community and technical colleges, as applicable. A look at student support and services shows that pay scales in student employment are not…

  7. Equity. IDRA Focus.

    ERIC Educational Resources Information Center

    IDRA Newsletter, 1998

    1998-01-01

    This theme issue focuses on equity in children's literature, public funding for private schools, women in educational fields, female dropouts, and the relationship between school violence and family and community violence. "Violence in Our Schools" (Bradley Scott) explores reasons for school violence (media violence, isolation from…

  8. Equity in the Classroom

    ERIC Educational Resources Information Center

    DiMartino, Joseph; Miles, Sherri

    2004-01-01

    In this article, the authors discuss three reform strategies designed to produce educational equity. The first strategy, heterogeneous grouping, does away with the controversial practice of placing students in different tracks based on their ability, which can polarize the student population into pro- and anti-school camps, create a "caste system"…

  9. Gender Equity. IDRA Focus.

    ERIC Educational Resources Information Center

    IDRA Newsletter, 1996

    1996-01-01

    This newsletter includes five articles on gender equity and related issues in education, with particular reference to the education of Hispanic girls. "IDRA's MIJA Program Expands" (Aurora Yanez-Perez) describes a program for sixth-grade Hispanic girls that promotes awareness of science- and math-related careers, provides training in…

  10. A national analysis of dental waiting lists and point-in-time geographic access to subsidised dental care: can geographic access be improved by offering public dental care through private dental clinics?

    PubMed

    Dudko, Yevgeni; Kruger, Estie; Tennant, Marc

    2017-01-01

    Australia is one of the least densely populated countries in the world, with a population concentrated on or around coastal areas. Up to 33% of the Australian population are likely to have untreated dental decay, while people with inadequate dentition (fewer than 21 teeth) account for up to 34% of Australian adults. Historically, inadequate access to public dental care has resulted in long waiting lists, received much media coverage and been the subject of a new federal and state initiative. The objective of this research was to gauge the potential for reducing the national dental waiting list through geographical advantage, which could arise from subcontracting the delivery of subsidised dental care to the existing network of private dental clinics across Australia. Eligible population data were collected from the Australian Bureau of Statistics website. Waiting list data from across Australia were collected from publicly available sources and confirmed through direct communication with each individual state or territory dental health body. Quantum geographic information system software was used to map distribution of the eligible population across Australia by statistical area, and to plot locations of government and private dental clinics. Catchment areas of 5 km for metropolitan clinics and 5 km and 50 km for rural clinics were defined. The number of people on the waiting list and those eligible for subsidised dental care covered by each of the catchment areas was calculated. Percentage of the eligible population and those on the waiting list that could benefit from the potential improvement in geographic access was ascertained for metropolitan and rural residents. Fifty three percent of people on the waiting list resided within metropolitan areas. Rural and remote residents made up 47% of the population waiting to receive care. The utilisation of both government and private dental clinics for the delivery of subsidised dental care to the eligible population

  11. 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.

  12. 7 CFR 1738.207 - Equity requirement.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ..., the applicant may satisfy the equity requirement at the time of application with an investor's... provide evidence in the application that clearly identifies the investor's commitment to the applicant; the amount, terms, and conditions of the investment; and the investor's bank or financial...

  13. Discrete-event simulation applied to analysis of waiting lists. Evaluation of a prioritization system for cataract surgery.

    PubMed

    Comas, Mercè; Castells, Xavier; Hoffmeister, Lorena; Román, Rubén; Cots, Francesc; Mar, Javier; Gutiérrez-Moreno, Santiago; Espallargues, Mireia

    2008-12-01

    To outline the methods used to build a discrete-event simulation model for use in decision-making in the context of waiting list management strategies for cataract surgery by comparing a waiting list prioritization system with the routinely used first-in, first-out (FIFO) discipline. The setting was the Spanish health system. The model reproduced the process of cataract, from incidence of need of surgery (meeting indication criteria), through demand, inclusion on a waiting list, and surgery. "Nonexpressed Need" represented the population that, even with need, would not be included on a waiting list. Parameters were estimated from administrative data and research databases. The impact of introducing a prioritization system on the waiting list compared with the FIFO system was assessed. For all patients entering the waiting list, the main outcome variable was waiting time weighted by priority score. A sensitivity analysis with different scenarios of mean waiting time was used to compare the two alternatives. The prioritization system shortened waiting time (weighted by priority score) by 1.55 months (95% CI: 1.47 to 1.62) compared with the FIFO system. This difference was statistically significant for all scenarios (which were defined from a waiting time of 4 months to 24 months under the FIFO system). A tendency to greater time savings in scenarios with longer waiting times was observed. Discrete-event simulation is useful in decision-making when assessing health services. Introducing a waiting list prioritization system produced greater benefit than allocating surgery by waiting time only. Use of the simulation model would allow the impact of proposed policies to reduce waiting lists or assign resources more efficiently to be tested.

  14. Referral rates and waiting lists: some empirical evidence.

    PubMed

    Goddard, J A; Tavakoli, M

    1998-09-01

    This paper provides some empirical evidence on topics discussed at greater length in a recent paper in Health Economics (Goddard, J.A., Malek, M. and Tavakoli, M. Health Economics 1995; 4: 41-55), which modelled the relationship between referral rates and waiting lists for hospital treatment for non-urgent conditions within a queuing theory framework. Here, we estimate a version of the demand function used in this model, with panel data for Scottish Health Board Areas during the period 1990-1992. Separate models are estimated for each of six broadly defined 'waiting list' specialisms, for which we have data on referral rates and waiting times. The six specialisms are General Surgery, Ear Nose and Throat Surgery, Gynaecol