Emergency department crowding: prioritising quantified crowding measures using a Delphi study.

AimsEmergency department (ED) crowding has been associated with a number of negative health outcomes, including unnecessary deaths, increased waiting times and a decrease in care quality. Despite the seriousness of this issue, there is little agreement on appropriate crowding measures to assess crowding effects on ED operations. The objective of this study was to prioritise a list of quantified crowding measures that would assess the current state of a department.MethodsA three round Delphi study was conducted via email and an Internet based survey tool. The panel consisted of 40 professionals who had exposure to and expertise in crowding. Participants submitted quantified crowding measures which, through three rounds, were evaluated and ranked to assess participant agreement for inclusion.ResultsThe panel identified 27 measures of which eight (29.6%) reached consensus at the end of the study. These measures comprised: (1) ability of ambulances to offload; (2) patients who leave without being seen or treated; (3) time until triage; (4) ED occupancy rate; (5) patients' total length of stay in the ED; (6) time to see a physician; (7) ED boarding time; and (8) number of patients boarding in the ED.ConclusionsThis study resulted in the identification of eight quantified crowding measures, which present a comprehensive view of how crowding is affecting ED operations, and highlighted areas of concern. These quantified measures have the potential to make a considerable contribution to decision making by ED management and to provide a basis for learning across different departments.

Total acquisition cost of overseas outsourcing/sourcing: A framework and a case study

Purpose - The purpose of this paper is to develop a framework of total acquisition cost of overseas outsourcing/sourcing in manufacturing industry. This framework contains categorized cost items that may occur during the overseas outsourcing/sourcing process. The framework was tested by a case study to establish both its feasibility and usability. Design/methodology/approach - First, interviews were carried out with practitioners who have the experience of overseas outsourcing/sourcing in order to obtain inputs from industry. The framework was then built up based on combined inputs from literature and from practitioners. Finally, the framework was tested by a case study in a multinational high-tech manufacturer to establish both its feasibility and usability. Findings - A practical barrier for implementing this framework is shortage of information. The predictability of the cost items in the framework varies. How to deal with the trade off between accuracy and applicability is a problem needed to be solved in the future research. Originality/value - There are always limitations to the generalizations that can be made from just one case. However, despite these limitations, this case study is believed to have shown the general requirement of modeling the uncertainty and dealing with the dilemma between accuracy and applicability in practice. © Emerald Group Publishing Limited.

Effects of solution exposure on the combined axial-shear behaviour of unidirectional CFRP rods

In fibre reinforced polymer (FRP) prestressed concrete applications, an FRP tendon must sustain high axial tensile stresses and, if cracks occur, additional dowel forces. The tendon may also be exposed to solutions and so the combined axial-shear stress performance after long-term environmental exposure is important. Experiments were conducted to investigate the combined axial-shear stress failure envelope for unidirectional carbon FRP tendons which had been exposed to either water, salt water or concrete pore solution at 60 °C for approximately 18 months. The underlying load resisting mechanisms were found to depend on the loading configuration, restraint effects and the initial stress state. When saturated, CFRP tendons are likely to exhibit a reduced shear stiffness. However, the ultimate limit state appeared to be fibre-dominated and was therefore less susceptible to reductions due to solution uptake effects. © 2012 Elsevier Ltd. All rights reserved.

Total Information Risk Management

This book provides you with all fundamental concepts, guidelines and tools to ensure core business information is identified, protected and used effectively, written in a language that is clear and easy to understand for non-technical ...

A survey on technology exposure and range of abilities of elderly and disabled users in India

This paper reports a survey on people with age-related and physical impairments in India. The survey evaluates functional parameters related to human computer interaction and reports subjective attitude and exposure of users towards technology. We found a significant cognitive decline in elderly users while their functional parameters are sufficient to use existing electronic devices. However young disabled users are found to be experienced with computer but could not have access to appropriate assistive devices, which would benefit them. Most users used desktop computers and mobile phone but none used tablet, smartphone or kiosks though they are keen to learn new technologies. Overall we hope that our results will be useful for HCI practitioners in developing countries. © 2013 Springer-Verlag Berlin Heidelberg.

Total Information Risk Management

This book provides you with all the fundamental concepts, guidelines and tools to ensure core business information is identified, protected and used effectively, and written in a language that is clear and easy to understand for non ...