Demand for hospital emergency departments : a conceptual understanding

BACKGROUND: Emergency departments (EDs) are critical to the management of acute illness and injury, and the provision of health system access. However, EDs have become increasingly congested due to increased demand, increased complexity of care and blocked access to ongoing care (access block). Congestion has clinical and organisational implications. This paper aims to describe the factors that appear to infl uence demand for ED services, and their interrelationships as the basis for further research into the role of private hospital EDs. DATA SOURCES: Multiple databases (PubMed, ProQuest, Academic Search Elite and Science Direct) and relevant journals were searched using terms related to EDs and emergency health needs. Literature pertaining to emergency department utilisation worldwide was identified, and articles selected for further examination on the basis of their relevance and significance to ED demand. RESULTS: Factors influencing ED demand can be categorized into those describing the health needs of the patients, those predisposing a patient to seeking help, and those relating to policy factors such as provision of services and insurance status. This paper describes the factors influencing ED presentations, and proposes a novel conceptual map of their interrelationship. CONCLUSION: This review has explored the factors contributing to the growing demand for ED care, the influence these factors have on ED demand, and their interrelationships depicted in the conceptual model.

Current affairs in British public service broadcasting : challenges and opportunities

This chapter looks at the challenges and opportunities of current affairs in British public service broadcasting

Epidemiologic modeling with FluSurge for pandemic (H1N1) 2009 outbreak, Queensland, Australia

At the beginning of the pandemic (H1N1) 2009 outbreak, we estimated the potential surge in demand for hospital-based services in 4 Health Service Districts of Queensland, Australia, using the FluSurge model. Modifications to the model were made on the basis of emergent evidence and results provided to local hospitals to inform resource planning for the forthcoming pandemic. To evaluate the fit of the model, a comparison between the model's predictions and actual hospitalizations was made. In early 2010, a Web-based survey was undertaken to evaluate the model's usefulness. Predictions based on modified assumptions arising from the new pandemic gained better fit than results from the default model. The survey identified that the modeling support was helpful and useful to service planning for local hospitals. Our research illustrates an integrated framework involving post hoc comparison and evaluation for implementing epidemiologic modeling in response to a public health emergency.

Conformance checking of service behavior

A service-oriented system is composed of independent software units, namely services, that interact with one another exclusively through message exchanges. The proper functioning of such system depends on whether or not each individual service behaves as the other services expect it to behave. Since services may be developed and operated independently, it is unrealistic to assume that this is always the case. This article addresses the problem of checking and quantifying how much the actual behavior of a service, as recorded in message logs, conforms to the expected behavior as specified in a process model.We consider the case where the expected behavior is defined using the BPEL industry standard (Business Process Execution Language for Web Services). BPEL process definitions are translated into Petri nets and Petri net-based conformance checking techniques are applied to derive two complementary indicators of conformance: fitness and appropriateness. The approach has been implemented in a toolset for business process analysis and mining, namely ProM, and has been tested in an environment comprising multiple Oracle BPEL servers.

Investigating pre-service teachers’ perceptions of their preparedness to teach

The experiences of transition to the teaching profession have a significant impact on a teachers’ potential length of career, feelings of professional efficacy and the quality of performance in the classroom (Gore & Thomas, 2003). While the transition to practice is characterized by much expectation and excitement, it also a time of stress and uncertainty for many beginning teachers. As such, it is important to investigate this period of transition for beginning teachers. This paper explores graduate teachers perceptions of their personal ‘preparedness to teach’. The group is graduating from one Australian university, and the data is captured at the end of their teacher preparation programs,before they take up positions in schools. These graduating pre-service teachers are from one year graduate entry programs that include individual programs of early years, middle years and senior years. The key findings indicate that this group of graduating pre-service teachers are already engaged in some level of reflective practice and are actively seeking further professional learning to improve the practical aspects of their classroom teaching.

Effects of wearing a pressure redistribution belt while lying in a hospital bed

Bedsores (ulcers) are caused by multiple factors which include, but are not limited to; pressure, shear force, friction, temperature, age and medication. Specialised support services, such as specialised mattresses, sheepskin coverings etc., are thought to decrease or relieve pressure, resulting in a lowering of pressure ulcer incidence [3]. The primary aim of this study was to compare the upper/central body pressure distribution between normal lying in a hospital bed versus the use of a pressure redistribution belt. The study involved 16 healthy voluntary subjects lying on a hospital bed with and without wearing the belt. Results showed that the use of a pressure redistribution belt results in reduced pressure peaks and prevents the pressure from increasing over time.

Effectiveness of powered hospital bed movers for reducing physiological strain and back muscle activation

Battery powered bed movers are becoming increasingly common within the hospital setting. The use of powered bed movers is believed to result in reduced physical efforts required by health care workers, which may be associated with a decreased risk of occupation related injuries. However, little work has been conducted assessing how powered bed movers impact on levels of physiological strain and muscle activation for the user. The muscular efforts associated with moving hospital beds using three different methods; manual pushing, StaminaLift Bed Mover (SBM) and Gzunda Bed Mover (GBM)were measured on six male subjects. Fourteen muscles were assessed moving a weighted hospital bed along a standardized route in an Australian hospital environment. Trunk inclination and upper spine acceleration were also quantified. Powered bed movers exhibited significantly lower muscle activation levels than manual pushing for the majority of muscles. When using the SBM, users adopted a more upright posture which was maintained while performing different tasks (e.g. turning a corner, entering a lift), while trunk inclination varied considerably for manual pushing and the GBM. The reduction in lower back muscular activation levels and the load reducing effect of a more upright posture may result in lower incidence of lower back injury.

Service delivery framework : an architectural strategy for next-generation service delivery in business network

The next-generation of service-oriented architecture (SOA) needs to scale for flexible service consumption, beyond organizational and application boundaries, into communities, ecosystems and business networks. In wider and, ultimately, global settings, new capabilities are needed so that business partners can efficiently and reliably enable, adapt and expose services. Those services can then be discovered, ordered, consumed, metered and paid for, through new applications and opportunities, driven by third-parties in the global “village”. This trend is already underway, in different ways, through different early adopter market segments. This paper proposes an architectural strategy for the provisioning and delivery of services in communities, ecosystems and business networks – a Service Delivery Framework (SDF). The SDF is intended to support multiple industries and deployments where a SOA platform is needed for collaborating partners and diverse consumers. Specifically, it is envisaged that the SDF allows providers to publish their services into network directories so that they can be repurposed, traded and consumed, and leveraging network utilities like B2B gateways and cloud hosting. To support these different facets of service delivery, the SDF extends the conventional service provider, service broker and service consumer of the Web Services Architecture to include service gateway, service hoster, service aggregator and service channel maker.

Diversified service provisioning in global business networks

Companies and their services are being increasingly exposed to global business networks and Internet-based ondemand services. Much of the focus is on flexible orchestration and consumption of services, beyond ownership and operational boundaries of services. However, ways in which third-parties in the “global village” can seamlessly self-create new offers out of existing services remains open. This paper proposes a framework for service provisioning in global business networks that allows an open-ended set of techniques for extending services through a rich, multi-tooling environment. The Service Provisioning Management Framework, as such, supports different modeling techniques, through supportive tools, allowing different parts of services to be integrated into new contexts. Integration of service user interfaces, business processes, operational interfaces and business object are supported. The integration specifications that arise from service extensions are uniformly reflected through a kernel technique, the Service Integration Technique. Thus, the framework preserves coherence of service provisioning tasks without constraining the modeling techniques needed for extending different aspects of services.

Towards a unified service description language for the internet of services : requirements and first developments

Service-oriented Architectures (SOA) and Web services leverage the technical value of solutions in the areas of distributed systems and cross-enterprise integration. The emergence of Internet marketplaces for business services is driving the need to describe services, not only from a technical level, but also from a business and operational perspective. While, SOA and Web services reside in an IT layer, organizations owing Internet marketplaces are requiring advertising and trading business services which reside in a business layer. As a result, the gap between business and IT needs to be closed. This paper presents USDL (Unified Service Description Language), a specification language to describe services from a business, operational and technical perspective. USDL plays a major role in the Internet of Services to describe tradable services which are advertised in electronic marketplaces. The language has been tested using two service marketplaces as use cases.

Composing services for third-party service delivery

This paper proposes a model-based technique for lowering the entrance barrier for service providers to register services with a marketplace broker, such that the service is rapidly configured to utilize the brokerpsilas local service delivery management components. Specifically, it uses process modeling for supporting the execution steps of a service and shows how service delivery functions (e.g. payment points) ldquolocalrdquo to a service broker can be correctly configured into the process model. By formalizing the different operations in a service delivery function (like payment or settlement) and their allowable execution sequences (full payments must follow partial payments), including cross-function dependencies, it shows how through tool support, the non-technical user can quickly configure service delivery functions in a consistent and complete way.

Non-desynchronizable service choreographies

A precise definition of interaction behavior between services is a prerequisite for successful business-to-business integration. Service choreographies provide a view on message exchanges and their ordering constraints from a global perspective. Assuming message sending and receiving as one atomic step allows to reduce the modelers’ effort. As downside, problematic race conditions resulting in deadlocks might appear when realizing the choreography using services that exchange messages asynchronously. This paper presents typical issues when desynchronizing service choreographies. Solutions from practice are discussed and a formal approach based on Petri nets is introduced for identifying desynchronizable choreographies.

The rise of web service ecosystems

The convergence of Internet marketplaces and service-oriented architectures has spurred the growth of Web service ecosystems. This paper articulates a vision for Web service ecosystems, discusses early manifestations of this vision, and presents a unifying architecture to support the emergence of larger and more sophisticated ecosystems

Application of Geographic Modeling Techniques to Quantify Spatial Access to Health Services Before and After an Acute Cardiac Event: The Cardiac ARIA Project

Background: Access to cardiac services is essential for appropriate implementation of evidence-based therapies to improve outcomes. The Cardiac Accessibility and Remoteness Index for Australia (Cardiac ARIA) aimed to derive an objective, geographic measure reflecting access to cardiac services. Methods: An expert panel defined an evidence-based clinical pathway. Using Geographic Information Systems (GIS), a numeric/alpha index was developed at two points along the continuum of care. The acute category (numeric) measured the time from the emergency call to arrival at an appropriate medical facility via road ambulance. The aftercare category (alpha) measured access to four basic services (family doctor, pharmacy, cardiac rehabilitation, and pathology services) when a patient returned to their community. Results: The numeric index ranged from 1 (access to principle referral center with cardiac catheterization service ≤ 1 hour) to 8 (no ambulance service, > 3 hours to medical facility, air transport required). The alphabetic index ranged from A (all 4 services available within 1 hour drive-time) to E (no services available within 1 hour). 13.9 million (71%) Australians resided within Cardiac ARIA 1A locations (hospital with cardiac catheterization laboratory and all aftercare within 1 hour). Those outside Cardiac 1A were over-represented by people aged over 65 years (32%) and Indigenous people (60%). Conclusion: The Cardiac ARIA index demonstrated substantial inequity in access to cardiac services in Australia. This methodology can be used to inform cardiology health service planning and the methodology could be applied to other common disease states within other regions of the world.

Cardiac ARIA Index: Measuring Accessibility to Cardiovascular Services in Rural and Remote Australia via Applied Geographic Spatial Technology

Cardiovascular disease (CVD) continues to impose a heavy burden in terms of cost, disability and death in Australia. Evidence suggests that increasing remoteness, where cardiac services are scarce, is linked to an increased risk of dying from CVD. Fatal CVD events are reported to be between 20% and 50% higher in rural areas compared to major cities. The Cardiac ARIA project, with its extensive use of geographic Information Systems (GIS), ranks each of Australia’s 20,387 urban, rural and remote population centres by accessibility to essential services or resources for the management of a cardiac event. This unique, innovative and highly collaborative project delivers a powerful tool to highlight and combat the burden imposed by cardiovascular disease (CVD) in Australia. Cardiac ARIA is innovative. It is a model that could be applied internationally and to other acute and chronic conditions such as mental health, midwifery, cancer, respiratory, diabetes and burns services. Cardiac ARIA was designed to: 1. Determine by expert panel, what were the minimal services and resources required for the management of a cardiac event in any urban, rural or remote population locations in Australia using a single patient pathway to access care. 2. Derive a classification using GIS accessibility modelling for each of Australia’s 20,387 urban, rural and remote population locations. 3. Compare the Cardiac ARIA categories and population locations with census derived population characteristics. Key findings are as follows: • In the event of a cardiac emergency, the majority of Australians had very good access to cardiac services. Approximately 71% or 13.9 million people lived within one hour of a category one hospital. • 68% of older Australians lived within one hour of a category one hospital (Principal Referral Hospital with access to Cardiac Catheterisation). • Only 40% of indigenous people lived within one hour of the category one hospital. • 16% (74000) of indigenous people lived more than one hour from a hospital. • 3% (91,000) of people 65 years of age or older lived more than one hour from any hospital or clinic. • Approximately 96%, or 19 million, of people lived within one hour of the four key services to support cardiac rehabilitation and secondary prevention. • 75% of indigenous people lived within one hour of the four cardiac rehabilitation services to support cardiac rehabilitation and secondary prevention. Fourteen percent (64,000 persons) indigenous people had poor access to the four key services to support cardiac rehabilitation and secondary prevention. • 12% (56,000) of indigenous people were more than one hour from a hospital and only had access one the four key services (usually a medical service) to support cardiac rehabilitation and secondary prevention.