Implementation of a chest pain management service improves patient care and reduces length of stay

Objective Chest pain is one of the most common complaints in patients presenting to an emergency department. Delays in management due to a lack of readily available objective tests to risk stratify patients with possible acute coronary syndromes can lead to an unnecessarily lengthy admission placing pressure on hospital beds or inappropriate discharge. The need for a co-ordinated system of clinical management based on enhanced communication between departments, timely and appropriate triage, clinical investigation, diagnosis, and treatment was identified. Methods An evidence-based Chest Pain Management Service and clinical pathway were developed and implemented, including the introduction of after-hours exercise stress testing. Results Between November 2005 and March 2013, 5662 patients were managed according to a Chest Pain Management pathway resulting in a reduction of 5181 admission nights by more timely identification of patients at low risk who could then be discharged. In addition, 1360 days were avoided in high-risk patients who received earlier diagnosis and treatment. Conclusions The creation of a Chest Pain Management pathway and the extended exercise stress testing service resulted in earlier discharge for low-risk patients; and timely treatment for patients with positive and equivocal exercise stress test results. This service demonstrated a significant saving in overnight admissions.

Milling innovations at Rocky Point

This paper reviews the innovations that have been introduced in the milling train at Rocky Point mill since 2001 and provides some operational, performance and maintenance comparisons of the technologies in use. The decision to install BHEM mills in the #2 and #3 mill positions to complement the six-roll mills in the #1 and #4 mill positions has proven a good one. Satisfactory performance is being obtained by these mills while maintenance costs are significantly less. Very good #1 mill extraction and final bagasse moisture content are being achieved. The innovation of using Hägglunds hydraulic drives at higher speed…

Changing travel patterns and journeys to health services in Great Britain 1985-2012: An examination health service utilisation using the National Travel Survey

Background This paper examines changing patterns in the utilisation and geographic access to health services in Great Britain using National Travel Survey data (1985-2012). The National Travel Survey (NTS) is a series of household surveys designed to provide data on personal travel and monitor changes in travel behaviour over time. The utilisation rate was derived using the proportion of journeys made to access health services. Geographic access was analysed by separating the concept into its accessibility and mobility dimensions. Methods Variables from the PSU, households, and individuals datasets were used as explanatory variables. Whereas, variables extracted from the journeys dataset were used as dependent variables to identify patterns of utilisation i.e. the proportion of journeys made by different groups to access health facilities in a particular journey distance or time band or by mode of transport; and geographic access to health services. A binary logistic regression analysis was conducted to identify the utilisation rate over the different time periods between different groups. This analysis shows the Odds Ratios (ORs) for different groups making a trip to utilise health services compared to their respective counterparts. Linear multiple regression analyses were conducted to then identify patterns of change in the accessibility and mobility level. Results Analysis of the data has shown that that journey distances to health facilities were signi fi cantly shorter and also gradually reduced over the period in question for Londoners, females, those without a car or on low incomes, and older people. Although rates of utilisation of health services we re Oral Abstracts / Journal of Transport & Health 2 (2015) S5 – S63 S43 signi fi cantly lower because of longer journey times. These fi ndings indicate that the rate of utilisation of health services largely depends on mobility level although previous research studies have traditionally overlooked the mobility dimension. Conclusions This fi nding, therefore, suggests the need to improve geographic access to services together with an enhanced mobility option for disadvantaged groups in order for them to have improved levels of access to health facilities. This research has also found that the volume of car trips to health services also increased steadily over the period 1985-2012 while all other modes accounted for a smaller number of trips. However, it is dif fi cult to conclude from this research whether this increase in the volume of car trips was due to a lack of alternative transport or due to an increase in the level of car-ownership.

Empirical insights into the development of a service-oriented enterprise architecture

Organisations use Enterprise Architecture (EA) to reduce organisational complexity, improve communication, align business and information technology (IT), and drive organisational change. Due to the dynamic nature of environmental and organisational factors, EA descriptions need to change over time to keep providing value for its stakeholders. Emerging business and IT trends, such as Service-Oriented Architecture (SOA), may impact EA frameworks, methodologies, governance and tools. However, the phenomenon of EA evolution is still poorly understood. Using Archer's morphogenetic theory as a foundation, this research conceptualises three analytical phases of EA evolution in organisations, namely conditioning, interaction and elaboration. Based on a case study with a government agency, this paper provides new empirically and theoretically grounded insights into EA evolution, in particular in relation to the introduction of SOA, and describes relevant generative mechanisms affecting EA evolution. By doing so, it builds a foundation to further examine the impact of other IT trends such as mobile or cloud-based solutions on EA evolution. At a practical level, the research delivers a model that can be used to guide professionals to manage EA and continually evolve it.

Integrated Chronic Disease Nurse Practitioner Service: Evaluation Final Report

Executive Summary Queensland University of Technology (QUT) was contracted to conduct an evaluation of an integrated chronic disease nurse practitioner service conducted at Meadowbrook Primary Care Practice. This evaluation is a collaborative project with nurse practitioners (NP) from Logan Hospital. The integrated chronic disease nurse practitioner service is an outpatient clinic for patients with two or more chronic diseases, including chronic kidney disease (CKD), heart failure (HF), diabetes (type I or II). This document reports on the first 12 months of the service (4th June, 2014 to 25th May, 2015). During this period: • 55 patients attended the NP clinic with 278 occasions of service provided • Almost all (95.7%) patients attended their scheduled appointments (only 4.3% did not attend an appointment) • Since attending the NP clinic, the majority of patients (77.6%) had no emergency department visits related to their chronic disease; only 3 required hospital admission. • 3 patients under the service were managed with Hospital In the Home which avoided more than 25 hospital bed days • 41 patients consented to join a prospective cohort study of patient-reported outcomes and patient satisfaction • 14 patient interviews and 3 stakeholder focus groups were also conducted to provide feedback on their perceptions of the NP-led service innovation. The report concludes with seven recommendations.

Controlling routine front line service workers: an Australian retail supermarket case

Food retail is known for its use of flexible labour and for the centralisation of functions at head office, resulting in a reduction of managerial autonomy at store level. This article employs a typology of controls developed from labour process scholarship to explore how retail managers negotiate the control of their predominantly part-time workforce. Using an Australian supermarket chain as a case, and mixed methods, the article demonstrates that supermarkets use a multiplicity of forms of control across their workforce. For front line service workers, the article identifies a new configuration of controls which intersects with employment status and acts differentially for checkout operators on different employment contracts.

Repositioning the innovation rationale for public service media

The values that gave rise to the ethos of public service broadcasting (PSB) almost a century ago, and which have provided the rationale for PSBs around the world across that time, are under question. This article argues that the process of reinvention of PSBs is enhanced through repositioning the innovation rationale for public service media (PSM). It is organized around a differentiation which is part of the standard repertoire of innovation studies – that between product, process and organizational innovation – as they are being practised by the two Australian PSBs, the Australian Broadcasting Corporation (ABC) and the Special Broadcasting Service (SBS). The article then considers the general problematics of innovation for PSBs through an analysis of the operations of the public value test in the context of European PSM, and its, to this stage, non-application in Australia. The innovation rationale is argued to be a distinctive via media between complementary and comprehensive roles for PSM, which in turn suggests an international, policy-relevant research agenda focusing on international circumstances in which the public broadcaster is not market dominant.

Leveraging of software as a service by small and medium enterprises: Information systems capabilities and organisational complementarities

This research explored how small and medium enterprises can achieve success with software as a service (SaaS) applications from cloud. Based upon an empirical investigation of six growth oriented and early technology adopting small and medium enterprises, this study proposes a SaaS for small and medium enterprise success model with two approaches: one for basic and one for advanced benefits. The basic model explains the effective use of SaaS for achieving informational and transactional benefits. The advanced model explains the enhanced use of software as a service for achieving strategic and transformational benefits. Both models explicate the information systems capabilities and organizational complementarities needed for achieving success with SaaS.

Civil service HRM reforms in a new democracy: The case of Bhutan

This research investigates Bhutan Civil Service Human Resource Management strategies, policies and practices, and their contribution to achieving the national goal of Gross National Happiness. The study finds that the HRM of the Bhutanese civil service is meeting its strategic objective of contributing to GNH. The civil service in Bhutan plays an important role in socio-economic development, influences private sector practices, strengthens good governance and provides continuity to the government. Participants in the study were government ministers and senior, highly experienced civil servants. A model of civil service HRM in Bhutan is developed.

Exploring university-community partnerships in arts-based service learning with Australian First Peoples and Arts Organizations

In this chapter we focus on the importance of partnerships in arts-based service learning with Australian First Peoples and community arts organizations. Drawing on six years of our own partnership and a wide body of literature, this chapter aims to act as a trigger for further reflection on ways to engage in meaningful partnerships with First Peoples and arts organizations. In particular, the continuum between transactional and transformational types of relationships provides a useful means for understanding our work and for positioning the various benefits and challenges associated with university-community partnerships more broadly.

Workplace belongingness, psychological distress and resilience in emergency service workers

- Objective Ambulance personnel provide emergency medical services to the community, often attending to highly challenging and traumatic scenes in complex and chaotic circumstances. Currently the assessment of predictors of psychological well-being remains limited. The current study investigated whether workplace belongingness was significant in predicting psychological distress as well as the presence of resilience in ambulance personnel whilst controlling for more routinely examined factors. - Method Australian ambulance officers (N = 740) completed a survey battery including the Kessler 10 (Kessler & Mroczek, 1994), Brief Resilience Scale (Smith et al., 2008) and Psychological Sense of Organisational Membership (Cockshaw & Shochet, 2010) scale. - Results Controlling for more commonly examined factors such as severity of trauma exposure and length of service, hierarchical multiple regression analyses demonstrated that workplace belongingness was significantly associated with reduced distress levels and enhanced resilience levels. - Conclusions Results suggest that strategies to enhance a sense of workplace belongingness in emergency service organisations could promote the well-being of emergency workers despite routine exposure to potentially traumatic events.

No Wrong Door: The Salvation Army Doorways Case Management Service

The primary aim of the evaluation project was to determine the impact of The Salvation Army Doorways case management model in relation to client satisfaction and meeting client needs. Specifically, the project sought to: • Provide an overview of structural barriers confronting individuals who are entrenched in enduring poverty; • Provide an overview of the specific issues encountered by individuals, including insight into personal challenges, hopes and dreams; • Analyse the effectiveness of Doorways interventions, specifically: o How important is the relationship with staff at the Doorways centre? o What skills and knowledge do staff need? o What Doorways activities are the most successful in breaking the cycle of poverty? o How important are community connections? • Provide information to The Salvation Army on what works well in Doorways and how Doorways might be improved or enhanced.

Assessment of transit quality of service with occupancy load factor and passenger travel time measures

This paper investigates quality of service (QoS) and resource productivity implications of transit route passenger loading and travel time. It highlights the value of occupancy load factor as a direct passenger comfort QoS measure. Automatic Fare Collection data for a premium radial bus route in Brisbane, Australia, is used to investigate time series correlation between occupancy load factor and passenger average travel time. Correlation is strong across the entire span of service in both directions. Passengers tend to be making longer, peak direction commuter trips under significantly less comfortable conditions than off-peak. The Transit Capacity and Quality of Service Manual uses segment based load factor as a measure of onboard loading comfort QoS. This paper provides additional insight into QoS by relating the two route based dimensions of occupancy load factor and passenger average travel time together in a two dimensional format, both from the passenger’s and operator’s perspectives. Future research will apply Value of Time to QoS measurement, reflecting perceived passenger comfort through crowding and average time spent onboard. This would also assist in transit service quality econometric modeling. The methodology can be readily applied in a practical setting where AFC data for fixed scheduled routes is available. The study outcomes also provide valuable research and development directions.

How to develop an online community for pre-service and early career teachers

This paper contributes a number of design principles for developing large-scale online communities of pre-service and early career teachers (PS&ECTs). It presents the paradigms of connected learning, networked learning and communities of practice and contrasts them. It describes the potential for online communities to meet the needs of PS&ECTs and it identifies gaps that exist within certain types of existing online communities that currently support PS&ECTs. The paper proposes design principles for a new type of online community for PS&ECTs. These principles are drawn from the literature and from the preliminary outcomes of a pilot study.

Distributed Robotic Vision as a service

The vision sense of standalone robots is limited by line of sight and onboard camera capabilities, but processing video from remote cameras puts a high computational burden on robots. This paper describes the Distributed Robotic Vision Service, DRVS, which implements an on-demand distributed visual object detection service. Robots specify visual information requirements in terms of regions of interest and object detection algorithms. DRVS dynamically distributes the object detection computation to remote vision systems with processing capabilities, and the robots receive high-level object detection information. DRVS relieves robots of managing sensor discovery and reduces data transmission compared to image sharing models of distributed vision. Navigating a sensorless robot from remote vision systems is demonstrated in simulation as a proof of concept.