Patients perceptions of emergency department services : better specialised staff, convenient and available services

Many factors are identified as contributing to the high demand for emergency department (ED) care. Similarly, there have been many initiatives taken to minimise the impact that is placed on EDs. Many of these, however, do not consider the patient's opinions and motivations. The aim of this cross-sectional study was to understand patients’ perspectives and reasons behind their decision to present to EDs. 911 surveys were collected from patients presenting to eight QLD EDs in 2011. Based on the Principal Component Analysis technique, a six-item scale entitled "Best services at emergency departments" was extracted (α = 0.729) measuring patients' opinions and perspectives. Further, the independent t-tests were conducted between various groups of ED users. The results suggest that multiple users more likely viewed EDs as the best place for their conditions than the first-time users (Median 10.73 v 11.56, p<0.001). Moreover, patients who made the decision to present by themselves had a more favourable perception of the ED services than those for whom the decision was made or others were involved (Median 11.38 v 10.80, p=0.003). Method of arrival did not affect the respondents’ perception of ED (11.13 v 11.00, p=0.65). The results of this research indicate that patients’ perception of ED as the best and most appropriate place for attention to their medical conditions plays an important role in their decision to present and keep returning to ED. Understanding patients’ reasons and decisions enhances the success of planning and implementing alternative services to manage the demand for ED services.

Emergency Health Services (EHS) : demand and service delivery models. monograph 3 : patients’ reasons and perceptions

Executive Summary Emergency health is a critical component of Australia’s health system and emergency departments (EDs) are increasingly congested from growing demand and blocked access to inpatient beds. The Emergency Health Services Queensland (EHSQ) study aims to identify the factors driving increased demand for emergency health and to evaluate strategies which may safely reduce the future demand growth. This monograph addresses the perspectives of users of both ambulance services and EDs. The research reported here aimed to identify the perspectives of users of emergency health services, both ambulance services and public hospital Emergency Departments and to identify the factors that they took into consideration when exercising their choice of location for acute health care. A cross-sectional survey design was used involving a survey of patients or their carers presenting to the EDs of a stratified sample of eight hospitals. A specific purpose questionnaire was developed based on a novel theoretical model which had been derived from analysis of the literature (Monograph 1). Two survey versions were developed: one for adult patients (self-complete); and one for children (to be completed by parents/guardians). The questionnaires measured perceptions of social support, health status, illness severity, self-efficacy; beliefs and attitudes towards ED and ambulance services; reasons for using these services, and actions taken prior to the service request. The survey was conducted at a stratified sample of eight hospitals representing major cities (four), inner regional (two) and outer regional and remote (two). Due to practical limitations, data were collected for ambulance and ED users within hospital EDs, while patients were waiting for or under treatment. A sample size quota was determined for each ED based on their 2009/10 presentation volumes. The data collection was conducted by four members of the research team and a group of eight interviewers between March and May 2011 (corresponding to autumn season). Of the total of 1608 patients in all eight emergency departments the interviewers were able to approach 1361 (85%) patients and seek their consent to participate in the study. In total, 911 valid surveys were available for analysis (response rate= 67%). These studies demonstrate that patients elected to attend hospital EDs in a considered fashion after weighing up alternatives and there is no evidence of deliberate or ill-informed misuse. • Patients attending ED have high levels of social support and self-efficacy that speak to the considered and purposeful nature of the exercise of choice. • About one third of patients have new conditions while two thirds have chronic illnesses • More than half the attendees (53.1%) had consulted a healthcare professional prior to making the decision. • The decision to seek urgent care at an ED was mostly constructed around the patient’s perception of the urgency and severity of their illness, reinforced by a strong perception that the hospital ED was the correct location for them (better specialised staff, better care for my condition, other options not as suitable). • 33% of the respondent held private hospital insurance but nevertheless attended a public hospital ED. Similarly patients exercised considered and rational judgements in their choice to seek help from the ambulance service. • The decision to call for ambulance assistance was based on a strong perception about the severity of the illness (too severe to use other means of transport) and that other options were not considered appropriate. • The decision also appeared influenced by a perception that the ambulance provided appropriate access to the ED which was considered most appropriate for their particular condition (too severe to go elsewhere, all facilities in one spot, better specialised and better care). • In 43.8% of cases a health care professional advised use of the ambulance. • Only a small number of people perceived that ambulance should be freely available regardless of severity or appropriateness. These findings confirm a growing understanding that the choice of professional emergency health care services is not made lightly but rather made by reasonable people exercising a judgement which is influenced by public awareness of the risks of acute health and which is most often informed by health professionals. It is also made on the basis of a rational weighing up of alternatives and a deliberate and considered choice to seek assistance from a service which the patient perceived was most appropriate to their needs at that time. These findings add weight to dispensing with public perceptions that ED and ambulance congestion is a result of inappropriate choice by patients. The challenge for health services is to better understand the patient’s needs and to design and validate services that meet those needs. The failure of our health system to do so should not be grounds for blaming the patient, claiming inappropriate patient choices.

Inward internationalization of consumer services : lessons from Australian firms

Purpose - The aim of this paper is to explore the inward internationalization process of consumer services. A review of the service internationalization literature is conducted and the resource-based view of the firm is used as a theoretical approach. Design/methodology - Case study methodology is used to explore the internationalization process of five different consumer service sectors: tourism, education, accommodation, transport and entertainment. The main data collection method was interviews conducted with top managers of 12 Australian consumer service firms from these sectors. Findings - Findings of this study show that inward internationalizing services confront most of their barriers, such as immigration policies, exchange rate fluctuations, and cultural differences, in the domestic market where the service is provided. The findings also suggest that superior intentional performance for consumer service firms combines firm-specific resources and capabilities, such as market orientation, service quality, cultural sensitivity, international communicational activities, partnerships and networks, with country-specific resources and capabilities, such as country-of-origin image and government support. Research limitations/implications - This is one of the few studies in the academic literature that directly addresses the issue of inward internationalization of consumer services. Limitations derive from the qualitative nature of this study. Practical implications - The process of inward internationalization applies to a broad range of service industries and can assist firms to develop more effective international marketing strategies. Originality/value - This study contributes to the international services literature by identifying the main barriers and drivers of international performance for inward internationalizing consumer service firms, which is a topic that has been neglected in the literature.

Skin cancer detection by one click - are we any closer?

To the editor...

The apps industry

Australian apps developers typify global industry segmentation, varying in function, focus, employment situation and background. They range from freelancers contracted to build apps on demand and venture capital-backed or bootstrapped startups, to specialist app studios and full service digital agencies for whom apps are one among many services that may include web development, marketing, advertising, business strategy, branding and games development.

Embedded digital creatives

Digital creatives are spread widely across the economy, and growing rapidly in number. New industries such as mobile applications (apps) development are creating new occupations and services, and transforming some older ones. Digital creatives are driving innovation and economic growth in these industries and service sectors. Digital technologies and processes are becoming increasingly important in virtually all spheres of creative work, as they are across the economy. And yet there is no broad agreement either in Australia or worldwide about the constitution of the digital creative grouping, and only limited understanding of both the role of creatives in the digital economy and innovation, and of the issues and challenges they face. Who are they? Where are they working? Where are their numbers growing? The answers to these questions will help to inform the development of policy and the fostering of an environment that promotes digital content and creativity.

Luxury brand identity : the influence of mobile digital technology

This thesis examined the influence of mobile digital technology on the brand identity of luxury brands. Specifically it focused on the use of mobile applications by automobile, hotel and beauty brands and compared the perceptions of marketing managers with consumers on how mobile applications influenced luxury brand identity and image. Outcomes of this research included a model to depict the ongoing process between mobile-mediated luxury brand identity and image, and a typology of luxury brand mobile applications listing key features of mobile-mediated luxemosphere. Overall findings suggest that the influence of mobile applications on luxury brand identity has been negative, as their brand image appeared to be degraded, resulting in diminishing the brand identity.

Mobile silencing in plants: what is the signal and what defines the target

RNA-mediated silencing in plants can spread from cell to cell and over a long distance, and such mobile silencing has been extensively studied in the past decade. However, major questions remain as to what is the exact nature of the mobile silencing signals, how the components of the RNA-directed DNA methylation pathway are involved, and why systemic spread of silencing has only been observed for transgenes but not endogenous genes. In this review, we provide an overview of the current knowledge on mobile gene silencing in plants and present a model where systemic silencing involves long nuclear RNA transcripts that serve as a template to amplify primary siRNA signals.

Front-line workers as intermediaries : the changing landscape of disability and employment services in Australia

Recent welfare reform in Australia has been constructed around the now-familiar principle of paid work and willingness to work as the fundamental marker of social citizenship. Beginning with the long-term unemployed in Australia in the mid 1990s, the scope of welfare reform has now extended to include people with a disability – which is a category of income support that has been growing in Australia. From the national government’s point of view this growth is a financial concern as it seeks to move as many people as possible into paid work to support the costs of an ageing population (DEWR, 2005). In doing so, the government has changed the meaning of disability in terms of eligibility for financial support from the state, and at the same time redefined the role of people with a disability with regard to work, and the role of the state with regard to the disabled. This has been a matter of some political contention in Australia.

A systematic review of telemedicine services for residents in long term care facilities

We conducted a systematic review of the literature on telemedicine use in long-term care facilities (LTCFs) and assessed the quality of the published evidence. A database search identified 22 papers which met the inclusion criteria. The quality of the studies was assessed and if they contained economic data, they were rated according to standard criteria. The clinical services provided by telemedicine included allied health (n = 5), dermatology (3), general practice (4), neurology (2), geriatrics (1), psychiatry (4) and multiple specialities (3). Most studies (17) employed real-time telemedicine using videoconferencing. The remaining five used store and forward telemedicine. The papers focused on economics (3), feasibility (9), stakeholder satisfaction (12), reliability (5) and service implementation (2). Overall, the quality of evidence for telemedicine in LTCFs was low. There was only one small randomised controlled trial (RCT). Most studies were observational and qualitative, and focused on utilisation. They were mainly based on surveys and interviews of stakeholders. A few studies evaluated the cost associated with implementing telemedicine services in LTCFs. The present review shows that there is evidence for feasibility and stakeholder satisfaction in using telemedicine in LTCFs in a number of clinical specialities.

Acceptability-based QoE models for mobile video

Quality of experience (QoE) measures the overall perceived quality of mobile video delivery from subjective user experience and objective system performance. Current QoE computing models have two main limitations: 1) insufficient consideration of the factors influencing QoE, and; 2) limited studies on QoE models for acceptability prediction. In this paper, a set of novel acceptability-based QoE models, denoted as A-QoE, is proposed based on the results of comprehensive user studies on subjective quality acceptance assessments. The models are able to predict users’ acceptability and pleasantness in various mobile video usage scenarios. Statistical regression analysis has been used to build the models with a group of influencing factors as independent predictors, including encoding parameters and bitrate, video content characteristics, and mobile device display resolution. The performance of the proposed A-QoE models has been compared with three well-known objective Video Quality Assessment metrics: PSNR, SSIM and VQM. The proposed A-QoE models have high prediction accuracy and usage flexibility. Future user-centred mobile video delivery systems can benefit from applying the proposed QoE-based management to optimize video coding and quality delivery decisions.

Punishment Avoidance and Intentional Risky Driving Behaviour : What are the Implications for ‘Getting Away with it’?

Every motorised jurisdiction mandates legal driving behaviour which facilitates driver mobility and road user safety through explicit road rules that are enforced by regulatory authorities such as the Police. In road safety, traffic law enforcement has been very successfully applied to modify road user behaviour, and increasingly technology is fundamental in detecting illegal road user behaviour. Furthermore, there is also sound evidence that highly visible and/or intensive enforcement programs achieve long-term deterrent effects. To illustrate, in Australia random breath testing has considerably reduced the incidence and prevalence of driving whilst under the influence of alcohol. There is, however, evidence that many road rules continue to be broken, including speeding and using a mobile phone whilst driving, and there are many instances where drivers are not detected or sufficiently sanctioned for these transgressions. Furthermore, there is a growing body of evidence suggesting that experiences of punishment avoidance – that is, successful attempts at avoiding punishment such as drivers talking themselves out of a ticket, or changing driving routes to evade detection –are associated with and predictive of the extent of illegal driving behaviour and future illegal driving intentions. Therefore there is a need to better understand the phenomenon of punishment avoidance to enhance our traffic law enforcement procedures and therefore safety of all road users. This chapter begins with a review of the young driver road safety problem, followed by an examination of contemporary deterrence theory to enhance our understanding of both the experiences and implications of punishment avoidance in the road environment. It is noteworthy that in situations where detection and punishment remain relatively rare, such as on extensive road networks, the research evidence suggests that experiences of punishment avoidance may have a stronger influence upon risky driving behaviour than experiences of punishment. Finally, data from a case study examining the risky behaviour of young drivers will be presented, and the implications for ‘getting away with it’ will be discussed.

Real-time mobile 3D temperature mapping

The ability to measure surface temperature and represent it on a metrically accurate 3D model has proven applications in many areas such as medical imaging, building energy auditing, and search and rescue. A system is proposed that enables this task to be performed with a handheld sensor, and for the first time with results able to be visualized and analyzed in real-time. A device comprising a thermal-infrared camera and range sensor is calibrated geometrically and used for data capture. The device is localized using a combination of ICP and video-based pose estimation from the thermal-infrared video footage which is shown to reduce the occurrence of failure modes. Furthermore, the problem of misregistration which can introduce severe distortions in assigned surface temperatures is avoided through the use of a risk-averse neighborhood weighting mechanism. Results demonstrate that the system is more stable and accurate than previous approaches, and can be used to accurately model complex objects and environments for practical tasks.

Concealed texting while driving : what are young people’s beliefs about this risky behaviour?

Making a conscious effort to hide the fact that one is texting while driving (i.e., concealed texting) is a deliberate and risky behaviour involving attention diverted from the road. As the most frequent users of text messaging services and mobile phones while driving, young people appear at heightened crash risk from engaging in this behaviour. First, several small focus group discussions (N = 12) were carried out to elicit the underlying salient beliefs regarding this behaviour, in accordance with the Theory of Planned Behaviour (TPB). Findings from these discussions, in conjunction with available prior evidence regarding general mobile phone use while driving, then informed questionnaire items that assessed young peoples’ beliefs regarding this behaviour, as well as intention to engage in this behaviour in the next week. In the questionnaire phase of the study, participants (N = 171) were aged 17–25 years, owned a mobile phone, and held a current driver’s licence. Results showed that there were significant differences between low and high intenders (to engage in concealed texting while driving) on the behavioural, normative, and control beliefs investigated. Specifically, high intenders were more likely to believe that concealed texting while driving would result in sharing information with others, using time effectively, and were less likely to think that free-flowing traffic would prevent their engagement in this behaviour. By targeting these beliefs, these findings may potentially inform the development of advertising and other public intervention strategies, aimed at ensuring young drivers reconsider their engagement in this risky behaviour.