To assess the association of patient and organisational factors with emergency department length of stay (ED-LOS) in elderly ED patients (226565 years old) and in younger patients (<65 years old).
A ...retrospective cohort study of internal medicine patients visiting the emergency department between September 1st 2010 and August 31st 2011 was performed. All emergency department visits by internal medicine patients 226565 years old and a random sample of internal medicine patients <65 years old were included. Organisational factors were defined as non-medical factors. ED-LOS is defined as the time between ED arrival and ED discharge or admission. Prolonged ED-LOS is defined as ≥75th percentile of ED-LOS in the study population, which was 208 minutes.
Data on 1782 emergency department visits by elderly patients and 597 emergency department visits by younger patients were analysed. Prolonged ED-LOS in elderly patients was associated with three organisational factors: >1 consultation during the emergency department visit (odds ratio (OR) 3.2, 95% confidence interval (CI) 2.3-4.3), a higher number of diagnostic tests (OR 1.2, 95% CI 1.16-1.33) and evaluation by a medical student or non-trainee resident compared with a medical specialist (OR 4.2, 95% CI 2.0-8.8 and OR 2.3, 95% CI 1.4-3.9). In younger patients, prolonged ED-LOS was associated with >1 consultation (OR 2.6, 95% CI 1.4-4.6). Factors associated with shorter ED-LOS were arrival during nights or weekends as well as a high urgency level in elderly patients and self-referral in younger patients.
Organisational factors, such as a higher number of consultations and tests in the emergency department and a lower seniority of the physician, were the main aspects associated with prolonged ED-LOS in elderly patients. Optimisation of the organisation and coordination of emergency care is important to accommodate the needs of the continuously growing number of elderly patients in a better way.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Emergency department (ED) crowding leads to prolonged emergency department length of stay (ED-LOS) and adverse patient outcomes. No uniform definition of ED crowding exists. Several scores have been ...developed to quantify ED crowding; the best known is the Emergency Department Work Index (EDWIN). Research on the EDWIN is often applied to limited settings and conducted over a short period of time.
To explore whether the EDWIN as a measure can track occupancy at a Dutch ED over the course of one year and to identify fluctuations in ED occupancy per hour, day, and month. Secondary objective is to investigate the discriminatory value of the EDWIN in detecting crowding, as compared with the occupancy rate and prolonged ED-LOS.
A retrospective cohort study of all ED visits during the period from September 2010 to August 2011 was performed in one hospital in the Netherlands. The EDWIN incorporates the number of patients per triage level, physicians, treatment beds and admitted patients to quantify ED crowding. The EDWIN was adjusted to emergency care in the Netherlands: modified EDWIN (mEDWIN). ED crowding was defined as the 75th percentile of mEDWIN per hour, which was ≥0.28.
In total, 28,220 ED visits were included in the analysis. The median mEDWIN per hour was 0.15 (Interquartile range (IQR) 0.05-0.28); median mEDWIN per patient was 0.25 (IQR 0.15-0.39). The EDWIN was higher on Wednesday (0.16) than on other days (0.14-0.16, p<0.001), and a peak in both mEDWIN (0.30-0.33) and ED crowding (52.9-63.4%) was found between 13:00-18:00 h. A comparison of the mEDWIN with the occupancy rate revealed an area under the curve (AUC) of 0.86 (95%CI 0.85-0.87). The AUC of mEDWIN compared with a prolonged ED-LOS (≥4 hours) was 0.50 (95%CI 0.40-0.60).
The mEDWIN was applicable at a Dutch ED. The mEDWIN was able to identify fluctuations in ED occupancy. In addition, the mEDWIN had high discriminatory power for identification of a busy ED, when compared with the occupancy rate.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Emergency department (ED) crowding leads to prolonged emergency department length of stay (ED-LOS) and adverse patient outcomes. No uniform definition of ED crowding exists. Several scores have been ...developed to quantify ED crowding; the best known is the Emergency Department Work Index (EDWIN). Research on the EDWIN is often applied to limited settings and conducted over a short period of time. To explore whether the EDWIN as a measure can track occupancy at a Dutch ED over the course of one year and to identify fluctuations in ED occupancy per hour, day, and month. Secondary objective is to investigate the discriminatory value of the EDWIN in detecting crowding, as compared with the occupancy rate and prolonged ED-LOS. A retrospective cohort study of all ED visits during the period from September 2010 to August 2011 was performed in one hospital in the Netherlands. The EDWIN incorporates the number of patients per triage level, physicians, treatment beds and admitted patients to quantify ED crowding. The EDWIN was adjusted to emergency care in the Netherlands: modified EDWIN (mEDWIN). ED crowding was defined as the 75.sup.th percentile of mEDWIN per hour, which was greater than or equal to0.28. In total, 28,220 ED visits were included in the analysis. The median mEDWIN per hour was 0.15 (Interquartile range (IQR) 0.05-0.28); median mEDWIN per patient was 0.25 (IQR 0.15-0.39). The EDWIN was higher on Wednesday (0.16) than on other days (0.14-0.16, p<0.001), and a peak in both mEDWIN (0.30-0.33) and ED crowding (52.9-63.4%) was found between 13:00-18:00 h. A comparison of the mEDWIN with the occupancy rate revealed an area under the curve (AUC) of 0.86 (95%CI 0.85-0.87). The AUC of mEDWIN compared with a prolonged ED-LOS (greater than or equal to4 hours) was 0.50 (95%CI 0.40-0.60). The mEDWIN was applicable at a Dutch ED. The mEDWIN was able to identify fluctuations in ED occupancy. In addition, the mEDWIN had high discriminatory power for identification of a busy ED, when compared with the occupancy rate.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Monitoring of cross-organizational processes requires the definition and implementation of monitoring processes that can deliver the right information to the right party in the collaboration. ...Monitoring processes should account for the temporal and aggregation dependencies among the monitoring information made available by the set of collaborating parties. We solve the problem of designing monitoring processes in collaborative settings using Product-Based Workflow Design (PBWD). We first discuss a methodology to apply PBWD in this context and then propose an architecture to implement the methodology using a service-oriented approach.
Product-based workflow support Vanderfeesten, Irene; Reijers, Hajo A.; van der Aalst, Wil M.P.
Information systems (Oxford),
04/2011, Letnik:
36, Številka:
2
Journal Article
Recenzirano
Despite the industrial need for the improvement of information-intensive business processes, few scientifically grounded approaches exist to support such initiatives. In this paper, we propose a new ...approach that builds on concepts that are part of a product-oriented view on process optimization. Essentially, this approach allows end users to flexibly decide on the best possible way to create an informational product within the limits that are imposed by regulations and logical dependencies. We argue that this provides various benefits in comparison to earlier work. To support end users in making sensible decisions, we describe two alternative approaches to provide them with recommendations to this end. We formalize these alternatives and discuss their relative strengths and weaknesses. The feasibility of the overall approach, which we refer to as Product-Based Workflow Support, is demonstrated by a workflow system that is realized using ProM and DECLARE.
► Product-Based Workflow Support is a new and scientifically grounded approach that provides flexible and dynamic support for workflow processes. ► Product-Based Workflow Support takes a product-oriented view on process optimization using the notion of the product Product Data Model. ► The feasibility of Product-Based Workflow Support is demonstrated by a workflow system that is realized using ProM and DECLARE. ► To support end-users in making decisions for executing the workflow process, the system provides them with recommendations for the best step to be taken next.
Building on the similarities between software programs and workflow processes, this paper proposes a heuristic that offers guidance for the creation and evaluation of process designs in ...administrative settings. Designers can use this heuristic to select from several alternatives the process design that is strongly cohesive and weakly coupled. It is argued that such a design will result in fewer errors during information exchanges and in more understandable activity descriptions. The paper includes an application of the heuristic in an industrial workflow setting, which supports its feasibility and practical value. The paper also presents the freely available
CoCoFlow tool that implements the heuristic and its associated metrics.
Business process modeling is an important corporate activity, but the understanding of what constitutes good process models is rather limited. In this paper, we turn to the cognitive dimensions ...framework and identify the understanding of the structural relationship between any pair of model elements as a hard mental operation. Based on the weakest-link metaphor, we introduce the cross-connectivity metric that measures the strength of the links between process model elements. The definition of this new metric builds on the hypothesis that process models are easier understood and contain less errors if they have a high cross-connectivity. We undertake a thorough empirical evaluation to test this hypothesis and present our findings. The good performance of this novel metric underlines the importance of cognitive research for advancing the field of process model measurement.
Building on the similarities between software programs and workflow processes, this paper proposes a heuristic that offers guidance for the creation and evaluation of process designs in ...administrative settings. Designers can use this heuristic to select from several alternatives the process design that is strongly cohesive and weakly coupled. It is argued that such a design will result in fewer errors during information exchanges and in more understandable activity descriptions. The paper includes an application of the heuristic in an industrial workflow setting, which supports its feasibility and practical value. The paper also presents the freely available CoCoFlow tool that implements the heuristic and its associated metrics. PUBLICATION ABSTRACT
Product Based Workflow Design (PBWD) is a successful new approach to workflow process support. A description of the product, the Product Data Model (PDM), is central to this approach. While other ...research so far has focused on deriving a process model from the PDM, this paper presents a way to directly execute the PDM. This leads to a more dynamic and flexible support for the workflow process.
Product Based Workflow Design (PBWD) is one of the few scientific methodologies for the (re)design of workflow processes. It is based on an analysis of the product that is produced in the workflow ...process and derives a process model from the product structure. Until now this derivation has been a manual task and is therefore a time-consuming and error-prone exercise. Automatic support would enhance the use of the PBWD methodology. In this paper we propose several algorithms to automatically generate process models from a product structure and we present a software tool (implemented in ProM) to support this. Finally, the properties of the resulting process models are analysed and discussed.
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