Zusammenfassung
Hintergrund
Zur optimalen Disposition von Selbstvorstellern mit geringer Fallschwere wurde die Einrichtung von integrierten Notfallzentren (INZ) vorgeschlagen. Da jedoch validierte ...Instrumente zur gezielten Patientenlenkung innerhalb der INZ fehlen, wird in dieser Studie untersucht, ob das Manchester Triage System (MTS) zur sicheren Lenkung von Notfallpatienten in der vertragsärztlichen Notfallversorgung eingesetzt werden kann.
Methode
Mittels Datenbankabfrage wurden die MTS-Kategorien aller nichttraumatologischen erwachsenen Notfallpatienten über einen Zeitraum von sechs Wochen ermittelt. Anschließend wurden die elektronischen Patientenakten aller Patienten mit niedriger Fallschwere der MTS-Kategorien 4 (grün) und 5 (blau) genauestens analysiert.
Ergebnisse
Von den 400 konsekutiven Notfallpatienten der MTS-Kategorien blau (
n
= 72) und grün (
n
= 328) wurden 139 Patienten als primär nicht weiterleitbar exkludiert (Vorstellung mit fachärztlicher Überweisung
n
= 110, Liegendeinlieferung durch Rettungsdienst
n
= 29). Von den verbleibenden 261 Patienten hätten 78,1 % aufgrund der lokalen Praxisöffnungszeiten ex ante in die vertragsärztliche Notfallversorgung weitergeleitet werden können. In Kenntnis des Verlaufs (ex post) wären dies jedoch nur 15,3 % der Patienten gewesen.
Schlussfolgerung
Unsere Daten zeigen, dass das MTS kein geeignetes Instrument ist, um Patienten sicher in den ambulanten Sektor zu lenken.
Abstract
Background
The establishment of Integrated Emergency Centres (INZ) was proposed for the optimal disposition of self-presenters with low case severity. However, due to the lack of validated instruments for targeted patient routing within INZs, this study investigates whether the Manchester Triage System (MTS) can be used to safely route emergency patients into primary care.
Methods
By means of a database query, the MTS categories of all non-traumatological adult emergency patients were determined over a period of 6 weeks. Subsequently, the electronic patient records of all patients with low case severity of MTS categories 4 (green) and 5 (blue) were analysed.
Results
Of the 400 consecutive emergency patients in the MTS categories blue (
n
= 72) and green (
n
= 328), 139 patients were excluded as primarily not forwardable (presentation with specialist referral
n
= 110, admission to bed by ambulance service
n
= 29). Of the remaining 261 patients, 78.1% could have been forwarded ex ante to primary emergency care due to local practice opening hours. Knowing the course (ex post), however, only 15.3% of the patients would have been.
Conclusion
Our data show that the MTS is not a suitable instrument for safely steering patients to the outpatient sector.
The concept of lean manufacturing was developed for maximizing the resource utilization through minimization of waste, later on lean was formulated in response to the fluctuating and competitive ...business environment. Due to rapidly changing business environment the organizations are forced to face challenges and complexities. Any organization whether manufacturing or service oriented to survive may ultimately depend on its ability to systematically and continuously respond to these changes for enhancing the product value. Therefore value adding process is necessary to achieve this perfection; hence implementing a lean manufacturing system is becoming a core competency for any type of organizations to sustain. The majority of the study focuses on single aspect of lean element, only very few focuses on more than one aspect of lean elements, but for the successful implementation of lean the organisation had to focuses on all the aspects such as Value Stream Mapping (VSM),Cellular Manufacturing (CM), U-line system, Line Balancing, Inventory control, Single Minute Exchange of Dies (SMED), Pull System, Kanban, Production Levelling etc., In this paper, an attempt has been made to develop a lean route map for the organization to implement the lean manufacturing system. Analyses of the exploratory survey results are summarized in this paper to illustrate the implementation sequence of lean elements in volatile business environment and the finding of this review was synthesized to develop a unified theory for implementation of lean elements.
The project here presented was developed in a metalworking company, where several areas requiring improvement were identified. The study addresses the elimination of waste and increase of ...productivity in the machining sector of the company. To this purpose key processes were identified and mapped using flowcharts and VSM (Value Stream Mapping). Achieved improvements involved decreasing setup times by resorting to the lean tool SMED (Single Minute Exchange of Die). Setup times were reduced in 40% on the vertical milling machine of the company, and in 57% on the horizontal milling machine.
Along with the increasing market of plastic packaging products resulting from the injection process and the rapid development of existing technology, we need a strategy to be able to continue to meet ...the customer’s needs and to be able to compete in the industry. One of the strategies that may be employed is Lean. Lean is a concept aimed at eliminating existing waste. One of the implementations of Lean’s concept is the SMED (Single Minute Exchange of Dies) concept. SMED is a concept aimed at reducing the changeover time, so the eliminated time can be used in the production process. P.T. BIL is one of the companies engaged in the production of plastic packaging with an injection process. Problems occurring at P.T. BIL was the absence of a measurement process for changeover time. The Operation Analysis Chart concept was used to analyze the carried-out activities. To optimize activities employing the SMED concept, Analytical Cards were used so that the change over time can be reduced. The 5S concept was applied to support the SMED concept, so the waste in the work area could be eliminated. By implementing the SMED concept, we reduced 18% of the change over time.
Purpose
Bangladesh's ready-made garment (RMG) industry plays a vital role in the economic growth of this country. As the global trend in the fashion market has introduced a high-mix, low-volume ...ordering style, manufacturers are facing an increased number of changeovers in their production systems. However, most of the Bangladeshi RMG manufacturers are not yet ready to respond to such small orders and to improve the flexibility of their production systems. Consequently, the industry is falling behind in global market competition. Thus, this study aims to advance the current performance of RMG manufacturing operations to respond to the fast-fashion industry's challenges effectively using quick changeover.
Design/methodology/approach
In this study, a Single-Minute Exchange of Dies (SMED) is applied to attain quick changeover following the best practices of lean manufacturing.
Findings
This study examined the performance of the SMED technique to reduce changeover time in two case organisations. The changeover time was reduced by 70.76% from 434.56 min to 127.08 min and 42.12% from 2,664 min to 1,542 min for the case organisations, respectively. The results of this study show that companies require improved changeover times to address the demand for high-mix, low-volume orders.
Originality/value
This study will certainly guide practitioners of the RMG industry to adopt SMED to reduce changeover time to meet small batch production.
Nuclear desalination is one of the ideal options to achieve net-zero emissions. However, most nuclear desalination plants extract steam from the power cycle to drive desalination, leading to a ...reduction of electricity output. To avoid the parasitic effects of desalination on the power cycle, this study considers recovering waste heat from the power plants' condensers to drive low-temperature desalination systems, including spray-assisted low-temperature desalination system (SLTD), multi-effect distillation system (MED) and spray-assisted multi-effect distillation system (SMED). Thermodynamic and economic models of the three desalination systems are firstly established and validated with experimental data. Then, the impacts of key design, operation and economic parameters are evaluated using the validated models. Results reveal that the productivity and thermodynamic efficiency are promoted by increasing the cooling water flowrate of desalination condenser, enlarging the heat exchanger area and lifting the heat source temperature, while the number of effects has an optimal value of 3. Under the optimal configuration, the gained-output ratio and Second Law efficiency of a 20 m3/day SLTD plant are 0.71 and 1.25 % respectively. In terms of economic performance, the levelized-cost of desalinated water (LCOW) for three plants can be reduced substantially under a larger plant capacity and longer lifespan. When the plant capacity exceeds 20,000 m3/day, the LCOW of SLTD can be reduced to 0.757 $/m3, which is lower than all other desalination systems coupled with power plants or renewable energy sources.
Display omitted
•Low-temperature desalination system driven by waste heat from the condenser nuclear power plants are proposed.•Thermo-economic analyses are conducted to evaluate energetic and economic performances of proposed systems.•Spray-assisted low-temperature desalination demonstrates lowest cost as compared to other technologies.•The levelized cost of desalination can be lowered to $0.757/m3 by expanding plant capacity.
•Survival analysis models provide accurate prediction changeover times.•The Cox regression models can handle product- and operator-dependent losses.•The models consider the stochastic nature of the ...work of the operators.•The interpretable models can support the identification the root causes of the losses.•The applicability of the method is demonstrated in the setups of cutting machines.
The losses associated with changeovers are becoming more significant in manufacturing due to the high variance of products and requirements for just-in-time production. The study is based on the single minute exchange of die (SMED) philosophy, which aims to reduce changeover times. We introduced a method for the analysis of these losses based on models that estimate the product- and operator-dependent changeover times using survival analysis. The root causes of the losses are identified by significance tests of the utilized Cox regression models. The resulting models can be used to design a performance management system that considers the stochastic nature of the work of the operators. An anonymized manufacturing example related to the setup of crimping and wire cutting machines demonstrates the applicability of the method.
Este artículo describe el proyecto de investigación realizado a una imprenta en la ciudad de Orizaba, Ver. para identificar y determinar el costo por mermas mediante la aplicación de herramientas ...administrativas como son: muestreo, diagrama de flujo y SMED. La metodología utilizada consiste en un análisis de información histórica de las órdenes de producción de los meses de julio a octubre de 2018, llevando a cabo la observación directa de los cuatro procesos de impresión, la toma de tiempos de las actividades ejecutadas por el operador para la preparación máquinas e impresión y el seguimiento de la orden de producción por los departamentos desde su creación hasta la conclusión.
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