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Pregnancy, parenthood, and family leave during residency

ANNALS OF EMERGENCY MEDICINE 2003年第4期41卷 568-573页

作者： Lewin, MR Univ Calif San Francisco Dept Emergency Med Fresno Emergency Med Residency Program Fresno CA 93702 USA

[ Ann Emerg Med . 2003;41:568-573.]

关键词：适应心理学职业选择急救医学/教育计划生育服务/组织和管理实习医师和住院医师职务/组织和管理组织方针双亲假/立法和法学行使父母职责/心理学人员选用/组织和管理人员配备和时间安排/组织和管理医师女/心理学医师女/统计学和数值数据孕妇/心理学学会医学/组织和管理美国妇女就业/教育妇女就业/心理学妇女就业/统计学和数值数据工作负荷量人类

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Emergency department contributors to ambulance diversion: A quantitative analysis

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ANNALS OF EMERGENCY MEDICINE 2003年第4期41卷 467-476页

作者： Schull, MJ Lazier, K Vermeulen, M Mawhinney, S Morrison, LJ Sunnybrook & Womens Coll Hlth Sci Ctr Dept Emergency Serv Toronto ON Canada Toronto Emergency Med Serv Prehosp Res Grp Toronto ON Canada Univ Toronto Div Emergency Med Dept Med Toronto ON Canada Univ Toronto Dept Hlth Adm Toronto ON Canada Dalhousie Univ Fac Med Halifax NS Canada Sunnybrook & Womens Coll Hlth Sci Ctr Clin Epidemiol Unit Toronto ON Canada

Study objective: We determine the relationship between physician, nursing, and patient factors on emergency department use of ambulance diversion. Methods: Data were collected at 1 ED in Toronto, Ontario, Canada, on the duration of ambulance diversion during consecutive 8-hour intervals from January to December 1999 (intervals=1,095). By using time series methods, the association between ambulance diversion and nurse hours, physician on duty, and boarded patients was determined. Covariates included patient volume, assessment time, and boarding time. Results: A total of 37,999 patients were treated in the ED over the study period (2% major trauma, 16% ambulance arrivals, and 22% admitted). Nurse hours per interval averaged 60. A mean of 3.2 admitted patients were boarded in the ED each interval. For admitted patients, the time from registration to admission order and from admission order to ED departure averaged 5.2 and 3.5 hours, respectively. There was no ambulance diversion during 170 (15.5%) intervals, whereas 17 (1.5%) intervals were continuously on diversion. In time series analyses, ambulance diversion increased with the number of admitted patients boarded in the ED (6.2 minutes per patient;95% confidence interval [Cl] 2.6 to 9.8 minutes), the number admitted per interval (4.6 minutes per patient;95% Cl 0.1 to 9.1 minutes), assessment time (9.9 minutes per hour;95% Cl 3.3 to 16.5 minutes), and boarding time (11.3 minutes per hour;95% Cl 5.6 to 17.0 minutes). Thirteen of 15 emergency physicians were not associated with ambulance diversion, 1 was associated with reduced use (-36.3 minutes;95% Cl -65.2 to -7.5 minutes), and 1 was associated with increased use (47.6 minutes;95% Cl 4.5 to 90.6 minutes). ED nurse hours were not associated with diversion. Ambulance-delivered patient volume was associated with diversion (5.2 minutes per patient;95% Cl 2.7 to 7.8 minutes), but walk-in patients and patients with major trauma were not. Conclusion: Admitted patients in th

关键词：救护车/统计学和数值数据方差分析拥挤急救医疗服务通信系统/统计学和数值数据急救医疗服务/统计学和数值数据急诊室医院/统计学和数值数据卫生服务研究医院病床数 500张以上医务人员医院/供应和分配护理人员医院/供应和分配安大略病人入院/统计学和数值数据病人转诊/统计学和数值数据人员配备和时间安排/组织和管理前瞻性研究单盲法时间因素时间和运动研究创伤诊治中心人类

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Staffing requirements for infection control programs in US health care facilities: Delphi project

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AMERICAN JOURNAL OF INFECTION CONTROL 2002年第6期30卷 321-333页

作者： O'Boyle, C Jackson, M Henly, SJ Univ Minnesota Sch Nursing Minneapolis MN 55455 USA Univ Calif San Diego Dept Educ Dev & Res Med Ctr La Jolla CA 92093 USA

Background: The guideline for staffing infection control programs of I infection control professional (ICP) for every 250 occupied acute care beds has been used in many health care facilities in the United States since 1985. Since that time, the health care system, patient populations, and expectations about the work of infection prevention and control programs have changed substantially. Methods: The Delphi method was used;data were obtained from a group of ICPs through a series of 10 surveys. Through this iterative process, participant responses were progressively synthesized and areas of agreement and disagreement identified. These surveys were conducted by electronic and paper mail to identify the personal ICP characteristics and structural variables associated with performance of activities required for contemporary infection prevention and control programs in a variety of health care settings. Results: Delphi panel members (n = 32) from 20 states and who represented acute care, long-term care, and community care settings reported tasks in addition to those identified in earlier task analyses as well as expanded responsibilities. Competing responsibilities and lack of adequate resources were the most frequently cited reasons for nonperformance of essential infection control tasks. A ratio of 0.8 to 1.0 ICP for every 100 occupied acute care beds was suggested as adequate staffing by the Delphi panel. Conclusions: Infection control responsibilities have expanded beyond the traditional acute care setting. Recommendations for staffing must not only consider the number of occupied beds (average daily census) but also include the scope of the program, the complexity of the health care facility or system, the characteristics of the patient population, and the unique or urgent needs of the facility and community.

关键词：病床利用率数据收集德尔菲技术卫生设施/组织和管理卫生服务需求医院病床数感染控制/方法感染控制/组织和管理感染控制人员/组织和管理人员配备和时间安排/组织和管理可重复性结果时间因素时间安排美国人类中年人

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Medical counterbioterrorism: The response to provide anthrax prophylaxis to New York City US postal service employees

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ANNALS OF EMERGENCY MEDICINE 2003年第4期41卷 441-446页

作者： Partridge, R Alexander, J Lawrence, T Suner, S Brown Univ Sch Med Rhode Isl Hosp Injury Prevent CtrDept Emergency Med Providence RI 02912 USA Maine Med Ctr Dept Emergency Med Portland ME 04102 USA Univ Vermont Coll Med Dept Surg Burlington VT USA Rhode Isl Dept Hlth Emergency Med Serv Children Providence RI 02908 USA Off Emergency Preparedness Dept Hlth & Human Serv Rockville MD USA

Study objective: We describe and analyze a recent rapid deployment of disaster medical assistance teams and other government agencies to provide medical screening and anthrax prophylaxis to New York City US Postal Service employees potentially exposed to letters contaminated with anthrax spores. Methods: A description of the response effort is presented. Data were collected on standardized forms and included the numbers of postal employees screened and offered antibiotic prophylaxis, as well as the numbers of patients seen per worker hour by various medical professionals. Results: One hundred members of 5 disaster medical assistance teams and other health professionals were deployed to New York City within 18 hours of activation. Over a 68-hour period, 7,076 patients were evaluated, representing all postal employees in the 6 major postal facilities in New York believed to be at risk for anthrax exposure. Of the total, 2,452 patients were seen during the first 24 hours, 3,875 during the second 24 hours, and the remaining 749 during the last 20 hours of operations. An average of 161 employees were screened per hour. The antibiotic most commonly dispensed was ciprofloxacin, followed by doxycycline and amoxicillin. Conclusion: The deployment of disaster medical assistance teams and other agencies to New York City to provide prophylaxis against inhalation anthrax to US Postal Service employees provides lessons for a rapid, efficient, and effective response to acts of bioterrorism. This deployment might also serve as a scaleable model for future events requiring medical prophylaxis.

关键词：炭疽/预防和控制抗菌药/治疗应用生物恐怖/预防和控制救灾计划/组织和管理效率组织预测卫生服务研究普查/组织和管理模型组织管理纽约市职业卫生服务/组织和管理病人依从/心理学病人依从/统计学和数值数据人员配备和时间安排/组织和管理邮政转诊和会诊/组织和管理回顾性研究危险因素时间因素工作负荷量人类

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The emergency department on-call backup crisis: Finding remedies for a serious public health problem

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ANNALS OF EMERGENCY MEDICINE 2001年第5期37卷 495-499页

作者： Johnson, LA Taylor, TB Lev, R Sutter Davis Hosp Emergency Dept Davis CA 95617 USA Good Samaritan Reg Med Ctr Dept Emergency Med Phoenix AZ USA Arizona Coll Osteopath Med Div Clin Educ Phoenix AZ USA Scripps Mercy Med Ctr Dept Emergency Med San Diego CA USA Univ San Diego San Diego CA 92110 USA

[Johnson LA, Taylor TB, Lev R. The emergency department on-call backup crisis: finding remedies for a serious public health problem. Ann Emerg Med. May 2001;37:495-499.]

关键词：伦理学医学设施的规章和管理/组织和管理预测卫生政策卫生服务研究管理医疗规划/组织和管理医务人员医院/立法和法学医务人员医院/供应和分配需求估价人员配备和时间安排/组织和管理公共卫生医生拒绝医治/立法和法学美国人类

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Calculus, chaos, and other models of emergency department crowding

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ANNALS OF EMERGENCY MEDICINE 2003年第2期42卷 181-184页

作者： Fields, WW Saddleback Mem Med Ctr Dept Emergency Med Laguna Hills CA 92653 USA Univ Calif Irvine Sch Med Dept Emergency Med Orange CA 92668 USA

[Ann Emerg Med. 2003;42:181-184.]

关键词：病床利用率拥挤急诊室医院/组织和管理卫生服务研究模型组织管理需求估价人员配备和时间安排/组织和管理患病率研究设计美国人类

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Speaking the language of finance.

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AORN journal 2001年第4期73卷 774-776,779-782,785-787页

作者： Hunt, P.S. Surgical Services Marion General Hospital Marion Ind. USA.

Nursing leadership skills have changed dramatically in a short period of time. Just being able to cover the schedule and ensure adequate orientation for new employees are not enough in today's health care environment. This article outlines steps to ensure adequate staffing levels, assess productivity, and justify the operational supplies and capital equipment necessary for effective patient care. It also outlines steps nursing leaders can take to market their programs and services.

关键词：预算基本建设经费效率组织医院综合/经济学印第安纳卫生服务使用研究护理管理人员/经济学护理管理人员/组织和管理手术室护理/经济学手术室护理/组织和管理人员配备和时间安排/经济学人员配备和时间安排/组织和管理外科设备/经济学人类

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Optimizing second shift OR staffing.

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AORN journal 2003年第4期77卷 825-830页

作者： Dexter, Franklin Epstein, Richard H Division of Management Consulting Department of Anesthesia University of Iowa Iowa City United States

In surgical suites when ORs sometimes run late, nurse anesthetists or perioperative nurses may be scheduled to work a second shift to cover procedures. Nurse anesthetists' OR workload in the afternoons can differ from that of perioperative nurses. At the end of long procedures, times to transport and stabilize patients can be considerable. This article shows that optimal second-shift OR staffing is the same for nurse anesthetists and perioperative nurses when assessed using anesthesia billing data and OR information systems data respectively. Managers do not need hospital information systems staff members to provide data from both anesthesia billing and OR information systems to make second-shift staffing decisions. One or the other is adequate.

关键词：医院费用美国中西部麻醉手术护士/经济学麻醉手术护士/组织和管理麻醉手术护士/供应和分配手术室信息系统手术室/经济学围手术期护理/经济学围手术期护理/组织和管理人员配备和时间安排/组织和管理人员配备和时间安排信息系统时间因素工作负荷量人类

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Staffing intelligence services: a survivor's guide.

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Health libraries review 1992年第2期9卷 52-61页

作者： Hepworth, J.B. Department of Information and Library Studies University College of Wales Aberystwyth United Kingdom

Work at the Department of Health on the information needs of District Health Authorities as purchasers demonstrates the need for co-ordinated information services that handle both numeric and text data--termed intelligence. The DHA Project has built information implications into its health needs assessment protocol and has shown, through pilots, the steps involved in developing co-ordinated provision. These developments contrast sharply with the long-established NHS dichotomy between the roles of librarians--often narrowly perceived, and those of information officers--equally narrowly defined but with a greater command of resources. Consideration of how intelligence services are to be staffed raises issues which involve appreciating wider changes in information education. Most current courses no longer perpetuate the skills divide between those who will be at ease handling text information (librarians) and those who are able to create and use database management systems holding numeric data (information officers). Skills needed for the intelligence function cross the boundary. Some librarians are already able to encompass the required range of skills, but without retraining many will face unequal competition with the new generations of graduates from information management and information science courses. Local training opportunities are essential, but there is also a growing number of higher degree courses which can be used for career enhancement and some of them are available on a distance learning basis. The NHS Training Directorate has begun the process of assisting courses it deems relevant to NHS information management training, but the Department of Health should specify the staff competencies required as part of quality assurance standards for intelligence services.

关键词：教育研究生/组织和管理教育研究生/发展趋势大不列颠信息服务/人力信息服务/组织和管理图书馆高级馆员人员配备和时间安排/组织和管理试点项目专业能力公费医疗

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Weekend Operating Room On Call Staffing Requirements

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AORN Journal 2001年第5期74卷 664-665页

作者： Dexter, Franklin department of anesthesia University of Iowa Iowa City United States Cornell University Ithaca NY United States

This article describes a statistical method used to determine the minimum number of OR teams that should be on call for urgent procedures, in-house versus on standby from home, to minimize labor costs. The OR manager obtains the number of ORs staffed at each hour of the 24-hour period of interest (eg, 7 AM Saturday to 7 AM Sunday) from the surgical suite's information system. The minimum number of total staffed hours needed to care for patients is calculated for a prespecified level of the acceptable risk of inadequate staffing. A method used to determine whether each staff member should work in-house or on standby from home then is introduced. This method enumerates all possible combinations of shifts to find the one with the lowest cost, and it ensures a prespecified service level. An example based on 248 weeks of data collected from a large surgical suite is presented, and staffing for emergency procedures is reviewed. AORN J 74 (Nov 2001) 664–671. © 2001 AORN, Inc.

关键词：成本及成本分析急症假日美国中西部模型统计学麻醉手术护士/组织和管理手术室护理/组织和管理手术室人员配备和时间安排/组织和管理危险因素外科手术/护理时间因素美国人类

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