Dissertations / Theses on the topic 'Hospitals Victoria Emergency service'
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O'Meara, Peter Francis Public Health & Community Medicine Faculty of Medicine UNSW. "Models of ambulance service delivery for rural Victoria." Awarded by:University of New South Wales. Public Health and Community Medicine, 2002. http://handle.unsw.edu.au/1959.4/18771.
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The primary aim of the research project was to develop conceptual models of rural ambulance service delivery based on different worldviews or philosophical positions, and then to compare and contrast these new and emerging models with existing organisational policy and practice. Four research aims were explored: community expectations of pre-hospital care, the existing organization of rural ambulance services, the measurement of ambulance service performance, and the comparative suitability of different pre-hospital models of service delivery. A unique feature was the use of soft systems methodology to develop the models of service delivery. It is one of the major non-traditional systems approaches to organisational research and lends itself to problem solving in the real world. The classic literature-hypothesis-experiment-results-conclusion model of research was not followed. Instead, policy and political analysis techniques were used as counter-points to the systems approach. The program of research employed a triangulation technique to adduce evidence from various sources in order to analyse ambulance services in rural Victoria. In particular, information from questionnaires, a focus group, interviews and performance data from the ambulance services themselves were used. These formed a rich dataset that provided new insight into rural ambulance services. Five service delivery models based on different worldviews were developed, each with its own characteristics, transformation processes and performance criteria. The models developed are titled: competitive; sufficing; community; expert; and practitioner. These conceptual models are presented as metaphors and in the form of holons and rich pictures, and then transformed into patient pathways for operational implementation. All five conceptual models meet the criteria for systemic desirability and were assessed for their political and cultural feasibility in a range of different rural communities. They provide a solid foundation for future discourse, debate and discussion about possible changes to the way pre-hospital services are delivered in rural Victoria.
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Andersson, Sanna, and Sandra Stålhult. "Hospitals exposed to flooding in Manila City, Philippines : GIS analyses of alternative emergency routes and allocation of emergency service and temporary medical centre." Thesis, Karlstads universitet, Fakulteten för humaniora och samhällsvetenskap (from 2013), 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-33042.
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Every year the Philippines get affected by a number of typhoons, which cause severe damage, sometimes due to flooding. The capital, Manila, is located on a flood plain that is partly at, and even below sea level and with several rivers crossing the area. These are some of the factors that contribute to that Manila often is affected by severe flooding. During ten weeks of the spring semester in 2014, this thesis was conducted as a completion of the bachelor program Geographic Information System (GIS) at Karlstad University, Sweden. Eight weeks were spent in Manila in the Philippines at the University of the Philippines Diliman, School of Urban and Regional Planning (UP SURP). The aim of the study was to investigate how hospitals in Manila City get affected during flooding. GIS was used to perform network analyses, in order to calculate the shortest route for the emergency service to travel from a station via a barangay to a hospital. The shortest alternative route during a 5-year flood was also calculated in order to compare the distance differences that might be due to flood. During a 100-year flood another type of analysis was performed, where suggestions for suitable locations for placing emergency service and temporary medical centre were presented. These suggestions on suitable locations were placed in an area that will not be affected during a 100-year flood. Results from the analyses showed that Manila City is a very exposed area during flood. During a 5-year flood some parts of Manila City will be highly exposed and about 1/4 of the population will be affected. The shortest alternative route for the emergency service to use during flood will generally be longer than in normal situations. Some hospitals cannot be accessed from some barangays due to impassable roads. During a 100-year flood the area gets gravely affected, almost 2/3 of the population will be affected and many roads become impassable, which limits the accessibility in Manila City.
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Frederick, John (John William) 1952. ""The help I need is more than the help they can give me" : a study of the life circumstances of emergency relief clients." Monash University, Dept. of Social Work, 2004. http://arrow.monash.edu.au/hdl/1959.1/5151.
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Mak, Kin-ming, and 麥健銘. "Emergency psychiatric attendance in a Hong Kong hospital: a local experience in understanding factors associatedwith re-attendance." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2006. http://hub.hku.hk/bib/B3972489X.
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梁寶珊 and Po-shan Melissa Leung. "The prevalence of domestic violence among the female Chinese population in the accident and emergency department." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2002. http://hub.hku.hk/bib/B25910681.
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Tse, Po-shu Patrick, and 謝寶樹. "An application of short-term scheduling tactics to the accident and emergency department of a public hospital in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1990. http://hub.hku.hk/bib/B31264785.
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Moore, Simon Peter. "Delays in the emergency department and their effects on the ambulance provider." CSUSB ScholarWorks, 2002. https://scholarworks.lib.csusb.edu/etd-project/2067.
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Silva, Nilce Mara da. "Aspectos facilitadores e dificultadores do trabalho do enfermeiro em cargos gerenciais em hospital." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-07032016-210705/.
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A nova configuração do papel dos hospitais, na perspectiva da construção de redes de atenção à saúde, tem implicações para o trabalho do enfermeiro com cargo gerencial no tocante às suas ações/decisões administrativas, assistenciais e de ensino. Nesse sentido, este estudo teve o objetivo de identificar os aspectos facilitadores e dificultadores do trabalho do enfermeiro em cargos gerenciais, em um hospital público, de urgência, do interior paulista. Para tanto, foi realizado um estudo descritivo de abordagem quantitativa de dados qualitativos, utilizando a Técnica do Incidente Crítico, para o levantamento das percepções e atitudes em relação ao objeto de investigação. O estudo foi desenvolvido em uma instituição hospitalar de ensino, pública, de nível terciário, situada no nordeste do Estado de São Paulo, Brasil. Participaram 15 enfermeiros em cargos gerenciais que atuavam no referido cargo há pelo menos um ano, sendo excluídos aqueles que se encontravam ausentes do local de trabalho à época da coleta dos dados, em decorrência de afastamentos legais ou por não ter sido possível realizar a entrevista após cinco agendamentos cancelados. A coleta dos dados ocorreu por meio de entrevista semiestruturada individual. Foram relatados incidentes críticos, que se constituíram em 42 situações, das quais 33,3% foram positivas e 66,7% negativas; repercutindo em 57 comportamentos, sendo 84,2% positivos e 15,8% negativos e 74 consequências, sendo 41,9% positivas e 58,1% negativas. Os dados da análise de conteúdo foram agrupados por similaridade de conteúdo. Consideram-se aspectos facilitadores situação/comportamento/consequência com referências predominantemente positivas, as categorias, a saber: interação: equipe, paciente, família; gerenciar a unidade de trabalho; questionar a implantação do Grupo Gestor e comunicar-se. Em contrapartida, foram considerados aspectos dificultadores situação/comportamento/consequência com referências predominantemente negativas, as categorias: estrutura organizacional; gestão de infraestrutura e gestão de pessoas. Cabe destacar que esses resultados podem subsidiar o trabalho do enfermeiro em cargo gerencial e, também, dos próprios gestores do hospital, uma vez que os aspectos dificultadores do trabalho do enfermeiro em cargo gerencial dizem respeito, em sua maioria, a questões de pouca governabilidade para esse profissional. Assim, evidencia-se a necessidade de maior aproximação dos gestores e enfermeiros com cargo gerencial, a fim de, juntos, solucionarem questões que favoreçam o processo de cuidar e de coordenar o trabalho. É inegável a clareza que os participantes trouxeram sobre sua responsabilidade profissional, visto que, embora os incidentes tenham tido referências predominantemente negativas, os comportamentos apresentados tiveram referências predominantemente positivas, evidenciando os esforços que esses profissionais despendem para superar as dificuldades vivenciadas e a importância considerada em poder compartilhar decisões e ações a serem realizadasThe new configuration of the role of hospitals, with a view to building health care networks, has implications for the work of nurses in management positions in relation to their administrative, helth care and teaching actions/decisions. This study aimed to identify the facilitating and hindering aspects of the work of nurses in management positions in a public emergency hospital in the interior of the state of São Paulo. A descriptive study with quantitative approach of the qualitative data was performed, using the Critical Incident Technique, to survey the perceptions and attitudes in relation to the researched object. The study was developed in a public tertiary-level teaching hospital, located in the northeast region of São Paulo state, Brazil. In total, 15 nurses in management positions, who worked in the function for at least one year, participated, excluding those who were absent from the workplace at the time of data collection as a result of legal absences or because it was not possible to conduct the interview after five appointments canceled. Data collection was performed through individual semi-structured interview. Critical incidents consisting of 42 cases were reported, of which 33.3% were positive and 66.7% negative, culminating in 57 behaviors, of which 84.2% positive and 15.8% negative, and 74 consequences, 41.9% positive and 58.1% negative. Content analysis data were grouped by similarity of content. Situation, behavior and consequence with predominantly positive references were considered as facilitating aspects, with the following categories: interaction- team, patient, family; to manage the work unit; to question the implementation of the Management Group and to communicate. On the other hand, situation, behavior and consequence with predominantly negative references were considered hindering aspects, with the following categories: organizational structure; infrastructure management and personnel management. It is highligted that these results may support the work of nurses in management positions as well as hospital managers, once the hindering aspects of the work of nurses in management positions are related mostly to issues of poor governance to this professional. Thus, the study evidences the need for closer alignment of managers and nurses with management position, in order to commonly solve issues that favor the care process and work coordination. It is undeniable the clarity that participants have about their professional liability, since although the incidents have had predominantly negative references, behaviors presented had mainly positive references, showing the efforts that these professionals expend to overcome the difficulties experienced and the importance considered in sharing decisions and actions to be taken
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Barakat, Soraia Fatima Coelho. ""Caracterização da demanda do Serviço de Emergências Clínicas de um hospital terciário do município de São Paulo"." Universidade de São Paulo, 2004. http://www.teses.usp.br/teses/disponiveis/5/5159/tde-07112005-174138/.
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A superlotação de serviços de emergência é problema sério e de grande relevância do sistema de saúde, não sendo restrito ao nosso meio. Os estudos que enfocam esse tema vêm tomando proporções na literatura internacional. O que se vem vivenciando há mais de uma década são prontos socorros lotados devido a um deslocamento da população em direção a estes serviços, configurando-os como prestadores de atenção primária de assistência à saúde e, não de fato, destinados ao atendimento de emergências. O principal objetivo do estudo foi recompor a trajetória do usuário do serviço de saúde até a chegada à unidade de emergência de um hospital terciário do município, qualificando-o segundo as razões de escolha de atendimento e caracterizando seu perfil socioeconômico e demográfico. Este estudo de corte transversal se restringiu à análise da demanda espontânea do Pronto Socorro de Emergências Clínicas do Hospital das Clínicas da Universidade de São Paulo. Foram entrevistados todos os usuários que procuraram este serviço durante uma semana típica. Dos pacientes entrevistados, foram incluídos no estudo 881 pacientes, o que representou 93,1% do total. Realizada a análise estatística univariada, seguida pela construção de um modelo de regressão logística, para estudo das variáveis associadas à vinda direta ao pronto socorro. Os resultados demonstraram que a demanda era constituída predominantemente de mulheres, brancas, com idade média de 44 anos, baixo grau de instrução, com rendimento per capita mensal de até uns salários mínimos e residentes no município de São Paulo (81,3%). Cinco por cento tinham direito à assistência médica privada. Quanto ao acesso a serviços de saúde, 72,5% residiam próximo a serviços de saúde de atenção primária e 53,4% a hospitais e/ou prontos socorros. Quanto à trajetória percorrida antes da chegada ao pronto socorro, 56,2% procuraram diretamente o pronto socorro. Dos pacientes que procuraram outros serviços previamente, 26,4% passaram por unidades básicas de saúde e 73,6% por outros hospitais/prontos socorros. Dos 881 pacientes entrevistados, 771 foram dispensados após consulta médica. As características associadas à vinda direta ao pronto socorro foram: nível superior de escolaridade, não ser casado, não ter diagnóstico médico, possuir cartão do Hospital das Clínicas, ter idade entre 25 e 39 anos e contribuir para a Previdência Social. Por outro lado, quanto maior a duração da queixa e quanto mais distante o local de residência, menor a probabilidade de procurar este serviço diretamente. As razões do uso dos serviços de emergência envolvem mecanismos complexos, além da credibilidade e confiança na instituição, facilidade de acesso e baixa resolutividade dos outros serviços da rede pública de saúde. Contrariamente ao senso comum e a visão corrente de vários gestores do sistema de saúde, a problemática de superlotação dos serviços de emergência não reside apenas na atenção primária, mas sim no baixo poder de resolução da rede hospitalar.Overcrowding in Emergency Department is a Public Health problem not only in Brazil. However, information about the population that search for emergency medical care at tertiary hospitals in Brazil is incomplete. Therefore, the main objective of this work was to reconstruct the pathway of these patients until their arrival to the Clinical Emergency Department of a tertiary Hospital. During a typical week, 1121 patients were attended at the Hospital das Clínicas Clinical Emergency Department, São Paulo, Brazil. From this total, 946 were interviewed and 881 (93,1%) were selected to the study. The selected patients were questioned by health care professionals before the medical consult, regarding their demographic characterization, as well as questions about the reasons why they choose this specific health service. Variables associated to the patients coming to the hospital were studied by univariate analysis followed by construction of a logistic regression model. The emergency service demand is composed predominantly by white women, 44 years old (mean age), living in São Paulo City (81,3%), low instruction grade, monthly income around US$ 80. Only 5% of them have private health care plan. Usually they have a primary medical service (72,5%) or a hospital/emergency service (53,4%)in their home neighborhoods. More than half of the patients (56,2%) came directly to the Clinical Emergency Department, without searching for a less complex service. The most frequent diagnosis was upper airways infections. More than 92% of the patients attended were discharged after a simple medical consultation, suggesting that they could have been seen in a less complex health care facility. Patients not married, aged between 25 and 39 years old, with higher level of instruction, without clinical disease and that had been attended at Hospital das Clínicas any time were more likely to search this emergency service before to go to other health services. In other hand, patients living far from the service and with symptoms during several days were less likely to search this service directly. Asked the reasons they search this specific Emergency Service, patients cited credibility and trust are major factors, along with lack of confidence and solving ability of the others services. Factors priming the patients to have this specific service as a first choice were living close to the Hospital, higher education level, symptoms lasting less than one day and fever as a presenting symptom. From the patients attended in other services, prior to their arrival at this Emergency Department, 26,4% were seen at primary care facilities and 73,6% at other hospitals. In this study we have shown that the reasons why patients search for a Clinical Emergency Department in a tertiary Hospital is very complex, including easy access, credibility and lack of trust in other services. These results are contrary to the common sense, and the current view of Health Care directors. Overcrowding in Emergency Departments is due not only to inefficiency Primary Care services, but also to low solving ability of hospital services.
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Wanecq, Charles-Antoine. "Sauver, protéger et soigner : une histoire des secours d’urgence en France (années 1920-années 1980)." Thesis, Paris, Institut d'études politiques, 2018. http://www.theses.fr/2018IEPP0039.
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Cette thèse porte sur l’élaboration et les usages sociaux de la notion d’urgence vitale dans la France contemporaine. Entendue comme la nécessité d’agir vite pour éviter une mort probable, l’urgence constitue un mode de plus en plus ordinaire de prise en charge des pathologies. À partir d’une étude de sources multiples, médicales, administratives, hospitalières ou encore associatives, cette recherche doctorale propose de saisir les logiques sociales, économiques et politiques que suscite un accident, lorsqu’une ou plusieurs vies humaines sont menacées. Alors que, dans l’entre-deux-guerres, les innovations médico-chirurgicales de la Première Guerre mondiale ne trouvent que rarement une traduction dans le monde civil, le risque nucléaire et l’augmentation rapide de la mortalité routière contribuent à la mise en œuvre d’une politique publique d’organisation des secours d’urgence, orchestrée par un bureau du ministère de la Santé et centrée sur l’hôpital public. Fondée sur une analyse de la division du travail et des dispositifs techniques qui rendent possible la rationalisation de l’offre de secours, la thèse replace les débats qui portent sur la valeur accordée aux vies humaines dans l’histoire de la santé et des institutions en charge de la protection des populationsThis dissertation deals with the elaboration and the social uses of the notion of vital emergency in contemporary France. The concept of emergency – defined as a need for urgent action to avoid death - constitutes an increasingly common form of medical care. Based on a study of multiple sources, including the archives of physicians, administrations, hospitals and associations, this doctoral research aims at understanding the social, economic and political processes set in motion by an accident, when one or several human lives are threatened. During the interwar period, the innovative medical and surgical techniques of the First World War were seldom implemented in the civilian world ; however the nuclear risk and the increasing mortality rate caused by road acccidents led to an organization of emergency medical services in public hospitals. This public policy was overseen by a division of the Ministry of Health. Through an analysis of the division of labour and of the technical devices which rationalized the provision of emergency care, this dissertation changes the focus of the debates on the value of human lives in the history of health and of the institutions in charge of the protection of populations
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Gallotti, Renata Mahfuz Daud. ""Eventos adversos e óbitos hospitalares em serviço de emergências clínicas de um hospital universitário terciário: um olhar para a qualidade da atenção"." Universidade de São Paulo, 2003. http://www.teses.usp.br/teses/disponiveis/5/5159/tde-15082005-171758/.
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Eventos adversos (EAs), definidos como complicações não intencionais decorrentes do cuidado prestado, são reconhecidos como um dos maiores problemas na área da saúde. Embora a maior parte dos eventos acarrete incapacitações leves, uma proporção considerável está relacionada à morte de pacientes. O atendimento de urgência é considerado importante fator de risco para o desencadeamento destas complicações. No Brasil, estudos relacionados a este tema não foram publicados até o momento. O presente estudo objetivou identificar a ocorrência de EAs em pacientes admitidos por acidente vascular cerebral (AVC) ao Pronto-Socorro de Clínica Médica (PSM) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP) e determinar as categorias de EAs associadas a óbito. Este estudo caso-controle pareado envolveu 468 pacientes admitidos por AVC ao PSM-HCFMUSP no período de março de 1996 a setembro de 1999. O grupo-caso compreendeu 234 óbitos hospitalares consecutivos e o grupo-controle 234 pacientes que receberam alta, pareados pelo diagnóstico provisório e pela época de internação. Eventos adversos, detectados por revisão de prontuários, foram classificados segundo sua gravidade, causas imediatas, sistemas acometidos e categorias profissionais envolvidas no cuidado aos pacientes. A associação com óbito foi analisada por regressão logística multivariada condicional, incluindo variáveis relacionadas a aspectos demográficos, gravidade do quadro inicial e características da assistência. Nos 468 pacientes foram identificados 1.218 EAs: 932 EAs (76,5%) em 170 casos e 286 EAs (23,5%) em 125 controles. Eventos adversos major corresponderam a 54,1% do total de eventos, com 659 episódios: 538 eventos em 143 casos e 121 em 65 controles. Os procedimentos diagnósticos e terapêuticos e os cuidados de enfermagem foram responsáveis em conjunto por 55,2% do total de eventos. Em relação ao tipo de sistema afetado, 46,0% dos EAs identificados ocasionaram manifestações gerais. Eventos adversos relacionados à enfermagem e EAs médicos representaram as categorias profissionais de EAs mais freqüentes (38,4% e 31,0% do total de eventos). Uma associação significante com óbito foi encontrada em relação a EAs major, EAs médicos e infecções hospitalares, com valores de OR ajustado estimados em 3,72 (IC 95% = 1,63-8,48), 3,69 (IC 95% = 1,60-8,50) e 3,20 (IC 95% = 1,20-8,51), respectivamente. Em resumo, eventos adversos, na sua maioria graves, foram freqüentes em casos e controles, determinando predominantemente manifestações gerais. Os procedimentos diagnósticos e terapêuticos e os cuidados de enfermagem corresponderam às principais causas imediatas de EAs. Em relação à categoria profissional envolvida, os EAs relacionados à enfermagem e os eventos médicos predominaram. Eventos adversos major, EAs médicos e as infecções hospitalares associaram-se de maneira significante com óbito em pacientes com AVC admitidos ao Pronto-Socorro de Clínica Médica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloAdverse events (AEs), defined as unintended injuries caused by medical care, are recognized as a major health problem. Although most of them lead to minimal impairments, a considerable proportion is related to patients death. Urgent care is considered an important AE risk factor. No related Brazilian studies were published so far. The present study aimed to identify the occurrence of AEs in patients admitted for stroke to the medical emergency department of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP) and to determine the AEs categories associated to death. This paired case-control study enrolled 468 patients admitted for stroke to the HCFMUSP medical emergency department from March 1996 to September 1999. The cases comprised 234 consecutive deaths and the controls 234 discharged patients, matched for primary diagnosis and admission period. AEs, detected by retrospective chart review, were classified with regard to their severity, immediate causes, affected systems and professional involved in patient care. The association with death was analyzed by multivariate conditional regression including variables related to demographic aspects, clinical severity on admission and care characteristics. A total of 1,218 AEs were identified in 468 patients: 932 AEs (76.5%) in 170 cases and 286 AEs (23.5%) in 125 controls. Major AEs corresponded to 54.1% of all AEs, with 659 episodes: 538 events in 143 cases and 121 in 65 controls. Diagnostic and therapeutic procedures and nursing activities accounted together for 55.2% of all events. Concerning the affected system, 46.0% of the identified AEs lead to general manifestations. Nursing and medical AEs represented the most frequent professional categories involved (38.4% and 31.0% of all events). A significant association with death was found regarding major AEs, medical AEs and nosocomial infections, with adjusted OR estimates of 3.72 (95% IC = 1.63-8.48), 3.69 (95% IC = 1.60-8.50) and 3.20 (95% IC = 1.20-8.51), respectively. In summary, adverse events, most of them severe, were frequent in cases and controls, leading mainly to general manifestations. Diagnostic and therapeutic procedures and nursing activities corresponded to the main AEs immediate causes. Regarding the professional involved, AEs related to nurses and physicians predominated. Major AEs, medical AEs and nosocomial infectious were significantly associated to death in stroke patients admitted to the medical emergency department of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
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Jaswal, Harpreet Kaur. "Seismic preparedness of hospitals in Victoria, British Columbia, Canada." Thesis, 2012. http://hdl.handle.net/1828/3997.
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This research explored the extent to which two hospitals in the City of Victoria are prepared for a future earthquake event. The goal is to examine the level of emergency preparedness of two tertiary care hospitals in Victoria for dealing with the potential damage caused by an earthquake in the region. The research objectives are aimed at highlighting current strengths regarding health sector emergency preparedness, reducing the vulnerability of the health sector by identifying key areas of improvement, and ultimately, increasing the capacity of the health sector to respond to the damages sustained by earthquakes. A small-scale mixed-methods approach was taken to assess hospital preparedness. A structured survey was administered to 26 key informants who were selected specifically based on their prior knowledge, experience and current roles and responsibilities pertaining to Disaster and Emergency Management in the province. A concerted effort was made to include a sample of participants from each of five target populations at the Provincial, Health Authority, and Local Health Authority levels. Data analysis included quantitative and qualitative techniques to generate simple statistics and thematic coding of the interview transcripts to identify main themes and patterns. Both quantitative and qualitative insights were used to provide a clearer picture of hospital preparedness and to foster credibility and dependability of key results. The findings and results confirm that there are excellent levels of engagement and integration between the Local Government, BC Ambulance Service and Fire Departments. There is room for improvement in regards to engaging and integrating NGOs with Hospital planning. Robust plans and protocols were found to be in place for Communication Systems, Emergency Operations Centres and Public Information and Media Relations. Hospital level respondents reported having less Emergency Management education and Training and had participated in fewer disaster exercises compared to Provincial and Local Emergency Managers. Although 76% of respondents had participated in a disaster exercise, only 5 % had responded to an earthquake. Only 23% of respondents had activated their planning in response to an earthquake. The results emphasize the immediate need for increased engagement and integration of earthquake response planning between health system stakeholders, communities and all levels of government. At the hospital level, increased attention needs to be directed to the following operational areas: Mass Casualty Planning, Resource Stockpiling, Department Level Contingency Plans, Evacuation and Relocation Protocols and Procedures, Volunteer Coordination Protocols, and Internal and External Traffic flow. Lastly, the results highlight the need for increased disaster education and training for front line acute care employees, hospital administrators and management staff. In addition to training and education, multi-jurisdictional and multi-agency exercises should be undertaken to engage all key community stakeholders and to promote a more integrated and optimal response in the event of an earthquake.Graduate
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Williams, Robert Melvin. "The costs of emergency department services dissertation submitted in partial fulfillment ... for the degree of Doctor of Public Health (Health Policy) ... /." 1994. http://books.google.com/books?id=JsdBAAAAMAAJ.
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O'Meara, Peter Francis. "Models of ambulance service delivery for rural Victoria /." 2002. http://www.library.unsw.edu.au/~thesis/adt-NUN/public/adt-NUN20030401.152156/index.html.
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Hartley, Peter Ross. "Paramedic practice and the cultural and religious needs of pre‐hospital patients in Victoria." Thesis, 2012. https://vuir.vu.edu.au/21301/.
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Religion and culture can impact profoundly on healthcare practices and health
outcomes. The Australian community is rich and diverse in differing cultures and
religions, and at times of medical emergency the paramedic increasingly will be required
to respond to healthcare needs of this diverse community. This study is designed to
investigate current paramedic practices as they relate to an awareness of the cultural
and religious needs of community groups as a holistic approach. It also incorporates the
voices of these community groups from their experiences with emergency paramedics
during pre‐hospital health care for those living in Melbourne, Australia.
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Butler, Patricia A. "Medicaid HMO enrollees in the emergency room use of non-emergency care : a dissertation submitted in partial fulfillment ... for the degree of Doctor of Public Health (Health Policy) ... /." 1996. http://books.google.com/books?id=PysoAAAAMAAJ.
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Kabongo, Diulu. "Severe hypertension in two emergency departments of Netcare Management (Pty) Limited hospitals, Johannesburg, South Africa." Thesis, 2014.
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Hypertension is the major cause of cardio-vascular diseases and contributes to 13.5% of premature deaths worldwide. With a 10–year risk to develop organ damages estimated at 30%, severe hypertension exposes even more patients to premature death. Severe hypertension is a type of hypertension with systolic blood pressure ≥ 180mmHg and/or diastolic blood pressure ≥ 110 mmHg that may present with or without symptoms/signs or target organ damages, and may be classified accordingly as asymptomatic (without symptoms/signs) severe hypertension, hypertension urgency (with symptoms/signs, no target organ damage) or hypertension emergency (with target organ damage). Hypertension urgency and hypertension emergency are considered hypertension crisis.
This study aimed to establish the socio-demographic and clinical characteristics of the patients who presented with severe hypertension at the Emergency Departments of two private hospitals of the Netcare Management (Pty) Limited in Johannesburg during the period from the 1st of January 2010 to 30th April 2011. These patients presumably receive quality health care and may not be expected to develop severe hypertension. Therefore, this study would contribute to efforts to identify patients at risk and those who may benefit from preventive measures.
The methodology of this study was a retrospective, transversal and comparative study. One thousand and forty-two patients were included in the study. All of these participants had a medical aid cover or were able to pay for medical consultation at a private hospital. Data were collected from an electronic database, the Medibank™, and from manual patients’ registers kept in each hospital’s Emergency Department.
Severe hypertension was found among 1.7% of all patients who presented to the studied emergency departments. Only 817 patients were classified in the different subtypes of SH. Asymptomatic severe hypertension was the most common (83.4%) type of severe hypertension and hypertension emergency was the least common (4.8%). At Mulbarton Hospital, 50.2% of severe hypertension patients were male and at Linksfield Hospital, 60.3% were female. Male patients were younger than female patients. White patients and elderly were mostly affected by severe hypertension in the studied population.
Systolic blood pressures were similar among the different races and genders. Black patients had higher diastolic blood pressure compared to white patients. White patients were older and may have had a tendency of isolated systolic hypertension.
Overall, the most common symptoms/signs in hypertension urgency were chest pains (46.4%), headache (34.0%) and epistaxis (11.3%). The most common target organ damages in hypertension emergency were stroke (58.9%), left ventricular failure/congestive cardiac failure (28.2%) and seizures (12.8%). None of the studied characteristics could be claimed predictors of hypertension crisis. Also, there was no association between seasons and days of presentation and onset of severe hypertension in each hospitals.
Further studies are required to include other factors that are known to affect the occurrence of severe hypertension, such as co-morbidities, smoking, alcohol intake and poor adherence to medication by known hypertensive patients. Also, risk factors contributing to the occurrence of SH among younger black patients need to be analysed.
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Han, Cheng-Hua, and 韓振華. "The Location Analysis of Heliports and Designated Hospitals for the Air Emergency Medical Service Network in Taiwan." Thesis, 1996. http://ndltd.ncl.edu.tw/handle/01831532422010113026.
Full textAbstract:
碩士國立成功大學
交通管理(科學)學系
84
The Emergency Medical Service (EMS) is of great importance to the lives of the people. In Taiwan, however, the natural geographical barriers, road congestion, and unevenly distributed medical resources have prohibited this vital service to some remote areas. Thus, the establishment of an efficient Air EMS network and making this service available to every individual is one of the urgent public works in Taiwan.The purpose of designing this network is to ensure patients and severely injured persons can always be transported in time to the designated medical service stations for medical treatments. Since such a service costs a lot, the planners have to locate this resource effectively.Upon surveying current and potential sites for medical facilities and heliports, we construct a mathematical model to simultaneously determine the heliport and designated hospital locations, numbers of helicopters, and delivery routes for the patients. We also propose a heuristic algorithm to solve this kind of location decision problem. Besides, we use the UfosNet planning software to display the results, so users can better see the location and their service areas of the heliports and the hospitals. Further, results from this case study can serve as a reference for government authorities to design the Air Emergency Medical Service System in the near future.
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"Analysis of accident and emergency services in Hong Kong: the level of inappropriate utilization and why?" Thesis, 2004. http://library.cuhk.edu.hk/record=b6075018.
Full textAbstract:
Objectives: This study has been conducted to determine the levels of inappropriate use of the A&E for conditions that could be treated by GPs, the nature of the morbidity pattern of those conditions, the reasons why primary care services were not being utilized, and also examined the validity (i.e. sensitivity and specificity) of patient classifications undertaken by nurses at the time of admission within this local context. Study design and setting: A cross sectional study was conducted over a one year period and subjects were randomly selected from four A&E departments located across the four principle geographic regions of Hong Kong by stratified, two-stage sampling. Main outcome measure: The gold standard in differentiating true emergency cases and GP cases was based on a retrospective record review conducted independently by a panel of emergency physicians. A random sub-sample of those classified as GP cases was interviewed and compared to a matched (via morbidity status) sample of primary care patients who had attended a hospitals' GOPC in order to determine factors distinguishing these two patient groups. Multiple Logistic Regression was used to distinguish the difference between GP cases and matched GOPC primary care patients on significance and odds ratios of the variables. The morbidity pattern according to ICPC was tabulated and analysed for the 'true' A&E cases and non-urgent cases. Sensitivity, specificity and positive predictive values were computed for both non-weighted and weighted conditions. Results: The level of GP cases was found to be 57% with a significant higher proportion of patients in younger age group, and late evening. The morbidity pattern of those top 10 diagnoses of non-urgent cases was very similar to the Hong Kong general practice morbidity pattern for self limiting conditions. Closure of the clinic was the main reason for GP cases attending A&E. Other major reasons were deterioration of symptoms, GPs' inability to diagnose efficiently and patients' wish to continue medical treatment in the same hospital. Affordability was the most pronounced reason for utilising the GOPC, but did not apply to the A&E GP patients. The most accurate weighted nurses' triage classification had the average sensitivity of 75%, specificity of 65.7%, and positive predictive value of 54%. The most accurate weighted patients' self-triage classification yielded a sensitivity of 43.3%, specificity of 49.2%, and a positive predictive value of 38.6%. Conclusion: The reasons for high level of utilisation of A&E services are complex and reflect problems of delivery of GP services. There is an urgent need for the GPs to set up a network system to provide out of hours services, and also for a better interfacing between primary and secondary care, and between public and private sectors, so that patients can be referred back to GPs. The design and measures chosen for this study will help provide A&E policy makers and planners with relevant information for better addressing practical solutions.Albert Lee.
Source: Dissertation Abstracts International, Volume: 73-01, Section: B, page: .
Thesis (M.D.)--Chinese University of Hong Kong, 2004.
Includes bibliographical references (leaves 137-151).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Appendix 4 in Chinese.
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Steinke, Claudia. "Service design in the ER." Thesis, 2008. http://hdl.handle.net/1828/2532.
Full textAbstract:
The Service Profit Chain is a simple conceptual framework linking employee satisfaction and loyalty, customer satisfaction and loyalty, and financial performance. Although widely used by practitioners, the Service Profit Chain's series of hypothesized relationships between employee, customer, and financial outcomes has seldom been tested using data that span all components of the model. Using a modified version of the Service Profit Chain, this study explores service design in the ER. In essence, the Service Outcome Chain asserts that certain structural elements. through their impact on process, have the potential to positively influence outcomes in the ER. The Service Outcome Chain proposes that for quality service to be delivered to the end-user (patients). service providers (nurses. physicians) must receive the support of those who serve them (management, training, the design of jobs and the design of the physical setting). Organizations that create the proper set of structural conditions for employee work also provide a basis for the development of a positive service climate. A positive service climate influences service quality and the end results of patient satisfaction with service and patient empowerment.
In this study, using data from frontline service providers and service recipients in the ER, principle chain relationships are explored. A mixed methods approach is applied to examine the relationships identified in the Service Outcome Chain. A survey of emergency nurses is conducted followed by case studies of two ERs where survey, interview and photographic methods arc applied. Insights into the relationship between the structural, process and outcome elements of service design are gained. In addition. findings about the how managerial practices and physical design significantly influence service climate and service quality are revealed. Some of the strongest results of this study point to the role of physical design and service climate in setting the stage for a quality service strategy in the ER. In sum, this research provides the first theoretical and empirical examination of the Service Profit Chain or a modified version of it. applied to public sector health care in general and ERs in particular. It also provides the first empirical examination of physical design, service climate and patient empowerment in the ER. The importance of these three elements has been highlighted by this research.
21
Teegala, Shyam Mohan Reddy Taylor Wendell C. Granchi Thomas Chen Chin-Hsing Xiong Momiao. "Factors associated with hospital admission of elder cardiovascular patients in an emergency center." 2008. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:1452162.
Full textAbstract:
Thesis (M.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2008.Source: Masters Abstracts International, Volume: 46-05, page: 2672. Adviser: Wendell C. Taylor. Includes bibliographical references.
22
hui, Hung-chien, and 洪千惠. "The Exploration of Emergency Social Work Service Model – Taking the regional hospitals and medical centers in Northern part of Taiwan as examples." Thesis, 2008. http://ndltd.ncl.edu.tw/handle/97561821865225488378.
Full textAbstract:
碩士東吳大學
社會工作學系
96
Summary In recent years, assisting with the medical examinations, providing the emotional supports and crisis interventions for the victims of domestic violence, child and elderly abuse and sexual abuse have become the important focus in emergency social work. Therefore, the emergency social worker plays an important role in the emergency medical team to assist those who are underprivileged with their medical care, financial, family, life security and discharge planning problems. This research was conducted with qualitative research methods to present the actual practice of the emergency social work by exploring the current situation in emergency social work practice, the roles and functions of emergency social workers, the difficulties, coping strategies, and the dynamics among team members. The data collection of this research was conducted with semi-structure interview. There are twelve hospital social workers agreed to be interviewed via mail or phone invitation. Among the twelve participants, five of them are from the medical centers and seven are from the regional hospitals. The main findings of this research are the followings: 1. Currently, most of the hospitals adopt the duty-assigned service model - having assigned social workers responsible for the emergency room as part of their job duties. Only two of the medical centers have full-time emergency social workers solely responsible for emergency room and there is still one hospital has emergency social workers taking shifts. Having social workers working full-time in the emergency is the expectation for most of the emergency social workers. 2. Serving the immigrants (foreign spouses), the elderly living alone, dealing with the complaints and medical disputes have become the newly main focus of emergency social work. 3. The job contents, familiar working environment and good team working relationship are the main reasons which keep the social workers willing to be working in the emergency. 4. The most important and obvious role of the emergency social worker plays is the coordinator of communication. Then, the emergency social worker also plays roles as consultant, resource provider, educator, preventer, and advocate. 5. The role conflicts of the emergency social workers mainly come from the overly high expectations and dependency from the medical and nursing team members. The mostly expected roles of the emergency social workers are: family surrogate, problem solver for the problems that medical staffs dislike or impatient with and omnipotent problem solver. 6. The new roles for the emergency social workers include preventers, staff supporters, educational trainers, and researchers. 7. The ways of working with the medical team include demonstrating the functions of social workers, providing immediate services, being empathetic, supporting and respecting the medical team members and continuing educational trainings. 8. The difficulties of emergency social work practice come from the individual, the medical team, the institution, and the environment. 9. The most useful ways of dealing with setbacks for emergency social workers are seeking the support for the director and the peers, constant communication and continuing professional learning. Key word: Emergency social work
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Otieno, Florence Awino. "Patient perception of quality of care and service delivery in emergency departments in Gauteng: a case study of one public hospital." Thesis, 2008. http://hdl.handle.net/10210/715.
Full textAbstract:
Quality of health care delivered in the public sector remains a major challenge with diminishing resources to meet the increasing health care demands. Improvements in quality health care are identified in the Department of Health’s strategic framework as a key challenge. In order to improve quality, one needs to measure it. The patients’ views are important in identifying what is important to them. Inexpensive, easy to collect metrics need to be developed to measure quality of care. The study investigated perceptions of patients as a reflection of quality of care provided. The study also determined the key success factors in quality care in emergency departments and priorities of quality of care for improvement. A prospective study was conducted using one of Gauteng hospitals’ emergency departments as a case study. A structured questionnaire based on an overall care index focusing on specific dimensions of patients’ experience with health care was used to collect the data. Quantitative analysis was done using the Epi Info statistical package and the results summarised in frequency diagrams and tables. The findings indicate that waiting time is a major factor in perception of quality of health care. Although other hospitality issues in health care are important to patients, the degree to which they affect perception of quality of health care is difficult to determine because of the overwhelming influence of waiting time. It is recommended that priorities in addressing what users really want from health care should concentrate on strategies to shorten the waiting time. It is further recommended that a similar study be carried out in future once the waiting times have been improved considerably thus eliminating its excessive influence. This may highlight other variables important to the patients that may need to be improved in order to improve quality of care.Dr. Susan Jennifer Armstrong
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Taggart, Michelle Rae. "The attitudes and activities of registered nurses towards health promotion and patient education in the emergency department." Thesis, 2008. http://hdl.handle.net/1828/2590.
Full textAbstract:
Emergency department (ED) registered nurses (RNs) can help empower patients toward greater wellbeing through health promotion and patient education (HPPE). The ED is often an individual's first and only access to the health care system, and is seen as an underused setting for HPPE. To investigate RNs' current attitudes and activites about educating patients in the ED, 223 Canadian ED RNs were surveyed using an adapted web-based questionnaire. The attitudes of ED RNs and their current HPPE activities were examined, as was the relationship between level of nursing education and these attitudes. Results showed that perceived importance is the major variable to explain HPPE. A relationship also exists between fewer barriers and feeling more comfortable providing HPPE to patients. More comfortable ED RNS are more likely to see the importance of HPPE. A relationship between perceived effectiveness of HPPE and the frequency of HPPE was found. In general, ED RNs believe that HPPE is important, but need to perceive that what they are providing is effective.
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Dawson, David. "Experiential and Organisational Factors Predicting the Mental Health of Emergency Paramedics: Beyond the Trauma." Thesis, 2021. https://vuir.vu.edu.au/42952/.
Full textAbstract:
This research aimed to investigate the prevalence and distribution of mental health conditions across the paramedic workforce, to compare levels with the general population and to assess the association of stressors with scores on measures of mental health.
A survey was constructed to assess general psychological health, depression, anxiety, stress, suicidality, posttraumatic stress disorder, sleep health and the frequency and severity of stressor variables. Impact scores for stressor variables were generated by multiplying frequency and severity scores. Participant and workplace sociodemographic variables were measured. The survey was distributed within Ambulance Victoria in September 2010. Only data from 879 participants that transported emergency patients was analysed.
The ANOVA procedure and chi-square tests were employed to compare means and prevalences of psychological health scores within the paramedic sample according to sociodemographic variables. Independent-sample t-tests and chi-square tests for independence were used to examine means and prevalence rates by comparing this paramedic sample with general population statistics and other paramedic populations. Logistic and multiple regression analyses were conducted to investigate associations between stressor impact scores and mental health conditions.
Key findings were the higher levels of suicidal thinking and planning, PTSD, substandard sleep health and poor general psychological health compared to the general population. The level of PTSD was comparable to other paramedic populations while suicidality was higher: there were mixed findings on the other measures. Regression analyses found that stressors related to the organisation, the broader work context and shift work were significantly associated with measures of mental health while, with the exception of anxiety, emergency work was not. There were no meaningful differences in levels of mental health conditions within groups across the paramedic workforce except that PTSD caseness was higher outside the major cities and, higher levels of suicidality were reported in three ambulance service regions.
The higher levels of suicidality in this paramedic sample is a new finding although further research is needed to determine its nature and sources. Many stressors associated with mental health are not emergency work related but are instead associated with the organization and aspects of the broader working environment, suggesting that some stressors may be amenable to being managed. The lack of meaningful differences within this paramedic sample indicates that targeting mental health interventions is not practical, and should instead be directed across the entire workforce.
26
Godfredson, Jeffrey. "An International Comparison of Emergency Medical Services Delivery Systems: Which Produces The Optimum Outcome For The Patient?" Thesis, 2018. https://vuir.vu.edu.au/37851/.
Full textAbstract:
This thesis was written to address a problem with ambulance service delivery
times in Victoria, Australia. For a number of years, ambulance response times have
been increasing to unacceptable levels. As a result of the ever-increasing problem it was
appropriate to see if the are other alternative solutions producing better results. There
are a number of different service delivery models for Emergency Medical Services
(EMS) around the world. The main two are the Anglo/American model (also known as
scoop and run) and the Franco/German model (also known a stay and play). There are
also two major delivery agencies; the British model of a separate third party public
sector service as used in UK, Australia and New Zealand or the fire service model
where the fire service is the main delivery agency such as most of Asia, Europe and
North America. Which model provides the best outcome for the patient? Such research
has not been done in the past. The research will also examine if the Metropolitan Fire
brigade has capacity to undertake possible EMS roles.
A number of case studies were undertaken and explored with key issues of
response times, patient outcomes, skills and new technologies compared. The results,
particularly of response time show that in Victoria the response time for fire EMS (8.3
minutes) to medical emergencies is similar to that provided by fire services delivering
EMS in North America. The MFB in Victoria is providing the equivalent of first
responder; the American and Canadian fire services are delivering Advanced Life
Support (ALS). The response times for Basic Life Support (BLS) in Victoria provided
by ambulance service are over twice as long (8.3 minutes for fire compared to 18.2
minutes for Victorian Ambulance at the 90%). The US and Canadian Fire Services
provide EMS response time considerably lower than Ambulance Victoria, some as low
as 7.43 minutes. UK Ambulance (on which the Victorian model is based) also provides
response time considerably less than Ambulance Victoria. The issue of whether the fire
service in Victoria has capacity to undertake further EMS delivery was explored and
whilst it has the capacity it is doubtful it could be delivered in the current industrial
environment with the union having the capability of vetoing managerial decisions.
The research raised fundamental questions regarding the effective use of scarce
public sector resources and agencies working across organisational boundaries in the
interests of serving the public. Data analysis involved pattern matching, explanation
building and time series analysis to identify trends and commonalities across the cases.
A number of themes emerged including continued increases in call volumes, challenges
meeting response times and the development of proactive programs to reduce the
impact of these trends.
27
LEE, CHIEN-TA, and 李建達. "A case study of quality of medical service for stroke and coronary heart disease before and after an upgrade to a hierarchical system of emergency services-responsive hospitals." Thesis, 2016. http://ndltd.ncl.edu.tw/handle/50527308236450069456.
Full textAbstract:
碩士國防醫學院
公共衛生學研究所
104
Abstract Cardiovascular diseases have long been among the ten major causes of death in Taiwan. To improve medical service quality and outcomes in patients with stroke or coronary heart disease, regional and above medical institutions have established treatment centers for stroke, coronary heart disease, and other cardiovascular diseases. Provider accountability for continuity of patient care is ensured through a hierarchical system of emergency services-responsive hospitals implemented in July 2009. However, whether or not the quality of medical care for stroke and coronary heart disease improved after this network of hospitals was implemented has seldom been considered. Therefore, in order to improve medical service processes and outcomes, a case study was conducted, using records of patients who received hospital emergency medical services between January 2012 and November 2015. The usage of health insurance was analyzed, the data were summarized, and relevant indices were evaluated. The study was carried out for 3 domains: structure, process, and outcome. Existing emergency medical service conditions and the care needs and standards applied in individual cases were analyzed. The evaluation considered the general medical care of stroke and coronary heart disease patients before and after implementation of this hierarchical system, and whether index variations changed or the government's objectives for the upgrade were fulfilled. Statistical analysis (Stata version 10.0) was performed to examine whether index ratios achieved certain goals. This study found that the upgrade to a hierarchical emergency care system significantly improved hospital care processes for stroke and coronary heart disease patients. The overall emergency hospitalization rate increased by approximately 3%, the treatment time for Grade 1 and Grade 2 triage cases reduced by about 15-25 min, the treatment efficiency for severe cases increased, and the proportion of emergency consultations over 30 min increased by approximately 5%. However, the proportion of hospitalized observation or holding cases of over 48 h increased by about 0.18%, suggesting the treatment efficiency for mild cases still needs improvement. On the other hand, the overall return-to-emergency rate decreased, no medical treatment errors occurred, and medical service quality achieved certain standards. In order to improve quality of care for patients with emergent and severe conditions, medical information technologies should be implemented. However, the intensive care capabilities in the included hospitals need further investigation. Keywords: hierarchical system, emergency services-responsive hospitals, medical service quality, cardiovascular diseases
28
Park, Seong Cheol. "Indianapolis emergency medical service and the Indiana Network for Patient Care : evaluating the patient match process." Thesis, 2014. http://hdl.handle.net/1805/3808.
Full textAbstract:
Indiana University-Purdue University Indianapolis (IUPUI)In 2009, Indianapolis Emergency Medical Service (I-EMS, formerly Wishard Ambulance Service) launched an electronic medical record system within their ambulances and started to exchange patient data with the Indiana Network for Patient Care (INPC). This unique system allows EMS personnel in an ambulance to get important medical information prior to the patient’s arrival to the accepting hospital from incident scene. In this retrospective cohort study, we found EMS personnel made 3,021 patient data requests (14%) of 21,215 EMS transports during a one-year period, with a “success” match rate of 46%, and a match “failure” rate of 17%. The three major factors for causing match “failure” were (1) ZIP code 55%, (2) Patient Name 22%, and (3) Birth Date 12%. This study shows that the ZIP code is not a robust identifier in the patient identification process and Non-ZIP code identifiers may be a better choice due to inaccuracies and changes of the ZIP code in a patient’s record.
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Martins, Emanuel de Jesus Marques. "Contratualização em Meio Hospitalar." Master's thesis, 2018. http://hdl.handle.net/10316/82780.
Full textAbstract:
Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de MedicinaO Serviço Nacional de Saúde é algo de essencial para a população portuguesa, tratando-se de um serviço a que os cidadãos recorrem sempre que precisam de cuidados de saúde, seja ao nível mais básico dos cuidados, os cuidados de saúde primários, seja a um nível mais diferenciado, como são os cuidados hospitalares, nomeadamente o serviço de urgência. É também um enorme empregador a nível nacional, com uma grande rede de instituições prestadoras de cuidados distribuídas por todo o território do país. Dada a especificidade da sua atividade, a saúde, que é uma área em constante desenvolvimento científico e tecnológico, é um setor dos serviços públicos que acarreta avultados custos, sendo fonte de pressão na economia nacional. Como forma de controlar os gastos, foi criado um mecanismo de gestão do sistema que está baseado na contratualização dos cuidados de saúde, entre as entidades prestadoras (desde os cuidados de saúde primários aos hospitalares, incluindo instituições mais especializadas como são os Institutos Portugueses de Oncologia) e o Estado, que visa promover a eficiência das instituições. Este modelo de gestão é apresentado neste trabalho, detalhando-se o processo de contratualização propriamente dito, explicitando as suas fases e intervenientes, bem como as linhas de produção contratualizadas com os hospitais (internamento, cirurgia, consulta externa, ambulatório, entre outras), fazendo uma abordagem mais aprofundada ao serviço de urgência e evidenciando ajustes feitos nos últimos anos. É um tema habitualmente reservado a administradores e gestores, mas que um estudante de medicina deverá conhecer, pois são os médicos que lidam no seu quotidiano com o sistema e que em última análise são responsáveis pelos serviços prestados, daí resultando os indicadores de acesso e qualidade através dos quais a instituição vai ser avaliada no âmbito da contratualização.
The portuguese National Health Service is essential for the portuguese population. It is a service that citizens use whenever they need health care, whether at the most basic level of care, primary health care or at a more differentiated level, such as hospital care, namely the emergency department. It is also a large employer at the national level, with a large network of care institutions distributed throughout the country. Given the specificity of its activity, health, which is an area in constant scientific and technological development, is a sector of the public services that carries great costs, being a source of pressure in the national economy. As a way of controlling expenses, a system management mechanism was created that is based on the contracting of healthcare between providers (from primary healthcare providers to hospitals, including more specialized institutions such as the Portuguese Oncology Institutes) and the State, which aims to promote the efficiency of institutions. This management model is presented in this paper, detailing the contracting process itself, explaining its phases and actors, as well as the contracted production lines with hospitals (hospitalization, surgery, outpatient clinic, medical appointments, among others), taking a more thorough approach to the emergency service and highlighting adjustments made in recent years. It is a theme usually reserved for administrators and managers, but that a medical student should know, because it is the doctors who deal in their daily lives with the system and who ultimately are responsible for the services provided, resulting in the indicators of access and quality through which the institution will be evaluated in the context of contracting.
30
Johnson, Charles Dean Jr Begley Charles E. Amick Benjamin C. "Evaluation of the LBJ Hospital Ask Your Nurse Advice Line." 2008. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:1454270.
Full textAbstract:
Thesis (M.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2008.Source: Masters Abstracts International, Volume: 47-01, page: . Adviser: Charles E. Begley. Includes bibliographical references.
31
O'Rourke, Christine Harris T. Robert Dallo Florence J. Southern Paul M. "A retrospective analysis of patients referred for tuberculosis testing at Parkland Hospital, Dallas, TX." 2009. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:1467442.
Full text
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Buthelezi, Jabulani Khulikani Ancon. "Implementation of customer care at the Casualty Department of Edenvale Regional Hospital in Gauteng Province." Diss., 2017. http://hdl.handle.net/10500/22992.
Full textAbstract:
The study aimed to investigate the implementation of customer care at the Casualty Department
of Edenvale Regional Hospital in Gauteng Province. The research was conducted using a
qualitative case study approach, which sought to gain deeper understanding of the impact of
customer care in the hospital’s Casualty Department from the employees’ point of view. Data was
collected from 16 purposively selected respondents using semi-structured interviews and
document analyses were interpreted by the researcher to give voice and meaning to the assessment
topic. Data was analysed using the Content Analysis framework and six themes emerged from the
data analysis: (1) High expectation levels from the community; (2) Quality of patient care; (3)
Lack of resources; (4) Malfunctioning equipment; (5) Compromised safety and security; (5)
Strategies to improve customer care; and (6) The effect of policies and guidelines on the quality
of services rendered. The study revealed that the surrounding community that is served by the
Edenvale Hospital’s Casualty Department had high expectations which the hospital was unable to
meet because of the many limitations, especially resource constraints. The issues and difficulties
associated with overcrowding in the emergency section were raised by respondents, who reported
several challenges experienced in the hospital. These included patients sleeping on floor mattresses
and even on stretchers, inadequate beds, shortage of staff, malfunctioning equipment and lack of
sufficient infrastructure. These challenges resulted in long waiting periods for patients to be given
open beds in the wards, bad attitudes from both patients and employees alike, poor communication
among staff and patients and their families, and an unsafe environment for the staff and customers
(patients). There is hence a need for the Gauteng Health Department together with the hospital
management to review resources allocated to the Edenvale Regional Hospital and to increase
awareness among the community about the operations of the level 2 hospitals such as this.Public Administration
M. P. A.