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京都大学 / 新制・論文博士 / 博士(社会健康医学) / 乙第13637号 / 論社医博第20号 / 新制||社医||13(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 石見 拓, 教授 大鶴 繁, 教授 尾野 亘 / 学位規則第4条第2項該当 / Doctor of Public Health / Kyoto University / DFAM

No / Immediate reporting, commonly referred to as a ‘hot reporting’, has been advocated as a method of effectively supporting clinical decision making. However, its implementation nationally has been limited with poor understanding of its value in practice. A cross sectional attitudinal survey was distributed to emergency department clinicians (medical and nursing staff) and radiographers to explore perceptions of an immediate reporting service in terms of its influence on professional role and autonomy, patient care and service quality. A total of 87 (n = 87/155; 56.1%) completed questionnaires were returned. The findings suggest that significant support for immediate reporting exists. Immediate reporting is believed to improve service quality, reduce clinical errors and provide opportunity for image interpretation skills development. However, responses were not consistent across clinical professions and staff grades. The immediate reporting of emergency department images is perceived to benefit patient, emergency department clinicians and hospital organisation.

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Objectives: CDUs have been implemented to address ED wait times. The objectives of this study were to investigate ED team members’ perceptions on the implementation of CDUs as well as the impact of CDUs on the delivery of emergency care. Methods: A case study design and change theories found in the literature were used to investigate the implementation of CDUs in four hospitals. Semi-structured interviews with ED team members led to the creation of themes for analysis. Results: Analysis demonstrated that patient flow, work processes and communication contribute to the type of CDU set-up, whether it is a co-located or virtual CDU. The sustainability of CDUs relies on communication and a common vision in the fulfillment of purposes and goals. Conclusions: This study contributes to the understanding of the implementation of CDUs. The application of change frameworks assists with the identification of key success factors for implementing and sustaining change.

Objectives: CDUs have been implemented to address ED wait times. The objectives of this study were to investigate ED team members’ perceptions on the implementation of CDUs as well as the impact of CDUs on the delivery of emergency care. Methods: A case study design and change theories found in the literature were used to investigate the implementation of CDUs in four hospitals. Semi-structured interviews with ED team members led to the creation of themes for analysis. Results: Analysis demonstrated that patient flow, work processes and communication contribute to the type of CDU set-up, whether it is a co-located or virtual CDU. The sustainability of CDUs relies on communication and a common vision in the fulfillment of purposes and goals. Conclusions: This study contributes to the understanding of the implementation of CDUs. The application of change frameworks assists with the identification of key success factors for implementing and sustaining change.

No description available.

This thesis investigates the causes of the long wait-time for patients in Emergency department (ED) of Victoria General Hospital, and suggests changes for improvements. Two prominent simulation techniques have been used to replicate the ED in a simulation model. These are Discrete-event simulation (DES) and Agent-based modeling (ABM). While DES provides the basic modeling framework ABM has been used to incorporate human behaviour in the ED. The patient flow in the ED has been divided into 3 phases: input, throughput, and output. Model results show that there could be multiple interventions to reduce time taken to be seen by the doctor for the first time (also called WTBS) either in the output phase or in the input phase. The model is able to predict that a reduction in the output phase would cause reduction in the WTBS but it is not equipped to suggest how this reduction can be achieved. To reduce WTBS by making interventions in the input phase this research proposes a strategy called fast-track treatment (FTT). This strategy helps the model to dynamically re-allocate resources if needed to alleviate high WTBS. Results show that FTT can reduce WTBS times by up-to 40%.