The emergency department of Lions Gate Hospital was studied both in regard to the patients' current visit to this facility and in regard to the patients' other sources of ambulatory medical care. The objectives of the study were: (1) to understand why patients seek care at Lions Gate's emergency department; (2) to discover how this facility fits into the patients' overall patterns of medical care; and (3) on the basis of the above data, to propose any appropriate changes in the organization of the emergency department. The study was conducted during 14 days in September, 1974; the sampling frame covered all hours of the day and all days of the week. Data were gathered by questionnaires administered in the emergency department, with 85.60 percent of the sample responding. The increase in demand for emergency department services has been attributed to a variety of factors. The present study determined that private physicians and their non-availability are the predominant factors contributing to emergency department usage at Lions Gate Hospital, indicating that this facility is substituting for the wider primary care system. Data pertaining to the patients' overall patterns of medical care provided further evidence that the emergency department has gained wide acceptance by the patients as a source of primary medical care. Moreover, the emergency department was identified as an important and continuing source of care in the medical care patterns of many of its patients. As a result of the above findings, it was recommended that future plans for either the modification or expansion of Lions Gate's emergency department should include the establishment within the department of a walk-in ambulatory clinic. The proposed ambulatory care department, consisting of an emergency centre and primary care clinic, would assist Lions Gate Hospital to fit its services to the medical care needs which its patients exhibit. / Business, Sauder School of / Graduate

Resource management is at the heart of many diverse science and engineering research areas. Although the general notion of what constitutes a resource entity seems similar in different research areas, their types, characteristics, and constraints governing their behavior are vastly different depending on the particular domain of research and the nature of the research itself. Often research related to resource modeling and management focus on largely homogeneous resources in a relatively simplified model of the real world. The problem becomes much more challenging to deal with when working with a complex real life domain with many heterogeneous resource types and intricate constraints. In this dissertation, we have looked at the modeling and management of resource instances and tried to develop a better sense of what makes them different from other objects in a system. As part of this work, We formally define the general resource management problem, identify its major sub problem areas and their associated complexities, and look at the problem in the context of a particularly complex and dynamic environment, namely the emergency department (ED) of a hospital. We propose an approach to the problem and some of its complexities by presenting an overall unifying view, as well as tools and methods for dealing with, this pervasive, yet surprisingly under examined, type of entity, i.e. resources. We have discovered that one of the discerning characteristics of resource instances in complex and dynamic environments seem to be their dynamic capability profile that may changes depending on system context. This, in turn, often results in complex substitutability relationship amongst resource instances. We have identified four major sub-problem areas that can provide a holistic view of any resource management service. These separate, yet interconnected, areas of con- cerns include resource modeling, resource request specification, resource constraint management, and resource allocation. Resource modeling involves capturing of re- source characteristics and their potentially dynamic behavior. Request definitions describe how resource users specify requirements for resources in a particular do- main. In most domains, there are constraints that need to be satisfied while serving resources to fulfill specific requests. The fourth area of concerns, the allocation of resources, is a complex component with multiple subcomponents that closely inter- act with each other. In this thesis, we have described an architecture for a exible resource management service based on the above described separation of concerns. We have proposed some simple, yet effective, techniques for modeling resource in- stances, specifying resource requests, specifying and managing resource constraints, and allocating resource instances to meet a resource demand characterized by a con- tinuous stream of requests. Using our proposed design, we have developed ROMEO, a resource management service and customized it to serve a task coordination frame- work based on Litlle-JIL process definition language. Our work then concentrated on evaluating the effectiveness of ROMEO in supporting simulations and executions of complex processes. For this evaluation purpose, we developed a simulation infras- tructure named JSim on top of Juliette, Little-JIL's execution environment. We ran a variety of simulations of patient care processes in EDs using our ROMEO-JSim infrastructure. We also used ROMEO to support the actual execution (rather than just the simulation) of a large mediation process. A central premise, hypothesized and explored in this thesis, is a novel way of thinking about resource instances in dynamic domains, namely defining them with a set of guarded capabilities, some of which may be dependent on the execution state of the system. This has led us to think about how to represent execution states of a running system and what types of system state information might be important for representing the guard functions on the capabilities of a resource instance that define the resource instance's ability to satisfy a request at a given execution state of the system. We have also identified a small set of common types of attributes of resource instances that seem able to support specification of a large variety of resource instances in complex domains. We believe that our research supports our hypothesis that specifying resource instances as having sets of guarded capabilities provides a useful abstraction for modeling many of the complex dynamic behaviors of resource instances in such domains as hospital EDs.

Bakgrund: Patienter med psykisk sjukdom har en ökad risk för somatiska sjukdomar, något som gör att de ofta är tvungna att söka sig till akutmottagningar där de ofta upplever att de inte blir sedda och inte heller trodda på. Tidigare studier visar på att stigmatisering av patienter med psykisk sjukdom förekommer såväl i samhället som hos vårdpersonal. Miljön på akutmottagningar är ofta stökig och sjuksköterskorna har ofta ont om tid. Syfte: Syftet var att undersöka hur sjuksköterskor i den somatiska akutsjukvården upplever att det är att vårda patienter med psykisk sjukdom. Metod: Forskningsdesignen som valdes var intervjustudie med kvalitativ ansats. Nio sjuksköterskor som jobbat på en akutmottagning i minst ett år intervjuades. Intervjuerna genomfördes på två akutmottagningar. Tematisk analys med induktiv ansats valdes som kvalitativ analysmetod. Resultat: Huvudresultaten av studien sammanfattades i två övergripande teman; den kännande sjuksköterskan och den professionella sjuksköterskan. Följande kategorier kunde placeras in i de två nämnda teman: känslor, fördomar, tid och miljö, bemötande och empati, kunskapsbrist och utbildning samt ansvar. Resultatet visade att sjuksköterskorna på akutmottagningar ofta upplevde känslor som frustration och hopplöshet då de vårdar patienter med psykisk sjukdom. Sjuksköterskorna upplevde att tidsbrist, kunskapsbrist och vårdmiljön på akutmottagningarna var faktorer som försämrade möjligheten till ett bra bemötande och god omvårdnad av patienter med psykisk sjukdom. Slutsats: Studiens resultat visar att sjuksköterskor på akutmottagningar stod inför många utmaningar och vården av patienter med psykisk sjukdom försvårades på grund utav flera faktorer. Dessa faktorer var kunskapsbrist, tidsbrist, stress, fördomar, ansvar samt vårdmiljön. Känslor som sjuksköterskorna ofta upplevde vid vårdandet av patienter med psykisk sjukdom var frustration och hopplöshet. / Background: Patients with mental illness have an increased risk of somatic diseases, which means that they are often forced to turn to emergency departments where they often feel unseen nor believed in. Previous studies show that stigmatization of patients with mental illness is present both in the society and among health professionals. The environment in emergency rooms are often messy and nurses often have little time. Aim: The aim was to examine how nurses in an emergency care experience about caring for patients with mental illness. Method: The research design that were chosen was an interview study with a qualitative approach. Nine nurses who worked in an emergency department for at least a year were interviewed. The interviews were conducted in two emergency departments. Thematic analysis with inductive approach was chosen as qualitative analysis. Results: The main results of the study were summarized in to two main themes; the sentient nurse and the professional nurse. The following categories could be placed into the two mentioned themes; feelings, prejudices, time and environment, attitudes and empathy, lack of knowledge and education, and responsibility. The results showed that nurses in emergency departments often experience feelings of frustration and hopelessness as they care for patients with mental illness. The nurses felt that the lack of time, lack of knowledge and the un-adapted environment in emergency departments were factors that worsened the possibility of good treatment and good nursing care of patients with mental illness. Conclusion: The results of the study show that nurses in emergency departments were facing many challenges and that the care of patients with mental illness was complicated because out of several factors. These factors were such as lack of knowledge, lack of time, stress, responsibility, preconception and the un-adapted environment. Feelings that nurses often experienced in the care of patients with mental illness was frustration and hopelessness.

A presente tese apresenta proposições para o desenvolvimento e aplicação de técnicas de mineração de textos, de modo a contribuir para a gestão de operações nas áreas médicas e de negócios. Os objetivos desta tese são: (i) identificar e estruturar técnicas de mineração de texto, de modo a elaborar um método para prever internações de pacientes provenientes de emergências hospitalares, tendo como base somente os registros textuais não estruturados escritos por médicos durante o primeiro encontro médico-paciente; (ii) comparar previsões realizadas pelo método proposto no objetivo (i) com análises médicas realizadas por humanos, de modo a verificar se computadores podem atuar de forma autônoma na tarefa de previsão de internações de pacientes provenientes de emergências hospitalares; e (iii) identificar e estruturar técnicas de mineração de texto, de modo a elaborar um método para prever a satisfação de clientes de companhias aéreas, tendo como base as avaliações escritas e publicadas por passageiros na internet. Os métodos propostos utilizaram diferentes técnicas de mineração de textos, sendo validados por estudos de caso. Em relação à área médica, o método proposto pode realizar previsões em tempo real sobre a necessidade de leitos, ajudando as equipes de gerenciamento de leitos a melhorar os processos de fluxo de pacientes. Além disso, verificou-se que tanto médicos (iniciantes ou experientes), quanto máquina, tiveram desempenhos semelhantes na tarefa de previsão de internação de pacientes. Já em relação à área de negócios, o método proposto permitiu extrair dimensões de satisfação de avaliações online, além dos sentimentos associados a elas, considerando diferentes perfis de passageiros, serviços e períodos de tempo. Desta forma, foi possível prever a recomendação de companhias aéreas baseado nas avaliações escritas por passageiros. / This dissertation presents propositions for the development and application of text mining techniques, in order to contribute to operations management in the medical and business areas. The objectives of this dissertation are: (i) identify and structure text mining techniques, in order to propose a method to predict admissions of patients from hospital emergencies, based only on unstructured textual records written by physicians during the first encounter with patients; (ii) compare predictions made by the method proposed in objective (i) with medical analyses carried out by humans, in order to verify if computers can work autonomously in predicting hospitalizations of patients coming from hospital emergencies; and (iii) identify and structure text mining techniques to develop a method for predicting airline customer satisfaction based on online customer reviews. The proposed methods used different text mining techniques, being validated by case studies. Regarding the medical area, the proposed method was able to perform real-time forecasts about the need for beds, helping bed management teams to improve patient flow processes. In addition, it was found that both physicians (novice or experienced) and machine had similar performances in predicting patient hospitalization. In relation to the business area, the proposed method allowed to extract satisfaction dimensions of online customer reviews, as well as sentiments associated to them, considering different profiles of passengers, services and time periods. It also enabled the prediction of airline recommendation based on online customer reviews.