Thesis (M.Psych.Org.) - University of Queensland, 2004. / Includes bibliography.

Thesis (Ed. D.)--Duquesne University, 2004. / Title from document title page. Abstract included in electronic submission form. Includes bibliographical references (p. 77-95) and index.

Background: The last 30 years have seen considerable growth in the scope of emergency medicine and the size, scale and expectations of emergency departments (EDs) in the USA and other countries, including Australia. The emphasis has changed from direct referral to departments in the hospital to treatment in and disposition from the ED. At the same time, emergency clinicians face increasing pressure to address patient needs with greater efficiency. Within this context, this project describes the character of the unique domain of work and collective identity that emergency clinicians carve out in their interactions with other emergency clinicians and with clinicians from other departments. Methods: Fieldwork was conducted over 10 months in the EDs of two tertiary referral hospitals in Sydney, Australia. It comprised approximately 535 hours of unstructured and structured observation, as well as 56 field interviews. Results: Emergency clinicians have a unique role as "gatekeepers" of the hospital. This ensures that their clinical work is inherently organisational - that is, interdepartmental and bureaucratic work. Emergency clinicians explicitly and implicitly negotiate the "patient pathway" through the hospital which is organised according to the "fragmented" body. This role demands previously under-recognised and complex immaterial work. Emergency clinicians seek to reconcile the individual trajectories of patients present in the ED with the ED?s broader function as a "carousel" in order to seek to provide the greatest good for the greatest number of future patients. The research uniquely charts the socialisation processes and informal education that produce tacit organisational expertise with which emergency nurses and doctors, both separately and jointly, negotiate the bureaucracy of the hospital. Conclusion: EDs are destined to struggle to provide the greatest good for the greatest number, reconciling shortcomings in the structure and provision of public and community health care. However, recognition and support for the unique clinical-organisational domain of ED care presents an opportunity for improved holistic care at the front door of the hospital. Our ageing population and its promise of more patients with complex health issues demand further research on the interdepartmental work of other whole-body specialties, such as Aged Care.

Background: The last 30 years have seen considerable growth in the scope of emergency medicine and the size, scale and expectations of emergency departments (EDs) in the USA and other countries, including Australia. The emphasis has changed from direct referral to departments in the hospital to treatment in and disposition from the ED. At the same time, emergency clinicians face increasing pressure to address patient needs with greater efficiency. Within this context, this project describes the character of the unique domain of work and collective identity that emergency clinicians carve out in their interactions with other emergency clinicians and with clinicians from other departments. Methods: Fieldwork was conducted over 10 months in the EDs of two tertiary referral hospitals in Sydney, Australia. It comprised approximately 535 hours of unstructured and structured observation, as well as 56 field interviews. Results: Emergency clinicians have a unique role as "gatekeepers" of the hospital. This ensures that their clinical work is inherently organisational - that is, interdepartmental and bureaucratic work. Emergency clinicians explicitly and implicitly negotiate the "patient pathway" through the hospital which is organised according to the "fragmented" body. This role demands previously under-recognised and complex immaterial work. Emergency clinicians seek to reconcile the individual trajectories of patients present in the ED with the ED?s broader function as a "carousel" in order to seek to provide the greatest good for the greatest number of future patients. The research uniquely charts the socialisation processes and informal education that produce tacit organisational expertise with which emergency nurses and doctors, both separately and jointly, negotiate the bureaucracy of the hospital. Conclusion: EDs are destined to struggle to provide the greatest good for the greatest number, reconciling shortcomings in the structure and provision of public and community health care. However, recognition and support for the unique clinical-organisational domain of ED care presents an opportunity for improved holistic care at the front door of the hospital. Our ageing population and its promise of more patients with complex health issues demand further research on the interdepartmental work of other whole-body specialties, such as Aged Care.

Seminar paper--University of Wisconsin--La Crosse. / Appendices: leaves [33]-ll5. Bibliography: leaves 31-32.

published_or_final_version / Public Administration / Master / Master of Public Administration

Thesis (M.P.A.)--University of Hong Kong, 1997. / Includes bibliographical references.

Thesis (M.P.A.)--University of Hong Kong, 1997. / Includes bibliographical references. Also available in print.

Thesis (M.Psych.Org.) - University of Queensland, 2006. / Includes bibliography.

Problem investigated: The activation and implementation of the Medical Emergency Team (MET) system. Procedures followed: The ability of the objective activation criteria to accurately identify patients at risk of three serious adverse events (cardiac arrest, unexpected death and unplanned intensive care admission) was assessed using a nested, matched case-control study. Sensitivity, specificity and Receiver Operating Characteristic curve (ROC) analyses were performed. The MET implementation process was studied using two convenience sample surveys of the nursing staff from the general wards of twelve intervention hospitals. These surveys measured the awareness and understanding of the MET system, level of attendance at MET education sessions, knowledge of the activation criteria, level of intention to call the MET and overall attitude to the MET system, and the hospital level of support for change, hospital capability and hospital culture. The association of these measures with the intention to call the MET and the level of MET utilisation was assessed using nonparametric correlation. Results obtained: The respiratory rate was missing in 20% of subjects. Using listwise deletion, the set of objective activation criteria investigated predicted an adverse event within 24 hours with a sensitivity of 55.4% (50.6-60.0%) and specificity of 93.7% (91.2-95.6%). An analysis approach that assumed the missing values would not have resulted in MET activation provided a sensitivity of 50.4% (45.7- 55.2%) and specificity of 93.3% (90.8-95.3%). Alternative models with modified cut-off values provided different results. The MET system was implemented with variable success during the MERIT study. Knowledge and understanding of the system, hospital readiness, and a positive attitude were all significantly positively associated with MET system utilisation, while defensive hospital cultures were negatively associated with the level of MET system utilisation. Major conclusions: The objective activation criteria studied have acceptable accuracy, but modification of the criteria may be considered. A satisfactory trade-off between the identification of patients at risk and workload requirements may be difficult to achieve. Measures of effectiveness of the implementation process may be associated with the level of MET system utilisation. Trials of the MET system should ensure good knowledge and understanding of the system, particularly amongst nursing staff.