Actions of a regulatory nurse in the management of surgical waiting lists

ABSTRACT Objectives: to describe the actions of the regulatory nurse in the management of waiting lines for elective surgeries in a public hospital. Methods: this is an experience report about the actions of the regulatory nurse in the management of waiting lines for elective surgeries. Results: the results of this initiative were: diminution in waiting times; elimination of discrepancies that led to access inequality; promotion of safer treatments; actions of the nurse as a manager, conducting and mediating situations between services; autonomy from the high management of the hospital with regard to the manager of waiting lists; and effective communication due to a constant feedback with the medical teams. Final Considerations: the management of the surgical waiting lists must be continuous and systematic, and it must be broader, to include teams that are not involved yet. This initiative can be replicated and improved in other health organizations.

Application of Queue for Filling the Admission Form in College

Queuing theory is the study of waiting lines and is very helpful in solving many problems. In this paper, the idea of queuing theory is adopted to model about practical problems like filling the admission form in colleges. The COVID-19 pandemic and resulting economic crisis has bought unprecedented challenges to higher education. The COVID-19 pandemic has left students and colleges struggling. The COVID-19 pandemic bought extraordinary disruption to the education landscape with the campuses everywhere almost overnight. This method can be extended to larger scales and would provide better idea of how to fill admission form in colleges while during the pandemic period COVID-19 is very essential in saving me, saving money and energy.

Opioids, Observation, and Restricting Access in the Public Emergency Room

This chapter presents ethnographic evidence of the restriction of medicine in the large, urban public emergency room. There are two routine problems facing triage staff: that there are always too many urgently sick patients whom staff have no real reason to favor for scarce hospital beds, and far too many less-urgently sick patients who technically should never receive beds. The rational rules of triage do not provide the means to reconcile these two problems and, moreover, they mandate that all of these patients be treated. The chapter details how a culture of understanding patients through criminal stigma, the widespread administration of pharmaceutical drugs during the wait, and police presence all work the resolve these two fundamental problems of hospitalization. It is this work that triage staff do—to produce patients that appear less medically needy—that ensures the extreme waiting lines do not become legally problematic.

Analyzing and Soft Solutions to Vehicle Traffic Problems in Crowded Institutions

There is no doubt that the traffic problem is one of the problems faced by universities in different intensities for roads, intersections, and parklands. The negative effects of traffic congestion and bottlenecks are clear; they include extension of long waiting lines and increasing the time of transport with the consequences of ill effects. The effective solutions placed to resolve these problems need specialized studies relying on scientific methods for collecting and analyzing relevant data and drawing effective conclusions, recommendations, and solutions. The main purpose of this study is to analyze the problems of traffic congestion in crowded institutions, with realistic application to an anonymous University in Saudi Arabia as a case study and to provide the best solutions to achieve fluent flow of traffic at the present time and in the near and far future. Due to the complexity of the problem and its huge data and to facilitate the analysis process, the problem has been divided into three main sections, and the data is collected in four different ways.

São Felipe Hospital: Capacity Management Challenge in a Hospital Emergency

ABSTRACT In July 2017, the board of directors of Hospital São Felipe, a traditional hospital located in Minas Gerais, met to discuss the results of the satisfaction survey conducted at the hospital, where it was clear there was great customer dissatisfaction with the emergency service. In the previous year, the hospital emergency service received, on average, about 6,300 patients a month, divided in three specialties: general clinic, orthopedics, and ophthalmology. The director of emergency services had twenty days to submit a plan of action to address the problems identified in the emergency area, particularly those related to the waiting lines: wait time, lack of comfort, inattention of employees, and so on. The first action taken by the director was to collect data that would enable him to analyze wait times during the process: What time did the patient arrive at the emergency service? How long the patient waited to be attended by the receptionist? How long the patient waited for triage? and so on. With these data, he believed that he would have a better understanding of the process flow and would be able to propose solutions to the problem of waiting lines in the emergency area. The case was written with the educational goal of working with the concept of capacity management in services and with ways to deal with the demand variability, especially in high-touch and unpredictable services, as in the case of an emergency service.

Hospital São Felipe: Desafio da Gestão da Capacidade em uma Emergência Hospitalar

ABSTRACT In July 2017, the board of directors of Hospital São Felipe, a traditional hospital located in Minas Gerais, met to discuss the results of the satisfaction survey conducted at the hospital, where it was clear there was great customer dissatisfaction with the emergency service. In the previous year, the hospital emergency service received, on average, about 6,300 patients a month, divided in three specialties: general clinic, orthopedics, and ophthalmology. The director of emergency services had twenty days to submit a plan of action to address the problems identified in the emergency area, particularly those related to the waiting lines: wait time, lack of comfort, inattention of employees, and so on. The first action taken by the director was to collect data that would enable him to analyze wait times during the process: What time did the patient arrive at the emergency service? How long the patient waited to be attended by the receptionist? How long the patient waited for triage? and so on. With these data, he believed that he would have a better understanding of the process flow and would be able to propose solutions to the problem of waiting lines in the emergency area. The case was written with the educational goal of working with the concept of capacity management in services and with ways to deal with the demand variability, especially in high-touch and unpredictable services, as in the case of an emergency service.

Abstract 16637: Echocardiographic Screening With Remote Reading as a Tool for Additional Cardiovascular Risk Stratification in Primary Care - Data From the PROVAR+ Study

Introduction: Morbidity and mortality associated with advanced heart disease (HD) is significant in Brazil. Underserved populations often experience long delays in diagnosis, with long waiting lines for echocardiography (echo). We aimed to evaluate the feasibility of integrating screening echocardiography (echo) with remote interpretation in the Brazilian primary care (PC), and to assess HD prevalence. Methods: In 36 months, 25 healthcare workers at 40 PC units were trained on simplified handheld (GE VSCAN) echo protocols. Screening (SC) groups, including patients aged 17-20, 35-40 and 60-65 years, and patients referred (RF) for clinical indications, in waiting lines, answered a clinical questionnaire and underwent focused echo, interpreted in US and Brazil by telemedicine. Significant HD was defined as moderate/severe valve disease, ventricular dysfunction/hypertrophy, pericardial effusion or wall-motion abnormalities. A study-derived score including clinical variables (sex, body mass, hypertension, coronary disease, heart failure, heart surgery, valve disease and Chagas disease: low (<13%), intermediate (13% - 69%) and high-risk (≥70%)) was applied to predict HD in echo screening. Results: From January 2017 to November 2019, 4425 patients underwent echo; 1338 (30%) in SC group. Mean age was 54±18 years, 63.7% were females; 57.8% had hypertension and 20.1% diabetes. The most frequent symptoms were chest pain (32.3%), dyspnea (32.3%) and palpitations (25.6%). Significant HD was found in 1409 (31.8%) patients, (28.8% in SC vs. 33.2% in RF group, p=0.004). Comparing SC to RF, severe left ventricular dysfunction was observed in 2.6% vs. 3.1%, p=0.45, severe aortic or mitral regurgitation in 1.5% vs. 1.0%, p=0.17. Prevalence was higher in high-risk patients according to the clinical score, compared to intermediate/low risk (45.3% vs. 26.6%, p<0.001). The continuous risk score was strongly associated with HD (odds ratio=25.8, 95% IC 16.5 - 40.4, p<0.001), with area under ROC curve=0.61. Conclusions: Integration of screening echo into PC is feasible in Brazil as a strategy to prioritize cardiovascular care in low income areas through task-shifting. In association with clinical variables, this tool may improve early diagnosis and referrals.