bluuebunny/crossref_metadata_2025_split huggingface dataset:
CHRONOS Project: The Transformation of Time-dependent Clinical Trajectories into Intelligent Ones Using an Innovative Technological Solution
Authors: Morissette Nathalie , Shabah Abdo 
Published: June 2023

Introduction:The health system faces many challenges including the lack of personnel or resources and the overcrowding of emergency rooms. In this context, Real Time Locating Systems (RTLS) offer the possibility of improving the efficiency, safety and quality of care management. Clinical trajectories are currently very dependent on manual processes. We believe that real-time management systems that use geolocation can optimize time-dependent clinical trajectories, improve critical care and transform the health network for patients, caregivers and managers. Typically, RTLS tools require a significant investment in terms of installation, configuration, and integration.Method:The Nano Data Center (NDC) system developed by Humanitas Solutions is equipped with an advanced and low-cost IT infrastructure. It is self-deploying, self-configurable and allows geolocation and autonomous telecommunication with multiple interfaces (WIFI, Bluetooth, electrical). It requires a power source and operates without requiring access to technological infrastructures, which is the major difference with similar products based mainly on cloud computing and dependent on internet connectivity. We tested, as a pilot project, the deployment of the NDC system in a complex hospital environment (Centre intégré de la santé et des services sociaux de la Montérégie-Centre, Quebec, Canada) in order to demonstrate its potential use.Results:Using the NDC system, we were successful in establishing an autonomous communication network over several hospital floors. This innovation made it possible to support the real-time geolocalization of fictive patients and the creation of a real-time dashboard for monitoring clinical trajectories, analyzing data, and evaluating performance.Conclusion:The next development phases of the CHRONOS project include real-time notification and transformation of clinical trajectories into smart trajectories. The independence of the NDC system in terms of infrastructures would allow its deployment in low-resource environments, such as temporary installations or remote areas. Thus, its potential benefit in creating connected environments in disaster situations.
Development of Sub-National Policies for Making Hospitals Safe from Disasters: Study in Yogyakarta Province, Indonesia
Authors: Donna Bella , Ariani Madelina 
Published: June 2023

Introduction:Disaster and emergency management planning has an essential role to ensure that hospitals can continue to function in disaster response situations. However, there are several gaps for safe hospital policies and implementations between national and provincial/district level. The Special Region of Yogyakarta, as one of the provinces with high disaster risk in Indonesia, initiated a study to identify local policies needed for safe hospitals.Method:Focus Group Discussion (FGD) series were conducted with several hospitals representing private, public, academic, and military hospitals located in the first ring of Mount Merapi, an active volcano located on the border between Yogyakarta and Central Java Province. The FGD participants consisted of the Hospital Disaster Plan team, hospital task force of COVID-19, emergency department and hospital management team. Three FGD were carried out with different topics of discussion in each session. The topics were hospital experiences in implementing Hospital Disaster Plans during COVID-19, hospital incident command, coordination and networking. In addition, they also conducted advocacy and public consultationResults:The study that involved 12 hospitals and 40 persons, resulting in 11 specific additional policies for Yogyakarta safe hospital which include; six additional Standard Operating Procedure (SOP) in terms of donation management, volunteers’ recruitment and cost claim; one initiated Memorandum of Understanding (MoU) for surge capacity; conducting functional exercise rather than full scale ritual simulation with management scenario, as well as develop two plans for cyber-attack and business continuity plan.Conclusion:The pocketbook of Yogyakarta’s safe hospital will be useful for more than 70 hospitals in implementing and developing their hospital disaster plan, improving coordination among hospitals in the disaster phase, as well as a lesson-learned process for other regions to develop their local-based safe hospital policies.
Development and Implementation of Prioritized Care in a Tertiary Hospital Intensive Care Unit During the Sars-Cov-2 Pandemic
Authors: Boroli Filippo , Tassaux Didier , Paubel Annie-Claude , Lenoir Helene , Pugin Jerome , Hagon Olivier 
Published: June 2023

Introduction:In the event of a major event or disaster, the intensive care unit (ICU) should be able to offer an adapted and proportional response, within a limited time frame, to the influx of patients who can benefit from the technical facilities of the University Hospitals of Geneva. We developed an innovative approach to ICU care aimed to guarantee continuity by protecting healthcare staff from excessive fatigue and by tailoring the care provided from individualized care to the best care for the most people.Method:A modified organizational and systematic investigation method (MINOS, Paries - 2013) was used to elaborate an ICU security model; threats to activity shut down were identified and their prevention, recovery, and mitigation were planned. These actions were updated following the evolution of the crisis. Crew resources management (CRM) and bedside simulations were used in the implementation phase.Results:The ICU security model pillars were staff protection and patient management; the identified threats to activity continuity were lack of human resources, activity overload, medical errors, pressure sores and healthcare acquired infections; they were evaluated at intermediate or high risk to patients’ safety. The prioritized care plan was developed to control, recover, and mitigate these threats. It consisted in: adaptable level of ICU care, modular organization by cell, huddles, matrix for activities prioritization and controlled delegation method. Before implementation, 55 nurses and 46 doctors were trained by CRM courses and simulations. The pilot phase was deployed in one cell, from December 2021 to January 2022; 67 patients were admitted in the period; 13 adaptations to the original plan were introduced. No critical safety issues were reported.Conclusion:The prioritized care could be an adapted and proportional ICU response to a major event allowing the continuity of the activity while protecting staff from overload. Further tests are needed.
Deployed in Disaster: Exploratory Study of Personnel Deployed into Ontario Long-Term Care Homes during the COVID-19 Pandemic
Authors: Oldenburger David , Baumann Andrea , Crea-Arsenio Mary , Baba Vishwanath , Deber Raisa 
Published: June 2023

Introduction:The COVID-19 pandemic had a devastating impact on long-term care in Canada, exacerbating an existing crisis of staff shortages, inadequate infrastructure and funding, into a disaster. In response, the province of Ontario enacted emergency legislation and requested federal government support, resulting in the deployment of personnel from the Canadian Armed Forces and acute care hospitals into long-term care homes across the province. This exploratory study aims to develop a rich description of the long-term care context during the pandemic, deployed personnel's perspectives on providing care in the context, and identification of lessons learned while working during the pandemic.Method:Descriptive exploratory design with demographic questionnaire and semi-structured interviews will be used to understand the background and perspective of deployed personnel and managers on working in long-term care during the pandemic. Thematic analysis will be used to analyze the transcripts, organize codes, and identify and describe major themes. Findings will also be compared with disaster literature to understand how the perspectives of deployed personnel compare with existing disaster research.Results:21 interviews were initially conducted. Analysis of these interviews identified key challenges experienced by those deployed, including human resources, leadership and accountability, and policies and regulations. Perspectives and strategies for overcoming these challenges were also shared.Conclusion:The scale, duration, and context of the redeployment of personnel into long-term is unprecedented and has seen little research. This exploratory study shares the experiences of personnel who deployed into long-term care and helps identify lessons learned from overcoming challenges in the disaster context. These findings will be able to inform future disaster research and how to better prepare responders in the future.
A Hole in the Safety Net: Failures of the Initial COVID-19 Pandemic in Kentucky
Authors: Katirji Linda , Desai Sameer 
Published: June 2023

Introduction:The COVID-19 pandemic hit Kentucky in March of 2020. While around the world the pandemic had already reared its head and strained international hospital systems at their core, Kentucky hospitals remained wholly underprepared. University of Kentucky Hospital is a relatively resource rich hospital. However, utilization of these resources was severely misplaced and inefficiently distributed. This led to unnecessarily large upfront costs in an attempt to prepare for large volumes of patients that never actually came, as well as risk stratifying patients in a costly and unproductive way.Method:We reviewed the initial response to the COVID-19 pandemic from the University of Kentucky as well as specifically within the emergency department. This included all system-wide preparations as well as emergency medicine-specific COVID-19 protocols regarding risk stratification of patients, testing, and delivering results.Results:Initially the number of patients that would need to be hospitalized with COVID-19 as well as how to risk stratify or treat them was completely unknown. This led to multiple large issues within University of Kentucky's response to the pandemic. A 400-bed field hospital was constructed out of University of Kentucky’s football field and subsequently deconstructed two months later before ever being used, costing the hospital $6.7 million dollars. Lack of tests and knowledge about the disease in combination with over ordering labs and CT scans in an attempt to risk stratify. There was no reliable way to obtain COVID-19 testing or deliver the results and this led to increased non-sick patients presenting to the ED just for information.Conclusion:The COVID-19 pandemic highlighted many shortcomings of our hospital system and its preparedness for a pandemic or mass disaster. The silver lining of these failures was the implementation of system wide improvements in throughput and preparation within our emergency department.
Mapping Nurses’ Advanced Roles in Emergency Departments Globally
Authors: Lamberti-Castronuovo Alessandro , Franchini Roberta , Ragazzoni Luca , Molin Alberto Dal 
Published: June 2023

Introduction:It is widely recognized that there is an increasing demand for healthcare in emergency departments (ED) around the world as well as a global shortage of healthcare workers (HCWs). This has led to ED overcrowding, which increases risks of avoidable complications and suboptimal care provision. Since ED overcrowding impacts patients, staff and quality of care, new strategies are needed for optimizing patient throughput and reducing waiting times. One such strategy is to reconsider the specific roles and professional duties of different cadres of HCWs. Empowering nurses to take on some of the tasks historically performed by physicians is a promising solution for improving ED healthcare provision. However, nurses’ professional responsibilities and competencies differ significantly from country to country. There are few studies about best practices and how to effectively implement such task-shifting strategies. The aim of this study is to map the evidence published in the scholarly literature on nurses’ advanced roles in ED as a strategy for reducing overcrowding, facilitating ED throughput, and, ultimately, improving quality of care.Method:A mapping review was performed by searching the following databases: PubMed, Embase, Scopus and Web of Science.Results:A total of 168 studies were analyzed and the data were grouped according to the countries where advanced tasks were implemented. The type of tasks that were carried out were: autonomous management of patients with minor injuries, triage-based ordering of exams and administration of therapy and management of patient flow.Conclusion:In some high-income countries having nurses take on advanced roles is well-established, and it contributes to reducing overcrowding in ED. Further evidence is needed to assess the barriers and facilitating factors to implementing this strategy in other contexts.
Quality Improvement Project: Optimizing Compliance with NICE CG176 Head Injury CT Time Standards at Wexford General Hospital Emergency Department
Authors: Orsmond Brendan , Andrews Robin , Bilal Muhammad , Jordaan Phillip , Price Alexander , Kennedy Keith , Kleinhans Rochelle , Conradie Maria , Molloy Michael , Wickham Bryce , Kelly Paul 
Published: June 2023

Introduction:Head trauma is a high-risk presentation to the emergency department (ED). Preventing secondary brain injury through earlier diagnosis and intervention relies on timely access to head CT. Wexford General Hospital (WGH) ED uses NICE guidelines, which recommend specific timeframes for acquiring CT in head trauma. Following an audit demonstrating low compliance to NICE CG176 time standards in 2020 (34%), a quality improvement project was undertaken to optimize imaging pathways for head trauma.Method:94 head trauma CT scans were analyzed over a two-month period (June 14, 2022-August 14, 2022) from the NIMIS and IPMS databases to establish current time compliance and median wait times for CT.Following the implementation of a head injury assessment proforma at triage to prompt earlier evaluation of high-risk head injuries, 108 head trauma CT’s were reviewed over a two-month period (August 15, 2022-October 15, 2022) to determine if these parameters improved.Unpaired, two-tailed Mann-Whitney’s test was used to compare median wait times from triage to CT. Two-tailed Chi-square test was used to compare overall compliance rates.Results:Overall ED compliance to NICE time standards improved following implementation of the proforma (43% vs. 36%, p=0.401).For CT scans that were indicated within one hour, there was a statistically significant decrease in median wait time from triage to CT (134mins vs. 186mins, p=0.046). There was also a decrease in median wait time for scans indicated within 8 hours; however, this did not reach the threshold for statistical significance (216mins vs. 275mins, p=0.230).Conclusion:Although there was an overall reduction in wait times for CT, this did not translate to a significant improvement in compliance rates to NICE CG176 time standards. This suggests that, despite earlier identification of these high-risk head injuries at triage, other systemic barriers to obtaining head CT are present and warrant further investigation.
Assessing Trends and Severity of Emergency Department Access Block by Measuring Median ED Length of Stay for Admitted Patients
Authors: Schwartz Dagan , Goldberg Avishay 
Published: June 2023

Introduction:The Emergency Department (ED) is the hospital’s main gateway, as well as the initial site for diagnosis and emergency medical care. In recent years, ED overcrowding is worsening in Israel and world-wide. Overcrowding has been shown to adversely affect patient service and care, fostering patient and caregiver dissatisfaction, as well as lowering quality of care and even increasing mortality. A main driver of ED overcrowding is ED patient boarding due to limited inpatient bed availability in conjunction with hospital policy. Measuring median length of ED stay (LOS) for admitted vs. discharged patients can serve as a simple indicator for the severity of the access block over time and between facilities.Method:ED operational data from the computerized system of four hospitals in Israel were collected over a year and analyzed. In parallel data was collected regarding hospital capacity and ED volumes. Data were analyzed using SPSS.Results:The Mean ED LOS was significantly higher for ED patients needing admission in all hospitals. Mean ED LOS for admitted vs. discharged patients was 227 min vs.431 in hospital A, 215 min vs. 222 in hospital B, 198 min vs. 440 in hospital C and 167 min vs. 190 in hospital D. The discrepancy in LOS for admitted patients was not related to the total hospital bed capacity or the hospital ED patient volume.Conclusion:ED boarding is a major challenge for ED's and hospitals worldwide and a significant contributor to ED overcrowding. A tool to assess boarding is proposed. The tool calculates the ratio of median ED LOS between patients admitted to the hospital and those discharged. Slightly higher LOS among those admitted is to be expected, considering the fact that they usually present with more complex medical problems. In this study the LOS ratios were 1.03, 1.12, 1.90 and 2.22.
Advancing Delivery of Emergency Care in Honduras: Creating a Reanimation Room
Authors: Argote-Araméndiz Killiam , Bárcenas Angel , Apolinar-Menéndez Hector , Ciliezar-López Elsa , Castro Fernando 
Published: June 2023

Introduction:Early recognition and treatment of critical clinical conditions have decreased morbidity and mortality in critically wounded and sick patients. Worldwide, Emergency Rooms (ER) are overcrowded, and the complexity and number of patients keep increasing. This phenomenon challenges health professionals when applying time-sensitive interventions generating unfavorable outcomes. Considering that the ER is the first point of contact for patients of Hospital Escuela, a 1306-bed, academic, tertiary care hospital in Honduras, we describe the creation of a Resuscitation Room (RR) to improve patient care in the ER.Method:Data from patients, including dates, source of admission, diagnosis, and outcomes, were recorded daily in a database from June 1, 2022, until October 31, 2022. Then the analysis and interpretation were made using Microsoft Excel.Results:In the five-month period, 1,118 patients were admitted to the RR, with 58% males, a 52-year-old mean, and October as the busiest month (33%). Most patients consulted between 0600 and 1800 hours (70%). The primary admission cause was a medical condition (71%), and shock (41%) was the most common type of emergency followed by trauma (25%). After stabilization, 86% of patients remained in observation areas of the ER, only 5% went to the operating theater, and 1% to the intensive care unit. The mortality rate was 5%, 48% trauma related.Conclusion:A RR meeting the minimal standards for space, trained staff, medical equipment, and consumable resources has been shown to be beneficial in improving interdisciplinary work in the ER. This RR has enabled life-threatening conditions to be recognized and treated rapidly while also promoting information gathering on critically wounded and sick patients and their outcomes. The need to standardize the clinical care to such patients has also been identified. Further efforts to protocolize the response are needed to improve patient care.
A Review of Policies Related to Internal Displacement in the Context of Disasters: An Australian Case Study
Authors: Krishna Revathi , Cross Suzanne , Spencer Caroline , Abrahams Jonathan , Archer Frank 
Published: June 2023

Introduction:According to the Internal Displacement Monitoring Centre (IDMC), more than 60% of the internal displacements recorded worldwide in 2021 were due to disasters. A conservative estimate by IDMC reports 65,000 new displacements between July 2019 and February 2020 as a result of the Black Summer bushfires and more than 42,000 displacements due to flooding in February and March 2022 in Australia. These are estimates as there are no consistent or consolidated data on those who are displaced in Australia affecting the measurement of the magnitude of displacement, and the knowledge of experience, impact and needs of displaced people to inform policy and practice. Thus, the aim of this study, as part of a larger project, is to review key international and Australian policies about data on internal displacement due to disasters.Method:We conducted a desk review of key international policies, such as the Sendai Framework for Disaster Risk Reduction and from the United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA), as well as Australian policies such as the Australian Disaster Preparedness Framework, Emergency Management Arrangements Handbook and even state level emergency legislation/acts and plans to understand the data collection and supports and services provided to those who become displaced due to disasters.Results:This review found that both international and Australian policies lacked specific focus on internal displacement, despite it being a key issue. While international policies and procedures in low income countries exist, in particular where the international humanitarian system is operational, this review found that Australia lacked specific focus on internal displacement.Conclusion:Data on displacement due to disasters, including the number of people displaced, and the patterns of their displacement is critical to inform better policies on prevention, emergency planning, evacuation response and finally to improve the support that people who are experiencing displacement receive.
The Growing Needs of Internally Displaced People in High-income Countries: Extending the Scope of Internal Displacement
Authors: Cross Suzanne , Krishna Revathi , Spencer Caroline , Abrahams Jonathan , Archer Frank 
Published: June 2023

Introduction:The concept of disaster related internal displacement is typically seen as something that occurs in low-income countries and is rarely considered in the setting of high-income countries. This leads to a paucity of data to support contextually appropriate best practices to address displacement. This research, funded by the Australian government, explores the lived experiences of those faced with forced displacement from disasters in high-income countries and aims to improve outcomes for this vulnerable cohort.Method:The first phase of the research, guided by a broad-based Steering Group, included a rapid literature review and thematic analysis of peer-reviewed literature of disaster related, internal displacement in high-income countries, including Australia.Results:The peer reviewed literature review identified only 12 papers that met the inclusion criteria. The literature from Australia and other developed countries indicated that internal displacement is a prominent feature of disaster impacts and that needs are complex, dynamic and diverse. Common themes of need were revealed: the need for the development of an evolving displacement policy framework to support human rights; the co-creation, coordination and provision of timely and flexible support services, and on-going data collection and sharing. No displacement, specific frameworks, measurable thresholds, or central data registries exist at federal or state government levels in Australia to support these needs.Conclusion:Inclusive policies, practices, and resources are required in Australia to support assets of displaced people and address their unmet needs in disasters, which also remain largely unmet in other high-income countries. Australia can learn from all countries faced with the challenges of managing displacement and also share its own experiences. Furthermore, it is recommended that WADEM consider extending its current Position Statement relating to Refugees and Internally Displaced Persons to include high-income countries based on the findings of our study and other sources.