title: Exploring discharge delay from an acute surgical unit

authors: Voogt, Jolene Elouise

subjects: Discharge

abstract: Background: Within the hospital system, efficient patient flow is essential. Discharge delay, the period of continued hospital stay after a patient is deemed medically fit to leave hospital, is one of the most significant barriers to optimal patient flow. Discharge delay retains non-acute patients in the acute environment unnecessarily, while preventing acutely presenting patients from accessing services in a timely manner. It results in overcrowded emergency departments with delayed admissions, slowed theatre schedules, and bed blocking in critical care, as well as negatively impacting on patient experience. In the context of a public health system under pressure, reducing discharge delay is critical to improving overall function of the system. This study aims to explore the features in the context of an acute surgical unit that cause discharge delay, the impacts of discharge delay, and the ways discharge delay could be minimised.
Methods: A two phased, mixed methods design was employed in this research. Phase one obtained qualitative data through semi-structured interview with staff members occupying different roles within the health care team within Te Whatu Ora – Waikato. Themes derived from phase one informed the development of an audit form utilised in phase two, which collected quantitative data through its completion by registered nurses working in the acute surgical unit during the two-week audit time period. This audit recorded discharge related times and delaying factors that occurred for all the patients discharged from the ward during the audit period.
Findings: Interviews were undertaken with nine participants (Hospital management n=2, Acute Surgical Unit management n=2, Registered Nurse n=1, Surgical Fellow n=1, Surgical Registrar n=1, Surgical House officer n=1, and multi-disciplinary team member n=1). Thematic analysis of the transcriptions revealed three core themes: (i) It takes a village to discharge a patient; (ii) Preparation, clearance, home; and (iii) Challenges and solutions to discharge delay. The survey was completed by 44 Registered Nurses and on analysis revealed a mean patient delay of 225 minutes, or 3.75 hours. For the audited patients, the most frequently occurring factor was ‘waiting for paperwork’ (55%) followed by ‘waiting for transport’ (40%).
Conclusions: This study found that to reduce discharge delay a coordinated, system-wide approach with discharge focused optimisation across the entire patient journey, and particular focus on reducing the amount of delay caused by discharge paperwork, is required. Introducing a ‘discharge-focused clinician’, would effectively reduce discharge delay by ensuring the prioritisation of discharges, allowing discharge paperwork to be completed promptly. In addition to the introduction of a discharge-focused clinician, the systems and policies surrounding discharge paperwork could also be improved. Additionally, improving the utilisation of transit lounge by routinely sending all appropriate patients to transit lounge to wait for their transport, will also reduce discharge delay.

text: Exploring discharge delay from an acute surgical unit Background: Within the hospital system, efficient patient flow is essential. Discharge delay, the period of continued hospital stay after a patient is deemed medically fit to leave hospital, is one of the most significant barriers to optimal patient flow. Discharge delay retains non-acute patients in the acute environment unnecessarily, while preventing acutely presenting patients from accessing services in a timely manner. It results in overcrowded emergency departments with delayed admissions, slowed theatre schedules, and bed blocking in critical care, as well as negatively impacting on patient experience. In the context of a public health system under pressure, reducing discharge delay is critical to improving overall function of the system. This study aims to explore the features in the context of an acute surgical unit that cause discharge delay, the impacts of discharge delay, and the ways discharge delay could be minimised.
Methods: A two phased, mixed methods design was employed in this research. Phase one obtained qualitative data through semi-structured interview with staff members occupying different roles within the health care team within Te Whatu Ora – Waikato. Themes derived from phase one informed the development of an audit form utilised in phase two, which collected quantitative data through its completion by registered nurses working in the acute surgical unit during the two-week audit time period. This audit recorded discharge related times and delaying factors that occurred for all the patients discharged from the ward during the audit period.
Findings: Interviews were undertaken with nine participants (Hospital management n=2, Acute Surgical Unit management n=2, Registered Nurse n=1, Surgical Fellow n=1, Surgical Registrar n=1, Surgical House officer n=1, and multi-disciplinary team member n=1). Thematic analysis of the transcriptions revealed three core themes: (i) It takes a village to discharge a patient; (ii) Preparation, clearance, home; and (iii) Challenges and solutions to discharge delay. The survey was completed by 44 Registered Nurses and on analysis revealed a mean patient delay of 225 minutes, or 3.75 hours. For the audited patients, the most frequently occurring factor was ‘waiting for paperwork’ (55%) followed by ‘waiting for transport’ (40%).
Conclusions: This study found that to reduce discharge delay a coordinated, system-wide approach with discharge focused optimisation across the entire patient journey, and particular focus on reducing the amount of delay caused by discharge paperwork, is required. Introducing a ‘discharge-focused clinician’, would effectively reduce discharge delay by ensuring the prioritisation of discharges, allowing discharge paperwork to be completed promptly. In addition to the introduction of a discharge-focused clinician, the systems and policies surrounding discharge paperwork could also be improved. Additionally, improving the utilisation of transit lounge by routinely sending all appropriate patients to transit lounge to wait for their transport, will also reduce discharge delay.

year: 2022

title: A contrast sensitivity model of the human visual system in modern conditions for presenting video content

authors: Mozhaeva, A

abstract: Digital video incurs many distortions during processing, compression, storage, and transmission, which can reduce perceived video quality. Developing adaptive video transmission methods that provide increased bandwidth and reduced storage space while preserving visual quality requires quality metrics that accurately describe how people perceive distortion. A severe problem for developing new video quality metrics is the limited data on how the early human visual system simultaneously processes spatial and temporal information. The problem is exacerbated by the fact that the few data collected in the middle of the last century do not consider current display equipment and are subject to medical intervention during collection, which does not guarantee a proper description of the conditions under which media content is currently consumed. In this paper, the 27840 thresholds of the visibility of spatio-temporal sinusoidal variations necessary to determine the artefacts that a human perceives were measured by a new method using different spatial sizes and temporal modulation rates. A multidimensional model of human contrast sensitivity in modern conditions of video content presentation is proposed based on new large-scale data obtained during the experiment. We demonstrate that the presented visibility model has a distinct advantage in predicting subjective video quality by testing with video quality metrics and including our and other visibility models against three publicly available video datasets.

text: A contrast sensitivity model of the human visual system in modern conditions for presenting video content Digital video incurs many distortions during processing, compression, storage, and transmission, which can reduce perceived video quality. Developing adaptive video transmission methods that provide increased bandwidth and reduced storage space while preserving visual quality requires quality metrics that accurately describe how people perceive distortion. A severe problem for developing new video quality metrics is the limited data on how the early human visual system simultaneously processes spatial and temporal information. The problem is exacerbated by the fact that the few data collected in the middle of the last century do not consider current display equipment and are subject to medical intervention during collection, which does not guarantee a proper description of the conditions under which media content is currently consumed. In this paper, the 27840 thresholds of the visibility of spatio-temporal sinusoidal variations necessary to determine the artefacts that a human perceives were measured by a new method using different spatial sizes and temporal modulation rates. A multidimensional model of human contrast sensitivity in modern conditions of video content presentation is proposed based on new large-scale data obtained during the experiment. We demonstrate that the presented visibility model has a distinct advantage in predicting subjective video quality by testing with video quality metrics and including our and other visibility models against three publicly available video datasets.

year: 2024

title: The general cognitive ability of Maori and European subjects: a comparative study of Queensland test performances and psychometric properties

authors: St George, Ross

abstract: Research was undertaken into the performances of New Zealand Maori and European children on the Queensland Test of Cognitive Abilities. In addition to studying the comparative performances of the two ethnic groups at six age levels, major psychometric properties of the instrument were investigated. Such data have an important bearing upon the issue of psychological equivalence across ethnic or culture group samples.
Seven hundred children (303 Maori and 397 European) aged between eight and a half and fourteen and a half years were tested with the Queensland Test. A small statistically significant ethnic group difference was found favouring the European children. Subsequent analyses indicated that the small difference was of little practical significance. Queensland Test subtest data were also analysed, This indicated that subtest performances were likely to be influenced by subject variables in a manner not necessarily evident in the overall test results. Gender differences in performance on the Pattern Matching Subtest were found and are consistent with other data. 
Queensland Test reliability, validity and item characteristics were researched for the two ethnic groups. 
To obtain test-retest reliability estimates and data on criterion related validity longitudinal studies were undertaken with four ethnically mixed class groups Standard 3 to Form 2). 
The Queensland Test was found to be equally reliable with both ethnic groups although the levels of reliability obtained were not considered entirely satisfactory. 
Validity data indicated that the same general intelligence construct could be employed in the interpretation of Queensland Test results with both European and Maori subjects. Content validity issues were considered and it was argued that in terms of both test content and measurement procedures the Queensland Test should provide an equally valid measure of general intelligence with both groups. 
The criterion related validity coefficients were of approximately the same order for each ethnic group although doubts were expressed about the adequacy of the criteria. Construct validity was investigated by considering the relationship of test performance to age and through factor analytic evidence. The analyses supported the view that the Queensland Test was primarily a measure of the same underlying construct within each ethnic group. In terms of prevailing psychological theories on human intelligence this construct was interpreted as being of a general intelligence nature.
Comparative data on item characteristics did not indicate any marked ethnic group differences. More apparent was the need to restructure particular subtests where items failed to discriminate adequately within both ethnic groups. It was concluded that the weight of evidence was in favour of the psychological equivalence of this ability measure with Maori and European children. 
Data for combined ethnic group samples have been reported, Pooled data were employed in some factor analyses and these supported a general intelligence interpretation of Queensland Test results. Preliminary norms were also derived from combined ethnic group data. 
Findings are discussed in relation to the concept of intelligence and its cross-cultural measurement, other Queensland Test research and recent cross-cultural studies on cognitive abilities in New Zealand.

text: The general cognitive ability of Maori and European subjects: a comparative study of Queensland test performances and psychometric properties Research was undertaken into the performances of New Zealand Maori and European children on the Queensland Test of Cognitive Abilities. In addition to studying the comparative performances of the two ethnic groups at six age levels, major psychometric properties of the instrument were investigated. Such data have an important bearing upon the issue of psychological equivalence across ethnic or culture group samples.
Seven hundred children (303 Maori and 397 European) aged between eight and a half and fourteen and a half years were tested with the Queensland Test. A small statistically significant ethnic group difference was found favouring the European children. Subsequent analyses indicated that the small difference was of little practical significance. Queensland Test subtest data were also analysed, This indicated that subtest performances were likely to be influenced by subject variables in a manner not necessarily evident in the overall test results. Gender differences in performance on the Pattern Matching Subtest were found and are consistent with other data. 
Queensland Test reliability, validity and item characteristics were researched for the two ethnic groups. 
To obtain test-retest reliability estimates and data on criterion related validity longitudinal studies were undertaken with four ethnically mixed class groups Standard 3 to Form 2). 
The Queensland Test was found to be equally reliable with both ethnic groups although the levels of reliability obtained were not considered entirely satisfactory. 
Validity data indicated that the same general intelligence construct could be employed in the interpretation of Queensland Test results with both European and Maori subjects. Content validity issues were considered and it was argued that in terms of both test content and measurement procedures the Queensland Test should provide an equally valid measure of general intelligence with both groups. 
The criterion related validity coefficients were of approximately the same order for each ethnic group although doubts were expressed about the adequacy of the criteria. Construct validity was investigated by considering the relationship of test performance to age and through factor analytic evidence. The analyses supported the view that the Queensland Test was primarily a measure of the same underlying construct within each ethnic group. In terms of prevailing psychological theories on human intelligence this construct was interpreted as being of a general intelligence nature.
Comparative data on item characteristics did not indicate any marked ethnic group differences. More apparent was the need to restructure particular subtests where items failed to discriminate adequately within both ethnic groups. It was concluded that the weight of evidence was in favour of the psychological equivalence of this ability measure with Maori and European children. 
Data for combined ethnic group samples have been reported, Pooled data were employed in some factor analyses and these supported a general intelligence interpretation of Queensland Test results. Preliminary norms were also derived from combined ethnic group data. 
Findings are discussed in relation to the concept of intelligence and its cross-cultural measurement, other Queensland Test research and recent cross-cultural studies on cognitive abilities in New Zealand.

year: 1977