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- Creators: School of Life Sciences
- Creators: Shunk, Dan
Description
For more than twenty years, clinical researchers have been publishing data regarding incidence and risk of adverse events (AEs) incurred during hospitalizations. Hospitals have standard operating policies and procedures (SOPP) to protect patients from AE. The AE specifics (rates, SOPP failures, timing and risk factors) during heart failure (HF) hospitalizations are unknown. There were 1,722 patients discharged with a primary diagnosis of HF from an academic hospital between January 2005 and December 2007. Three hundred eighty-one patients experienced 566 AEs, classified into four categories: medication (43.9%), infection (18.9%), patient care (26.3%), or procedural (10.9%). Three distinct analyses were performed: 1) patient's perspective of SOPP reliability including cumulative distribution and hazard functions of time to AEs; 2) Cox proportional hazards model to determine independent patient-specific risk factors for AEs; and 3) hospital administration's perspective of SOPP reliability through three years of the study including cumulative distribution and hazard functions of time between AEs and moving range statistical process control (SPC) charts for days between failures of each type. This is the first study, to our knowledge, to consider reliability of SOPP from both the patient's and hospital administration's perspective. AE rates in hospitalized patients are similar to other recently published reports and did not improve during the study period. Operations research methodologies will be necessary to improve reliability of care delivered to hospitalized patients.
ContributorsHuddleston, Jeanne (Author) / Fowler, John (Thesis advisor) / Montgomery, Douglas C. (Thesis advisor) / Gel, Esma (Committee member) / Shunk, Dan (Committee member) / Arizona State University (Publisher)
Created2012
Description
The current Enterprise Requirements and Acquisition Model (ERAM), a discrete event simulation of the major tasks and decisions within the DoD acquisition system, identifies several what-if intervention strategies to improve program completion time. However, processes that contribute to the program acquisition completion time were not explicitly identified in the simulation study. This research seeks to determine the acquisition processes that contribute significantly to total simulated program time in the acquisition system for all programs reaching Milestone C. Specifically, this research examines the effect of increased scope management, technology maturity, and decreased variation and mean process times in post-Design Readiness Review contractor activities by performing additional simulation analyses. Potential policies are formulated from the results to further improve program acquisition completion time.
ContributorsWorger, Danielle Marie (Author) / Wu, Teresa (Thesis director) / Shunk, Dan (Committee member) / Wirthlin, J. Robert (Committee member) / Industrial, Systems (Contributor) / Barrett, The Honors College (Contributor)
Created2013-05
Description
The use of medical scribes in emergency departments has been associated with faster patient discharge times, increased numbers of patients treated, and improved patient satisfaction ratings in previous research studies and has also been correlated with improved levels of physician satisfaction as well as a high degree of gratification from scribes. For this paper, I examined the nature of scribing, essentially analyzing the role of the scribe in modern healthcare, and the effects of the occupation on the medical field. Though a shortage of prior research regarding medical scribing persisted, the data I received here mirrored some of the results from earlier studies, specifically those which proclaimed that physicians admit to increased work efficiency when accompanied by scribes. Unlike prior studies, however, this thesis presents novel information regarding scribes‘ perspectives of the profession, including some of the complaints they possess, which are most notably long and irregular shifts, far commute distances, and low wages. Through my research, which relied heavily on interviews and surveys and less heavily on EMR-simulating examinations, scribes were discovered to have a greater average typing speed (64 wpm) than physicians (30 wpm) and performed better in three drills that simulated different manners of patient charting. It was the opinion of all physicians that scribes were beneficial—both to them as physicians and to patients. Though scribes represented varying opinions about their role, the majority (9/11) of those who were interviewed classified scribing as a somewhat stressful job but also stated that they were mostly satisfied with their position.
ContributorsAguirre, Abel (Author) / Robert, Jason (Thesis director) / Maienschein, Jane (Committee member) / Ellison, Karin (Committee member) / Barrett, The Honors College (Contributor) / College of Liberal Arts and Sciences (Contributor) / School of Life Sciences (Contributor)
Created2012-12
Description
Childbirth, an essential stage of human life, has been carried out and treated differently in numerous ways throughout time. Although the overall method of birth is biologically the same, women and medical professionals in the United States in particular have changed how they view and manage childbirth over the past 70 years. Some of said changes are extensive and occurred more rapidly than one might typically expect for such a delicate and important stage of a woman‘s, and infant‘s, life. As consumerism, capitalism, and the courts have changed America‘s lifestyles, politics, and society, so too have they drastically affected the way we are conditioned to approach childbirth. More importantly, as society changes over time, the medical field and
methods of specialists also change, and although the benefits of these changes are challenged by some individuals, these procedures and recommendations from professionals inevitably affect us all. Methods and procedures of modern, medicalized childbirth, and even the significance placed on the event, are products of historical and cultural factors influenced by scientific and social trends. However, there exists a small and steadily growing number of women and families who choose to have their birth take place outside of the present societal norm, and consequently outside of hospitals. This group‘s existence and growth has been attributed to several factors, including changes in societal values, differentiation between different financial classes, and the
medicalization of childbirth. Although statistically a small percentage of the majority, these women who choose to give birth outside of a hospital exist amidst an immense ongoing controversy between gynecologists, physicians, mothers, and midwives regarding what options should be available when childbirth is undertaken in the United States.
methods of specialists also change, and although the benefits of these changes are challenged by some individuals, these procedures and recommendations from professionals inevitably affect us all. Methods and procedures of modern, medicalized childbirth, and even the significance placed on the event, are products of historical and cultural factors influenced by scientific and social trends. However, there exists a small and steadily growing number of women and families who choose to have their birth take place outside of the present societal norm, and consequently outside of hospitals. This group‘s existence and growth has been attributed to several factors, including changes in societal values, differentiation between different financial classes, and the
medicalization of childbirth. Although statistically a small percentage of the majority, these women who choose to give birth outside of a hospital exist amidst an immense ongoing controversy between gynecologists, physicians, mothers, and midwives regarding what options should be available when childbirth is undertaken in the United States.
ContributorsHernandez, Dustin (Author) / Nguyen, Christy (Author) / Koblitz, Ann (Thesis director) / Budolfson, Arthur (Committee member) / Walker, Shell (Committee member) / Barrett, The Honors College (Contributor) / School of Life Sciences (Contributor) / W. P. Carey School of Business (Contributor)
Created2012-12