Matching Items (6)

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An Ethical Evaluation of the Boarding of Psychiatric Patients in the Emergency Department

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My thesis project, "An Ethical Evaluation of the Practice of Psychiatric Patient Boarding in the Emergency Department" sets out to address a relatively nameless problem in the healthcare system in

My thesis project, "An Ethical Evaluation of the Practice of Psychiatric Patient Boarding in the Emergency Department" sets out to address a relatively nameless problem in the healthcare system in the United States. This problem is the boarding of psychiatric patients in emergency departments nationwide. What is psychiatric patient boarding? This term refers to the increasingly common practice of care provided to psychiatric patients upon arrival at an emergency department. When inpatient psychiatric beds or services are not available, "boarding" is performed by simply storing mentally ill patients in hallways or other emergency room areas while they wait for the availability of psychiatric treatment, which may take hours, or in more extreme cases has been cited to last for days at a time (Alakeson et. al, 2010). While any individual can expect to wait a prolonged period of time for medical care in the increasingly overcrowded emergency departments, the psychiatric patient experience is astonishingly unique. A psychiatric patient presenting, or arriving, at the ED in crisis can often times find him or herself not only waiting hours to be admitted and assessed as a medical patient would, but with a limited and ever attenuating supply of psychiatric treatment rooms and services, these patients will often times be harbored in an ED room designed for short-term medical treatment without care until psychiatric services become available. Patients can be left waiting for days for an in-patient vacancy; all the while not receiving true psychiatric treatment and in some cases being held against their will in a chaotic environment far from conducive for treatment of a mental health ailment. In this analysis, I will discuss and review aspects of psychiatric patient boarding from various literature, such as why boarding occurs from a hospital and historical standpoint, negative implications of boarding for psychiatric and medical patients, and the burden placed on the hospital when practicing psychiatric boarding. To learn further on the topic, I will share the results from 14 semi-structured, qualitative interviews performed with ED healthcare professionals, being physicians, charge nurses, nursing staff, and certified nursing assistants or patient safety advocates. This portion of my investigation is designed to offer a perspective that the literature cannot, being a first hand outlook on psychiatric boarding from those working on the front line, focusing on topics of all aspects, such as causation, consequences for all involved parties, and proposed solutions.

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Date Created
  • 2017-05

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Addressing the Pediatric Asthma Cluster in South and Central Phoenix

Description

Objective: To explain the origins of the pediatric asthma cluster present in south and central phoenix, and propose potential solutions to combat this cluster. Methods: A comprehensive literature review of

Objective: To explain the origins of the pediatric asthma cluster present in south and central phoenix, and propose potential solutions to combat this cluster. Methods: A comprehensive literature review of the different factors that contribute to asthma starting at a national level and working down to the Maricopa county level was conducted. Afterwards a literature review of past pediatric asthma intervention case studies was conducted. The results of both literature reviews were synthesized in regards to applicability in south and central phoenix. Results: A combined targeted intervention in health care delivery, patient/clinician education, and housing status/infrastructure could yield promising results in regards to combatting the pediatric asthma cluster in south and central phoenix.

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Date Created
  • 2018-05

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An Integrated Framework for Patient Access Staffing Decision

Description

The challenge of healthcare delivery has attracted widespread attention since the report published by the World Health Organization in 2000, ranking the US 37th in overall health systems performance among

The challenge of healthcare delivery has attracted widespread attention since the report published by the World Health Organization in 2000, ranking the US 37th in overall health systems performance among 191 Member States. In addition, Davis et al. (2007) demonstrated that healthcare costs in the US were higher than all other countries, despite the fact that care was not the better than all other countries. The growing population in the US, combined with continued medical advances, has increased the demand for quality healthcare services. With this growth, however, comes the challenge of managing rising costs and maintaining efficient operations while satisfying patient's service level. Research has explored methods of improvement from system engineering, lean and process improvement, and mathematical programming of healthcare operations, to improve healthcare operations. In this project, we are interested in a patient access (patient registration) problem. The key research question is: what is an optimal decision in terms of patient admitting points considering both hospital cost and service level of patient access? To answer this question, we propose the use of the Queueing Theory to evaluate scenarios in a multi-objective decision setting implemented by Excel VBA (Visual Basic for Application). The first objective is to provide a "generic" Excel-based model with user-friendly interface such that users are able to visualize outcomes by changing chosen parameters and understand model sensitivities. The second objective is to evaluate the use Queueing in this patient access staffing decision. The data was provided by Healthcare Excellence Institute (HEI), a Phoenix-based consulting company which has experience in improving healthcare operation for more than 8 years. HEI has several hospital clients interested in determining the "optimal" number of admitting points which motivates us to develop this research project. Please note due to business confidentiality, the date used in this thesis has been modified.

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Date Created
  • 2012-05

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Behavioral Health Integration in Primary Care: A Systematic Review

Description

The integration of behavioral health services into primary care in a rapidly evolving innovation that has shown potential to improve access to care, health outcomes, and lower health costs. In

The integration of behavioral health services into primary care in a rapidly evolving innovation that has shown potential to improve access to care, health outcomes, and lower health costs. In an effort to reform healthcare system, integrating behavioral health services become a vital part of the patient-centered medical home (PCMH). As research and developments in integration continue to evolve, there is a need to identify consistencies, discrepancies, and gaps in the field to inform the best ways to move forward. This study is a systematic review seeking to identify trends, gaps, and future directions of research in integrated behavioral health in primary care. Using Google Scholar 171 papers were included, 95 being original research and 76 being reviews, commentary, and editorials. From the results, it is clear that the case for integration has been made, and now it is time to move to the specifics. Both empirical and theoretical evidence supports the benefits of integration to patients and health systems. However, there is a lack of literature that tackles problems that hinder or facilitate integration in independent clinics with unique characteristics. Most notably, specific interventions that are effective and appropriate in primary care, payment reforms that are feasible and sustainable, and the effect of integration on health disparities.

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Date Created
  • 2019-12

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The Medical Pal: A Smartphone Application to Improve Healthcare Delivery to Palliative Patients

Description

Smartphone-based healthcare. It's becoming more real as technology advances, adding value to healthcare and opening the doors to more personalized medicine. The Medical Pal is a smartphone application that can

Smartphone-based healthcare. It's becoming more real as technology advances, adding value to healthcare and opening the doors to more personalized medicine. The Medical Pal is a smartphone application that can track symptoms and analyze trends in the severity of those symptoms, alerting healthcare providers when there is a significant increase in the symptom severity. This is especially directed to the palliative patient, whose care is focused on managing symptoms and providing comfort. The HIPAA-compliant server used for the smartphone application was Catalyze.io and 40 Mayo Clinic Arizona palliative patients were surveyed on their smartphone usage to test the acceptance of this app in a clinical setting. A trial involving 9 simulated patients was conducted over a two week period to test the functionality of the app. A majority of surveyed patients (85%) expressed favor for the idea of a mobile ESAS, and the app was functioning, with the capability of displaying patient data on a healthcare provider's account. This project is intentionally a door-opener to an open field of opportunity for mobile health, symptom observation, and improvements in healthcare delivery.

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Created

Date Created
  • 2015-05

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An iOS Application for Palliative Care Patients

Description

As technology's influence pushes every industry to change, healthcare professionals must move to a more connected model. The nearly ubiquitous presence of smartphones presents a unique opportunity for physicians to

As technology's influence pushes every industry to change, healthcare professionals must move to a more connected model. The nearly ubiquitous presence of smartphones presents a unique opportunity for physicians to collect and process data from their patients more frequently. The Mayo Clinic, in partnership with the Barrett Honors College, has designed and developed a prototype smartphone application targeting palliative care patients. The application collects symptom data from the patients and presents it to the doctors. This development project serves as a proof-of-concept for the application, and shows how such an application might look and function. Additionally, the project has revealed significant possibilities for the future of the application.

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Created

Date Created
  • 2015-05