The Impact of Longer Consultation Time: A Simulation-Based Approach

Background  Maintaining a sufficient consultation length in primary health care (PHC) is a fundamental part of providing quality care that results in patient safety and satisfaction. Many facilities have limited capacity and increasing consultation time could result in a longer waiting time for patients and longer working hours for physicians. The use of simulation can be practical for quantifying the impact of workflow scenarios and guide the decision-making. Objective  To examine the impact of increasing consultation time on patient waiting time and physician working hours. Methods  Using discrete events simulation, we modeled the existing workflow and tested five different scenarios with a longer consultation time. In each scenario, we examined the impact of consultation time on patient waiting time, physician hours, and rate of staff utilization. Results  At baseline scenarios (5-minute consultation time), the average waiting time was 9.87 minutes and gradually increased to 89.93 minutes in scenario five (10 minutes consultation time). However, the impact of increasing consultation time on patients waiting time did not impact all patients evenly where patients who arrive later tend to wait longer. Scenarios with a longer consultation time were more sensitive to the patients'' order of arrival than those with a shorter consultation time. Conclusion  By using simulation, we assessed the impact of increasing the consultation time in a risk-free environment. The increase in patients waiting time was somewhat gradual, and patients who arrive later in the day are more likely to wait longer than those who arrive earlier in the day. Increasing consultation time was more sensitive to the patients'' order of arrival than those with a shorter consultation time.     

Can reproducibility be improved in clinical natural language processing? A study of 7 clinical NLP suites

BackgroundThe increasing complexity of data streams and computational processes in modern clinical health information systems makes reproducibility challenging. Clinical natural language processing (NLP) pipelines are routinely leveraged for the secondary use of data. Workflow management systems (WMS) have been widely used in bioinformatics to handle the reproducibility bottleneck.ObjectiveTo evaluate if WMS and other bioinformatics practices could impact the reproducibility of clinical NLP frameworks.Materials and MethodsBased on the literature across multiple researcho fields (NLP, bioinformatics and clinical informatics) we selected articles which (1) review reproducibility practices and (2) highlight a set of rules or guidelines to ensure tool or pipeline reproducibility. We aggregate insight from the literature to define reproducibility recommendations. Finally, we assess the compliance of 7 NLP frameworks to the recommendations.ResultsWe identified 40 reproducibility features from 8 selected articles. Frameworks based on WMS match more than 50% of features (26 features for LAPPS Grid, 22 features for OpenMinted) compared to 18 features for current clinical NLP framework (cTakes, CLAMP) and 17 features for GATE, ScispaCy, and Textflows.Discussion34 recommendations are endorsed by at least 2 articles from our selection. Overall, 15 features were adopted by every NLP Framework. Nevertheless, frameworks based on WMS had a better compliance with the features.ConclusionNLP frameworks could benefit from lessons learned from the bioinformatics field (eg, public repositories of curated tools and workflows or use of containers for shareability) to enhance the reproducibility in a clinical setting.     

成人重症患者深静脉血栓医护一体快速筛查流程的构建

目的 探讨适合我国成人重症患者深静脉血栓快速筛查的流程，为血栓预防护理提供参考。方法 应用循证护理方法，针对成人重症患者深静脉血栓筛查流程提出问题，进行系统检索、证据提取 等，形成成人重症患者深静脉血栓医护一体筛查的证据；通过2轮焦点小组访谈确定成人重症患者深静脉血栓医护一体快速筛查流程。结果 形成的成人重症患者深静脉血栓医护一体快速筛查流程包括风险评估、超声筛查、深静脉血栓预防、管理与质控4个步骤。结论 本研究构建的成人重症患者深静脉血栓医护一体快速筛查流程，可用于成人重症患者深静脉血栓风险筛查。     

Optimised workflow and organisation – from the point of view of an anaesthesiology department

The operating theatre is one of the most expensive facilities in most hospitals. In order to meet the increasing demands of a professional and process‐oriented management, it will be necessary to introduce clear and unambiguous management concepts in all hospitals. To optimise the workflow and the organisation as part of a future‐oriented OR management, operating room resources were allocated to the surgeons according to an internal assessment and budgeting procedure that permitted an objective evaluation of the efficiency and effectiveness of each user.     

IT服务流程中子流程的设计和应用

将子流程技术应用于电子政务系统工作流设计中，笔者以E—cology为平台，以信息技术服务流程为例，详细描述了系统设计的实现。     

Expanding the Role of Nonclinical Personnel in the OR

Ideally, quality health care should be accessible, affordable, and equitable. Working toward these goals in the OR necessitates examining and redesigning work processes and nursing workflow to make better use of the education and skills of perioperative nurses and assistive personnel. This article describes a pilot project undertaken in the OR at Massachusetts General Hospital, Boston, to identify tasks that took nurses away from direct patient care and to better incorporate assistive personnel into the workflow to increase nurses' contact with patients. The pilot program resulted in an expanded role for assistive personnel and more direct patient contact for nurses.     

Support of Daily ECG Procedures in a Cardiology Department via the Integration of an Existing Clinical Database and a Commercial ECG Management System

Background: In the context of HYGEIAnet, the regional health telematics network of Crete, a clinical cardiology database (CARDIS) has been installed in several hospitals. The large number of resting ECGs recorded daily made it a priority to have computerized support for the entire ECG procedure. Methods: Starting in late 2000, ICS‐FORTH and Mortara Instrument, Inc., collaborated to integrate the Mortara E‐Scribe/NT ECG management system with CAROIS in order to support daily ECG procedures. CARDIS was extended to allow automatic ordering of daily ECGs via E‐Scribe/NT. The ECG order list is downloaded to the electrocardiographs and executed, the recorded ECGs are transmitted to E‐Scribe/NT, where confirmed ECG records are linked back to CARDIS. A thorough testing period was used to identify and correct problems. An ECG viewer/printer was extended to read ECG files in E‐Scribe/NT format. Results: The integration of E‐Scribe/NT and CARDIS, enabling automatic scheduling of ECG orders and immediate availability of confirmed ECGs records for viewing and printing in the clinical database, took approximately 4 man months. The performance of the system is highly satisfactory and it is now ready for deployment in the hospital. Conclusions: Integration of a commercially available ECG management system with an existing clinical database can provide a rapid, practical solution that requires no major modifications to either software component. The success of this project makes us optimistic about extending CARDIS to support additional examination‐procedures such as digital coronary angiography and ultrasound examinations. A.N.E. 2002;7(3):263–270