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Discrete-event simulation can be used as an effective tool for healthcare administrators to "test" various operational decisions. The recent growth in hospital outpatient volumes and a constrained financial environment make discrete-event simulation a cost-effective way to diagnose inefficiency and create and test strategies for improvement. This study(More)
Orbital involvement by multiple myeloma is rare and affects older individuals usually. The youngest reported patient in a recent series that cites a median age of 56 years is 30 years of age. The present case involves a 19-year-old pregnant black female subject who complained initially of diplopia and whose presenting sign was proptosis. An extensive(More)
OBJECTIVE The primary objective of this study was to create a methodology for measuring transient levels of physician workload in a live emergency department (ED) environment. BACKGROUND Characterizing, defining, and measuring aspects of this interrupt-driven work environment represent the preliminary steps in addressing impending issues concerning ED(More)
BACKGROUND As the demands on the emergency medicine (EM) system continue to increase, improvements in the organization of work and the access to timely clinical and system information will be required for providers to manage their workload in a safe and efficient manner. Information technology (IT) solutions are beginning to find their place in the(More)
Patients with diabetic autonomic neuropathy (DAN) exhibit decreased heart rate variability (HRV) and are prone to sudden death. When HRV was used as an index of DAN, the circadian rhythmicity of heart rate and QT intervals was studied in 17 patients with diabetes who had varying degrees of DAN and 13 healthy control subjects. Heart rate and QT and QTc(More)
STUDY OBJECTIVE We determine the effect of crowding on emergency department (ED) waiting room, treatment, and boarding times across multiple sites and acuity groups. METHODS This was a retrospective cohort study that included ED visit and inpatient medicine occupancy data for a 1-year period at 4 EDs. We measured crowding at 30-minute intervals throughout(More)
STUDY OBJECTIVE The objective of this investigation is to determine time-dependent workload patterns for emergency department (ED) physician teams across work shifts. A secondary aim was to demonstrate how ED demand patterns and the timing of shift changes influence the balance of workload among a physician team. METHODS Operational measurements of an(More)
STUDY OBJECTIVE To develop a discrete event simulation of emergency department (ED) patient flow for the purpose of forecasting near-future operating conditions and to validate the forecasts with several measures of ED crowding. METHODS We developed a discrete event simulation of patient flow with evidence from the literature. Development was purely(More)
BACKGROUND Emergency Department (ED) overcrowding is a serious public health issue, but few solutions exist. OBJECTIVES We sought to determine the impact of physician triage on ED length of stay for discharged and admitted patients, left-without-being-seen (LWBS) rates, and ambulance diversion. METHODS This was a pre-post study performed using(More)
BACKGROUND  Google Flu Trends (GFT) is a novel Internet-based influenza surveillance system that uses search engine query data to estimate influenza activity and is available in near real time. This study assesses the temporal correlation of city GFT data to cases of influenza and standard crowding indices from an inner-city emergency department (ED). (More)