Biomedical subjects

Stuart B Boxerman

Publications and source records attributed to Stuart B Boxerman.

3 recordsLinked to original sources

PubMed2006

Emergency department overcrowding: analysis of the factors of renege rate.

BACKGROUND: Reneging (i.e., leaving without being seen) is an important outcome of emergency department (ED) overcrowding. The input-throughput-output conceptualization of ED patient flow is helpful in understanding and measuring the impact of various factors on this outcome. OBJECTIVES: To quantify the impact of input and output factors on ED renege rate. METHODS: The authors used patient-level and system-level data from multiple sources in their institution to build logistic regression models, with reneging as the dependent variable. This approach provides the impact of each input and output factor on renege rate expressed as an odds ratio (OR). RESULTS: The OR for reneging attributable to the difference between the 80th and 20th percentile values for inpatient bed utilization is 1.05. Comparing 80th and 20th percentile values for boarded ED admits as of 7 AM, the OR is 1.73; for daily ED arrivals, the OR is 2.00; and for admission percentage, the OR is 1.12. The OR for evening versus morning patient arrival time is 3.9 and for patient arrival on a Monday versus a Sunday is 2.7. The OR for reneging for a patient presenting on Monday evening versus Sunday morning is 10.5. CONCLUSIONS: The effects of ED input and output factors on renege rate are significant and quantifiable. At least some of the variation in these factors and subsequently their effects are predictable, suggesting that further refinement in the management of ED and inpatient resources could affect improvement in ED renege rate. Continued efforts at quantifying the effects are warranted.

Adult↗

PubMed2006

Describing nurses' work: combining quantitative and qualitative analysis.

OBJECTIVE: To better understand nursing activities and working conditions. BACKGROUND: Nursing practice involves astute clinical decision making and the competent delivery of nursing care procedures. To complete nursing procedures, nurses must simultaneously organize and reorganize priorities and manage changing clinical information for multiple patients. Few researchers have examined the specific nature of nurses' activities and the effect of the environment on their work. METHODS: Quantitative and qualitative methods were used to collect data on 7 nurses engaged in nursing activities. Examples of methods include link analysis, subject matter expert, task analysis, cognitive pathway, and "stacking." Data collection focused on how nurses managed priorities, changing clinical information, and interruptions. RESULTS: The "cognitive pathway" graphically depicts the nature of nurses' work. Specifically, it reveals the shifting of the nurse's attention from patient to patient and the occurrence of interruptions. "Stacking" shows the number of tasks a nurse must balance at any one time. On average, nurses had 10 or more activities waiting to be performed and experienced 3.4 interruptions/hr. CONCLUSION: These methods provide unique insight into the dynamic nature of patient care and nursing work. APPLICATION: Extension of the methods demonstrated here may be useful in guiding efforts to change the work of nursing to better provide quality care and less stressful work environments.

Evaluation Studies as Topic↗

PubMed2003

The association of cytomegalovirus sero-pairing with outcomes and costs following cadaveric renal transplantation prior to the introduction of oral ganciclovir CMV prophylaxis.

Cytomegalovirus (CMV) is an important cause of morbidity, mortality and cost in cadaveric renal transplantation. This study was designed to document the clinical and economic outcomes associated with donor and recipient CMV sero-pairing. Data were drawn from the United States Renal Data System (USRDS) on 17 001 cadaveric renal transplant recipients transplanted between 1995 and 1997 with recorded donor and recipient CMV sero-status. In multivariate analysis, CMV-seropositive recipients were associated with a significantly higher incidence of delayed graft function, a lower incidence of graft loss, and lower costs than CMV-seronegative recipients. CMV-seropositive compared to seronegative donors were associated with significantly higher incidence of CMV disease, graft loss, and higher costs when transplanted into CMV-seronegative recipients. However, CMV-seronegative donors into seropositive recipients had no significant association with outcome beyond a higher incidence of CMV disease compared to CMV-seronegative donor and recipient pairs. The outcomes associated with CMV-seropositive donors and seronegative recipients call for tailored management strategies which may include avoidance of such mismatching, antiviral therapy, immunization, or modified immunosuppression.

Administration, Oral↗