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År 2024 upplevde Sverige längre väntetider och sämre tillgänglighet inom både primär- och specialiserad vård jämfört med andra länder. Detta ledde till ökat tryck på akutmottagningar då många patienter sökte sig dit för vård som annars kunde hanterats på ordinära mottagningar om tillräcklig personal funnits tillgänglig. Denna studie fokuserar på att undersöka patientflöden vid Danderyds sjukhus genom att identifiera flaskhalsar inom akutmottagningen. Studiens syfte var att hitta flaskhalsar som kan åtgärdas för att minska väntetiderna och förbättra resursanvändningen genom att använda matematiska modeller och diskret händelsesimulering. Analysen baseras på data insamlad under det första kvartalet för åren 2022, 2023 och 2024. Resultaten från simuleringarna visar kritiska statistiska mått som är avgörande för att förstå systemets kapacitet och prestanda under varierande belastningar. Dessa resultat belyser även nödvändigheten av resursallokering och förväntade väntetider för patienter. Studien bidrar inte bara till en bra förståelse av de nuvarande processerna utan presenterar även strategier för att effektivt hantera de utmaningar akutmottagningarna står inför. Slutsatserna diskuterar de teoretiska och praktiska implikationerna med betoning på hur simuleringarna kan användas för att utforska nya arbetsmetoder för akutmottagningar framöver. Denna forskning lägger grunden för framtida innovationer inom sjukvårdens arbetsflöden och resursallokering, vilket kan leda till förbättrad patientvård och effektivare sjukhusdrift., In 2024, Sweden experienced longer wait times and reduced accessibility in both primary and specialized care compared to other countries. This led to increased pressure on emergency departments, as many patients sought care there that could have been managed at regular clinics if sufficient staff were available. This study focuses on examining patient flows at Danderyd Hospital by identifying bottlenecks within the emergency department. The aim of the study was to find bottlenecks that can be addressed to reduce wait times and improve resource utilization through the use of mathematical models and discrete event simulation. The analysis is based on data collected during the first quarter of the years 2022, 2023, and 2024. The results from the simulations reveal critical statistical measures that are essential for understanding the system's capacity and performance under varying loads. These results also highlight the need for resource allocation and expected wait times for patients. The study not only contributes to a better understanding of the current processes but also presents strategies for effectively addressing the challenges faced by emergency departments. The conclusions discuss the theoretical and practical implications, emphasizing how the simulations can be used to explore new working methods for emergency departments in the future. This research lays the foundation for future innovations in healthcare workflows and resource allocation, which can lead to improved patient care and more efficient hospital operations.

År 2024 upplevde Sverige längre väntetider och sämre tillgänglighet inom både primär- och specialiserad vård jämfört med andra länder. Detta ledde till ökat tryck på akutmottagningar då många patienter sökte sig dit för vård som annars kunde hanterats på ordinära mottagningar om tillräcklig personal funnits tillgänglig. Denna studie fokuserar på att undersöka patientflöden vid Danderyds sjukhus genom att identifiera flaskhalsar inom akutmottagningen. Studiens syfte var att hitta flaskhalsar som kan åtgärdas för att minska väntetiderna och förbättra resursanvändningen genom att använda matematiska modeller och diskret händelsesimulering. Analysen baseras på data insamlad under det första kvartalet för åren 2022, 2023 och 2024. Resultaten från simuleringarna visar kritiska statistiska mått som är avgörande för att förstå systemets kapacitet och prestanda under varierande belastningar. Dessa resultat belyser även nödvändigheten av resursallokering och förväntade väntetider för patienter. Studien bidrar inte bara till en bra förståelse av de nuvarande processerna utan presenterar även strategier för att effektivt hantera de utmaningar akutmottagningarna står inför. Slutsatserna diskuterar de teoretiska och praktiska implikationerna med betoning på hur simuleringarna kan användas för att utforska nya arbetsmetoder för akutmottagningar framöver. Denna forskning lägger grunden för framtida innovationer inom sjukvårdens arbetsflöden och resursallokering, vilket kan leda till förbättrad patientvård och effektivare sjukhusdrift., In 2024, Sweden experienced longer wait times and reduced accessibility in both primary and specialized care compared to other countries. This led to increased pressure on emergency departments, as many patients sought care there that could have been managed at regular clinics if sufficient staff were available. This study focuses on examining patient flows at Danderyd Hospital by identifying bottlenecks within the emergency department. The aim of the study was to find bottlenecks that can be addressed to reduce wait times and improve resource utilization through the use of mathematical models and discrete event simulation. The analysis is based on data collected during the first quarter of the years 2022, 2023, and 2024. The results from the simulations reveal critical statistical measures that are essential for understanding the system's capacity and performance under varying loads. These results also highlight the need for resource allocation and expected wait times for patients. The study not only contributes to a better understanding of the current processes but also presents strategies for effectively addressing the challenges faced by emergency departments. The conclusions discuss the theoretical and practical implications, emphasizing how the simulations can be used to explore new working methods for emergency departments in the future. This research lays the foundation for future innovations in healthcare workflows and resource allocation, which can lead to improved patient care and more efficient hospital operations.

This thesis synthesises advancements made in the method of assessment of emergency patients with possible acute cardiac disease and has defined new assessment strategies that supports the safe early discharge of patients at low risk for acute coronary syndromes. These important findings have informed clinicians and health services about improvements that can be made at this current time in the process of care of ED patients, and the studies have had local, national and international influence.

The positive rate of head CT in non-trauma patients presenting to the emergency department (ED) is low. Currently, indications for imaging are based on the individual experience of the treating physician, which contributes to overutilization and variability in imaging utilization. The goals of this study are to ascertain the predictors of positive head CT in non-trauma patients and demonstrate feasibility of a clinical scoring algorithm to improve yield. We retrospectively reviewed 500 consecutive ED non-trauma patients evaluated with non-contrast head CT after presenting with headache, altered mentation, syncope, dizziness, or focal neurologic deficit. Medical records were assessed for clinical risk factors: focal neurologic deficit, altered mental status, nausea/vomiting, known malignancy, coagulopathy, and age. Data was analyzed using logistic regression and receiver operator characteristic (ROC) curves and three derived algorithms. Positive CTs were found in 51 of 500 patients (10.2 %). Only two clinical factors were significant: focal neurologic deficit (adjusted odds ratio (OR) 20.7; 95 % confidence interval (CI) 9.4-45.7) and age >55 (adjusted OR 3.08; CI 1.44-6.56). Area under the ROC curve for all three algorithms was 0.73-0.83. In proposed algorithm C, only patients with focal neurologic deficit (major risk factor) or ≥2 of the five minor risk factors (altered mental status, nausea/vomiting, known malignancy, coagulopathy, and age) would undergo CT imaging. This may reduce utilization by 34 % with only a small decrease in sensitivity (98 %). Our simple scoring algorithm utilizing multiple clinical risk factors could help to predict the non-trauma patients who will benefit from CT imaging, resulting in reduced radiation exposure without sacrificing sensitivity.

Technology Management and Policy Graduate Consortium presentation

Student research poster, LAI Annual Meeting, Dana Point, CA

This paper is not subject to U.S. copyright. The definitive version was published in Environmental Health Perspectives 117 (2009): 1239–1243, doi:10.1289/ehp.0900645., Algal blooms of Karenia brevis, a harmful marine algae, occur almost annually off the west coast of Florida. At high concentrations, K. brevis blooms can cause harm through the release of potent toxins, known as brevetoxins, to the atmosphere. Epidemiologic studies suggest that aerosolized brevetoxins are linked to respiratory illnesses in humans. We hypothesized a relationship between K. brevis blooms and respiratory illness visits to hospital emergency departments (EDs) while controlling for environmental factors, disease, and tourism. We sought to use this relationship to estimate the costs of illness associated with aerosolized brevetoxins. We developed a statistical exposure–response model to express hypotheses about the relationship between respiratory illnesses and bloom events. We estimated the model with data on ED visits, K. brevis cell densities, and measures of pollen, pollutants, respiratory disease, and intra-annual population changes. We found that lagged K. brevis cell counts, low air temperatures, influenza outbreaks, high pollen counts, and tourist visits helped explain the number of respiratory-specific ED diagnoses. The capitalized estimated marginal costs of illness for ED respiratory illnesses associated with K. brevis blooms in Sarasota County, Florida, alone ranged from $0.5 to $4 million, depending on bloom severity. Blooms of K. brevis lead to significant economic impacts. The costs of illness of ED visits are a conservative estimate of the total economic impacts. It will become increasingly necessary to understand the scale of the economic losses associated with K. brevis blooms to make rational choices about appropriate mitigation., Sponsored by the Florida Fish & Wildlife Conservation Commission (07182) and the Departments of Environmental Protection and Health ; the U.S. Centers for Disease Control and Prevention ; the Center for Oceans and Human Health at the Woods Hole Oceanographic Institution [National Science Foundation (NSF) OCE-0430724 ; National Institute of Environmental Health Sciences (NIEHS) P50 ES012742] ; the Ocean and Human Health Center at the University of Miami Rosenstiel School (NSF 0CE0432368 ; NIEHS 1 P50 ES12736) ; and the NIEHS (PO1 ES 10594) .

This paper is not subject to U.S. copyright. The definitive version was published in Environmental Health Perspectives 117 (2009): 1239–1243, doi:10.1289/ehp.0900645., Algal blooms of Karenia brevis, a harmful marine algae, occur almost annually off the west coast of Florida. At high concentrations, K. brevis blooms can cause harm through the release of potent toxins, known as brevetoxins, to the atmosphere. Epidemiologic studies suggest that aerosolized brevetoxins are linked to respiratory illnesses in humans. We hypothesized a relationship between K. brevis blooms and respiratory illness visits to hospital emergency departments (EDs) while controlling for environmental factors, disease, and tourism. We sought to use this relationship to estimate the costs of illness associated with aerosolized brevetoxins. We developed a statistical exposure–response model to express hypotheses about the relationship between respiratory illnesses and bloom events. We estimated the model with data on ED visits, K. brevis cell densities, and measures of pollen, pollutants, respiratory disease, and intra-annual population changes. We found that lagged K. brevis cell counts, low air temperatures, influenza outbreaks, high pollen counts, and tourist visits helped explain the number of respiratory-specific ED diagnoses. The capitalized estimated marginal costs of illness for ED respiratory illnesses associated with K. brevis blooms in Sarasota County, Florida, alone ranged from $0.5 to $4 million, depending on bloom severity. Blooms of K. brevis lead to significant economic impacts. The costs of illness of ED visits are a conservative estimate of the total economic impacts. It will become increasingly necessary to understand the scale of the economic losses associated with K. brevis blooms to make rational choices about appropriate mitigation., Sponsored by the Florida Fish & Wildlife Conservation Commission (07182) and the Departments of Environmental Protection and Health ; the U.S. Centers for Disease Control and Prevention ; the Center for Oceans and Human Health at the Woods Hole Oceanographic Institution [National Science Foundation (NSF) OCE-0430724 ; National Institute of Environmental Health Sciences (NIEHS) P50 ES012742] ; the Ocean and Human Health Center at the University of Miami Rosenstiel School (NSF 0CE0432368 ; NIEHS 1 P50 ES12736) ; and the NIEHS (PO1 ES 10594) .

peer-reviewed, Background: Admission to the Emergency Department (ED) can be stressful for older people with advanced dementia and their family members. Previous research has tended to emphasise the negatives and deficits in care. Little research seeks out what works well or what matters in dementia care experiences in this context. Knowledge embedded in the experiences of family members accompanying an older person with dementia in ED and the experiences of emergency nurses caring for them may be part of the solution in developing strategies for improvement. Aim: This study was conducted in a large ED in the southwest of Ireland. It sought to explore the experiences of family members accompanying an older person with dementia in ED and the experiences of ED nurses caring for the older person with dementia and their family member in an episode of care. The intention was to generate new knowledge to co-create future possibilities for development. Four academic papers are weaved into the thesis. Methodology: Appreciative Inquiry (AI) was the participatory methodology used in this study. AI is an approach which focuses on generating new insights to open the gateway for possibilities and alternative ways of doing. This study pertains to the Discovery and Dream Phases of AI. Methods: In the Discovery Phase, data generation methods were participant observation with ED nurses (n=12) caring for older people with dementia in ED and interviews with family members (n=15) who accompanied an older person with dementia in ED. Interviews were framed through a storytelling approach. In the Dream Phase, ED nurses (n=10) participated in a Learning Conversations Session for further data generation and to co-analyse findings from the Discovery Phase. Data generation methods in the Dream Phase were appreciative framing and dialogue, storytelling and collective sensemaking. These methods were creatively used to maximise the potential for generating new knowledge about worked well in enhancing the exper

peer-reviewed, Background: Admission to the Emergency Department (ED) can be stressful for older people with advanced dementia and their family members. Previous research has tended to emphasise the negatives and deficits in care. Little research seeks out what works well or what matters in dementia care experiences in this context. Knowledge embedded in the experiences of family members accompanying an older person with dementia in ED and the experiences of emergency nurses caring for them may be part of the solution in developing strategies for improvement. Aim: This study was conducted in a large ED in the southwest of Ireland. It sought to explore the experiences of family members accompanying an older person with dementia in ED and the experiences of ED nurses caring for the older person with dementia and their family member in an episode of care. The intention was to generate new knowledge to co-create future possibilities for development. Four academic papers are weaved into the thesis. Methodology: Appreciative Inquiry (AI) was the participatory methodology used in this study. AI is an approach which focuses on generating new insights to open the gateway for possibilities and alternative ways of doing. This study pertains to the Discovery and Dream Phases of AI. Methods: In the Discovery Phase, data generation methods were participant observation with ED nurses (n=12) caring for older people with dementia in ED and interviews with family members (n=15) who accompanied an older person with dementia in ED. Interviews were framed through a storytelling approach. In the Dream Phase, ED nurses (n=10) participated in a Learning Conversations Session for further data generation and to co-analyse findings from the Discovery Phase. Data generation methods in the Dream Phase were appreciative framing and dialogue, storytelling and collective sensemaking. These methods were creatively used to maximise the potential for generating new knowledge about worked well in enhancing the exper

peer-reviewed, Introduction Social Work (SW) referrals made in the emergency department (ED) highlight the weaknesses in the existing support system for vulnerable and disadvantaged patients. SW personnel play a pivotal role in some EDs but are not integrated into the team in several jurisdictions. Our objective was to provide a detailed description of the need for SW support in the ED setting by describing SW consultation patterns in an urban ED location. Methods A three-year analysis of ED SW referrals made through a network of four acute care hospitals serving a city population of 1.2 million inhabitants where social workers operate from 8 a.m. to 10 p.m. The study design was descriptive reporting proportions. The descriptors of interest were the types of ED patients receiving SW consultations and the reasons for patient referral to the SW Department. Results During the study period, there were 46,970 SW consultations, representing 8.02% of the 572,804 patients who visited the ED across Calgary, yielding 42.9 referrals per day to social workers through the ED. Consultations for domestic violence were three times more prevalent for women (6% of referrals). However, domestic violence consultations were still an active issue for men (1.9%). Comparisons by age group yielded illness adjustments (15.3%), discharge planning (31.2%), and legal decision making (23.9%) as the most common reasons for referral of patients over 75 years old; 92.8% of patients over 75 years were admitted following the SW consultation. Reasons for deferral of patients under 30 years of age were illness adjustments (12.2%), discharge planning (16.4 %), and legal decision making (1.4%); 57.3% of patients under 30 years were admitted following the consultation. Addiction/drug use and homelessness were more common in those under the age of 30, comprising 24.1% and 15.4% of the SW referrals, respectively, compared to 1.6% and 0.4% of referrals for those over age 75, respectively. Conclusions The demand for SW supp