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Objective: Many factors influence patient flow through an ED, including streaming, treatment spaces and staff resources. This pilot study explored and compared real time patient flow using a single‐stream system versus varying configurations of possible two‐stream systems using computer simulation. Methods: Simulation modelling was used to assess the delay in treatment of a rapid‐antigen‐tested‐based, two‐stream model for patient flow through ED during the peak phase of the COVID pandemic. Results: Modelling two‐stream configuration for all patients (minimum time to be seen for both COVID‐positive and COVID‐negative patients) showed that in the case study ED, a two‐stream system and linked changes in bed configuration for managing the risks of infection can impact delays in treatment. Conclusions: Data‐driven modelling within specific clinical settings can inform the (in)efficiency of patient flow processes and help clinicians and managers make evidence‐based decisions about patient transition through EDs. This can assist with reconfiguration of ED patient streaming particularly during periods of unique need, such as the recent COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Objectives: To compare time metrics associated with a temporary disruption to ED computed tomography (CT) scanner location from adjacent to the ED with direct access from resuscitation rooms, to a location remote to the ED. Methods: A retrospective before and after study was conducted in a public metropolitan ED with over 66 000 presentations annually. Time‐to‐CT metrics, operational time metrics and ED length of stay were extracted and analysed from presentations between October 2020 and January 2021. Results: There were 3031 CT scans during the study period. Overall, the disruption was associated with a significant 27–36 min delay (P < 0.01) in time‐to‐CT start; these delays were also observed in a subset of trauma patients. In a subset of presumed stroke patients, time‐to‐brain perfusion was significantly delayed by up to 10 min (P < 0.01). There was a 14% (P < 0.01) greater demand for operational services and a time imposition of up to 8 min (P < 0.01) to transport patients to or from CT scanning when the CT scanner was located away from the ED. ED length of stay was consistent at all time points. Conclusion: Although rapid, proximate access to CT scanning is often considered desirable in terms of the management of trauma and other time‐critical emergencies, the wider time and resource implications demonstrated in this study suggest a potential broader benefit to co‐located CT scanning in ED. Our experience could be considered in future re‐design of EDs. [ABSTRACT FROM AUTHOR]

The article presents the discussion on telemedicine and digital technologies supporting the provision of emergency care for more than 20 years. Topics include enabling ubiquitous, high quality, secure video conferencing, remote monitoring and digital ordering and review of investigations; and implications for the emergency and primary care workforces, particularly in rural and regional centres.

We investigate the credibility of central bank research by searching for traces of researcher bias, which is a tendency to use undisclosed analytical procedures that raise measured levels of statistical significance (stars) in artificial ways. To conduct our search, we compile a new dataset and borrow 2 bias-detection methods from the literature: the p-curve and z-curve. The results are mixed. The p-curve shows no traces of researcher bias but has a high propensity to produce false negatives. The z-curve shows some traces of researcher bias but requires strong assumptions. We examine those assumptions and challenge their merit. At this point, all that is clear is that central banks produce results with patterns different from those in top economic journals, there being less bunching around the 5 per cent threshold of statistical significance. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to demonstrate through practical application how a system dynamics (SD) patient flow model of an emergency department (ED) can show which levers effectively reduce backlogs to improve access to care. Overcrowded EDs are struggling to meet demand and access targets. In 2016 and 2017, in the UK and Australia, respectively, 15% and 28% of arrivals waited longer than the targeted 4‐hr treatment time. Historically, simulation models that have informed access to emergency care have ignored the wider systems impacts. There is a growing awareness of the value of systems analysis tools for informing interventions and policy. In this study, we constructed a pilot system dynamics patient flow model, where the scope was the ambulatory and ambulance patient arrivals, the ED processes for acute and fast‐track pathways, pathology and radiology services, the ED short‐stay unit, and the Medical Assessment Planning Inpatient Unit. Patients queued to access constrained ED resources (doctors and beds) and diagnostic services (pathology and X‐ray). The model was tested on actual data from five separate historical periods spanning 3 years. The resultant daily pattern of peaks and troughs in patient flow and system delays accurately replicated patterns in actual patient flows, resource use, and the location of delays. "What if" scenario analysis (b) simulated how access would have looked in the sample weeks with different intervention strategies, (b) simulated system limits on the basis of current resources, (c) accurately identified levers that historically have been most effective at minimizing ambulance ramping, and (d) identified when additional staffing would fail to improve flow. [ABSTRACT FROM AUTHOR]

The Reserve Bank of Australia is the sole issuer and redeemer of Australian banknotes, but between issuance and destruction there is little information about where banknotes go or what they are used for. We estimate the whereabouts and uses of Australian banknotes, and find that 15–35 per cent are used to facilitate legitimate transactions, 4–7 per cent are used for transactions in the shadow economy, while the remainder are non‐transactional. The vast majority of non‐transactional banknotes are likely to be hoarded, and we estimate that 5–10 per cent of outstanding banknotes are lost or collected. [ABSTRACT FROM AUTHOR]

Traditional and current approaches to modelling the impacts of health care interventions have focused on detail complexity and been ceteris paribus dependent and thereby ignored the wider system impacts. In this study, we have demonstrated that system dynamics (SD) offers theoretical and practical advantages over conventional methodologies and the qualitative assessment tools that have informed the business of emergency care. We translate the key findings of qualitative research, existing literature reviews and studies of the use of simulation and economic evaluation models into a value proposition for using SD tools. We conclude that there is growing evidence of a strong value proposition for the use of SD tools to investigate interventions targeting improved emergency care access. SD models can incorporate dynamic and organizational complexity and fill a gap beyond the microscope of the conventional methodologies informing health care. This potential to strengthen health care systems warrants further investigation. [ABSTRACT FROM AUTHOR]