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Aims Employers in the United States incur substantial costs associated with substance use disorders. Our goal was to examine the effectiveness of employer‐led interventions to reduce the adverse effects of drug misuse in the workplace. Methods We conducted a systematic review of studies that evaluated the effectiveness of recommended workplace interventions for opioids and related drugs: employee education, drug testing, employee assistance programs, supervisor training, written workplace drug‐free policy, and restructuring employee health benefit plans. We searched PubMed MEDLINE, EMBASE (embase.com), PsycINFO (Ebsco), ABI Inform Global, Business Source Premier, EconLit, CENTRAL, Web of Science (Thomson Reuters), Scopus (Elsevier), Proquest Dissertations, and Epistemonikos from inception through May 8, 2019, with no date or language restrictions. We included randomized controlled trials, quasi‐experimental studies, and cross‐sectional studies with no language or date restrictions. The Downs and Black questionnaire was used to assess the quality of included studies. The results were reported using the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines. Results In all, 27 studies met our inclusion criteria and were included in the systematic review. Results were mixed, with each intervention shown to be effective in at least one study, but none showing effectiveness in over 50% of studies. Studies examining the impact of interventions on workplace injuries or accidents were more commonly reported to be effective. Although four studies were randomized controlled trials, the quality of all included studies was “fair” or “poor.” Conclusions Despite the opioid epidemic, high‐quality studies evaluating the effectiveness of employer‐led interventions to prevent or reduce the adverse effects of substance use are lacking. Higher quality and mixed methods studies are needed to determine whether any of the interventions are generalizable and whether contextual adaptations are needed. In the meantime, there is a reason to believe that commonly recommended, employer‐led interventions may be effective in some environments.

Objectives Systems theory suggests that there should be relatively high correlations among quality measures within an organization. This was an examination of hospital performance across three types of quality measures included in Medicare's Hospital Inpatient Value-Based Purchasing (HVBP) program: emergency department (ED)-related clinical process measures, inpatient clinical process measures, and patient experience measures. The purpose of this analysis was to determine whether hospital achievement and improvement on the ED quality measures represent a distinct domain of quality. Methods This was an exploratory, descriptive analysis using publicly available data. Composite scores for the ED, inpatient, and patient experience measures included in the HVBP program were calculated. Correlations and frequencies were run to examine the extent to which achievement and improvement were related across the three quality domains and the number of hospitals that were in the top quartile for performance across multiple quality domains. Results Achievement scores were calculated for 2,927 hospitals, and improvement scores were calculated for 2,842 hospitals. There was a positive, moderate correlation between ED and inpatient achievement scores (correlation coefficient of 0.50, 95% confidence interval [CI] = 0.47 to 0.53), but all other correlations were weak (0.16 or less). Only 96 hospitals (3.3%) scored in the top quartile for achievement across the three quality domains; 73 (2.6%) scored in the top quartile for improvement across all three quality domains. Conclusions Little consistency was found in achievement or improvement across the three quality domains, suggesting that the ED performance represents a distinct domain of quality. Implications include the following: 1) there are broad opportunities for hospitals to improve, 2) patients may not experience consistent quality levels throughout their hospital visit, 3) quality improvement interventions may need to be tailored specifically to the department, and 4) consumers and policy-makers may not be able to draw conclusions on overall facility quality based on information about one domain. Resumen Objetivos La teoria de sistemas indica que deberia haber correlaciones relativamente altas entre las medidas de calidad dentro una organizacion. Se trata de una evaluacion del rendimiento hospitalario a traves de tres tipos de medidas de calidad incluidas en el programa Hospital Inpatient Value-Based Purchasing (HVBP) de Medicare: medidas del proceso clinico relativo al servicio de urgencias (SU), medidas del proceso clinico del paciente hospitalizado y medidas de la experiencia del paciente. El proposito de este analisis fue determinar si las medidas de calidad en el logro y la mejora del SU y del hospital representan un dominio distinto de la calidad. Metodologia Se trata de un analisis descriptivo y exploratorio que utilizo los datos disponibles de dominio publico. Se calcularon las puntuaciones compuestas para el SU, el paciente hospitalizado y las medidas de la experiencia del paciente incluidas en el programa HVBP. Se calcularon las frecuencias y correlaciones para examinar el grado en el que el logro y la mejora se relacionaban a traves de los tres dominios de calidad, y el numero de hospitales que estuvieron en el cuartil superior de rendimiento de multiples dominios de calidad. Resultados Se asignaron las puntuaciones del logro a 2.927 hospitales y 2.842 recibieron puntuaciones de la mejora bajo el programa HVBP. Hubo una correlacion positiva moderada entre las puntuaciones de los logros entre el SU y el paciente hospitalizado (coeficiente de correlacion de 0,50, intervalo de confianza [IC] 95% = 0,47 a 0,53), pero el resto de las correlaciones fueron debiles (0,16 o menos). Solo 96 hospitales (3,3%) puntuaron en el cuartil superior para el logro de los objetivos a traves de las tres dimensiones de calidad; 73 (2,6%) puntuaron en el cuartil superior para la mejora a traves de las tres dimensiones de la calidad. Conclusiones Se encontro poca consistencia en el logro o la mejora a traves de los tres dominios de calidad, lo que indica que el rendimiento del SU representa un dominio distinto de calidad. Esto supone las siguientes implicaciones: 1) existen amplias oportunidades para que los hospitales mejoren, 2) los pacientes pueden no experimentar grados de calidad consistentes a lo largo su visita hospitalaria, 3) se pueden necesitar intervenciones en mejora de calidad para ser especificamente adaptadas al servicio, y 4) los responsables politicos y los usuarios pueden no ser capaces de sacar conclusiones sobre la calidad general de las instalaciones si se basan en la informacion de un solo dominio.

ACADEMIC EMERGENCY MEDICINE 2012; 19:106–109 © 2011 by the Society for Academic Emergency Medicine Abstract Objectives: Patient acuity triage systems can play an important role in supporting patient safety and emergency department (ED) operations. In 2003, the boards of the American College of Emergency Physicians (ACEP) and the Emergency Nurses Association (ENA) approved a joint statement calling for hospitals to adopt a reliable, valid, five-level triage scale such as the Emergency Severity Index (ESI). Still, there appears to be considerable variation in use of triage acuity systems in the United States, with many hospitals using three- and four-level systems that have not been validated. The purpose of this effort was to measure the use of various triage acuity systems in U.S. hospitals. Methods: The authors conducted a cross-sectional analysis of secondary data. Data were obtained from the 2009 American Hospital Association (AHA) Annual Survey—an intensive questionnaire mailed to all U.S. general medical and surgical hospitals. In 2009, a question was added to the survey about hospitals’ use of triage systems in EDs. Descriptive statistics were used to explore various triage acuity systems used by different types of hospitals. Results: Of the 4,897 hospitals surveyed, 82% responded, and 62% (3,024 hospitals) provided information on their ED triage system. The 2009 data revealed that the most commonly used triage system types were the five-level ESI (56.9% of responding hospitals) and three-level triage systems (25.2%). More than 70% of large hospitals and teaching hospitals use the ESI, and the unvalidated three-level systems were more common in small hospitals, public hospitals, nonteaching hospitals, and hospitals in the Midwest. The majority (72.1%) of all ED patient visits to hospitals in our sample were assessed using ESI; only 13.1% of visits were assessed using a three-level system. Conclusions: Among our sample of more than 3,000 hospitals, the ESI was the most commonly used triage system, and more patients were triaged using the ESI than any other triage acuity system. Still, there is an opportunity to further promote the adoption of validated, reliable triage systems.

Electromyographic signals detected from the quadriceps femoris during various constant force contractions were decomposed to identify individual motor unit discharges and mean firing rates (FRs). Subject and group mean FRs were calculated for each force level. Mean FR values and FR variability increased with force. Individual, subject, and group mean FRs showed slight increases until 30% of maximum voluntary contraction and larger increases thereafter. Findings are discussed in relation to motor unit recruitment, frequency modulation, and fatigue.