Background. The use of lights and siren transport (LST) has been a matter of debate because of the short time savings and well-established increased risks for Emergency Medical Services (EMS) and bystanders. Time-critical hospital intervention (TCHI) denotes urgently needed procedures that cannot be performed properly in an out-of-hospital setting. Since 2013, rapid transportation from the field, fast-track, is currently used for patients with acute ST-elevation myocardial infarction, suspicion of acute stroke and out-of-hospital cardiac arrest. The aim of this study was to determine whether the use of LST was associated with the realization of TCHI for nontrauma cases within 15 minutes of hospital arrival, to quantify overtriage (LST without TCHI) and to identify the predictors of TCHI. Methods. This is a monocentric prospective observational study of nontrauma patients transported by ambulance. Based on Ross et al.’s work in 2016 on trauma patients, TCHI procedures were developed by the study team. Descriptive statistics were used to determine whether the use of LST was associated with the realization of TCHI. Multivariable analyses determined the predictors of TCHI and compared clinical outcomes. Results. On the 324 patients included, 67 (20.7%) benefitted from LST, with 40 (59.7%) receiving TCHI (p<0.001). The overtriage rate was 40.3%. The most common medical TCHI was the fast-track (65.2% of all TCHI). LST was predictive of the need for TCHI (p<0.001), as was the clinical condition of the patient and also when EMS providers expected TCHI. Conclusions. A majority of the LST benefitted from TCHI with an overtriage rate of 40%. To reduce the rate of overtriage (LST without TCHI), LST should mainly be used for fast-track and when TCHI is expected by the EMS providers.
'Evaluation clauses' are a legal basis requiring mandatory evaluation of public policies' impact. Evaluation becomes a procedural institutionalization but, although they are widespread, no phrasing standards have been yet established. Without clarification, the questions raised by origins and effects of mandatory evaluation remained impossible to treat. Past studies dealing with this topic dismissed the legal feature of the evaluation process to focus only on organisations. This paper aims to apply a methodology based on the numerical taxonomy to construct a conceptual scheme for classifying evaluation clauses. A hierarchical cluster analysis was run on 319 cases with eight variables related to their normative density. From such heterogeneous legal object, two families of clauses have emerged, and three significant templates are identified. This paper opens a research track which considers evaluation clauses to investigate both the reason why a specific type of phrasing is chosen and the consequences of these institution types. * I would like to thank Prof. Eugene Horber for his valuable help regarding the methodology and PhD. Christian Roser and Johanna Schnabel for their helpful comments. This paper is part of SynEval project that analyses the relationship between different attributes of political systems and the practice and institutionalisation of policy evaluation (http://www.syneval.ch).
Typologies are widely used in research on federalism, e.g. to distinguish dual from cooperative or coming-together from holding-together federations. More general, ideal types, archetypes and categories are frequently used in political science research to define concepts and classify cases. As recently as in 2014, Filho et al. pointed out that Cluster Analysis is still hardly used when it comes to developing typologies in political science. Rather, political scientists rely on more intuitive methods or factor analysis. Our paper argues that Cluster Analysis is of great usefulness because it a) focuses on the relationship between cases and not variables and b) draws on empirical data when identifying the clusters. This paper proposes to apply this fruitful approach to the field of federalism to exemplify its major heuristic potential. Furthermore, we emphasize that testing the secondary validity is a crucial step. Our paper provides two original examples from comparative federal politics and public management that illustrate the strength of Cluster Analysis both in testing and generating hypotheses through the establishment of typologies. For both examples, the validity of the Cluster Analysis is tested by checking for correlations between the clusters and the distribution of power. Hence, the typologies established through Cluster Analysis not only define our respective dependent variables related to aspects of intergovernmental coordination within federations and the normative density of evaluation clauses in the Swiss federation, but also offer strong insights in issues of regional autonomy.
Background: The use of lights and siren transport (LST) has been a matter of debate because of the short time savings and well-established increased risks for Emergency Medical Services (EMS) and bystanders. Time-critical hospital intervention (TCHI) denotes urgently needed procedures that cannot be performed properly in an out-of-hospital setting. Since 2013, rapid transportation from the field – fast-track – is currently used for patients with acute ST-elevation myocardial infarction, suspicion of acute stroke and out-of-hospital cardiac arrest. We aimed to determine whether the use of LST was associated with the realization of TCHI for non-trauma cases within 15 minutes of hospital arrival, to identify the predictors of TCHI and to compare clinical outcomes in patients transported with or without LST. Methods: This is a monocentric prospective observational study of non-trauma patients transported by ambulance. Based on Ross et al.’s work in 2016 on trauma patients, TCHI procedures were developed by the study team. We used descriptive statistics to determine whether the use of LST was associated with the realization of TCHI. Univariate and multivariate analyses determined the predictors of TCHI and compared clinical outcomes. Results: On the 324 patients included, 67 (20.7%) benefitted from LST, with 40 (59.7%) receiving TCHI ( p < 0.001). The most common medical TCHI was the fast-track (65.2% of all TCHI). LST was predictive of the need for TCHI ( p < 0.001), as was the clinical condition of the patient and also when EMS providers expected TCHI. When transported with LST, patients were hospitalized significantly more often in acute care units and less often in general wards or discharged from the Emergency Department ( p < 0.001). Conclusions: The use of LST for non-trauma patients was positively associated with the realization of TCHI. EMS providers demonstrated a high level of precision in discerning which patients deserved LST. A majority of the LST benefitted from TCHI. Nevertheless, when fast-track was excluded the rate dropped by more than 50%. To reduce the rate of over-triage (LST without TCHI), LST should be used only for fast-track and also when TCHI is expected by the EMS providers.
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