Objectives: The objective was to examine the relationship between laboratory testing (including test volume and turnaround time [TAT]) and emergency department (ED) length of stay (LOS), using linked patient-level data from four hospitals across 4 years.Methods: This was a retrospective, multisite cohort study of patients presenting to any one of four EDs in New South Wales, Australia, during a 2-month period (August and September) in 2008, 2009, 2010, and 2011. Data from ED information systems were linked to laboratory test data. A cross-classified random-effect modeling approach was applied to identify factors affecting ED LOS, taking into account the correlation between patients' presentations at the same hospital and/or in the same calendar year. Number of test order episodes (tests ordered at one point in time during the ED stay) and TAT (time from laboratory order receipt to result available) were examined.Results: As the number of test order episodes increased, so did the duration of patient ED LOS (p < 0.0001). For every five additional tests ordered per test order episode, the median ED LOS increased by 10 minutes (2.9%, p < 0.0001); each 30-minute increase in TAT was, on average, associated with a 5.1% (17 minutes; p < 0.0001) increase in ED LOS, after adjustment for other factors. Patients presenting to the ED at night (7 p.m. to 7 a.m.) had longer stays than those presenting during the daytime, although the median TATs at nights were shorter than those during the daytime.Conclusions: Laboratory testing has a direct effect on patients' LOS in ED. Laboratory TAT, number of testing episodes, and test volume influence ED LOS. Targeted increases of ED resources and staffing after-hours may also contribute to reductions in ED LOS.ACADEMIC EMERGENCY MEDICINE 2015;22:38-46
ObjectivesTo examine the basis of multidisciplinary teamwork. In real-world healthcare settings, clinicians often cluster in profession-based tribal silos, form hierarchies and exhibit stereotypical behaviours. It is not clear whether these social structures are more a product of inherent characteristics of the individuals or groups comprising the professions, or attributable to a greater extent to workplace factors.SettingControlled laboratory environment with well-appointed, quiet rooms and video and audio equipment.ParticipantsClinical professionals (n=133) divided into 35 groups of doctors, nurses and allied health professions, or mixed professions.InterventionsParticipants engaged in one of three team tasks, and their performance was video-recorded and assessed.Primary and secondary measuresPrimary: teamwork performance. Secondary, pre-experimental: a bank of personality questionnaires designed to assess participants’ individual differences. Postexperimental: the 16-item Mayo High Performance Teamwork Scale (MHPTS) to measure teamwork skills; this was self-assessed by participants and also by external raters. In addition, external, arm's length blinded observations of the videotapes were conducted.ResultsAt baseline, there were few significant differences between the professions in collective orientation, most of the personality factors, Machiavellianism and conservatism. Teams generally functioned well, with effective relationships, and exhibited little by way of discernible tribal or hierarchical behaviours, and no obvious differences between groups (F (3, 31)=0.94, p=0.43).ConclusionsOnce clinicians are taken out of the workplace and put in controlled settings, tribalism, hierarchical and stereotype behaviours largely dissolve. It is unwise therefore to attribute these factors to fundamental sociological or psychological differences between individuals in the professions, or aggregated group differences. Workplace cultures are more likely to be influential in shaping such behaviours. The results underscore the importance of culture and context in improvement activities. Future initiatives should factor in culture and context as well as individuals’ or professions’ characteristics as the basis for inducing more lateral teamwork or better interprofessional collaboration.
The benefits of binocular vision have been debated throughout the history of vision science yet few studies have considered its contribution beyond a viewing distance of a few meters. In the first set of experiments, we compared monocular and binocular performance on depth interval estimation and discrimination tasks at 4.5, 9.0 or 18.0 m. Under monocular conditions, perceived depth was significantly compressed. Binocular depth estimates were much nearer to veridical although also compressed. Regression-based precision measures were much more precise for binocular compared to monocular conditions (ratios between 2.1 and 48). We confirm that stereopsis supports reliable depth discriminations beyond typical laboratory distances. Furthermore, binocular vision can significantly improve both the accuracy and precision of depth estimation to at least 18 m. In another experiment, we used a novel paradigm that allowed the presentation of real binocular disparity stimuli in the presence of rich environmental cues to distance but not interstimulus depth. We found that the presence of environmental cues to distance greatly enhanced stereoscopic depth constancy at distances of 4.5 and 9.0 m. We conclude that stereopsis is an effective cue for depth discrimination and estimation for distances beyond those traditionally assumed. In normal environments, distance information from other sources such as perspective can be effective in scaling depth from disparity.
Despite the extensive investigation of binocular and stereoscopic vision, relatively little is known about its importance in natural visually guided behavior. In this paper, we explored the role of binocular vision when walking over and around obstacles. We monitored eye position during the task as an indicator of the difference between monocular and binocular performances. We found that binocular vision clearly facilitates walking performance. Walkers were slowed by about 10% in monocular vision and raised their foot higher when stepping over obstacles. Although the location and sequence of the fixations did not change in monocular vision, the timing of the fixations relative to the actions was different. Subjects spent proportionately more time fixating the obstacles and fixated longer while guiding foot placement near an obstacle. The data are consistent with greater uncertainty in monocular vision, leading to a greater reliance on feedback in the control of the movements.
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