Suchergebnisse

Desde hace 50 años, los filósofos de la tradición analítica anglosajona (E. Anscombre, P. Geach, A. Kenny, P. Foot) han buscado ponerse en la escuela de Tomás de Aquino, que utilizan antes que todo como fuente para sobrepasar la epistemología cartesiana y desarrollar una ética de la virtud. Más recientemente, J. Haldane ha inaugurado un programa de "tomismo analítico", cuyo principal resultado hasta el presente ha sido su "teoría de identidad mente/mundo". No obstante, ninguno de esos admiradores de Tomás ha encontrado todavía el medio de asimilar su metafísica del ser.

Abstract Background Internationally, emergency departments are struggling with crowding and its associated morbidity, mortality, and decreased patient and health-care worker satisfaction. The objective was to evaluate the addition of a MDRNSTAT (Physician (MD)-Nurse (RN) Supplementary Team At Triage) on emergency department patient flow and quality of care. Methods Pragmatic cluster randomized trial. From 131 weekday shifts (8:00–14:30) during a 26-week period, we randomized 65 days (3173 visits) to the intervention cluster with a MDRNSTAT presence, and 66 days (3163 visits) to the nurse-only triage control cluster. The primary outcome was emergency department length-of-stay (EDLOS) for patients managed and discharged only by the emergency department. Secondary outcomes included EDLOS for patients initially seen by the emergency department, and subsequently consulted and admitted, patients reaching government-mandated thresholds, time to initial physician assessment, left-without being seen rate, time to investigation, and measurement of harm. Results The intervention's median EDLOS for discharged, non-consulted, high acuity patients was 4:05 [95 th% CI: 3:58 to 4:15] versus 4:29 [95 th% CI: 4:19–4:38] during comparator shifts. The intervention's median EDLOS for discharged, non-consulted, low acuity patients was 1:55 [95 th% CI: 1:48 to 2:05] versus 2:08 [95 th% CI: 2:02–2:14]. The intervention's median physician initial assessment time was 0:55 [95 th% CI: 0:53 to 0:58] versus 1:21 [95 th% CI: 1:18 to 1:25]. The intervention's left-without-being-seen rate was 1.5% versus 2.2% for the control (p = 0.06). The MDRNSTAT subgroup analysis resulted in significant decreases in median EDLOS for discharged, non-consulted high (4:01 [95 th% CI: 3:43–4:16]) and low acuity patients (1:10 95 th% CI: 0:58–1:19]), as well as physician initial assessment time (0:25 [95 th% CI: 0:23–0:26]). No patients returned to the emergency department after being discharged by the MDRNSTAT at triage. Conclusions The intervention reduced delays and left-without-being-seen rate without increased return visits or jeopardizing urgent care of severely ill patients. Trial registration number NCT00991471 ClinicalTrials.gov

Objective To compare performance and factors predicting failure to reach Ontario and Australian government time targets between a Canadian (Sunnybrook Hospital) and an Australian (Austin Health) academic tertiary-level hospitals in 2012, and to assess for change of factors and performance in 2016 between the same hospitals. Methods This was a retrospective, observational study of patient administrative data in two calendar years. The main outcome measure was reaching Ontario and Australian ED time targets for admissions, high and low urgency discharges. Secondary outcomes were factors predicting failure to reach these targets. Results Between 2012 and 2016, Sunnybrook and Austin experienced increased patient volume of 10.2% and 19.2%, respectively. Bed capacity decreased at Sunnybrook (-10.8%) but increased at the Austin (+30.3%). For both years, Austin failed to achieve the Australian time target, but succeeded for all Ontario targets except for low urgency discharges. Sunnybrook failed all targets irrespective of year. The top factors for failing Ontario ED length-of-stay targets for both hospitals in 2012 and 2016 were bed request greater than 6 h, access block greater than 1 h, use of cross-sectional imaging, consultation and waiting for the emergency physician greater than 2 h. Conclusion Austin outperformed Sunnybrook for Ontario and Australian government time targets. Both hospitals failed the Australian targets. Factors predicting failure to achieve targets were different between hospitals, but were mainly clinical resources. Sunnybrook focussed on increasing human resources. Austin focussed on increasing human resources, observation unit and hospital beds. Intrinsic hospital characteristics and infrastructure influenced target success. ; Peer reviewed