Massey Documents by Type

Permanent URI for this communityhttps://mro.massey.ac.nz/handle/10179/294

Browse

Subject: search.filters.subject.Emergency medical services

Search Results

Now showing 1 - 4 of 4
  • Thumbnail Image
    Item
    Seasonal demand for emergency department services : a thesis presented in partial fulfillment of the requirements for the degree of Master of Information Systems in Information Systems at Massey University, Palmerston North, New Zealand
    (Massey University, 2008) Coutts, Dirk Annandale
    There may be various explanations for what appears to be temporary breakdowns in the operations of Emergency Departments. One obviously can not anticipate natural disasters - what is also referred to as acts of God, but what of other situations which may develop ever so often? This begs several questions, including: • Are there "seasonal" factors at play which influence the influx of ED attendances? • And if that is the case - are there "seasonality"-related problems with the management of such surges in demand for ED services? In fact, when questions to this effect were first raised with some in ED Management in the "District" (managed by the District Health Board) the existence of "seasonality" was acknowledged, as was its potential for causing operational difficulties. In other words, there is an acknowledgement that there are "ebbs and flows" in demand for Emergency Services, and that while such can not always be anticipated absolutely, an attempt must none the less be made to pre-empt its fluctuations more accurately, and thus the following rephrased problem description "derived" from the foregoing questions: There seems to be some seasonality in the demand for ED services and it is causing operational difficulties. · For the purpose of brevity the following succinct Problem Description will be used liberally throughout the remainder of this Research Project / Thesis, namely that this is an attempt at determining Seasonal Demand for ED Services. This compacted rework of the original questions and discussion therefore represent mentioned questions and discussion. Whenever used in the remainder of this Research Project it implies that which precedes it in Chapter 1.1. For the time being that will suffice, but the author will define "season" and "seasonality" more specifically later in the Thesis, in view of some of the earlier "weather" / "season"-related studies mentioned in the Literature Review / References (Section 2.4.2 of Chapter 2). [FROM INTRODUCTION]
  • Thumbnail Image
    Item
    An analysis of the trauma management system in a predominantly rural New Zealand setting : a preventable death study : a thesis presented in partial fulfilment of the requirements for the degree of Master of Business Studies in Health Systems Management at Massey University
    (Massey University, 2000) Lockhart, Caroline Anne
    A one-year prospective study of all trauma deaths in the greater Manawatu region is reported on in this thesis. The aims of the study were to first, establish a database of the trauma deaths and second, to analyse trauma management systems within the region. A total of 56 cases satisfied the inclusion criteria for the 12-month study period. Deaths by category of trauma for the population were 31 (55.3%) road crash victims; 16 (28.5%) deaths due to suicide; five (8.9%) homicidal deaths; and, four deaths due to other causes, namely a fall, an electrocution, burns and one drowning following a head injury. Of these 36 (64%) were found by ambulance services to be 'in cardiac arrest' and five (8.9%) were 'not in cardiac arrest' but died later at the scene. One case died in transit and 14 cases (25%) died in hospital. Data on pre-incident factors such as alcohol, speed and safety practices showed that eight (24%) of the 31 motor vehicle related deaths had positive blood alcohol levels. Inappropriately high speed was an additional factor in three of these deaths as was the absence of safety equipment. Co-morbidity, where this existed, was also found to be a significant factor. Post-incident factors which influenced the fatal outcome of the incident included geographical location and ensuing access to the individual, the actual injuries sustained, and the provision of timely and appropriate treatment of injuries. An expert panel was convened to classify the deaths and evaluate the care provided by personnel in the trauma management system. The panel identified a number of pre-hospital and in-hospital deficiencies but determined that these deficiencies had no effect in terms of deaths. Of the twenty cases evaluated, eighteen deaths were classified as 'not preventable', one death was unable to be classified by the panel, and one death was classified 'possibly preventable'. If the trauma system in the greater Manawatu region had been flawless one life may have been saved - (5%) of the trauma death population. It is recommended that an efficacy study (encompassing both live and dead trauma victims) is conducted in the region to provide a more accurate perspective and evaluation of the trauma management system. The opportunity exists for further research to be conducted in an area with a similar geography and population distribution, also serviced by one second-level hospital, that does not currently have a regional trauma system in place.
  • Thumbnail Image
    Item
    Patients' attitudes to analgesics and expectations of emergency care : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University, Palmerston North, New Zealand
    (Massey University, 2009) Lemow, Jolanda Jozefa
    Alleviating pain and suffering has long been a goal of health professionals. Pain has been shown to be one of the leading reasons that patients present to emergency departments (ED) throughout the world and the use of analgesics in ED's has been extensively explored. What has been less extensively researched is why some patients in pain choose not to use analgesics and what it is that they expect from emergency health care. The present work is an exploratory study looking at the attitudes of patients in pain, presenting to an urban ED and declining analgesics. It asks why patients decline analgesics and what they expect from emergency care. Seven participants were recruited over a two month period and volunteered to participate in semi-structured interviews while waiting to see a health professional. Four women and three men participated. Thematic analysis led to several themes being reported. People did not like taking analgesics because their injury was "not that painful"; they used "pain as a reference point"; and they had an "aversion to taking medications". Reasons for accessing emergency services included a "need to know what's wrong" and a belief that "diagnostic tests" were required. A surprising theme to emerge was the use of dental pain as a reference point for pain tolerance and pain behaviours. It was concluded that health professionals should accept that some patients in pain do not desire analgesics. Patients have non-pharmacological means of coping with pain. They access emergency care for diagnosis, active treatment, and have an underlying need to understand the cause of their pain. It is suggested that future study might include interviews with health professionals to compare and contrast their subjective perceptions with objective observations and to investigate the use of dental pain as a reference point.
  • Thumbnail Image
    Item
    Patients who present to the Emergency department but do not wait : an exploratory study : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Nursing at Massey University
    (Massey University, 2004) Baur, Peter
    People who do not require urgent treatment often visit Emergency Departments. Furthermore, a small - yet significant - group leave the Emergency Department (ED) before even being seen by a doctor. Previous studies suggest that most people who do not wait (DNW) having presented to the ED and then leave without being seen by a doctor may have non-urgent conditions. However, other studies contradict this. This is an exploratory study into this subject. Its main aims are to: □ correctly define this DNW group who present to EDs; □ identify the size of a DNW population in a New Zealand setting; □ establish common factors that influence people's decision to present then leave and; □ ascertain whether nursing practice may impact on this population of emergency presentations. Data collection took place, over a period of 4 months, in a Level 5 District Health Board Emergency Department in New Zealand. The study uses a retrospective cross-sectional postal survey design to secure data on people's experiences of the ED, asking them, amongst other things, why they did not wait. The study sample consisted of 642 people. 489 people were sent postal surveys which resulted in a response rate of 18% (n = 92). Data was analysed and compared using a combination of quantitative and qualitative techniques, using SPSS© and MS Excel© statistics software, elements of operations research (field observation) and content analysis. Subjective data was illuminated and extended by qualitative methods, namely interpretative and descriptive content analysis and an abstract conceptualisation of the themes generated is offered. Regional Ethics Committee approval was sought and granted prior to this investigation commencing. The results indicate that the majority of DNWs occur during daylight hours. The mean age of those who DNW was 27 years. They tended to be male. The greatest proportion of the DNW population analysed lived locally and waited a mean time of 112 minutes before choosing to leave. All Australasian Triage Scale categories (except ATS 1) demonstrated examples of those who took a DNW discharge. The most common complaints people presented with were ones they had endured for more than 12 hours and were sometimes days old. A high proportion of people reported that they received definitive treatment within 12 -24 hours following their departure from the ED. Common themes identified as reasons people chose to leave the ED related to their perception of action, perception of their illness and environment. Additional themes extracted from the data that influenced people's decisions to leave concerned their perceptions of staff communication/behaviour; systems processes; feelings of abandonment; other commitments and waiting time.