Transport Delay Research Articles

Reducing Inpatient Transport Delays: The Right Patient at the Right Time

Introduction: Transportation of inpatients throughout hospitalization remains a critical aspect of patient care. Transport delays hinder the timely delivery of surgical procedures, radiology, and patient triage, consequently impacting the flow and receipt of treatment. This study reviews transport delays in a quaternary care hospital's inpatient orthopedic unit to the preoperative unit. The goal of the project was to reengineer processes for maximized efficiency and improve on-time starts for all surgical services. Methods: Manufacturing methods of an assembly-line–like model and contemporary process-improvement tools in Lean and Six Sigma were used to gauge, reengineer, and monitor processes to ameliorate patient flow. In addition to value streamlining the flow, evaluating communication triggers, eliminating redundant operations, and shifting roles and responsibilities, multiple data sources were used to assess flow for a redesign. Results: Changes in process operations led to a 40% decrease in delays. The grace period for 100 cases was decreased by 5 minutes, in addition to a savings of $110,000 in operating room costs in the first week and 3.5 full-time equivalents annually. Physician satisfaction with timely patient arrival increased in addition to a simplified workflow, which improved patient readiness on the inpatient surgical floor and increased safety. Discussion: Using data-driven approaches, overnight acuity level was removed as a barrier to the timely care of add-on cases. With a standardized process, prediction model, and simplified evidence-based communication strategies coupled with a “pull” manufacturing model, we implemented a structured, safe, and reliable method of efficient patient transport.

Analisis Resiko Operasional dalam Industri Travel Yuk Kita Tour Untuk Meningkatkan Efisiensi dan Kepuasan Pelanggan

This study aims to investigate the identification, assessment, and control of operational risks in the travel industry, with a focus on PT Yuk Kita Tour. Direct observation and interview methods are used to identify the risks faced by the company. Risk assessment is conducted by considering the likelihood of occurrence and its impact on the company's operations, followed by appropriate mitigation strategies. The analysis results show that risks such as online booking system disruptions, lack of staff training, currency exchange rate fluctuations, regulatory changes, natural disasters, disease outbreaks, transportation delays, and terrorism threats affect operational efficiency and customer satisfaction.To control these risks, PT Yuk Kita Tour implements a comprehensive mitigation strategy, including improved cybersecurity systems, staff training programs, currency hedging strategies, active regulatory monitoring, travel insurance, strict health policies, cooperation with transportation operators, and clear security information to customers. The implementation of these risk control strategies has had a positive impact on the company's performance, with year-on-year increases in revenue and customer satisfaction. This study provides insights into the importance of operational risk management in the travel industry and demonstrates that a proactive approach to risk identification, assessment, and control is possible. This study provides insight into the importance of operational risk management in the travel industry and demonstrates that a proactive approach to risk identification, assessment, and control can improve operational efficiency and customer satisfaction. The practical implication of this study is the importance of continuously monitoring existing risks, adapting control strategies, and involving stakeholders in risk management to ensure sustainable business continuity and superior customer service in a dynamic business environment.

Assessing vessel transportation delays affected by tropical cyclones using AIS data and a bayesian network: A case study of veronica in northwestern Australia

Tropical cyclones frequently disrupt maritime transportation systems, impacting the normal operation of vessels and causing transportation delays. Analyzing the occurrence and degree of vessel transportation delays under disaster conditions is one of the critical aspects of maritime transportation management. This article, based on Automatic Identification System (AIS) data, examined the real behavioral trajectories of vessels and delay characteristics during tropical cyclones. Taking the example of Tropical Cyclone Veronica, which occurred in the waters off northwestern Australia in 2019, we conducted a comprehensive analysis. This involved numerical simulations of the entire disaster process and the cleaning and matching of trajectory data for all affected vessels in the area. We delved deeply into the relationship between vessel behavior characteristics and tropical cyclones, identified factors contributing to delays, and, based on our findings, constructed a Bayesian network inference model for vessel transportation delays under disaster conditions. This model uses information such as tropical cyclone intensity, vessel basic attributes, behavior choices, and port disaster avoidance measures as its primary nodes. The research results indicate that vessel rerouting, vessel loss of control, and waiting for port entry are the three major sources of vessel delays during disasters. Key influencing factors contributing to these consequences include port closure measures, the duration of vessels being adversely affected by strong winds, vessel tendencies toward loss of control, and risk preferences. To control the extent of vessel delays more effectively, it is crucial to prioritize these sensitive factors and strengthen monitoring and management efforts. This model is driven by real data, providing an objective reflection of real-world scenarios, and its effectiveness has been validated through sensitivity analysis. The research perspective and algorithmic framework presented in this paper offer a novel paradigm and fresh perspective for the study of maritime transportation disasters. The research findings have significant implications for bolstering the resilience of maritime transportation networks, enhancing our comprehension and anticipation of delays, and ensuring the continuity, security, and efficiency of the global supply chain for goods.

Coercion During Psychiatric Ambulance Versus Police Transport in Mental Health Crises: A Pre- and Postimplementation Study.

Police officers are often the first responders when individuals experience a mental health crisis and typically remain responsible for transport to a psychiatric emergency department. In 2014, a psychiatric ambulance (PA) was introduced in the city of Amsterdam to take over the transport of individuals in a mental health crisis. The purpose of the PA was to use fewer restrictive measures while guaranteeing safety for both patients and personnel. A preimplementation-postimplementation design was used to assess the feasibility and utility of a single-vehicle PA service compared with police transport. Data on 498 rides were collected in the 4 months before implementation of the PA (pre-PA cohort) and on 655 rides in the 6 months after implementation (PA cohort). After PA implementation, most patients were transported by the PA (82%), and rides by police vehicle were very rare (1%). Individuals in the PA cohort had a greater transportation delay, compared with those in the pre-PA cohort, but the PA reduced use of coercive measures with no increase in the incidence of patient aggression. Among individuals in the PA cohort, hospitalization was more often voluntary than among those in the pre-PA cohort. Transporting emergency psychiatric patients by a special PA rather than by the police reduced the use of coercive measures during transport, kept the occurrence of aggressive incidents stable, and was associated with fewer coercive hospital admissions.

Research on Optimization of International Multimodal Transportation Routes Based on Uncertainty Theory

Delays in international multimodal marine transport can result in subsequent connection delays, leading to prolonged transportation time and increased uncertainty. To identify more reliable and cost-effective robust transportation routes, this study establishes a constrained planning model for multimodal transportation routes. Employing uncertainty theory, the model is transformed into a deterministic equivalent class model and ultimately incorporates an adaptive differential evolution (ADE) algorithm. Results of a case study indicate that: (i) the proposed model, compared with deterministic models, exhibits greater robustness and better aligns with practical transportation scenarios, resulting in substantial reductions in actual transportation time and cost; (ii) the solution efficiency of the ADE algorithm surpasses that of the genetic algorithm and Dijkstra algorithm; (iii) the start time of transportation and the confidence level of uncertainty also play crucial roles in influencing route selection. Therefore, decision-makers should consider a multifaceted approach when formulating transportation routes.

Unraveling Extreme Weather Impacts on Air Transportation and Passenger Delays Using Location-Based Data

Unraveling Extreme Weather Impacts on Air Transportation and Passenger Delays Using Location-Based Data

A State-Interactive MAC Layer TDMA Protocol Based on Smart Antennas

Mobile ad hoc networks are self-organizing networks that do not rely on fixed infrastructure. Smart antennas employ advanced beamforming technology, enabling ultra-long-range directional transmission in wireless networks, which leads to lower power consumption and better utilization of spatial resources. The media access control (MAC) protocol design using smart antennas can lead to efficient usage of channel resources. However, during ultra-long-distance transmissions, there may be significant transport delays. In addition, when using the time division multiple access (TDMA) schemes, it can be difficult to manage conflicts arising from adjacent time slot advancement caused by latency compensation in ultra-long-range propagation. Directional transmission and reception can also cause interference between links that reuse the same time slot. This paper proposes a new distributed dynamic TDMA protocol called State Interaction-based Slot Allocation Protocol (SISAP) to address these issues. This protocol is based on slot states and includes TDMA frame structure, slot allocation process, interference self-avoidance strategy, and slot allocation algorithms. According to the simulation results, the MAC layer design scheme suggested in this paper can achieve ultra-long-distance transmission without conflicts. Additionally, it can reduce the interference between links while space multiplexing. Furthermore, the system exhibits remarkable performance in various network aspects, such as throughput and link delay.

Reducing blood product wastage through the inter-hospital redistribution of near-outdate inventory.

Hospital transfusion services order blood products to satisfy orders and maintain inventory levels during unexpected periods of increased blood demand. Surplus inventory may outdate before being allocated to a recipient. Blood product outdating is the largest contributor to blood wastage. A province-wide redistribution program was designed and implemented to redistribute near-outdate plasma protein and related blood products from low-usage to high-usage hospitals. Program operations and details are described in this paper. Two transport container configurations were designed and validated for transport of all blood products. A cost-analysis was performed to determine the effectiveness of this redistribution program. A total of 130 hospital transfusion services contributed at least one near-outdate blood product for redistribution between January 2012 and March 2020. These services redistributed 15,499 products through 3412 shipments, preventing the outdating of $17,570,700 CAD worth of product. Program costs were $14,900 for shipping and $30,000 for staffing. Failed time limits or non-compliance with packing configurations resulted in $388,200 worth of blood products (97 shipments containing 816 products) being discarded. Courier transport delays was the most common reason (42/97; 43%) for transport failure. Redistributing near-outdate blood products between hospitals is a feasible solution to minimize outdating. Despite heterogeneity of Canadian blood product inventory, all products (each with unique storage and transport requirements) were successfully redistributed in one of two validated and simple containers. Total operation costs of this program were small in comparison to the $17.6 million in savings associated with preventing the discard of outdated products.

Virtual Sensing of Key Variables in the Hydrogen Production Process: A Comparative Study of Data-Driven Models.

Hydrogen is an ideal energy carrier manufactured mainly by the natural gas steam reforming hydrogen production process. The concentrations of CH4, CO, CO2, and H2 in this process are key variables related to product quality, which thus need to be controlled accurately in real-time. However, conventional measurement methods for these concentrations suffer from significant delays or huge acquisition and upkeep costs. Virtual sensors effectively compensate for these shortcomings. Unfortunately, previously developed virtual sensors have not fully considered the complex characteristics of the hydrogen production process. Therefore, a virtual sensor model, called "moving window-based dynamic variational Bayesian principal component analysis (MW-DVBPCA)" is developed for key gas concentration estimation. The MW-DVBPCA considers complicated characteristics of the hydrogen production process, involving dynamics, time variations, and transportation delays. Specifically, the dynamics are modeled by the finite impulse response paradigm, the transportation delays are automatically determined using the differential evolution algorithm, and the time variations are captured by the moving window method. Moreover, a comparative study of data-driven virtual sensors is carried out, which is sporadically discussed in the literature. Meanwhile, the performance of the developed MW-DVBPCA is verified by the real-life natural gas steam reforming hydrogen production process.

IDENTIFICATION AND EVALUATION OF DISTRIBUTION RISK IN FOOD SUPPLY CHAIN USING AHP METHOD

The study aims to present a structured approach for identifying and assessing distribution risk within the food supply chain by employing the Analytic Hierarchy Process (AHP) method. Through a comprehensive literature review, various risk factors impacting the distribution network of food supply chains are identified, facilitating the development of a hierarchical framework. This framework integrates multiple criteria and sub-criteria to enable a systematic evaluation of distribution risks, considering aspects such as transportation delays, inventory management, quality control, and supplier reliability. The AHP method is then applied to assign relative weights to these criteria, allowing for a quantitative analysis of risk levels and prioritization of mitigation strategies. The findings reveal that the AHP model offers a valuable decision-making tool for stakeholders in the food industry to proactively manage and mitigate distribution risks, thereby enhancing operational efficiency and ensuring food safety and security. Keywords: identification, evaluation, distribution risk, food supply chain, Analytic Hierarchy Process (AHP), criteria, mitigation strategies, operational efficiency, food safety.

A coordinated operation method for networked hydrogen-power-transportation system

Hydrogen fuel cell vehicles have been promoted as a complement to electric vehicles (EVs) to facilitate the decarbonization of transportation networks (TNs). The coordinated operation of a networked hydrogen-power-transportation system with distributed hydrogen supplies is proposed in this research. To maximize the synergistic effect, TN's couplings in hydrogen transport delays and refueling/charging demand are further integrated into the conventional hydrogen-power system. The objective is to maximize the total profits, subject to both the coupling and network constraints. To present the storage effect of hydrogen tube trailers with delays, an extended discrete user equilibrium (UE) is developed and the traditional UE is adopted to formulate refueling-charging demand couplings. Considering the hydrogen supply process, it especially involves the constraints of hydrogen production, storage, utilization, and dispensation. A data-driven robust chance-constrained programming is provided to account for multiple uncertainties from energy/traffic demand and renewable power. Simulation results of the 48-node system show that the proposed model improves the total profits.

Resonant effect and models of InP-based photodiode

In this paper, the frequency responses of InP/InGaAs vertical-incidence p-i-n photodiodes with various optical apertures of 50–80 μm are investigated. The same resonant frequency (fR) of approximately 1.02 GHz was observed for all device apertures. There are two conditions that can lead to the resonance of the frequency response. Therefore, an equivalent circuit model and a carrier transport model were used to fit and analyze the resonance curve. We then found that the resonant circuit can produce frequency response oscillations, but the peak position occurs at a higher frequency and the radio-frequency response drops more rapidly, which does not match the measured curve. Therefore, we believe that carrier transport delay is the main cause of the resonance. Based on the energy bands of our detectors and comparison with a reference device, it was found that when the blocked holes at the InGaAsP/InGaAs heterojunction interface tunnel through the potential barrier, a resonant frequency could be induced. Using our material structure and tunneling model, the tunneling frequency of the holes was calculated to be 0.99 GHz, which matched the measured resonant frequency value. Our resonant models provided two methods to improve the bandwidth for various photodetectors without any other change on the performance characteristics.

Reliability assessment of integrated electricity and district cooling systems considering the thermal dynamics of pipelines and buildings

The tight interactions between energy sectors increase the risk of affecting integrated energy systems (IESs); therefore, reliability assessment is important for identifying vulnerability and improving security in IESs. In the literature, the network topology, transmission loss, and distinguishing thermal dynamics in IESs are seldom addressed for reliability assessment, rendering the results unreliable. To bridge this gap, an integrated electricity and district cooling model is formulated for IESs that involves elaborate network topologies and transmission losses to reflect their impacts on reliability characteristics. In addition, the evaluation of reliability indices for district cooling systems is improved by considering the thermal inertia characteristics of buildings and the transportation delay of circulating water to characterize the reliability levels of district cooling systems more accurately. Numerical results using a 12-node case validate the improved accuracy of the proposed reliability assessment method and reveal the potential of district cooling systems for enhancing the reliability of power systems.

Reducing maternal mortality in low- and middle-income countries: the Nepalese approach of helicopter retrieval

Ninety-four percent of global maternal deaths occur in low- and middle-income countries (LMICs). The UN has a goal of reducing maternal deaths to <70 per 100,000 live births by 2030, but progress is minimal. Maternal deaths in LMICs are associated with 3 delays in the care of women with obstetrical emergencies: 1) in the family of the woman realizing that her life is at risk, 2) in the transport of the woman to a hospital, and 3) in providing care after arrival at the hospital. These 3 delays function like links in a chain, and failure of any link leads to maternal death. LMICs have characteristics that make it likely that the chain will break. Women in LMICs frequently have low standing, and cultural beliefs often lead to delay in the recognition of obstetrical emergencies. LMICs are characterized by poor roads and long distances to hospitals leading to transport delays. Cultural and other factors also lead to treatment delays when a woman reaches a suitably-equipped and staffed hospital. Nepal has addressed these delays and reduced maternal mortality. Firstly, we have reported in the Journal the use of culturally acceptable approaches to improving the knowledge about antenatal care in remote villages. In the case of Nepal, singing songs related to maternal care proved to be a highly effective strategy. We now report that the government of Nepal has repurposed military helicopters to overcome the tyranny of poor roads to allow rapid transport of women with obstetrical emergencies to a small number of fully-equipped and staffed hospitals. As of June 2023, this service has successfully retrieved 625 women in four and half years. The Nepalese government has included questions on maternal mortality in the 2021 national census, followed by a verbal autopsy. These data indicate a fall in the maternal mortality ratio from 239 in 2016 to 151 in 2021. The efficiency of the triage service continues to improve, suggesting that maternal mortality will continue to fall. This may provide a model that can be implemented in other LMICs and highlights factors that may be responsible for recent increases in the US maternal mortality ratio.

A Robust Distributed Algorithm for Solving the Economic Dispatch Problem with the Penetration of Renewables and Battery Systems

In the field of energy networks, for their effective functioning, it is necessary to distribute the required load between all online generating units in a proper way to cover the demand. The load schedule is obtained by solving the so-called Economic Dispatch Problem (EDP). The EDP can be solved in many ways, resulting in a power distribution plan between online generating units in the network so that the resulting price per unit of energy is minimal. This article focuses on designing a distributed gradient algorithm for solving EDP, supplemented by models of renewable sources, Battery Energy Storage System (BESS), variable fuel prices, and consideration of multiple uncertainties at once. Specifically, these are: time-variable transport delays, noisy gradient calculation, line losses, and drop-off packet representations. The algorithm can thus be denoted as robust, which can work even in unfavorable conditions commonly found in real applications. The capabilities of the presented algorithm will be demonstrated and evaluated on six examples.

Predictors of clinical deterioration and intensive care unit admission in trauma patients transferred from northern Quebec to a level 1 trauma centre: a retrospective cohort study.

Trauma care in Nunavik, Quebec, is highly challenging. Geographic distances and delays in transport can translate into precarious patient transfers to tertiary trauma care centres. The objective of this study was to identify predictors of clinical deterioration during transport and eventual intensive care unit (ICU) admission for trauma patients transferred from Nunavik to a tertiary trauma care centre. This is a retrospective cohort study using the Montreal General Hospital (MGH) trauma registry. All adult trauma patients transferred from Nunavik and admitted to the MGH from 2010 to 2019 were included. Main outcomes of interest were hemodynamic and neurologic deterioration during transport and ICU admission. In total, 704 patients were transferred from Nunavik and admitted to the MGH during the study period. The median age was 33 (interquartile range [IQR] 23-47) years and the median Injury Severity Score was 10 (IQR 5-17). On multiple regression analysis, transport time from site of injury to the MGH (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.01-1.06), thoracic injuries (OR 1.75, 95% CI 1.03-2.99), and head and neck injuries (OR 3.76, 95% CI 2.10-6.76) predicted clinical deterioration during transfer. Injury Severity Score (OR 1.04, 95% CI 1.01-1.08), abnormal local Glasgow Coma Scale score (OR 2.57, 95% CI 1.34-4.95), clinical deterioration during transfer (OR 4.22, 95% CI 1.99-8.93), traumatic brain injury (OR 2.44, 95% CI 1.05-5.68), and transfusion requirement at the MGH (OR 4.63, 95% CI 2.35-9.09) were independent predictors of ICU admission. Our study identified several predictors of clinical deterioration during transfer and eventual ICU admission for trauma patients transferred from Nunavik. These factors could be used to refine triage criteria in Nunavik for more timely evacuation and higher level care during transport.

Penetrating Fishhook Ocular Injury: Challenging management in low- resource country

Introduction : Fishing is a common income source in rural areas, but fishhook eye injuries are rare. This report describes a case of a rare penetrating fishhook ocular injury, which resulted in endophthalmitis and eye evisceration, and highlights the challenges caused by delayed referral and limited options for intravitreal antibiotics due to inadequate consumable availability.&#x0D; Case Illustration : A 13-year-old boy from Vanuatu had a fishhook in his right eye and was referred to an Ophthalmologist one day later due to unavailability of flights. Upon arrival, endophthalmitis signs were noted, with the left eye having a visual acuity of 6/7.5 and the right eye showing only hand movement. The right eye showed corneal edema and a blood stain around the fishhook, fresh keratic precipitates, discharge and conjunctival edema. The fishhook was removed, and the cornea repaired under local anesthesia. On Day 1 post-operation, Intravitreal vancomycin and moxifloxacin were administered after procuring privately from pharmacies outside the hospital. However, the patient's condition worsened, requiring evisceration of the right eye.&#x0D; Discussion : Prompt management of penetrating eye injuries is crucial, with patients requiring broad spectrum antibiotics, tetanus shots, and an eye shield during referral. However, challenges such as lack of an eye shield and transportation delays worsened the patient's condition before arrival. This case also highlights the challenges faced in treating the patient effectively by the ophthalmologist due to limited options intravitreal antibiotics.&#x0D; Conclusion Timely management and urgent referral are crucial in low-resource areas to prevent complications. Essential consumables are necessary for effective treatment by an ophthalmologist.

The lived experiences of healthcare professionals working in pre-hospital emergency services in Jordan: A qualitative exploratory study

IntroductionGlobally, injuries account for 9% of all deaths, with road accidents contributing to approximately a quarter of these fatalities. A major concern is the inadequacy of pre-hospital care (emergency medical services provided before arrival at a hospital) and delays in transportation to medical facilities, identified as leading causes of preventable injury-related deaths. This study explores the experiences of emergency health professionals (EHPs) in peri-hospital services (emergency medical services provided immediately upon arrival and within the hospital setting). MethodsA qualitative exploratory design, underpinned by Van Manen’s (1990) descriptive phenomenological principles, was used. Thirty EHPs from five central and southern Jordanian emergency departments were purposefully sampled, including physicians, nurses, and paramedics from both emergency departments and pre-hospital services. ResultsTwo primary themes emerged: (1) In Search of Clarity: The Unsettled Journey of Pre-hospital Emergency Care Providers; (2) Frustrations on the Frontline: Role Ambiguity and Emotional Exhaustion in Trauma Care, with EHPs reporting fluid and unclear roles, physical and verbal abuse, and limited authority in critical interventions. ConclusionThe study highlights several service lapses in peri-hospital care that negatively impact healthcare professionals, posing risks to patient safety. These findings urge decision-makers to devise actionable strategies to rectify these deficiencies, enhancing care quality and thereby decreasing injury-induced mortality and morbidity.

Study of Pre-Analytical Errors in Laboratory &amp; Steps to Improve

Objectives: Pre-analytical errors decisively influence the total laboratory errors and consequently the diagnostic accuracy. The following were the objectives of the study. 1) To detect the percentage of pre-analytical errors in venous specimens in Laboratory. 2) To categorize these pre-analytical errors. 3) To formulate steps of corrective measures to avoid such type of errors. Study Design and Result: Type of Study - Retrospective study. Study period - 12 months (June 2015 to May 2016), documenting the frequency and type of pre-analytical errors. Results: Total number of pre-analytical errors detected in the period of 12 months’ study were 180. Improper timing of specimens, hemolyzed &amp; clotted specimens and improper requests were the major concerns followed by delay in specimen transport. Conclusion: Pre-analytical phase is an important component of Total Laboratory Quality. Pre-analytical errors are not inevitable and can be avoided or minimized with diligent application of quality control, continuing education, effective protocols, and standardized procedures for effective blood collection systems to ensure total Quality patient care.

Water Reservoir Placement Methodology for Forest Firefighting: A Case Study of Valparaíso, Chile

Climate change has a significant impact on generating forest fires. These fires damage property, interrupt productive processes, reduce employment sources, and generate direct economic losses. Also, fires contribute to climate change, resulting in a negative cycle. Therefore, the effective management of forest fires is of vital importance. This research focuses on the combat and mitigation phase of forest fires, with special emphasis on using helicopters to transport water from nearby reservoirs to the fire site. The location of these reservoirs is key since a greater distance traveled by helicopter means a longer delay in water transport, which favors the spread of the fire. For this reason, this research proposes an optimization model to determine the optimal location of these reservoirs in a territory. The proposed model is illustrated with a case study of the region of Valparaiso, demonstrating its usefulness for management and decision making when locating reservoirs for firefighting.