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A new triage method, MBCE (Medical Bio Social Ethics), is presented with social justice, bio, and medical ethics for critical resource distribution during a pandemic. Ethical triage is a complex and challenging process that requires careful consideration of medical, social, cultural, and ethical factors to guide the decision-making process and ensure fair and transparent allocation of resources. When assigning priorities to patients, a clinician would evaluate each patient’s medical condition, age, comorbidities, and prognosis, as well as their cultural and social background and ethical factors.

A statistical analysis shows no interactions among the ethical triage factors. It implies the ethical components have no moderation effect; hence, each is independent. The result also points out that medical and bioethics may have an affinity for interactions. In such cases, there seem to be some ethical factors related to bio and medical ethics that are correlated. Therefore, the triage team should be careful in evaluating patient cases. The algorithm is explained with case histories of the selected patient. A group of triage nurses and general medical practitioners assists with the triage.

The MBCE triage algorithm aims to allocate scarce resources fairly and equitably. Another ethical principle in this triage algorithm is the principle of utility. In a pandemic, the principle of utility may require prioritizing patients with a higher likelihood of survival or requiring less medical care. The research presents a sensitivity analysis of a patient’s triage score to show the algorithm’s robustness. A weighted score of ethical factors combined with an assessment of triage factors combines multiple objectives to assign a fair triage score. These distinctive features of the algorithm are reasonably easy to implement and a new direction for the unbiased triage principle.

The idea is to make decisions about distributing and using scarce medical resources. Triage algorithms raise ethical issues, such as discrimination and justice, guiding medical ethics in treating patients with terminal diseases or comorbidity. One of the main ethical principles in triage algorithms is the principle of distributive justice.

Overcrowding continues to afflict emergency departments (EDs), and its attendant consequences are becoming increasingly severe. The burden of the COVID-19 pandemic is further escalating the situation worldwide. One of the most critical questions is how to adequately quantify what constitutes overcrowding and determine implications for operations management in improving service efficiency. This paper aims to discuss the aforementioned.

The authors propose the time and class complexity measures for ED service systems, taking into account important patient-level and system characteristics. Using an extensive data set from a Canadian ED, the authors investigate the performance of complexity-based measures in predicting service delays.

The authors find that the complexity measure is potentially more important than some well-known crowding metrics. In particular, EDs can improve service efficiency by managing the level of complexity within a desirable interval. Furthermore, complexity exposes how the interplay between demand-side behavioral changes and supply-side responses affects operational performance. Moreover, the results suggest that arrival patterns—the number of patients of each class arriving per time and times between events (arrivals and service completions)—increase the risk of service delays more than the demand volume.

This paper is the first to provide an extensive investigation into the application of the complexity-based measure for ED crowding. The study demonstrates potential values to be gained in ED service systems if complexity measure is incorporated into their operations management decisions.

The purpose of this discussion paper is to describe the transition over the past five years of a highly specialist group treatment programme to a tiered public health delivery model within the offender personality disorder (OPD) pathway. The focus of this journey of transformation has been the Challenge programme, currently the only OPD specialist service for men with sexual convictions in the community in England and Wales, and now a pan-London service.

More than 600 high-risk men with sexual convictions are screened into the OPD pathway and reside currently in the community across London. The programme leads have developed a triage model – based on the wider OPD model – that applies the principles of the least intervention necessary and the most effective use of limited resources.

Preliminary informal feedback was sought on the new consultation approach and innovative joint casework delivery models. The model of care is discussed in relation to the preliminary feedback, which was encouraging in terms of satisfaction with the consultation service and in terms of the people on probation who found that participating in the joint casework enhanced their working relationship with offender managers. The consistent use of a single model of care and a careful triage approach across the city to working with this group of individuals is still in development. Early feedback suggests that the service has to potential to be effective, but establishing this requires formal evaluation.

Practice implications include the need to address the lack of confidence that many practitioners report when working with people with sexual convictions. Virtually delivered group consultation may enhance the development of skills as it may providing a flexible toolkit for delivery.

This practice paper describes the only specialist community service for men with high-risk, high-harm sexual convictions and personality difficulties in the UK.

The purpose of this study is to explore the sustainability of innovations introduced during the coronavirus disease 2019 (Covid-19) pandemic in remote and rural primary care advanced clinical practice.

The methodology includes an exploratory qualitative study of eight key stakeholders from Scottish remote and rural primary care advanced practice (three policymakers and five advanced practitioners). Data were collected using semi-structured interviews during 2022 and analysed thematically.

Advanced practice in remote and rural primary care is characterised by a shortage of doctors, close-knit communities and a broad scope of practice. Covid-19 catalysed changes in the delivery of healthcare. Innovations which participants wanted to sustain include hybrid working, triage, online training and development, and increased inter-professional support networks.

Findings provide valuable insights into how best to support remote and rural advanced practice which may have implications for retaining healthcare professionals. They also identified useful innovations which could benefit from further investment.

Given current healthcare workforce pressures, identifying and sustaining innovations which will support and retain staff are imperative. Hybrid consultations and online access to training, development and support should be sustained to support the remote and rural advanced practice workforce. Further research should explore the sustainability of innovations introduced during the Covid-19 pandemic in other care contexts.

Patient length of stay (LOS) is an important indicator of emergency department (ED) performance. Investigating factors that influence LOS could thus improve healthcare delivery and patient safety. Previous studies have focused on patient-level factors to explain LOS variation, with little research into service-related factors. This study examined the association between LOS and multi-level factors including patient-, service- and organization-level factors.

This study uses a retrospective observational design to identify a cohort of patients from arrival to discharge from ED. A year-long data regarding patients flow trhoguh ED were analyzed using analytics techniques and multi-regression models. The response variable was patient LOS, and the independent variables were patient characteristics, service-related factors and organizational variables.

The findings of this study showed that older patients, middle triage and hospitalization were all associated with longer LOS. Service-related factors such as complexity of care provided, initial ward designation and ward transfer had a significant impact as well. Finally, prolonged LOS was associated with a higher ratio of patients per medical doctor and per nurse. In contrast, a higher number of residents in the ED were associated with longer patient LOS.

Previous studies on patient LOS have focused on patient-level factors, with little research on service-related factors. This study has addressed that gap by examining the association between LOS and multi-level factors including patient-, service- and organization-level factors. Patient-level factors included demographics, acuity, arrival shift, arrival mode and discharge type. Service-level factors consisted of first ward, ward transfer and complexity of care provided. Organizational factors consisted of three ratios: patients per MD, patients per nurse and patients per resident. The results add to the current understanding of factors that increase patient LOS in EDs and contribute to the body of knowledge on ED performance, operation management and quality of care. The study also provides practical and managerial insights that could be used to improve patient flow in EDs and reduce LOS.

This study presented the experience of improving the nucleic acid sample collection and transportation service in response to the epidemic. The main purpose is that through intelligent path planning, combined with the time scheduling of sample points, the process of obtaining results to determine the state of COVID-19 patients could be speeding up.

The research optimized the process, including finding an optimal path to traverse all sample points in the hospital area via intelligent path planning method and standardizing the operation through the time sequence scheduling of each round of support staff to collect and send samples in the hospital area, so as to ensure the shortest time in each round. And the study examines these real-time experiments through retrospective examination.

The real-time experiments' data showed that the proposed path planning and scheduling model could provide a reliable reference for improving the efficiency of hospital logistics. Testing is a very important part of diagnosis and prompt results are essential. It shows the possibility of applying the shortest-path algorithms to optimize sample collection processes in the hospital and presents the case study that gives the expected outcomes of such a process.

The value of the study lies in the abstraction of a very practical and urgent problem into a TSP. Combining the ant colony algorithm with the genetic algorithm (ACAGA), the performance of path planning is improved. Under the intervention and guidance, the efficiency of hospital regional logistics planning was greatly improved, which may be of greater benefit to critical patients who must go through fever clinic during the epidemic. By detailing how to more rapidly obtain results through engineering method, the paper contributes ideas and plans for practitioners to use. The experience and lessons learned from Tongji Hospital are expected to provide guidance for supporting service measures in national public health infrastructure management and valuable reference for the development of hospitals in other countries or regions.

This paper conceptualises how managers psychologically experience and respond to crises via metaphor analysis.

This paper uses a discourse dynamics approach to metaphor analysis. Conceptual metaphors were analysed and developed into concept maps through 37 semi-structured interviews with senior managers from different portfolios within 16 public universities in South Africa after #FeesMustFall protests.

Five domains emerged, including (1) looming crisis, (2) crisis onset, (3) crisis triage and containment, (4) (not) taking action and (5) post-crisis reflection. These domains shape a framework for the crisis adaptation cycle.

This study suggests that organisations should pay more attention to understanding emotions in crises and can use the adaptation model to develop their managers. It shows how metaphors can help explain affective and cognitive experiences and how emotions shift and evolve during a crisis. Managers should be aware of early signs of the crisis and its potential impact on their business operation in the looming and recognition stages, analyse the situation and work collectively on possible actions to minimise losses and maximise gains.

This is a rare investigation into the emotions of senior managers in the public sector in a social movement and national crisis via unconventional research methods to advance cognitive appraisal theory in crisis management.

In response to a critical need for uniform school crisis preparedness and response efforts across districts, the National Association of School Psychologists developed PREPaRE, a model and training curriculum aimed to equip school-based professionals to engage in comprehensive school crisis prevention and intervention practices. The PREPaRE acronym stands for: Prevent/Prepare for psychological trauma; Reaffirm physical health, security, and safety; Evaluate psychological trauma; Provide interventions (and) Respond to psychological needs; and Examine the effectiveness of prevention and intervention efforts. The model spans four crisis preparedness phases: Prevention, Mitigation, Response, and Recovery. This chapter provides a detailed overview of the development and structure of the PREPaRE model's core components and the organizational framework of the Incident Command System. It delineates elements of the basic school crisis response plan, assessment of mental health risk following a crisis event, and the provision of crisis interventions within a multitiered system of support framework. Additionally, it summarizes ongoing effectiveness and implementation research used to evaluate and improve the model based on immediate training outcomes assessed through pre and postmeasures and training transfer to applied school contexts. Implications for research and public policy regarding school safety and crisis prevention and intervention, as well as the future of PREPaRE curriculum development, are discussed.

Virtual care is any interaction between a patient and clinician or clinicians, occurring remotely using information technologies. Like many international services, United Kingdom (UK) ambulance services use paramedics and nurses to undertake telephone assessments of patients calling the 999 emergency service line. Using their clinical knowledge, experience, and, at times, computer decision support software, these clinicians assess patients from a range of clinical acuities to confirm the need for an emergency response or identify and support those patients who can be cared for with remote treatment advice and referral. The Covid-19 pandemic saw UK ambulance services change and adapt their operating models to meet social distancing requirements, increase clinical staff numbers and mitigate staff becoming unavailable for work due to self-isolation. One such strategy was moving clinicians from Emergency Operations Centres (EOCs) to working at home. Staff utilised digital phone systems, remote computer-aided dispatch modules, remote clinical decision support software and video platforms, which allowed close to full functionality compared to inside typical EOCs. There is a dearth of literature exploring the comparative practice of clinicians from home rather than from EOCs. Therefore, this study reports the findings of a qualitative analysis of these effects from the clinician's perspective. The authors hope that the findings from this study will inform the operating, education and leadership practices of those delivering such services.

A convenience sample of telephone nurses and paramedics from one UK ambulance service in which home working had been implemented were contacted. 15 clinicians with recent home working experience responded to the invite out of a possible 31 (48%). All participants had previously practised remote assessment from within an EOC. Semi-structured interviews took place via video conferencing software and were recorded, transcribed and thematically analysed. An inductive approach was taken to generating codes and both researchers separately reading the transcripts before re-reading them, assigning initial themes and determining frequency.

Four main themes were identified with further associated sub-themes: (1) performance, (2) support, (3) distractions and interruptions and (4) confidence in decision-making.

There are very few studies exploring the practice of remote clinicians in emergency EOCs. This study identified that home working clinicians felt their productivity had increased, making them more satisfied in their practice. However, there were mixed feelings over the level of support they perceived they now received, despite the mechanisms of support being largely the same. Supervisors found it especially challenging to provide support to practitioners; and employers might need to clarify the support mechanisms they provide to homeworkers. The elimination of distractions and interruptions was seen as a largely positive result of homeworking; however, these interruptions were not seen as inappropriate, thus, identifying a need for role clarity and task coordination rather than interruption elimination. Finally, clinicians felt that they become more confident when working from home, researching more, trusting themselves more and relying less on others to reach safe outcomes. However, there were missed opportunities to learn from listening to others' clinical practice.

Disaster management and humanitarian logistics (HT) play crucial roles in large-scale events such as earthquakes, floods, hurricanes and tsunamis. Well-organized disaster response is crucial for effectively managing medical centres, staff allocation and casualty distribution during emergencies. To address this issue, this study aims to introduce a multi-objective stochastic programming model to enhance disaster preparedness and response, focusing on the critical first 72 h after earthquakes. The purpose is to optimize the allocation of resources, temporary medical centres and medical staff to save lives effectively.

This study uses stochastic programming-based dynamic modelling and a discrete-time Markov Chain to address uncertainty. The model considers potential road and hospital damage and distance limits and introduces an a-reliability level for untreated casualties. It divides the initial 72 h into four periods to capture earthquake dynamics.

Using a real case study in Istanbul’s Kartal district, the model’s effectiveness is demonstrated for earthquake scenarios. Key insights include optimal medical centre locations, required capacities, necessary medical staff and casualty allocation strategies, all vital for efficient disaster response within the critical first 72 h.

This study innovates by integrating stochastic programming and dynamic modelling to tackle post-disaster medical response. The use of a Markov Chain for uncertain health conditions and focus on the immediate aftermath of earthquakes offer practical value. By optimizing resource allocation amid uncertainties, the study contributes significantly to disaster management and HT research.