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Context: An emergency department (ED) in a hospital provides 24-hour care for the injured/severely ill patients.EDs are essential in any health care system. However, they face many challenges to provide timely treatment such as shortage of specialists, inadequate infrastructure, and unavailability of hospital beds, among others. These challenges are worldwide and undermine the effectiveness of operations and quality of services throughout the hospital. Methods: This study aims to improve the performance of EDs using key performance indicators (KPIs). The KPIs will help decision makers to monitor and manage the performance of EDs systematically. Based on an in-depth field study, expert opinions, and literature review, we propose 5 categories of KPIs regarding Capacity for, Temporality of, Quality of, Outcomes of, and Economics of emergency care. The KPIs are applicable to the basic stages of emergency care. The achievement of the KPIs in each stage will be a function of (1) how the KPIs are used, (2) resources for achieving the KPIs, and (3) management of the resources. The unified systemic framework to manage EDs is presented as an ontology that articulates the very large number of potential ways of ED performance management. Results: Seventy-five KPIs were defined for monitoring purposes. The KPIs and the proposed framework were validated and applied in 2 EDs at a public children's hospital and a medium size clinic in Chile.Conclusions: Based on the study, we propose to standardize the essential information necessary to assess the

Planning and Scheduling tools used by construction professionals nowadays not always consider the effect of variability in the construction process; they do not consider explicitly the effect of changes in activity durations along the production chain. Discrete event simulation approach is a relevant exception that deserves particular attention from the construction industry. The present research proposes a discrete event simulation model applied to a simplified construction process schedule. This model considered main construction activities divided in: foundations, structure and roofing. The model can be extended and easily applied to other construction activities. Input parameters for the model were obtained directly from on-site field experience and a beta unimodal distribution assigned. On a first stage, PERT scheduling methodology was used for the model, which was later compared with discrete event simulation. Results did not provide evidence of significant statistical differences between different probability distribution used with respect to the mean project duration obtained using PERT scheduling as compared to the discrete event simulation model. This provides conclusions about total project duration and validation of the probability distribution types considered in the present research.

This work reports on the results obtained from the application of learning environments on the basis of one integrative problem and a series of other smaller problems that limit the contents to be investigated and learned by the students. This methodology, which is a variation to traditional problem-based learning approaches, is here illustrated in terms of its application in an engineering economics course, a subject that is taught in most engineering programs. The purpose of this methodology is to improve students' learning, which is measured through the students' academic performance and their learning strategies, and to characterise them as a function of these variables. The results obtained after the systematic application of this methodology are positive. The surveyed students showed significant changes in the examined variables as well as in their satisfaction and motivation level, and in their commitment to learning.

BackgroundIn Chile, the use of costing systems in the public sector is limited. The Ministry of Health requires hospitals to manage themselves with the aim of decentralizing health care services and increasing their quality. However, self-management with a lack of accounting information is almost impossible. On the other hand, nutrition department costs have barely been studied before, and there are no studies specifically for activity based costing (ABC) systems. ABC focuses on the process and traces health care activities to gain a more accurate measurement of the object costs and the financial performance of an organization.MethodThis paper uses ABC in a nutrition unit of a public hospital of high complexity to determine costs associated with the different meals for inpatients. The paper also provides an activity based management (ABM) analysis for this unit.ResultsThe results show positive effects on the reduction of costs for the nutrition department after implementing ABC/ABM. Therefore, there are opportunities to improve the profitability of the area and the results could also be replicated to other areas in the hospital. ABC shed light on the amount of nutritionist time devoted to completing paperwork, and as a result, system changes were introduced to reduce this burden and allow them to focus on more relevant activities. Additional efficiencies were achieved through the elimination of non-value adding activities and automation of reports. ABC reduced the cost of the nutrition department and could produce similar results in other areas of the hospital.ConclusionsThis is a practical application of a financial management tool, ABC, which would be useful for hospital managers to reduce costs and improve the management of the unit. This paper takes ABC and examines its use in an area, which has had little exposure to the benefits of this tool.