242 Background: Emergency Department (ED) surges at MD Anderson Cancer Center (MDACC) lead to overcrowding, safety risks, privacy concerns, staff burnout, and adverse events associated with delays in care, including death. In 2015, the ED Interdisciplinary Quality & Safety Committee (EDIQSC) at MDACC was developed to review and address safety events. We report on the preliminary results of a quality improvement project with a long-term goal of developing a systematic solution of proactively responding to ED surge and overcrowding (EDSO). Methods: First, EDIQSC reviewed the current literature regarding EDSO. Subsequently an ED Surge and ED Overcrowding Committee (EDSOC) was established to identify solutions to address patient safety risks and improve patient experience in the ED. Results: Literature review showed that NEDOCS (Weiss, SJ et al) was the best scoring tool to calculate ED Overcrowding levels. EDSOC’s weekly meetings facilitated by the Office of Performance Improvement (OPI) explored factors related to EDSO via FMEA a quality improvement tool that proactively evaluate process associated risks. In addition, the following immediate solutions were implemented in the ED: daily status reporting by ED to institutional leaders, a “fast-track” care area implementation, senior executive rounding during ED Surge, electronic medical record (EMR) configuration for high census accommodation, continuous ED Nursing Leadership unit needs assessment, and prioritization of needs based on hospital throughput. Additional interventions in current development include a real-time EMR dashboard accurately reflecting ED capacity, and a NEDOCS guided interdisciplinary operational action plan. Conclusions: ED Surge & Overcrowding is a complex issue with various external and internal contributing factors that cannot be solved with one approach. It is a dynamic, interdisciplinary system that requires vigilant planning, assessment of downstream change effects, stakeholder agility and continuous risk anticipation. EDSOC continues these efforts in an attempt to develop and implement a comprehensive, interdisciplinary tool to direct institutional operations during times of ED Surge & Overcrowding.
THE efficiency of factory legislation in our country has not been ub-T tained in a short time. Events in our industrial history have resulted in enactments made to meet the particular need of the event. In considering the history of England in the fourteenth century, two things stand out as having a powerful effect on the industrial conditions of our country, the great wars with France, and the Plague, which acted on the industrial conditions in the same way, that is, by producing a dearth of labourers. The wars with France lasted so many years that the proportion of able-bodied men who were killed was comparatively great; and in addition, the continued absence of labourers on the Continent brought down the numbers of possible labourers to a minimum. The service of the King made a more powerful appeal to the populace than the peaceful Industrial and agricultural calling. When the tide of human beings had flowed back to our Island, and there was a prospect of the conditions of labour becoming normal, tulle &dquo; Black Death&dquo; appeared and decimated the population. The dread disease was potent not only against the weak and ailing, hut against the strong and healthy; indeed, tlie latter appear to have suffered more than tlle former. The demand for labour was so much in excess of the supply that it enabled those men who could work to demand a high rate of wages. As a result of this the price of food stuff became excessive, and there is no doubt that the ravages of tlle plague in the later months were increased by the semi-starved state of the poorer classes. Affairs became so bad that in 1341i an Act was passed prohibiting labourers and certain craftsmen from taking more for their labour than they were wont to be paid during the previous six years. But it was found that although wages were reduced the prices of food remained high, with the result that the ordinary labourer could not obtain sufficient nourishment with t1e wages lie earned, and in order to remedy this there at Purdue University on June 12, 2015 rsh.sagepub.com Downloaded from 554 was passed in the same year an Act which prohibited bakers, butchers, and brewers from selliny food except at a reasonable price.It is interesting to note the methods then in vogue of obtaining obedience to the law, for the Bishops were requested to have these statutes published iu the churches and to direct the clergy to exhort and admonish their parishioners to observed the statutes.. A more forcible method was used in 1352, when an Act was passed fixing the wages of labourers and certain artificers at a definite standard, penalties being imposed for giving or receivingmore than this. The enactment was made only for the benefit of the employer, and the attempt at fixing wages with this end only in view naturally resulted in disaster.In the later years of Edward III. there was a marked growth in the manufactures of the country, and English wool, which had previously been exported to Flanders, was woven at home. Coincident with this increase, enactments were made with the...
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