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Offload delay is a prolonged interval between ambulance arrival in the emergency department (ED) and transfer of patient care, typically occurring when EDs are crowded. The offload zone (OZ), which manages ambulance patients waiting for an ED bed, has been implemented to mitigate the impact of ED crowding on ambulance availability. Little is known about the safety or efficiency. The study objectives were to process map the OZ and conduct a hazard analysis to identify steps that could compromise patient safety or process efficiency.
A Health Care Failure Mode and Effect Analysis was conducted. Failure modes (FM) were identified. For each FM, a probability to occur and severity of impact on patient safety and process efficiency was determined, and a hazard score (probability X severity) was calculated. For any hazard score considered high risk, root causes were identified, and mitigations were sought.
The OZ consists of six major processes: 1) patient transported by ambulance, 2) arrival to the ED, 3) transfer of patient care, 4) patient assessment in OZ, 5) patient care in OZ, and 6) patient transfer out of OZ; 78 FM were identified, of which 28 (35.9%) were deemed high risk and classified as impact on patient safety (n=7/28, 25.0%), process efficiency (n=10/28, 35.7%), or both (n=11/28, 39.3%). Seventeen mitigations were suggested.
This process map and hazard analysis is a first step in understanding the safety and efficiency of the OZ. The results from this study will inform current policy and practice, and future work to reduce offload delay.
Executive Summary
Wind energy offers significant potential for near-term (2020) and long-term (2050) greenhouse gas (GHG) emissions reductions. A number of different wind energy technologies are available across a range of applications, but the primary use of wind energy of relevance to climate change mitigation is to generate electricity from larger, grid-connected wind turbines, deployed either on- or offshore. Focusing on these technologies, the wind power capacity installed by the end of 2009 was capable of meeting roughly 1.8% of worldwide electricity demand, and that contribution could grow to in excess of 20% by 2050 if ambitious efforts are made to reduce GHG emissions and to address the other impediments to increased wind energy deployment. Onshore wind energy is already being deployed at a rapid pace in many countries, and no insurmountable technical barriers exist that preclude increased levels of wind energy penetration into electricity supply systems. Moreover, though average wind speeds vary considerably by location, ample technical potential exists in most regions of the world to enable significant wind energy deployment. In some areas with good wind resources, the cost of wind energy is already competitive with current energy market prices, even without considering relative environmental impacts. Nonetheless, in most regions of the world, policy measures are still required to ensure rapid deployment. Continued advances in on- and offshore wind energy technology are expected, however, further reducing the cost of wind energy and improving wind energy's GHG emissions reduction potential.
The in-situ diffusion experiment was conducted at AECL's Underground Research Laboratory (URL) to improve the understanding of diffusive solute transport in sparsely fractured or intact granitic rock (SFR). The experimental program used a comparative series of laboratory and in-situ field experiments to evaluate the ability of laboratory measurements to estimate in-situ rock properties and to explore issues surrounding the influence of stress relaxation, rock texture, porosity, pore geometry, and anisotropy on derived effective diffusion coefficients (De). In-situ experiments yielded iodide Debetween 1.4 × 10−13 and 1.1 × 10−12 m2/s. Unlike laboratory results, the in-situ De estimates did not exhibit correlation with sample depth or varied stress regime. Laboratory-derived measurements of De, porosity and permeability were found to systematically increase for samples removed from greater depths and higher stress regimes. Laboratory-derived iodide De values consistently trended higher than in-situ values by a factor of 1 to 15, except on the shallowest 240-m Level (σ1 ≍ 30 MPa) where differences were negligible. Laboratory-derived estimates of permeability were consistently higher than in-situ derived values by a factor of 2 to 100. This experimental program provides evidence that laboratory steady-state diffusion experiments are most likely to yield conservative values of De for simulation of diffusive mass transport in SFR.
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