Can patient flow be effectively controlled?

BACKGROUND Emergency department (ED) overcrowding may affect the ability to provide quality care and maximize patient flow. Study objectives To analyse the impact of the control of the patient flow during a conflict on ED overcrowding. METHODS During a recent military conflict in Israel the Ministry of Health issued a directive aimed at redirecting the patient flow to EDs in a metropolitan area. The admissions were monitored to identify trends and determine if any changes occurred after the policy change. RESULTS Medical admissions in the only level I trauma centre decreased by 6.5% after the notification, while rising in two other level II hospitals by 3.7% and 4.3%, respectively. Pre- and post-conflict trauma admissions in the level I trauma centre dropped by 2.2% and increased by 6.4% and 1.8%, respectively, in the other hospitals. CONCLUSIONS It is possible to direct the flow of patients to EDs and rationalize the use of resources, making it possible for patients to be admitted to EDs best able to care for them. These findings are especially relevant to emergency situations, but also to non-emergent situations in which control of patient flow may be required. Direct communication with the public is recommended to minimize the implementation time of directives regarding patient flow.     

The selected ion flow tube (SIFT)—A novel technique for biological monitoring

We describe the use of our selected ion flow tube (SIFT) technique for the rapid detection and quantification of trace gases in atmospheric air, with special reference to the analysis of human breath. It is based on the chemical ionization of the breath trace gases to the exclusion of the major breath gases, using ‘soft’ proton transfer from H₃O⁺ ions. Breath samples can either be introduced into the SIFT from bags or by direct breathing into the apparatus, the advantage of the latter approach being that surface active gases such as ammonia and many organic vapours which adsorb onto bag surfaces can be more accurately quantified. We present examples of the analysis of laboratory air, the breath of a non-smoker and of a smoker taken from bag samples, and illustrate the rapid time response of the technique by showing the time profile of acetone on breath during direct breathing into the apparatus. The current partial pressure sensitivity of our SIFT method is within the range 30 ppb to in excess of 100 ppm, but with further development the device could be made more sensitive, 1 ppb being well within reach. A transportable SIFT device is under development which will have applications in environmental, medical and biological research, health and safety monitoring, and in clinical diagnosis.     

The influence of occupants’ body mass on carbon dioxide mass flow rate inside a university classroom – case study

From 2014 to 2017, through the cold season, 37 experimental measurements of carbon dioxide (CO₂) concentration were done inside a selected university classroom, during the same type of activity, namely written examination. Based on the data obtained from the experimental measurements, the article sought to primarily establish a correlation between the body mass of the students and the intensity of carbon dioxide releases inside the experimental classroom. This relationship was determined by using statistical analysis (general least-square estimation of the regression line). The resulting equation may be used to determine in an easier way the required outdoor air volume flow rate inside a university classroom.     

What does free cash flow tell us about hospital efficiency? A stochastic frontier analysis of cost inefficiency in California hospitals

Hospitals are facing substantial financial and economic pressure as a result of health plan payment restructuring, unfunded mandates, and other factors. This article analyzes the relationship between free cash flow (FCF) and hospital efficiency given these financial challenges. Data from 270 California hospitals were used to estimate a stochastic frontier model of hospital cost efficiency that explicitly takes into account outpatient heterogeneity. The findings indicate that hospital FCF is significantly linked to firm efficiency/inefficiency. The results indicate that higher positive cash flows are related to lower cost inefficiency, but higher negative cash flows are related to higher cost inefficiency. Thus, cash flows not only impact the ability of hospitals to meet current liabilities, they are also related to the ability of the hospitals to use resources effectively.     

Assessment of cerebral blood flow in patients with multiple chemical sensitivity using near-infrared spectroscopy—recovery after olfactory stimulation: a case–control study

Objectives

Multiple chemical sensitivity (MCS) is a chronic acquired disorder characterized by non-specific symptoms in multiple organ systems associated with exposure to odorous chemicals. We previously observed significant activations in the prefrontal cortex (PFC) during olfactory stimulation using several different odorants in patients with MCS by near-infrared spectroscopy (NIRS) imaging. We also observed that the patients with MCS did not adequately distinguish non-odorant in the late stage of the repeated olfactory stimulation test. The sensory recovery of the olfactory system in the patients with MCS may process odors differently from healthy subjects after olfactory stimulation.

Methods

We examined the recovery process of regional cerebral blood flow (rCBF) after olfactory stimulation in patients with MCS. NIRS imaging was performed in 6 patients with MCS and in 6 controls. The olfactory stimulation test was continuously repeated 10 times. The study also included a subjective assessment of the physical and psychological status and of the perception of irritating and hedonic odors.

Results

After olfactory stimulation, significant activations were observed in the PFC of patients with MCS on both the right and left sides compared with controls. The activations were specifically strong in the orbitofrontal cortex (OFC). Compared with controls, autonomic perception and feelings identification were poorer in patients with MCS. OFC is associated with stimuli response and the representation of preferences.

Conclusions

These results suggest that a past strong exposure to hazardous chemicals activates the PFC during olfactory stimuli in patients with MCS, and a strong activation in the OFC remains after the stimuli.     

Straight talk: new approaches in healthcare. Are you ready to send HIPPA-compliant transactions? Your cash flow is at stake. Panel discussion

The deadlines are looming for compliance with the transaction and code set requirements set forth in the Health Insurance Portability and Accountability Act of 1996 (HIPAA). If your hospital filed for an extension in October 2002, you need to begin testing transactions by April 2003 and sending transactions by October 2003. But don't rely on your technology vendors to give you the ability to send compliant transactions. While vendors can provide the correct computer data format, they can't gather the correct information. If you can't send a compliant transaction, the Centers for Medicare and Medicaid Services could reject your claims, drying up a big percentage of your cash flow.     

Utility of ultrasound of the upper urinary tract in elderly men with indicators of obstructive symptoms or abnormal flow: how often can silent hydronephrosis be detected in general practice?

BACKGROUND AND OBJECTIVE: While the prevalence of hydronephrosis is very low in obduction studies, a prevalence of 3-13% is reported for patients with an obstruction who are listed for prostatectomy. In order to evaluate the usefulness of transabdominal ultrasound in primary care, we determined the occurrence of hydronephrosis in males with symptoms of urinary obstruction in a general practice setting. METHOD: A micturition questionnaire (a modified Boyarsky) was sent to all men of 55 years or more who were registered in 10 general practices in Maastricht, and was followed by an examination at their general practice. Men with obstructive symptoms and/or with a free-flow abnormality were examined in the hospital with transabdominal ultrasound in order to detect dilatation of the upper urinary tract. This ultrasound was repeated approximately 15 months later. RESULTS: At the first measurement, none of the examined men (n = 178) had hydronephrosis, and this was still the case for 94 men 15 months later. CONCLUSION: Renal ultrasound is not necessary in general practice for men with uncomplicated obstructive complaints.     

The ebb and flow of the NHS waiting list: how do recruitment and admission affect event‐based measures of the length of ‘time‐to‐admission’?

The likelihood of admission is reported in England as the percentage of elective episodes occurring within a certain time, for example, within three months of the date of enrollment on the waiting list. This event-based measure is calculated from cross-sectional data: the denominator is the number of elective episodes occurring in a specified calendar period, and the numerator is the number found to have enrolled on the waiting list less than three months previously. Now the number of elective episodes occurring within three months reflects the likelihood of admission and the numbers eligible to be admitted. If there is any increase in the likelihood of admission or in the number of people exposed to that likelihood then there will be an increase in the number of elective episodes found to have enrolled on the waiting list less than three months previously. Thus the numerator used by the Government Statistical Service accurately reflects conditions during the calendar period and within the enrollment cohorts of interest. The Government Statistical Service also needs a denominator so the episodes observed 0-2, 3-5, 6-8, 9-11 etc. months after enrollment are added as an indication of the number of people that could have been admitted within three months. This denominator implies that the number of people eligible for admission from the 3-5 month waiting time category is the same as the number surviving admission from the 0-2 month waiting time category but, during the period of interest, these two groups of people belong to cohorts that were recruited to the waiting list quite independently. As a result, this denominator will be too big if the number surviving to the end of one waiting time category is bigger than the number eligible for admission from the next and it will be too small if the number surviving to the end of one waiting time category is smaller than the number eligible for admission from the next. The event-based measure assumes that the waiting list is stationary and closed and only gives unbiased estimates under these conditions. This paper describes three alternative measures which recognize that the number of people recruited or admitted may vary from one quarter to the next. It uses Department of Health data to assess the size of the error if the event-based measure is used in these circumstances.