scholarly journals P128: Time of transfer of admitted patients from the ED: a potential area for improvement of patient flow in very high-volume emergency departments

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S102-S102
Author(s):  
L. Salehi ◽  
P. Phalpher ◽  
V. Jegatheeswaran ◽  
R. Valani ◽  
J. Herman ◽  
...  
Keyword(s):  
Patient Flow ◽  
Low Cost ◽  
High Volume ◽  
Early Morning ◽  
Time Of Day ◽  
Current Status ◽  
Community Hospitals ◽  
Current Time ◽  
Operational Issues ◽  
Very High

Introduction: Bed boarding of admitted patients in the Emergency Department (ED) is widely recognized as a major contributor to overcrowding, particularly in very high-volume hospitals. The issue of bed boarding is directly tied to hospital-wide capacity, flow and operations. Early morning discharge from inpatient units has been identified as a low-cost intervention to decrease bed boarding, as it allows earlier transfer of admitted patients from the ED. Several hospitals have instituted discharge before noon, or discharge before 10AM policies, practices and targets. Our objectives were 1) to assess the current status of flow within 3 high-volume community hospitals with respect to time of day of discharges from the in-patient units and time of day of transfers from the ED to in-patient units, and 2) to assess the association between time of transfer from the ED and total ED Length of Stay (EDLOS) of admitted patients. Methods: We conducted a retrospective multi-centre observational study during the period of January 1, 2015 to December 31, 2015 at three high-volume community hospitals within Ontario, Canada. All patients admitted to the Medicine service were identified. Time of discharge from the in-patient units and time of transfer from the ED were collected for all patients. EDLOS was calculated for all patients as a function of time of transfer from the ED. Results: Preliminary findings show that, for the three community hospitals, only 11.7% - 19.6% of admitted patients were discharged from the in-patient units during the period between 6AM and 12PM, with a peak discharge time of 2PM in all three hospitals. A concurrent lag was observed in the time of transfer of patients from the ED, with peak transfer times occurring the late afternoon between 3PM and 9PM, and coinciding with a peak in patient volume in the ED. Patients transferred out of the ED earlier in the day (between 12AM 11:59AM) had between 1.4 hours to 8.0 hours lower mean EDLOS when compared to those patients transferred later in the day (between 12PM 11:59PM). Conclusion: Hospital-wide flow and operational issues have a significant impact on ED bed boarding, and potential efficiencies seem at the current time to be underutilized. Interventions aimed at optimizing flow must be implemented alongside those aimed at increasing capacity in order to improve bed boarding. ** These findings are best communicated in graphic form to better represent the dynamics of the flow in and out of the ED over a 24-hour period, and will be presented in graphic format if selected for the conference.

scholarly journals A credible pathway for heavy ion driven target fabrication and injection

2002 ◽  
Vol 20 (3) ◽  
pp. 515-520 ◽  
Author(s):  
D.T. GOODIN ◽  
A. NOBILE ◽  
N.B. ALEXANDER ◽  
L.C. BROWN ◽  
J.L. MAXWELL ◽  
...  
Keyword(s):  
Low Cost ◽  
Fusion Energy ◽  
Scale Up ◽  
Development Program ◽  
High Volume ◽  
Heavy Ion ◽  
Current Status ◽  
Target Chamber ◽  
Inertial Fusion ◽  
Inertial Fusion Energy

The Target Fabrication Facility (TFF) of an inertial fusion energy (IFE) power plant must supply about 500,000 targets per day. The target is injected into the target chamber at a rate of 5–10 Hz and tracked precisely so the heavy ion driver beams can be directed to the target. The feasibility of developing successful fabrication and injection methodologies at the low cost required for energy production (about $0.25/target, approximately 104 times less than current costs) is a critical issue for inertial fusion energy. A significant program is underway to develop the high-volume methods to supply economical IFE targets. This article reviews the requirements for heavy ion driven IFE target fabrication and injection, and presents the current status of and results from the development program. For the first time, an entire pathway from beginning to end is outlined for fabrication of a high-gain, distributed radiator target. A significant development and scale-up program will be necessary to implement this pathway for mass production of IFE targets.

scholarly journals LO009: Impact of physician navigators on measures of emergency department efficiency

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S33-S33
Author(s):  
A. Leung ◽  
Z. Gong ◽  
B. Chen ◽  
M. Duic
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Patient Flow ◽  
High Volume ◽  
Physician Satisfaction ◽  
Intervention Period ◽  
Post Intervention ◽  
Post Intervention Period ◽  
Secondary Outcomes ◽  
Very High

Introduction: The Physician Navigator (PN) is a novel position created to manage patient flow in real-time at a very-high volume emergency department (ED). When paired with an emergency physician, PNs actively track patient wait times, and direct the physician to see and re-assess patients in a particular order to improve measures of emergency department efficiency, and maximize patient flow. Anecdotal evidence has shown that PNs decrease length-of-stay times for non-resuscitative patients in the setting of increased patient volumes, and without additional nursing or physician hours. The objective was to study the operational impact of PN on emergency department patient flow. Methods: A 48-month pre-/post-intervention retrospective chart review at an urban community emergency department from September 2011 to September 2015. The PN program started on March 1, 2013. The main outcome is emergency department length-of-stay (LOS). Secondary outcomes include time to physician-initial-assessment (PIA), left-without-being-seen rates (LWBS), left-against-medical-advice (LAMA), and physician satisfaction rates. Autoregressive integrated moving average models were generated for Canadian Triage and Acuity Scale (CTAS) 2 to 5 patients to quantify the immediate impact of the intervention on the outcome levels, and whether the impact was sustained over time. Results: Interim results are provided. 399,958 patients attended the ED during the study period. Daily patient volumes increased 11.2% during the post-intervention period. There were no significant increases in the number of physicians shifts/day, and physician hours/day during the post-intervention period. Post-intervention, for CTAS 2-5 patients, there was a reduction in average LOS by 0.04 hours/PN (p<0.05), and 90th-percentile LOS by 0.14 hours/PN (p<0.05). For secondary outcomes, there was a decrease in overall average PIA by 6.37 minutes/PN (p<0.05), and 90th-percentile PIA by 8.29 minutes/PN (p<0.05). LWBS rates decreased by 40.8% (p<0.05). There were no significant changes in LAMA rates. Conclusion: The implementation of Physician Navigators is associated with significant reductions in LOS, PIA, and LWBS rates for non-resuscitative patients at a very-high volume emergency department.

Decomposition of the metastable beta titanium alloy Ti-15-3

1983 ◽  
Vol 41 ◽  
pp. 264-265
Author(s):  
Y. L. Chen ◽  
S. Fujlshiro
Keyword(s):  
Low Cost ◽  
High Strength ◽  
Alpha Phase ◽  
Thick Sheet ◽  
Omega Phase ◽  
Beta Titanium Alloy ◽  
Beta Titanium ◽  
Beta Matrix ◽  
Metastable Beta ◽  
Very High

Metastable beta titanium alloys have been known to have numerous advantages such as cold formability, high strength, good fracture resistance, deep hardenability, and cost effectiveness. Very high strength is obtainable by precipitation of the hexagonal alpha phase in a bcc beta matrix in these alloys. Precipitation hardening in the metastable beta alloys may also result from the formation of transition phases such as omega phase. Ti-15-3 (Ti-15V- 3Cr-3Al-3Sn) has been developed recently by TIMET and USAF for low cost sheet metal applications. The purpose of the present study was to examine the aging characteristics in this alloy.The composition of the as-received material is: 14.7 V, 3.14 Cr, 3.05 Al, 2.26 Sn, and 0.145 Fe. The beta transus temperature as determined by optical metallographic method was about 770°C. Specimen coupons were prepared from a mill-annealed 1.2 mm thick sheet, and solution treated at 827°C for 2 hr in argon, then water quenched. Aging was also done in argon at temperatures ranging from 316 to 616°C for various times.

Review on Switches for Power Applications: Macro to Micro

2019 ◽  
Vol 12 (3) ◽  
pp. 200-209
Author(s):  
Femi Robert
Keyword(s):  
Leakage Current ◽  
Power Loss ◽  
Low Cost ◽  
Electrical System ◽  
High Isolation ◽  
Fast Switching ◽  
Environmental Friendly ◽  
State Resistance ◽  
Very High ◽  
Bulk Production

Background: Switches are important component in electrical system. The switches needs to have the advantages of low ON-state resistance, very high OFF-state resistance, high isolation, no leakage current, less power loss, fast switching, high linearity, small size, arcless and low cost in bulk production. Also these switches have to be reliable and environmental friendly. Methods: In this paper, macro and microswitches for power applications are extensively reviewed and summarized. Various types of switches such as mechanical, solid-state, hybrid and micromechanical switches have been used for power applications are reviewed. The importance and challenge in achieving arcless switching is presented. Results: The use of micromechanical switches for power applications, actuation techniques, switching modes, reliability and lifetime are also reviewed. The modeling and design challenges are also reviewed. Conclusion: The applications of micromechanical switches shows that the switches can reduce the leakage current in battery operated systems and reduce the size of the system considerably.

Introduction of Wireless Buzzer to Improve Efficiency in Gynecology Triage (Preprint)

2020 ◽  
Author(s):  
Nicholas Mark Stansbury ◽  
Erin Nelson
Keyword(s):  
Medical Students ◽  
Nurse Practitioners ◽  
Nursing Staff ◽  
Internal Control ◽  
Patient Flow ◽  
Low Cost ◽  
Work Flow ◽  
Optimal Time ◽  
Nursing Experience ◽  
Asking Questions

BACKGROUND Current workflow in GYN triage has medical students interviewing patients after triage by nursing staff. The optimal time to initiate patient contact is unclear. This confusion has led to duplication of questions to patients, interruptions for nurses and fewer patient encounters for students. OBJECTIVE Determine if a restaurant-style buzzer can streamline workflow in gynecology (GYN) triage. METHODS A Plan-Do-Study-Act approach was used. Stakeholders were medical students, nurses, Nurse Practitioners and physicians. Factors contributing to workflow slowdown: students re-asking questions of patients, interruption of nursing staff, confusion about optimal patient flow. The net result was fewer interviews completed by students. The project was introduced during clerkship orientation. Buzzers were provided on weeks 1, 3, 5 of the rotation. Weeks 2, 4, 6 no buzzers were provided as an internal control. After each clerkship, students received a survey assessing key areas of waste and workflow disruption. A focus group with ten nurses was also conducted. RESULTS From February-July 2019, 30/45 surveys were completed (66%) 1. Very difficult/difficult to know when to begin the encounter: 90% without; 21.4% with buzzer p<.001 2. Students re-asking questions: very often/often 96.7% without; 14.8% with buzzer p<.001 3. Nursing staff interruptions: 76.7% very often/often without; 18.5% with buzzer p<.001 4. The odds of interviewing 5 or more patients per shift are ~10X greater using the buzzer χ²=14.2; p<.001 CONCLUSIONS The 10 nurses interviewed unanimously favored the use of the buzzer. Introduction of a simple, low-cost restaurant-style buzzer improved triage work-flow, student and nursing experience.

Thermoregulatory responses to cold water at different times of day

1999 ◽  
Vol 87 (1) ◽  
pp. 243-246 ◽  
Author(s):  
John W. Castellani ◽  
Andrew J. Young ◽  
James E. Kain ◽  
Michael N. Sawka
Keyword(s):  
Cold Water ◽  
Water Immersion ◽  
Early Morning ◽  
Cold Water Immersion ◽  
Time Of Day ◽  
Mean Skin Temperature ◽  
Mean Body Temperature ◽  
Metabolic Heat ◽  
Body Temperature Change ◽  
The Mean

This study examined how time of day affects thermoregulation during cold-water immersion (CWI). It was hypothesized that the shivering and vasoconstrictor responses to CWI would differ at 0700 vs. 1500 because of lower initial core temperatures (Tcore) at 0700. Nine men were immersed (20°C, 2 h) at 0700 and 1500 on 2 days. No differences ( P > 0.05) between times were observed for metabolic heat production (M˙, 150 W ⋅ m−2), heat flow (250 W ⋅ m−2), mean skin temperature (T sk, 21°C), and the mean body temperature-change in M˙(ΔM˙) relationship. Rectal temperature (Tre) was higher ( P < 0.05) before (Δ = 0.4°C) and throughout CWI during 1500. The change in Tre was greater ( P < 0.05) at 1500 (−1.4°C) vs. 0700 (−1.2°C), likely because of the higher Tre-T skgradient (0.3°C) at 1500. These data indicate that shivering and vasoconstriction are not affected by time of day. These observations raise the possibility that CWI may increase the risk of hypothermia in the early morning because of a lower initial Tcore.

scholarly journals A rapid, accurate, scalable, and portable testing system for COVID-19 diagnosis

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Guanhua Xun ◽  
Stephan Thomas Lane ◽  
Vassily Andrew Petrov ◽  
Brandon Elliott Pepa ◽  
Huimin Zhao
Keyword(s):  
Limit Of Detection ◽  
Low Cost ◽  
High Volume ◽  
N Gene ◽  
Testing System ◽  
Target Sequence ◽  
One Pot ◽  
Sequence Detection ◽  
Highly Sensitive ◽  
Speed Accuracy

AbstractThe need for rapid, accurate, and scalable testing systems for COVID-19 diagnosis is clear and urgent. Here, we report a rapid Scalable and Portable Testing (SPOT) system consisting of a rapid, highly sensitive, and accurate assay and a battery-powered portable device for COVID-19 diagnosis. The SPOT assay comprises a one-pot reverse transcriptase-loop-mediated isothermal amplification (RT-LAMP) followed by PfAgo-based target sequence detection. It is capable of detecting the N gene and E gene in a multiplexed reaction with the limit of detection (LoD) of 0.44 copies/μL and 1.09 copies/μL, respectively, in SARS-CoV-2 virus-spiked saliva samples within 30 min. Moreover, the SPOT system is used to analyze 104 clinical saliva samples and identified 28/30 (93.3% sensitivity) SARS-CoV-2 positive samples (100% sensitivity if LoD is considered) and 73/74 (98.6% specificity) SARS-CoV-2 negative samples. This combination of speed, accuracy, sensitivity, and portability will enable high-volume, low-cost access to areas in need of urgent COVID-19 testing capabilities.

Relationship of hospital volume on outcomes in patients with acute pulmonary embolism: Analysis of a 70,000 patient database

2020 ◽  
pp. 1358863X2097026
Author(s):  
Mark Finkelstein ◽  
Mario A Cedillo ◽  
David C Kestenbaum ◽  
Obaib S Shoaib ◽  
Aaron M Fischman ◽  
...  
Keyword(s):  
New York ◽  
Pulmonary Embolism ◽  
Length Of Stay ◽  
New York State ◽  
Multivariable Analysis ◽  
High Volume ◽  
Categorical Variables ◽  
Patient Database ◽  
Very High ◽  
Total Charges

Positive relationships between volume and outcome have been seen in several surgical and medical conditions, resulting in more centralized and specialized care structures. Currently, there is a scarcity of literature involving the volume–outcome relationship in pulmonary embolism (PE). Using a state-wide dataset that encapsulates all non-federal admissions in New York State, we performed a retrospective cohort study on admitted patients with a diagnosis of PE. A total of 70,443 cases were separated into volume groups stratified by hospital quartile. Continuous and categorical variables were compared between cohorts. Multivariable regression analysis was conducted to assess predictors of 1-year mortality, 30-day all-cause readmission, 30-day PE-related readmission, length of stay, and total charges. Of the 205 facilities that were included, 128 (62%) were labeled low volume, 39 (19%) medium volume, 23 (11%) high volume, and 15 (7%) very high volume. Multivariable analysis showed that very high volume was associated with decreased 30-day PE-related readmission (OR 0.64; 95% CI, 0.55 to 0.73), decreased 30-day all-cause readmission (OR 0.84; 95% CI, 0.79 to 0.89), decreased 1-year mortality (OR 0.85; 95% CI, 0.80 to 0.91), decreased total charges (OR 0.96; 95% CI, 0.94 to 0.98), and decreased length of stay (OR 0.94; 95% CI, 0.92 to 0.96). In summary, facilities with higher volumes of acute PE were found to have less 30-day PE-related readmissions, less all-cause readmissions, shorter length of stay, decreased 1-year mortality, and decreased total charges.

scholarly journals High spatial resolution photo mosaicking for the monitoring of coralligenous reefs

Coral Reefs ◽  
2021 ◽  
Author(s):  
E. Casoli ◽  
D. Ventura ◽  
G. Mancini ◽  
D. S. Pace ◽  
A. Belluscio ◽  
...  
Keyword(s):  
Spatial Resolution ◽  
High Spatial Resolution ◽  
Low Cost ◽  
Pixel Resolution ◽  
Recording Apparatus ◽  
Assemblage Composition ◽  
Very High Spatial Resolution ◽  
Vertical Walls ◽  
Non Destructive ◽  
Very High

AbstractCoralligenous reefs are characterized by large bathymetric and spatial distribution, as well as heterogeneity; in shallow environments, they develop mainly on vertical and sub-vertical rocky walls. Mainly diver-based techniques are carried out to gain detailed information on such habitats. Here, we propose a non-destructive and multi-purpose photo mosaicking method to study and monitor coralligenous reefs developing on vertical walls. High-pixel resolution images using three different commercial cameras were acquired on a 10 m2 reef, to compare the effectiveness of photomosaic method to the traditional photoquadrats technique in quantifying the coralligenous assemblage. Results showed very high spatial resolution and accuracy among the photomosaic acquired with different cameras and no significant differences with photoquadrats in assessing the assemblage composition. Despite the large difference in costs of each recording apparatus, little differences emerged from the assemblage characterization: through the analysis of the three photomosaics twelve taxa/morphological categories covered 97–99% of the sampled surface. Photo mosaicking represents a low-cost method that minimizes the time spent underwater by divers and capable of providing new opportunities for further studies on shallow coralligenous reefs.

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