Stress on the ward: evidence of safety tipping points in hospitals

Do hospitals experience safety tipping points as utilization increases, and if so, what are the implications for hospital operations management? We argue that safety tipping points occur when managerial escalation policies are exhausted and workload variability buffers are depleted. Front-line clinical staff is forced to ration resources and, at the same time, becomes more error prone as a result of elevated stress hormone levels. We confirm the existence of safety tipping points for in-hospital mortality using the discharge records of 82,280 patients across six high-mortality-risk conditions from 256 clinical departments of 83 German hospitals. Focusing on survival during the first seven days following admission, we estimate a mortality tipping point at an occupancy level of 92.5%. Among the 17% of patients in our sample who experienced occupancy above the tipping point during the first seven days of their hospital stay, high occupancy accounted for one in seven deaths. The existence of a safety tipping point has important implications for hospital management. First, flexible capacity expansion is more cost-effective for safety improvement than rigid capacity, because it will only be used when occupancy reaches the tipping point. In the context of our sample, flexible staffing saves more than 40% of the cost of a fully staffed capacity expansion, while achieving the same reduction in mortality. Second, reducing the variability of demand by pooling capacity in hospital clusters can greatly increase safety in a hospital system, because it reduces the likelihood that a patient will experience occupancy levels beyond the tipping point. Pooling the capacity of nearby hospitals in our sample reduces the number of deaths due to high occupancy by 34%.

Development of teaching resources for physical modelling community

Physical modelling of interesting geotechnical problems has helped clarify behaviours and failure mechanisms of many civil engineering systems. Interesting visual information from physical modelling can also be used in teaching to foster interest in geotechnical engineering and recruit young researchers to our field. With this intention, the Teaching Committee of TC2 developed a web-based teaching resources centre. In this paper, the development and organisation of the resource centre using Wordpress. Wordpress is an open-source content management system which allows user content to be edited and site administration to be controlled remotely via a built-in interface. Example data from a centrifuge test on shallow foundations which could be used for undergraduate or graduate level courses is presented and its use illustrated. A discussion on the development of wiki-style addition to the resource centre for commonly used physical model terms is also presented. © 2010 Taylor & Francis Group, London.