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%.

A family of simple benzene 1,3,5-tricarboxamide (BTA) aromatic carboxylic acid hydrogels.

We present the characterisation of a hydrogel forming family of benzene 1,3,5-tricarboxamide (BTA) aromatic carboxylic acid derivatives. The simple, easy to synthesise compounds presented here exhibit consistent gel formation at low concentrations through the use of a pH trigger.

A single-Stream jet noise prediction model for a family of chevron nozzles

This study develops a single-stream jet noise prediction model for a family of chevron nozzles. An original equation is proposed for the fourth-order space-time cross-correlations. They are expressed in flow parameters such as streamwise circulation and turbulent kinetic energy. The cross-correlations based on a Reynolds Averaged Navier-Stokes (RANS) flowfield showed a good agreement with those based on a Large Eddy Simulation (LES) flowfield. This proves that the proposed equation describes the cross-correlations accurately. With this novel source description, there is an excellent agreement between our model's far-field noise predictions and measurements1 for a wide range of frequencies and radiation angles. Our model captures the spectral shape, amplitude and peak frequency very well. This establishes that our model holds good for a family of chevron nozzles. As our model provides quick and accurate predictions, a parametric study was performed to understand the effects of a chevron nozzle geometry on jet noise and thrust loss. Chevron penetration is the underpinning factor for jet noise reduction. The reduction of jet noise per unit thrust loss decreases linearly with chevron penetration. The number of chevrons also has a considerable effect on jet noise.