Investigating Fractured Flow from Orthopaedics to Rehabilitation

Patients often spend time as inpatients in hospitals outside their home area because of the need to access specialist services. If there is a need for ongoing care after the need for specialist care has passed, patients are transferred (or ‘repatriated’) back to the inpatient care of a hospital in their local Health and Social Care Trust. The need for bed space in specialist units means that there is pressure for this transition to occur in a timely way. We investigated the flow of patients through a trauma and orthopaedics unit using the 6M Design® framework and Vitals Charts® in order to investigate concerns about delayed repatriation. We found that repatriation was part of a complex system that had interdependent components. There was considerable variation in the number of discharges (to any destination) by day of week, with a reduction on Saturdays and Sundays. Understanding that the pressure for quicker repatriation was really due to high work-in-progress led us to model the effects of strategies to address the high work-in-progress. We found that, because only a small proportion of patients require repatriation, expediting the repatriation process by one day for each patient would only reduce WIP by an average of 1.6 patients. Reducing the average length of stay for all trauma and orthopaedics inpatients by one day would reduce the WIP by 10 patients, which would make a much greater impact on the problem of high bed occupancy. Though the smooth and timely repatriation of patients to rehabilitation units is desirable, it is unlikely that efforts to achieve this will have a substantial impact on the problem of high WIP, so other strategies will be required. We will model the effects of strategies to reduce variation in daily discharges by the day of week in a future essay.

Efficient and Selectable Production of Reactive Species Using a Nanosecond Pulsed Discharge in Gas Bubbles in Liquid

A plasma gas bubble-in-liquid method for high production of selectable reactive species using a nanosecond pulse generator has been developed. The gas of choice is fed through a hollow needle in a point-to-plate bubble discharge, enabling improved selection of reactive species. The increased interface reactions, between the gas-plasma and water through bubbles, give higher productivity. H₂O₂ was the predominant species produced using Ar plasma, while predominantly  and NO₂ were generated using air plasma, in good agreement with the observed emission spectra. This method has nearly 100% selectivity for H₂O₂, with seven times higher production, and 92% selectivity for , with nearly twice the production, compared with a plasma above the water.