The use of cusum analysis in the early detection and management of hospital bed occupancy crises

Objective: To assess the value of cusum analysis in hospital bed management. Design: Comparative analysis of medical patient flows, bed occupancy, and emergency department admission rates and access block over 2 years. Setting: Internal Medicine Services and Emergency Department in a teaching hospital. Interventions: Improvements in bed use and changes in the level of available beds. Main outcome measures: Average length of stay; percentage occupancy of available beds; number of patients waiting more than 8 hours for admission (access block); number of medical patients occupying beds in non-medical wards; and number of elective surgical admissions. Results: Cusum analysis provided a simple means of revealing important trends in patient flows that were not obvious in conventional time-series data. This prompted improvements in bed use that resulted in a decrease of 9500 occupied bed-days over a year. Unfortunately and unexpectedly, after some initial improvement, the levels of access block, medical ward congestion and elective surgical admissions all then deteriorated significantly. This was probably caused by excessive bed closures in response to the initial improvement in bed use. Conclusion: Cusum analysis is a useful technique for the early detection of significant changes in patient flows and bed use, and in determining the appropriate number of beds required for a given rate of patient flow.

Segmental lung lobe torsion in a 7-week-old Pug

Case summary: A 7-week-old, intact female Pug was referred with an acute history of expiratory dyspnea, tachypnea, and pyrexia. Radiologic evaluation revealed bilateral pleural effusion and a poorly demarcated area of soft tissue opacity cranial to the heart. The presence of air bronchograms in the cranial lung lobes suggested alveolar parenchymal pathology consistent with pulmonary edema, congestion, or cellular infiltration. Exploratory thoracotomy revealed a segmental torsion of the left cranial lung lobe. The affected lobe was removed and the puppy recovered uneventfully. Unique information: Lung lobe torsion tends to occur more frequently in mature large breed dogs at a mean age of 3 years. The age, breed, and segmental nature of the torsion in the reported case are contrary to most of the previously documented cases of lung lobe torsion. To the authors' knowledge, this is the first report of lung lobe torsion in a 7-week-old dog.