Time to analgesia for care delivered by nurse practitioners in the emergency department: A retrospective chart audit

Objectives To evaluate quality of care delivered to patients presenting to the emergency department (ED) with pain and managed by emergency nurse practitioners by measuring: 1) Evaluate time to analgesia from initial presentation 2) Evaluate time from being seen to next analgesia 3) Pain score documentation Background The delivery of quality care in the emergency department (ED) is emerging as one of the most important service indicators being measured by health services. Emergency nurse practitioner services are designed to improve timely, quality care for patients. One of the goals of quality emergency care is the timely and effective delivery of analgesia for patients. Timely analgesia is an important indicator of ED service performance. Methods A retrospective explicit chart review of 128 consecutive patients with pain and managed by emergency nurse practitioners was conducted. Data collected included demographics, presenting complaint, pain scores, and time to first dose of analgesia. Patients were identified from the ED Patient Information System (Cerner log) and data were extracted from electronic medical records Results Pain scores were documented in 67 (52.3%; 95% CI: 43.3-61.2) patients. The median time to analgesia from presentation was 60.5 (IQR 30-87) minutes, with 34 (26.6%; 95% CI: 19.1-35.1) patients receiving analgesia within 30 minutes of presentation to hospital. There were 22 (17.2%; 95% CI: 11.1-24.9) patients who received analgesia prior to assessment by a nurse practitioner. Among patients that received analgesia after assessment by a nurse practitioner, the median time to analgesia after assessment was 25 (IQR 12-50) minutes, with 65 (61.3%; 95% CI: 51.4-70.6) patients receiving analgesia within 30 minutes of assessment. Conclusions The majority of patients assessed by nurse practitioners received analgesia within 30 minutes after assessment. However, opportunities for substantial improvement in such times along with documentation of pain scores were identified and will be targeted in future research.

Sequential monitoring of hospital adverse events when control charts fail : the example of fall injuries in hospitals

Objective To evaluate methods for monitoring monthly aggregated hospital adverse event data that display clustering, non-linear trends and possible autocorrelation. Design Retrospective audit. Setting The Northern Hospital, Melbourne, Australia. Participants 171,059 patients admitted between January 2001 and December 2006. Measurements The analysis is illustrated with 72 months of patient fall injury data using a modified Shewhart U control chart, and charts derived from a quasi-Poisson generalised linear model (GLM) and a generalised additive mixed model (GAMM) that included an approximate upper control limit. Results The data were overdispersed and displayed a downward trend and possible autocorrelation. The downward trend was followed by a predictable period after December 2003. The GLM-estimated incidence rate ratio was 0.98 (95% CI 0.98 to 0.99) per month. The GAMM-fitted count fell from 12.67 (95% CI 10.05 to 15.97) in January 2001 to 5.23 (95% CI 3.82 to 7.15) in December 2006 (p<0.001). The corresponding values for the GLM were 11.9 and 3.94. Residual plots suggested that the GLM underestimated the rate at the beginning and end of the series and overestimated it in the middle. The data suggested a more rapid rate fall before 2004 and a steady state thereafter, a pattern reflected in the GAMM chart. The approximate upper two-sigma equivalent control limit in the GLM and GAMM charts identified 2 months that showed possible special-cause variation. Conclusion Charts based on GAMM analysis are a suitable alternative to Shewhart U control charts with these data.

T chart to evaluate consolidation test results

Using Terzaghi's degree of consolidation, U, and the time factor, T, relationship, if M-U1 and M-U2 (M-U1 not equal M-U2) are slopes of the U-root T curve at any two time factors T-U1 and T-U2, then it can be shown that a unique relationship exists between T-U2/T-U1, M-U1/M-U2, and TU, (or TU2), and knowing any two of these, the third can be uniquely determined. A chart, called the T chart, has been plotted using these three variables for quickly determining T and U at any experimental time, t, to determine the coefficient of consolidation, c(v), corrected zero settlement, delta(o), and ultimate primary settlement, delta(100). The chart can be used even in those cases where settlement and time, at the instant of load increment, are not known.

Aids in the design of microstrip components I: Getsinger's chart

Charts relating the capacitance to the width, spacing, thickness and height above the ground plane of coupled microstrips have been obtained. These are used to design hairpin line and hybrid hairpin line filters as well as multiplexers using microstrip comb line filters. The experimental results agree reasonably well with the design specifications. Getsinger's original charts for parallel coupled bars between parallel plates have been formulated for the microstrip case. Corresponding charts relating the capacitances to the width, spacing, thickness and height above the ground plane of coupled microstrips have been obtained. Examples of the use of these charts are shown in the design of hairpin lines and hybrid hairpin line filters as well as multiplexers using comb line filters. The hairpin line/hybrid hairpin line filters were designed to operate at a central frequency of 9÷5 GHz with 11 per cent bandwidth and 0÷5 dB ripple. The three filters constituting the comb line filters have center frequencies of 2÷4, 3÷0 and 3÷6 GHz. The components so designed were fabricated and tested. The dielectric used for the microstrip was teflon. Experimental curves for the attenuation (insertion loss) and VSWR are given. The design specifications arc satisfied quite well.

EXIT Chart Based Design of Irregular LDPC Codes for Large-MIMO Systems

In this letter, we characterize the extrinsic information transfer (EXIT) behavior of a factor graph based message passing algorithm for detection in large multiple-input multiple-output (MIMO) systems with tens to hundreds of antennas. The EXIT curves of a joint detection-decoding receiver are obtained for low density parity check (LDPC) codes of given degree distributions. From the obtained EXIT curves, an optimization of the LDPC code degree profiles is carried out to design irregular LDPC codes matched to the large-MIMO channel and joint message passing receiver. With low complexity joint detection-decoding, these codes are shown to perform better than off-the-shelf irregular codes in the literature by about 1 to 1.5 dB at a coded BER of 10(-5) in 16 x 16, 64 x 64 and 256 x 256 MIMO systems.

Analysing admittance of obstacles in evanescent waveguide using the Imaginary Smith Chart

We present a technique, using the Imaginary Smith Chart, for determining the admittance of obstacles introduced into evanescent waveguide. The admittance of an inductive iris, capacitive iris, capacitive post, variable width strip and length of evanescent waveuide are investigated. © 2012 IEEE.

Increased Bandwidth Evanescent Open-Ended Waveguide Antenna Design Using the Imaginary Smith Chart

We present a novel antenna matching technique that uses the Imaginary Smith Chart to permit wideband matching of an evanescent open-ended waveguide antenna using a dielectric sheet air-spaced from the aperture. The fabricated antenna design is demonstrated to have a measured bandwidth of 24%, from 2.13–2.7 GHz, for reflection coefficient $qquad{<} -!!10~{rm dB}$ , with 2.725 GHz waveguide cutoff. The antenna's maximum aperture dimension is ${< 0.5}lambda_{0}$ at the upper frequency in the bandwidth and so it is suitable for use in a wide angle scanning phased array

Using Modern Tools to Explain the Use of the Smith Chart

The concept of explaining the use of an old tool like the Smith chart, using modern tools like MATLAB [1] scripts in combination with e-learning facilities, is exemplified by two MATLAB scripts. These display, step by step, the graphical procedure that must be used to solve the double-stub impedance-matching problem. These two scripts correspond to two different possible ways to analyze this matching problem, and they are important for students to learn by themselves.

From the portolan chart of the mediterranean to the latitude chart of the atlantic

Thesis submitted to the Instituto Superior de Estatística e Gestão de Informação da Universidade Nova de Lisboa in partial fulfillment of the requirements for the Degree of Doctor of Philosophy in Information Management – Geographic Information Systems

Chart of estimate of work done on the Port Dalhousie and Thorold Railway by Messrs. Brown and McDonell, contractors, on sections 1, 2, and 3 ending at St. Catharines for the month ending Dec. 1, 1854

Chart of estimate of work done on the Port Dalhousie and Thorold Railway by Messrs. Brown and McDonell, contractors, on sections 1, 2, and 3 ending at St. Catharines for the month ending Dec. 1, 1854, signed by S.D. Woodruff, Jan. 1855.

Chart of estimate of work done on the Port Dalhousie and Thorold Railway by Messrs. Brown and McDonell

Chart of estimate of work done on the Port Dalhousie and Thorold Railway by Messrs. Brown and McDonell, contractors, on sections 1, 2, and 3 ending at St. Catharines for the month of Jan. 1855, signed by S.D. Woodruff, Feb. 1855.