Bed management: studio di fattibilità per la creazione di un modello applicabile al sistema sanitario emiliano-romagnolo

Da qualche anno gli standard di posti letto ospedalieri tendono a ridursi. È in corso un processo di ristrutturazione e riorganizzazione dell’azione ospedaliera che trova le sue ragioni nella necessità di calare la spesa del servizio sanitario. Questo fatto porta alla conclusione che la risorsa “posti letto” stia diventando sempre di più una risorsa limitata, che necessiti di una gestione attenta, precisa e ponderata. Da un punto di vista manageriale, capire le inefficienze e i modi in cui questa risorsa si interfaccia con la restante realtà ospedaliera è cruciale per poter attuare giuste politiche sanitarie. L’obiettivo di questa tesi consiste nella valutazione delle specifiche per la costruzione di un modello da applicare al sistema sanitario emiliano-romagnolo, compiendo una gap analysis su dati ufficiali forniti direttamente dal SS dell’Emilia-Romagna. Per la creazione del modello applicato ai posti letto ospedalieri il lavoro è proceduto prendendo in considerazione l’attuale modello in uso in regione [3] “Pianificazione tattica delle sale operatorie: un modello di ottimizzazione in ambito regionale. Margherita Vitali. 2014”. La creazione del modello oggetto di questa tesi è avvenuta attraverso l’ampliamento del modello [3]. Le modifiche proposte hanno avuto come scopo l’ottenimento di un modello dipendente dalla risorsa posti letto a valle delle sale operatorie. I vincoli aggiuntivi conferiscono una maggiore completezza al modello [3] ampliandone le vedute sulla filiera ospedaliera.

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.

Tracking the patient journey by combining multiple hospital database systems

With new national targets for patient flow in public hospitals designed to increase efficiencies in patient care and resource use, better knowledge of events affecting length of stay will support improved bed management and scheduling of procedures. This paper presents a case study involving the integration of material from each of three databases in operation at one tertiary hospital and demonstrates it is possible to follow patient journeys from admission to discharge. What is known about this topic? At present, patient data at one Queensland tertiary hospital are assembled in three information systems: (1) the Hospital Based Corporate Information System (HBCIS), which tracks patients from in-patient admission to discharge; (2) the Emergency Department Information System (EDIS) containing patient data from presentation to departure from the emergency department; and (3) Operation Room Management Information System (ORMIS), which records surgical operations. What does this paper add? This paper describes how a new enquiry tool may be used to link the three hospital information systems for studying the hospital journey through different wards and/or operating theatres for both individual and groups of patients. What are the implications for practitioners? An understanding of the patients’ journeys provides better insight into patient flow and provides the tool for research relating to access block, as well as optimising the use of physical and human resources.

Modèles organisationnels et compétences infirmières en gestion de lits

Travail dirigé présenté à la Faculté des sciences infirmières en vue de l’obtention du grade de Maître ès sciences (M.Sc.) en sciences infirmières option formation des sciences infirmières

Modèles organisationnels et compétences infirmières en gestion de lits

Travail dirigé présenté à la Faculté des sciences infirmières en vue de l’obtention du grade de Maître ès sciences (M.Sc.) en sciences infirmières option formation des sciences infirmières

MEDIDAS PARA MINIMIZAR A EMISSÃO DE AMÔNIA NA PRODUÇÃO DE FRANGOS DE CORTE: REVISÃO

The main sources of ammonia generation are in agricultural activities, with great representation of poultry, by using feed lot systems with adoption of deep bedding on floor to retain the manure. Ammonia produced in broiler systems production generates damages to animals, humans and environment. The main source of ammonia in the manure deposited on the bed is the excreted nitrogen. With the adoption of appropriate techniques of environmental management, through of adequate ventilation and bed management, control of pH, temperature and humidity are possible significant reductions in ammonia emission, as well as with the use of additives and control the appropriate nitrogen content that is provided in the rations.

Precious Corals in Hawaii: Discovery of a New Bed and Revised Management Measures for Existing Beds

The fishery for deepwater precious corals in the Hawaiian Islands has experienced an on-and-off history for almost 40 years. In spite of this, research, driven primarily by the precious coral jewelry industry, remains active. In this paper, the results of deepwater surveys in 2000 and 2001 are reported. In summary, a new bed on the summit of Cross Seamount is described and revised estimates of MSY’s for pink coral, Corallium secundum; red coral, Corallium regale; and gold coral, Ger ardia sp., in the two known beds off Makapuu, Oahu, and Keahole Point, Hawaii, in the main Hawaiian Islands, are presented. The population dynamics of each species is described, as well as their ecological limits on Hawaii’s deep reefs, island shelves, and seamounts. The local supply of precious coral in the main Hawaiian Islands is sufficient to support the local industry, but cost/ benefits of selective harvest requirements and weather constraints limit profitability of the fish

The Impact of Admissions for the Management of End-stage renal disease on hospital bed occupancy

BACKGROUND:

End-stage renal disease (ESRD) is increasingly prevalent but the inpatient costs associated with this condition are poorly defined due to limitations with data extraction and failure to differentiate between hospitalisation for renal and non-renal disease reasons. The impact of admissions primarily for the management of ESRD on hospital bed utilisation was assessed over a 5-year period in a large teaching hospital.

METHODS:

All admission episodes were reviewed and the ESRD group was identified by a primary International Classification of Diseases code for ESRD or a non-specific primary renal failure code with a secondary code for ESRD. The frequency and duration of hospitalisation and contribution to bed day occupancy of this group with ESRD was determined.

RESULTS:

There were 70,808 patients responsible for a total of 116,915 admissions and 919,212 bed days over the study period. Of these, 988 (1.4%) patients were admitted for the management of ESRD, accounting for 2,387 (2.0%) of admissions and utilisation of 23,011 (2.5%) bed days. After adjustment for age and gender, those admitted for ESRD management were significantly more likely to have a prolonged admission exceeding 30 days (odds ratio 1.46, 95% confidence interval 1.23-1.72, p < 0.001). When the admission was an emergency rather than an elective event, the patient was 4.6 times more likely to be hospitalised for over 30 days.

CONCLUSIONS:

Persons admitted for ESRD management are hospitalised more frequently and for longer than the overall inpatient population, occupying a substantial number of bed days.

The nurse's guide or Short and safer rules for the management of women of each rank and condition in child-bed : : with directions about the choice of a wet-nurse in a dialogue betwixt a surgeon and a nurse.

Mode of access: Internet.

Alternate structural system of incorporating flat bed rail wagons as low volume road bridge decks

The stimulus for this project rose from the need to find an alternative solution to aging superstructures of road-bridge in low volume roads (LVR). The solution investigated, designed and consequently plans to construct, involved replacing an aging super-structure of a 10m span bridge with Flat-Bed Rail Wagon (FBRW). The main focus of this paper is to present alternate structural system for the design of the FBRW as road bridge deck conforming to AS5100. The structural adequacy of the primary members of the FBRW was first validated using full scale experimental investigation to AS5100 serviceability and ultimate limit state loading. The bare FBRW was further developed to include a running surface. Two options were evaluated during the design phase, namely timber and reinforced concrete. First option, which is presented here, involved strengthening of the FBRW using numerous steel sections and overlaying the bridge deck with timber planks. The idea of this approach was to use all the primary and secondary members of the FBRW in load sharing and to provide additional members where weaknesses in the original members arose. The second option, which was the preferred option for construction, involved use of primary members only with an overlaying reinforced concrete slab deck. This option minimised the risk associated with any uncertainty of secondary members to its structural adequacy. The paper will report selected results of the experiment as well as the design phases of option one with conclusions highlighting the viability of option 1 and its limitations.

Nursing resource implications of the unoccupied bed

Objective: To explore the specific factors that impact on nursing resources in relation to the ‘unoccupied bed’. Design: Descriptive observational Setting: Multiple wards in single site, tertiary referral hospital Main outcome measure: Identification and classification of tasks related to the unoccupied bed. Results: Our study identified three main areas of nursing work, which centre on the ‘unoccupied bed’: 1) bed preparation for admission; 2) temporary transfer; 3) bed preparation post patient discharge. Conclusion: The unoccupied bed is not resource neutral and may involve considerable nursing time. The time associated with each of the reasons for the bed being unoccupied remains to be quantified.

Smart Grid Test Bed Design and Implementation

Given there is currently a migration trend from traditional electrical supervisory control and data acquisition (SCADA) systems towards a smart grid based approach to critical infrastructure management. This project provides an evaluation of existing and proposed implementations for both traditional electrical SCADA and smart grid based architectures, and proposals a set of reference requirements which test bed implementations should implement. A high-level design for smart grid test beds is proposed and initial implementation performed, based on the proposed design, using open source and freely available software tools. The project examines the move towards smart grid based critical infrastructure management and illustrates the increased security requirements. The implemented test bed provides a basic framework for testing network requirements in a smart grid environment, as well as a platform for further research and development. Particularly to develop, implement and test network security related disturbances such as intrusion detection and network forensics. The project undertaken proposes and develops an architecture of the emulation of some smart grid functionality. The Common Open Research Emulator (CORE) platform was used to emulate the communication network of the smart grid. Specifically CORE was used to virtualise and emulate the TCP/IP networking stack. This is intended to be used for further evaluation and analysis, for example the analysis of application protocol messages, etc. As a proof of concept, software libraries were designed, developed and documented to enable and support the design and development of further smart grid emulated components, such as reclosers, switches, smart meters, etc. As part of the testing and evaluation a Modbus based smart meter emulator was developed to provide basic functionality of a smart meter. Further code was developed to send Modbus request messages to the emulated smart meter and receive Modbus responses from it. Although the functionality of the emulated components were limited, it does provide a starting point for further research and development. The design is extensible to enable the design and implementation of additional SCADA protocols. The project also defines an evaluation criteria for the evaluation of the implemented test bed, and experiments are designed to evaluate the test bed according to the defined criteria. The results of the experiments are collated and presented, and conclusions drawn from the results to facilitate discussion on the test bed implementation. The discussion undertaken also present possible future work.

Thin bed masonry system: review and future prospects

Masonry is one of the most ancient construction materials in the World. When compared to other civil engineering practices, masonry construction is highly labour intensive, which can affect the quality and productivity adversely. With a view to improving quality and in light of the limited skilled labour in the recent times several innovative masonry construction methods such as the dry stack and the thin bed masonry have been developed. This paper focuses on the thin bed masonry system, which is used in many parts of Europe. Thin bed masonry system utilises thin layer of polymer modified mortars connecting the accurately dimensioned and/or interlockable units. This assembly process has the potential for automated panelised construction system in the industry setting or being adopted in the site using less skilled labour, without sacrificing the quality. This is because unlike the conventional masonry construction, the thin bed technology uses thinner mortar (or glue) layer which can be controlled easily through some novel methods described in this paper. Structurally, reduction in the thickness of the mortar joint has beneficial effects; for example it increases the compressive strength of masonry; in addition polymer added glue mortar enhances lateral load capacity relative to conventional masonry. This paper reviews the details of the recent research outcomes on the structural characteristics and construction practices of thin bed masonry. Finally the suitability of thin bed masonry in developing countries where masonry remains as the most common material for residential building construction is discussed.

Assessing ease of use of the Staminalift bed mover

Battery powered bed movers are increasingly being used within the hospital setting. These energy augmenting devices facilitate the safe movement of beds and patients by healthcare workers. The use of powered bed movers is believed to result in reduced physical efforts on the behalf of staff members, which may be associated with a decreased risk of occupational related injuries. A provisional study was performed in a hospital environment to assess the muscular efforts associated with moving hospital beds both manually and with the aid of a bed mover. The results enable the effects of using bed movers to be quantified.