Standardizing admission and discharge processes to improve patient flow: a cross sectional study

Background: The aim of this study was to evaluate how hospital capacity was managed focusing on standardizing the admission and discharge processes. Methods: This study was set in a 900-bed university affiliated hospital of the National Health Service, near Barcelona (Spain). This is a cross-sectional study of a set of interventions which were gradually implemented between April and December 2008. Mainly, they were focused on standardizing the admission and discharge processes to improve patient flow. Primary administrative data was obtained from the 2007 and 2009 Hospital Database. Main outcome measures were median length of stay, percentage of planned discharges, number of surgery cancellations and median number of delayed emergency admissions at 8:00 am. For statistical bivariate analysis, we used a Chi-squared for linear trend for qualitative variables and a Wilcoxon signed ranks test and a Mann-Whitney test for non-normal continuous variables. Results: The median patients' global length of stay was 8.56 days in 2007 and 7.93 days in 2009 (p < 0.051). The percentage of patients admitted the same day as surgery increased from 64.87% in 2007 to 86.01% in 2009 (p < 0.05). The number of cancelled interventions due to lack of beds was 216 patients in 2007 and 42 patients in 2009. The median number of planned discharges went from 43.05% in 2007 to 86.01% in 2009 (p < 0.01). The median number of emergency patients waiting for an in-hospital bed at 8:00 am was 5 patients in 2007 and 3 patients in 2009 (p < 0.01). Conclusions: In conclusion, standardization of admission and discharge processes are largely in our control. There is a significant opportunity to create important benefits for increasing bed capacity and hospital throughput

Is a delayed treatment with GnRH, hCG or progesterone beneficial for reducing embryonic mortality in buffaloes?

Contents: The aims of this study were to verify the efficacy of delayed hormonal treatments performed on day 25 post-insemination on pregnancy rate at 45 and 70 days in buffalo. The trial was performed on 385 buffaloes synchronized by the Ovsynch/TAI protocol and submitted to artificial insemination (AI). Twenty-five days after AI, pregnant animals were assigned to four treatments: (1) GnRH agonist (n = 52), 12 μg of buserelin acetate; (2) hCG (n = 51), 1500 IU of human chorionic gonadotrophin; (3) Progesterone (n = 47), 341 mg of P4 intramuscular (im) every 4 days for three times; (4) Control (n = 54), treatment with physiological saline (0.9% NaCl). Milk samples were collected on days 10, 20 and 25 after AI in all buffaloes to determine progesterone concentration in whey by radioimmunoassay method. Statistical analysis was performed by anova. Pregnancy rate on day 25 after AI was 52.9%, but declined to 41.8% by day 45, indicating an embryonic mortality (EM) of 21%. If only control group is considered, the incidence of EM was 38.9%. Pregnant buffaloes had higher (p < 0.01) progesterone concentrations on day 20 and 25 after AI than both non-pregnant buffaloes and buffaloes that showed EM. The treatments on day 25 increased (p < 0.01) pregnancy rate, although in buffaloes with a low whey progesterone concentration on day 20 and 25 after AI (n = 22); all treatments were ineffective to reduce EM. © 2008 The Authors. Journal compilatio

Experimental and model analyses of the effects of competition on individual size variation in wood frog ( Rana sylvatica ) tadpoles

1.   Size variation is a ubiquitous feature of animal populations and is predicted to strongly influence species abundance and dynamics; however, the factors that determine size variation are not well understood. 2.   In a mesocosm experiment, we found that the relationship between mean and variation in wood frog ( Rana sylvatica ) tadpole size is qualitatively different at different levels of competition created by manipulating resource supply rates or tadpole density. At low competition, relative size variation (as measured by the coefficient of variation) decreased as a function of mean size, while at high competition, relative size variation increased. Therefore, increased competition magnified differences in individual performance as measured by growth rate. 3.   A model was developed to estimate the contribution of size-dependent factors (i.e. based on size alone) and size-independent factors (i.e. resulting from persistent inherent phenotypic differences other than size that affect growth) on the empirical patterns. 4.   Model analysis of the low competition treatment indicated that size-dependent factors alone can describe the relationship between mean size and size variation. To fit the data, the size scaling exponent that describes the dependence of growth rate on size was determined. The estimated value, 0·83, is in the range of that derived from physiological studies. 5.   At high competition, the model analysis indicated that individual differences in foraging ability, either size-based or due to inherent phenotypic differences (size-independent factors), were much more pronounced than at low competition. The model was used to quantify the changes in size-dependent or size-independent factors that underlie the effect of competition on size-variation. In contrast to results at low competition, parameters derived from physiological studies could not be used to describe the observed relationships. 6.   Our experimental and model results elucidate the role of size-dependent and size-independent factors in the development of size variation, and highlight and quantify the context dependence of individual (intrapopulation) differences in competitive abilities. Journal of Animal Ecology (2006) 75 , 990 –999 doi: 10.1111/j.1365-2656.2006.01119.xPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/71731/1/j.1365-2656.2006.01119.x.pd