scholarly journals Reducing admission time to Broadmoor High Secure Hospital – a case review

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S313-S313
Author(s):  
Maria Vittoria Capanna ◽  
Saima Ali ◽  
Robert Bates
Keyword(s):  
Negative Impact ◽  
Patient Flow ◽  
Waiting Times ◽  
Psychiatric Hospitals ◽  
Service Level ◽  
Special Focus ◽  
Case Review ◽  
Exclusion Criteria ◽  
Increased Risk ◽  
Rate Limiting

AimsProlonged waiting times for admission to psychiatric hospital settings are a common and widespread issue. Delayed admissions may result in poorer outcomes due to prolonged mental suffering and delays in initiating treatment. Long waiting times also have a negative impact at a service level, impeding patient flow.National guidance has been recently updated, recommending that patient transfers to secure services take no longer than 28 days from referral. These transfers are frequently affected by delays in admission, possibly resulting in increased risk to patients, staff and the public.The aim of this project was to audit all referrals to Broadmoor High Secure Hospital in England within a one year period with special focus taken on calculating the time taken from referral to admission. We aimed to assess if there were any rate limiting steps which could be targeted to reduce time from referral to admission.MethodWe collected data and conducted a retrospective cohort review for all admissions from September 2019-September 2020. Where available, information was obtained for each step of the referrals process. Individual patient records were reviewed where required.Exclusion criteria: data withdrawn, transfers from other high secure services (HSS), incomplete data, “MOJ instruction” or urgent admission bypassing the process.Result18 cases were excluded as per exclusion criteria. 46 patients were included in the study. 16 referrals originated from medium secure psychiatric hospitals, and 30 from prison.The average time from referral to admission was 44.3 days. Admission of patients from MSUs was quicker, taking an average of 40.3 days when compared to prison referrals, which took 45.9 days.The breakdown of timings for each step in the referrals process was calculated to determine if a rate limiting step could be identified.On average it took 2.1 working days to allocate a case to a clinician, 7.6 days for an assessment, 9.2 days to complete a report and 3.5 days to submit this to the admissions panel. The mean time from referral to the date of the panel hearing was 22.5 working days, and admission took a further 21.8 days on average.ConclusionThe current average time to admission exceeds the new 28 day recommendation. This could both be due to the COVID-19 pandemic, and miscommunication about time targets. We will review the process and aim to reduce the time from referral to admission in line with new guidance.

scholarly journals Rethinking Elective Cataract Surgery Diagnostics, Assessments, and Tools after the COVID-19 Pandemic Experience and Beyond: Insights from the EUROCOVCAT Group

Diagnostics ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 1035
Author(s):  
Daniele Tognetto ◽  
Antoine P. Brézin ◽  
Arthur B. Cummings ◽  
Boris E. Malyugin ◽  
Ozlem Evren Kemer ◽  
...  
Keyword(s):  
Cataract Surgery ◽  
Negative Impact ◽  
Waiting Times ◽  
The Elderly ◽  
Recovery Phase ◽  
Diagnostic Tools ◽  
Special Focus ◽  
Critical Issues ◽  
Precautionary Measures ◽  
The Impact

The progressive deterioration of the visual function in patients on waiting lists for cataract surgery has a negative impact on their quality of life, especially in the elderly population. Patient waiting times for cataract surgeries in many healthcare settings have increased recently due to the prolonged stop or slowdown of elective cataract surgery as a result of coronavirus disease 19 (COVID-19). The aim of this review is to highlight the impact of such a “de-prioritization” of cataract surgery and to summarize some critical issues and useful hints on how to reorganize cataract pathways, with a special focus on perioperative diagnostic tools during the recovery phase and beyond. The experiences of a group of surgeons originating from nine different countries, named the European COVID-19 Cataract Group (EUROCOVCAT), have been combined with the literature and recommendations from scientific ophthalmic societies and healthcare institutions. Key considerations for elective cataract surgery should include the reduction of the number of unnecessary visits and examinations, adoption of precautionary measures, and implementation of telemedicine instruments. New strategies should be adopted to provide an adequate level of assistance and to guarantee safety conditions. Flexibility will be the watchword and regular updates would be necessary following scientific insights and the development of the pandemic.

scholarly journals POCT in Emergency Rooms: One Key Factor for Process Streamlining with Lean Management

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Verena Lindenau-Stockfisch ◽  
Julia Searle ◽  
Martin Möckel
Keyword(s):  
Negative Impact ◽  
Patient Flow ◽  
Waiting Times ◽  
Care Hospital ◽  
Lean Management ◽  
Emergency Rooms ◽  
Flow Process ◽  
Value Stream ◽  
Current State ◽  
Key Factor

Overcrowding is a common problem in Emergency Departments (ED) worldwide and has a negative impact on patient satisfaction and, more importantly, patient safety. So, the Emergency Department of the secondary-care hospital Paul Gerhardt Stift in Wittenberg, Germany, was faced with increasing numbers of patients. Lean management was introduced to analyse, optimise, and standardise ED processes. Consequently, a project group concentrated on “cycling muda” which is to identify waste and cost drivers along a representative patient path using one suitable Lean tool: mapping the current state in a value stream. As a result, it became clear that both patients and staff suffered from immense waiting times that lead to risky patient care and employee frustration. By subsequently eliminating the waste drivers and designing a high-quality patient flow process creating standards supported by state-of-the-art technology, the hospital’s ED turned into a streamlined department with reduced waiting times offering employees a satisfactory and modern workplace where patients benefit from first-class care.

Nutritional Intervention May Improve Body Mass Index of Malnourished Hospitalized Psychiatric Patients – A Preliminary Observation

2019 ◽  
Vol 18 (3) ◽  
pp. 256-259
Author(s):  
Hou Y.C. ◽  
Hsieh Y.L. ◽  
Tzeng I.S. ◽  
Kuo C.Y.
Keyword(s):  
Body Weight ◽  
Psychiatric Patients ◽  
Psychiatric Hospitals ◽  
Nutritional Intervention ◽  
Nutrition Intervention ◽  
Calorie Intake ◽  
Psychiatric Ward ◽  
Increased Risk ◽  
Total Calorie ◽  
Total Calorie Intake

Malnutrition is an important issue in hospitalized patients. Poor nutrition may lead to increased risk of morbidity and death, impaired mental and physical conditions, apathy, depression, self-neglect, increased risk of medical complications, increased risk of pressure ulcers, reduced immune response, delayed wound healing, longer hospital stays, and reduced quality of life. However, few studies have investigated malnutrition in psychiatric patients. Psychiatric patients are known to have an increased risk of malnutrition, but psychiatric hospitals rarely conduct physical examinations and nutritional assessments. In this preliminary study, patients from a psychiatric ward of the Taipei Tzu Chi Hospital were chosen using the Malnutrition Universal Screening Tool. We used the before-and-after analysis to test the effect of a nutrition intervention on the selected parameters. We found that patients who had an impaired nutritional status showed significant increases in body weight (mean: 43.6 ± 7.5 vs. 46.5 ± 8.2 kg; P < 0.001), BMI (mean: 16.8 ± 2.0 vs. 17.9 ± 2.1 kg/m2; P < 0.001), and total calorie intake (mean: 1128 ± 230 vs. 1378 ± 320 Kcal; P < 0.001). Nutritional intervention significantly improved body weight, BMI, and total calorie intake. Nutritional intervention may help prevent malnutrition and improve the management of psychiatric patients.

Organic chemical devulcanization of rubber vulcanizates in supercritical carbon dioxide and associated less eco-unfriendly approaches: A review

2021 ◽  
pp. 0734242X2110085
Author(s):  
Jabulani I Gumede ◽  
Buyiswa G Hlangothi ◽  
Chris D Woolard ◽  
Shanganyane P Hlangothi
Keyword(s):  
Carbon Dioxide ◽  
Supercritical Carbon Dioxide ◽  
Negative Impact ◽  
Raw Materials ◽  
Chemical Components ◽  
Organic Chemical ◽  
Attractive Alternative ◽  
Special Focus ◽  
Waste Tyres ◽  
Supercritical Carbon

There is a growing need to recover raw materials from waste due to increasing environmental concerns and the widely adopted transition to circular economy. For waste tyres, it is necessary to continuously develop methods and processes that can devulcanize rubber vulcanizates into rubber products with qualities and properties that can closely match those of the virgin rubber. Currently, the most common, due to its efficiency and perceived eco-friendliness in recovering raw rubber from waste rubbers, such as tyres, is devulcanization in supercritical carbon dioxide (scCO2) using commercial and typical devulcanizing agents. The scCO2 has been generally accepted as an attractive alternative to the traditional liquid-based devulcanization media because of the resultant devulcanized rubber has relatively better quality than other processes. For instance, when scCO2 is employed to recover rubber from waste tyres (e.g. truck tyres) and the recovered rubber is blended with virgin natural rubber (NR) in various compositions, the curing and mechanical properties of the blends closely match those of virgin NR. The atmospheric toxicity and cost of the commonly used devulcanization materials like chemical agents, oils and solvents have enabled a shift towards utilization of greener (mainly organic) and readily available devulcanization chemical components. This literature review paper discusses the approaches, which have less negative impact on the environment, in chemical devulcanization of rubber vulcanizates. A special focus has been on thermo-chemical devulcanization of waste tyres in scCO2 using common organic devulcanizing agents.

Principles of capacity management, applied in the mental health context

2018 ◽  
Vol 42 (4) ◽  
pp. 438
Author(s):  
Kathryn Zeitz ◽  
Darryl Watson
Keyword(s):  
Mental Health ◽  
Mental Health Problems ◽  
Average Length ◽  
Patient Flow ◽  
Waiting Times ◽  
Capacity Management ◽  
Mental Health Setting ◽  
Mental Health Consumer ◽  
Mental Health Consumers ◽  
Flow Improvement

Objective The aim of the paper was to describe a suite of capacity management principles that have been applied in the mental health setting that resulted in a significant reduction in time spent in two emergency departments (ED) and improved throughput. Methods The project consisted of a multifocal change approach over three phases that included: (1) the implementation of a suite of fundamental capacity management activities led by the service and clinical director; (2) a targeted Winter Demand Plan supported by McKinsey and Co.; and (3) a sustainability of change phase. Descriptive statistics was used to analyse the performance data that was collected through-out the project. Results This capacity management project has resulted in sustained patient flow improvement. There was a reduction in the average length of stay (LOS) in the ED for consumers with mental health presentations to the ED. At the commencement of the project, in July 2014, the average LOS was 20.5 h compared with 8.5 h in December 2015 post the sustainability phase. In July 2014, the percentage of consumers staying longer than 24 h was 26% (n = 112); in November and December 2015, this had reduced to 6% and 7 5% respectively (less than one consumer per day). Conclusion Improving patient flow is multifactorial. Increased attendances in public EDs by people with mental health problems and the lengthening boarding in the ED affect the overall ED throughput. Key strategies to improve mental health consumer flow need to focus on engagement, leadership, embedding fundamentals, managing and target setting. What is known about the topic? Improving patient flow in the acute sector is an emerging topic in the health literature in response to increasing pressures of access block in EDs. What does this paper add? This paper describes the application of a suite of patient flow improvement principles that were applied in the mental health setting that significantly reduced the waiting time for consumers in two EDs. What are the implications for practitioners? No single improvement will reduce access block in the ED for mental health consumers. Reductions in waiting times require a concerted, multifocal approach across all components of the acute mental health journey.

scholarly journals A performance model for mobile robot-based part feeding systems to supermarkets

2021 ◽  
Author(s):  
Emilio Moretti ◽  
Elena Tappia ◽  
Martina Mauri ◽  
Marco Melacini
Keyword(s):  
Negative Impact ◽  
Positive Impact ◽  
Waiting Times ◽  
Performance Model ◽  
Innovative Technology ◽  
Shop Floor ◽  
Storage And Retrieval ◽  
Trade Offs ◽  
Part Feeding ◽  
Feeding Systems

AbstractIn a context where companies are striving to produce highly customised goods in small batches and within short lead times, increasing attention is being put on the design and management of part feeding systems. This research is the first to model automated part feeding to supermarkets in a factory environment, considering an innovative technology called vertical robotic storage and retrieval systems. This technology allows automating the storage, picking, and internal transportation activities in an integrated process, thanks to rack-climbing robots roaming in both the shop floor and the storage racks. We develop an analytical model based on the queuing network approach to analyse the system performance, and we use it to perform numerical experiments and to evaluate the design trade-offs with reference to a real case in the automotive industry. Results show that an increase in the number of robots leads to better performance since the positive impact on the response time is stronger than the negative impact on the waiting times of robots at the supermarkets due to congestion. Furthermore, a configuration with multiple small supermarkets improves the efficiency of the replenishment process, compared to a setting with few big supermarkets.

scholarly journals SAT0306 SEMIQUANTITATIVE AND QUANTITATIVE ANALYSIS OF LUNG CT IN THE ASSESSMENT OF INTERSTITIAL LUNG DISEASE IN IDIOPATHIC INFLAMMATORY MYOPATHIES WITH A FOCUS ON ANTISYNTHETASE.

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1098.2-1098
Author(s):  
S. Barsotti ◽  
C. Roncella ◽  
A. Valentini ◽  
L. Cavagna ◽  
R. Castellana ◽  
...  
Keyword(s):  
Quantitative Analysis ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Special Focus ◽  
Idiopathic Inflammatory Myopathies ◽  
Inflammatory Myopathies ◽  
Increased Risk ◽  
Group 2 ◽  
Lung Ct ◽  
Group 1

Background:Interstitial lung disease (ILD), is common in patients with idiopathic inflammatory myopathies (IIM) and strongly impact on patients’ morbidity and mortality. Patients with anti-aminoacyl-transfer RNA-synthetases (anti-ARS) antibodies are associated with an increased risk of ILD.Objectives:Defining the radiological characteristics of IIM patients, with special focus on serological groups, through qualitative, semiquantitative and quantitative analysis of lung CT.Methods:This was a prospective study conducted from 2016 to 2019. Ninety-eight IIM patients (35 men, 63 women) were included. Myositis specific autoantibodies (MSA) were assessed with Myositis Prophyle III (Euroimmune, Lubeck).Each patient had a baseline CT; the total score of Warrick (WS) was obtained at semiquantitative analysis. The radiological scores ILD% (interstitial lung disease %) and PVRS% (pulmonary vascular related structure) were the result of quantitative analysis in 61 patients (CALIPER). Pulmonary function tests (PFTs) included TLC%, FVC% and DLCO% (65 patients). The analysis was conducted in the whole group and divided in subgroups based on their MSA pattern: in particular anti-ARS (Group 1) and patients negative to MSA (Group 2) were analysed.Results:Positive correlations between ILD% and PVRS% (Rho=0.916; ρ=0.000), WS and ILD% (Rho=0.663; ρ=0.000) and WS and PVRS% (Rho=0.637; ρ<0.001) were found.The most relevant inverse correlations were found between ILD% and DLCO% (Rho=-0.590; ρ=0.001), PVRS% and DLCO% (Rho=-0.549; ρ<0.001) and WS and DLCO% (Rho=-0.471; ρ<0.001).Statistically significant higher values of WS, ILD% and PVRS% were found in Group 1 (WS=15, ILD%=11 and PVRS%=3.5), compared to Group 2 (WS=2.5, ILD%=0.84 and PVRS%=2.2). NSIP pattern resulted dominant represented in the two groups (80% Group 1, 75% Group 2). No statistically significant differences of DLCO%, FVC% and TLCO% were found.Conclusion:The inverse correlations between the radiological scores and the functional data TLC% and DLCO% (ρ<0.001) confirm the role of lung CT in the clinical management of ILD in IIM patients, and may represent a promising tool for clinical trials. For the first time anti-ARS and serological negative patients were defined through qualitative, semiquantitative and quantitative analysis of lung CT. Further study should be conducted in order to define the prognostic value of the quantitative analysis of lung CT in the follow up of IIM patients.Disclosure of Interests:None declared

scholarly journals Overt acts of perceived discrimination reported by British working-age adults with and without disability

2019 ◽  
Author(s):  
Eric Emerson ◽  
Allison Milner ◽  
Zoe Aitken ◽  
Lauren Krnjacki ◽  
Cathy Vaughan ◽  
...  
Keyword(s):  
Public Health ◽  
Negative Impact ◽  
Policy Research ◽  
Secondary Analysis ◽  
People With Disabilities ◽  
Public Health Problem ◽  
Health Staff ◽  
Cross Sectional ◽  
Increased Risk ◽  
The Uk

Abstract Background Exposure to discrimination can have a negative impact on health. There is little robust evidence on the prevalence of exposure of people with disabilities to discrimination, the sources and nature of discrimination they face, and the personal and contextual factors associated with increased risk of exposure. Methods Secondary analysis of de-identified cross-sectional data from the three waves of the UK’s ‘Life Opportunities Survey’. Results In the UK (i) adults with disabilities were over three times more likely than their peers to be exposed to discrimination, (ii) the two most common sources of discrimination were strangers in the street and health staff and (iii) discrimination was more likely to be reported by participants who were younger, more highly educated, who were unemployed or economically inactive, who reported financial stress or material hardship and who had impairments associated with hearing, memory/speaking, dexterity, behavioural/mental health, intellectual/learning difficulties and breathing. Conclusions Discrimination faced by people with disabilities is an under-recognised public health problem that is likely to contribute to disability-based health inequities. Public health policy, research and practice needs to concentrate efforts on developing programs that reduce discrimination experienced by people with disabilities.

Simulation of a Hospital Disaster Plan: A Virtual, Live Exercise

2008 ◽  
Vol 23 (4) ◽  
pp. 346-353 ◽  
Author(s):  
Jeffrey M. Franc-Law ◽  
Michael Bullard ◽  
F. Della Corte
Keyword(s):  
Emergency Department ◽  
Patient Flow ◽  
Learning Experience ◽  
Significant Degree ◽  
Primary Objective ◽  
Simulated Patients ◽  
Disaster Plan ◽  
Actual Patient ◽  
Patient Database ◽  
Rate Limiting

AbstractIntroduction:Currently, there is no widely available method to evaluate an emergency department disaster plan. Creation of a standardized patient data- base and the use of a virtual, live exercise may lead to a standardized and reproducible method that can be used to evaluate a disaster plan.Purpose:A virtual, live exercise was designed with the primary objective of evaluating a hospital's emergency department disaster plan. Education and training of participants was a secondary goal.Methods:A database (disastermed.ca) of histories, physical examination findings, and laboratory results for 136 simulated patients was created using information derived from actual patient encounters.The patient database was used to perform a virtual, live exercise using a training version of the emergency department's information system software.Results:Several solutions to increase patient flow were demonstrated during the exercise. Conducting the exercise helped identify several faults in the hospital disaster plan, including outlining the important rate-limiting step. In addition, a significant degree of under-triage was demonstrated. Estimates of multiple markers of patient flow were identified and compared to Canadian guidelines. Most participants reported that the exercise was a valuable learning experience.Conclusions:A virtual, live exercise using the disastermed.ca patient database was an inexpensive method to evaluate the emergency department disaster plan. This included discovery of new approaches to managing patients, delineating the rate-limiting steps, and evaluating triage accuracy. Use of the patient timestamps has potential as a standardized international benchmark of hospital disaster plan efficacy. Participant satisfaction was high.

scholarly journals Appendiceal Carcinoids In Crohn’s Disease

2003 ◽  
Vol 17 (1) ◽  
pp. 43-46 ◽  
Author(s):  
Hugh J Freeman
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Carcinoid Tumour ◽  
Intestinal Resection ◽  
Case Review ◽  
Appendiceal Neoplasms ◽  
Increased Risk ◽  
Intestinal Neoplasms ◽  
Resection Specimen ◽  
Sporadic Cases

Earlier investigations demonstrate an increased risk for colon cancer in Crohn's disease. For other intestinal neoplasms, such as carcinoids, studies are limited. In Crohn's disease, repeated endoscopic and imaging studies along with intestinal resections may facilitate clinical recognition of neoplastic diseases, including appendiceal neoplasms. To date, however, only sporadic cases of appendiceal carcinoids have been described in Crohn's disease. In the present study, in a single clinician database of 1000 Crohn's disease patients, three of the 441 patients who had undergone intestinal resection had appendiceal carcinoids, all of which were pathologically confirmed. All were observed in female patients and were not suspected before surgical treatment. In one case, even though management was not altered, the tumour had already invaded serosal fat indicating a potential for more advanced disease. In this series, a carcinoid tumour was found in a resection specimen during a later clinical case review and another was a microcarcinoid, implying that these tumours may be overlooked in Crohn's disease. The percentage detected in the entire database (0.3%) exceeds the reported rates of detection of appendiceal carcinoids after removal of the appendix for appendicitis, as well as the rate of detection of appendiceal carcinoids in autopsy studies. This percentage would be higher if only those having an intestinal resection were considered (0.68%). Additional studies are needed to further define this risk of appendiceal carcinoids in Crohn's disease.

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