BACKGROUND: Emergency departments(EDs) face problems with overcrowding, access block, cost containment, and increasing demand from patients. In order to resolve these problems, there is rising interest to an approach ...BACKGROUND: Emergency departments(EDs) face problems with overcrowding, access block, cost containment, and increasing demand from patients. In order to resolve these problems, there is rising interest to an approach called "lean" management. This study aims to(1) evaluate the current patient flow in ED,(2) to identify and eliminate the non-valued added process, and(3) to modify the existing process.METHODS: It was a quantitative, pre- and post-lean design study with a series of lean management work implemented to improve the admission and blood result waiting time. These included structured re-design process, priority admission triage(PAT) program, enhanced communication with medical department, and use of new high sensitivity troponin-T(hsTnT) blood test. Triage waiting time, consultation waiting time, blood result time, admission waiting time, total processing time and ED length of stay were compared.RESULTS: Among all the processes carried out in ED, the most time consuming processes were to wait for an admission bed(38.24 minutes; SD 66.35) and blood testing result(mean 52.73 minutes, SD 24.03). The triage waiting time and end waiting time for consultation were significantly decreased. The admission waiting time of emergency medical ward(EMW) was significantly decreased from 54.76 minutes to 24.45 minutes after implementation of PAT program(P<0.05).CONCLUSION: The application of lean management can improve the patient flow in ED. Acquiescence to the principle of lean is crucial to enhance high quality emergency care and patient satisfaction.展开更多
Smart environment is being used in many areas to deliver more services to individuals in a physical space, such as a hospital. In the UK, the National Health Service(NHS) provides free and high quality healthcare serv...Smart environment is being used in many areas to deliver more services to individuals in a physical space, such as a hospital. In the UK, the National Health Service(NHS) provides free and high quality healthcare service for all residents. Smart hospital environment is able to support NHS and provide more convenience. Patient flow scheduling is a crucial section in a smart hospital environment. Smart hospital environment aims to provide a smart environment in the hospital to facilitate individual experience and improve the quality of healthcare service.First of all, this paper investigates a real world patient flow scenario of a hospital in the UK and models a general scheduling scheme based on the scenario using a compositional formal approach, i.e. performance evaluation process algebra(PEPA). This scheduling scheme uses an easy-implemented solution(the grouping scheme) to reduce the waiting queue in the hospital. Secondly, fluid flow analysis is used for the performance analysis by generating a set of ordinary differential equations(ODEs) in terms of the PEPA model.展开更多
Urgent care clinics and emergency departments around the world periodically suffer from extended wait times beyond patient expectations due to surges in patient flows.The delays arising from inadequate staffing levels...Urgent care clinics and emergency departments around the world periodically suffer from extended wait times beyond patient expectations due to surges in patient flows.The delays arising from inadequate staffing levels during these periods have been linked with adverse clinical outcomes.Previous research into forecasting patient flows has mostly used statistical techniques.These studies have also predominately focussed on short‐term forecasts,which have limited practicality for the resourcing of medical personnel.This study joins an emerging body of work which seeks to explore the potential of machine learning algorithms to generate accurate forecasts of patient presentations.Our research uses datasets covering 10 years from two large urgent care clinics to develop long‐term patient flow forecasts up to one quarter ahead using a range of state‐of‐the‐art algo-rithms.A distinctive feature of this study is the use of eXplainable Artificial Intelligence(XAI)tools like Shapely and LIME that enable an in‐depth analysis of the behaviour of the models,which would otherwise be uninterpretable.These analysis tools enabled us to explore the ability of the models to adapt to the volatility in patient demand during the COVID‐19 pandemic lockdowns and to identify the most impactful variables,resulting in valuable insights into their performance.The results showed that a novel combination of advanced univariate models like Prophet as well as gradient boosting,into an ensemble,delivered the most accurate and consistent solutions on average.This approach generated improvements in the range of 16%-30%over the existing in‐house methods for esti-mating the daily patient flows 90 days ahead.展开更多
Thirty patients in coma state underwent dynamic SPECT with 133Xe, a validated technique for the quantitation of CBF by SPECT, using a new brain dedicated tomograph: CERTO-96. CMRO2 was computed by multiplying the mean...Thirty patients in coma state underwent dynamic SPECT with 133Xe, a validated technique for the quantitation of CBF by SPECT, using a new brain dedicated tomograph: CERTO-96. CMRO2 was computed by multiplying the mean CBF by AVDO2 according to the Fick’s principle. The mean values of CBF, AVDO2 and CMRO2 in patients with good outcome were significantly different from those with worse outcome. On the basis of the best "discriminant threshold", CBF and AVDO2 demonstrated an intermediate accuracy in separating the two groups, while CMRO2 showed a satisfactory accuracy.展开更多
Objective To explore effects of decompressive craniectomy on cerebral blood flow volume and brain metabolism in different aged patients with severe traumatic brain injury. Methods 71 cases were divided into three grou...Objective To explore effects of decompressive craniectomy on cerebral blood flow volume and brain metabolism in different aged patients with severe traumatic brain injury. Methods 71 cases were divided into three groups according age: group A( 【 30 years) ,group B ( 30 ～ 50 years) 。展开更多
Purpose: The purpose of this study was to investigate the effects of Micro Vibrational therapy (MVT) on muscle stiffness and blood flow in the skin before and after Micro Vibrational therapy in healthy subjects in ord...Purpose: The purpose of this study was to investigate the effects of Micro Vibrational therapy (MVT) on muscle stiffness and blood flow in the skin before and after Micro Vibrational therapy in healthy subjects in order to scientifically verify the effects of MVT. Methods: Micro Vibrational therapy is nurse care use in Japan. It was performed on the backs of 30 subjects (8 males and 22 females) in their 20 s to 50 s according to the eligibility criteria. The resting state before implementation was set as the baseline for the control group, and after 30 seconds of MVT was set as the intervention group. The effects of the MVT were statistically analyzed by these factors and subjective sensation by Visual Analog Scale. Results: The muscle hardness of the area where the MVT was applied for 30 seconds decreased to 29.54 (SD 5.04) after the application, compared to 30.45 (SD 5.05) before. A corresponding t-test showed a significant difference (p = 0.019). Skin blood flow increased from a median of 0.76 (variance 0.062) before to a median of 0.86 (variance 0.16) after the procedure. The Wilcoxon rank test showed a significant difference (p = 0.000). Circulatory response was confirmed by SBP, DBP, and HR. SBP of 108.6 mmHg (SD 14.8) before the study decreased to 105.7 mmHg (SD 15.0) after the study, and DBP of 65.6 mmHg (SD 11.1) before the study decreased to 62.7 mmHg (SD 11.8) after the study. HR decreased from 71.6 beats per minute (SD 10.3) before to 69.2 beats per minute (SD 11.7) after. There was a significant difference in all cardiovascular indices (p < 0.05). VAS (pain, stiffness, and fatigue) was significantly decreased after MVT (p < 0.05). Conclusion: Micro Vibrational therapy tended to decrease muscle hardness and increase skin blood flow even in the short time of 30 seconds. The results suggest that local vibration stimulation is not likely to cause a sudden increase in blood pressure or pulse rate fluctuation. These results suggest that hand vibration nursing care may be applicable to acute patients with unstable circulatory conditions.展开更多
文摘BACKGROUND: Emergency departments(EDs) face problems with overcrowding, access block, cost containment, and increasing demand from patients. In order to resolve these problems, there is rising interest to an approach called "lean" management. This study aims to(1) evaluate the current patient flow in ED,(2) to identify and eliminate the non-valued added process, and(3) to modify the existing process.METHODS: It was a quantitative, pre- and post-lean design study with a series of lean management work implemented to improve the admission and blood result waiting time. These included structured re-design process, priority admission triage(PAT) program, enhanced communication with medical department, and use of new high sensitivity troponin-T(hsTnT) blood test. Triage waiting time, consultation waiting time, blood result time, admission waiting time, total processing time and ED length of stay were compared.RESULTS: Among all the processes carried out in ED, the most time consuming processes were to wait for an admission bed(38.24 minutes; SD 66.35) and blood testing result(mean 52.73 minutes, SD 24.03). The triage waiting time and end waiting time for consultation were significantly decreased. The admission waiting time of emergency medical ward(EMW) was significantly decreased from 54.76 minutes to 24.45 minutes after implementation of PAT program(P<0.05).CONCLUSION: The application of lean management can improve the patient flow in ED. Acquiescence to the principle of lean is crucial to enhance high quality emergency care and patient satisfaction.
基金the National Natural Science Foundation of China(Nos.61502206 and 61472343)the Natural Science Foundation of Jiangsu Province(Nos.BK20160543 and BK20150523)the Open Project of Key Laboratory of Jiangsu Province(No.BM20082061507)
文摘Smart environment is being used in many areas to deliver more services to individuals in a physical space, such as a hospital. In the UK, the National Health Service(NHS) provides free and high quality healthcare service for all residents. Smart hospital environment is able to support NHS and provide more convenience. Patient flow scheduling is a crucial section in a smart hospital environment. Smart hospital environment aims to provide a smart environment in the hospital to facilitate individual experience and improve the quality of healthcare service.First of all, this paper investigates a real world patient flow scenario of a hospital in the UK and models a general scheduling scheme based on the scenario using a compositional formal approach, i.e. performance evaluation process algebra(PEPA). This scheduling scheme uses an easy-implemented solution(the grouping scheme) to reduce the waiting queue in the hospital. Secondly, fluid flow analysis is used for the performance analysis by generating a set of ordinary differential equations(ODEs) in terms of the PEPA model.
文摘Urgent care clinics and emergency departments around the world periodically suffer from extended wait times beyond patient expectations due to surges in patient flows.The delays arising from inadequate staffing levels during these periods have been linked with adverse clinical outcomes.Previous research into forecasting patient flows has mostly used statistical techniques.These studies have also predominately focussed on short‐term forecasts,which have limited practicality for the resourcing of medical personnel.This study joins an emerging body of work which seeks to explore the potential of machine learning algorithms to generate accurate forecasts of patient presentations.Our research uses datasets covering 10 years from two large urgent care clinics to develop long‐term patient flow forecasts up to one quarter ahead using a range of state‐of‐the‐art algo-rithms.A distinctive feature of this study is the use of eXplainable Artificial Intelligence(XAI)tools like Shapely and LIME that enable an in‐depth analysis of the behaviour of the models,which would otherwise be uninterpretable.These analysis tools enabled us to explore the ability of the models to adapt to the volatility in patient demand during the COVID‐19 pandemic lockdowns and to identify the most impactful variables,resulting in valuable insights into their performance.The results showed that a novel combination of advanced univariate models like Prophet as well as gradient boosting,into an ensemble,delivered the most accurate and consistent solutions on average.This approach generated improvements in the range of 16%-30%over the existing in‐house methods for esti-mating the daily patient flows 90 days ahead.
文摘Thirty patients in coma state underwent dynamic SPECT with 133Xe, a validated technique for the quantitation of CBF by SPECT, using a new brain dedicated tomograph: CERTO-96. CMRO2 was computed by multiplying the mean CBF by AVDO2 according to the Fick’s principle. The mean values of CBF, AVDO2 and CMRO2 in patients with good outcome were significantly different from those with worse outcome. On the basis of the best "discriminant threshold", CBF and AVDO2 demonstrated an intermediate accuracy in separating the two groups, while CMRO2 showed a satisfactory accuracy.
文摘Objective To explore effects of decompressive craniectomy on cerebral blood flow volume and brain metabolism in different aged patients with severe traumatic brain injury. Methods 71 cases were divided into three groups according age: group A( 【 30 years) ,group B ( 30 ～ 50 years) 。
文摘Purpose: The purpose of this study was to investigate the effects of Micro Vibrational therapy (MVT) on muscle stiffness and blood flow in the skin before and after Micro Vibrational therapy in healthy subjects in order to scientifically verify the effects of MVT. Methods: Micro Vibrational therapy is nurse care use in Japan. It was performed on the backs of 30 subjects (8 males and 22 females) in their 20 s to 50 s according to the eligibility criteria. The resting state before implementation was set as the baseline for the control group, and after 30 seconds of MVT was set as the intervention group. The effects of the MVT were statistically analyzed by these factors and subjective sensation by Visual Analog Scale. Results: The muscle hardness of the area where the MVT was applied for 30 seconds decreased to 29.54 (SD 5.04) after the application, compared to 30.45 (SD 5.05) before. A corresponding t-test showed a significant difference (p = 0.019). Skin blood flow increased from a median of 0.76 (variance 0.062) before to a median of 0.86 (variance 0.16) after the procedure. The Wilcoxon rank test showed a significant difference (p = 0.000). Circulatory response was confirmed by SBP, DBP, and HR. SBP of 108.6 mmHg (SD 14.8) before the study decreased to 105.7 mmHg (SD 15.0) after the study, and DBP of 65.6 mmHg (SD 11.1) before the study decreased to 62.7 mmHg (SD 11.8) after the study. HR decreased from 71.6 beats per minute (SD 10.3) before to 69.2 beats per minute (SD 11.7) after. There was a significant difference in all cardiovascular indices (p < 0.05). VAS (pain, stiffness, and fatigue) was significantly decreased after MVT (p < 0.05). Conclusion: Micro Vibrational therapy tended to decrease muscle hardness and increase skin blood flow even in the short time of 30 seconds. The results suggest that local vibration stimulation is not likely to cause a sudden increase in blood pressure or pulse rate fluctuation. These results suggest that hand vibration nursing care may be applicable to acute patients with unstable circulatory conditions.
