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The relationship between in-hospital location and outcomes of care in patients of a large general medical service

2013-05-13T01:25:23Z

Title: The relationship between in-hospital location and outcomes of care in patients of a large general medical service Authors: Perimal-Lewis, Lua; Li, Jordan Y; Hakendorf, Paul Haylett; Ben-Tovim, David Isaac; Qin, Shaowen; Thompson, Campbell Henry Abstract: Background: The discrepancy between the number of admissions and the allocation of hospital beds means many patients admitted under the care of a general medical service can be placed in other departments’ wards. These patients are called “outliers” and their outcomes are unknown. Aims: To examine the relation between the proportion of time each patient spent in their “home ward” during an index admission and the outcomes of that hospital stay. Methods: Data from Flinders Medical Centre’s (FMC) patient journey database were extracted and analysed. The analysis was carried out on the patient journeys of patients admitted under the General Medicine units. Results: Outlier patients’ length of stay (LOS) was significantly shorter than that of the inlier patients (110.7 hours cf 141.9 hours; p < 0.001).They had a reduced risk of readmission within 28 days of discharge from hospital. Outlier patients’ discharge summaries were less likely to be completed within a week (64.3% cf 78.0%; p < 0.001). Being an outlier patient increased the risk-adjusted risk of in-hospital mortality by over 40%. 50% of deaths in the outlier group occurred within 48 hours of admission. Outlier patients had spent longer in the Emergency Department (ED) waiting for a bed (6.3 hours cf 5.3 hours; p < 0.001) but duration of ED stay was not an independent predictor of mortality risk. Conclusion: Outlier patients had significantly shorter LOS in hospital, but significantly greater in-patient death rates. Surviving outlier patients had lower rates of readmission but lower rates of discharge summary completion.

Gaining insight from patient journey data using process-oriented analysis approach

2013-05-13T01:25:25Z

Title: Gaining insight from patient journey data using process-oriented analysis approach Authors: Perimal-Lewis, Lua; Qin, Shaowen; Thompson, Campbell Henry; Hakendorf, Paul Haylett Abstract: Hospitals are continually struggling to cater for the increasing demand for inpatient services. This is due to increased population, aging, and the rising incidence of chronic diseases associated with modern life. The high demand for hospital services leads to unpredictable bed availability, longer waiting period for acute admission, difficulties in keeping planned admission, stressed hospital staff, undesirable patient and family experience, as well as unclear long term impact on health care capacity. This study aims to derive some correlation between various factors contributing to ward occupancy rate and operation efficiency. The aim is also to discover the inpatient flow process model proposing to use process mining techniques combined with data analysis to depict the relationships among inpatients, wards and Length of Stay (LOS) in an effort to gain insight into factors that could be focused to relieve access block. Open source process mining software - ProM is used for this study. The study is done in collaboration with Flinders Medical Centre (FMC) using data from their Patient Journey Database as case study.

Analysing homogenous patient journeys to assess quality of care for patients admitted outside of their ‘home-ward’

2013-05-13T01:25:28Z

Title: Analysing homogenous patient journeys to assess quality of care for patients admitted outside of their ‘home-ward’ Authors: Perimal-Lewis, Lua; Qin, Shaowen; Thompson, Campbell Henry; Hakendorf, Paul Haylett Abstract: This study is the first to explore the quality of care based on the outlier or the inlier status of patients for a large heterogeneous General Medicine (GM) service at a busy public hospital. The study compared the quality of care between ward outliers and ward inliers based on a homogenous group of patients using Two-step clustering method. Contrary to common perception, ward outliers had overall shorter Length of Stay (LOS) than ward inliers. The study also was unable to support the perception of shorter LOS in the outlier group being associated with higher in-hospital mortality. The study confirmed that overall the outliers received inferior quality of care as discharge summaries for the outliers were delayed and more outliers were re-admitted within 7 days of discharge in comparison to the inliers.

Methyl rotor dependent vibrational interactions in toluene

2013-05-13T02:10:37Z

Title: Methyl rotor dependent vibrational interactions in toluene Authors: Gascooke, Jason; Lawrance, Warren Donald Abstract: The methyl rotor dependence of a three state Fermi resonance in S1 toluene at ∼460 cm−1 has been investigated using two-dimensional laser induced fluorescence. An earlier time-resolved study has shown the Fermi resonance levels to have different energy spacings at the two lowest methyl rotor states, m = 0 and 1. The overlapped m = 0 and 1 spectral features have been separated to provide direct spectral evidence for the m dependence of the resonance. The resonance has been probed at m = 3a″1 for the first time and found to be absent, providing further evidence for a large change in the interaction with m. Deperturbing the resonance at m = 0 and 1 reveals that the m dependence arises through differences in the separations of the “zero-order,” locally coupled states. It is shown that this is the result of the local “zero-order” states being perturbed by long-range torsion-vibration coupling that shifts their energy by small amounts. The m dependence of the shifts arises from the Δm = ±3n (n = 1, 2, …) coupling selection rule associated with torsion-rotation coupling in combination with the m2 scaling of the rotor energies, which changes the ΔE for the interaction for each m. There is also an increase in the number of states that can couple to m = 1 compared with m = 0. Consideration of the magnitude of reported torsion-rotation coupling constants suggests that this effect is likely to be pervasive in molecules with methyl rotors.