http://hdl.handle.net/2328/25724 2013-05-25T11:15:51Z http://hdl.handle.net/2328/26697 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. 2012-12-24T00:00:00Z http://hdl.handle.net/2328/26695 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. 2012-01-01T00:00:00Z http://hdl.handle.net/2328/26694 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. 2013-01-01T00:00:00Z http://hdl.handle.net/2328/26558 Title: Stability and transport of parallel velocity shear driven mode with negative magnetic shear Authors: Sen, S; Cairns, R A; Storer, Robin George; McCarthy, D R Abstract: The linear and quasilinear behavior of the drift-like perturbation with a parallel velocity shear is studied in a sheared slab geometry. Full analytic studies show that when the magnetic shear has the same sign as the second derivative of the parallel velocity with respect to the radial coordinate, the linear mode may become unstable and turbulent momentum transport increases. On the other hand, when the magnetic shear has opposite sign to the second derivative of the parallel velocity, the linear mode is completely stabilized and turbulent momentum transport reduces. 2000-01-01T00:00:00Z