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At least 37 records · Page 2Linked to original sources
PubMed2001

Strategies for cutting hospital beds: the impact on patient service.

OBJECTIVE: To develop insights on the impact of size, average length of stay, variability, and organization of clinical services on the relationship between occupancy rates and delays for beds. DATA SOURCES: The primary data source was Beth Israel Deaconess Medical Center in Boston. Secondary data were obtained from the United Hospital Fund of New York reflecting data from about 150 hospitals. STUDY DESIGN: Data from Beth Israel Deaconess on discharges and length of stay were analyzed and fit into appropriate queueing models to generate tables and graphs illustrating the relationship between the variables mentioned above and the relationship between occupancy levels and delays. In addition, specific issues of current concern to hospital administrators were analyzed, including the impact of consolidation of clinical services and utilizing hospital beds uniformly across seven days a week rather than five. PRINCIPAL FINDINGS: Using target occupancy levels as the primary determinant of bed capacity is inadequate and may lead to excessive delays for beds. Also, attempts to reduce hospital beds by consolidation of different clinical services into single nursing units may be counterproductive. CONCLUSIONS: More sophisticated methodologies are needed to support decisions that involve bed capacity and organization in order to understand the impact on patient service.

Bed Conversion↗
PubMed2003

Making room for more beds. With additional patients streaming in every day, hospitals must learn to think creatively to find space for everyone.

With more patients streaming inside, acute-care hospitals are being forced to get creative about finding spots for beds. Some are reactivating dormant rooms, opening shuttered wings or transforming administrative areas into clinical space, such as Florida Hospital East Orlando, left. The surge comes as the number of hospitals drops and the number of beds rises along with census counts.

Bed Conversion↗
PubMed1992

[Effects of isosorbide dinitrate and diltiazem used alone or combined on arterial hemodynamic and viscoelastic parameters. Experimental data in the rabbit].

An experimental model of simultaneous recording of aortic pressure and flow and vascular diameter at the entrance to a limited territory of systemic circulation has been developed in the rabbit. A system of data acquisitions and treatment has also been perfected to evaluate the different parietal viscoelastic parameters of arterial flow in capacitance and resistance arteries. This model was used to study the pharmacodynamic effects of two vasodilator drugs, isosorbide dinitrate (ISDN) and diltiazem (DILT), administered alone or in association (ISDN + DILT) by slow intravenous infusion over 30 minutes at dosages chosen to induce comparable hypotension of about 10%. Under these conditions, the effects of ISDN, DILT and ISDN + DILT on resistance parameters were slightly different. The ISDN had no marked effect on mean aortic flow (Qm) apart from a slight decrease after 10 minutes infusion (-10.4 +/- 3.8%, p less than 0.05). On the other hand, DILT alone or in association with IDN was associated with a significant increase in Qm (DILT: +8.5 +/- 0.8%, p less than 0.001; ISDN + DILT: +9.7 +/- 2.1%, p less than 0.01). This explains the absence of a significant effect of ISDN on peripheral resistance (PR) or entrance impedance (Zc) of the vascular bed. Conversely, the effects of DILT and ISDN + DILT on these parameters were very marked (DILT:RP = -17.2 +/- 0.9%, p less than 0.001; Zc = -8.2 +/- 0.5%, p less than 0.001; ISDN + DILT: RP = -16 +/- 1.4%, p less than 0.001; Zc = -8.0 +/- 0.4%, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

Evaluation of redesignation of acute medical wards to geriatric rehabilitation/assessment.

This paper examines the results of the change of use of 44 out of a complement of 128 general medical beds to geriatric rehabilitation/assessment beds in a general hospital. The method is based on bed utilisation statistics and the results demonstrate that the reduced complement of medical beds functions more efficiently with no reduction in the number of discharges despite a reduction of 34% in available beds.

Acute Disease↗
PubMed1995

Use of general practitioner beds in Leicestershire community hospitals.

BACKGROUND: The shift in care from secondary to primary services is likely to place greater demands on community hospitals. Before changes in the provision of community hospitals can occur, baseline data are needed, outlining their current use. AIM: A study was undertaken to obtain baseline data describing the use of general practitioner beds in Leicestershire community hospitals. METHOD: A three-month prospective, observational study was carried out between February and May 1992 using data from a questionnaire completed by nurses and general practitioners and from patient hospital records. Study patients comprised all patients admitted to general practitioner beds in all eight Leicestershire community hospitals. RESULTS: A 100% questionnaire response rate was obtained giving data on 685 hospital admissions. Around 70% of admissions were of patients aged 75 years and over. Of admissions, 35% were for acute care, 31% for respite care, 22% for rehabilitation, 7% for terminal/palliative care and 5% for other reasons. Fifteen per cent of patients had been transferred from a consultant bed. Of those not transferred, 91% were admitted by their usual general practitioner or practice partner and for 96% of these patients this was the general practitioner's first choice for care. There was significant variation in both the age mix and care category mix of patients between individual hospitals. Medical deterioration in an underlying condition and family pressure on the general practitioner or carers' inability to cope each contributed to around half of all admissions. Of all admissions, 38% lived alone, and 18% of carers were disabled. Incontinence was reported for 35% of patients, and 26% of all patients were of a high nursing dependency. There was low utilization of community services before admission and 33% received none. There was variation between individual hospitals in use of local and district general hospital investigations, specialist referral and types of therapy. Of 685 admissions 11% died during their stay. Of those discharged, 76% went to their own or a relative's home, 10% to a residential or nursing home and 9% were transferred to an acute bed. Nine percent of discharges were postponed and 10% were brought forward. On discharge to non-residential care, 26% of patients received no community services. CONCLUSION: Shifting resources from secondary to primary care is a priority for purchasers. Both the introduction of the National Health Service and community care act 1990, and acute units having increasing incentives for earlier discharge, are likely to place greater demands on community hospital beds. Not all general practitioners have the option of community hospital beds. Before access to general practitioner beds can be broadened, existing beds should be used appropriately and shown to be cost-effective. Purchasers therefore require criteria for the appropriateness of admissions to general practitioner beds, and the results of a general practitioner bed cost-benefit analysis.

Bed Conversion↗
PubMed2003

[Influence and mechanism of calcium-based desulfurizer on NO conversion in fluidized bed of coal].

On the experimental table of fluidized bed which scale was phi 150 mm x 1000 mm and temperature interval was from 840 degrees C to 960 degrees C, the influence of desulfurizer variety, particle size and molar ratios Ca/S on nitrogen conversion to NO were studied. This paper elaborated on the mechanism of calcium-based desulfurizer lead to the increase of NO conversion rate. Experiment presented that given identical quantities, burnt calcium had maximum NO conversion rate, then limestone, calcite last. Nitrogen conversion to NO increased with increasing molar ratios Ca/S. When the particle size was between 1-2 mm, the NO conversion rate was the maximum, second was 2-3 mm, the last 0.2-1 mm. HCl, HF, SO2 decreased with calcium addition. At the same time H, OH, HO2 radicals increased. The CO oxidation was favored, the reaction of monoxide and NO catalyzed by char, sand, ash will weaken, therefore NO content will increase.

Calcium↗
PubMed1992

Swing bed program in a small rural hospital: discharge outcome.

Swing beds contribute significantly to inpatient rehabilitation and skilled nursing care of the rural elderly, but little information is available in the general clinical literature regarding the types and outcomes of patients admitted to these programs. All swing bed admissions to a small rural hospital for the 1989 fiscal year were identified and the records were reviewed. The mean age of the patients was 81 years, and the average length of stay was 13 days. Most patients were admitted because of acute problems necessitating short-term rehabilitation or because no bed was available in an appropriate skilled-care nursing home. At discharge, 40% of patients were able to return home. Information regarding the availability and appropriate use of swing beds needs to be disseminated to physicians who care for the elderly. More study is needed to determine optimal use of and requirements for swing beds on a national level.

Aged↗
PubMedDate not supplied

[The management control system of the Roma/C Local Health Authority. Financial year 2004].

The aim of this study was to describe the budgeting process of the Roma/C Local Health Authority during the 2004 financial year. The planning-control process, which included preparing regular reports, allowed performing comparisons between actual with planned results so that the necessary corrective actions could be taken in a timely manner. It also led to a confrontation between the various managers involved, regarding: 1. the conversion of ordinary regime hospital beds into day hospital beds; 2. the development of a new model of emergency care aimed at integrating care between the hospital and the community; 3. the need to implement dataware housing.

Bed Conversion↗
PubMed2002

Development of an ultrahigh-temperature process for the enzymatic hydrolysis of lactose. IV. Immobilization of two thermostable beta-glycosidases and optimization of a packed-bed reactor for lactose conversion.

Recombinant hyperthermostable beta-glycosidases from the archaea Sulfolobus solfataricus (Ss beta Gly) and Pyrococcus furiosus (CelB) were covalently attached onto the insoluble carriers chitosan, controlled pore glass (CPG), and Eupergit C. For each enzyme/carrier pair, the protein-binding capacity, the immobilization yield, the pH profiles for activity and stability, the activity/temperature profile, and the kinetic constants for lactose hydrolysis at 70 degrees C were determined. Eupergit C was best among the carriers in regard to retention of native-like activity and stability of Ss beta Gly and CelB over the pH range 3.0-7.5. Its protein binding capacity of approximately 0.003 (on a mass basis) was one-third times that of CPG, while immobilization yields were typically 80% in each case. Activation energies for lactose conversion by the immobilized enzymes at pH 5.5 were in the range 50-60 kJ/mol. This is compared to values of approximately 75 kJ/mol for the free enzymes. Immobilization expands the useful pH range for CelB and Ss beta Gly by approximately 1.5 pH units toward pH 3.5 and pH 4.5, respectively. A packed-bed enzyme reactor was developed for the continuous conversion of lactose in different media, including whey and milk, and operated over extended reaction times of up to 14 days. The productivities of the Eupergit C-immobilized enzyme reactor were determined at dilution rates between 1 and 12 h(-1), and using 45 and 170 g/L initial lactose. Results of kinetic modeling for the same reactor, assuming plug flow and steady state, suggest the presence of mass-transfer limitation of the reaction rate under the conditions used. Formation of galacto-oligosaccharides in the continuous packed-bed reactor and in the batch reactor using free enzyme was closely similar in regard to yield and individual saccharide components produced.

Animals↗
PubMed1998

Angiotensin I-to-II conversion in the human renal vascular bed.

OBJECTIVE: During previous studies in humans and pigs, using infusions of 125I-angiotensin into the right antecubital vein or the left cardiac ventricle, we were unable to demonstrate conversion of arterial angiotensin I in the renal vascular bed. The arterial 125I-angiotensin I levels in these studies may have been too low to result in detectable renal venous 125I-angiotensin II levels, especially in view of the extensive degradation of angiotensins in the kidney. To overcome this problem, we now infused 125I-angiotensin I directly into the renal artery. DESIGN AND METHODS: Five subjects (three women, two men) with essential hypertension (n = 4) or unilateral renal artery stenosis (n = 1), not treated with an ACE inhibitor, were given a 10-min infusion of 125I-angiotensin I (3.6+/-0.4 x 10(6) cpm/min, mean +/- SEM) into the left (n = 4) or right (n = 1) renal artery. Blood samples for the measurement of endogenous and radiolabelled angiotensin I and II were taken under steady-state conditions from the aorta and the renal vein of the 125I-angiotensin I-perfused kidney. RESULTS: At steady-state, the levels of 125I-angiotensin I in renal venous blood were 5-6 fold lower, and those of 125I-angiotensin II were 4-5 fold higher than in renal arterial blood. On the basis of these levels, angiotensin I extraction in the renal vascular bed was calculated to be 80+/-3%, of which 9+/-1% was due to angiotensin I-to-II conversion. The renal venous levels of endogenous angiotensin I were 50% higher than its arterial levels, whereas the levels of endogenous angiotensin II were 50% lower in renal venous blood than in arterial blood. Taking into consideration the regional metabolism of arterially delivered angiotensins, and the generation of angiotensin I in circulating blood by plasma renin activity, it could be calculated that renal venous angiotensin I is largely derived from renal tissue sites, and that renal venous angiotensin II has no other sources than arterially delivered angiotensin I and II and angiotensin I generated by plasma renin activity in the renal vascular bed. CONCLUSIONS: Less than 10% of arterially delivered angiotensin I is converted to angiotensin II in the renal vascular bed. Conversion of angiotensin I generated at renal tissue sites does not contribute to the level of angiotensin II in the renal vein, although it is the main source of angiotensin II in renal tissue. Thus, the intrarenal formation of angiotensin II is highly compartmentalised.

Adult↗