A&E tipping points
248 British Journal of Healthcare Management 2015 Vol 21 No 5 © 2 01 5 M A H ea lth ca re L td Figure 2 clearly shows the impact of the last two of these tipping points on AE 2013). No sane health care administration would ever expect to run hospitals at the level of occupancy common in the UK—but sanity appears to be sadly lacking in this case, and the consequences are entirely predictable. The reasons for the sudden jumps in AE Jones and Beauchant, 2015)—although politicians appear determined to avoid any discussion of the real issues for fear of jeopardising their own pet policies. There will be Rod Jones A&E tipping points
A Simple Method to Forecast Future Bed Requirements: A Pragmatic Alternative to Queuing Theory
Aims: To review the current state of hospital bed planning, and to develop a simple tool to estimate short-term future bed requirements using historical bed occupancy data. Study Design: Analysis of daily bed occupancy between January 2008 and October 2015. Synthesis of trends into a method for forecasting bed numbers for each day of the year. Place and Duration of Study: Daily occupied bed statistics for King’s College University Hospital, a large London Teaching Hospital having 1,600 beds. Methodology: An eight-year time-series of daily midnight bed occupancy covering elective, emergency and transfer admissions has been used to estimate the number of beds required to deliver a delay-free hospital. Results: In this large 1,600 bed hospital it is estimated that 100 extra beds (a 6.3% increase) are required to deliver delay free admissions, i.e. no delays to admission from the emergency department or delays due to cancelled elective operations. Conclusion: The analysis reveals that far higher flexibility is required in staffing levels than is currently available. Potential strategies are discussed to address this issue.
Two new organic reference materials for delta13C and delta15N measurements and a new value for the delta13C of NBS 22 oil.
Analytical grade L-glutamic acid is chemically stable and has a C/N mole ratio of 5, which is close to that of many of natural biological materials, such as blood and animal tissue. Two L-glutamic acid reference materials with substantially different 13C and 15N abundances have been prepared for use as organic reference materials for C and N isotopic measurements. USGS40 is analytical grade L-glutamic acid and has a delta13C value of -26.24 per thousand relative to VPDB and a delta15N value of -4.52 per thousand relative to N2 in air. USGS41 was prepared by dissolving analytical grade L-glutamic acid with L-glutamic acid enriched in 13C and 15N. USGS41 has a delta13C value of +37.76 per thousand and a delta15N value of +47.57 per thousand. The delta13C and delta15N values of both materials were measured against the international reference materials NBS 19 calcium carbonate (delta13C=+1.95 per thousand ), L-SVEC lithium carbonate (delta13C=-46.48 per thousand ), IAEA-N-1 ammonium sulfate (delta15N=0.43 per thousand ), and USGS32 potassium nitrate (delta15N=180 per thousand ) by on-line combustion continuous-flow and off-line dual-inlet isotope-ratio mass spectrometry. Both USGS40 and USGS41 are isotopically homogeneous; reproducibility of delta13C is better than 0.13 per thousand, and that of delta15N is better than 0.13 per thousand in 100-microg amounts. These two isotopic reference materials can be used for (i) calibrating local laboratory reference materials, and (ii) quantifying drift with time, mass-dependent fractionations, and isotope-ratio-scale contraction in the isotopic analysis of various biological materials. Isotopic results presented in this paper yield a delta13C value for NBS 22 oil of -29.91 per thousand, in contrast to the commonly accepted value of -29.78 per thousand for which off-line blank corrections probably have not been quantified satisfactorily.