Search results

The purpose of the paper is to investigate the potential relationships between emergency-care flow, patient mortality and healthcare costs using a patient-flow model.

The researchers used performance data from one UK NHS trust collected over three years to identify periods where patient flow was compromised. The delays’ root causes in the entire emergency care system were investigated. Event time-lines that disrupted patient flow and patient mortality statistics were compared.

Data showed that patient mortality increases at times when accident and emergency (A&E) department staff were struggling to admit patients. Four delays influenced mortality: first, volume increase and mixed admissions; second, process delays; third, unplanned hospital capacity adjustments and finally, long-term capacity restructuring downstream.

This is an observational study that uses process control data to find times when mortality increases coincide with other events. It captures contextual background to whole system issues that affect patient mortality.

Managers must consider cost-decisions and flow in the whole system. Localised, cost-focused decisions can have a detrimental effect on patient care. Attention must also be paid to mortality reports as existing data-presentation methods do not allow correlation analysis.

Previous studies correlate A&E overcrowding and mortality. This method allows the whole system to be studied and increased mortality root causes to be understood.

The paper seeks to investigate decision‐making processes within hospital improvement activity, to understand how performance measurement systems influence decisions and potentially lead to unsuccessful or unsustainable process changes.

A longitudinal study over a 33‐month period investigates key events, decisions and outcomes at one medium‐sized hospital in the UK. Process improvement events are monitored using process control methods and by direct observation. The authors took a systems perspective of the health‐care processes, ensuring that the impacts of decisions across the health‐care supply chain were appropriately interpreted.

The research uncovers the ways in which measurement systems disguise failed decisions and encourage managers to take a low‐risk approach of “symptomatic relief” when trying to improve performance metrics. This prevents many managers from trying higher risk, sustainable process improvement changes. The behaviour of the health‐care system is not understood by many managers and this leads to poor analysis of problem situations.

Measurement using time‐series methodologies, such as statistical process control are vital for a better understanding of the systems impact of changes. Senior managers must also be aware of the behavioural influence of similar performance measurement systems that discourage sustainable improvement. There is a risk that such experiences will tarnish the reputation of performance management as a discipline.

Recommends process control measures as a way of creating an organization memory of how decisions affect performance – something that is currently lacking.

The Milk and Dairies Bill introduced by Mr. SAMUEL aims at securing better inspection of dairies, including all premises in which milk is obtained, stored, or sold, such as cowsheds, milk depots, and milk shops. It also aims at the tracing of impure milk and the prevention of its infection, as well as the elimination of cows yielding tuberculous milk.

EVERY method employed by librar ns to bring books to the notice of readers may be justified It is thus desirable to devote an occasional issue of THE LIBRARY WORLD to this attractive subject. Our writers take differing views, but there is always a single aim in their work: to bring right book and reader into acquaintance. We might have to meet the challenge, which indeed one of our writers implies, that such book display may deflect the Library from its original, rightful purpose. Until these terms are defined such a challenge is a begging of the question. Often we have mentioned the question, For what public is the public library working? Was it intended to serve as an auxiliary, and then an extension, of the official education system? It has always indeed been more and less than that. Our founders were able to argue that libraries would withdraw men from beer and ill‐company, but from the first they probably failed to do that, and made their appeal to the intelligent elements in the community. As they developed and public education waxed, there grew up an enormous literature, available in early years in small quantity, the aim of which was entertainment only, and there survived—there survives still—a notion which was based on an earlier conception of books, that to read was somehow educative and virtuous, whatever was read. Librarians hold this notion in some measure to‐day, although the recent success of twopenny libraries which are mainly devoted to the entertainment type of literature must have made them revise the view somewhat.

That ice‐creams prepared with dirty materials and under dirty conditions will themselves be dirty is a proposition which, to the merely ordinary mind, appears to be sufficiently obvious without the institution of a series of elaborate and highly “scientific” experiments to attempt to prove it. But, to the mind of the bacteriological medicine‐man, it is by microbic culture alone that anything that is dirty can be scientifically proved to be so. Not long ago, it having been observed that the itinerant vendor of ice‐creams was in the habit of rinsing his glasses, and, some say, of washing himself—although this is doubtful—in a pail of water attached to his barrow, samples of the liquor contained by such pails were duly obtained, and were solemnly submitted to a well‐known bacteriologist for bacteriological examination. After the interval necessary for the carrying out of the bacterial rites required, the eminent expert's report was published, and it may be admitted that after a cautious study of the same the conclusion seems justifiable that the pail waters were dirty, although it may well be doubted that an allegation to this effect, based on the report, would have stood the test of cross‐examination. It is true that our old and valued friend the Bacillus coli communis was reported as present, but his reputation as an awful example and as a producer of evil has been so much damaged that no one but a dangerous bacteriologist would think of hanging a dog—or even an ice‐cream vendor—on the evidence afforded by his presence. A further illustration of bacteriological trop de zèle is afforded by the recent prosecutions of some vendors of ice‐cream, whose commodities were reported to contain “millions of microbes,” including, of course, the in‐evitable and ubiquitous Bacillus coli very “communis.” To institute a prosecution under the Sale of Food and Drugs Act upon the evidence yielded by a bacteriological examination of ice‐cream is a proceeding which is foredoomed, and rightly foredoomed, to failure. The only conceivable ground upon which such a prosecution could be undertaken is the allegation that the “millions of microbes ” make the ice‐cream injurious to health. Inas‐much as not one of these millions can be proved beyond the possibility of doubt to be injurious, in the present state of knowledge; and as millions of microbes exist in everything everywhere, the breakdown of such a case must be a foregone conclusion. Moreover, a glance at the Act will show that, under existing circumstances at any rate, samples cannot be submitted to public analysts for bacteriological examination—with which, in fact, the Act has nothing to do—even if such examinations yielded results upon which it would be possible to found action. In order to prevent the sale of foul and unwholesome or actual disease‐creating ice‐cream, the proper course is to control the premises where such articles are prepared; while, at the same time, the sale of such materials should also be checked by the methods employed under the Public Health Act in dealing with decomposed and polluted articles of food. In this, no doubt, the aid of the public analyst may sometimes be sought as one of the scientific advisers of the authority taking action, but not officially in his capacity as public analyst under the Adulteration Act. And in those cases in which such advice is sought it may be hoped that it will be based, as indeed it can be based, upon something more practical, tangible and certain than the nebulous results of a bacteriological test.