Contents of Fourth 2005 Issue

Nosokinetics

Fourth Issue in 2005

(c)Authors for content; Peter Millard, Roy Johnston for e-version

(comments to rjtechne at iol dot ie)

In this 4th issue of 2005 we have four main papers, followed by notices. The notices are embedded in this page, and the papers are hotlinked each to their own page. Our thanks to IMS for the e-version. Ed.

Here first are the full e-versions of the substantive papers:

Nursing Workload: Skill mix and Outcomes Research, by Christine Duffield

Small numbers make big differences. Using a queuing model and data from the Philadelphia mental health system, Naoru Koizumi's PhD thesis, and a recent paper, explain how lack of facilities for supported living in the community causes 'upstream blocking' in acute hospitals.

Measuring bed requirements: skewed data, wrong method, wrong result: Mark Joy

Modelling 'Rate of Admission' for Treatment and Bed Queues: Leon K Au

***

Nosokinetics News: Web e-version sponsored by IMS.

Thanks to R&D manager Paul Cooper, Roy Johnston is developing a screen-friendly version of the newsletter for us. To ease our task, bearing in mind the differing requirements of print and screen editing, contributors are asked to send articles as raw text, leaving print-editing to Peter and screen-editing to Roy. Please send just the basic text, preferably as e-mail, with headers and paragraphs separated by blank lines, with captions of pictures or diagrams inserted as separate paragraphs, thus indicating their preferred locations. Pictures and diagrams should be in separate JPG or GIF files, named so as to indicate author and fig number. They should be not more than 600 pixels wide, to avoid lateral scrolling in the smallest screen.

IFORS Conference Hawaii 'Quote of the week'

Prof Gary Harrison: 'Millard says the average stay is a bad measure, I prefer to call it incomplete.' Hearing those words, I recognised the error of my ways, emotion not logic rules my heart. To understand why the average stay is incomplete and misleading, see page six 'Opening the Black box' a report of an article by Christos Vasilakis and Adele Marshall, JORS (2005) 56,862-869. Also see Nosokinetics News 1.4 page 1 for the percentile distribution data that opened my eyes..

Healthcare Quality Improvement and Implementation

An exciting new open-access, online journal titled Healthcare Quality Improvement and Implementation Science is being developed. To be published by BioMed Central, the proposed journal will focus on the study of methods to accelerate the implementation of evidence-based clinical practices in routine healthcare settings. See:

http://www.hsrd.research.va.gov/for_researchers/journal-information.cfm

Quantitative Modelling of Patient Flow in Acute Care

A workshop to present and discuss information on patient flow in acute care was recently held at the Royal Melbourne Hospital in Melbourne, Australia. The Clinical Epidemiology and Health Service Evaluation Unit (Royal Melbourne Hospital), Melbourne Health and The University of Melbourne sponsored the workshop. The workshop featured two presentations, followed by a panel discussion. Work place redesign featured strongly in the discussions. Details about the workshop, including the presentations, can be accessed at:

http://mh1.mh.org.au/ClinicalEpidemiology/New_files/Workshopmodelling.htm

Warning: this requires a password, and unless you have it, you can't get back without crashing. RJ.

Here are the workshop headers:

Forecasting Demand and Modelling Patient Flows by David Sier, CSIRO, Southern Health;
Complexity Modelling and Hospital Beds: Progress of Research by Mark MacKay, Department of Psychology, University of Adelaide;
Three approaches to modelling hospital patient flows by Dept of Mathematics & Statistics, University of Melbourne and CSIRO;
Challenges in Scheduling the Operating Theatre by Damian Armour, Barwon Health;
A Whole of Hospital Simulation by Phil Cooper, Iridium Consulting, Donald Campbell & Christopher Bain, Melbourne Health.

***

Lean thinking: Institute of Health Care download on Lean thinking:

http://www.ihi.org/IHI/Products/WhitePapers/GoingLeaninHealthCare.htm

Priority Medicines and the Elderly: CoverAGE, briefing English version:

http://www.age-platform.org/AGE/IMG/pdf/CoverAGE_June2005_EN.pdf

NEW! Masters in Science in Medical Informatics & Biostatistics in Romania:

http://www.umfcv.ro/MIB

Gaming in A&E: BMJ (21st May) 2005; 330: 1188-9

One in eight patients admitted from A&E moved out of the department in the final 20 minutes of the four hour target period; UK data: 83 departments, 428593 patients, 22% admitted.

Hospital in the Nursing Home, an 'emergency department' based model of care:

http://www.nicsl.com.au/

The Gold Coast emergency department piloted this innovative model of care that has a focus on keeping elderly patients in an environment they are familiar with and avoiding admission to hospital. The program has demonstrated improved outcomes for the patients, the nursing homes and the hospital. A copy of the presentation for the 2004 International Conference on Emergency Medicine can be found in the web-site as above.

I have tried this and had problems with it; perhaps we need a simple explicit navigation sequence from the home page. Feedback to RJ please.

Modelling nationwide hospital length of stay: opening the black box: Vasilakis, C. and Marshall, (2005) Journal of the Operational Research Society 56: 862-869.

Christos and Adele compare and contrast alternative methods of analysing and modelling length of stay data. Statistical methods - survival analysis, mixed exponential and phase-type distributions - and decision modelling techniques - compartmental and simulation models are explained. Stroke illness is used as an exemplar, for by its very nature, it has short, medium and long stay patients.

The table shows the statistics. Note that the average stay is 14 days. Coxian phase type distributions of discharges and exponential analysis of occupancy time gave similar results:

Coxian, 92.3% of discharges left in 10.8 days, 7.5% in 40 days and 0.2% in 667 days;

Exponential 90.2%, 10.8 days; 8.9%, 36.7 days and 0.9%, 653 days.

However, note the min-max distribution in the data is 0-4906 days, so analysis of discharge data alone masks the use of beds by longer stay patients.

Basic Statistics English HES Stroke Patients:

1 April 94-31st March 95: No of Discharges 105765

Descriptive statistics LOS (days)

Mean 14.3, 25th Percentile 3, Median 7, 75th Percentile 15

Min - max 0 -4906, Std Deviation 52.04, Skewness 42.19, Kurtosis 2609.21

Forthcoming conferences: also see http://www2.wmin.ac.uk/coiec/nosokinetics.htm

International Conference on Health and Social Care Modelling and Applications (HSCM 2006) will be held at the University of Adelaide, Adelaide, South Australia, 19 - 21 April, 2006. Information will be mailed during early August.
Important dates: Invited session submission October 2005; Deadline for abstract submission: 15 November 2005; Notification of acceptance: 8 December 2005; contact Mark Mackay.

The First East European Conference on Health Care Modelling and Computation (HCMC 2005), Craiova, Romania: 31 August to 2nd of September 2005. Conference organisers Florin Gorunescu and Elia ElDarzi.

OR Society Conference, University College Chester, 13th - 15th September 2005; Chris Sherlaw-Johnson or Gillian Mould.

MASHnet launch: Tues 20th September 2005 12.00 - 5.00pm, hosted by West Midlands Operational Research Society in the new building at Warwick Business School. MASHnet is an EPSRC network for modelling and simulation in health care. For further information contact Martin Pitt.

Congratulations to Barry Shaw from Adele's Group and Kevin Xie from Thierry's group.

Barry won a presentation prize at the Eighteenth IEEE Symposium on Computer Based Medical Systems conference in Dublin 23 - 24th June 2005. A contribution from Barry will be in the next issue. Kevin Xie and Barry have also been invited to contribute their papers to a special issue arising from the conference. Photo of Barry by Kevin.

Nosokinetics News is mailed individually to supporters and collaborators interested in developing a scientifically valid approach to measuring and modeling health and social care systems. To be added to / removed from the mailing list email nosokinetics.

For contributions, correspondence mail Editor: Prof Peter H Millard.
For earlier printed editions http://www2.wmin.ac.uk/coiec/nosokinetics.htm.

We are indebted to IMS MAXIMS plc's sponsorship for enabling the website version to be developed. IMS is a significant supplier to NHS and has an ongoing interest in enhancing the scope of IT support in the NHS, especially in the areas of clinical knowledge and decision support. Developers of systems looking for market opportunities are invited to contact IMS at their UK office, or by e-mail to Paul Cooper (pcooper at imsmaxims dot com). Accessing their web-site http://www.imsmaxims.com will give a feel for the scope of their work.

[Archive Overview]

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