Bed Management Research Articles

Factors affecting evaporation of water from cattle bedding materials

In livestock farming, maintaining dry bedding is considered to be important for maximising animal performance and welfare. A better understanding of the mechanisms that regulate drying has the potential to improve bedding management and reduce production costs. A custom laboratory-scale method was developed to explore the effects of environmental conditions and bedding characteristics on drying rate (DR). Samples (n = 256) of different types of bedding materials were exposed to controlled environmental conditions by using a climate chamber equipped with a custom cabinet capable of simulating different levels of air velocity and bedding temperature. The effects of the type of material, bedding moisture content, bedding temperature, air temperature, air relative humidity (RH) and air velocity were evaluated in a full factorial experimental design. Under the experimental conditions tested, DR ranged from 0.28 to 6.04 kg m −2 d −1 , with an average of 2.03 kg m −2 d −1 . All variables significantly affected DR, but large variation in the magnitude of effects was found. Bedding moisture content, air velocity and air RH had considerably larger effects than the other variables, together accounting for more than 70% of the variance in DR. The DR from bedding samples increased with bedding moisture content and air velocity but decreased with increasing air RH. The results of the current study may have important implications in the design and management of bedded pack barns. To increase the DR and keep bedding dry, producers should focus primarily on providing adequate barn ventilation (both in terms of air velocity and air exchange), whereas maintaining a high pack temperature may yield poorer-than-expected results. • Water evaporation from livestock bedding materials has been measured experimentally. • Drying rate depends on environmental conditions and bedding characteristics. • Bedding moisture content, air velocity and air RH are the most important factors. • Producers with bedded pack barns should focus on providing adequate ventilation.

The Role of Intermittent Pneumatic Compression in the Treatment of Lower Extremity Chronic Wounds

Intermittent pneumatic compression devices (IPC) are often used as noninvasive adjuncts in patients with lymphedema, and more recently with venous stasis disease, to promote flow and reduce the adverse effects of interstitial edema associated with both disorders. We will be focusing on lower extremity wounds associated with venous and/or lymphatic disease, the combination often referred to as “lymphophlebitic” disease, and the treatment effect of IPC on this disease process and its sequelae. The function and purpose of pneumatic compression is closely examined along with a variety of pneumatic compression devices that currently exist in the market. A thorough review of the literature was conducted to evaluate the utility of intermittent pneumatic compression in the treatment of lower extremity venous stasis ulcers. Additionally, the author describes personal experience with the use of pneumatic compression on 10 patients with venous stasis ulcers at a single center. There is significant data supporting the use of IPC in patients with lymphophlebitic disease. Overall, ideal patient selection may be crucial. Previous data has shown that patients with high body mass index (>33 kg/m2) and poor functional status (walking less than 200m a day) are related to poor ulcer healing. Therefore, a study that looks primarily at this group (as our small quality assurance [QA] project did) may show increased benefit in this population. It is clear that IPC is of benefit to some patient cohorts with lymphophlebitic disease. This advanced therapy would help patients who have failure of their calf muscle pump and an inability to improve it through other means. However, it is only part of an algorithm that includes: direct wound bed management, moisture control, possible primary venous disease intervention, physical therapy, weight loss, and improved nutrition.

Bed management in psychiatry: ensuring that the patient perspective is not forgotten

SUMMARYBed management and the transfer of patients is an area of clinical care that is frequently overlooked. Often, the lack of discussion leads to the patient perspective being ignored and to transfers to new hospitals without appropriate handovers, both to the detriment of patient outcomes. This article reflects on the real-world consequences of the bed management systems used within the UK's National Health Service (NHS), using the example of a patient in psychiatric services.

Editors' Note: Association of Guideline Publication and Delays to Treatment in Pediatric Status Epilepticus

In “Association of guideline publication and delays to treatment in pediatric status epilepticus,” Fernandez et al. reported that despite publication of evidence of delays in treatment of refractory status epilepticus (SE) in the Pediatric Status Epilepticus Research Group (pSERG) at the end of 2014, there was no difference in time to initiation of benzodiazepines, nonbenzodiazepine antiepileptic drugs (AEDs), and continuous infusions to patients with refractory SE in pSERG in the hospital between 2011–2014 and 2015–2019. The authors identified a number of proposed actions to overcome potential barriers to the timely initiation of AEDs. Albuja et al. commented that they improved the time to administration of second-line AEDs at their institution by creating a SE alert system to contact neurology, pharmacy, the rapid response team, and the bed manager simultaneously when an inpatient is suspected to be in SE. Amengual-Gual et al. applauded them for implementing this initiative. It is imperative to continue to identify quality improvement measures to identify SE and ensure that AEDs are given in a timely fashion to patients with SE because it becomes more resistant over time, which may lead to increased morbidity and mortality.[1][1],[2][2] In “Association of guideline publication and delays to treatment in pediatric status epilepticus,” Fernandez et al. reported that despite publication of evidence of delays in treatment of refractory status epilepticus (SE) in the Pediatric Status Epilepticus Research Group (pSERG) at the end of 2014, there was no difference in time to initiation of benzodiazepines, nonbenzodiazepine antiepileptic drugs (AEDs), and continuous infusions to patients with refractory SE in pSERG in the hospital between 2011–2014 and 2015–2019. The authors identified a number of proposed actions to overcome potential barriers to the timely initiation of AEDs. Albuja et al. commented that they improved the time to administration of second-line AEDs at their institution by creating a SE alert system to contact neurology, pharmacy, the rapid response team, and the bed manager simultaneously when an inpatient is suspected to be in SE. Amengual-Gual et al. applauded them for implementing this initiative. It is imperative to continue to identify quality improvement measures to identify SE and ensure that AEDs are given in a timely fashion to patients with SE because it becomes more resistant over time, which may lead to increased morbidity and mortality.1,2 [1]: #ref-1 [2]: #ref-2

Postcalving udder health and productivity in cows approaching dry-off with intramammary infections caused by non-aureus Staphylococcus, Aerococcus, Enterococcus, Lactococcus, and Streptococcus species

The objective of this prospective cohort study was to explore associations between intramammary infection (IMI) in late-lactation cows and postcalving udder health and productivity. Cows (n = 2,763) from 74 US dairy herds were recruited as part of a previously published cross-sectional study of bedding management and IMI in late-lactation cows. Each herd was visited twice for sampling. At each visit, aseptic quarter milk samples were collected from 20 cows approaching dry-off (>180 d pregnant), which were cultured using standard bacteriological methods and MALDI-TOF for identification of isolates. Quarter-level culture results were used to establish cow-level IMI status at enrollment. Cows were followed from enrollment until 120 d in milk (DIM) in the subsequent lactation. Herd records were used to establish whether subjects experienced clinical mastitis or removal from the herd, and DHIA test-day data were used to record subclinical mastitis events (somatic cell count >200,000 cells/mL) and milk yield (kg/d) during the follow-up period. Cox regression and generalized estimating equations were used to evaluate the associations between IMI and the outcome of interest. The presence of late-lactation IMI caused by major pathogens was positively associated with postcalving clinical mastitis [hazard ratio = 1.5, 95% confidence interval (CI): 1.2, 2.0] and subclinical mastitis (risk ratio = 1.5, 95% CI: 1.3, 1.9). Species within the non-aureus Staphylococcus (NAS) group varied in their associations with postcalving udder health, with some species being associated with increases in clinical and subclinical mastitis in the subsequent lactation. Late-lactation IMI caused by Streptococcus and Streptococcus (Strep)-like organisms, other than Aerococcus spp. (i.e., Enterococcus, Lactococcus, and Streptococcus spp.) were associated with increases in postcalving clinical and subclinical mastitis. Test-day milk yield from 1 to 120 DIM was lower (-0.9 kg, 95% CI: -1.6, -0.3) in late-lactation cows with any IMI compared with cows without IMI. No associations were detected between IMI in late lactation and risk for postcalving removal from the herd within the first 120 DIM. Effect estimates reported in this study may be less than the underlying quarter-level effect size for IMI at dry-off and postcalving clinical and subclinical mastitis, because of the use of late-lactation IMI as a proxy for IMI at dry-off and the use of cow-level exposure and outcome measurements. Furthermore, the large number of models run in this study (n = 94) increases the chance of identifying chance associations. Therefore, confirmatory studies should be conducted. We conclude that IMI in late lactation may increase risk of clinical and subclinical mastitis in the subsequent lactation. The relationship between IMI and postcalving health and productivity is likely to vary among pathogens, with Staphylococcus aureus, Streptococcus spp., Enterococcus spp., and Lactococcus spp. being the most important pathogens identified in the current study.

P0194 / #1925: AMELIORATING IMPACT OF THE PRESENCE OF AN INTENSIVIST IN PEDIATRIC INTENSIVE CARE UNIT

Aims & Objectives: To evaluate the effect of first graduate of the PICU fellowship program on process of care and patient outcomes in PICU. Methods: This study is retrospective observational study and conducted in 16-bed PICU of tertiary referral center in Turkey. Two years (2013-2015) period of the PICU without an intensivist and sequential two years (2015-2017) period managed by an intensivist are compared. Results: Number of patients followed in PICU was increased more than 2 fold. Number of mechanically ventilated patients was increased more than 2 folds and presence of intensivist reduced the MV duration 59%. Presence of intensivist reduced mortality 2.18 times. It was showed that management of PICU beds by intensivist yielded increased number of PICU hospitalizations, care of true critical care patients with more intensive therapies and invasive procedures including extracorporeal treatment options, decreased length of stay, decreased number and rate of nosocomial infections and solely decreased mortality. Conclusions: What transforms a unit filled with critical care patients to an intensive care unit is a dedicated intensivist. The current study demonstrates that intensivist is the crucial component of PICUs.

Delayed transfers of care for older people: a wider perspective.

Delayed transfers of care (DTOC), often unhelpfully referred to as 'bed blocking', has become a byword for waste and inefficiency in healthcare systems throughout the world. An estimated 2.7 million bed days are occupied each year in England by older people no longer in need of acute treatment, estimated to cost £820 million (2014/15) in inpatient care. Policy and media attention have often been drawn to this narrative of financial waste, resulting in policy setting that directly targets the level of DTOC, but has done little to put patient health first. These figures and policies portray a misleading image of the delays as primarily of concern in terms of their financial burden on acute hospital care, with little consideration given to the quantification on patient health or wider societal impacts. In spite of the multi-factorial decision-making process that occurs for each patient discharge, current evaluation frameworks and national policy setting fail to reflect the complexity of the process. In this commentary, we interrogate the current approach to the quantification of the DTOC impact and explore how policies and evaluation methods can do more to reflect the true impact of the delays.

Identifying proactive ICU patient admission, transfer and diversion policies in a public-private hospital network

Management of hospital beds is a high-impact issue for two-tier healthcare systems, due principally to their critical importance and high costs. Bed capacity in the public sector is generally insufficient to provide immediate care to all critical patients and thus a significant proportion of public expenditure is assigned to the diversion of patients for treatment in the private sector. We formulate and approximately solve a discounted infinite-horizon Markov Decision Process (MDP) that seeks to identify cost-effective policies for transferring ICU patients between hospitals or diverting them to private clinics. The solution approach employs an affine architecture for approximating the value function of the MDP model and solves the equivalent linear programming model using column generation. The approach can handle a high level of dimensionality, enabling it to consider the arriving patients’ many different diagnostic groups and their corresponding lengths of stay. The decisions generated through this approach often differ from the intuitive ones produced in a typical day-by-day decision process, that does not consider the impact of the current day’s decisions on the future performance of the system. In particular, the resulting policies will in many cases proactively transfer patients to a different public facility or divert them to a private one even though the hospital they first arrived at had beds available. The performance of the proposed method was evaluated by simulating a case study based on data from a hospital network in Santiago, Chile, producing savings of almost 49% due mostly to reduced usage of private services.

Refining Knowledge of Factors Affecting Vitamin B12 Concentration in Bovine Milk.

Simple SummaryMilk is considered a staple and complete food that contains several essential nutrients for humans. For instance, it is an excellent natural source of vitamin B12 (B12) due to the presence in the bovine rumen of a myriad of bacteria and archaea capable of producing the vitamin. This vitamin is only produced by prokaryotic microorganisms; vegetal products do not naturally contain it. A 250-mL glass of milk contains about 46% of the daily recommended dietary allowance of B12 for individuals over 13 years old. However, B12 concentration is variable in milk; therefore, identifying factors contributing to its variation is critical to ensure a stable B12 supply for consumers. The aims of these experiments are to gather more knowledge on possible sources of variation in B12 concentrations in milk in order to optimize and stabilize its levels and thereby improve the perception of milk in terms of its health benefits. We observed that B12 concentration increases when the conditions of the rumen are optimal, such as with elevated pH. We also studied if bedding type—e.g., recycled manure solid bedding or straw, which has been reported to impact milk microbiota—could have an impact on milk B12 concentration. In this study, no such correlation was detected. This paper is one of a series seeking to elucidate factors responsible for variations in milk B12 concentration.Milk is an excellent source of vitamin B12 (B12) for humans. Therefore, being able to guarantee a high and consistent concentration of this vitamin would enhance consumer perception of milk as a health food. The aim of the paper was to gather additional knowledge on factors that could explain B12 variation in cow milk through two observational studies: (1) to explore the relationship between milk B12 and ruminal conditions, such as pH and volatile fatty acid concentrations; and (2) to examine the impact of bedding on B12 concentrations in bulk tank milk. For study 1, a total of 72 milk and ruminal liquid samples were obtained from 45 Holstein cows fitted with ruminal cannula between 10 and 392 days of lactation. For study 2, bulk tank milk samples were obtained from 83 commercial herds; 26 herds used recycled manure solid bedding and 57 used straw bedding. Milk samples were analyzed for B12 using radioassay. Using principal component regression analysis, we observed that ruminal pH and the acetate:propionate ratio for cows receiving the early lactation ration were positively correlated with milk B12. Bedding did not influence milk B12 in bulk tanks, which averaged 4276 pg/mL. In conclusion, as B12 is synthesized by ruminal bacteria, optimizing ruminal conditions had a positive effect on milk B12, while bedding management had no influence.

Developing a nursing dependency scoring tool for children's palliative care: the impact on hospice care.

Occupancy is commonly used to measure bed management in hospices. However, the increasing complexity of children and young people and growing dependence on technology mean that this is no longer effective. To develop a dependency tool that enables the hospice to safely and effectively manage the use of beds for planned short breaks (respite care), preserving capacity for children requiring symptom management and end-of-life care. A comprehensive literature review and existing tools were used to inform the development of the Martin House Dependency Tool Framework. Training was provided to staff and the tool was piloted before applying it across the hospice caseload. The tool has been used on 431 children (93.1% of caseload). The tool enabled consistency of assessment and more effective management of resources, due to a contemporaneous understanding of the clinical needs of those on the caseload. The tool has enabled consistent and transparent assessment of children, improving safety, effectiveness and responsiveness, and the management of the workforce and resources.

Essential elements in determining patient's complexity of nursing care.

Nurses dedicate majority of working time to satisfy patients' needs, which are oftentimes complex. Although the concept of patient's complexity of care (PCC) has been extensively studied, it remains undefined in its essential characteristics. Various tools for assessing PCC have been developed, yet, there is no gold standard of reference. This study intends to explore the elements that determine PCC focusing on the patient's needs. The bed management team of a University Hospital developed in 2010 a PCC measurement instrument, similar to a triage system, to classify rapidly patients into macro-levels of care complexity (low, medium, high, intensive). Descriptive analysis of prospectively collected data registered in nursing records during 2016-2017 are presented in this study. The incidence of individual metrics on the value assigned to the overall PCC level was calculated. 26593 patients' records were analyzed. The final level of PCC was equal to patient's level of autonomy in 92,2% of cases, to clinical stability in 74,4% and to cognitive status in 58,4%. Our finding indicate that essential elements to determine PCC are patient's autonomy and clinical stability. Therefore, nurses can use these metrics to classify quickly PCC in their work settings. Identifying and measuring PCC is very important for nurses. It can facilitate and support nurse decision-making in design, implementation and evaluation of activities aimed at improving patient care. Moreover, it can help in the distribution of care loads in the shift, and from an organizational point of view, it can allow defining staffing assets.

A fuzzy rule-based efficient hospital bed management approach for coronavirus disease-19 infected patients.

Coronavirus disease-19 (COVID-19) is a very dangerous infectious disease for the entire world in the current scenario. Coronavirus spreads from one person to another person very rapidly. It spreads exponentially throughout the globe. Everyone should be cautious to avoid the spreading of this novel disease. In this paper, a fuzzy rule-based approach using priority-based method is proposed for the management of hospital beds for COVID-19 infected patients in the worst-case scenario where the number of hospital beds is very less as compared to the number of COVID-19 infected patients. This approach mainly attempts to minimize the number of hospital beds as well as emergency beds requirement for the treatment of COVID-19 infected patients to handle such a critical situation. In this work, higher priority has given to severe COVID-19 infected patients as compared to mild COVID-19 infected patients to handle this critical situation so that the survival probability of the COVID-19 infected patients can be increased. The proposed method is compared with first-come first-serve (FCFS)-based method to analyze the practical problems that arise during the assignment of hospital beds and emergency beds for the treatment of COVID-19 patients. The simulation of this work is carried out using MATLAB R2015b.

Clinical benefits and costs of an outpatient parenteral antimicrobial therapy service.

The enrolment of patients to an outpatient parenteral antimicrobial therapy (OPAT) service can be a means of mitigating financial burdens related to the provision of care and optimisation of hospital bed management. This study aimed to identify the clinical benefit of the Maltese OPAT service and to quantify the costs incurred to run it. The study period ran for 156 weeks during 1st October 2016 to 1st October 2019. Patient demographics, infection type, referring care team, antimicrobial agent/s used, type of vascular access device (VAD) available and service completion status (defined as provision of care without re-hospitalisation) were recorded. Time allocated for OPAT service delivery and expenses incurred were collected and an activity-based costing exercise was performed. The patient population who benefited from the service was of 117, 15 of whom used the service twice, for a total of 132 episodes. Patients received 149 antimicrobial treatment courses, with ceftriaxone being the most common single agent used (n=52, 34.9%). Teicoplanin with ertapenem was the most common regimen selected for combination therapy (n=9, 52.9%). A total of 23 episodes (17.4%) resulted in a readmission, 6 (30%) of which were because of patient deterioration. The mean service running weekly cost was €455.47/$538.68 and a total of 3287 days of hospital stay were avoided. This effectively illustrates that the OPAT service optimised hospital bed availability without compromising care delivery. The national OPAT service proved to be a safe and effective alternative for patient management to promote patient-centred care without hospitalisation.

A soft silicone foam dressing that aids healing and comfort in oncology care.

Maintaining skin integrity plays a key role in the ongoing care and comfort of patients at the end of life. Unfortunately, patients receiving cancer treatments are at higher risk of altered skin integrity. Cancer treatments involve multiple modalities, all of which impair wound healing. Excess exudate can be distressing to patients, resulting in catastrophic damage to the wound bed and surrounding skin, reducing quality of life and increasing the need for specialist services. This article describes the use of the Kliniderm foam silicone range of dressings, in combination with best practice, in the treatment of wounds in the oncology setting. The case study evidence presented indicates that this range of dressings is useful in the management of radiotherapy and oncology wounds. It had a positive effect on the exudate level, wound-association pain and the peri-wound skin in these patients, aiding the management of the wound bed.

Admission control of hospitalization with patient gender by using Markov decision process

AbstractAdmission control of hospitalization considering patient gender is an interesting issue in the study of hospital bed management. This paper addresses the decision on the admission of patients who should immediately be admitted into a same‐gender room or rejected. Note that a patient is admitted depending on different conditions, such as his/her health condition, gender, the availability of beds, the length of stay, and the reward of hospitalization. Focusing on the key factor, patient gender, this paper sets up an infinite‐horizon total discounted reward Markov decision process model with the purpose to maximize the total expected reward for the hospital, which leads to an optimal dynamic policy. Then, the structural properties of the optimal policy are analyzed. Additionally, a value iteration algorithm is proposed to find the optimal policy. Finally, some numerical experiments are used to discuss how the optimal dynamic policy depends on some key parameters of the system. Furthermore, the performance of the optimal policy is discussed though comparison with the three other policies by means of simulating different scenarios.

Brief intensive observation areas in the management of acute heart failure in elderly patients leading to high stabilisation rate and less admissions

Objectives. Acute heart failure is major cause of hospitalisation in Western countries. As patients with acute heart failure cannot be admitted directly to the wards, they stay in emergency rooms, causing access block. Brief Intensive Observation areas are holding units dedicated to the stabilisation of patients requiring close monitoring. However, these units have been associated with acute exacerbation of heart failure. This study aimed to evaluate the impact of Brief Intensive Observation areas on the management of acute heart failure in elderly patients. Methods. This retrospective, single-centred observational study analysed patients who presented in the emergency room with acute heart failure in 2017 and divided them into two cohorts: those treated in the Brief Intensive Observation and those who were not. The reduction of colour codes at discharge, mortality rate within the emergency rooms, hospitalisation rate, rate of transfer to less intensive facilities and readmission rate at 7, 14 and 30 days after discharge were compared. Results. Of the 694 patients, 62% were transferred to the Brief Intensive Observation for stabilisation. Age and sex between the cohorts were not significantly different. However, compared to non-Brief Intensive Observation patients, the Brief Intensive Observation patients had worse clinical conditions on arrival and longer stabilisation period. The stabilisation rate was higher in Brief Intensive Observation patients than in non-Brief Intensive Observation patients. Conclusions. Brief Intensive Observation areas allows effective stabilisation of elderly patients, better management of beds, reduced admission rates and reduced use of high intensity care unit beds.

Software development for emergency bed management

ABSTRACT Objective: to describe the process of developing a software for emergency bed management. Methods: a participatory research based on User-Centered Design in four stages: 1) definition of requirements and structure elaboration; 2) generation of alternatives and prototyping; 3) tests; 4) implementation. Seminars were held with health professionals between May 21, 2018 and May 31, 2019 for the preparation and assessment of software content. Results: the software CuidarTech KRONOS was developed for emergency bed management using the kanban methodology. Final considerations: this software will assist professionals' and managers' decision-making providing more reliable data to enable the improvement of work processes and the quality of patient care. Developing a bed management software is innovative in the health field, and no articles were found describing this methodology.

The Development and Operation of a Home Management System during the COVID-19 Pandemic: an Experience of the Local Government (Gyeonggi-do) in South Korea

During the three the coronavirus disease 2019 (COVID-19) surges in South Korea, there was a shortage of hospital beds for COVID-19 patients, and as a result, there were cases of death while waiting for hospitalization. To minimize the risk of death and to allow those confirmed with COVID-19 to safely wait for hospitalization at home, the local government of Gyeonggi-do in South Korea developed a novel home management system (HMS). The HMS team, comprised of doctors and nurses, was organized to operate HMS. HMS provided a two-way channel for the taskforce and patients to monitor the severity of patient's condition and to provide healthcare counseling as needed. In addition, the HMS team cooperated with a triage/bed assignment team to expedite the response in case of an emergency, and managed a database of severity for real-time monitoring of patients. The HMS became operational for the first time in August 2020, initially managing only 181 patients; it currently manages a total of 3,707 patients. The HMS supplemented the government's COVID-19 confirmed case management framework by managing patients waiting at home for hospitalization due to lack of hospital and residential treatment center beds. HMS also could contribute a sense of psychological stability in patients and prevented the situation from worsening by efficient management of hospital beds and reduction of workloads on public healthcare centers. To stabilize and improve the management of COVID-19 confirmed cases, governments should organically develop self-treatment and HMS, and implement a decisive division of roles within the local governments.

Analysis of Length of Stay (LOS) Data from the Medical Records of Tertiary Care Hospital in Saudi Arabia for Five Diagnosis Related Groups: Application of Cox Prediction Model

Background: One of the main objectives of hospital managements is to control the length of stay (LOS). Successful control of LOS of inpatients will result in reduction in the cost of care, decrease in nosocomial infections, medication side effects, and better management of the limited number of available patients’ beds. The length of stay (LOS) is an important indicator of the efficiency of hospital management by improving the quality of treatment, and increased hospital profit with more efficient bed management. The purpose of this study was to model the distribution of LOS as a function of patient’s age, and the Diagnosis Related Groups (DRG), based on electronic medical records of a large tertiary care hospital. Materials and Methods: Information related to the research subjects were retrieved from a database of patients admitted to King Faisal Specialist Hospital and Research Center hospital in Riyadh, Saudi Arabia between January 2014 and December 2016. Subjects’ confidential information was masked from the investigators. The data analyses were reported visually, descriptively, and analytically using Cox proportional hazard regression model to predict the risk of long-stay when patients’ age and the DRG are considered as antecedent risk factors. Results: Predicting the risk of long stay depends significantly on the age at admission, and the DRG to which a patient belongs to. We demonstrated the validity of the Cox regression model for the available data as the proportionality assumption is shown to be satisfied. Two examples were presented to demonstrate the utility of the Cox model in this regard.

Hospital indicators after implementation of bed regulation strategies: an integrative review.

to analyze the scientific evidence available in literature on hospital indicators after implementation of bed regulation strategies. this is an integrative review conducted with studies available in five databases and in the reference database of the Center for Study and Research in Nursing Services Management in October 2019. Articles on hospital bed management, available in full in English, Spanish or Portuguese, without temporal delimitation were included. 1,118 eligible articles were found, of which 37 were duplicated. Among 1,081 pre-selected studies, 112 studies were eligible and 11 articles were included. Six studies addressed the emergency services. Three addressed hospital indicators in general, another focused on a psychiatric ward and one analyzed the indicators of two hospitals administered differently. the studies focused on emergency services, demonstrating the importance of organizing these services for health institutions.