Bed Utilization Research Articles

Considering Sun Safety Policies in the United States.

As they are collectively the most common malignancies, the personal and systemic burden of skin cancers represent a significant public health concern in the United States. Ultraviolet radiation from the sun as well as from artificial sources such as tanning beds is a carcinogen well-known to increase the risk of developing skin cancer in individuals. Public health policies can help mitigate these risks. In this perspectives article, we review sunscreen and sunglasses standards, tanning bed utilization, and workplace sun protection guidelines in the US and provide focused examples for improvement from Australia and the United Kingdom where skin cancer is a well-documented public health concern. These comparative examples can inform interventions in the US that have the potential to modify exposure to risk factors associated with skin cancer.

P32 Assessing outpatient parenteral antimicrobial therapy (OPAT) referrals to determine number of bed days saved in secondary care

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) is a safe and effective service to manage infections in patients.1 OPAT allows medical admission avoidance for stable patients and allows for early discharge for patients with ongoing IV antimicrobial therapy needs. OPAT therefore allows the optimization of hospital bed management and relieve pressures on the NHS.2 The primary aim of this audit is to determine the number of bed days saved in secondary care through early discharge and admission avoidance by the OPAT service which is completed by Cornwall Foundation Trust’s Acute Care at Home (ACAH) Team. This study did not require ethics approval. Objectives (i) To quantify the total number of bed days saved by referral to OPAT; (ii) to determine the total number of days of each IV antibiotic received by patients under the OPAT service and (iii) to compare treatment course lengths for infections being managed by the OPAT service against nationally reported data. Standards 100% of patients must be receiving IV antibiotics with an indication whilst under OPAT. 100% of patients must have an IV antibiotic dose, frequency and administration method documented. 100% of patients must have an acceptance date by the OPAT team. Methods Patients were identified from daily handover documents from the ACAH team for the period of 1 February to 28 February 2023. Data collection was obtained using the clinical recording and electronic health recording system, RiO and Maxims, and the electronic prescribing and medicine administration (EPMA) system. The number of bed days saved is calculated from the acceptance date to OPAT to the discharge date from OPAT for each patient. Results A total of 70 patients were captured during initial data gathering, of which 41 patients met the inclusion criteria for the audit. Of these 41 patients meeting the audit criteria, 21 (51.2%) patients were referred from primary care and 20 (48.9%) patients were referred from RCHT. The total sum of bed days saved was 343 days, and the total sum of OPAT treatment days was 302 days. The most prescribed antibiotic was Ceftriaxone, with 27 patients (%) receiving this antibiotic; other antibiotics included the following: Tazocin (n = 5), ertapenem (n = 5), flucloxacillin (n = 2), gentamicin (n = 1), meropenem (n = 1) and teicoplanin (n = 1). The recorded indications were recorded, and when compared with the average treatment duration for each infection type against the NORS 2015–2020 data,3 the average treatment days in this audit were within range. Conclusions These results demonstrate that the OPAT service utilized by RCHT has a significant impact on bed utilization, through reducing hospital admissions and facilitating early discharge. Course lengths are in keeping with the national reported average indicating that patients are receiving comparable course lengths to other OPAT providers; further work to compare these course lengths against national best practice would be useful. There are limitations to the results, as the number of bed days saved was capped to the end of the audit data collection period. Recommendation to improve would be to re-audit with a longer data collection time frame.

Flow-Sizing Critical Care Resources.

To describe the factors affecting critical care capacity and how critical care organizations (CCOs) within academic centers in the U.S. flow-size critical care resources under normal operations, strain, and surge conditions. PubMed, federal agency and American Hospital Association reports, and previous CCO survey results were reviewed. Studies and reports of critical care bed capacity and utilization within CCOs and in the United States were selected. The Academic Leaders in the Critical Care Medicine Task Force established regular conference calls to reach a consensus on the approach of CCOs to "flow-sizing" critical care services. The approach of CCOs to "flow-sizing" critical care is outlined. The vertical (relation to institutional resources, e.g., space allocation, equipment, personnel redistribution) and horizontal (interdepartmental, e.g., emergency department, operating room, inpatient floors) integration of critical care delivery (ICUs, rapid response) for healthcare organizations and the methods by which CCOs flow-size critical care during normal operations, strain, and surge conditions are described. The advantages, barriers, and recommendations for the rapid and efficient scaling of critical care operations via a CCO structure are explained. Comprehensive guidance and resources for the development of "flow-sizing" capability by a CCO within a healthcare organization are provided. We identified and summarized the fundamental principles affecting critical care capacity. The taskforce highlighted the advantages of the CCO governance model to achieve rapid and cost-effective "flow-sizing" of critical care services and provide recommendations and resources to facilitate this capability. The relevance of a comprehensive approach to "flow-sizing" has become particularly relevant in the wake of the latest COVID-19 pandemic. In light of the growing risks of another extreme epidemic, planning for adequate capacity to confront the next critical care crisis is urgent.

Risk factors for the transmission of Clostridioides difficile or methicillin-resistant Staphylococcus aureus in acute care

Background: Some hospitals continue to struggle with nosocomial transmission of Clostridioides difficile infection (CDI) and methicillin-resistant Staphylococcus aureus (MRSA) despite years of infection control efforts. We investigated the relationship between unit infrastructural–organizational risk factors and nosocomial transmission of CDI and MRSA. Methods: This retrospective observational study included 100 eligible acute-care inpatient units from 12 hospitals in British Columbia, Canada, from April 1, 2020, to September 16, 2021. The outcome variables included whether a unit was on the CDI or MRSA vulnerable unit list (ie, defined as having ≥5 CDI cases or ≥6 MRSA cases being attributed to the unit in the last 6 fiscal periods), the average CDI/MRSA rate, as well as the average CDI/MRSA standardized infection ratio (SIR). Independent variables included, but were not limited to, infection control factors (eg hand hygiene rate), infrastructural factors (eg, unit age, total beds on unit), and organizational factors (eg, hallway bed utilization, nursing overtime). Multivariable regression was performed to identify statistically significant risk factors using SAS, R Studio, and Stata software. Results: For CDI, older units were associated with higher odds of being on the CDI vulnerable unit list (aOR, 1.086; 95% CI, 1.024–1.175), higher CDI rate (adjusted relative risk [aRR], 0.012; 95% CI, 0.004–0.020), and higher CDI SIR (aRR, 0.011; 95% CI, 0.003–0.020). Larger unit size was associated with higher odds of being on the CDI vulnerable unit list (aOR, 1.210; 95% CI, 1.095–1.400) and higher CDI SIR (aRR, 0.013; 95% CI, 0.001–0.026). For MRSA, an increase in hand hygiene rate was associated with lower odds of being on the MRSA vulnerable unit list (aOR, 0.71; 95% CI, 0.53–0.897), lower MRSA rate (aRR, −0.035; 95% CI, −0.063 to −0.008), and lower MRSA SIR (aRR, −0.039; 95% CI, −0.069 to −0.008). Higher MRSA bioburden was associated with higher odds of being on the MRSA vulnerable unit list (aOR, >999; 95% CI, >999 to >999), higher MRSA rate (aRR, 9.008; 95% CI, 5.586–12.429), and higher MRSA SIR (aRR, 4.964; 95% CI, 1.971–7.958). Additionally, higher MRSA rates were associated increased utilization of hallway beds (aRR, 0.680; 95% CI, 0.094–1.267), increased nursing overtime rate (aRR, 5.018; 95% CI, 1.210–8.826), and not having a clean supply room with the door consistently closed (aRR, −0.283; 95% CI, −0.536 to −0.03). Conclusions: Several infrastructural and organizational factors were associated with nosocomial transmissions of CDI and MRSA. Further research is needed to investigate the mechanisms by which these factors are associated.Disclosures: None

17th International Conference on Malignant Lymphoma, Palazzo dei Congressi, Lugano, Switzerland, 13 - 17 June, 2023.

Introduction: Lymphoma is one of the most prevalent cancers diagnosed in the Republic of Ireland, with approximately 800 cases of Non-Hodgkin lymphoma and 150 cases of Hodgkin lymphoma (HL) diagnosed annually. Previous studies have demonstrated that time to diagnosis can range substantially, with diagnosis to treatment interval associated with survival outcomes. Aims & Methods: The primary aim of this study was to compare the diagnostic efficiency according to histology specimen type. The secondary aims included time to lymphoma diagnosis, and predictors associated with diagnostic delays. A retrospective analysis was performed on all patients diagnosed at a tertiary (non-fee paying) centre in Ireland between 2016 and 2021. Baseline demographic data and diagnostics were obtained from electronic records. Referral to treatment interval (RTI) was calculated from the date of initial review in the referral centre to commencement of therapy. Results: A total of 225 new lymphoma diagnoses were made during the study period. The median age was 63.3 years (IQR 44.2, 73.6) Males accounted for 54.7% (n = 123) of the population. DLBCL was the most common subtype (n = 94; 41.8%); followed by classical HL (n = 40; 17.8%) and Follicular lymphoma (n = 32; 14.2%). Fifty four percent (n = 122) had their diagnostic histology attained during an inpatient episode. The median time to diagnosis was 24 days (IQR 13.0, 58.0). A total of 350 histology specimens were attained. Core biopsy yielded a diagnosis in 64% (n = 144), excision biopsy in 35.6% (n = 80) and FNA in 0.4% (n = 1). The positive diagnostic rate was 69.5% for core biopsy, 93% for excision biopsy and 1.7% for FNA. The median financial cost of diagnosis was €13714 (IQR €4050, €24044). The total cost for this patient group was €3.7 million over a 5 year period. The median RTI was 47 days (IQR 23.0, 91.0). In the univariate analysis, we confirmed patients with older age are more likely to have longer RTI (p = 0.0007). Diagnostic biopsy performed as inpatient was associated with a shorter RTI (p ≤ .0001). Patients referred direct to haematology services had a longer RTI (p = 0.0004). In the multivariable analysis, patients with older age remained significant associated with prolonged RTI (p = 0.0251). Diagnostic biopsy performed as an inpatient remained significant (p ≤ .0001). Similarly, patients referred directly to Haematology services has significantly longer RTI (p = 0.0051). Conclusion: In this review, we confirm the higher diagnostic yield of excision biopsy for diagnosis. Older age at presentation and referral direct to haematology was associated with longer RTI. Inpatient diagnostic’s was associated with shorter RTI. We confirm an over reliance on inpatient diagnostics. With the increasing financial burden of healthcare and increased demand on resources including bed utilisation, the appropriate choice of investigations and diagnostic sampling is ever more critical. Encore Abstract - previously submitted to regional or national meetings (up to <1000 attendees) Keywords: cancer health disparities, diagnostic and prognostic biomarkers, Imaging and Early Detection - Other No conflicts of interests pertinent to the abstract.

Judicious ending of isolation based on reverse transcription–polymerase chain reaction (RT-PCR) cycle threshold only for patients with coronavirus disease 2019 (COVID-19) requiring in-hospital therapy for longer than 20 days after symptom onset

BackgroundFor patients with coronavirus disease 2019 (COVID-19) requiring hospitalization, extending isolation is warranted. As a cautious protocol, ending isolation based on polymerase chain reaction cycle threshold (Ct) value was introduced for patients requiring therapy for >20 days after symptom onset. MethodWe compared a Ct-based strategy using Smart Gene® between March 2022 and January 2023 with a preceding control period (March 2021 to February 2022) when two consecutive negative reverse transcription–polymerase chain reaction tests using FilmArray® were required for ending isolation. Ct was evaluated on day 21, and ending isolation was permitted in patients with Ct ≥ 38. Although patients with Ct 35–37 were transferred to a non-COVID-19 ward, isolation was continued. ResultsThe duration of stay on a COVID-19 ward in the Ct group was 9.7 days shorter than that in controls. The cumulative number of tests was 3.7 in controls and 1.2 in the Ct group. There was no nosocomial transmission after ending isolation in either group. The number of days from symptom onset to testing was 20.7 ± 2.1 in Ct group, and five patients had Ct < 35, nine Ct 35–37, and 71 Ct ≥ 38. No patients were moderately or severely immunocompromised. Steroid use was an independent risk factor for prolonged low Ct (odds ratio 9.40, 95% confidence interval 2.31–38.15, p = 0.002) ConclusionsThe efficacy of ending isolation based on Ct values could improve bed utilization without the risk of transmission among patients with COVID-19 requiring therapy for >20 days after symptom onset.

MP-453085-11 ALLIED PROFESSIONALS DISPOSITION PATHWAY WITH CONDITIONAL DISCHARGE REDUCES BED UTILIZATION AND HOSPITAL RESOURCES

Increasing demands of inpatient level of care continue to pose challenges to hospital resources and available capacity. Alternative disposition pathways overseen by allied professionals (AP) that utilize extended recovery unit (ERU) hours and conditional discharge (CD) can reduce inpatient bed use, total time spent at the hospital and overall resource utilization. To demonstrate that implementation of disposition pathways utilizing CD and same day discharge (SDD) with an ERU reduces hospital resources without compromising patient safety. An ERU was created to reduce inpatient hospital bed utilization and optimize disposition pathways. This unit included 6 patient beds, 2 registered nurses and overnight coverage. Patients (pts) presenting for elective electrophysiology procedures were classified into three different disposition pathways including SDD, CD and admission to EP allied professional (EP AP) service. All 3 pathways were overseen by EP APs. Pts in the SDD and CD group were required to meet specific criteria noted by the AP to be considered safe for discharge. We compared these new pathways with prior disposition orders in relation to efficiency, safety and resource utilization. From 8/28/2022 to 11/13/2022, 918 pts presented for an EP procedure including cardiac device implantation and ablation. Of these, 200/918(21.8%) were eligible for our disposition pathway. There were 74(8.1%) pts who were SDD, 51(5.6%) pts in the CD pathway, 61(6.6%) pts admitted to the EP AP service, and 14(1.5%) pts were cross-over pathways (failed CD transitioned to EP AP service). The remainder were either already inpatient or felt pre-procedure to require inpatient level of care. Pts evaluated on the EP AP service in the ERU had an average discharge time of 10:04AM vs 12:53PM for pts on the EP AP service admitted to an inpatient unit. Patients in the CD group located in the ERU had an average discharge time of 7:49AM. Discharge time with these pathways improved over time (Figure 1). The total number of pts admitted to the ERU and/or discharged the same day was 186 pts, indicating 186 total hospital beds saved. There were no differences in overall complications between disposition groups compared to prior to implementation of this strategy. The implementation of a disposition pathway strategy utilizing SDD, CD and an ERU overseen by APs is associated with reduced resource utilization without compromising pt safety.

A STATISTICAL STUDY ON KEY PERFORMANCE INDICATORS IN HEALTH SYSTEM

In this paper, a statistical study on key performance indicators in health system is given and two regression models with the average cost of hospitalization as the dependent variable are found. Using linear regression, it was found that a decrease in the average cost per day of hospitalization can be achieved by increasing the bed utilization rate and increasing the number of cases treated in a calendar year. Also, the decrease in the case-mix index, which can be achieved by increasing the number of resolved cases, leads to a decrease in the average cost of hospitalization per day. The obtained results were interpreted and certain measures are proposed to improve health management.

A cross-sectional analysis of paediatric urologists’ current practices, opinions and areas of perceived importance in the delivery of adolescent & transitional care

Complex urological anomalies often require continued care as patients reach adulthood. Adequate transition for adolescents with ongoing urological care needs is critical to allow for seamless care in adult hospitals. Studies have shown that this can lead to improved patient and parental satisfaction, and lower utilisation of unplanned inpatient beds and emergency department visits. There is currently no ESPU-EAU consensus on the adequate mechanism and very few individual papers examining the role of urological transition for these patients in a European setting. This study aimed to identify current practice patterns in paediatric urologists providing adolescent/transitional care, to assess their opinions towards formal transition and to look for variations in care. This has implications for long-term patient health and specialist care. An 18-item cross-sectional survey was compiled and pre-approved through the EAU-EWPU and ESPU board offices prior to dissemination to all registered ordinary members affiliated with the ESPU. This was created using a mini-Delphi method through the EWPU research meetings to provide current semi-quantitative data relating to current opinions and attitudes of this cohort. A total of 172 respondents (55% paediatric general surgery; 45% urology) across 28 countries completed the survey. The majority of respondents were in practice >10 years and spent >80% time in paediatric urology. There was no formal transition process according to 50% respondents and over half of those that did have less than 1/month, with <10% using validated questionnaires. More than two-thirds respondents continued to provide care after transition, as >70% units had no designated corresponding adult service. Furthermore, 93% paediatric believe a formal transition service to be very important, using a multidisciplinary framework. A pareto chart demonstrated 10 specific conditions to be of most interest in transition to adulthood. This is the first study to assess the requirements of paediatric urologists for adequate transitional care, however due to the nature of the survey's distribution, this was a non-scientific poll based on a convenience sample of respondents. It is critical that dual-trained or adult-trained urologists with a specific interest in paediatric urology work with current paediatric urologists in a multidisciplinary fashion to facilitate early transition based on the adolescent's developmental and biopsychosocial requirements. National urological and paediatric surgical societies need to make transitional urology a priority. The ESPU and EAU should collaboratively consider developing transitional urology guidelines to allow a framework by which this can occur.

Expediting the TIA Workup (P6-5.024)

<h3>Objective:</h3> Reduction of length of stay (LOS) for transient ischemic attack (TIA) admissions at a public safety net community hospital. <h3>Background:</h3> Transient focal neurologic deficits are a common chief complaint among patients presenting to Emergency Department (ED). Admitting these patients is costly and increases utilization of limited hospital resources. Thus, the current national trend is to avoid admitting “low risk” TIA patients. The purpose of this study is to design a “TIA pathway,” in a public safety net hospital setting to expedite evaluation of these patients. <h3>Design/Methods:</h3> We based our TIA pathway protocol on work done by Boyle et al. We tailored our protocol, based on the socioeconomic needs of our patients (27.2% uninsured, 5.2% undomiciled), to further improve access to stroke care for our community. With ED collaboration, physician training was performed, including utilization of an order set and understanding guidelines for the TIA pathway and inpatient admission. TIA pathway utilization data and data from admitted TIA patients was gathered from the medical record and AHA Get with the Guidelines registry. In addition, safety data including adverse events, 30 day follow up, readmission, and outcomes were monitored and reviewed monthly by stroke leadership. <h3>Results:</h3> A total of 247 TIA cases were recorded in February 2020 through August 2022. The average LOS of patients admitted to the TIA pathway was 1.58 days, while the average LOS for patients admitted inpatient for TIA workup was 2.92 days. Since the inauguration of TIA pathway, we decreased bed utilization by 130 hospital days. <h3>Conclusions:</h3> A dedicated TIA pathway with well-constructed guidelines, order-sets, and physician education resulted in a significant reduction in hospital LOS for the initial evaluation of TIA patients. Follow up outcome studies will be performed to assess the safety and efficacy of an expedited TIA workup. <b>Disclosure:</b> Dr. Wen has nothing to disclose.

High-capacity/high-rate hybrid column for high-performance ion exchange

Herein, a fixed-bed high-capacity/high-rate (HC/HR) hybrid column was developed using commercial ion-exchange beads (IEBs) and ion-exchange fibers (IEFs). The as-fabricated HC/HR hybrid column exhibited excellent breakthrough bed volume (BV) and utilization efficiency of capacity (UEC) at a high service flow rate (SFR) for the adsorption of Cd(II). The IEBs displayed a high adsorption capacity of 235.2 ± 9.8 mg g−1 and slow adsorption kinetics (k2 = 0.0001 g mg−1 min−1) for the sorption of Cd(II); meanwhile, the IEFs showed a maximum adsorption capacity of only 146.3 ± 7.5 mg g−1, which is lower than that of the IEBs, but fast kinetics (k2 = 0.0130 g mg−1 min−1). At an SFR of 104.23 BV h−1, the HC/HR hybrid column showed excellent performance for the sorption of Cd(II), having a high breakthrough BV of 1009.11 and a UEC of 92.86%; these values are much higher than those of the IEB-packed column. Furthermore, at an increased SFR (318.47 BV h−1), the HC/HR hybrid column maintained its high performance, demonstrating a breakthrough BV of 568.80 and UEC of 83.90%. The regeneration experiment indicates that 97% of the initial capacity was retained. Thus, the HC/HR hybrid column could easily be applied to existing column systems and shows promising performance in ion-exchange processes.

Leaving the hospital on time: hospital bed utilization and reasons for discharge delay in the Netherlands.

Inappropriate bed occupancy due to delayed hospital discharge affects both physical and psychological well-being in patients and can disrupt patient flow. The Dutch healthcare system is facing ongoing pressure, especially during the current coronavirus disease pandemic, intensifying the need for optimal use of hospital beds. The aim of this study was to quantify inappropriate patient stays and describe the underlying reasons for the delays in discharge. The Day of Care Survey (DoCS) is a validated tool used to gain information about appropriate and inappropriate bed occupancy in hospitals. Between February 2019 and January 2021, the DoCS was performed five times in three different hospitals within the region of Amsterdam, the Netherlands. All inpatients were screened, using standardized criteria, for their need for in-hospital care at the time of survey and reasons for discharge delay. A total of 782 inpatients were surveyed. Of these patients, 94 (12%) were planned for definite discharge that day. Of all other patients, 145 (21%, ranging from 14% to 35%) were without the need for acute in-hospital care. In 74% (107/145) of patients, the reason for discharge delay was due to issues outside the hospital; most frequently due to a shortage of available places in care homes (26%, 37/145). The most frequent reason for discharge delay inside the hospital was patients awaiting a decision or review by the treating physician (14%, 20/145). Patients who did not meet the criteria for hospital stay were, in general, older [median 75, interquartile range (IQR) 65-84 years, and 67, IQR 55-75 years, respectively, P < .001] and had spent more days in hospital (7, IQR 5-14 days, and 3, IQR 1-8 days respectively, P < .001). Approximately one in five admitted patients occupying hospital beds did not meet the criteria for acute in-hospital stay or care at the time of the survey. Most delays were related to issues outside the immediate control of the hospital. Improvement programmes working with stakeholders focusing on the transfer from hospital to outside areas of care need to be further developed and may offer potential for the greatest gain. The DoCS can be a tool to periodically monitor changes and improvements in patient flow.

Assessing the Impact of Massage Bed Utilization on Range of Motion and Pressure Pain Threshold in Individuals with Chronic Low Back Pain: A Case Study Approach

Assessing the Impact of Massage Bed Utilization on Range of Motion and Pressure Pain Threshold in Individuals with Chronic Low Back Pain: A Case Study Approach

Bed utilization pattern of intensive care units affiliated to Ministry of Health: a national study in Egypt prior to the COVID-19 pandemic

BACKGROUND: This study aims to calculate the following bed utilization of intensive care Units (ICU) at the national and regional levels. METHODS: A descriptive retrospective record-based study was done in all ICUs affiliated to Ministry of Health and Population (MOHP). RESULTS: ICU admission rate ranged from 0.09% to 0.41% with 0.19%. BOR ranged from 10% to 72% with 60%. The ALS (Days) ranged from 1.92 days to 5.41 days with 3.61 days. The average ABTI per year ranged from 1.42 days to 25.04 days with 2.46 days. The average ABTR ranged from 13.14 to 101.02 with 60.14. CONCLUSIONS: Utilization of ICUs affiliated to MOHP is not optimal at the national level and there is a room for improvement.

Optimal admission and queuing control with reneging behavior under premature discharge decisions

AbstractQueues or waiting lines are a common phenomenon in healthcare facilities. The increasing number of admissions to hospital emergency departments (EDs) has resulted in overcrowded EDs and decreased quality of care. Patients may renege with dissatisfaction while waiting, prolonged hospital stays, or the cancelation of surgeries, especially for those with acute diseases. This paper studies patient admission and queuing control policies, considering premature discharge decisions and reneging behavior. First, we formulate this problem as an infinite‐horizon total discounted cost Markov decision process to balance bed utility and experiences of patients waiting for admission to minimize the total expected cost for the hospital. Then, we characterize an optimal admission threshold policy by analyzing the structural properties of the optimal value function. Numerical experiments are employed to discuss how the optimal dynamic policy depends on some key parameters of the system. Finally, the performance of the optimal policy is discussed through comparison with the benchmark: A myopic rule (first come, first served) mimicking the decision‐making in practice under different scenarios. The numerical results show that the reneging behavior can affect the superiority of the optimal policy compared to the benchmark, and the optimal policy can significantly reduce the number of waiting patients without increasing the total expected cost when the system is overloaded.

Comparative Statistical Analysis of Key Performance Indicators in the Health System.

In this paper, a comparative statistical analysis of some performance indicators from the health system at SCJU Craiova and SJU Slatina is made in the period 2010-2021. Also, the correlations between the average duration of hospitalization, the bed utilization rate, the number of cases and the case complexity index for each hospital are studied. It is found that there are similarities, but also statistically significant differences between the two analyzed hospitals. Thus, it turns out that there are no significant differences between the bed utilization rate and the complexity index between the two hospitals, but there are statistically significant differences at a significance threshold of 5% between the average duration of hospitalization and the number of cases registered at the two hospitals analyzed. Moreover, the case complexity index is strongly negatively correlated with the bed utilization rate and with the number of cases in both hospitals, but positively correlated with the average duration of hospitalization at SCJU Craiova and weakly negatively correlated at SJU Slatina.

Optimal Decision of Dynamic Bed Allocation and Patient Admission with Buffer Wards during an Epidemic

To effectively prevent patients from nosocomial cross-infection and secondary infections, buffer wards for screening infectious patients who cannot be detected due to the incubation period are established in public hospitals in addition to isolation wards and general wards. In this paper, we consider two control mechanisms for three types of wards and patients: one is the dynamic bed allocation to balance the resource utilization among isolation, buffer, and general wards; the other is to effectively control the admission of arriving patients according to the evolution process of the epidemic to reduce mortality for COVID-19, emergency, and elective patients. Taking the COVID-19 pandemic as an example, we first develop a mixed-integer programming (MIP) model to study the joint optimization problem for dynamic bed allocation and patient admission control. Then, we propose a biogeography-based optimization for dynamic bed and patient admission (BBO-DBPA) algorithm to obtain the optimal decision scheme. Furthermore, some numerical experiments are presented to discuss the optimal decision scheme and provide some sensitivity analysis. Finally, the performance of the proposed optimal policy is discussed in comparison with the other different benchmark policies. The results show that adopting the dynamic bed allocation and admission control policy could significantly reduce the total operating cost during an epidemic. The findings can give some decision support for hospital managers in avoiding nosocomial cross-infection, improving bed utilization, and overall patient survival during an epidemic.

Adsorption dynamics of ethane from air in structured fixed beds with different microfibrous composites

Adsorption dynamics of ethane in two granular fixed beds and structured fixed beds with microfibrous composites was studied. 5A zeolite membrane 5A/PSSF (paper-like sintered stainless steel fiber) and microfibrous entrapped activated carbon (MEAC) composites were prepared by wet layup papermaking/sintering technique and in-situ hydrothermal method. Microfibrous composites were characterized by X-ray diffraction, scanning electron microscopy and N2 adsorption/desorption. Structured fixed beds were designed by filling granular adsorbents (5A zeolite or activated carbon) and microfibrous composites at the inlet and outlet of the beds, respectively. Effects of flow rate, bed height and structure on the breakthrough curves were investigated. The length of unused bed (LUB) was determined, and Yoon–Nelson model was used to fit the breakthrough curves. The experimental results showed ethane was effectively adsorbed on the granular adsorbents and microfibrous composites. Both composites could decrease the LUB values and enhance bed utilization. All breakthrough curves fitted well to Yoon–Nelson model, with correlation coefficient exceeding 0.89. The adsorption rate of ethane could be improved in the structured fixed beds, which showed an enhanced mass transfer efficiency for ethane adsorption. LUB values of structured fixed beds with 5A/PSSF composites were larger, the bed utilization values were lower, and the adsorption rate constants were higher than those with MEAC composites under the same conditions.

A 3-year analysis of the impact of COVID-19 pandemic on NSTEMI incidence, clinical characteristics, management, and outcomes.

The COVID-19 pandemic has been associated with decreased incidence of acute coronary syndrome with worsened outcomes. Few studies have addressed the effects beyond the initial phases of the pandemic. This study elucidated the incidence, clinical characteristics, management, and outcomes of NSTEMI at a tertiary referral center from sample time periods of 2019-2022. This study included consecutive NSTEMI patients from March 14-May9,2019-2022. Variables included baseline characteristics, clinical features on arrival, management strategy, time parameters, and adverse outcomes. The primary outcome was defined as death, heart failure requiring diuretics, and/or sustained ventricular arrhythmia. This study comprised 250 patients of whom 181 who were admitted during the COVID-19 outbreak. Baseline characteristics were similar among groups. There was a reduction in door-to-angiography time from 29 h in 2019 to 19 h in 2020 [p = 0.01]and 20 h in 2021 [p = 0.02]. PCI intervention increased from 31.8% in 2019% to 50.0% in 2020 [p = 0.05]and 54.7% in 2021 [p < 0.01]. Median length-of-stay (LOS) was reduced from 3 days in 2019 to 2 days in 2020 [p = 0.03]. There was no significant change in outcomes in COVID-19 cohorts compared to control year. NSTEMI patients during the first 2 years of the COVID-19 pandemic were associated with reduced door-to-angiography times and increased percutaneous coronary intervention (PCI), and patients in year one were associated with reduced LOS. This study suggests that NSTEMI may be managed more efficiently thus reducing hospital bed utilization and potential costs.

265: ELASTICITY IN ICU TRIAGE DURING THE COVID-19 PANDEMIC

Introduction: ICU admission occurs for active treatment (ventilation, vasopressors) and to monitor patients at risk. The Acute Physiology and Chronic Health Evaluation (APACHE) IVb defines Low Risk Monitor (LRM) as not actively treated on ICU day 1 and < 10% prospective risk of ever needing active treatment. LRM patients potentially fill ICU beds required by acutely ill patients. We investigated if unprecedented ICU demand during the COVID-19 pandemic decreased LRM admissions during COVID surges. Methods: Retrospective analysis of hospitals tracking COVID-19 status and consistently contributing to the APACHE database March 23, 2020 to December 31, 2021. Baseline pre-pandemic data was also assessed. Patients with primary surgical and trauma diagnoses were removed to eliminate incidental COVID diagnoses. Pearson’s correlation coefficient (r) assessed the weekly relationship between %COVID and LRM patients. Results: 117,004 patients were admitted to ICU at 43 hospitals. Baseline LRM averaged 28.6% pre-COVID. During successive COVID peaks in April, July and December 2020 and April, August and December 2021, there was high inverse correlation (r=-0.90) between COVID census and LRM percentage. For example, in September 2020 COVID% was 7.81 and LRM was 28.2%. In December 2020, COVID surged to 31.1% and LRM dropped to 21.3%. These percentages returned to COVID 9.5% and LRM 28.2% during the March 2021 trough. Hospital mortality was 10.9% pre-pandemic, and 14.69% actual/13.66 predicted (SMR=1.08) from April 2020 through December 2021. Mean ventilator days were 4.08 pre- and 5.58 pandemic. ICU LOS increased from 3.52 to 4.16 days (ratio 1.11). Conclusions: LRM admissions decreased dramatically during successive COVID-19 surges, demonstrating considerable elasticity in ICU triage decisions. Mortality, ventilator days and ICU LOS all increased during the pandemic compared to baseline. Consistent measurement of % LRM may be helpful in recognizing opportunities to reduce inappropriate ICU bed utilization and as a marker of strained capacity.