Robert Champion

Forecasting Emergency Department presentations

OBJECTIVE To forecast the number of patients who will present each month at the emergency department of a hospital in regional Victoria. METHODS The data on which the forecasts are based are the number of presentations in the emergency department for each month from 2000 to 2005. The statistical forecasting methods used are exponential smoothing and Box-Jenkins methods as implemented in the software package SPSS version 14.0 (SPSS Inc, Chicago, Ill, USA). RESULTS For the particular time series, of the available models, a simple seasonal exponential smoothing model provides optimal forecasting performance. Forecasts for the first five months in 2006 compare well with the observed attendance data. CONCLUSIONS Time series analysis is shown to provide a useful, readily available tool for predicting emergency department demand. The approach and lessons from this experience may assist other hospitals and emergency departments to conduct their own analysis to aid planning.

The FIRST2ACT simulation program improves nursing practice in a rural Australian hospital

OBJECTIVE To measure the impact of the Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends (FIRST(2) ACT) simulation program on nursing observations and practice relevant to patient deterioration in a rural Australian hospital. DESIGN Interrupted time series analysis. SETTING A rural Australian hospital. PARTICIPANTS All registered nurses (Division 1) employed on an acute medical/surgical ward. INTERVENTION The FIRST(2) ACT simulation program. OUTCOME MEASURES Appropriate frequency of a range of observations and administration of oxygen therapy. RESULTS Thirty-four nurses participated (83% of eligible nurses) in the FIRST(2) ACT program, and 258 records were audited before the program and 242 records after. There were statistically significant reductions in less than satisfactory frequency of observations (P = 0.009) and pain score charting (P = 0.003). There was no measurable improvement in the administration of oxygen therapy (P = 0.143), while the incidence of inappropriate nursing practice for other measures both before and after the intervention was too low to warrant analysis. CONCLUSION FIRST(2) ACT was associated with measurable improvements in nursing practice.

Mapping patient flow in a regional Australian emergency department: A model driven approach

Unified Modelling Language (UML) models of the patient journey in a regional Australian emergency department (ED) were used to develop an accurate, complete representation of ED processes and drive the collection of comprehensive quantitative and qualitative service delivery and patient treatment data as an evidence base for hospital service planning. The focus was to identify bottle-necks that contribute to over-crowding. Data was collected entirely independently of the routine hospital data collection system. The greatest source of delay in patient flow was the waiting time from a bed request to exit from the ED for hospital admission. It represented 61% of the time that these patients occupied ED cubicles. The physical layout of the triage area was identified as counterproductive to efficient triaging, and the results of investigations were often observed to be available for some time before clinical staff became aware. The use of independent primary data to construct UML models of the patient journey was effective in identifying sources of delay in patient flow, and aspects of ED activity that could be improved. The findings contributed to recent department re-design and informed an initiative to develop a business intelligence system for predicting impending occurrence of access block.

Assessing the impact of streaming in a regional emergency department

Objective:  To evaluate the impact of a streaming model, previously validated in metropolitan EDs, on selected performance indicators in a regional ED.

A semirigid bender analysis of ring puckering in cyclopentene

Abstract The large-amplitude ring puckering vibration of cyclopentene has been investigated using the semirigid bender model. The structure of the molecule throughout the puckering motion was defined by assuming the atoms follow minimum potential energy paths, derived from ab initio molecular orbital predictions. The double-minimum potential function, determined by fitting rotational and vibrational spectra, has a barrier to planarity of 230 cm −1 and a ring puckering angle of 25.4°. This method of combining ab initio predictions with the semirigid bender method is suitable for modeling large-amplitude vibrational motion of nonrigid molecules with substantial energy barriers and has the advantage of more accurately locating the potential minima.

A Variational Approach to Splines

This is an expository paper in which we present an introduction to a variational approach to spline interpolation. We present a sequence of theorems which starts with Holladays classical result concerning natural cubic splines and culminates in some general abstract results.

A semirigid bender analysis of rinh-puckering in cyclobutane

Abstract The semirigid bender method has been used to fit vibrational frequencies associated with the ring-puckering mode of cyclobutane and cyclobutane-d 8 . Molecular orbital predictions were used exclusively to predict the puckering vibration path. The ability to accurately estimate a known potential function and structural and inertial parameters, determined experimentally from a combination of vibrational spectra, electron diffraction measurements, and rotational spectra (of cyclobutane-d 1 ), demonstrates the success of the method. The commonly used series expressions for the vibrational path in the semirigid bender method are shown to adequately represent the molecular orbital predictions of the path followed by atoms during the large-amplitude puckering motion.

Correlation of MAPT scores with clinical and radiographic assessment of patients awaiting THR/TKR.

Background:  The Multi‐attribute Arthritis Prioritisation Tool (MAPT) score is used as a tool to prioritize referrals to specialist clinics and care given to patients with hip and knee problems. Our pilot study aimed to determine the extent of any relationship between the MAPT scores and the clinicians assessment of severity of disease in terms of surgical waiting list (SWL) categories and radiological assessment.

Demonstrating the Durbin–Watson Statistic

The paper describes one way to demonstrate the Durbin-Watson statistic to a large class of students.