BACKGROUND:Patients backlogged in the emergency department(ED) waiting for an inpatient bed(boarders) continue to require the attention of ED physicians,exacerbating crowding in the ED.To address this problem,we added...BACKGROUND:Patients backlogged in the emergency department(ED) waiting for an inpatient bed(boarders) continue to require the attention of ED physicians,exacerbating crowding in the ED.To address this problem,we added a "float shift" to our winter schedule solely to care for boarders.We sought to quantify the effect of this float shift,hypothesizing greater physician productivity.METHODS:We performed a retrospective observational study in our community hospital ED,measuring the number of new patients seen in each 10-hour shift in the presence or absence of a float shift physician.We calculated the number of new patients seen per shift for each of the 7 daily shifts,during February(float shift scheduled) and May(float shift unscheduled) of 2008.We then compared the mean number of patients seen per shift in February with May.RESULTS:Total monthly patient volume was 6 656 for February and 6 775 for May,with the mean daily census being 230 and 219 patients,respectively.The number of new patients seen during each shift was greater in February than in May,with a mean increase of 1.1 patients per shift(with the float shift).Surveying participants about intervention effectiveness showed 92%of residents,but only 65%of attending physicians,in favor of maintaining the float shift.CONCLUSION:The presence of a "float shift" physician caring only for boarding patients allows other physicians to maintain and even increase their productivity in our ED,despite the presence of longer throughput times and increased time on diversion.展开更多
Numerous studies on eutrophication remediation have mainly focused on purifying water first, then restoring submerged macrophytes. A restoration-promoting integrated floating bed （RPIFB） was designed to combine the ...Numerous studies on eutrophication remediation have mainly focused on purifying water first, then restoring submerged macrophytes. A restoration-promoting integrated floating bed （RPIFB） was designed to combine the processes of water purification and macrophyte restoration simultaneously. Two outdoor experiments were conducted to evaluate the ecological functions of the RP1FB. Trial 1 was conducted to compare the eutrophication purification among floating bed, gradual-submerging bed （GSB） and RPIFB technologies. The results illustrated that RPIFB has the best purification capacity. Removal efficiencies of RPIFB for TN, TP,NH4＋-N, NO3-N, CODcr, Chlorophyll-a and turbidity were 74.45%, 98.31%, 74.71%, 88.81%, 71.42%, 90.17% and 85%, respectively. In trial 2, influences of depth of GSB and photic area in RPIFB on biota were investigated. When the depth of GSB decreased and the photic area of RPIFB grew, the height of Potamogeton crispus Linn. increased, but the biomass of Canna indica Linn. was reduced. The mortalities of Misgurnus anguillicaudatus and Bellamya aeruginosa in each group were all less than 7%. All results indicated that when the RPIFB was embedded into the eutrophic water, the regime shift from phytoplankton-dominated to macrophyte-dominated state could be promoted. Thus, the RPIFB is a promising remediation technology for eutrophication and submerged macrophyte restoration.展开更多
文摘BACKGROUND:Patients backlogged in the emergency department(ED) waiting for an inpatient bed(boarders) continue to require the attention of ED physicians,exacerbating crowding in the ED.To address this problem,we added a "float shift" to our winter schedule solely to care for boarders.We sought to quantify the effect of this float shift,hypothesizing greater physician productivity.METHODS:We performed a retrospective observational study in our community hospital ED,measuring the number of new patients seen in each 10-hour shift in the presence or absence of a float shift physician.We calculated the number of new patients seen per shift for each of the 7 daily shifts,during February(float shift scheduled) and May(float shift unscheduled) of 2008.We then compared the mean number of patients seen per shift in February with May.RESULTS:Total monthly patient volume was 6 656 for February and 6 775 for May,with the mean daily census being 230 and 219 patients,respectively.The number of new patients seen during each shift was greater in February than in May,with a mean increase of 1.1 patients per shift(with the float shift).Surveying participants about intervention effectiveness showed 92%of residents,but only 65%of attending physicians,in favor of maintaining the float shift.CONCLUSION:The presence of a "float shift" physician caring only for boarding patients allows other physicians to maintain and even increase their productivity in our ED,despite the presence of longer throughput times and increased time on diversion.
基金supported by the National Natural Science Foundation of China(No.41271332the Natural Science Foundation of Hunan Province,China(No.11JJ2031)
文摘Numerous studies on eutrophication remediation have mainly focused on purifying water first, then restoring submerged macrophytes. A restoration-promoting integrated floating bed （RPIFB） was designed to combine the processes of water purification and macrophyte restoration simultaneously. Two outdoor experiments were conducted to evaluate the ecological functions of the RP1FB. Trial 1 was conducted to compare the eutrophication purification among floating bed, gradual-submerging bed （GSB） and RPIFB technologies. The results illustrated that RPIFB has the best purification capacity. Removal efficiencies of RPIFB for TN, TP,NH4＋-N, NO3-N, CODcr, Chlorophyll-a and turbidity were 74.45%, 98.31%, 74.71%, 88.81%, 71.42%, 90.17% and 85%, respectively. In trial 2, influences of depth of GSB and photic area in RPIFB on biota were investigated. When the depth of GSB decreased and the photic area of RPIFB grew, the height of Potamogeton crispus Linn. increased, but the biomass of Canna indica Linn. was reduced. The mortalities of Misgurnus anguillicaudatus and Bellamya aeruginosa in each group were all less than 7%. All results indicated that when the RPIFB was embedded into the eutrophic water, the regime shift from phytoplankton-dominated to macrophyte-dominated state could be promoted. Thus, the RPIFB is a promising remediation technology for eutrophication and submerged macrophyte restoration.
