The factors affecting graft patency are first introduced and a miniature model of a by-pass graft junction is described. The flow conditions in the model were established by appropriate modelling criteria and the flow was visualized under both steady and pulsating conditions by using as the working fluid anticoagulated plasma plus a few red cells. Qualitative results are described. By neutralizing the anticoagulant some insight into the clotting process was obtained. Experimental work on a large scale, two-dimensional models, together with relevant theoretical predictions, aimed at evaluating the distribution of wall shear stress around a junction are also described.
Aims
The transfer of responsibility for patient care across the Emergency Department (ED)/ inpatient interface has always been recognised as a challenging process. Current research focuses on qualitative data and is based occasionally on anecdotal information. The aim of this study was to identify barriers to efficient patient flow with a specific focus on type and quality of referrals and logistics involved.
Methods
Quantitative retrospective data was collected on referrals received by the surgical team from ED (n = 83). The outcome of the referral was recorded. Quality of referrals was assessed on clinical information, examination and investigations performed as well as working diagnoses. Further data was collected on location and time to review referred patients.
Results
Outcome of referral: 14.5% were discharged directly from ED, 16.9% were admitted for <24 hours, 4.8% were referred to another speciality within 24 hours and 63.9% were admitted for > 24 hours. Quality of referral: 18.1% patients were referred without working diagnosis. 31% of patients presenting with upper abdominal pain did not have amylase checked prior to referral and 20% of patients with suspected PR bleeding lacked a PR examination. Logistics: 57% of patients were seen in ED. 15.7% were reviewed within 1 hour (median: 133mins).
Conclusions
Referrals often failed to meet the needs/criteria of the speciality team. Combining the above with high volume of referrals and logistical challenges of working across multiple areas leads to potential delays in timely patients’ review. Intense workloads create stressful environments which eventually breed interpersonal discord.
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