There are a number of frequent barriers to discharge encountered in our hospital that may be avoidable with planning, effective communication methods, more timely preparation and tools to standardise the discharge process.

In stark contrast to a few decades ago when lung cancer was predominantly a disease of men who smoke, incidence rates of lung cancer in women are now comparable to or higher than those in men and are rising alarmingly in many parts of the world. Women face a unique set of risk factors for lung cancer compared to men. These include exogenous exposures including radon, prior radiation, and fumes from indoor cooking materials such as coal, in addition to endogenous exposures such as oestrogen and distinct genetic polymorphisms. Current screening guidelines only address tobacco use and likely underrepresent lung cancer risk in women. Women were also not well represented in some of the landmark prospective studies that led to the development of current screening guidelines. Women diagnosed with lung cancer have a clear mortality benefit compared to men even when other clinical and demographic characteristics are accounted for. However, there may be sex-based differences in outcomes and side effects of systemic therapy, particularly with chemotherapy and immunotherapy. Ongoing research is needed to better investigate these differences to address the rapidly changing demographics of lung cancer worldwide.

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BACKGROUND:High hospital occupancy is a challenge for quality of care and access, while low levels of occupancy may be inefficient in terms of resource utilization. Variability from scheduling decisions may affect occupancy and be amenable to alteration.OBJECTIVE:Describe variability in admission, discharge, and occupancy patterns at a large children's hospital and assess the relationship between scheduled admissions and occupancy.DESIGN:Retrospective administrative data analysis.SETTING:One urban, tertiary‐care children's hospital.PATIENTS:A total of 22,310 consecutive patients admitted from July 1, 2007 to June 30, 2008.MEASUREMENTS:Admission‐discharge‐transfer (ADT) data for 1 fiscal year were abstracted for analysis of admission and occupancy patterns.RESULTS:Among 22,310 admissions, 78% were coded as emergent and 22% as scheduled. Variation in admission volume by day of week was high for scheduled admissions (coefficient of variation [CV] 65.3%), while it was more consistent for emergent admissions (CV 12.0%). For patients with length of stay (LOS) ≤7 days (84%), Mondays and Tuesdays generated 45.2% of scheduled patient hours. Wednesdays and Thursdays had the highest frequency of high occupancy.CONCLUSIONS:Scheduled admissions contribute significantly to variability in occupancy and risk of mid‐week crowding. Predictable patterns of admissions lead to high occupancy on some days and unused capacity on others, which can be addressed with proactive management of admissions (eg, greater use of unused capacity on weekends and in summer). Hospitals interested in optimizing patient flow should assess their admission and occupancy patterns. Further studies should link variation in occupancy to outcomes including quality of care, educational activities, and staff satisfaction. Journal of Hospital Medicine 2010;. © 2010 Society of Hospital Medicine.