Lower health literacy levels are independently associated with longer index hospitalization lengths of stay for patients who are undergoing major abdominal surgery. The role of health literacy needs to be further evaluated within surgical practices to improve health care outcomes and use.

Summary A wireless sensor network (WSN) is a prominent technology that could assist in the fourth industrial revolution. Sensor nodes present in the WSNs are functioned by a battery. It is impossible to recharge or replace the battery, hence energy is the most important resource of WSNs. Many techniques have been devised and used over the years to conserve this scarce resource of WSNs. Clustering has turned out to be one of the most efficient methods for this purpose. This paper intends to propose an efficient technique for election of cluster heads in WSNs to increase the network lifespan. For the achievement of this task, grey wolf optimizer (GWO) has been employed. In this paper, the general GWO has been modified to cater to the specific purpose of cluster head selection in WSNs. The objective function for the proposed formulation considers average intra‐cluster distance, sink distance, residual energy, and CH balancing factor. The simulations are carried out in diverse conditions. On comparison of the proposed protocol, ie, GWO‐C protocol with some well‐known clustering protocols, the obtained results prove that the proposed protocol outperforms with respect to the consumption of the energy, throughput, and the lifespan of the network. The proposed protocol forms energy‐efficient and scalable clusters.

The developing elective schedule predicts final case volume weeks in advance. After implementation, overly high- or low-volume days are revealed in advance, allowing nursing, ancillary service, and anesthesia managers to proactively fine-tune staffing up or down to match demand.

BackgroundA major restructuring of perioperative care delivery is required to reduce cost while improving patient outcomes. In a test implementation of this notion, we developed and implemented a perioperative consult service (PCS) for colorectal surgery patients.MethodsA 6-month planning process was undertaken to engage key stakeholders from surgery, nursing, and anesthesia in a healthcare redesign project that resulted in the creation of a PCS to implement a coordinated clinical pathway. After Institutional Review Board (IRB) approval, data were collected for all elective colorectal procedures for three phases: phase 0 (pre-implementation; 1/2014–6/2014), phase 1 (7/2014–10/2014), and phase 2 (11/2014–10/2015). Length of stay (primary endpoint; LOS), total hospital cost, use of clinical pathway components, markers of functional recovery, and readmission and reoperation rates were analyzed. Outcomes and patient characteristics among phases were compared by two-tailed t tests and Wilcoxon rank-sum tests. Categorical variables were analyzed by chi-square and Fisher’s exact tests.ResultsWe studied 544 patients (phase 0 = 179; phase 1 = 124; phase 2 = 241), with 365 consecutive patients being cared for in the redesigned care structure. Median LOS was reduced and sustained after implementation (phase 0, 4.24 days; phase 1, 3.32 days; phase 2, 3.32 days, P < 0.01 phase 0 v. phases 1 and 2), and mean LOS was reduced in phase 2 (phase 0, 5.26 days; phase 1, 4.93 days; phase 2, 4.36 days, P < 0.01 phase 0 v. phase 2). Total hospital cost was reduced by 17 % (P = 0.05, median). Application of clinical pathway components was higher in phases 1 and 2 compared to phase 0 (P < 0.01 for all components except anti-emetics); measures of functional recovery improved with successive phases. Reoperation and 30-day readmission rates were no different in phase 1 or phase 2 compared to phase 0 (P > 0.15).ConclusionsRestructuring of perioperative care delivery through the launch of a PCS-reduced LOS and total cost in a significant and sustainable fashion for colorectal surgery patients. Based on the success of this care redesign project, hospital administration is funding expansion to additional services.Electronic supplementary materialThe online version of this article (doi:10.1186/s13741-016-0028-1) contains supplementary material, which is available to authorized users.

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