Identifying avoidable switchboard delays in England's NHS hospitals: phase one of the national SWITCH project.

BACKGROUND: Inter-hospital communication frequently requires mediation via a switchboard. Identifying and eliminating switchboard inefficiencies may improve patient care. METHODS: All 175 acute hospital switchboards in England were contacted six times. Call contents and duration were recorded. No clinician calls or bleeps were connected. RESULTS: The mean delay before contacting a switchboard operative was 55±46 seconds. 115 hospitals (66%) used automated switchboards; 34 of these (30%) had infection control messages. Robot operators introduced an additional 40 second delay versus humans (mean 70.3±28 versus 29.8±23 seconds, p<0.0001). Multivariate analysis identified robot operators (HR 5.1, p<0.0001) and infection control messages (HR 2.9, p=0.003) as predictors of delays over 60 seconds. CONCLUSIONS: There are significant avoidable delays in contacting switchboard operatives across England. Quality improvement is underway.

Radiative or neutron transport modeling using a lattice Boltzmann equation framework.

In this paper, the lattice Boltzmann equation (LBE)-based framework is used to obtain the solution for the linear radiative or neutron transport equation. The LBE framework is devised for the integrodifferential forms of these equations which arise due to the inclusion of the scattering terms. The interparticle collisions are neglected, hence omitting the nonlinear collision term. Furthermore, typical representative examples for one-dimensional or two-dimensional geometries and inclusion or exclusion of the scattering term (isotropic and anisotropic) in the Boltzmann transport equation are illustrated to prove the validity of the method. It has been shown that the solution from the LBE methodology is equivalent to the well-known P(n) and S(n) methods. This suggests that the LBE can potentially provide a more convenient and easy approach to solve the physical problems of neutron and radiation transport.

MECKEL'S DIVERTICULUM - REVISITED.

Twenty five cases of Meckel's diverticulum were studied between 1985-1995. Eight of these were symptomatic and in the remaining 17 it was an incidental finding. The symptomatic patients presented with intestinal obstruction (5 cases), perforated peritonitis (2 cases) and intussusception (1 case). All cases of acute appendicitis were also subjected to a search for Meckel's diverticulum. Of the 25 Meckel's diverticuli encountered, 22 were resected and in 3 patients it was left in situ. Both the patients with perforated Meckel's diverticulum showed ectopic gastric mucosa. Complications occurred only after surgery for symptomatic Meckel's diverticulum. All patients undergoing incidental diverticulectomy had a smooth and uncomplicated recovery.

ROLE OF RADIOLOGY IN THE DIAGNOSIS AND MANAGEMENT OF HYDATID DISEASE OF THE LIVER.

Twelve patients with hepatic hydatid cysts were studied for radiological features. All had undergone plain radiography abdomen (AP view) and ultrasound study. Six patients had undergone computerised tomography (CT). On plain radiography, curvilinear calcification was the only important positive finding (3 cases). Ultrasonographic findings were - single thick walled cyst (2 cases), multiple cysts (3 cases), multilocular cysts (3 cases), internal septum/floating membrane (2 cases), hydatid sand (1 case), and ill-defined cyst (1 case). CT findings of 6 patients were : single cyst (2 cases), multiple cyst (1 case), multilocular cysts (1 case), and ill-defined cysts (2 cases).