A clinical audit of neurosurgical bed usage.

AIM: To investigate inefficiencies during patients' stay in neurosurgical beds. METHODS: A prospective audit of neurosurgical inpatients was conducted over approximately 2 months. We recorded the causes and duration of inappropriate delays, defined as actions requiring more that 24 h from initiation until completion. RESULTS: One-hundred-and-thirty-eight patients were studied (61 elective and 77 emergency admissions). The audited patients were in hospital for a total of 1665 days. Of these, 482 days (29%) were due to delays. 92.5% of these wasted days involved emergency admissions. The main categories of delay were transfer back to referring hospital (46% of all delays), operative (26%) and radiological (19%). Our own hospital was responsible for the longest transfer delays (6.3 days/patient compared with an average of 2.8 for all hospitals). Operative waits arose because of problems with both the timing and capacity of lists. Radiological delays resulted in particular from waits for MRI scans and neuroradiologist-performed procedures. The effect of eliminating all these inappropriate delays would be equivalent to liberating 10.7 of our 37 neurosurgical beds at any one time. CONCLUSIONS: Clinician-led analysis of organizational aspects of patient care has revealed serious structure, process and capacity problems in efficient bed usage, We have made proposals to address the cause of the inappropriate delays.

Writing and publishing case reports: the road to success.

Case reports, by virtue of their simplicity, are ideal for the novice writer. The temptation is to write up anything that is remotely interesting in the hope that you get your name in print. One soon discovers that this is a self-defeating exercise when rejections of a mediocre manuscript come a plenty. Choosing an appropriate case is the difficult first step and getting started remains a challenge for the uninitiated. This article outlines our systematic approach for busy junior doctors to write high-quality and meaningful case reports with relative ease.

Unifocal amyloidosis: a rare cause of spinal cord compression.

A 75-year-old man presented with a 3-month history of progressive paraparesis due to an extradural mass causing cord compression at the T7 level of the thoracic spine. He underwent decompressive surgery, and later vertebrectomy and cage fixation. Histologically, the lesion was a localized mass of amyloid associated with a clonal plasma cell infiltrate. Localized 'amyloidomas' of the spine are rare, evolve slowly and often have a good prognosis following surgery.