The ever increasing pressures to ensure the most efficient and effective use of limited health service resources will, over time, encourage policy makers turn system modelling solutions. Such techniques have been available for decades, but despite ample research which demonstrates potential, their application in services date is limited. This article surveys breadth approaches support delivery design across many areas levels healthcare planning. A case study emergency stroke care presented...

The efficient deployment of resources in home-based care is considered crucial for the sustainability health and social systems worldwide. aim this study was to identify review operational research approaches support decision-making home care. We identified a set linked decisions at different planning levels (strategic, tactical, operational) conducted systematic used address these decisions. also sampled OR literature applied analogous other settings. 77 papers selected focused...

Machine learning for hospital operations is under-studied. We present a prediction pipeline that uses live electronic health-records patients in UK teaching hospital's emergency department (ED) to generate short-term, probabilistic forecasts of admissions. A set XGBoost classifiers applied 109,465 ED visits yielded AUROCs from 0.82 0.90 depending on elapsed visit-time at the point prediction. Patient-level probabilities admission were aggregated forecast number admissions among current and,...

Field-induced magnetization jumps with similar characteristics are observed at low temperature for the intermetallic germanide Gd5Ge4and mixed-valent manganite Pr0.6Ca0.4Mn0.96Ga0.04O3. We report that field location -and even existence- of these depends critically on magnetic sweep rate used to record data. It is proposed that, both compounds, martensitic character their antiferromagnetic-to-ferromagnetic transitions origin steps.

The fifth Millennium Development Goal target for 90% of births in low and middle income countries to have a skilled birth attendant (SBA) by 2015 will not be met. In response this, policy has focused on increasing SBA access. However, reducing maternal mortality also requires policies prevent deaths among women giving unattended. We aimed generate estimates the absolute number non-SBA between 2011 South Asia sub-Saharan Africa, given optimistic assumptions future trends attendance. These...

To explore changes over time in the 30-day mortality rate for paediatric cardiac surgery and to understand role of attendant case mix.Included were: all mandatory submissions National Institute Cardiovascular Outcomes Research (NICOR) relating UK patients aged <16 years. The χ(2) test trend was used retrospectively analyse proportion surgical episodes ending with various mix indicators, 10 consecutive periods, from 2000 2010. Comparisons were made between two 5-year eras of: mortality,...

Introduction Ethnic differences in the birth prevalence of congenital heart defects (CHDs) have been reported; however, studies contemporary UK population are lacking. We investigated ethnic variations incidence serious CHDs requiring cardiac intervention before 1 year age. Methods All infants who had a England and Wales between January 2005 31 December 2010 were identified national disease surgical audit matched with paediatric intensive care admission records to create linked individual...

Tackling childhood malnutrition is a global health priority. A key indicator the estimated prevalence of malnutrition, measured by nutrition surveys. Most aspects survey design are standardised, but data 'cleaning criteria' not. These aim to exclude extreme values which may represent measurement or data-entry errors. The effect different cleaning criteria on estimates was unknown. We applied five commonly used (WHO 2006; EPI-Info; WHO 1995 fixed; flexible; SMART) 21 national Demographic and...

Background Improvements in hospital‐based care have reduced early mortality congenital heart disease. Later adverse outcomes may be reducible by focusing on at or after discharge. We aimed to identify risk factors for such events within 1 year of discharge intervention infancy and, separately, subgroups that might benefit from different forms intervention. Methods and Results Cardiac procedures performed infants between 2005 2010 England Wales the UK National Congenital Heart Disease Audit...

To implement routine in-house monitoring of risk-adjusted 30-day mortality following paediatric cardiac surgery.Collaborative software development and implementation in three specialist centres.Analyses incorporated 2 years data routinely audited by the National Institute Cardiac Outcomes Research (NICOR). Exclusion criteria were patients over 16 or undergoing non-cardiac only catheter procedures. We applied partial risk adjustment surgery (PRAiS) model for death within 30 days generated...

Congenital heart disease (CHD) is the most common class of birth defects, which encompasses a broad spectrum severity ranging from relatively minor to extremely complex. Improvements in surgery and intensive care have resulted an increasing number infants with complex lesions surviving after until time discharge hospital, but there remain concerns about out-of-hospital mortality, variability how services are provided at beyond, difficulties experienced by some families accessing care.As part...

Abstract Increasing numbers of operations in small infants with complex congenital heart disease are being carried out the UK year on year, more surviving initial operation. However, even after successful surgery some these remain fragile when they discharged home. The aim study was to elicit parents' experiences caring for a child needs major surgery. We conducted qualitative involving semi‐structured interviews parents 20 children (aged &lt;1–5 months at hospital discharge), who had...

Box 1. Elements to consider when improving health-care quality in resource-poor settings

Partial Risk Adjustment in Surgery (PRAiS), a risk model for 30-day mortality after children's heart surgery, has been used by the UK National Congenital Heart Disease Audit to report expected risk-adjusted survival since 2013. This study aimed improve incorporating additional comorbidity and diagnostic information.The development dataset was all procedures performed between 2009 2014 Ireland congenital cardiac centers. The outcome measure death within each surgical episode. Model followed...

Objective To qualitatively assess the discharge processes and postdischarge care in community for infants discharged after congenital heart interventions first year of life. Design Qualitative study using semistructured interviews Framework Analysis. Setting UK specialist cardiac centres services their patients are to. Subjects Twenty-five cardiologists nurses from tertiary centres, 11 primary secondary health professionals 20 parents children who had either died or needed emergency...

Infants with congenital heart disease (CHD) are clinically vulnerable to cardiac deteriorations and intercurrent infections. We aimed quantify the impact of health system disruptions during COVID-19 pandemic, on their clinical outcomes whether these differed by socioeconomic ethnic subgroups. In this population-based cohort study, we used linked electronic healthcare datasets from England Wales identify infants nine sentinel CHDs born undergoing intervention in 2018-2022. The timing, infant...

Improvement science has emerged as an interdisciplinary field of enquiry to provide methodological and scientific rigour the practice study improvements in healthcare, with contributions from a wide range stakeholders perspectives. However, compared more well-established health-related sciences, improvement remains relative infancy. Whilst community grown considerably, there is no existing articulation scope what matters health social care community, how this aligns enquiries science. This...

We aimed to ascertain rates of completion essential cardiac procedures and their overall contribution longer-term mortality in children with congenital heart disease (CHD). Cohort study using the United Kingdom National CHD Audit. For 9 sentinel CHDs (hypoplastic left syndrome (HLHS), non-HLHS functionally univentricular heart, ventricular septal defect, tetralogy Fallot, coarctation, aortic stenosis, atrioventricular transposition great arteries pulmonary atresia) we described pathway...

Aims To describe the ways in which parents recognise and make decisions about their child's symptoms following discharge home after congenital heart interventions first year of life experiences seeking help. Methods This was a qualitative study involving semistructured interviews with parents. Twenty-one were recruited to study. Parents all had child who surgery between September 2009 October 2013 at one three UK cardiac centres; children either died or readmitted as an emergency initial...

Overcrowding affects hospital emergency departments (ED) worldwide. Most OR studies addressing overcrowding develop bespoke models to explore potential improvements but ignore the organisational context in which they would be implemented, and few influence practice. There is interest whether reusable models, for ED crowding healthcare generally, could have more impact. We developed a configurable approach tackling overcrowding. A queuing model exploring drivers of performance was augmented...

Provision of essential newborn care (ENC) can save many lives in poor resource settings but coverage is far from universal and varies by country place delivery. Understanding gaps current where good, different contexts places delivery, could make a valuable contribution to the future design interventions reduce neonatal mortality. We sought describe practices for births institutions, at home with skilled birth attendant, without attendant (SBA) rural areas Bangladesh, Nepal, India. used data...