Acute Hospital Beds Research Articles

The blocked bed: Definition of a problem

The ‘blocked bed’ is a term familiar to doctors and hospital administrators, but has no conventional definition. Estimates of the prevalence of bed blockage vary and are largely subjective. A survey of Area and Regional Health Authorities in the U.K. was used to collect information on the nature and extent of bed blockage. The definitions offered focus on the match between patient characteristics and services provided, and refer in the main to elderly patients in acute hospital beds. It is argued that the emergence of blockage as a problem is related to a dominant model of acute care in hospitals, which does not accurately reflect the situation of elderly patients of their needs for treatment.

A model to assist planning the provision of hospital services.

One of the most important health service issues concerns the level of provision of acute hospital beds. To assist resolution of this issue a model is proposed which simulates how hospital beds are used in terms of admission rates and lengths of stay for different categories of disease. The model can be used to predict the likely effects of changes in the provision of beds. Thus if it is proposed to increase the supply of beds, the model will estimate, by disease type, how much of an increase this will cause in admission rates and lengths of stay. The ability of the model to make reasonably accurate predictions is demonstrated by testing it with hospital data from Quebec Province, Canada. Some ways of improving the model's predictive power are discussed and possible future applications to hospital policy issues are outlined.

Infections in Long-Term Care Facilities

Letters and Corrections1 May 1979Infections in Long-Term Care FacilitiesFREDRICK T. SHERMAN, M.D., LESLIE S. LIBOW, M.D.FREDRICK T. SHERMAN, M.D.Search for more papers by this author, LESLIE S. LIBOW, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-90-5-855_3 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: We have just completed our report on infection surveillance in a skilled nursing facility (1) and were struck by the absence of such a focus in the National Institute of Allergy and Infectious Disease's recent symposium, "The Impact of Infection on Medical Care in the United States: Problems and Priorities for Future Research" (2).The symposium addressed itself mainly to bacterial infections acquired in the community as well as in the one million acute hospital beds in this country. None of the authors who discussed problems needing clinical investigation referred to infection surveillance or control among approximately...

Contribution of general practitioner hospitals in England and Wales.

A survey of a one-in-seven sample of general practitioner hospitals in England and Wales, performed to determine the contribution they make to overall hospital work load and the attitudes of the general practitioners working in them, showed that 3% of acute hospital beds in England and Wales were in general practitioner hospitals, which provided initial hospital care for up to 20% of the population. Altogether 16% of general practitioners and 22% of consultants were on the staffs, and they coped with more than 13% of all casualties, 6% of operations, and 4% of x-ray examinations. Nearly a million casualties were treated at no cost to the National Health Service. Twenty new district general hospitals would be needed to cope with the work load currently dealt with by general practitioner hospitals. The results of this survey indicate that these smaller hospitals deal efficiently and cheaply with their work load, and that morale is high. General practitioner hospitals could have an important part to play in providing certain types of care, but there are no financial incentives to enable general practitioners to realise this potential fully.

Blocked beds.

In a cross-sectional survey of 325 surgical and orthopaedic beds 43 (16%) of the 265 occupied beds were filled by patients who had no medical need to be in an acute ward. They had been in hospital for a median time of 40 weeks up to the survey date. Of the 43 patients, 11 were awaiting transfer to a geriatric ward; 13 to community residential care; and seven to their homes. There was no plan for discharge or transfer for the remaining 12 (28%). Those "at risk" of becoming long-stay patients for social reasons on these wards were women, over 75, living alone or with one relative, who had been admitted to hospital in emergency with a fractured femur, head injury, or other trauma. Action necessary to reduce the number of social long-stay patients includes (a) changing attitudes to the solving of social case problems; (b) revising procedures of assessment and planning of future care; (c) improving teamwork and record keeping within the hospital and the community services; (d) providing a better balance of acute, medium and long-stay hospital beds; and (e) putting more resources into rehabilitation.

Planning for a Pediatric Disaster — Experience Gained from Caring for 1600 Vietnamese Orphans

The sudden arrival of 1600 Vietnamese orphans in San Francisco required the rapid development of a co-ordinated disaster plan, including the overnight establishment of a 1000-bed pediatric field hospital. The plan required rapid identification and involvement of lay and governmental resources, acute medical triage and provision of ongoing medical care and basic nurturing services and eventual discharge to adoptive families. Because one third of the orphans were under six months of age, conventional nursery resources were insufficient, and a "warehouse" model was implemented. This process required development of a specialized transportation and communication system, the services of 800 physicians, 1400 nurses, and 3200 volunteers and 162 back-up acute hospital beds. Disaster planning in most sizable American cities has focused on the problems of adults. Because of the unusual problem presented by infants and small children, we recommend that cities carefully evaluate their disaster planning with special reference to the needs of children.

Certification of need laws.

Certification of Need (CON) laws aim to establish the optimal mixture of health facilities and services in a community. In most areas, the initial step has been to limit construction of facilities for acute hospital beds, thus exerting pressure on the profession to use ambulatory facilities more widely than before. The rationale is a demonstrated limitation in resources available, even in an affluent society, for health care. Most of the 20 states that have enacted CON laws require that all projects involving more than $100,000 capital expenditure be approved by a designated state agency. The Social Security Amendments of 1972 support states that enact CON laws by excluding nonconforming institutions from reimbursement for capital expenditures through federally funded programs. It is predicted that many more states will seek the economies in health care that the laws strive to promote.

Resources and Systems

As the health services in developed countries continue to expand, their demands increase on skilled and expensively trained manpower. Already they employ approximately six per cent of the total manpower in some countries, ranking as the second or third largest employers. As a matter of fact, at the present rate of growth the health industry could be the biggest employer of labor well before the end of the century. On the one hand, the consumer wishes to have the latest and the best, in the way of treatment and specialties, of the technologic revolution in medicine. On the other, there has been little measurable payoff during the past three decades in terms of reduced death rates in any age group and little evidence of benefit in reduced disability; indeed, often the very advances in biomedical science simply mean that more people survive into old age, frequently on maintenance therapy and at further risk of an even more critical episode. Thus, most developed countries now proclaim a shortage of skilled manpower, some admit to having to ration resources, a few are considering a ceiling on training specialist physicians, and at least the United Kingdom is reducing the supply of acute hospital beds by one-third. In the Liverpool area, the present and related studies have contributed to such a radical redeployment of resources. This paper presents a preliminary budget of investment in the twelve study areas of the World Health Organization/International Collaborative Study of Medical Care Utilization. It gives

Concepts and Methodology in Planning Patient Care Services

MONROE COUNTY, New York, has had a better-than-ten-year history of studying methods of determining the community's need for services if the right patient were to be put in the right bed. The questions to which planners sought answers were specific and carried time limits. But each question-What is the need for more acute hospital beds? What is it for chronic beds? What is the potential scope of home care services?-was studied from the point of view that existing services and beds could not be projected to future needs without first correcting for patient misplacement. This made it necessary to study a wide range of patient services-or more accurately, to study patients in a wide range of services to see how their care needs compared with the services they were receiving. The traditional method of projecting

Bed Utilization Studies for Community Planning

Bed utilization studies were used for planning the number of acute care hospital beds needed in Rochester, NY. Local physician observers estimated that 14.3% of patients hospitalized on a given day could receive appropriate care in less costly facilities, while out-of-town physicians would have placed 18.8% of the patients elsewhere. With such a review of randomly selected patients, a direct estimate of the kinds of facilities needed could be made. The decision in Rochester was to build fewer additional acute care beds and more extended care beds.