Lower Bed Occupancy Research Articles

Is the Workload Indicators of Staffing Needs (WISN) method rigorous enough to tell us how many nurses we need in a general hospital?

ABSTRACT This study aimed to evaluate the practical use of the Workload Indicators of Staffing Needs (WISN) method in a general hospital in Iran. This method was used to determine the staffing needs of nurses in various hospital units, and the study examined the gap between the theoretical calculations and the actual use of the data in the hospital. Data was collected through a mixed-method approach including observations, interviews, and document analysis. The results showed that the WISN method indicated a surplus of nursing staff and no work pressure on nurses. However, the method did not account for the complexity of nurses managing multiple tasks simultaneously, and the low bed occupancy and low hospital revenue raised concerns about the excess of nurses obtained by the WISN method. The study suggests that decision-making on staff arrangements should not be solely based on WISN's numbers, and modalities of nursing care should also be considered. While the WISN method is important in determining nurse workload, it must be used with other factors to ensure the standard of patient care is not compromised. This study contributes to the understanding of the practical use of the WISN method in the context of Iran's healthcare system.

Implementing A Mixed-Gender Ward Policy to Curtail Admission Cancelations and Enhance Occupancy Rates

This paper analyzes the implementation of mixed-gender inpatient wards at Security Forces Hospital in Riyadh, KSA, between 2018 and 2023. Historically, hospitals separate wards by gender, leading to operational issues, including appointment cancelations and low bed occupancy rates. This hospital responded by assembling a team to analyze the problem and propose solutions. The key recommendation was to eliminate gender restrictions in wards to allow universal bed access while preserving patient privacy. A descriptive exploratory study design enabled an in-depth analysis of the factors causing admission cancelations and poor bed utilization. Comprehensive hospital data from 2018–2023 permitted an analysis of trends over several years. Implementation of mixed-gender wards eliminated patient cancelations from 1,094 in 2018 to zero and increased midnight bed utilization rates (61% to 79%), indicating enhanced operational efficiency. Crucial factors contributing to success included obtaining executive management support to drive organizational change, actively engaging patients to address cultural sensitivities, specialized training to equip staff for the new model of care, strategic input from nursing administration regarding workflows and staffing, and adapting security practices to ensure patient safety. Key lessons for hospital administrators considering similar initiatives include focusing on patient-centric care, optimizing operational efficiency through improved resource allocation, securing buy-in from organizational leadership, demonstrating cultural competence, investing in education and training for healthcare providers, engaging nursing administration strategically, and updating security protocols to match patient flow. In conclusion, this hospital’s experience illustrates how implementing mixed-gender inpatient units with a flexible, patient-focused approach can transform patient care delivery, augment bed utilization, streamline hospital operations, and nurture an inclusive, culturally sensitive healthcare environment. This multifaceted and collaborative strategy provides a model for healthcare facilities pursuing positive system-wide changes.

Challenges in Healthcare Management Models in The Country of Georgia and Proposed Solutions

The article "Problems in Georgia's Health Care Management System and the Proposed Solutions" examines the impact of ongoing health care reforms in Georgia on the overall health status of the population and its influence on changes in such indicators as the country's demography. The article eexplores both the primary health care system and the secondary care and highlights that despite much interventions and funding coming from donor organizations and the state budget, Georgia's health care system is still far from reaching the European Core Health Indicators (ECHI). Specifically: referral rates to a "family doctor" is low; the proportion of "out-of-pocket" payment is still high; there is a substantial shortage of nurses and a surplus of doctors; low hospital bed occupancy rates; funding for primary care on a "residual principle" remains a challenge and more. Concomitantly, all of the above reflected the demographic indicators of the country, and within the last three decades over the period from 1990 to 2021 the birth rates declined, mortality increased, and average life expectancy decreased. Based on the findings, the authors conclude that it is hard to close the existing gaps the country's health care system is facing by means of a single sectoral approach, and propose a strategy for inter-sectoral management model for health care within one cluster. The article examines a model on the example of the Samtskhe-Javakheti region of Georgia. Keywords: health care reforms; management of reforms; "Family Doctor"; Family Medicine; intersectoral management; cluster.

Estimating the Impact of Influenza Vaccination on Acute and ICU Hospital Bed Usage in an Influenza Season under Endemic COVID-19 in the US.

In 2021-2022, influenza vaccine coverage in the US dropped below pre-COVID-19 pandemic levels. Cocirculation of COVID-19 and influenza could place a substantial burden on hospital utilization in future seasons, particularly given the reduced exposure to influenza during the pandemic. We used a dynamic susceptible-exposed-infected-recovered model to simulate influenza transmission with varying influenza vaccine coverage against a background of COVID-19 circulation, in order to estimate acute and ICU hospital bed occupancy for both diseases. We evaluated two vaccine scenarios: egg-based quadrivalent influenza vaccine (QIVe) for all age groups or cell-based QIV (QIVc) for 0.5-64 year-olds with adjuvanted QIV (aQIV) for ≥65 year-olds. ICU bed availability was more limiting than general hospital bed availability, with a vaccine coverage of ≥70% required to avoid negatively impacting ICU bed availability in a high-incidence influenza season. The timing of disease peaks was a key factor together with vaccine coverage, with a difference of ≥50 days needed between peak influenza and COVID-19 bed usage together with 65% influenza vaccine coverage to avoid negative impacts. QIVc + aQIV resulted in lower bed occupancy which, while not substantial, may be critical in very high hospital resource usage situations. In a situation with co-circulating influenza and COVID-19, proactive vaccination planning could help to avert overwhelming healthcare systems in upcoming influenza seasons.

Analysis of the Bed-occupancy, Utilization and Turnover Rate of Acharya Vinoba Bhave Rural Hospital, India

Background: Hospital expenses in healthcare system are the key component of health care. For this reason, investment is the main objective of increased expenditure in healthcare sector, expertise. As a developing country, India has had in order to face many economic and political difficulties. For administrative department as well as policy makers of hospital there is a big question of improper exploitation of hospital assets. This improper utilization is mainly affected by three factors which are patients related, administration related and physician related problems. Social and financial position of patients is responsible for inappropriate utilization of beds and it is considered as patient related factor. This study aims to assess the Bed-Occupancy, Utilization and Turnover Rate, assess problems in utilization and recommend the measures to improve.
 Methodology: This will be a Record based cross sectional retrospective study conducted at Acharya Vinoba Bhave Rural Hospital, Wardha. Data will be gathered from the AVBRH medical record section.
 Results: Indices for Bed occupancy rate, average length of stay, Bed turnover rats will be obtained. Data will be analysed with appropriate statistical tests.
 Conclusion: Causes for underutilization, low bed occupancy and turnover rate will be revealed and necessary improvement measures will be recommended.

To triage or not to triage? The history and evidence for this model of care in psychiatry

SUMMARYTriage wards were introduced as a new model of psychiatric in-patient care in 2004. However, there is limited evidence comparing them with the traditional in-patient models of care. This article reviews the history of triage wards, their principles, the evidence for this model (e.g. length of in-patient stay, readmission rates, staff and patient satisfaction) and the development of assessment wards based on the triage model of care. The evidence shows that the triage model has higher rates of rapid discharge, with a greater proportion of ‘acute care’ performed in the community with the support of home treatment teams. This leads to lower bed occupancy in the triage wards without increased rates of readmission or a worse patient experience of in-patient care. However, overall staff experience was better in the traditional model, given that staff satisfaction rates were lower on locality wards in settings with triage systems in place. Future research should explore the potential impact on home treatment teams, and the rates of serious incidents due to the high number of acutely unwell patients on triage wards.

Clinico-etiological profile of children who had unplanned extubation and subsequent re-intubation in level-4 pediatric intensive care unit

Background: There are few studies on unplanned extubation (UE) in pediatric intensive care units (PICU). This study is to identify factors associated with UE in PICUs. Subjects and Methods: In this observational study, the data of UE from January 1, 2013, to May 31, 2019, in a level-4 PICU were analyzed with an objective to study the etiology of UE and its impact on therapeutic outcomes. Results: Of 7079 patients hospitalized in PICU, 1721 were invasively ventilated (mean ventilator days 4.33 days). UE occurred in 39 patients (2.26% of intubated patients) at 0.52 UE events per 100 ventilation days. The median age was 14 months. The most common cause of UE was inadequate sedation (n = 24, 61.53%), endotracheal tube suctioning (n = 05, 20.8%), one during adjusting ET tube (4.1%), one during central venous line insertion (4.1%), and one during Foley's catheter insertion (4.1%) and 7 unexplained (29.1%). As long as the appropriate nurse: patient ratio was maintained, the incidence of UE was un-affected by day versus night shift or high versus low bed occupancy rates. Re-intubation rate in UE cohort was higher (74.35%) than planned-extubation cohort 0.11% (P < 0.001). All re-intubations were within 2 h of UE. Most common cause of re-intubation following UE was respiratory distress (72.41%), stridor (17.24%), and apnea (10.34%). Re-intubations following UE showed higher incidence of ventilator-associated pneumonia but statistically not significant (P = 0.54). Conclusion: UE is associated with a significantly high incidence of re-intubations and associated complications arising from re-intubations. Maintaining a pool of skilled nurses in adequate nurse-to-patient ratio may play an important role in preventing UE. UE can be minimized by optimizing sedation and monitoring during common ICU procedures. Multicentric studies are warranted to design a uniform standard of care of ventilated patients aimed at reducing the incidence of UE.

Facility assessment of neonatal intensive care units of urban Allahabad

Background: During the last decade there has been a phenomenal growth of neonatal intensive care units in the country, especially in the corporatized health care sector and to a lesser extent in public sector health care facilities. Sick & premature newborn requiring specialized hospital care dies because facilities and skills required for Neonatal Intensive Care Unit (NICU) are usually unavailable. This study was conducted with an objective to assess the facility i.e. Neonatal Intensive Care Units, both public & private sector, in urban Allahabad. Methods: The present study was conducted in the Newborn Intensive Care Units of Government and Private settings of urban Allahabad, Uttar Pradesh during the year 2015-2016. For the conduction of study, the factors were classified as Neonatal Factors and Health facility based i.e. NICU factors, which could influence the survival outcome of the neonates. The assessment of Facility was done on the basis of standards as suggested in the Ministry of Health and Family Welfare guidelines. Results: Both the public & private sectors had the availability of 24 hour newborn services, which included 24 hour availability of pediatricians and nurses, facility for resuscitation, thermal care and breastfeeding support services. The present study reported asepsis score of 9 and 8 in Government and Private sectors respectively. The private sectors had better nurse bed ratio and low bed occupancy i.e. low patient load as compared to the government sector. The services, asepsis practices, equipments & drugs are comparable. Conclusion: The study revealed poor human resources (doctor: bed ratio & nurse: bed ratio) as against the recommended standards for intensive care for neonates. So, the recruitment of human resources is recommended.

Optimistic recovery expectations are associated with critical attitudes toward coercion among mental health professionals

The use of coercion poses a key concern in terms of patients’ rights. To reduce coercive interventions, a change in the attitudes of mental health professionals toward coercion has been proposed. This study examined whether individual and workplace characteristics are associated with attitudes toward coercion. A sample of 110 staff members of a large psychiatric hospital working on open or closed wards completed a survey that included measures of issues such as attitudes toward coercion (Staff Attitude to Coercion Scale [SACS]), recovery orientation (RAQ-7), and individual and workplace characteristics. We also assessed ward characteristics from routine medical data. Associations were determined by correlations and regression analysis. Overall, 73.6% of the professionals were critical of the use of coercion, whereas 5.5% had positive attitudes toward coercive measures. Participants with more optimistic recovery expectations, other than nurses, and those working on open wards held more critical attitudes toward coercion (p < 0.05). Wards characterized by less coercive measures, lower bed occupancy, fewer involuntary admissions and substance-use disorders were associated with more critical attitudes (p < 0.05). We conclude that training of mental health professionals—especially nurses and those who work on closed wards—in recovery orientation may help promote critical attitudes toward coercion and may reduce coercive measures.

Do hospital pressures change following rotavirus vaccine introduction? A retrospective database analysis in a large paediatric hospital in the UK

ObjectiveHospitals in the UK are under increasing clinical and financial pressures. Following introduction of childhood rotavirus vaccination in the UK in 2013, rotavirus gastroenteritis (RVGE) hospitalisations reduced significantly. We evaluated...

The cost of providing and scaling up surgery: a comparison of a district hospital and a referral hospital in Zambia.

The lack of access to quality-assured surgery in rural parts of sub-Saharan Africa, where the numbers of trained health workers are often insufficient, presents challenges for national governments. The case for investing in scaling up surgical systems in low-resource settings is 3-fold: the potential beneficial impact on a large proportion of the global burden of disease; better access for rural populations who have the greatest unmet need; and the economic case. The economic losses from untreated surgical conditions far exceed any expenditure that would be required to scale up surgical care. We identified the resources used in delivering surgery at a rural district-level hospital and an urban based referral hospital in Zambia and calculated their cost through a combination of bottom-up costing and step-down accounting. Surgery performed at the referral hospital is ∼50% more expensive compared with the district hospital, mostly because of the higher cost of hospital stay. The low bed occupancy rates at the two hospitals suggest underutilization of the capacity, and/or missing elements of needed capacity, to conduct surgery. Nevertheless, our study confirms that scaling up district-level surgery makes sense, through bringing economies of scale, while acknowledging the need for more comprehensive assessments and costing of capacity constraints. We quantified the economies of scale under different scaling scenarios. If surgery at the district hospital was scaled up by 10, 20 or 50%, the total cost of surgery would increase proportionately less than that, i.e. by 6, 12 and 30%, respectively. If this were to lead to less demand for surgery at the referral hospital, say 10% less surgery, it would result in a reduction of 2.7% in the total cost. Although the health system as a whole would benefit, the referring hospitals would not derive the full economic benefit, unless Government increased resources for district-level surgery.

Medical Care for Children with Cancer in the Donetsk People’s Republic: Results of an Ecological Study in 2014–2017

Background.Analysis of medical care delivery for children with cancer in armed conflict is highly important because the high-tech treatment in this context is extraordinary difficult and challenging task. Objective. Our aim was to analyze the morbidity and mortality rates in children with malignant tumors, to assess the pediatric patient capacity and medical service density in the Donetsk People’s Republic.Methods.The ecological study was conducted where the units of analysis were represented by the aggregated data of the Republican Cancer Registry on the number of primary and secondary patients with malignant and benign tumors, the deceased patients in the DNR in 2014–2017, pediatric patient capacity, and medical service density.Results.The number of pediatric patient capacity for children with cancer was 10 (0.27 per 10,000 children aged 0–17), pediatric patient capacity for children with hematological disorders — 40 (1.37 per 10,000 children aged 0–17). The treatment of children with cancer was performed by 5 healthcare providers: 1 pediatric oncologist (0.02 per 10,000 children aged 0–17), 3 hematologists (0.08 per 10,000 pediatric population aged 0–17), and 1 practitioner who did not have a specialist certificate in oncology. Morbidity rate for malignant neoplasms from 2014 to 2017 decreased by 25% (in 2014 — 9.6 per 10,000 children aged 0–17; in 2017 — 7.2). In the morbidity structure, the incidence proportion of hemoblastoses was 68.4%, brain tumors — 2.6%, other solid tumors — 29%. The death rate due to malignant neoplasms decreased by 37% (in 2014 — 2.7; in 2017 — 1.7).Conclusion.Low levels of the incidence rate and pattern of morbidity indicate defects in the identification and recording of patients. This explains the performance of the bed: low average bed occupancy per year and low turnover. For a reliable analysis of mortality statistical data is not available: in 2014–2015 only the number of in-hospital deceased patients is presented. Limited data is due to the lack of reliable patient catamnesis which is explained by the high rate of population migration.

Management decision of hospital surge: assessing seasonal upsurge in inpatient medical bed occupancy rate among public acute hospitals in Hong Kong.

There were recurrent upsurges in demand for public hospital services in Hong Kong. An understanding of the contribution of some possible factors for the rise in health care burden would help to inform hospital management strategies. To evaluate the utilization patterns of hospitalizations in medical wards among public acute hospitals in Hong Kong during surge periods. Retrospective study. By extracting the information in press releases between 2014 and 2018, descriptive statistics about medical ward occupancy situation during six surge periods were generated. A time series model was constructed to estimate the occupancy rate at each hospital and assess its relationship with the intensity of seasonal influenza activity, extreme weather, day of week and long holidays. There was a significant increase in the number of admissions to medical wards in all six surge periods. A significant variation in occupancy rate between weekdays and geographic regions was observed. The occupancy rate in 10, out of 15, hospitals was significantly associated with the influenza activity, while there was limited effect of weather on the occupancy rate. A significant holiday effect was observed during Christmas and Chinese New Year, resulting in a lower bed occupancy rate. A differential burden in public hospitals during surge periods was reported. Contingency bed and staff management shall be tailored to individual hospitals, given their differences in the determinants for inpatient bed occupancy.

Individual and hospital-related determinants of potentially inappropriate admissions emerging from administrative records

IntroductionThe appropriate use of health care is an important issue in developed countries. The purpose of this study was to ascertain the extent of potentially inappropriate hospital admissions and their individual, clinical and hospital-related determinants. MethodsMedical records were analyzed for the year 2014 held by the Local Heath Unit n. 13 in the Veneto Region of north-east Italy (19,000 records). The outcomes calculated were: admissions for conditions amenable to day hospital care; brief medical admissions; outlier lengths of stay for elderly patients’ medical admissions; and medical admissions to surgical wards. Univariate analyses and logistic regression models were used to test associations with demographic, clinical and hospital ward covariates, including organizational indicators. ResultsInappropriate reliance on acute care beds ranged from 6% to 28%, depending on the type of quality indicator analyzed. Some individual features, and wards’ specific characteristics were associated with at least one of the phenomena of inappropriate hospital resource usage. In particular, male gender, younger age and transferals seemed to affect inappropriate admissions to surgical wards. Potentially avoidable admissions featuring inpatients amenable to day hospital care were associated with subjects with fewer comorbidities and lower case-mix wards, while inappropriately short medical stays were influenced by patients’ higher functional status and local residency and by lower bed occupancy rates. In conclusion, inappropriately long hospital stays for elderly cases were associated with patients with multiple pathologies in wards with a low bed-occupancy. Education level and citizenship did not seem to influence inappropriate admissions. ConclusionsSome individual, clinical ad structural characteristics of patients and wards emerging from administrative records could be associated with inappropriate reliance on acute hospital beds. Analyzing the indicators considered in this study could generate inexpensive real-time data for identifying what determines potentially inappropriate hospital resource usage, and thus orient auditing activities and health care policy-making.

Comparing Performance Indicators of Obstetrics and Gynecology Ward at Yazd Educational Hospitals with Expected Limits of Indicators, 2015

ObjectivesThe purpose of this study was to evaluate the performance indicators for obstetrics and gynecology wards in Iran. MethodsThis study was designed as a cross-sectional study and was carried out in obstetrics and gynecology wards of Afshar and Shahid Sadoughi hospitals in 2015. The information required for the performance indicators was gathered through questionnaires, statistical forms, and direct observation. In several tables, performance rating and performance status are presented using the Likert scale index based on the expected limits. ResultsAccording to the results of the categories of input indicators, the bed occupancy rate of Afshar Hospital’s obstetrics and gynecology ward was, at 83%, higher than expected (79%), and that in Shahid Sadoughi Hospital (at 69%) was lower than expected. For medicinal methods and nonmedicinal methods of pain alleviation, the index process at Afshar Hospital was much lower than expected (40%). In Afshar Hospital, patient satisfaction at discharge was about 66.74%. ConclusionEffective steps can be taken to improve the input and output criteria: allocating appropriate physical space, examining the reasons for low bed occupancy rate by using complex analytical models, and in order to study the reasons for large number of cesarean section childbirth, it was recommended to place more emphasis on training of pregnant mothers and to inform them about the side effects of cesarean section and advantages of natural childbirth.

Efficacy of Artesunate-mefloquine for Chloroquine-resistant Plasmodium vivax Malaria in Malaysia: An Open-label, Randomized, Controlled Trial.

Chloroquine (CQ)-resistant Plasmodium vivax is increasingly reported throughout southeast Asia. The efficacy of CQ and alternative artemisinin combination therapies (ACTs) for vivax malaria in Malaysia is unknown. A randomized, controlled trial of CQ vs artesunate-mefloquine (AS-MQ) for uncomplicated vivax malaria was conducted in 3 district hospitals in Sabah, Malaysia. Primaquine was administered on day 28. The primary outcome was the cumulative risk of treatment failure by day 28 by Kaplan-Meier analysis. From 2012 to 2014, 103 adults and children were enrolled. Treatment failure by day 28 was 61.1% (95% confidence interval [CI], 46.8-75.6) after CQ and 0% (95% CI, 0-.08) following AS-MQ (P < .001), of which 8.2% (95% CI, 2.5-9.6) were early treatment failures. All patients with treatment failure had therapeutic plasma CQ concentrations at day 7. Compared with CQ, AS-MQ was associated with faster parasite clearance (normalized clearance slope, 0.311 vs 0.127; P < .001) and fever clearance (mean, 19.0 vs 37.7 hours; P =001) and with lower risk of anemia at day 28 (odds ratio = 3.7; 95% CI, 1.5-9.3; P =005). Gametocytes were present at day 28 in 23.8% (10/42) of patients following CQ vs none with AS-MQ (P < .001). AS-MQ resulted in lower bed occupancy: 4037 vs 6510 days/1000 patients (incidence rate ratio 0.62; 95% CI, .60-.65; P < .001). One patient developed severe anemia not regarded as related to their AS-MQ treatment. High-grade CQ-resistant P. vivax is prevalent in eastern Malaysia. AS-MQ is an efficacious ACT for all malaria species. Wider CQ-efficacy surveillance is needed in vivax-endemic regions with earlier replacement with ACT when treatment failure is detected.Clinical Trials Registration NCT01708876.

Lower bed occupancy means fewer deaths and better A&amp;E results in UK hospital study

Lower bed occupancy means fewer deaths and better A&amp;E results in UK hospital study

Emergency department crowding predicts admission length-of-stay but not mortality in a large health system.

Emergency department (ED) crowding has been identified as a major threat to public health. We assessed patient transit times and ED system crowding measures based on their associations with outcomes. Retrospective cohort study. We accessed electronic health record data on 136,740 adults with a visit to any of 13 health system EDs from January 2008 to December 2010. Patient transit times (waiting, evaluation and treatment, boarding) and ED system crowding [nonindex patient length-of-stay (LOS) and boarding, bed occupancy] were determined. Outcomes included individual inpatient mortality and admission LOS. Covariates included demographic characteristics, past comorbidities, severity of illness, arrival time, and admission diagnoses. No patient transit time or ED system crowding measure predicted increased mortality after control for patient characteristics. Index patient boarding time and lower bed occupancy were associated with admission LOS (based on nonoverlapping 95% CI vs. the median value). As boarding time increased from none to 14 hours, admission LOS increased an additional 6 hours. As mean occupancy decreased below the median (80% occupancy), admission LOS decreased as much as 9 hours. Measures indicating crowded ED conditions were not predictive of mortality after case-mix adjustment. The first half-day of boarding added to admission LOS rather than substituted for it. Our findings support the use of boarding time as a measure of ED crowding based on robust prediction of admission LOS. Interpretation of measures based on other patient ED transit times may be limited to the timeliness of care.

High levels of bed occupancy associated with increased inpatient and thirty-day hospital mortality in Denmark.

High bed occupancy rates have been considered a matter of reduced patient comfort and privacy and an indicator of high productivity for hospitals. Hospitals with bed occupancy rates of above 85 percent are generally considered to have bed shortages. Little attention has been paid to the impact of these shortages on patients' outcomes. We analyzed all 2.65 million admissions to Danish hospitals' departments of medicine in the period 1995-2012. We found that high bed occupancy rates were associated with a significant 9 percent increase in rates of in-hospital mortality and thirty-day mortality, compared to low bed occupancy rates. Being admitted to a hospital outside of normal working hours or on a weekend or holiday was also significantly associated with increased mortality. The health risks of bed shortages, including mortality, could be better documented as a priority health issue. Resources should be allocated to researching the causes and effects of bed shortages, with the aim of creating greater interest in exploring new methods to avoid or reduce bed shortages.

Kalos Rehabilitation Hospital in Vela Luka, Croatia

Kalos Rehabilitation Hospital in Vela Luka, Croatia