Number Of Available Beds Research Articles

Workload of postanaesthesia care unit nurses and intensive care overflow

The admission of intensive care unit (ICU) overflow patients in the post anaesthesia care unit (PACU) has come about as a result of an increasing demand for ICU services, which is not followed by a respective increase in the number of available beds. This has raised many concerns from nurses, with extensive workload and lack of personnel being the most important. This study was conducted in the General University Hospital of Patras, Greece, from 1 January 2003 to 30 June 2004. Admissions of ICU patients in the PACU were recorded and Project Research in Nursing (PRN), a Canadian workload measurement system, was used to estimate nursing workload. One hundred and three ICU patients were admitted and they stayed for a total time of 2812 hours. PRN scores of these ICU patients were much higher than for post anaesthesia patients. Clinically important increases of total PRN score, total care time and nursing personnel needs were evident in the presence of an ICU overflow patient during all shifts. Unless there is the appropriate number of personnel, increases in total care time are likely to lead to the neglect of post anaesthesia patients' needs.

Hospital disaster preparedness in Los Angeles County, California

Study objectives: We characterize disaster preparedness among a cohort of hospitals, focusing on practice variation, plan characteristics, and surge capacity.Methods: This was a descriptive, cross-sectional study using an in-person hospital survey and a 117-item questionnaire in Los Angeles County, CA. The study included 45 of the 81 designated 911 receiving hospitals, including private and tertiary care facilities. Observations include a description of hospital disaster plans, modes of intra- and interhospital communication, community and interagency involvement, decontamination capability and training, drills, pharmaceutical stockpiles, and each facility's surge capacity (assessed by monthly emergency department [ED] diversion status, number of available beds, ventilators, and negative pressure isolation rooms). Additional measures of preparedness included whether hospitals had the following: mutual aid agreements with other hospitals, long-term care facilities, and medical vendors; protocols for canceling elective surgeries and early in-patient discharge; surveillance systems; ongoing training with local emergency medical services and fire departments; communication with the public health department; volunteer credentialing systems; and a protocol for mass fatality incidents.Results: Ninety-five percent had adopted the Hospital Emergency Incident Command System, and 100% used the ReddiNet, a radio-based communications network. Ninety-five percent had memoranda of understanding with medical suppliers. However, 67% never had joint training programs with local police and fire agencies, and only 16% and 7% had written mutual aid agreements with other hospitals and long-term care facilities, respectively. Eighty-eight percent of hospitals had level B and/or C personal protective equipment, and 44% had decontamination facilities suitable in inclement weather. Ninety-six percent of respondents noted a nurse shortage, 58% had a monthly ED diversion rate of greater than 20%, and 69% estimated a surge capacity of less than 20 beds. Fifty-eight percent of responding hospitals had fewer than 10 negative pressure isolation rooms, only 36% had more than 10 ventilators, and 55% did not keep a stockpile of antibiotics or antidotes. Although 93% and 98%, respectively, had protocols for canceling elective surgeries and early in-patient discharge, only 64% had plans in place for a mass fatality incident.Conclusion: There are no objective measures of “hospital preparedness” or “hospital surge capacity.” In addition to establishing such standards, focus must be placed on enhancing interagency and interhospital communications. Current numbers of available hospital beds, ventilators, isolation rooms, and pharmaceuticals may be insufficient to effectively care for victims of large-scale disasters and other public health emergencies.

Japanese versus USA clinical services for sleep medicine

In order to compare clinical services in sleep medicine in Japan and the USA, a survey was sent to sleep clinicians who were identified through the American Academy of Sleep Medicine (USA), the Japanese Society of Sleep Research (Japan), and other related sources (Japan). The survey assessed the number of available beds for polysomnography (PSG), the number of overnight PSGs and multiple sleep latency tests (MSLTs) performed, the percentage of PSGs used for diagnosing and evaluating sleep-disordered breathing (SDB) patients, and the main treatment strategies for SDB. The number of beds in sleep centers/laboratories in the USA ranged from two to 12, and PSGs were performed on a daily basis (median number of PSGs per week: 20). However, 67.8% of Japanese sleep facilities did not have beds exclusively used for PSG, and they did occasional PSGs (median: three per month). Because there are a lot of facilities where they did not have beds for PSGs, PSGs were conducted in rooms that served a different purpose. Multiple sleep latency tests in the USA were performed on a weekly basis (i.e. 1–5/week), but were widely unavailable in Japan. On average, 79.4% of PSGs were used to diagnose or manage SDB in the USA. This was more variable in Japan. Nasal continuous positive airway pressure (nCPAP) was the first choice for therapy of most patients with SDB in the USA, while therapy in Japan depended more on the facilities available. A very small number of Japanese sleep facilities are used to conduct PSGs routinely, and fewer still are used for MSLTs. Therefore, most patients remain undiagnosed and untreated. In addition, in Japan, there is no regulatory consensus about the standards of sleep clinics and laboratories, or the requirements for diagnostic methodology or treatment strategies.

T EMPORAL T RENDS IN A MBULANCE D IVERSION IN A M ID-SIZED M ETROPOLITAN A REA

Objectives. To evaluate the amount of ambulance diversion in an emergency medical services (EMS) system and to investigate potential predictive factors. Methods. Ambulance diversion status of hospitals in the four-county metropolitan Portland, Oregon, area has been recorded for approximately 15 years. These data are used by EMS transporting agencies to determine appropriate hospital destination for their patients. The authors calculated the total yearly hospital ambulance diversion time for “Total Ambulance Divert (TAD)” and “Critical Care Divert (CCD)” for the time period between January 1, 1996, and December 31, 1999. Yearly EMS 9-1-1-generated patient transport volume, hospital emergency department (ED) census volume, total population, amount of health maintenance organization (HMO) penetration, and number of licensed and available hospital beds were calculated for each yearly interval. Kendall's tau-b correlation was used to determine significant secular trends. Potential predictive factors for the amount of ambulance diversion were tested using Pearson's correlation. Results. Total TAD increased 122.5% (p = 0.04), total CCD increased 64.4% (p = 0.50), total EMS transport volume increased 16.1% (p = 0.04), total ED census increased 9.4% (p = 0.04), total licensed beds decreased 5.7% (p = 0.17), total available beds decreased 15.8% (p = 0.17), HMO penetration increased 4.7% (p = 0.04), and total population increased 9.7% (p = 0.04) over the four-year study period. CCD and TAD were not significantly related to each other (p = 0.50). The only significant factor associated with the increase in TAD was number of available beds (p = 0.03). There were no significant factors associated with CCD. Conclusion. TAD increased significantly over time and was associated only with the decrease in available hospital beds.

Evaluation of triage decisions for intensive care admission.

To assess physician decision-making in triage for intensive care and how judgments impact on patient survival. Prospective, descriptive study. General intensive care unit, university medical center. All patients triaged for admission to a general intensive care unit were studied. Information was collected for the patient's age, diagnoses, surgical status, admission purpose, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and mortality. The number of available beds at the time of triage and reasons for refused admission were obtained. Of 382 patients, 290 were admitted, 92 (24%) were refused admission, and 31 were admitted at a later time. Differences between admission diagnoses were found between patients admitted or not admitted (p < .001). Patients refused admission had higher APACHE II scores (15.6+/-1.5 admitted later and 15.8+/-1.4 never admitted) than did admitted patients (12.1+/-.4; p < .001). The frequency of admitting patients decreased when the intensive care unit was full (p < .001). Multivariate analysis revealed that triage to intensive care correlated with age, a full unit, surgical status, and diagnoses. Hospital mortality was lower in admitted (14%) than in refused patients (36% admitted later and 46% never admitted; p < .01) and in admitted patients with APACHE II scores of 11 to 20 (p = .02). The 28-day survival of patients was greater for admitted patients compared with patients never admitted (p = .01). Physicians triage patients to intensive care based on the number of beds available, the admission diagnosis, severity of disease, age, and operative status. Admitting patients to intensive care is associated with a lower mortality rate, especially in patients with APACHE scores of 11 to 20.

Methicillin-resistant Staphylococcus aureus infection in palliative care.

Our objective was to assess the impact of methicillin-resistant Staphylococcus aureus (MRSA) infection in palliative care. The study was conducted at three hospices in south London, totalling 118 beds, and the following two methods were used. Firstly, a retrospective review of the notes of patients who were known to be MRSA positive at admission or were subsequently found to be MRSA positive was taken. Secondly, a prospective study of factors influencing bed occupancy in one hospice was conducted. The proportion of admissions who were MRSA positive ranged from 4% to 8% in the three hospices. Seven of the 43 patients who had MRSA suffered clinically significant infections. Risk factors for colonization and bacteraemia were similar to the general population. Sites of infection were variable and multiple and treatment regimes for eradication were variable, with varying outcomes. MRSA infection appeared to delay admission because of the need for single rooms, of which there are few Time spent cleaning rooms after discharge or death also reduced the number of available beds. It was concluded that MRSA infection is associated with significant morbidity in a small number of palliative care patients. Beds unavailable because of MRSA should be considered in bed occupancy figures, otherwise bed occupancy may appear artificially low. The psychological and financial impact of the infection in palliative care patients needs further evaluation.

The Geographical Distribution of Mental Disorder in Denmark 1971–1990: A Study of First Admission Rates

Geografisk Tidsskrift, Danish Journal of Geography 97: 132–142, 1997. In the period 1971–90 the first admission rate to Danish psychiatric hospitals and wards decreased by approximately 45%. This might reflect the similar decrease in number of available psychiatric beds. Generally, the decrease of first admission rates was larger in the metropolitan area than in the rest of the country. Consequently, the disparity in admission rates between town and country was reduced. Number of available beds has gained increasing importance as a predictor of variations between counties and municipalities whereas the importance of distance to hospital and degree of urbanization has declined. As regards socio-demographic variables special importance should be attached to variables for social aid and the employment rate in the social and health sector. However, it is generally difficult to determine whether regional variations are due to differences in treatment facilities or morbidity differences. From a disaggregate analysis it will appear that the diagnoses schizophrenia and alcoholism are especially related to low status areas whereas a connection with social status regarding neuroses and manic-depressive psychoses is less obvious.

Acute psychiatric beds: distribution and staffing in NSW and ACT.

This study examined the availability and staffing of acute psychiatry beds in NSW and ACT. "Gazetted" acute psychiatry hospitals (which take compulsory admissions under mental health law) were polled directly for bed numbers, occupancy and staffing for the year 1990-1991. The NSW Department of Health provided beds numbers for non-gazetted and private hospitals. Four analyses sequentially reallocated beds according to the origin of patients to estimate acute bed availability and use by regional populations. Socio-demographic determinants of acute admission rates were measured. Acute "gazetted" beds averaged 13.2 per 100,000 population but ranged from 6.9 to 49.1 per 100,000 when cross-regional flows were considered. "Non-gazetted" beds raised the provision to 15.5 per 100,000 and private beds raised provision further to 24.5 per 100,000. Inner metropolitan provision was higher than rural or provincial provision. The only determinant of the admission rate to gazetted beds was the number of available beds. Bed availability did not affect either bed occupancy or referral of patients to remote hospitals. Nursing staffing of gazetted units was reasonably uniform, although smaller units had significantly more nurses per bed. Medical staffing was highly variable and appears determined by staff availability. The average provision of acute psychiatric beds approximates lowest levels seen in international models for psychiatric services. Average occupancy rates suggest that there is not an overall shortfall of acute psychiatric beds, but uneven bed distribution creates barriers to access. Referral of patients to remote hospitals is not related to actual bed provision in the regions, but appears to reflect attitudes to ensuring local care. Recommendations about current de facto standards are made. Current average nursing and medical staffing standards are reported.

Trends in psychiatric hospitalization and changes in admission patterns in two counties in Denmark from 1977 to 1989.

Based on data from the nationwide Danish Psychiatric Case Register, trends in admission rates and treatment-day rates were studied in two Danish counties between 1977 and 1989. During the observation period, the number of available beds in the counties investigated decreased from 1.78 to 1.10 per 1000 inhabitants aged 15 years or more. Over the same period, the admission rates decreased by 20% for in-patients and 38% for day-patients. At the same time, treatment-day rates for in-patients decreased by approximately 50% and treatment-day rates for day-patients by 32%. The decrease was seen in all age groups both for admission rates and treatment-day-rates. Rates for short-term hospitalization showed a steeper decrease than those for long-term hospitalization. For schizophrenia, admission rates increased except among men under 25 years of age, and treatment-day rates decreased in all age groups. Affective disorders, neuroses, personality disorders, and alcohol and drug abuse showed the most pronounced decreases in admission rates and treatment-day rates. The same trend was seen for treatment-day rates for organic disorders. A marked decrease in admission rates was seen in the provincial towns. Treatment-day rates decreased markedly in city areas, and less so in rural areas.

Trends in psychiatric hospitalization in Denmark: a 10-year register-based investigation.

Information about all admissions to psychiatric hospitals and departments in Denmark in 1977, 1982 and 1987 and about all resident patients on census days in the same years were extracted from the central psychiatric register. The number of available beds decreased by 43% from 1977 to 1987. The admission rates decreased for all diagnostic groups but schizophrenia, which increased. The group of younger schizophrenic men declined in size, which is alarming if mentally ill homeless people are considered. The census study shows a decrease in all diagnostic groups, most pronounced in the elderly age groups. Patients with neuroses disappear from the available beds in the mental hospitals and departments. The changes in the psychiatric service system from mostly hospitalization to outpatient treatment and community psychiatric treatment require a comprehensive personal registration of treatment regardless of the administrative affiliations of these services.

Registerbaserede undersogelser af skizofreni

On an international basis Danish psychiatric registerbased research is centrally placed. The Psychiatric Central register was used in the investigation of schizophrenia, and the results showed a significant decrease in the number of new cases in Danish psychiatric hospitals and psychiatric departments since the early 70s. In the same period the number of available beds for psychiatric patients decreased by 50%. Alongside this development the mortality among schizophrenic patients has increased, especially due to suicides, and in the shelters and welfare homes the number of mentally ill, including schizophrenic patients, has increased. Mergings of the large person-identifiable registers open up the prospect of epidemiologic research. For instance, merging of the Twin Register with the Psychiatric Central Register made it possible to create the Danish Twin Study. The results from this study provide weighty arguments in discussing the factor of heredity in schizophrenia. In the years to come the method will ...

European attitudes towards ethical problems in intensive care medicine: Results of an ethical questionnaire

A questionnaire was sent to the 590 members of the European Society of Intensive Care Medicine to define both the current practices and the opinions of these specialists on various ethical issues. The answers from 242 (41%) European members were collected and analysed. The first part of the questionnaire was designed to define the criteria for admission to Intensive Care throughout Europe. Admissions to the ICU were generally or commonly limited by the number of available beds according to 57% of the respondents and sometimes or almost never according to 41% (100/242). Bed availability in the ICU was especially limited in Spain, Portugal, Italy and the United Kingdom. Despite limited bed availability, two thirds of the respondents did admit patients who were thought to have little or no hope of survival other than for a few weeks. When asked about what ought to be done in these circumstances, the number of respondents who supported the admission of such terminal patients to ICU was halved. These data illustrate the heterogeneity of admission practices in Europe and stress the need for all ICUs to define a policy for admission. The second part was designed to assess the information given to patients in the ICU. Only 24 (10%) of the respondents stated that they always delivered complete information to their patients and only 31 (13%) thought they should do so. When an iatrogenic incident occurred, only 39 (16%) claimed to relate exactly what had happened, to the patient or their relatives but 121 (50%) thought they should. Informed consent was usually required for surgery or gastroscopy and the administration of a new medication.

Nursing Homes After Nuclear War: Neglected Medical Resources

To the Editor.— In assessing the medical resources in the United States after a massive nuclear attack, Abrams 1 neglects the nursing home. My analysis of the additional beds and personnel in nursing homes shows how the total number of available beds (hospital plus nursing home) in the postattack period is doubled and new options for subacute, long-term, and rehabilitative care of casualties are made available (Table). Using the same death and incapacitation rates and urban locations as Abrams and excluding beds allocated for psychiatric patients, there will be more beds in nursing homes in the postattack period than in short- and long-stay hospitals (283,841 v 273,000). 2 This estimate for available nursing home beds is conservative for the following reasons. (1) Most nursing homes have been built in the past 20 years and are probably sounder structurally than older hospitals. (2) Most nursing homes are one or two stories,

Economic cycles and mental health care policy: An examination of the macro-context for social service planning

This paper examines the political economy of social service planning. Specifically, it is concerned to demonstrate the links between the general state of the economy and mental health care policy. An examination of the social history of the asylum clarifies the importance of two trends in developing policy attitudes: changing political and professional judgments regarding the appropriate form of confinement for the insane; and variations in care associated with fiscal pressures and chemotherapeutic advances. These trends are explored in detail for the case of the Province of Ontario. The secular (long term) trend in Ontario for the period 1875–1977 is dominated by an increase in levels of admissions, discharges and numbers of patients on the hospital books. These century-long trends are reversed only after 1960, in a climate of increasing costs, mistrust of mental hospitals and advances in drug treatment of mental patients. As a consequence of policy changes, the levels of admissions and discharges increase rapidly, while the resident hospital population diminishes. There is a simultaneous increase in the levels of psychiatric activity in the new treatment centers—the psychiatric units of general hospitals and community-based mental health units. The crucial 1960–1977 period is subject to a more precise time series analysis. Monthly data for five indicators of policy practice at one psychiatric hospital (Hamilton) is related to two indicators of economic activity. Using an iterative least squares regression technique, clear relationships are demonstrated between the rates of unemployment and inflation and the levels of admission, discharge, patients on books, vacancy rate and number of available beds in the hospital.

Clinical decision-making: A study of general surgery within trent RHA

A theory of consultant behaviour is summarized and used to generate three hypotheses on the interrelationship between the level of resources provided and the demand for hospital care. Routine hospital statistical data for General Surgery in Trent RHA provided a means of testing the hypotheses; no evidence was found to disprove them. It is suggested that a 1% increase in the number of consultants per 1000 population will lead to a 1% increase in the size of the waiting list. A measure of met demand such as the number of admissions per 1000 population was found to depend upon the number of available beds per 1000 population. Some possible policy implications for the management of waiting lists in the NHS are considered.

The Regional System and Postgraduate Medical Training in Czechoslovakia

As a heritage of the past, Czechoslovakia, after World War II, contained a heterogeneous, spontaneously developed conglomeration of dispersed hospital and outpatient facilities, lacking any system. These included state, provincial, municipal, public and a few private hospitals. Many district hospitals had only one department and the total number of available beds was 4.5 per 1000 population. Moreover, these hospital beds were very unevenly distributed.

The extent of hospital sickness.

Morbidity studies based on hospital admission rates are complicated because all admissions to a defined group of hospitals rarely come from a de fined population and all admissions from a defined population rarely go to a defined group of hospitals. As a consequence, if the starting point of the study is either the complete records of a hospital group or the complete enumeration of the population in a geo graphical area, the available data are usually precise for either the numerator or the denominator of admis sion rates but not for both. For a morbidity study the most realistic starting point is the population of a given area, but this is often served by a large number of hospitals both inside and outside its boundaries. As a result, the scrutiny of a mass of medical records is necessary in order that residents of the given area, if admitted to hospital, are included in the survey no matter where the hospital is situated, and in order that non-residents are excluded even though they are admitted to hospitals inside the geographical boundaries of the area studied. Apart from the practical difficulties of deriving reliable hospital admission rates with numerator and denominator properly related, their interpretation must be made with extreme care. Hospital admis sions depend on several factors, such as the number of available beds in various specialties and the attitude of general practitioners and their patients to hospital treatment. Such factors vary between areas; hence what may be true of one area may not be true of another or of the country in general. The Hospital In-Patient Enquiry (H.I.P.E.)?the 10 per cent, national sample survey of hospital patients organized by the General Register Office on behalf of the Ministry of Health?will enable the variation of hospital sickness between and within areas to be studied. Meanwhile the results of an analysis of all hospital admissions of persons living in a defined area may be of interest. The present paper gives a general analysis of the results. In a future paper, an attempt will be made to relate this analysis with certain social indices.

Transorbital leucotomy in a state hospital program.

State hospitals throughout the United States are faced with the problem of an expanding general population with an increasing number of mentally ill, great numbers of whom are denied proper and adequate state hospital care because of the relatively static and insufficient number of available beds. It has been estimated that there are today 8,470,000 psychiatric cases in the United States, of which 938,000 are cases of psychoses and 434,000 of psychoneuroses.1Of the total 680,913 neuropsychiatric beds in the United States, comprising 47.9 per cent of all hospital beds, 562,678 are in state hospitals.2An estimated 311,000 additional beds3are required to meet the state hospital needs, and the state hospital overcrowding, nationally, averages 16.3 per cent.4This, in addition to the human, social and economic aspects, is a vital and urgent physical problem requiring attention. With approximately 210,000 new patients5being admitted annually