Abstract
OBJECTIVE--This study aimed to assess the appropriateness of bed use by determining patients' suitability for patient hotel accommodation and day treatment and by examining timeliness of discharge, and to assess patient and staff views about patient hotels. DESIGN--Patients were assessed by a doctor and nurse in terms of an agreed case definition for patient hotel use. Patient suitability was validated and patient acceptability measured by semi-structured interviews with a random sample of patients judged suitable for hotel accommodation. All senior medical and nursing staff completed a further questionnaire. SETTING--The study took place at University Hospital of Wales, Cardiff (856 beds), and all specialties, except intensive care wards, participated. SUBJECTS--Patients occupying a total of 3972 bed days, accumulated over seven randomly chosen census days, were studied. RESULTS--Data were available for 88% of eligible inpatients. Ten per cent (405 of 3972) of patients were judged suitable for a patient hotel. Specialties indicating major use were obstetrics and gynaecology, general surgery, and general and geriatric medicine. Sixty three per cent (254 of 405) of these subjects required low level investigation or treatment. Preoperative and postoperative and antenatal patients were often suitable also. Three per cent (119 of 3972, 95% confidence interval 2.5, 3.6%) of inpatients were judged suitable for day treatment/investigation. Seventy nine per cent (291 of 369) of patients suitable for discharge were discharged on the same or the next day. The patient hotel idea was acceptable to 58 of 68 (85%) randomly selected patients and to 84 of 93 (90%) staff. CONCLUSIONS--With allowance for non-response, our study indicates that a general hospital of this size generates the need (inpatients, relatives, and ward attenders) for a mean of 72 patient hotel beds. There is also residual scope for increasing day treatment/investigation and for releasing beds by speeding discharge. The patient hotel idea is highly acceptable to both patients and staff and should be widely considered as a means of making patient care more efficient.
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Selected References
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- Anderson P., Meara J., Brodhurst S., Attwood S., Timbrell M., Gatherer A. Use of hospital beds: a cohort study of admissions to a provincial teaching hospital. BMJ. 1988 Oct 8;297(6653):910–912. doi: 10.1136/bmj.297.6653.910. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Beech R., Challah S., Ingram R. H. Impact of cuts in acute beds on services for patients. Br Med J (Clin Res Ed) 1987 Mar 14;294(6573):685–688. doi: 10.1136/bmj.294.6573.685. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Davies C. Enjoy your stay at our patient hotel. Health Serv J. 1990 Sep 6;100(5217):1316–1317. [PubMed] [Google Scholar]
- Gertman P. M., Restuccia J. D. The appropriateness evaluation protocol: a technique for assessing unnecessary days of hospital care. Med Care. 1981 Aug;19(8):855–871. [PubMed] [Google Scholar]
- Koran L. M. The reliability of clinical methods, data and judgments (second of two parts). N Engl J Med. 1975 Oct 2;293(14):695–701. doi: 10.1056/NEJM197510022931405. [DOI] [PubMed] [Google Scholar]
- Murphy F. W. Blocked beds. Br Med J. 1977 May 28;1(6073):1395–1396. doi: 10.1136/bmj.1.6073.1395. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rosser R. M. The reliability and application of clinical judgment in evaluating the use of hospital beds. Med Care. 1976 Jan;14(1):39–47. doi: 10.1097/00005650-197601000-00004. [DOI] [PubMed] [Google Scholar]
- Torrance N., Lawson J. A., Hogg B., Knox J. D. Acute admissions to medical beds. J R Coll Gen Pract. 1972 Apr;22(117):211–219. [PMC free article] [PubMed] [Google Scholar]
- Zimmer J. G., Groomes E. W. An observer reliability study of physicians' and nurses' decisions in utilization review of chronic-care facilities. Med Care. 1969 Jan-Feb;7(1):14–20. doi: 10.1097/00005650-196901000-00002. [DOI] [PubMed] [Google Scholar]