A study on bed utilization in the gynaecological ward of a district hospital in West Bengal

A study was conducted in a non-paying gynaecological ward of the district hospital, South 24 Parganas, West Bengal to assess different bed efficiency indicators. Total 331 patients were admitted in 23 study beds (12 OPD beds and 11 emergency beds) during an observation period of six months. Overall average number of admissions were 14.4 and average length of stay 14.7days. Bed turnover rate was 13.8 and was higher for emergency beds (22.1) compared to OPD beds (9). Bed occupancy rate was 61.3% with significant difference between OPD beds (57.5%) and emergency beds (65.4%).     

应用因子分析法对医疗工作质量进行综合评价

目的 分析医疗质量指标的潜在影响因素,综合评价医疗工作质量,为医院的经营管理提供一定的参考依据.方法 应用因子分析法统计徐州医学院附属医院部分科室13项医疗指标,包括出院人数、门诊人数、平均病床周转率、平均病床工作日、平均病床使用率、治愈好转率、实际占用总床日数、平均开放病床数、门诊与出院诊断符合率、入院与出院诊断符合率、三日确诊率、危重病人抢救成功率、危重病人住院率,应用SAS 9.13软件进行统计学处理.结果 从13项指标中提取出4个公因子,第一公因子为病床利用因子;第二公因子为诊断水平因子;第三公因子为流动因子;第四公因子为住院因子.4个公因子的累积方差贡献率达76.654%.结论 病床利用情况、诊断水平、病人流动情况和住院情况是医疗工作质量指标的主要影响因素,因子得分可以为医疗质量综合评价提供指导建议.     

应用灰色关联法对影响住院病人收治因素的探讨

目的找出影响住院病人收治的主要因素。方法采用灰色关联度分析法和Excel汇总分析2000—2005年住院病人的资料。结果影响病人收治的主要因素为病床周转率、门急诊就诊人次和手术人数。结论医院应不断提升品牌意识、服务意识;缩短平均住院日,加快床位周转,以满足不同人群的需求。     

Parameters affecting hospital occupancy and implications for facility sizing.

Simulation is used to investigate the effects on hospital occupancy of the number of beds in the facility, the percentage of patients who are emergencies, the percentage of elective patients who are scheduled, and the average lengths of stay of emergency and elective patients. A practical method is presented for estimating the optimum size of a short-term hospital on the basis of expected demand, and use of the results in planning is discussed.     

Forecasting demand of emergency care

This paper describes a model that can forecast the daily number of occupied beds due to emergency admissions in an acute hospital. Out of sample forecasts 32 day days in advance, have an RMS error of 3% of the mean number of beds used for emergency admissions. We find that the number of occupied beds due to emergency admissions is related to both air temperature and PHLS data on influenza like illnesses. We find that a period of high volatility, indicated by GARCH errors, will result in an increase in waiting times in the A&E Department. Furthermore, volatility gives more warning of waiting times in A&E than total bed occupancy.     

关于全院统筹收治病人制度弊端的分析

现有文献报道认为,全院统筹收治病人制度可有效利用医院床位,加快床位周转,为医院创造更大的社会和经济价值.文章认为,全院统筹收治病人理论上只能提高床位使用率,而我国大、中城市三甲医院床位使用率已基本饱和,尤其随着各种疾病发病率的提高及老年化的趋势,我国医院的床位数已不能满足需要,全院统筹收治病人已无法发挥提高床位使用率的作用.全院统筹收治病人制度可导致医护患沟通缺乏,存在医疗隐患等弊端,在我国现阶段大型医院不适宜施行该制度.     

Introducing DRG-based financing in Hungary: a study into the relationship between supply of hospital beds and use of these beds under changing institutional circumstances

Most hospital reforms carried out in Europe over the past few decades concern the supply of hospital beds and hospital financing systems. In Hungary, financing was not tied to hospital input or output until a Diagnosis-Related-Group system was introduced. This change provided an opportunity to study the effect of the new system, taking the supply of hospital beds into account. We studied the effect of the financing system and bed supply on four output parameters, average length of stay; admission rate; occupancy; and case-mix. The incentives of the financing system influenced the length of stay (shorter) and the admission rate (more admissions). Although the case-mix did increase, occupancy was not affected. The supply of more beds resulted in higher admission rates and a slightly lower efficiency (a lower occupancy rate). No interaction effects of (variations in) the bed supply and the financing system were found.     

Novel indicator for the assessment of hospital bed occupancy

In the past decades the bed occupancy of hospitals in Hungary has been calculated from the average of in-patient days and the number of beds during a given period of time. This is the only measure being currently looked at when evaluating the performance of hospitals and changing their bed capacity. The author outlines how limited is the use of this indicator and what other statistical indicators may characterize the occupancy of hospital beds. Since adjustment of capacity to patient needs becomes increasingly important, it is essential to find indicator(s) that can be easily applied in practice and can assist medical personal and funders who do not work with statistics. Author recommends the use of daily bed occupancy as a base for all these statistical indicators.     

Bed occupancy. Don't take it lying down

There is no standard optimum occupancy rate for hospitals. Bed occupancy rates must be considered in relation to the number of beds in a hospital. In general, a large hospital operating the same occupancy rate as a small one will have to turn away fewer patients. The bed needs of each trust need to be analysed in greater detail than has previously been the case.     

Reform of tuberculosis control and DOTS within Russian public health systems: an ecological study

OBJECTIVES: To investigate the association between clinical need and hospital bed supply and utilization in Russia; and, to investigate these associations in areas where traditional Russian tuberculosis health care systems exist and where the directly observed therapy-short course (DOTS) strategy has been implemented. DESIGN: Ecological study using 2002 routine data. MAIN OUTCOME MEASURES: Hospital bed utilization and hospital admissions for patients with tuberculosis in regions that adhere to the traditional Russian method of managing tuberculosis and those where the DOTS strategy has been implemented. RESULTS: The ratio of beds per newly notified case was 0.86. The mean duration of hospital stay per admission was 86 days for non-DOTS regions and 90 days for regions where the DOTS strategy had been implemented. The number of admissions in each region correlated closely with the number of newly registered cases and hospital beds were, on average, occupied for 325 days. In the regions where the DOTS strategy had been implemented bed occupancy was 324 days. CONCLUSIONS: Under the Russian tuberculosis control system, hospital utilization is predominantly determined by supply-side factors, namely the number of tuberculosis dedicated hospital beds, and this system extends across all regions. Implementation of the DOTS strategy in Russia has not led to fundamental structural changes in tuberculosis control systems.     

The effect of hospital bed reduction on the use of beds: a comparative study of 10 European countries

In Europe, the reduction of acute care hospital beds has been one of the measures implemented to restrict hospital expenditure. The aim of this study is to gain insight into the effect bed reductions have on the use of the remaining beds within different healthcare systems. We concentrated on two healthcare system elements: hospital financing system (per diem and global budget systems) and physician remuneration system (fee-for-service and salary systems). We also controlled for technological development and demand for healthcare. We used data from the OECD health data files of 10 North-Western European countries on hospital bed supply and use. The hospital bed indicators used were occupancy rate, average length of stay and admission rate. The data were analysed with multilevel analysis. We found some indication that the different financial incentives of hospital financing systems do indeed influence hospital bed use in the case of reductions in acute care hospital bed supply in different ways. However, we found significant effects only for the hospital bed use indicators "occupancy rate" and "admission rate". For physician financing systems, no significant effects were found.     

Spill Over Effects of Inpatient Bed Capacity on Accident and Emergency Performance in England

The English National Health Service (NHS) has failed to meet the four-hour waiting time target to admit, transfer or discharge 95 per cent of patients attending Accident and Emergency Departments (A&E) since 2013. A growing number of patients requiring inpatient care are waiting on trolleys longer than four hours before admission to a hospital bed. This study examines the role of bed occupancy in the deterioration of A&E performance in the NHS. Longitudinal panel data methods are used to analyse hospital data (n = 72,129,886) for 143 Trusts from 1^st June 2016 to 31^st October 2019. The average bed occupancy rate across the study period was 93.2%. A 1% increase in bed occupancy was associated with a 9.5 percentage point decrease in the Trusts’ probabilitay of meeting the waiting target, and an approximately 6 patient increase in four hours to 12 -hs trolley waits per 1,000 admissions. These relationships became more pronounced with rising bed occupancy levels above a 90% threshold. Bed occupancy is associated with significant negative spill-over effects on A&E performance. We estimate a minimum investment in 3,861 additional inpatient beds across the NHS to improve A&E performance in England. Relevant lessons can be derived for health care systems that have observed similar trends in increasing bed occupancy and deteriorations in A&E performance, including Ireland, Canada and Israel.     

Modeling the emergency cardiac in-patient flow: an application of queuing theory

This study investigates the bottlenecks in the emergency care chain of cardiac in-patient flow. The primary goal is to determine the optimal bed allocation over the care chain given a maximum number of refused admissions. Another objective is to provide deeper insight in the relation between natural variation in arrivals and length of stay and occupancy rates. The strong focus on raising occupancy rates of hospital management is unrealistic and counterproductive. Economies of scale cannot be neglected. An important result is that refused admissions at the First Cardiac Aid (FCA) are primarily caused by unavailability of beds downstream the care chain. Both variability in LOS and fluctuations in arrivals result in large workload variations. Techniques from operations research were successfully used to describe the complexity and dynamics of emergency in-patient flow.     

Cyclic fluctuations in hospital bed occupancy in Roma (Italy): supply or demand driven?

The objective of this study was to assess hospital bed occupancy both by planned and unplanned cases, and to assess how supply and demand affect bed occupancy. Data was obtained from the Lazio Hospital Information System (HIS) dataset on all hospital discharges from July 1998 to June 2001. Using Diagnosis Related Groups (DRG) as the reason for hospital stay, admissions were classified into four categories: 'planned stay', 'presumed planned stay', 'presumed unplanned stay', and 'unplanned stay'. Time series analysis of daily bed occupancy by category of stay was performed. Generalized Additive Models (GAMs) were used to asses the effect of weekdays and holidays on bed occupancy. Fluctuations in daily occupancy were observed in all categories of stay-in general, bed occupancy decreased over weekends, on national holidays, and during the major holiday season of August. In comparison with unplanned stays, the largest fluctuations were observed for planned stays while presumed planned and unplanned stays showed lesser fluctuations. It is possible to distinguish planned and unplanned hospital stays by using DRG grouping. Cyclic rigidities in the supply of services rather than the availability of beds or demand for beds seem to dictate hospital use in Roma so that restrictions in services hamper any reallocation of beds for 'planned stay' when demand for 'unplanned stay' beds declines.     

收容流程再造提高床位周转率

中国卫生统计年鉴显示,2005年以来,我国800张以上床位的医院数量上升了152.8%,同期三级医院床位数量增长了78.4%,但仍然不能满足广大患者的需求。为了满足患者的住院需求,使医院的现有床位发挥最大效益,从2010年改造收容流程开始,有效提高床位周转率,优化病房诊疗秩序,收到良好效果。     

CRITIC法在医院医疗质量评价中的应用

目的 对某医院2009—2013年医疗质量进行综合评价,为医院管理和决策提供可靠依据。方法 采用Critic法,对门诊人数、出院人数、手术人数、病床周转率、病床使用率、治愈好转率、抢救成功率、平均住院日和病死率9项指标进行综合评价。结果 2009—2012年医疗质量逐年提高,综合评价值依次为0.9059、0.9532、0.9722、1.1241,2013年有所下降,综合评价值为1.0151。结论 医疗质量为医院管理和决策提供可靠依据,而医院管理和决策对医疗质量起着至关重要的作用。     

Strategies for cutting hospital beds: the impact on patient service.

OBJECTIVE: To develop insights on the impact of size, average length of stay, variability, and organization of clinical services on the relationship between occupancy rates and delays for beds. DATA SOURCES: The primary data source was Beth Israel Deaconess Medical Center in Boston. Secondary data were obtained from the United Hospital Fund of New York reflecting data from about 150 hospitals. STUDY DESIGN: Data from Beth Israel Deaconess on discharges and length of stay were analyzed and fit into appropriate queueing models to generate tables and graphs illustrating the relationship between the variables mentioned above and the relationship between occupancy levels and delays. In addition, specific issues of current concern to hospital administrators were analyzed, including the impact of consolidation of clinical services and utilizing hospital beds uniformly across seven days a week rather than five. PRINCIPAL FINDINGS: Using target occupancy levels as the primary determinant of bed capacity is inadequate and may lead to excessive delays for beds. Also, attempts to reduce hospital beds by consolidation of different clinical services into single nursing units may be counterproductive. CONCLUSIONS: More sophisticated methodologies are needed to support decisions that involve bed capacity and organization in order to understand the impact on patient service.     

矫正的病床综合工作效率指标的研制与应用

目的 针对传统的病床工作效率评价方法的缺陷,提出矫正的病床工作效率指标,为医院病床资源的合理配置提供技术支持。方法 资料来源于唐山市某综合医院2008年的医疗统计报表和绩效考核方案。用标准住院天数对病床综合效率指标进行矫正,并测算各科室的开放床位的可信区间。结果 各科室的病床工作效率存在较大差异,口腔科、ICU和儿科的效率最高。20个科室中病床设置合理的有6个科室,14个科室需要调整,其中需增加床位的有6个科室,需减少床位的有8个科室。结论 矫正的病床工作效率指标具有更广泛的适用范围,应探索应用单病种或病例分型的标准平均住院天数矫正病床工作效率。     

经CD率校正的床位效率指数及其影响因素分析

目的评价某三甲医院2018年各月及各科的校正后床位效率指数,分析其高效率或低效率运行的原因,并分析校正后床位效率指数的影响因素,为医院合理配置床位提供参考依据。方法采用“归一法”计算某三甲医院2018年各月及各科的床位效率指数,用CD率进行校正;采用多元线性回归法分析校正后床位效率指数的影响因素。结果2018年各月校正后床位效率指数中,7月最高(1.13),2月最低(0.58),除2月外其余月份效率指数均在0.9以上;各科校正后床位效率指数中,部分科室床位高效率运行的同时也有科室存在床位闲置的现象,重症医学科效率指数最高(4.06);线性回归分析发现,期初人数、入院人数、2或3类切口手术人数越多,急诊入院率越高,校正后床位效率指数越大,床位效率越高;三四级手术例数越多,床位效率指数越低。结论利用具体床位效率指数的影响因素,通过行政管理介入和医疗服务模式改善,可以有效实现医院床位的合理配置。     

效率指数模型在肿瘤医院床位工作效率评价中的应用

目的 利用床位效率指数模型来评价肿瘤医院床位工作效率,为提高医院床位管理水平提供依据。 方法 根据2015年住院患者统计报表数据中的床位使用率和床位周转次数建立床位效率指数模型并分析评价。 结果 床位压床型科室有胸腹放疗科、乳腺放疗科。占科室总数7.41%;床位效率型科室有胃肠外科、泌尿科、乳腺外一科、乳腺外二科、乳腺头颈外科等。占科室总数62.96%;床位闲置型科室有姑息治疗科。占科室总数3.70%;床位周转型科室有胸外科、骨与软组织科、神经外科、核医学科等。占科室总数25.93%。 结论 利用床位效率指数的统计分析方法将床位使用率和床位周转次数综合起来分析医院床位工作效率,为医院管理决策层优化资源配置、充分利用现有资源提供参考依据。