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.     

Hospital output forecasts and the cost of empty hospital beds.

This article investigates the cost incurred when hospitals have different levels of beds to treat a given number of patients. The cost of hospital care is affected by both the forecasted level of admissions and the actual number of admissions. When the relationship between forecasted and actual admissions is held constant, it is found that an empty hospital bed at a typical hospital in Michigan has a relatively low cost, about 13 percent or less of the cost of an occupied bed. However, empty beds in large hospitals do add significantly to cost. If hospital beds are closed, whether by closing beds at hospitals which remain in business or by closing entire hospitals, cost savings are estimated to be small.     

Hospital uses service for follow-up calls

San Juan Regional Medical Center contracted nurses to make discharge follow-up calls 24/7. Hospital identifies trends through calls. Calls escalated to hospital nurse if there are medication or clinical problems.     

Hospital service quality: a managerial challenge

While much is known generally about predictions of customer-perceived service quality, their application to health services is rarer. No attempt has been made to examine the impact of social support and patient education on overall service quality perception. Together with six quality dimensions identified from the literature, this study seeks to provide a more holistic comprehension of hospital service quality prediction. Although 79 percent of variation is explained, other than technical quality the impact of the remaining factors on quality perception is far from constant, and socio-economic variables further complicate unpredictability. Contrary to established beliefs, the cost factor was found to be insignificant. Hence, to manage service quality effectively, the test lies in how well healthcare providers know the customers they serve. It is not only crucial in a globalized environment, where trans-national patient mobility is increasingly the norm, but also within homogeneous societies that appear to converge culturally.     

Hospital family planning: a vasectomy service

The vasectomy service at King's College Hospital in London has performed over 1600 operations since 1969 and evaluation of the program is presented. A counselling interview is held with the patient and his wife 2-4 weeks before the operation and is considered an indispensable part of the procedure. The outpatient operation is simple and performed under local anesthesia. The patient is advised to take a day or 2 off work, and seminal samples are collected until 2 consecutive negative samples are obtained and sterilization is achieved. The majority of vasectomy patients seen at this hospital were skilled manual laborers under 40 years old. The reason for vasectomy in 72% of the cases was completion of desired family size. A 5% complications rate was reported with this series of operations, and only 3 cases out of 1120 required hospitalization. In 79% of the cases the first 2 postoperative seminal fluid analyses were negative. Recanalization apparently occurred in 3 cases. Vasectomy was well accepted by the patients in this series and is viewed as a highly advantageous means of family planning for certain couples.