EVALUATION OF HOSPITAL BED UTILIZATION PATTERN AT A TERTIARY CARE HOSPITAL

1. Associate Professor, Department of Hospital Administration, Gandhi Medical College, Secunderabad. 2. Post Graduate 3 rd year, Department of Hospital Administration, Gandhi Medical College, Secunderabad. 3. Senior Resident, Department of Hospital Administration, Gandhi Medical College, Secunderabad. 4. Professor & Head,, Department of Hospital Administration, Gandhi Medical College, Secunderabad. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 20 April 2020 Final Accepted: 25 May 2020 Published: June 2020


ISSN: 2320-5407
Int. J. Adv. Res. 8(06), 1402-1408 1403 A hospital bed is both a scarce and expensive commodity in healthcare. 1 The availability of beds is perhaps the single most important factor in determination of the hospital utilization in a country. 2

Sanctioned Bed:
It is the official bed capacity of a hospital.

Functional Bed:
This is the actual functional status of beds in a hospital.

Bed days / Patient Days:
A bed day is a day during which a person is confined to a bed and in which the patient stays overnight in a hospital. It is the unit of measure denoting the services rendered to one inpatient day in the hospital.

Utilization:
Defined as the manner in which a certain community makes use of its available hospital resources. Utilization of a Hospital can be measured by: Volume of Hospital Utilization: This is calculated according to number of discharges (patients) of a hospital, Days of hospital care (service days) and Average length of stay (ALS) the mean.
Character of Individuals Utilizing Hospital: Use according to age, sex, procedure, diagnosis (through international classification of disease).
Efficiency of Hospital Utilization: An efficient hospital is one that is capable of achieving these results with no or minimal waste. Efficient bed management is most important for better utilization of hospitals.Dynamics of utilization of beds was studied retrospectively for a period of 3 months (July -September 2018) by observing the trend of bed complements; bed occupancy rates (BOR), average Length of stay (ALS) Bed Turn Over Interval (BTI) and bed turn-over rates (BTR). Hospital utilization indices are sensitive indicators to find pressure areas and thus help in proper allocation and utilization of resources. Bed utilization efficiency and hospital resource utilization are of prime importance to remove the "Hospital Bottlenecks" which in turn reduces the length of stay of in-patients. The hospital utilization statistics are also known as "patient movement statistics" and also reflects the performance of the hospital itself in relation to its patient care services being rendered.

Hospital Statistics:
The information that is obtained from the hospital outpatient, in patient and other facilities regarding quality of care, utilization of services, quantity of services delivered, work load and other hospital related administrative and logistic services is called Hospital statistics.

Objective:-
To study the pattern of hospital bed utilization from July to September 2018 in General Medicine Department of Gandhi Hospital. The total census for the months from July to September 2018 of General Medicine wards was found to be 18020 with 10912 males and 7108 females. The total numbers of admissions were 4121 with 2547 males and 1591 females. The total numbers of discharges were 2403 in male wards and 1502 in female wards with a total of 3905 discharges. Total numbers of deaths were 248 with 182 in male wards and 66 in female wards  These indices not only provide data of the services being provided, but also give lot of inputs and required information to take up necessary measures to improve the quality of services and also help in proper planning to implement the requirements for better services.

Bed turn over interval (BTI) = B-N/ (D+d):
Bed Occupancy Rate reflects the quality of services of the hospital. The level of BOR also varies with the size and scale and types of facilities available in the hospital.
Usually larger the number of beds, the larger is the number of doctors also. As a result more facilities are provided and the level of medical care tends to be of higher magnitude. Given this, it is normally the case that the BOR in District Hospitals is higher than the BOR in the Area and Community Health Centres. It is considered that the BOR from 80-85% is ideal for good quality of patient care.15-20% beds are vacant for emergency, isolation, disaster and intensive care (Dead Space Beds).100% occupancy means over utilization. Occupancy less than 80% is uneconomical.
The Bed Turnover Rate essentially defines the period for which a bed is occupied. The BTOR indicates the speed with which patients on any bed are rotated. Obviously the more complicate the case dealt with by the hospitals, the smaller the BTOR. Too large BTOR indicates that only simple type of treatment is being provided. Too small BTOR would indicate fewer people utilizing the hospital and patients being unnecessarily retained on the premises. Both are not desirable.
The Average Length of Stay represents the time the patient is retained in the hospital. As in the case of the turnover rate, a longer ALOS is to be expected in the case of hospitals having better facilities such as the District Hospitals.
In the case of Community Health centres where the level of treatment in general is lower, the average length of stay is likely to be less.
The Bed Turn over Interval is the average length of time that elapses between the discharge of one inpatient and the admission of the next in patient to the same bed. It is the average period in days that a bed remains empty. Negative BTI indicates scarcity of beds and over utilization.

Discussion:-
The study shows that the institute is catering to the services of more number of patients than the beds sanctioned in the medical wards. In the study, as the BOR is more than 100% in the months of August and September, it clearly indicates that there is over utilization of beds. The BOR is less than 100% that is 99% in the month of July which leads to a positive BTI in that month.  5 . The ALOS is often used as an indicator of efficiency. The shorter the ALOS, cost per discharge will get reduced. The average duration of hospital stay is variable and highest in departments dealing with chronic diseases. There is need to concentrate on these and patients may be discharged if found fit. Here the ALS is less because floor beds are used over and above the formally sanctioned beds. So the actual ALS will be more if the sanctioned beds only are used.
The BTI in the study was found to be 0.04, -0.14, -0.14 days respectively. Hence negative BTI clearly shows us the picture that there is scarcity of beds to cater the needs of patients getting admitted. Also from the data observed it has been found that major share of admissions are into the General Medicine Wards with cases varying from poisoning, snake bite, malaria, Ascites, Asthma, jaundice, CVA cases etc. It"s a common finding that daily census exceeds the total number of beds in the wards. Hence as stated earlier that the hospital is catering to more than sanctioned, there are floor beds too which are functional almost throughout the year especially in this department.
BTR in the study was 7.08, 7.36, 7.17respectively. Hence it means that average of 7 patients are cared for a given bed during a given period. BTR gives the net effect of changes in occupancy rates and ALOS. High BTR negatively implies the quality of medical care and also projects the need for sanctioning of more beds. 14. Accommodation problem for Attendants.
Inspite of the small gaps and lacunae in the regular services, the patient care services are very much satisfactory as the hospital indices being evaluated as a part of the observational study reflects better utilization of services.

Conclusion:-
By studying the different indices (BOR, ALOS, BTR, BTI), it was found that hospital utilization is more than the optimum. Being a government tertiary care hospital more number of patients seek health care and also large proportion of cases are being referred from neighbouring places as well as from private and corporate hospitals within the city.
It is specifically found that there are lot of cases with poor prognosis or in terminal stages are being referred to Gandhi Hospital and get admitted here and also the patients don"t follow up regularly as advised by the physician and moreover many patients do not take prescribed medication on time or as advised and hence they get admitted again.
The study in General Medicine Department shows high BOR requiring allocation of extra beds. To overcome this, regular month wise analysis and evaluation will help to find high patient load spots so that a better allocation of hospital resources can be done leading to higher Patient"s satisfaction.

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By studying the pattern of hospital utilization, we can better plan hospital services with allocation of required resources which can be properly utilized. With the adequate resources in hand, we can identify the high pressure areas with provision of necessary requirements with regular monitoring of services will be very helpful. There is need to increase the no. of beds as per the requirement and laid down guidelines and to plan for the establishment of expansion of departments with super-specialty services by taking help of all the resources from state and central like PMSSY project.

Suggestions:-
Facility to be enhanced to cater the demand of investigations to be done on OPD basis.
The Diagnostic facilities should be well established on a priority basis to cater the needs of Inpatients in time for better patient care services.
Relocating the patients from the areas where BOR is high to the areas where the BOR is less than optimum to overcome the overutilization crisis.
To establish proper SOP"s and Infection Control Committees to control the hospital acquired infections.
Appropriate measure to be taken to Increase the nursing staff to provide timely treatment as well as to timely follow the orders of treating physician when it comes to sending samples for diagnosis and drug indenting Appointment of adequate number of Patient Care Providers who are in charge of handling, shifting and transfer of the patients for all services Day care to be encouraged: Measures to be taken to initiate and establish proper Sop"s for outpatient, Admissions and discharges with a regular monitoring on them.