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Politicians should stop skiting about hospital bed numbers

After the release last week of the latest national hospital stats, SA’s Premier Mike Rann got busy on Twitter.

Doesn’t it say something about the absurd state of health debate when a politician is proud to skite about having more hospital beds than other places?

Wouldn’t it make more sense – in an ideal world – to be able to skite about needing fewer hospital beds than other places?

Presumably this might mean you have a healthier population for all sorts of reasons. It might also mean that you don’t need as many hospital beds because your public health programs, primary health and community-based care, and aged care services are doing so well?

It might also suggest that your hospitals are providing such good service that fewer patients are having to be re-admitted because of adverse events arising from their care.

Skiting about hospital bed numbers makes no sense, to me at least. Presumably this is just another example of the gulf we so often see between sensible health policy and effective health politics.

***

Update (May 3)

More on why we should stop the focus on hospital beds

Thanks to the Croakey reader who referred me to this paper, Hospital capacity planning: from measuring stocks to modelling flows, published in the Bulletin of the World Health Organization last year.

It notes that hospital capacity planning remains dominated by “bed numbers”, although there are several problems with this approach, including that bed numbers or bed occupancy do not provide a good measure of the services provided inside hospitals, and are also not  suitable for predicting future demand. Nor are bed numbers a useful measure of hospital capacity given the trend towards growing numbers of day cases and shorter lengths of hospital stay.

“Thus, while bed numbers have the benefit of convenience, as they are one of the few indices of hospital capacity that are routinely collected, there is a growing recognition of the intrinsic limits of this measure,” state the authors, from England and the Netherlands.

Patient flows are a more useful measure, they say, citing the example of a childrens’ hospital in  California that was able to admit 7% more children per year and improve patient satisfaction by use of improved patient flow systems.

An interesting extract from the article:

Traditionally, hospitals were designed around specialties and departments rather than around the needs of patients. Patients often spend most of their time in hospitals waiting for something to happen, with large areas provided for this inactivity. The situation is often exacerbated by the inefficient management of admission and discharge. In the United Kingdom of Great Britain and Northern Ireland, a patient admitted on a Friday night may have a length of stay that is 25% longer than a patient admitted on a Tuesday.  To accommodate this phenomenon, beds and wards in effect become holding areas for “work in progress” and have, in the past, been planned accordingly. A consequence is that in many hospitals the flow of patients is inefficient, dislocated and disorganized….

Comments 3

  1. Gavin Mooney says:

    Agreed and in citizens juries I have done in Australia not one has prioritised more hospital beds.

    So what are the ‘indicators’ of a better health care system? Low cost and good health? Exporting doctors to poor countries rather than importing them? A growing percentage of expenditure outside hospitals? The health gap between rich and poor narrowing? More patients saying their GP is caring? Family friendly children’s hospitals? More Aboriginally culturally secure health services? More old folks dying where they choose to die in the way they want to die?

    I can speculate but in the end I think we should use indicators reflecting what critically informed citizens want … which doesn’t seem to be more hospital beds, Mr Rann.

  2. William says:

    Give the guy a break: Mr Rann is a State Premier responsible for running a hospital service. he’s not responsible for public health, primary care etc etc. These are federal issues…

    And Gavin I can’t really see what the relevance of your citizens juries is here. They’re hardly likely to request more hospital beds given the way that you set them up. Try doing a citizens jury down at the ED of our hospital at about 11pm and ask the frail elderly folk stacked in corridors on trolleys waiting for a bed next to the drunken injured, or the frightened folks waiting in regional hospitals for a bed to become available at a tertiary centre so they can get evidence based treatment for their acute coronary syndrome…or maybe have a citizens jury inviting people who have had their elective ortho/eye/ent op rescheduled again because of lack of a bed…

  3. Liquid8 says:

    In every hospital one thing that has been consistent for years is the need for additional bed numbers. I’m not sure the relevance of citizen juries or their opinions, but it has to pointed out that if a hospital has insufficient beds, then people spend more time waiting in emergency departments waiting to be transferred, meaning that those waiting to be seen have to endure even longer waiting times or put up being in a corridor or some other unsuitable location.

    For a long time health beaurocrats have ignored this issue mainly because 1) the infrastructure costs too much, 2) more doctors and nurses need to be employed which is costly, and 3) the belief that additional capacity will just used up so why bother?

    Mental health, a favourite of this blog, is a suitable case in point. Go into any Emergency Department around Australia on any weekend and you will see they are full of mental health consumers. There are simply not enough acute beds, resulting in patients getting discharged before they are well enough, and representing to ED! The high turnover of patients results in ridiculous amounts of paperwork, it means more staff burnout, more unpaid overtime and an overall impression of psychiatry as an unattractive specialty to new graduates who also see it as having
    one of the lowest remuneration figures out of all the medical specialties. Mental health units tend to treat their junior staff quite poorly, then ponder over why they can’t attract new nurses or psychiatry trainees, or why new consultants who have put up with substandard conditions for years are all too quick to leave a flagging public system.

    I have no idea of the accuracy of Mr Rann’s figures, but I hope South Australia has sorted out it’s Northern area – one hospital is notoriously bad and a few years ago when I was posted there every morning it was announced over the loudspeaker that the hospital was over 100% capacity. For a number of years a new mental health ward was opened that had 5 beds that were not in use because of the 3 reasons outlined above. What did it take for those beds to get utilized? Tragically, it took the death of a patient who absconded from the Emergency Department while waiting for a free bed.

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AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
#OKtoAskAu
#OTCC2017
#ResearchTranslation17
#TheMHS2017
#VMIACConf17
#WCPH2017
Australian Palliative Care Conference
2018 conferences
#6rrhss
#ACEM18