A Method of Evaluating the Use Made of Hospital Beds

Abstract

Illness is not in itself a sufficient ground either for admission to hospital or for continued stay in hospital. A patient should be admitted for the purpose of receiving specific medical attention, and when treatment is completed he should be discharged to the care of his general practitioner as soon as he no longer requires nursing care which can be provided only in hospital. A simple checklist procedure is described for rapidly and objectively assessing a patient's daily state of dependency on nursing care. A patient-nurse dependency chart is designed primarily to assist the attending doctor in determining the earliest time at which his patient is ready for discharge; in addition, the charts for all patients in a ward together provide the ward sister with a rapid measure of the total nursing load which must be met by her staff. In a study of uncomplicated dilation and curettage cases, it was estimated that the average stay of 5.5 days could have been safely shortened by 1–2 days if patients had been discharged as soon as they required only light nursing care such as could be provided by domiciliary services. The need for closer integration of all health services is stressed and the employment of district nurses on a fee-for-service basis is advocated.