Inadequate acute hospital beds and the limits of primary care and prevention

Abstract

Metropolitan Australia is suffering from a serious shortage of acute hospital beds. Simplistic comparisons with the Organisation for Economic Co-operation and Development bed numbers are misleading because of the hybrid Australian public/private hospital system. The unavailability of most private beds for acute emergency cases and urban/rural bed imbalances have not been adequately considered. There is a lack of advocacy for acute bed availability. This attitude permeates government, health professions and the health bureaucracy. Planners, politicians, analysts and the media have adopted false hopes of reducing acute demand by prevention and primary care strategies, vital as these services are to a balanced healthcare system. This paper directly challenges the ideology that says Australia depends too heavily on hospital-based healthcare. Rebuilding the bed base requires recognition of the need for an adequate acute hospital service and strong advocacy for bed-based care in the medical and nursing professionals who should be driving policy. The forces opposing bed-based care are strong and solutions might include legislative definition of bed numbers and availability.

Utilisation of beds on the general medical unit by ‘non‐acute medical’ patients: a retrospective study of incidence and cost in two Tasmanian regional medical hospital units

“…However, rural and regional communities lack the critical mass of allied healthcare practitioners and community services that can help make self‐management programmes effective. There are strong arguments that policy makers' preferences for non‐hospital‐based solutions to managing acute hospital bed shortages are not evidence based and inadequately account for the limits of prevention and primary healthcare …”

“…By 2050 also, if existing hospital bed use trends continue in a context of exponential rises in frail older patients, a 62% increase in hospital beds will be needed to meet the projected demand – costing almost as much as the current budget for the entire system of healthcare in Australia . At the same time, over the last quarter of a century in Australia, the total number of acute public hospital beds has decreased by a third, from 74 000 beds (1983) to 56 900 beds in 2009–2010 . This translates into a 60% fall, adjusted for population growth, from 4.8 public acute beds per 1000 population in 1983 to 2.5 per 1000 population (2.6 per 1000, including psychiatric beds) .…”

“…At the same time, over the last quarter of a century in Australia, the total number of acute public hospital beds has decreased by a third, from 74 000 beds (1983) to 56 900 beds in 2009–2010 . This translates into a 60% fall, adjusted for population growth, from 4.8 public acute beds per 1000 population in 1983 to 2.5 per 1000 population (2.6 per 1000, including psychiatric beds) . Yet it is also known that public hospital bed availability varies throughout Australia: regional, rural and remote areas have more public hospital beds available per 1000 population than urban areas .…”

Paracetamol toxicity: What would be the implications of a change in Australian treatment guidelines?

“…A NAC infusion requires at least a 24 h stay in hospital. ED and hospital bed access are already problematic in the UK and Australia; the change in paracetamol overdose treatment guidelines in the UK might exacerbate this …”

“…ED and hospital bed access are already problematic in the UK and Australia; the change in paracetamol overdose treatment guidelines in the UK might exacerbate this. 25,26 It is well known that the incidence of anaphylactoid reactions to NAC is inversely related to the plasma paracetamol concentration. 13,14 The change in UK guidelines has the potential to result in significantly more patients receiving NAC at lower plasma paracetamol concentrations.…”