Is bed turnover rate a good metric for hospital scale efficiency? A measure of resource utilization rate for hospitals in Southeast Nigeria

Abstract

Background Nigeria health sector, like that of other sub-Saharan African countries, increasingly faces critical resource constraints. Thus, there is need to seek for ways of improving efficient use of scarce health resources. The aim of this study was to determine resource utilization rate of teaching hospitals in Southeast Nigeria as a means of estimating their efficiency. Methods The study is a longitudinal cross sectional study. It applied ratio indicators and Pabon Lasso model using data on the number of hospital bed, number of inpatients and total inpatient-days from purposefully selected teaching hospitals in Southeast Nigeria to measure efficiency over a period of 6 years (2011–2011). Results The hospitals’ mean bed occupancy rate was as low as 42.14%, far below standard benchmark of 80–85%. The mean average length of stay was as high as 8.15 days and observed mean bed turnover was 21.27 patients/bed/year. These findings portrayed high level of inefficiency in Nigeria teaching hospitals, which was further illustrated by Pabon Lasso graph, with only 10–20% of the hospital-years located within or near the efficient zone or quadrant. Conclusion The study was able to show that health ratio indicators such as hospital bed turnover rate (BTR) and bed occupancy rate (BOR), as well as patients’ average length of stay (ALS) can be used as tools for assessing hospital performance or its efficiency in resource utilization. Thus, in low and middle income countries where medical record keeping may be inadequate or poor, ratio indicators used alone or with Pabon Lasso graph/chart could be an optional metrics for hospital efficiency.

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“…The average bed occupancy rate (BOR) reflects efficiency in the use of hospital beds. Hospital can be said to be operating efficiently at BOR of 80-90% [7][8][9][10]. This rate varies depending on the country but also depending on the hospital's healthcare mission and capacities.…”

“…This rate varies depending on the country but also depending on the hospital's healthcare mission and capacities. It ranged from 42% to 78,8% [7,8,11,12].…”

“…A short LOS could be regarded as an indicator of hospital efficiency. In 2018, the average length of stay in hospitals for all causes of hospitalisation was 7,5 days across some european countries [13], while it was about 8,15 days in some african countries [8,14].…”

“…Last but not least, the turnover interval (BTOI) referred to a measurment of the average times or days that hospital beds are unoccupied between successive inpatients. The ideal turnover interval is suggested to be 1-3 days [8,15], but depends among other things on the bed capacity of the hospital. Our total BTOI was equal to 3,39 days in 2020 comparing to 1,6 days in 2019.…”

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“… The inpatient bed occupancy rate shows the relationship between the number of hospitalization days and the number of establishment beds. It is an access relevant measure as it is closely related to the waiting time and beds' availability (Aloh et al 2020 ). Studies show that the ideal value for this indicator is around 85%.…”