The hospital bed: on its way out?
BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f1563 (Published 12 March 2013) Cite this as: BMJ 2013;346:f1563
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Appleby tells us that the average length of stay in an acute hospital bed has reduced from 9.4 to 3 days in just over 30 years.
It has been said, and very plausibly but I cannot give a reference, that the activity in caring for an inpatient is greatest in the first two days and on the day of discharge. An average stay of three days means that currently the vast majority of inpatients are requiring either early care or discharge activity.
In addition, those patients who are in hospital for longer than three days are the sicker ones requiring more care; those who are recovering well and in little need of attention are those who are being discharged sooner than they used to be.
What this ought to have meant is that the number of nurses in particular employed on a 30-bed ward is greater than it was three decades ago. Sadly, it does not.
Competing interests: No competing interests
Fewer hospital beds: Is the increased ‘efficiency’ better for patient care or is it financially biased?
Understaffing is a problem in hospitals at the moment, with fewer staff working harder and longer to maintain good patient care. The question raised by Appleby of “how low can we go?”1 is an important one. Understaffing at night is a major problem with 10.6 patients per registered nurse (RN) and 6.1 per RN or Healthcare assistant2. These nurses are not necessarily dealing with well patients awaiting increased package of care or home but also patients at the end of life and seriously ill, thus requiring more care.
The patient: staff ratios are larger when looking at doctors, with a mean ratio of 61 per doctor (range 1-400)3 with the most senior doctor often being an F1 or F2. This is further compounded by a recent Royal College of Physicians report about the Medical Registrar, which highlighted their heavy workload and limited training opportunities4. This may be having a knock on effect with junior doctors being deterred from the important role of the Medical Registrar.
The statistics support the conclusion that where senior staffing levels are lower, the mortality rates are higher5. A balance must be struck between cost-cutting efficiency and safe, good quality medical care.
1 Appleby J. The Hospital Bed: On its way out? BMJ 2013;346:f1 563.
2 Ball J and Pike G. Past imperfect, future tense: nurses’ employment and morale in 2009, London: RCN. 2009.
3 Goddard A, Hodgson H and Newbery N. Impact of EWTD on patient:doctor ratios and working practices for junior doctors in England and Wales 2009. Clinical Medicine 2010;10; 4:330-5.
4 Royal College of Physicians. The medical registrar: empowering the unsung heroes of patient care.
London: RCP, 2013. www.rcplondon.ac.uk/projects/medical-registrar-empowering-unsung-heroes-...
5 Dr Foster Hospital Guide 2001-2011. Inside your hospital. Dr Foster intelligence. 2011: 20
Competing interests: No competing interests
Re: The hospital bed: on its way out?
I have never really understood why we encourage people in hospital to stay in bed all day. Perhaps beds in hospital wards should be put away during the day?
As a GP my workload is increasing with the "closer to home" agenda. When visiting "ill" people it is relatively rare to find them lying in bed at home. Usually being bed bound is associated with pyrexia, terminally ill or severe mobility problems such as a major stroke or end stage Parkinson's. The vast majority will be fully dressed using the sofa or comfortable chair, and mobilising between lounge and kitchen.
It would be an interesting comparison to see the difference in bed hours between patients with similar conditions treated at home or hospital. I wonder if the traditional Florence Nightingale ward full of beds really needs to be questioned and redesigned in the interest of patients and not doctors and nurses?
Competing interests: No competing interests