Two questions help determine validity of bed occupancy

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7406.107-c (Published 10 July 2003) Cite this as: BMJ 2003;327:107
  1. Irving Cobden, consultant physician (irving.cobden{at}northumbria-healthcare.nhs.uk)
  1. North Tyneside Hospital, North Shields NE20 8NH

    EDITOR–Alijani et al investigated the appropriateness of surgical bed occupancy and devised a tool to validate it.1 With the current heavy pressure on using acute beds, patient flows must be maintained and doctors be seen to be asking two questions.

    The first is obvious: How sick is this person? The second sometimes escapes attention: What arewe doing for this patient? In other words, what value are we adding to that person's care that cannot be delivered in some more appropriate environment?

    The added value may consist of treatments, observation of vital signs, or clinical interventions that are available safely only in acute wards. Waiting for test results and keeping people in hospital just because they are “not well” are not valid reasons. This point was highlighted for me by the first three criteria in the assessment tool. As a gastroenterologist my outpatient clinics are full of people with unexplained abdominal pain, nausea, and abdominal tenderness. Heaven forbidI should admit them all.

    Thinking about the two reasons is even more important when doctors are dealing with acute relapses of chronic diseases. In such cases the need for an acute hospital bed disappears very quickly–if it ever existed in the first place.

    This is not just an issue in the arguments about beds and emergency targets. Hospitals are dangerous places for patients. Doctors need to re-educate the public and remind themselves about the reasons for patients being there.


    • Competing interests None declared


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