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
Rapid Response:
Re: The hospital bed: on its way out?
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