An article in the British Medical Journal (BMJ 2013;346;f1563) reported, “With more patients being treated but fewer beds, there’s no doubt that beds are being used more efficiently. But more intensive use could be a problem”.
The trend in fewer beds in use in hospitals can be seen in most countries in the Organisation for Economic Cooperation and Development (Fig 2).
In England this trend in the fewer number of hospital beds in use – by 59% for all beds since 1979 till 2012 can be viewed from Fig. 1, also shows sharp reduction in beds used for acute care, for maternity, geriatric care, mental illness and learning disability.This trend is the direct result of concerns (BMJ 2013;346;f1563) about “the need to save money and improve labour efficiency in the light of a shortage of nurses and general pressures on health service budgets.”
Since the number of beds in use has reduced but with increases in population, thus with more patients being treated but fewer beds, the time patients spend in hospital i.e the average length of stay (ALOS) a patient spends in hospital also needs to be reduced (shortened). John in (BMJ 2013;346;f1563) gives the example of ALOS for an acute case in England that “has shrunk from around 9.4 days in 1979 to about three days in 2011.”
John (BMJ 2013;346;f1563) adds some reasons in his article as he examined these trends and found new changes as follows that “have helped shift care from the ward to the outpatient department and beyond the walls of hospitals” :
- medical practice
- diagnostic procedures
- policies which deliberately moved mental health, learning disability, and
geriatric services out of hospital and into the community
Fewer beds but more patients being treated means the daily bed occupancy (BOR) rises. For example, daily average BOR data across all hospitals for England reached over 90% on several days (Fig. 3). John (BMJ 2013;346;f1563) infers that “Such high occupancy rates reduce the time available for cleaning between patients and increase the chances of infection.”, although he believes and I believe too that “there’s no doubt that beds are being used more efficiently.”
- John, A 2013, The Hospital Bed: On Its Way Out?, March 2013, vol. 346, British Medical Journal, BMJ Publishing Group Ltd, London