Inpatient Bed Occupancy and Specialty Costs Within Scottish Hospitals

Health care management

Baillie, Heather Mary

University:University of Glasgow

关键词: Health care management;   

Others  :  http://theses.gla.ac.uk/75421/1/13815604.pdf

来源: University of Glasgow

【 摘 要 】

The main motivation behind this piece of research were the wide variations apparent in inpatient bed occupancy rates and specialty costs within Scottish hospitals. Routine hospital discharge summaries (form SMR1) and Scottish Health Service Cost data were used to investigate these variations for two specialty groupings; general medicine and its associated sub-specialties (such as cardiology or gastroenterology) as a high occupancy, high emergency admission category and combination of ear, nose and throat (ENT), gynaecology and ophthalmology as a lower occupancy, high elective admission category. It was important to have this distinction because the workload undertaken by each is likely to vary considerably, which could influence the bed use and costs of each. Aims The main aims of this thesis were: to unpack annual bed occupancy rates by looking at daily and seasonal trends, to examine the effects of case-mix on length of stay and hence the effects on the perceived efficiency of a hospital, to investigate the variation in specialty costs between hospitals in Scotland and to highlight any factors that may contribute to increased unit costs such as bed occupancy, length of stay (LOS) and teaching status. Methods: Daily bed occupancy Patients' length of stay, dates of admission and discharge are recorded on SMR1 which made it possible to calculate the number of occupied beds in a particular specialty on any given day. The number of available beds to each specialty within each hospital was also recorded in the Scottish Health Service Costs, allowing occupancy to be estimated in all hospitals for general medicine and its associated sub-specialties and for ENT, gynaecology and ophthalmology for each day of the financial year 1994/95. The calculation of daily bed occupancy rates, then enabled seasonal and day of the week trends to be plotted for eight chosen hospitals (see Chapter 2). Case-mix and length of stay The information recorded on SMR1 also made it possible to examine the case-mix differences of hospitals. Healthcare Resource Groups (HRGs) were used to obtain an adjusted length of stay score based on hospital caseload compositions (see Chapter 3). The regression analysis was also carried out within a multilevel framework, so that variation attributable to year-on- year differences within hospitals and the variation between hospitals could be disentangled (see Chapters 4 and 5). Conclusions and discussion: The descriptive analysis of daily bed occupancy rates reinforced the argument that annual bed occupancy figures do not effectively measure or indicate the efficient use of hospital resources. However, at the local level, short-term trends in daily bed occupancy can provide a helpful means for more effective management of beds. It was also apparent that bed occupancy is not a suitable target variable for reducing unit costs (at most a probable 1% increase would reduce cost per case by