Appriopriate use of Hospital beds in an overburdened Teaching Hospital, in a developing country, a case study of the University Teaching Hospital, Lusaka, Zambia

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Mwale, Aaron
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A bed census was carried out on 16th June 1998 in the University Teaching Hospital (UTH)wards to look into appropriate use of hospital beds. The main objectives of the study were to determine the extent of appropriate (Medically necessary) and inappropriate bed use and levels of care to patients admitted to the UTH. The study also aimed at obtaining accurate information on bed use and designing a feasible and dependable instrument of regular collection of information on inpatients. The study design was a cross sectional survey of all patients occupying a Hospital bed hence called a bed census. The data required for the study was obtained by administering a structured questionnaire to patients admitted to the UTH wards on a selected day. 56 Nurses who were trained for the exercise performed this. Each Nurse was assigned to one ward on that particular day to interview patients. The data was analyzed using EPI-Info statistical software. Statistical tests of Chi - Square and regression analysis were used to arrive at appropriate tests of significance of P-Values and correlation coefficient. It was found out that 37.9 % of the patients had non-clinical reasons for being on the ward (Pvalue=0.000). The proportion of medically inappropriate use for stays of one to six days was significantly higher than average. It was further found out that for those patients with longer stay on the wards, their admission was clinically appropriate. The trend towards decreasing rates of inappropriate hospital use for increasingly longer stays was statistically significant at P-Value = 0.0000. A test for correlation (Linear regression) gave a result of r = -0.049. This result signifies that as stay in hospital increased rates of inappropriate use decreased.Conversely, as stay in Hospital decreased, rates of inappropriate use increased. The bed census showed bed occupancy of 48.39 % on the day of the census, which is half of the previous year's estimate of 71%. This happened by chance because on this particular day, some of the wards were congested and some of them were half full in order to prepare bed space for new admissions on the next day. According to the criteria of the interview, it was observed that 37.9 % of the admissions were inappropriate (Medically unnecessary). It further goes to reveal that 79 % of these could have been handled by the Urban Clinics which shows their failure to handle them. Geographical distances, delayed laboratory and X-ray results and failure to conclude the seriousness of the disease or its recovery were other contributing factors for prolonged occupation of beds in the UTH. 90% of all bed occupants were terminally ill. It would be unethical to reveal the causes of terminal illnesses if one guaranteed the confidentiality of its occupants. Finally it is concluded that the situation at UTH can be improved but it is necessary now to have a sister Hospital of equal status for the simple reason that the population of Lusaka is no longer 300,000 (1965 when the UTH was built) but more than 2 Million (1998). Information on bed use is not readily available in the UTH.It is therefore recommended that bed censuses be introduced so as to avail clinicians and management valid information for planning and decision making. Routine bed censuses carried out on two consecutive midnight's are known to offer such information as is not readily available in the routine hospital statistics.
Public Health-Appriopriate use of hospital beds in developing countries