Bed use in the medical wards of Red Cross War Memorial Children's Hospital, Cape Town
Henley, L.; Smit, M.; Roux, P.; Zwarenstein, M.
South African Medical Journal 80(10): 487-490
1991
ISSN/ISBN: 0256-9574 PMID: 1948463 Document Number: 382616
Objective: To determine extent of appropriate (medically necessary) and inappropriate bed use and level of care (LOC) needed by patients admitted to hospital. Design: A cross-sectional, descriptive survey. Setting: Medical wards of Red Cross War Memorial Children's Hospital (RCCH), a teaching hospital of the University of Cape Town (South Africa). Measurement and results: A 25% sample of beds was selected randomly each day for 12 consecutive days during September - October 1990. Data were collected using a questionnaire based on the Pediatric Appropriateness Evaluation Protocol and the Delay Tool. A subjective measure of LOC was developed. Questionnaires were completed for 171 admissions and 365 patient days; 98% of admissions and 79.5% of patient days were medically justified, and 49% of admissions needed tertiary care. The remaining 51% could have been treated by general paediatricians (17%) or medical officers (32%) in community hospitals. Of delays (unnecessary patient days) 62% were hospital-related, 20% were family-related and 18% were related to inadequate lower level institutional care and out-patient services. Conclusion: RCCH is functioning as a general, specialist and super-specialist hospital. Its future role as a tertiary referral centre will depend on adequate provision of community-based care. Further cost-benefit research is needed to address areas of inappropriate bed use identified in this study.