|Year : 2022 | Volume
| Issue : 1 | Page : 5-6
Optimizing the bed distribution system in resource-constrained settings
Bal Krishna Mishra, Akhil Kapoor
Department of Medical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre and Homi Bhabha Cancer Hospital, Tata Memorial Centre, Varanasi, Uttar Pradesh, India
|Date of Submission||02-Dec-2022|
|Date of Decision||03-Sep-2022|
|Date of Acceptance||03-Sep-2022|
|Date of Web Publication||31-Mar-2022|
Department of Medical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre and Homi Bhabha Cancer Hospital, Tata Memorial Centre, Varanasi, Uttar Pradesh - 221 005
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mishra BK, Kapoor A. Optimizing the bed distribution system in resource-constrained settings. Cancer Res Stat Treat 2022;5:5-6
Development of an effective bed distribution system is a significant problem for all hospitals in resource-constrained settings. The number of admissions required in each specialty varies across hospitals because of regional demographics, epidemiological changes, geographical characteristics, and socioeconomic factors. Hence, each hospital needs to develop a customized system for bed distribution as per its need. To optimize bed utilization, we need consider various issues related to bed distribution, appropriateness of hospital stay, and the need for a dedicated admission unit for each specialty. The ultimate goal of each hospital is to shorten the waiting time for patients and adjust bed distribution optimally across all departments.
Bekker et al., in their article, have described the various possible bed allocation systems. Each system has some merits and demerits. In a simple merging ward system, all beds are allocated on a first-come, first-served basis, so that each specialty has an equal chance of getting a bed. However, this requires skilled staff that can handle all types of patients. The other popular system is the separate ward system in which each specialty is allocated a defined number of beds, which are utilized according to their need. A separate ward system can ensure that patients receive quality care with ease, as each specialty can train their staff to look after their patients' needs as per protocol. Sometimes, in some specialties, a certain number of beds may remain unoccupied because of unavailability of patients. An unoccupied bed can cause monetary loss to the hospital. At the same time, other specialties may have a long waiting list of patients who require admission. Hence, we need a more dynamic system that can prevent monetary loss and ensure optimal utilization of available resources.
Chevalier et al. were able to find a solution for call centers receiving different types of calls. They suggested building two types of workforces – one that could handle a specific set of problems and another that could handle several different types of problems. On occasions where all single-skilled staff were busy, the calls could be received by multi-skilled staff. Multi-skilled staff could handle the overflow of calls from multiple servers, thus sharing the load of single-skilled staff. They found that an 80:20 ratio of single-skilled to multi-skilled workforce worked well for most call centers receiving a wide range of calls. This strategy could be adopted by the healthcare sector to design a hybrid system for hospitals. A certain number of beds could be allocated to each specialty as per their workload. These could be managed by single-skilled staff dedicated to a given specialty. At the same time, a certain number of beds could be spared for managing an overflow of patients across various specialties. These could be managed by specially trained multi-skilled staff. The ratio of dedicated and common beds need not necessarily be 80:20 and may be adjusted as per different situations or emergencies. Eventually, all patients occupying common beds could be transferred to their dedicated specialty beds based on availability. This transfer would facilitate the continuous availability of common beds in the ward.
Another factor that could improve the availability of beds is assessment of the appropriateness of hospital stays. Ghods et al. showed that 7.4% of admissions and 22.1% of hospital stays are inappropriate. This could be due to an inappropriate length of stay, inappropriate admissions, and other factors related to the hospitals. The most common reasons for inappropriate hospital stays were waiting for diagnostic or therapeutic procedures (35.1%) and delay in discharge of patients by physicians due to conservative medical policy (20.6%). Other reasons were unavailability of physicians, delayed consultation or physician opinion, postponement of surgery, temporary discharge, and delayed diagnostic tests. Inappropriate hospital stays could be circumvented by expanding outpatient diagnostic and treatment services and implementing quality improvement methods. For all patients, the major part of the workup could be completed on an outpatient basis, and the patient could be admitted once a treatment plan is finalized. Surgical patients should get admitted once an operation theater slot is available after the pre-anesthetic checkup. All admitted patients should be reviewed daily for discharge.
Ortiga et al. suggested the implementation of a Surgery Admission Unit for patients undergoing elective surgery. This strategy has been proven to shorten the length of stay and increase the proportion of patients admitted on the same day as the surgery. They further suggested that all elective surgical patients could be admitted and accommodated in a chair (like a daycare) and all preoperative preparations could be completed during the chair admission. All these patients could be transferred to routine beds after completion of preoperative preparation on that particular day. One chair could accommodate the admission of three patients in a single day. The patients' overall length of stay could be reduced to 5.5 days from 6.2 days. Presurgery length of stay was reduced from 0.46 days to 0.29 days after the intervention. These changes increased the availability of beds for other uses.
In conclusion, we need to develop an effective bed distribution system for resource-constrained settings that suits our professional needs. A hybrid system can help accommodate the dynamic needs of hospitals. Hospital administration can change the prespecified ratio as per the waiting list trends in various specialties or based on the occurrence of emergencies. The appropriateness of hospital stays can be improved by implementing various measures, and each specialty can develop its dedicated admission unit, which will optimize the use of indoor beds.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Bekker R, Koole G, Roubos D. Flexible bed allocations for hospital wards. Health Care Manag Sci 2017;20:453-66.
Ghods AA, Khabiri R, Raeisdana N, Ansari M, Hoshmand Motlagh N, Sadeghi M, et al
. Predictors of inappropriate hospital stay: Experience from Iran. Glob J Health Sci 2014;7:82-9.
Ortiga B, Salazar A, Jovell A, Escarrabill J, Marca G, Corbella X. Standardizing admission and discharge processes to improve patient flow: A cross-sectional study. BMC Health Serv Res 2012;12:180.