1Kangra Government Medical College and Hospital, Tanda, Himachal Pradesh, India
2Department of Hospital Administration, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
3School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
4Department of Biostatistics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Background and Objectives: Hospital bed utilization is influenced by various factors, which may be categorized into patient-related, physician-related, and administration-related issues. It could be argued that the causes of inappropriate hospital bed utilization would be perceived differently by the clinicians and the patients. Given the unique role of clinical practitioners in quality of care, their views on the causes of inefficient hospital resources use should be referred to in any improvement initiative. The aim of this study, thus, was to survey the relative importance of factors influencing utilization of hospital beds as perceived by the resident doctors and nurses.
Methods: This cross sectional study was conducted in an Apex Tertiary Care Public Institution in northern India. All the resident doctors and nurses from 18 wards of 7 specialties and 7 super-specialties were interviewed using a structured validated self-administered questionnaire. The data were summarized by descriptive statistical methods and analyzed using ANOVA and Chi-square tests.
Findings: While a substantial percentage of clinicians perceived that hospital beds were inappropriately utilized, the resident doctors were more convinced of inefficient hospital bed utilization than the nurses. High expertise of the doctors, reputation of the Institution, and limited autonomy of the residents were perceived as the causes for overstay. In addition, the resident doctors considered lack of training, unclear job description, and long duty hours as the reasons for inappropriate bed utilization, while their nursing counterparts did not opine such. Most doctors agreed that lack of appropriate policy for and lengthy procedures of admission and discharge influence the hospital stay, whereas corresponding emphasis was not recorded from the nurses. Also congruent with some previous studies, the majority of the nurses and doctors perceived ineffective hospital information system, absence of standard operating procedures, and lack of quality assurance system in ward management as potential contributing factors to overutilization of hospital resources.
Conclusions: While nurses highlighted administrative factors as the major causes of overstay, the resident doctors perceived all examined factors, including patient-related, physician-related, and administrative factors to be important; though in agreement with their nursing counterparts, they gave a higher weight to the administrative issues. The information provided on the relative importance of factors contributing to patient overstay may help policy-makers and administrators to promote more efficient utilization of healthcare system resources. According to our results, implementation of quality assurance system in ward management, revising admission and discharge policy, improving hospital information system, use of modern technology, providing clear-cut job description, and providing the clinicians with appropriate training may help alleviate the patient overstay and suboptimal utilization of resources in hospital.