High bed occupancy rates in hospitals denote inferior quality of care
Dr KK Aggarwal
Padma Shri Awardee
When patients choose a hospital for treatment, they usually judge a hospital by its location, the infrastructure, the amenities and services it provides, quality of care and cost of care.
Bed occupancy rate is an indicator of hospital utilization. It is a measurement of efficiency and effectiveness of a hospital. Bed occupancy rate of a hospital varies at any given point of time. While a ‘full house’ would perhaps appear to be most satisfying, it is not actually so, especially for a hospital.
According to the Australian Medical Association, Irish Medical Organisation, Australasian College for Emergency Medicine and NHS England, a bed occupancy rate above 85% or ‘overcrowding’ is considered to have an adverse effect on patient safety and the operational efficiency of the hospital.
High bed occupancy rate increases the risk of spread of hospital-acquired infections such as MRSA and Clostridium difficile via cross transmission. Such hospitals also run the risk of bed shortages when they are most needed, such as during outbreaks, or disasters.
Overcrowding means not enough beds for patients from emergency department. A long waiting time for transfer to the appropriate inpatient bed increases mortality and chances of adverse events.
Overcrowding compromises quality of care. Medications may not be administered in time; the chances and frequency of errors increase as well.
Hospitals, in particular Govt. hospitals, have a policy of not denying admission to any patient, even if this means allotting the same hospital bed to two inpatients, or sometimes even three in pediatric wards. The outcome is an inferior quality of care, at the same time, it also creates an impression that we can manage even with inadequate infrastructure and resources available to us.
No hospital, whether Govt. or private, should have more than 85% bed occupancy rate. Admitting 150 patients in a 100-bedded hospital is not correct. This means that for 50 extra patients, you are compromising care of 100 patients as resources are shared for a much larger number of patients than meant for.
This would also be applicable to govt. hospitals, if they over admit patients in view of the recent govt. notification, which makes it mandatory for all clinical establishments, chemists/pharmacists to notify every case of TB or else face penal provisions under sections 269 and 270 of the Indian Penal Code