PURPOSE: Emergency department (ED) overcrowding is recognized as a major concern not only because it is associated with patient dissatisfaction, but also because it impinges on quality of care. The goal of this study is to evaluate the mid-term effects of hospital bed capacity expansion on overcrowding in the emergency department for two years. METHODS: This was a pre-post study conducted using administrative data from the ED. On May 1st, 2011, the hospital licensed beds were expanded from 1150 to 1300. Data from one year of the pre-expansion period (May 1st, 2010 to April 30th, 2011) and two years of post-expansion were divided into two periods; early period and late period were included for this analysis. In these periods, we calculated the National Emergency Department Overcrowding Scale (NEDOCS) and occupancy rate at the same time of every day. The main outcomes included length of stay (LOS) in the ED and NEDOCS. RESULTS: A total of 177,766 patients were included. The mean number of daily ED patients was increased; 156.3+/-32.5 in the pre-expansion period, 162.5+/-32.5 and 167.9+/-32.4 in the early and late post-expansion periods, respectively (p<0.001). In multivariate linear regression analysis, hospital bed expansion, the number of admission hold patients, age, number of admission patients and operating rate of hospital beds showed association with mean ED LOS (coefficient=-82.9, 2.7, 6.4, 11.4 and 5.4 respectively, R2=0.628, p<0.001). CONCLUSION: Expansion of hospital beds could be helpful in resolving ED overcrowding for at least two years.
Bed Occupancy ; Crowding ; Emergency Service, Hospital* ; Hospital Bed Capacity ; Humans ; Length of Stay ; Linear Models ; Tertiary Care Centers*

PURPOSE: This study aimed to evaluate the current status of hospice palliative care facilities in Korea. Based on the result, we attempted to suggest activation plans of hospice palliative in Korea. METHODS: To conduct a survey, we obtained a list of hospice palliative care facilities from related agencies and academic societies. A survey was conducted from February, 2009 to March, 2009. The survey was consisted of general characteristics of organizations, manpower, facilities & equipments, and so on. In addition, we used data from Statistics Korea to estimate the number of beds required and the bed occupancy rate. RESULTS: Total number of facilities responded to the questionnaire were 53. Forty-two facilities were general hospitals and 6 facilities were clinics among the total 53 facilities, and 18.8% of facilities were located in Seoul, Incheon and Gyeonggido. Overall bed occupancy rate was rather low as 21.9%, and there were 4 provinces where bed occupancy rates were 0%. Deaths in hospice palliative care facilities during 2008 were 6.3% of total deaths from cancers. As for the questions about the financial status of facilities, 86% of facilities were answered financial insufficiency. Also more than half of the facilities gave financial insufficiency as the reason for shortage of human resource supplies and inability to achieve the standard for authorization by the government. Facilities answered in order to activate the hospice palliative care, governmental support is needed, mostly in financial support (71.2%), donation tax deduction (43.1%), and setting up a public utility foundation (23.5%). CONCLUSION: This study showed low rates of hospice palliative care use and bed occupancy in Korea. Regional variance in bed occupancy rate was significantly high. As a roadblock for these problems, most of the facilities cited financial insufficiency. Therefore, there must be some action plans to boost financial support to activate hospice palliative care in Korea. Finally, efforts to improve these circumstances including lack of understanding about hospice and palliative care, are needed as well.
Bed Occupancy ; Equipment and Supplies ; Financial Support ; Hospice Care ; Hospices ; Hospitals, General ; Humans ; Korea ; Palliative Care ; Social Change ; Social Problems ; Taxes ; Surveys and Questionnaires

PURPOSE: The purpose of this study was to propose optimal hospitalization fees for nurse staffing levels and to improve the current nursing fee policy. METHODS: A break-even analysis was used to evaluate the impact of a nursing fee policy on hospital's financial performance. Variables considered included the number of beds, bed occupancy rate, annual total patient days, hospitalization fees for nurse staffing levels, the initial annual nurses' salary, and the ratio of overhead costs to nursing labor costs. Data were collected as secondary data from annual reports of the Hospital Nursing Association and national health insurance. RESULTS: The hospitalization fees according to nurse staffing levels in general hospitals are required to sustain or decrease in grades 1, 2, 3, 4, and 7, and increase in grades 5 and 6. It is suggested that the range between grade 2 and 3 be sustained at the current level, the range between grade 4 and 5 be widen or merged into one, and the range between grade 6 and 7 be divided into several grades. CONCLUSION: Readjusting hospitalization fees for nurse staffing level will improve nurse-patient ratio and enhance the quality of nursing care in hospitals. Follow-up studies including tertiary hospitals and small hospitals are recommended.
Bed Occupancy/economics ; Costs and Cost Analysis ; Hospitals, General/*economics ; Humans ; National Health Programs/*economics ; Nurse-Patient Relations ; Nursing Care ; Nursing Staff, Hospital/economics

BACKGROUND: Adequate staffing is necessary to meet patient care needs and provide safe, quality nursing care. In November 1999, the Korean government implemented a new staffing policy that differentiates nursing fees for inpatients based on nurse-to-bed ratios. The purpose was to prevent hospitals from delegating nursing care to family members of patients or paid caregivers, and ultimately deteriorating the quality of nursing care services. PURPOSE: To examine nurse staffing levels and related factors including hospital, nursing and medical staff, and financial characteristics. METHODS: A cross-sectional design was employed using two administrative databases, Medical Care Institution Database and Medical Claims Data for May 1-31, 2002. Nurse staffing was graded from 1 to 6, based on grading criteria of nurse-to-bed ratios provided by the policy. The study sample consisted of 42 tertiary and 186 general acute care hospitals. RESULTS: None of tertiary or general hospitals gained the highest nurse staffing of Grade 1 (i.e., less than 2 beds per nurse in tertiary hospitals; less than 2.5 beds per nurse in general hospitals). Two thirds of the general hospitals had the lowest staffing of Grade 6 (i.e., 4 or more beds per nurse in tertiary hospitals; 4.5 or more beds per nurse in general hospitals). Tertiary hospitals were better staffed than general hospitals, and private hospitals had higher staffing levels compared to public hospitals. Large-sized general hospitals located in metropolitan areas had higher staffing than other general hospitals. Occupancy rate was positively related to nurse staffing. A negative relationship between nursing assistant and nurse staffing was found in general hospitals. A greater number of physician specialists were associated with better nurse staffing. CONCLUSIONS: The staffing policy needs to be evaluated and modified to make it more effective in leading hospitals to increase nurse staffing.
Workload/economics ; Program Evaluation ; Personnel Staffing and Scheduling/*economics ; Nursing Staff, Hospital/economics/*supply & distribution ; Logistic Models ; Korea ; Humans ; *Hospital Charges ; *Health Policy ; Cross-Sectional Studies ; Bed Occupancy/economics ; Analysis of Variance