Background: Through the years of improving quality health service delivery, hospital bed capacity in the Philippines has remained to be a persistent challenge. In light of the aim of the Universal Health Care Act to protect and promote the right to health of every Filipino, one metric used to identify areas that are in most need or are under served, is the number of public hospital beds vis a vis the catchment population. Methods: The systematic review of literature was utilized to generate a policy brief presented to the invited stakeholders of the policy issue for the roundtable discussion participated by all key stakeholders of the policy issue. Evidence and insights were thematically analyzed to generate consensus policy recommendations. Results: With the current hospital bed availability and maldistribution, the Philippines still faces compounded issues in addressing healthcare demands. Currently, the request for increasing bed capacity is done through legislation. In context, this request is also parallel in expanding service capacity through the allocation of more funds and personnel. The ratio of private and charity beds must ensure to have equity among all patients of varying segments of the population. Enjoining private hospitals to share bed capacity for public service was also explored given appropriate subsidies. Conclusion and Recommendation To ensure equity in health service delivery, it is imperative to assess, strategize, and conduct prioritization of the needs of government hospitals for increased bed capacity, considering the distribution, socio-demographic profile, and health needs of the catchment population.
Privatization ; Philippines ; Hospital Bed Capacity

Ambulatory Care ; COVID-19 ; Health Facility Planning ; Hospital Bed Capacity ; Hospitals, Rehabilitation ; Humans ; Infection Control ; Rehabilitation ; Remote Consultation ; SARS-CoV-2 ; Singapore ; Telerehabilitation ; Triage

BACKGROUND/AIMS: The modified early warning score (MEWS) is used to predict patient intensive care unit (ICU) admission and mortality. Lactate (LA) in the blood lactate (BLA) is measured to evaluate disease severity and treatment efficacy in patients with severe sepsis/septic shock. The usefulness of a combination of MEWS and BLA to predict ICU transfer in severe sepsis/septic shock patients is unclear. We evaluated whether use of a combination of MEWS and BLA enhances prediction of ICU transfer and mortality in hospitalized patients with severe sepsis/septic shock. METHODS: Patients with severe sepsis/septic shock who were screened or contacted by a medical emergency team between January 2012 and August 2012 were enrolled at a university-affiliated hospital with ~2,700 beds, including 28 medical ICU beds. RESULTS: One hundred patients were enrolled and the rate of ICU admittance was 38%. MEWS (7.37 vs. 4.85) and BLA concentration (5 mmol/L vs. 2.19 mmol/L) were significantly higher in patients transferred to ICU than those in patients treated in general wards. The combination of MEWS and BLA was more accurate than MEWS alone in terms of ICU transfer (C-statistics: 0.898 vs. 0.816, p = 0.019). The 28-day mortality rate was 19%. MEWS was the only factor significantly associated with 28-day mortality rate (odds ratio, 1.462; 95% confidence interval, 1.122 to 1.905; p = 0.005). CONCLUSIONS: The combination of MEWS and BLA may enhance prediction of ICU transfer in patients with severe sepsis/septic shock.
Adult ; Aged ; Biomarkers/blood ; *Decision Support Techniques ; Female ; Health Status ; *Health Status Indicators ; Hospital Bed Capacity ; Hospital Mortality ; Hospitals, University ; Humans ; *Intensive Care Units ; Lactic Acid/*blood ; Male ; Middle Aged ; *Patient Transfer ; Predictive Value of Tests ; Prognosis ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Sepsis/blood/*diagnosis/mortality/therapy ; Shock, Septic/blood/*diagnosis/mortality/therapy ; Time Factors

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*

Regional hub neonatal intensive care centers are opening supported by Ministry of Health and Welfare, with the need for more neonatal intensive care unit (NICU) beds response to increasing number of prematurity. Besides beds expansion, functional role of NICU is important and the evaluation tool of functional analysis of NICU is necessary. In this review, admission of preterm infant born before 32 gestational weeks was considered as a functional component and the annual number of those babies was used as an activity marker. The activity of NICU was higher with increased bed number, but also increased equipment, NICU personnel, obstetric personnel were independent factors for the higher NICU activity. Levels of NICU can be defined according to the activity, and reference bed size, equipment, personnel can be defined according to each level. In reverse, functional analysis of NICU can be performed with known bed size or equipment predicting activity level. Meanwhile, the evaluation of 13 regional hub NICU revealed that they partially contributed to the regionalization of NICU, and the activity was increased in all regional hub NICUs. Three regional hub NICUs showed markedly increased activity after opening, and those centers showed increased NICU personnel and obstetric personnel compared to other centers. In terms of regional hub government support, multilateral plan should be operated, besides simple bed size, considering distribution of different functional level of regional NICUs and leaking patient in the region.
Hospital Bed Capacity ; Humans ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal

BACKGROUND/AIMS: The high mortality attributable to persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia in spite of glycopeptide treatment has heightened the need for early detection and intervention with alternative agents. The purpose of this study was to determine the clinical characteristics of and risk factors for persistent MRSA bacteremia. METHODS: All first episodes of significant MRSA bacteremia at a 710-bed academic medical center from November 2009 through August 2010 were recorded. Blood cultures were conducted at 3 days and every 2 to 3 days thereafter until clearance. Clinical characteristics and outcomes were compared between persistent MRSA bacteremia (> or = 7 days) and nonpersistent MRSA bacteremia (< or = 3 days). RESULTS: Of 79 patients with MRSA bacteremia during the study period, 31 (39.2%) had persistent MRSA bacteremia. The persistent MRSA bacteremia group had significantly higher 30-day mortality than the nonpersistent MRSA bacteremia group (58.1% vs. 16.7%, p < 0.001). Multivariate analysis indicated that metastatic infection at presentation (odds ratio [OR], 14.57; 95% confidence interval [CI], 3.52 to 60.34; p < 0.001) and delayed catheter removal in catheter-related infection (OR, 3.80; 95% CI, 1.04 to 13.88; p = 0.004) were independent predictors of persistent MRSA bacteremia. Patients with a time to blood culture positivity (TTP) of < 11.8 hours were at increased risk of persistent MRSA bacteremia (29.0% vs. 8.3%, p = 0.029). CONCLUSIONS: High mortality in patients with persistent MRSA bacteremia was noted. Early detection of metastatic infection and early removal of infected intravascular catheters should be considered to reduce the risk of persistent MRSA bacteremia. Further studies are needed to evaluate the role of TTP for predicting persistent MRSA bacteremia.
Academic Medical Centers ; Aged ; Anti-Bacterial Agents/therapeutic use ; Catheter-Related Infections/diagnosis/drug therapy/*microbiology/mortality ; Catheters, Indwelling/*adverse effects ; Comorbidity ; Device Removal ; Female ; Hospital Bed Capacity ; Humans ; Logistic Models ; Male ; Methicillin-Resistant Staphylococcus aureus/drug effects/*isolation & purification ; Middle Aged ; Multivariate Analysis ; Neoplasms/microbiology/mortality ; Odds Ratio ; Prospective Studies ; Republic of Korea ; Risk Factors ; Staphylococcal Infections/diagnosis/drug therapy/*microbiology/mortality ; Time Factors ; Treatment Outcome

This paper was aimed to find an efficient plan for the arrangement of the beds in hospitals so that the bed-operating efficiency could be raised and the requirements of patients could be perfectly met. After analyzing the data using the method of mathematical statistics, we defined the concept of "Waste Index". In addition to the concept, we realized the auto-simulation of the model using the dynamic programming model, and design the program by MATLAB. We got the characteristics of bed-occupation conditions by data analysis. We obtained the result of optimizing model by programming and the most efficient plan which was obviously better than the traditional FCFS (First Come First Serve) plan. It can be well concluded that the mathematical model should be of great maneuverability in the practical situation to ameliorate the management efficiency of hospital beds considerably.
China ; Efficiency, Organizational ; Hospital Administration ; Hospital Bed Capacity ; Humans ; Models, Theoretical ; Ophthalmology ; Patient Admission

OBJECTIVE: To construct prediction model for health workforce and hospital beds in county hospitals of Hunan by multiple linear regression. METHODS: We surveyed 16 counties in Hunan with stratified random sampling according to uniform questionnaires,and multiple linear regression analysis with 20 quotas selected by literature view was done. RESULTS: Independent variables in the multiple linear regression model on medical personnels in county hospitals included the counties' urban residents' income, crude death rate, medical beds, business occupancy, professional equipment value, the number of devices valued above 10 000 yuan, fixed assets, long-term debt, medical income, medical expenses, outpatient and emergency visits, hospital visits, actual available bed days, and utilization rate of hospital beds. Independent variables in the multiple linear regression model on county hospital beds included the the population of aged 65 and above in the counties, disposable income of urban residents, medical personnel of medical institutions in county area, business occupancy, the total value of professional equipment, fixed assets, long-term debt, medical income, medical expenses, outpatient and emergency visits, hospital visits, actual available bed days, utilization rate of hospital beds, and length of hospitalization. CONCLUSION The prediction model shows good explanatory and fitting, and may be used for short- and mid-term forecasting.
China ; Forecasting ; Hospital Bed Capacity ; Hospitals, County ; Humans ; Linear Models ; Models, Theoretical ; Workforce

INTRODUCTIONBased on the estimate results of the capacity and preparedness of Beijing hospitals to respond to pandemic influenza, using flu surge model to evaluate its applicable hypothesis and to provide government with sentient strategy in planning pandemic influenza. Through collection of medical resources information, we calculated the possible impaction on hospitals by Flu Surge model and explored the applicable hypothesis in model operation through a questionnaire, direct observation and group discussion in 3 hospitals in Beijing. Based on flu surge model estimation during a 6-week epidemic from a pandemic virus with 35% attack rate, Beijing would have had an estimation of 5 383 000 influenza illnesses, 2 691 500 influenza outpatients, 76 450 influenza hospitalizations and 14 508 excess deaths. For a 6-week period with 35% attack rate, there would be a peak demand for 8% of beds, 210% of ICU beds, and 128% of ventilators estimated. Outpatients in different level hospital were quite disproportionated with 1742/ hospital/day, 650/hospital/day, and 139/hospital/day respectively. The sampled health workers had a mastery of 63.4% of the total knowledge and skills of diagnosing and treating of influenza, 73.5% of them washed their hands and 63.5% used PPE correctly. The total beds capacity, medical beds capacity and respiratory medical beds capacity would increase 8%, 35% and 128% respectively.

CONCLUSIONThe estimation results could be referenced when planning the pandemic strategy, but the results should be treated objectively when considering the hypothesis and practical situation in this model being used.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Disease Outbreaks ; statistics & numerical data ; Female ; Hospital Bed Capacity ; Hospital Planning ; Hospitalization ; statistics & numerical data ; Humans ; Infant ; Infant, Newborn ; Influenza, Human ; epidemiology ; Male ; Middle Aged ; Models, Statistical ; Surge Capacity ; Young Adult

PURPOSE: This study was performed to give direction to quality improvement strategies of nursing services by comparing the differences in quality perceptions and satisfaction for nursing services between patients and nurses in small-medium sized general hospitals with 200 beds. METHOD: The subjects, who were 150 inpatients and 162 nurses of 4 general hospitals in a community, answered a self-report questionnaire with a SERVQUAL scale. RESULT: There were differences between patients' and nurses' expectations and perceptions of nursing service and satisfaction. In the service expectation, the highest factor was 'the responsiveness', and in the perceived performance, the highest was the 'assurance'. In addition, overall patients' perceptions on nursing services showed higher than nurses'. There were positive correlations among the expectations and perceptions on nursing service, and satisfaction. The correlation between perception and satisfaction was higher than the correlation between expectations and satisfaction. CONCLUSION: To improve the nursing service quality at small-medium hospitals, strengthening the 'assurance' factor and improving the nursing service support system is needed. Also, this study on nurses' perceived nursing service at small-medium sized hospitals should be duplicated.
Adolescent ; Adult ; Attitude of Health Personnel ; Female ; Hospital Bed Capacity ; *Hospitals, General ; Humans ; Korea ; Male ; Middle Aged ; Nursing Services/*standards ; Nursing Staff, Hospital/*psychology ; *Patient Satisfaction ; *Quality of Health Care