Bed use in the medical wards of Red Cross War Memorial Children's Hospital, Cape Town.

OBJECTIVE

To determine extent of appropriate (medically necessary) and inappropriate bed use and level of care (LOC) needed by patients admitted to hospital.

DESIGN

A cross-sectional, descriptive survey.

SETTING

Medical wards of Red Cross War Memorial Children's Hospital (RCCH), a teaching hospital of the University of Cape Town.

MEASUREMENT AND RESULTS

A 25% sample of beds was selected randomly each day for 12 consecutive days during September-October 1990. Data were collected using a questionnaire based on the Pediatric Appropriateness Evaluation Protocol and the Delay Tool. A subjective measure of LOC was developed. Questionnaires were completed for 171 admissions and 365 patient days; 98% of admissions and 79.5% of patient days were medically justified, and 49% of admissions needed tertiary care. The remaining 51% could have been treated by general paediatricians (17%) or medical officers (32%) in community hospitals. Of delays (unnecessary patient days) 62% were hospital-related, 20% were family-related and 18% were related to inadequate lower level institutional care and outpatient services.

CONCLUSION

RCCH is functioning as a general, specialist and super-specialist hospital. Its future role as a tertiary referral centre will depend on adequate provision of community-based care. Further cost-benefit research is needed to address areas of inappropriate bed use identified in this study.