Henley L, Smit M, Roux P, Zwarenstein M
Department of Paediatrics and Child Health, University of Cape Town.
S Afr Med J. 1991 Nov 16;80(10):487-90.
To determine extent of appropriate (medically necessary) and inappropriate bed use and level of care (LOC) needed by patients admitted to hospital.
A cross-sectional, descriptive survey.
Medical wards of Red Cross War Memorial Children's Hospital (RCCH), a teaching hospital of the University of Cape Town.
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.
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.
确定入院患者合理（医疗必需）和不合理床位使用情况以及所需护理级别。
横断面描述性调查。
开普敦大学教学医院红十字战争纪念儿童医院（RCCH）的内科病房。
在1990年9月至10月期间，连续12天每天随机抽取25%的床位样本。使用基于儿科适宜性评估方案和延误工具的问卷收集数据。制定了护理级别的主观测量方法。完成了171例入院病例和365个患者日的问卷调查；98%的入院病例和79.5%的患者日有医学依据，49%的入院病例需要三级护理。其余51%的病例可由社区医院的普通儿科医生（17%）或医务人员（32%）治疗。在延误（不必要的患者日）中，62%与医院相关，20%与家庭相关，18%与较低级别机构护理和门诊服务不足有关。
RCCH作为一家综合、专科和超级专科医院发挥着作用。其未来作为三级转诊中心的作用将取决于社区护理的充分提供。需要进一步进行成本效益研究，以解决本研究中确定的不适当床位使用领域的问题。
