Petty R, Gumpel M
Department of Medicine, Northwick Park Hospital, Harrow, Middlesex.
J R Coll Physicians Lond. 1990 Jan;24(1):32-5.
The aim of this study was to gather information on the consequences of hospital bed closures on acute admission patterns. Each November during 1986-1988 we carried out a survey of requests and referrals for acute medical admission to Northwick Park Hospital (NPH). Between the first study in 1986 and the second study in 1987, 15 acute medical and 16 surgical beds were closed. In 1986 the hospital was 'full' and closed overnight to admissions from general practitioners (GPs) on 3/25 days. In 1987 this had increased to 16/27 days and in 1988 it was closed overnight on 20/31 days. Because GPs found it unreasonably difficult to admit patients to NPH, the number of patients referred by them fell from 55.8% of all admissions to 49.8% and 44.3%, while the number of self-referred patients rose from 27.1% to 34.5% and 39.1%. An increasing proportion of elderly patients had to be admitted to acute medical beds: those over 75 years of age represented 24.8% of admissions in 1986, 43.7% in 1987, and 43.8% in 1988. These changes have had important effects on our medical practice, and we suggest that audits of this type are necessary to quantify these changes. We make suggestions for improving such medical audits in the future.
本研究的目的是收集有关医院病床关闭对急性入院模式影响的信息。在1986年至1988年期间，每年11月我们都对诺斯威克公园医院（NPH）急性内科入院的申请和转诊情况进行调查。在1986年的首次研究和1987年的第二次研究之间，15张急性内科病床和16张外科病床被关闭。1986年，该医院“满员”，在25天中有3天夜间停止接收全科医生（GP）转诊的患者。1987年，这一情况增加到27天中有16天，1988年则是31天中有20天夜间关闭。由于全科医生发现将患者转诊至NPH异常困难，他们转诊的患者数量占所有入院患者的比例从55.8%降至49.8%和44.3%，而自行转诊患者的数量从27.1%升至34.5%和39.1%。越来越多的老年患者不得不被收治到急性内科病床：75岁以上的患者在1986年占入院患者的24.8%，1987年为43.7%，1988年为43.8%。这些变化对我们的医疗实践产生了重要影响，我们认为有必要进行此类审计以量化这些变化。我们对未来改进此类医疗审计提出了建议。
