Ellis B W, Rivett R C, Dudley H A
Ashford Hospital, Middlesex.
BMJ. 1990 Jul 21;301(6744):159-62. doi: 10.1136/bmj.301.6744.159.
To create a means by which we can examine and understand the interrelations among the fundamental elements of hospital inpatient care (patients, beds, theatre time, and staff).
Predictive study of resource utilisation based on a computerised clinical information system of five years' audit data from a surgical management system.
One surgical firm (of one consultant, one registrar, and one preregistration houseman) in a district general hospital.
5267 Patients whose admission records were part of the five years' audit of surgical management.
Mean length of stay; number of occupied beds; turnover interval; throughput (patients/bed); percentage elective theatre occupancy; waiting time for elective admissions; and theatre, hotel, and total costs.
Predicted outcome was analysed in the model, taking the actual outcomes in 1988-9 as baseline values, for four clinical scenarios: an increase in accident and emergency admissions, a reduction in beds, a reduced length of stay, and creation of a new firm. Baseline values showed a mean stay of just over five days in 15 beds and with a theatre occupancy of 94%; the total cost was 812,000 pounds (hotel costs 597,000 pounds). Increasing the accident and emergency admissions to 460/year (19%), based on projected trends from 1984 to 1988, resulted in increased hotel costs (55,000 pounds) and reducing bed numbers (by halving admissions) in decreased use of theatres to 71%, decreased throughput, and increased waiting time, from 20 to 92 weeks, at a saving of 99,000 pounds (12%). Reducing stay marginally reduced bed occupancy (8%) and hotel costs (14%), and creating a new surgical team considerably reduced bed occupancy (14%) and waiting time for elective operations (by 20%). The minimum number of beds for referrals, accident and emergency admissions, and planned admissions was 9.0; that for urgent elective admissions was 3.3 and for non-urgent admissions was 2.4.
A well designed clinical information system with the routine collection of data can provide the necessary output data to enable resource modelling.
Use of such a model will allow clinicians to participate in resource planning on the basis of what is actually happening within the hospital.
创建一种方法，通过该方法我们能够检查和理解医院住院护理的基本要素（患者、床位、手术时间和工作人员）之间的相互关系。
基于一个外科管理系统的五年审计数据的计算机化临床信息系统对资源利用情况进行预测性研究。
一家地区综合医院的一个外科科室（由一名顾问医生、一名住院医生和一名预注册实习医生组成）。
5267名患者，其入院记录是外科管理五年审计的一部分。
平均住院时间；占用床位数；周转间隔；周转率（患者数/床位）；择期手术占用率百分比；择期入院等待时间；以及手术室、病房和总成本。
以1988 - 199年的实际结果作为基线值，在模型中分析了四种临床情景下的预测结果：急诊入院人数增加、床位减少、住院时间缩短以及创建一个新科室。基线值显示，15张床位的平均住院时间略超过5天，手术室占用率为94%；总成本为81.2万英镑（病房成本59.7万英镑）。根据1984年至1988年的预测趋势，将急诊入院人数增加到每年460例（增加19%），导致病房成本增加（5.5万英镑），而减少床位数（通过将入院人数减半）则使手术室使用率降至71%，周转率降低，等待时间从20周增加到92周，节省了9.9万英镑（12%）。略微缩短住院时间可使床位占用率降低（8%）和病房成本降低（14%），创建一个新的外科团队可大幅降低床位占用率（14%）和择期手术等待时间（降低20%）。转诊、急诊入院和计划入院的最少床位数为9.0；紧急择期入院的最少床位数为3.3，非紧急入院的最少床位数为2.4。
一个精心设计的临床信息系统，结合常规数据收集，能够提供必要的输出数据以实现资源建模。
使用这样的模型将使临床医生能够根据医院实际发生的情况参与资源规划。
