Styrborn K, Thorslund M
Department of Social Medicine, University Hospital, Uppsala, Sweden.
Scand J Soc Med. 1993 Dec;21(4):272-80. doi: 10.1177/140349489302100407.
With an ageing population an increased pressure on health care resources will be seen in most countries. Patients with delayed discharge from short-term hospitals, sometimes called "bed-blockers", are of special interest in Sweden, especially as liability for payments for these patients has been placed on the municipal authorities by a new reform in 1992. A retrospective study was made of 428 bed-blockers above the age of 64 years from one health district in Uppsala during the two-year period 1987-1988. The median age was 81.6 years, and the majority were women. The patients had a median number of diagnoses of 4.1. Additional medical events/symptoms were noted in half of the patients after they had been classified as medically ready for discharge. Even though they were classified "medically ready" for discharge, they still needed care. One-third needed further rehabilitation and another 1/3 further medical attention. Only 1/10 were independent in daily activities of living. At the final discharge 1/3 actually returned home and 16% died on the acute ward. The results clearly demonstrate that these patients often still had further medical needs after the application for transfer. One crucial question, that needs discussion, is the vague definition of a "bed-blocker". Related questions are when and where should these patients be transferred, as well as the relevance of the term "bed-blocker" from ethical perspectives.
随着人口老龄化，大多数国家的医疗保健资源压力将会增加。短期医院延迟出院的患者，有时被称为“床位占用者”，在瑞典受到特别关注，尤其是因为1992年的一项新改革将这些患者的支付责任转交给了市政当局。对乌普萨拉一个卫生区1987 - 1988年两年期间428名64岁以上的床位占用者进行了一项回顾性研究。中位年龄为81.6岁，大多数为女性。患者的诊断中位数为4.1项。在一半被判定医疗上已准备好出院的患者中，发现了额外的医疗事件/症状。尽管他们被判定“医疗上已准备好”出院，但仍需要护理。三分之一的患者需要进一步康复治疗，另有三分之一需要进一步的医疗护理。只有十分之一的患者在日常生活活动中能够自理。最终出院时，三分之一的患者实际回家，16%的患者在急症病房死亡。结果清楚地表明，这些患者在申请转院后往往仍有进一步的医疗需求。一个需要讨论的关键问题是“床位占用者”的定义模糊。相关问题包括这些患者何时、何地应该被转院，以及从伦理角度来看“床位占用者”这一术语的相关性。
