位于美国大城市的一家拥有750张床位的教学医院再次人满为患. 没有住院床位. 的 hospital is forced to board patients in hallways and procedural recovery areas. Its emergency department (ED) has been put on diversion, sending emergency transports bearing nontrauma patients to other EDs in the area.
Scenarios like this have become common for many hospitals, 尤其是在城市地区, and patients are worried about whether the services they need will be available. 医院 are concerned about maintaining quality, 改善患者体验, 尽量减少对底线的影响.
专家警告说,越来越多的医院床位将被闲置,因为纳税人要求在更便宜的环境中提供医疗bet8娱乐. 但如果住院病人数量呈下降趋势, why are many hospitals scrambling to find additional beds?
利用的转变
Utilization data suggests that a large portion of patient volume is not declining, 但转移:观察病人经常被关在住院病房,由病房护士照顾. 结果是, 可用于急诊科住院病人或手术恢复期病人的床位越来越少.
This trend presents a strategic dilemma for hospital leadership. From a facility and capital planning perspective, hospitals experiencing bed shortages must decide whether to invest in new beds.
医院应该投资新床位吗?
随着医院采用新的护理模式, it’s likely that fewer observation patients will be cared for in the hospital. 例如, COVID - 19大流行期间取得的远程医疗成果表明,通过适当的门诊随访,可以在患者家中对其进行监测. 另外, 来访的临床bet8网站备用可以为在家中或类似酒店的环境中从手术中恢复的患者提供支持. 考虑到这些趋势, 医院除了增加住院容量之外,还有其他选择来解决单位床位使用效率低下的问题,特别是因为对床位容量的需求在不断发展.
医院 must put the foundations in place (e.g., 护理管理结构, 技术, and digital capabilities) to safely care for patients in less expensive settings. 这正迅速成为一种经济上的需要,有些人甚至认为这是一种道德义务. 进一步, alternative payment structures are becoming prevalent, holding provider organizations at risk for a greater share of total health costs.
Many hospitals need observation beds now—and will for the foreseeable future. Investing in a dedicated observation unit or units can result in a positive ROI. 一项研究 showed hospitals establishing observation units could save $1,平均每个病人572, 除了为有需要的病人腾出专门护理床位所获得的收入外,还代表着收入. 通过调整每位患者的适当临床工作人员水平,可以实现额外的成本效益.
然而,关键是要确保这一点
facility designs are flexible enough to adapt as needed on a daily, seasonal,
或者紧急情况.
深入研究利用率
Utilization data sheds further light on the issue. 正如许多人预测的那样,在美国各地,住院人数正在下降. 全国住院病人使用率以每年1%的复合增长率(CAGR)下降.0% since the Affordable Care Act was signed into law. Inpatient admissions decreased from 114 per 1,000 population in 2010 to 104 in 2015and have remained stagnant between 103 and 105 through 2019.
Research also shows that 24-hour-plus observation stays have increased significantly. Among Medicare patients, these stays grew 22.1%,从2011年到2013年, a 10.5%的复合年增长率. This trend has continued through at least 2014, 这一趋势在商业计划的患者身上也同样适用(尽管增长速度没有那么快)。, 如下所示.
When examined together, what do these trends suggest?
According to a Medicare Payment Advisory Commission 分析 40%的住院病人 decline can be explained by hospital patients being classified as under 观察而非承认. 这是一个相当大的比例,这很有帮助 explain why many hospitals are exploring the need to add capacity when they had 计划裁员. From a strategic perspective, it’s important to note that 60% of the inpatient decline is not explained by the shift to observation. 的 trend toward outpatient care is still occurring, just not quite as fast as some 统计数据显示.
观察床位与住院床位
While observation patients are considered outpatients by all payers, they often spend time in the hospital—sometimes one or two nights. 但是他们需要什么样的床呢?
比较住院床位和观察床位的不同资源和空间需求是有帮助的. 住院病房往往是私人的, have generous footprints (260 to 300-plus net square feet at contemporary standards), 而且大多数都有浴室. Observation beds have less stringent space and configuration requirements. Although hospital leaders want a pleasant environment for observation patients, particularly given the renewed focus on patient-centered care and satisfaction, 住宿不需要像住院室那样全面或昂贵.[1]
灵活的设施空间
解决能力限制的一个解决方案是建立一个专门的观察室,以照顾不符合住院标准的短期住院病人, 但在出院前需要长期护理. 这一选择决定了符合这些患者特定需求的资源和设计, 包括适当的人员配备水平, 空间配置, 功能性邻接. 与此形成鲜明对比的是, 被安置在住院病房的观察患者最终可能会在医院呆的时间超过必要的时间, 他们的护理方案不太统一, 而且管理成本更高.
Not all observation patient types are the same. 分类有以下几种:
- 在急诊科做出的临床决定.
- 一般医学观察.
- 术后长期恢复.
(医院bet8网站备用和急诊科bet8网站备用), 空间可用性, and the degree of need to free up ED treatment rooms versus inpatient beds, 如下图所示.
的信息样本
academic medical centers, in the table below, shows where their observation
patients are bedded in the absence of an observation unit (or units) and illustrates
some idea of the often diverse needs of these patients. 心脏外科
(M-S) and intensive care units (ICUs) treat a high proportion of the
observation beds outside of the ED, while labor and delivery (L&D)患者
在专门的L&D单位.
Finding space for a new bed unit can be difficult; many hospitals in urban settings are facing capacity constraints. 但是,当考虑到观察单元的较小空间要求时,可能会出现其他选择. 一些遇到能力限制的医院一直在实施观察和延长康复床位,其数量约相当于其总住院床位容量的5%至10%. This percentage depends on the specific market dynamics, the scale and service mix of the inpatient facility, bet8网站备用保险, 除其他因素外. 除了, a business occupancy classification should be considered for observation beds, 尤其是门诊手术, 为了进一步减少成本和空间限制,通常与为住院病人入住而设计的建筑物相关.
Having a scalable facility plan is important, particularly as outpatient care models continue to expand and become 根深蒂固的. To help mitigate financial risk, an observation unit should be designed with flexibility in mind to accommodate multiple patient types over time. 为 example, building these units adjacent to EDs is typically a good strategy. Most observation patients originate in the ED and may be cared for by ED staff, and the units can be readily converted to additional ED treatment space should 需求出现了. 的 same is true for observation units adjacent to procedural recovery or outpatient clinic space, which provide a logical expansion path for 这些bet8娱乐.
规划未来
最近与COVID - 19大流行相关的人口普查波动明确了我们对医疗中心如何才能最好地适应突然甚至可能长期涌入的复杂情况的思考, 高传染性病人——如何根据病人的病情进行分类和隔离, 把病人放在哪里最好, 以及如何管理员工和资源. 平衡短期空间需求与长期目标和预测可能是一项挑战, 观察单位, 就其本质而言, 医疗保健组织的适应性投资是否能够容纳大量卧床病人.
通过设计可扩展的, 为观察患者提供灵活的病房, 住院护理中心——从农村社区医院到城市学术医疗中心——可以立即实现收入目标, 为他们的社区提供及时的护理, 为未来的需求做好准备.
了解更多关于医院如何在今天提高能力的同时为明天住院bet8娱乐的减少做计划的信息!
脚注
- 1.
To be in accordance with 2018 FGI guidelines, each inpatient room must have natural light by means of a window to the outside and private patient toilet rooms, among other requirements.
出版于2021年12月7日