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Alternative longer-term solutions needed for hospital reform.
More hospital beds will only give a short reprieve to acute hospital bed shortage, according to a new study.
The study, published in Australian Health Review, suggests alternative longer-term solutions that involve both hospital and non-hospital sectors, such as improving hospital efficiency and decreasing demand for acute hospital beds.
“There is a growing demand for inpatient care in Australia, with presentations to public hospital emergency departments increasing by 4.9 per cent per year over the last five years and admission numbers increasing by 3.6 per cent per year,” said study author Ian Scott, associate professor and director of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital. Brisbane.
“Increasing demand on public hospital beds has led to what many see as a hospital bed crisis requiring substantial increases in bed numbers. However, by 2050, if current bed use trends persist and as the numbers of frail older patients rise exponentially, a 62 per cent increase in hospital beds will be required to meet expected demand, at a cost almost equal to the entire current Australian healthcare budget.
The study examines the effectiveness of different strategies for reducing hospital demand targeting both the hospital sector and the non-hospital sector.
It found that hospitals could be made more efficient by adopting a number of strategies. These include: outsourcing public hospital clinical services to the private sector, undertaking whole-of-hospital reform of care processes and patient flow that address both access and exit block, separating acute from elective beds and services, increasing rates of day-only or short stay admissions, and curtailing ineffective or marginally effective clinical interventions.
“In regards to the non-hospital sector, potentially the biggest gains in reducing hospital demand will come from improved access to residential care, rehabilitation services, and domiciliary support as patients awaiting such services currently account for 70 per cent of acute hospital bed-days,” Scott said.
“More widespread use of acute care and advance care planning within residential care facilities and population-based chronic disease management programs can also assist.”
Overall, the study concludes that, in reducing hospital bed demand, clinical process redesign within hospitals and capacity enhancement of non-hospital care services and chronic disease management (CDM) programs are effective strategies that should be considered before investing heavily in creating additional hospital beds devoid of any critical reappraisal of current models of care.
“The potentially biggest gains in hospital productivity will come from improved access to residential care, rehabilitation services, and domiciliary support combined with population-based CDM programs led by primary care agencies, and acute care and advance care planning.”
“There are no magic bullets for increasing hospital capacity or decreasing hospital demand. Health service managers must assess potential strategies on the basis of evidence and not prematurely adopt strategies promoted by enthusiasts that lack proof of concept, adequate pilot evaluations, and evidence of cost-effectiveness.
There remain two elephants in the room, Scott said. Increasingly unsustainable expectations of more hospital care driven by doctors, politicians, the media and the community itself; and inefficiencies maintained by separate funding of hospital and community healthcare by two different levels of government.
“We need a public debate about the role of hospitals within the healthcare system and how we can manage future population healthcare needs in a sustainable way. In the meantime, all hospitals must consider implementing reforms with potential to improve their productivity and reduce access block for those who really need acute hospital care.”
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