Myths of Ideal Hospital Occupancy Article Critique

While these critiques are certainly valid, and the authors clearly demonstrate, as stated in the abstract, that more research may be required, their approach also underlines the weaknesses of a literature review-based article to make a healthcare proposal. Another problem with the use of literature reviews is that it can be difficult to present the results in a meaningful fashion in a chart or graph, to demonstrate the researcher's findings. The format of a literature review -- drawing upon the statistical evidence of a wide range of studies and examining general trends, patterns, and weaknesses -- often means it is comparing apples to oranges, as every study has a slightly different format. The article has a deconstructive purpose, but offers nothing constructive to suggest in the policy's place.

But more disturbingly, there are serious repercussions if the author's ideas are taken seriously, given the problems that could ensue with overcrowding and overburdened healthcare professionals. While the idea that the uniqueness of different healthcare facilities may seem self-evident, it also seems evident that even a non-acute, well-staffed setting at 95% capacity might experience quality-of-care deficits. Additionally, in the event of an emergency or the need to operate under extraordinary circumstances, an already overburdened, nearly fully 'booked' hospital might experience extreme resource strain upon staff and medical supplies. The focus of the analysis is upon the crises that result in turnover or 'bed blockage' or when not enough patients are leaving the hospital to allow for incoming patients. But even if a higher rate of capacity than 85% is possible without 'bed blockage,' a single-minded focus upon this issue ignores other, serious concerns related to capacity beyond that of merely finding enough space for patients.

The article's conclusion seems intuitive -- that 85% is too arbitrary a figure to be merely asserted, without question, as straining the resources of all facilities and resulting in bed blockage. On the other hand, there is the question of what the consequences might be if this requirement was waived, and hospitals attempted to maximize their capacity to a greater degree.The authors assert: "new tools that continually monitor service utilization and estimate future mismatches between patient demand and hospital capacity obviate the need for an arbitrary figure such as 85%. The mathematical modeling that lies behind these tools is reasonably well understood, but the models still need to be tailored to fit different hospital environments" (Taylor, McDonnell & Georgiou 2010:42). But estimating overcapacity to such a fine degree and trying to press the limits of the facility seems dangerous, given that such a site-specific model would presumably have to take into consideration the experience levels of nurses, fatigue of residents, and other factors that might affect patient care. Even if a statistical analysis suggested that the facility could operate at a higher level of capacity without problems of bed blockage and patient bed turnover rates, the limits of looking at bed blockage rates alone seem dubious.

Instead of attempting to determine if hospitals can operate at higher levels of capacity to make use of existing resources, a more fruitful study might be how to better use existing resources to reduce contributors to patient care deficits when facilities are operating at a high level of capacity, such as reducing physician and nurse fatigue, and reducing errors. Bed blockage cannot be studied in isolation -- the reasons that cause it may be due to compromised patient care that results in longer patient stays due to caregiver fatigue, or other systemic reasons. The article does have a point that current 'queuing' research may be too narrowly focused on acute units and turnover rates, but simply applying a narrow focus to a wider range of facilities does not present a holistic portrait enough of overburdened hospitals today.

Reference

Bain, Christopher a.; Peter G. Taylor, Geoff McDonnell & Andrew Georgiou. (2010, January

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