Hospital Bed Utilization: Perceptions of Healthcare Practitioners from Northern India

Hospital bed utilization is influenced by various factors which may be categorized into patient-related, physician-related, and administration-related issues. It could be argued that the causes of inappropriate hospital bed utilization would be perceived differently by the clinicians and the patients. Given the unique role of clinical practitioners in quality of care, their views on the causes of inefficient hospital resources use should be referred to in any improvement initiative. The aim of this study, thus, was to survey the factors influencing utilization of hospital beds as perceived by the resident doctors and nurses. This cross sectional study was conducted in an apex tertiary care public institution in northern region of India. All the resident doctors and nurses from 18 wards of 7 specialties and 7 super specialties were interviewed using a structured validated self-administered questionnaire. The data were summarized by descriptive statistical methods and analyzed using ANOVA and Chi-square tests. While a substantial percentage of clinicians perceived that hospital beds were inappropriately utilized, resident doctors were more convinced of inefficient hospital bed utilization than nurses. High expertise of the doctors, reputation the institution, and limited autonomy of residents were perceived as the causes for overstay. In addition, resident doctors considered lack of training, clear-cut job description, and long duty hours as the reasons for inappropriate bed utilization, while their nursing counterparts did not opine such. Most doctors agreed that lack of appropriate policy for and lengthy procedures of admission and discharge influence the hospital stay, whereas corresponding emphasis was not recorded among the nurses. Also, congruent with some previous studies, the majority of the nurses and doctors perceived that ineffective hospital information system, absence of standard operating procedures and quality assurance mechanisms in ward management could influence utilization of hospital resources. While nurses highlighted administrative factors as the major causes of overstay, the resident doctors perceived all examined factors, including patient-related, physician-related and administrative factors to be important, though in agreement with their nursing counterparts they gave a higher weight to the administrative issues. The information provided on the relative importance of factors contributing to patient overstay as perceived by the clinicians may help policy-makers and administrators to promote more efficient utilization of healthcare system resources. According to our study, administrative factors, including development of standard operating procedures and promoting quality assurance mechanisms in ward management should receive priority in intervention.