Peer review of utilisation of medical beds at Flinders Medical Centre

A clinical audit of all medical inpatients was undertaken and the appropriateness of admissions and of length of stay was assessed from a clinical viewpoint on 4 separate days within an 11 day period. In addition, the mode of entry of hospital, length of stay of patients, occupancy rate, and the vacancy interval were analysed for all medical patients during the preceding three months. The mean length of stay of medical patients in hospital during this 3 months period was 5.6 days, with an occupancy rate of 93% and a vacancy interval of 0.43 days. Seventy-four percent of all medical inpatients were admitted through the Accident and Emergency Department (A&E). The short length of stay, high occupancy rate and low vacancy interval indicated that bed usage in the medical wards was efficient. A total of 493 reviews was carried out on 294 individual patients. In 87% of cases, both admission to hospital and length of stay were appropriate on clinical grounds alone. The number of patients whose admission to hospital (11), or length of stay (27) was not justified on medical grounds alone was 38 (13% of total patients). These patients were elderly, or had complex social and psychological problems contributing to their illness. It was concluded that stricter control of admissions or length of stay was unlikely to make a significant numbers of beds available for other admissions.