Instrument for objective assessment of appropriateness of surgical bed occupancy: validation study

The number of hospital beds per head of population has fallen by more than 2% a year since 1980.1 Levels of bed occupancy have risen during this period.1 Appropriate bed occupancy is crucial to the NHS, as occupancy rates exceeding 85% in acute hospitals are associated with problems in dealing with emergency and elective admissions.1 We aimed to develop a valid instrument for the objective assessment of appropriateness of occupancy of surgical beds. We drew potential criteria for the instrument from analyses of the medical notes of 200 general surgical inpatients. We chose criteria such that if any one was met we could judge that particular day of surgical care to be appropriate. We shortlisted the criteria after each had been scrutinised by a consultant physician or surgeon of the relevant subspecialty, and we structured them into an instrument. We modified the instrument (box) after a pilot study of 40 bed days. We conducted a validation study on 100 bed days in a general surgical unit with an interest in colorectal surgery. We selected 10 bed days once a week for 10 weeks by using computer generated random numbers. Two …