Enhancing appropriateness of acute bed use: role of the patient hotel.

OBJECTIVE--This study aimed to assess the appropriateness of bed use by determining patients' suitability for patient hotel accommodation and day treatment and by examining timeliness of discharge, and to assess patient and staff views about patient hotels. DESIGN--Patients were assessed by a doctor and nurse in terms of an agreed case definition for patient hotel use. Patient suitability was validated and patient acceptability measured by semi-structured interviews with a random sample of patients judged suitable for hotel accommodation. All senior medical and nursing staff completed a further questionnaire. SETTING--The study took place at University Hospital of Wales, Cardiff (856 beds), and all specialties, except intensive care wards, participated. SUBJECTS--Patients occupying a total of 3972 bed days, accumulated over seven randomly chosen census days, were studied. RESULTS--Data were available for 88% of eligible inpatients. Ten per cent (405 of 3972) of patients were judged suitable for a patient hotel. Specialties indicating major use were obstetrics and gynaecology, general surgery, and general and geriatric medicine. Sixty three per cent (254 of 405) of these subjects required low level investigation or treatment. Preoperative and postoperative and antenatal patients were often suitable also. Three per cent (119 of 3972, 95% confidence interval 2.5, 3.6%) of inpatients were judged suitable for day treatment/investigation. Seventy nine per cent (291 of 369) of patients suitable for discharge were discharged on the same or the next day. The patient hotel idea was acceptable to 58 of 68 (85%) randomly selected patients and to 84 of 93 (90%) staff. CONCLUSIONS--With allowance for non-response, our study indicates that a general hospital of this size generates the need (inpatients, relatives, and ward attenders) for a mean of 72 patient hotel beds. There is also residual scope for increasing day treatment/investigation and for releasing beds by speeding discharge. The patient hotel idea is highly acceptable to both patients and staff and should be widely considered as a means of making patient care more efficient.