Arthritis as a cause of prolonged in-patient admission in acute medical beds

A. Keough and J. R. Kirwan

Academic Rheumatology Unit, Bristol Royal Infirmary, Bristol BS2 8HW, UK

SIR, With the ever-increasing drive for efficient use of resources in the NHS, many hospitals have seen a decrease in dedicated in-patient rheumatology beds with more emphasis on the provision of out-patient services. However, it is well recognized that hospital discharges are delayed for non-medical reasons. Selker et al. found that 30% of discharges were delayed for these reasons [1]. Measures such as discharge planning [2] and the diversion of winter money to purchasing residential and intermediate care [3] beds can reduce the number of lost bed days. What is not clear is whether patient stays in acute medical beds are being prolonged due to musculoskeletal problems.

As part of a review of acute services, we undertook an audit of the reasons for continuing admission of all medical in-patients on one day at the Bristol Royal Infirmary. Although there are no rheumatology beds on site, there is provision for rheumatology in-patients at another hospital 4 miles away. Using the nursing cardex and senior ward nurse as sources of data, we gathered information including age, reason for admission, reasons for continued admission on the day of the survey and presence of arthritis as the cause of continuing admission.

There were 240 medical in-patients on the day of the survey (Table 1Go). Of these, 48 (20%) were awaiting placement or a care package. There were nine patients (‘arthritis patients’) whose active problem and reason for continued hospital admission was a musculoskeletal condition (Table 1Go). Three patients had rheumatoid arthritis, one had rheumatoid arthritis and osteoarthritis, two had osteoarthritis and three had ‘arthritis' unspecified.


View this table:
[in this window]
[in a new window]
 
TABLE 1. Reasons for admission and for continued in-patient stay

 
It seems likely that for many of the arthritis patients the presenting complaint was directly or indirectly related to their arthritis, and their continued in-patient stay was due to arthritis. These findings give a minimum estimate of the true in-patient burden caused by arthritis because of the under-recognition of locomotor symptoms and signs [4]. More research is needed to discover if dedicated on-site rheumatology beds and staff can actually reduce the total number of days in hospital and potentially save precious NHS resources as well as delivering a more patient-centred service.

Notes

Correspondence to: A. Keough. E-mail: adk{at}doctors.org.uk; alex.keough{at}virgin.net Back

References

  1. Selker HP, Beshansky JR, Pauker SG, Kassirer JP. The epidemiology of delays in a teaching hospital: The development and use of a tool that detects unnecessary hospital days. Med Care 1989;27:422–8.
  2. Parkes J, Shepperd S. Discharge planning from hospital to home (Cochrane Review). In: The Cochrane Library, Issue 3. Oxford: Update Software, 2002.
  3. Pascoe G. Hospital discharges: Creating bed room. Health Serv J 2001;111:28–9.
  4. Doherty M, Abawi J, Pattrick. Audit of medical inpatient examination: a cry from the joint. J R Coll Physicians Lond 1990;24:115–8.[ISI][Medline]
Accepted 22 November 2002