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 1). 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 1
). Three patients had rheumatoid arthritis, one had rheumatoid arthritis and osteoarthritis, two had osteoarthritis and three had arthritis' unspecified.
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Notes
Correspondence to: A. Keough. E-mail: adk{at}doctors.org.uk; alex.keough{at}virgin.net
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