병상 이용의 적절성에 영향을 미치는 요인에 관한 연구 -한 대학병원 자료를 중심으로-

Appropriateness of Bed Utilization in One University Hospital

This study is designed to find clues to make a plan for efficient hospital bed utilization. Author has tried to estimate the level of appropriateness and to find out factors affecting intra-hospital variation of inappropriate bed utilization using modified Appropriateness Evaluation Protocol of which criteria are based on service intensity and patients' conditions. Systematic random sampling was done from the population of inpatients during one month in on university hospital. Data were collected by concurrent and retrospective medical record review and analysed by multiple logistic regression. In medical services, 83.5% of admission reveals appropriate and the level of inappropriate admission shows significant differences by patients' residence, type of department admitted to, admission 개\ulcorner, and length of stay. In surgical services, 97.3% and 34.7% are appropriate in location and timing of surgery respectively. Inappropriate timing of surgery differs significantly depending on patients' age, type of department admitted to, admission route, and length of stay. Sixty two percent of hospital days shows appropriate and the level of inappropriateness show marked differences by patients'age, type of services, admission routes, part of the month, part of the stay, and length of stay. Inappropriate hospital days are due to inappropriate level of care, premature admission, improper scheduling of diagnostic or therapeutic procedures, and problems in scheduling surgery in sequence. In conclusion, substantially high proportion of inappropriate hospital bed utilization was confirmed. To reduce it, it is necessary to develop alternative services with which can replace inpatient services, and to introduce utilization management system which may include internal peer review.