Abstract
The purpose of this study was to examine how the hospital characteristics relate to the proportion of high-acuity patients who require critical and/or intensive care. A survey on hospital nursing was conducted in September of 1991. A 20 pecent random sample, by size of hospital measured in terms of the number of beds, type of ownership and proportion of psychiatric beds, was drawn for all hospitals in Japan for the survey. The survey collected a wide range of information about hospital characteristics as well as characteristics of each ward such as number of beds, case mix and nurse staffing. Usable questionnaires were received from 642 hospitals (34.0%) included in the survey sample, and from 1,281 wards of which the total number of 70,144 beds accouts for 4.2% of all the hospital beds in Japan.
Out of 39,178 patients in 927 general wards, the total number of high-acuity patients were 2,111 patients (5.4%). By the size of hospital, the percentage of high-acuity patients was 3.0% in the category of hospitals with fewer than 100 beds, whereas it was 7.8% in the category of hospitals with 500 or more beds. The percentage of high-acuity patients of university hospitals was the highest (9.9%) among all categories of type of ownership. Generally, non-public hospitals had lower proportion of high-acuity patients than the others; 3.6% of patients of private hospitals and 4.1% of patients of medical care juridical corporation hospitals were high-acuity.
By the patient classification system commonly used in Japan, the patients who are bedridden and require continuous observation by nurses are classified into the group with the greatest nursing needs (so called “A-I” patient). The distribution of “A-I” patients, however, suffered a slippage from the distribution of high-acuity patients in some categories of hospitals classified by their characteristics. It is apprehended that the patient classification system above-mentioned does not reflect nursing care as practiced in the hospitals.
