WINTER ADMISSIONS TO LONDON HOSPITALS

1065 SUMMARY

A survey was undertaken to determine what proportion of beds in a ward should reasonably be provided in single rooms in order to satisfy the medical needs of the patient. After reference to a number of consultants, a list of 31 conditions qualifying patients for accommodation in

single

rooms was

compiled..

This schedule of conditions was used by housemen, in 29 wards of 8 general hospitals, to record each day over a period of a month whether the patients in the ward qualified for single rooms. An analysis of these records enabled conclusions to be drawn about the most desirable provision of single For wards of sixteen beds these are : rooms. 4 General medical wards 3 General surgical wards Gynaecological wards......3 2 Maternity wards ....

single

....

......

.

"

"

or

3

rooms " "

single

rooms

-For larger wards the proportion of single-room beds to total beds would be somewhat less and for smaller wards it would be somewhat greater. I should like to thank the staff ofthe 8 hospitals who kept such painstaking records on their daily rounds, and Mr. Bailey for his invaluable statistical work on analysing the records.

WINTER ADMISSIONS TO LONDON Work of

HOSPITALS the Emergency Bed Service, 1950-51

As is

generally known, in the past winter great difficulty experienced in London in the admission of acutely ill patients to hospital. These difficulties caused great hardship to patients as well as extra work for their doctors. But it is not easy to turn these generalisations into facts and figures. There are no figures to show the total number of urgent cases requiring admission to the London hospitals, though many of the hospitals keep a note of their own figures. Thus the figures of the Bed Service seem to be the only (E.B.S.) Emergency ones covering greater London as a whole. The E.B.S. is an auxiliary service intended to help doctors who have made an unsuccessful direct application for the -admission of a patient to the hospital of their choice. What proportion of the acute cases in London are admitted through such direct applications by their doctors could only be discovered by putting a lot of extra work on hospital officials. Random checks have shown that some hospitals admit three or four acute cases direct from doctors to every one admitted through the E.B.S. ; in others the proportion is about equal; was

and on the average the ratio of direct to E.B.S. seems to be about 2 : 1. But these proportions apply to total admissions, and it must be remembered that the doctor who cannot get his patient admitted direct can apply to the E.B.S., who may be more fortunate ; whereas if the E.B.S. fails to find a bed for a patient the failure is usually final. Thus, though only about a third of all the admissions are arranged through the E.B.S., the service’s failures represent a much larger proportion of the totalindeed, if all London doctors make a rule of trying the E.B.S. before resigning themselves to keeping the patient at home, then the E.B.S. failures will be the total failures in London. Broadly speaking, then, the E.B.S. experience will give a reasonably representative picture of the position in London. THE WINTER’S WORK The work of the E.B.S. followed normal lines until Dec. 9, 1950, when, presumably owing to the influenza epidemic, it began to increase rapidly, instead of slackening, as is usual, before Christmas. For the first time in the 13 years since the service started, Christmas Day,

1950, was a busy day, 106 applications being received for the admission of acute cases compared with 68 on Christmas Day, 1949. Thereafter the curve ofapplications rose steadily, as it always does after Christmas ; and on Jan. 1, 1951, the total reached its peak figure of 293-the highest number yet recorded on one day. This exacerbation lasted for about 10 days, after which the demand began to fall steadily ; even so, January’s applications were 35% higher than the total for January, 1950. The accompanying chart shows that the admissions kept up fairly well with the applications until Christmas, but thereafter the admissions rapidly fell behind ; for the whole of January the E.B.S. found a bed in only two-thirds of the cases applying for admission. In other words, one applicant out of every three could not get into hospital. For February and March the proportions of successful applications were 75-7% and 80.5% ; and by the end of March the E.B.S. was once again well normally. What do these figures mean in actual cases ?2 At the worst time the failures amounted to 100 a day. In January applications for admission were received for 7064 acute medical and surgical cases, of which 4632 were admitted and 2432 could not be placed. Among the patients for whom beds could not be found were 247 whose applications were withdrawn, and these should not be counted among the failures. Without them the month’s daily average of failures was 70-5. If we assume that an application is received by the E.B .S: for 1 in every 3 urgent cases and that the remainder

working pretty

are all admitted, direct—for

otlierwise tne doctors win

surely try the E.B.S.-then the total number of patients applying for admission to the London hospitals in January was three times the total E.B.S. applications, or about 21,200; all except the E.B.S. failures were so the failure-rate for London as a whole can be estimated as 11-6%. The E.B.S. served an area 200 not containing hospitals, counting fever hospitals

admitted,

1066

highly specialised ones. A daily average of 70-5 unsuccessful applications for admission suggests that

or

enough extra beds to accommodate all the acute cases could be provided without laying an impossible burden on the hospitals. This may read like an attempt to explain away the winter’s anxieties ; but it was in fact a time of serious crisis, and the regional boards, whose agent the E.B.S. is, took all the steps open to them to overcome it. THE FUTURE

being made on the basis of the winter’s should experience go far to prevent the recurrence of such an emergency and enable the hospitals and their auxiliaries to deal with any unduly large number of applications for admission.*. It is clearly impracticable always to keep enough empty beds fully staffed and ready for the acute cases to meet major crises which only arise occasionally. Even if it was possible, this would be an unjustifiable waste of personnel and material. In an emergency, hospitals can usually increase their accommodation for acute cases by admitting fewer patients from their waiting-lists and by other means. This winter, however, the position was complicated by the large number of nurses and other members of the hospitals’ stafts who were incapacitated by influenza. In future epidemics the same complication will almost certainly recur, and this must be taken into consideration when devising plans for the future. The scheme now being prepared is an adaptation of the air-raid warning system of the late war. The warning system will come into operation automatically when the pressure on the E.B.S. mounts above a prearranged level. When applications for admission reach the critical figure, a warning will be despatched to all the hospitals in the London area ; this will be the signal for them to take whatever steps they consider necessary to clear beds for acute cases. The scheme is intended to bring the full power of the hospitals to bear in a crisis ; but there will be a corresponding system of allclear signals to ensure that the hospitals are not called on to continue their supreme effort when the immediate crisis is over. Plans

now

THE FESTIVAL EXHIBITIONS MEDICAL SCIENCE DISPLAYED

ON May 3, the Festival of Britain was inaugurated by H.M. The King and on the following day the South At last therefore Bank Exhibition opened its doors. there is an opportunity to judge this much-criticised venture on its own merits, unclouded by controversy as to whether it ought ever to have been. THE SOUTH BANK

The first and most remarkable impression is the sense of space on this very restricted site. Hemmed in by the River and York Road, by County Hall and Waterloo Bridge, the designers have achieved an astonishing amount of elbow-room, and the great central concourse, with its flower-beds, fountains, and trees is most unexpected. The river terrace, on the inner bend of the river, commands the whole sweep from Westminster to St. Paul’s and is certainly a magnificent permanent accession to the beauties of London-a new " lung " of inestimable value from which the gay busy life of the river can be watched against a varied and fascinating skyline. The architecture of the exhibition buildings is very modern, and of its kind excellent, with bold sweeping lines, clear bright colours, and skilful use of space. Those who like such things will enjoy it ; those who do not will hate it. There are enough " modernistic "

provide controversy for many a dinner-table. The twenty pavilions set out to illustrate the contribution of Britain in many fields of science, engineering, and industry. The way of life of the British people, their character and homes, their sport, recreations, and scenery, are all covered, and it is notable that the Official Guide lays much stress on the importance of all these to health. Health however, has a pavilion to itself, under Waterloo Bridge, where the contributions of Britain to medical science and art are displayed and where the value of these contributions to the community and the individual are illustrated. At the entrance to the Health Pavilion is a section on " how the body works," illustrated by admirable working models of the circulation and respiration and of reflex action, and a less convincing one of the alimentary tract. This leads on to nutrition and this to " the preservation of health," the latter including public health, water, sewage, immunisation, and so on. The contributions of medicine and surgery are next dealt with : surgical instruments are well displayed and biological standards are also shown. Blood-transfusion is excellently handled, and then comes a section on anaesthesia. A large wall-painting of Florence Nightingale at Scutari, effective but somewhat imaginative, introduces a number of screens illustrating various aspects of nursing, and finally there is a remarkable section on. plastic surgery. This is likely to cause more controversy than all the rest of the pavilion put together. Two excellent models demonstrating how burns and scalds can occur in children and old people lead on to a series of photographs, some in colour, illustrating the treatment of such burns-as well as the effects of inadequate treatment. Punches are not pulled here, and it is questionable how far the propaganda effect in the preventing of burns will outweigh the protests of the squeamish. Of the quality and sincerity of this section there can be no question-the photographs are brilliant -and it may well do much good. The Royal Festival Hall is perhaps the most exciting thing on the South Bank. At the moment it looks rather incongruous-a huge solid mass among the flimsy exhibition structures-and it is too early to judge how its outside will look when completed and surrounded by parks and river walks. But of its triumphant interior there can be only one opinion. London once more has a concert hall where music can be properly heard in a comfort never previously experienced; and the planning of the promenades, restaurants, and foyers is spacious and dignified, giving really magnificent views of the river. If nothing else had come out of the Festival of Britain this would have been worth while. statues and frescoes to

SOUTH KENSINGTON

At the Festival Exhibition of Science, to be seen at the Science Museum, South Kensington, there is a sprinkling of medical demonstrations among the predominant ones illustrating the atomic age. Indeed from the very entrance through a tortuous darkened tunnel, perhaps more suggestive of an approaching fun-fair than a scientific exhibition, one is confronted with larger and larger scale models of the ultimate structure of graphite. On emerging from the darkness the main exhibition hall is a dazzle of light coming from stereotyped structural formulse constructed of electric bulbs, artificial lightning, and glowing cathoderay tubes. This atomic approach merges easily with medicine in the description of the use of isotopes to measure the rate of replacement of plasma-proteins and red cells and the use of isotopically labelled B12 for the study of its metabolism. Models illustrate the use of X-ray diffraction in crystallography, and an imposing electronic brain