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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 rooms. For wards of sixteen beds these are : General medical wards .... 4 single rooms General surgical wards .... 3 " " Gynaecological wards...... 3 " " Maternity wards ...... 2 or 3 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 of the 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 HOSPITALS Work of the Emergency Bed Service, 1950-51 As is generally known, in the past winter great difficulty was 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 Emergency Bed Service (E.B.S.) seem to be the only 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; 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 total- indeed, 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 slacken- ing, 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 ofapplica- tions 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 working pretty 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 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 admitted, so the failure-rate for London as a whole can be estimated as 11-6%. The E.B.S. served an area containing 200 hospitals, not counting fever hospitals

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Page 1: WINTER ADMISSIONS TO LONDON HOSPITALS

1065

SUMMARY

A survey was undertaken to determine what proportionof beds in a ward should reasonably be provided in singlerooms in order to satisfy the medical needs of the patient.

After reference to a number of consultants, a list of31 conditions qualifying patients for accommodation insingle rooms was compiled..

This schedule of conditions was used by housemen, in29 wards of 8 general hospitals, to record each day over aperiod of a month whether the patients in the wardqualified for single rooms.An analysis of these records enabled conclusions to

be drawn about the most desirable provision of singlerooms. For wards of sixteen beds these are :

General medical wards .... 4 single roomsGeneral surgical wards .... 3 " "

Gynaecological wards...... 3 " "

.

Maternity wards ...... 2 or 3 single rooms

-For larger wards the proportion of single-room beds tototal beds would be somewhat less and for smaller wardsit would be somewhat greater.

I should like to thank the staff of the 8 hospitals who keptsuch painstaking records on their daily rounds, and Mr. Baileyfor his invaluable statistical work on analysing the records.

WINTER ADMISSIONS TO LONDONHOSPITALS

Work of the Emergency Bed Service, 1950-51

As is generally known, in the past winter greatdifficulty was experienced in London in the admission ofacutely ill patients to hospital. These difficulties causedgreat hardship to patients as well as extra work for theirdoctors. But it is not easy to turn these generalisationsinto facts and figures. There are no figures to show thetotal number of urgent cases requiring admission to theLondon hospitals, though many of the hospitals keep anote of their own figures. Thus the figures of the

Emergency Bed Service (E.B.S.) seem to be the onlyones covering greater London as a whole.The E.B.S. is an auxiliary service intended to help

doctors who have made an unsuccessful direct applicationfor the -admission of a patient to the hospital of theirchoice. What proportion of the acute cases in Londonare admitted through such direct applications by theirdoctors could only be discovered by putting a lot ofextra work on hospital officials. Random checks haveshown that some hospitals admit three or four acutecases direct from doctors to every one admitted throughthe E.B.S. ; in others the proportion is about equal;and on the average the ratio of direct to E.B.S. seemsto be about 2 : 1. But these proportions apply to totaladmissions, and it must be remembered that the doctorwho cannot get his patient admitted direct can apply tothe E.B.S., who may be more fortunate ; whereas if theE.B.S. fails to find a bed for a patient the failure is usuallyfinal. Thus, though only about a third of all theadmissions are arranged through the E.B.S., the service’sfailures represent a much larger proportion of the total-indeed, if all London doctors make a rule of trying theE.B.S. before resigning themselves to keeping the patientat home, then the E.B.S. failures will be the total failuresin London. Broadly speaking, then, the E.B.S. experiencewill give a reasonably representative picture of theposition in London.

THE WINTER’S WORK

The work of the E.B.S. followed normal lines untilDec. 9, 1950, when, presumably owing to the influenzaepidemic, it began to increase rapidly, instead of slacken-ing, as is usual, before Christmas. For the first timein the 13 years since the service started, Christmas Day,

1950, was a busy day, 106 applications being receivedfor the admission of acute cases compared with 68 onChristmas Day, 1949. Thereafter the curve ofapplica-tions rose steadily, as it always does after Christmas ;and on Jan. 1, 1951, the total reached its peak figure of293-the highest number yet recorded on one day.This exacerbation lasted for about 10 days, after whichthe demand began to fall steadily ; even so, January’sapplications 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 ; forthe whole of January the E.B.S. found a bed in onlytwo-thirds of the cases applying for admission. In otherwords, one applicant out of every three could not getinto hospital. For February and March the proportionsof successful applications were 75-7% and 80.5% ;and by the end of March the E.B.S. was once againworking pretty 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 for7064 acute medical and surgical cases, of which 4632were admitted and 2432 could not be placed. Amongthe patients for whom beds could not be found were247 whose applications were withdrawn, and these shouldnot be counted among the failures. Without them themonth’s daily average of failures was 70-5.

If we assume that an application is received by theE.B .S: for 1 in every 3 urgent cases and that the remainderare all admitted, direct—for otlierwise tne doctors win

surely try the E.B.S.-then the total number of patientsapplying 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 wereadmitted, so the failure-rate for London as a whole canbe estimated as 11-6%. The E.B.S. served an area

containing 200 hospitals, not counting fever hospitals

Page 2: WINTER ADMISSIONS TO LONDON HOSPITALS

1066

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

enough extra beds to accommodate all the acute casescould be provided without laying an impossible burdenon the hospitals.

This may read like an attempt to explain away thewinter’s anxieties ; but it was in fact a time of seriouscrisis, and the regional boards, whose agent the E.B.S.is, took all the steps open to them to overcome it.

THE FUTURE

Plans now being made on the basis of the winter’sexperience should go far to prevent the recurrence ofsuch an emergency and enable the hospitals and theirauxiliaries 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 casesto meet major crises which only arise occasionally. Evenif it was possible, this would be an unjustifiable waste ofpersonnel and material. In an emergency, hospitals canusually increase their accommodation for acute cases byadmitting fewer patients from their waiting-lists andby other means.

This winter, however, the position was complicatedby the large number of nurses and other members of thehospitals’ stafts who were incapacitated by influenza.In future epidemics the same complication will almostcertainly recur, and this must be taken into considerationwhen devising plans for the future.The scheme now being prepared is an adaptation of

the air-raid warning system of the late war. The warningsystem will come into operation automatically when thepressure 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 signalfor them to take whatever steps they consider necessaryto clear beds for acute cases. The scheme is intendedto bring the full power of the hospitals to bear in a

crisis ; but there will be a corresponding system of all-clear signals to ensure that the hospitals are not calledon to continue their supreme effort when the immediatecrisis is over.

THE FESTIVAL EXHIBITIONS

MEDICAL SCIENCE DISPLAYED

ON May 3, the Festival of Britain was inauguratedby H.M. The King and on the following day the SouthBank Exhibition opened its doors. At last thereforethere is an opportunity to judge this much-criticisedventure on its own merits, unclouded by controversy asto whether it ought ever to have been.

THE SOUTH BANK

The first and most remarkable impression is the senseof space on this very restricted site. Hemmed in bythe River and York Road, by County Hall and WaterlooBridge, the designers have achieved an astonishingamount 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 ofthe river, commands the whole sweep from Westminsterto St. Paul’s and is certainly a magnificent permanentaccession to the beauties of London-a new " lung "of inestimable value from which the gay busy life of theriver can be watched against a varied and fascinatingskyline. The architecture of the exhibition buildings isvery modern, and of its kind excellent, with bold sweepinglines, clear bright colours, and skilful use of space.Those who like such things will enjoy it ; those who donot will hate it. There are enough " modernistic "

statues and frescoes to provide controversy for many adinner-table.The twenty pavilions set out to illustrate the contribu-

tion 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, andscenery, are all covered, and it is notable that the OfficialGuide lays much stress on the importance of all theseto health. Health however, has a pavilion to itself,under Waterloo Bridge, where the contributions ofBritain to medical science and art are displayed andwhere the value of these contributions to the communityand the individual are illustrated.At the entrance to the Health Pavilion is a section on

" how the body works," illustrated by admirable workingmodels of the circulation and respiration and of reflexaction, and a less convincing one of the alimentarytract. This leads on to nutrition and this to " thepreservation of health," the latter including publichealth, water, sewage, immunisation, and so on. Thecontributions of medicine and surgery are next dealtwith : surgical instruments are well displayed andbiological standards are also shown. Blood-transfusionis excellently handled, and then comes a section onanaesthesia. A large wall-painting of Florence Nightingaleat Scutari, effective but somewhat imaginative, introducesa number of screens illustrating various aspects of

nursing, and finally there is a remarkable section on.

plastic surgery. This is likely to cause more controversythan all the rest of the pavilion put together. Twoexcellent models demonstrating how burns and scaldscan occur in children and old people lead on to a seriesof photographs, some in colour, illustrating the treatmentof such burns-as well as the effects of inadequatetreatment. Punches are not pulled here, and it is

questionable how far the propaganda effect in thepreventing of burns will outweigh the protests of thesqueamish. Of the quality and sincerity of this sectionthere 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 ratherincongruous-a huge solid mass among the flimsyexhibition structures-and it is too early to judge howits outside will look when completed and surroundedby parks and river walks. But of its triumphant interiorthere can be only one opinion. London once more hasa concert hall where music can be properly heard in acomfort never previously experienced; and the planning of the promenades, restaurants, and foyers is spaciousand dignified, giving really magnificent views of theriver. If nothing else had come out of the Festival ofBritain this would have been worth while.

SOUTH KENSINGTON

At the Festival Exhibition of Science, to be seen atthe Science Museum, South Kensington, there is a

sprinkling of medical demonstrations among the pre-dominant ones illustrating the atomic age. Indeedfrom the very entrance through a tortuous darkenedtunnel, perhaps more suggestive of an approachingfun-fair than a scientific exhibition, one is confrontedwith larger and larger scale models of the ultimatestructure of graphite. On emerging from the darknessthe main exhibition hall is a dazzle of light comingfrom stereotyped structural formulse constructed ofelectric bulbs, artificial lightning, and glowing cathode-ray tubes. This atomic approach merges easily withmedicine in the description of the use of isotopes tomeasure the rate of replacement of plasma-proteinsand red cells and the use of isotopically labelled B12for the study of its metabolism.

Models illustrate the use of X-ray diffraction in

crystallography, and an imposing electronic brain