Re-organization of hospital units of department of radiation oncology at the institute of oncology Ljubljana
Abstract
Background: In 2004, activities related to the reorganization of the hospital units of the Department of Radiation Oncology at the Institute of Oncology Ljubljana were initiated. The need for reorganization arose from the dissipation of different types of management currently followed in all four hospital units of the Department. The aim of our article is to present an approach which we used when planning above mentioned reorganization.
Methods: In December 2004 and January 2005, two separate applicative studies were performed, i.e. the cross-sectional studies »Hostel« and »Palliative Care«. The studies were being carried out in three (altogether 124 beds) of the four hospital units of the Department of Radiation Oncology with a total bed capacity of 138. Considering the type and complexity of the nursing care, the patients were categorized by the preliminarily determined criteria into three groups: Group 1 – patients hospitalized in a standard hospital unit, Group 2 – patients hospitalized in the »Hostel«, and Group 3 – patients hospitalized in the unit for palliative care. The control of the criteria and of their fulfillment was made daily by a therapist and registered nurse during the morning rounds.
Results: Average number of patients eligible for hostel care was 16.5, which represented 16.7 % of the patients hospitalized daily at that time. Average number of patients in the »palliative care« category was 36.8, or 39.6 % of the hospitalized patients. During the performance of »Palliative Care« cross-sectional study, it was realized that 61.7 % of hospitalized patients were partly or completely dependent upon the nursing staff in performing routine personal activities. The higher dependence on nursing staff was confirmed by the statistically significant higher percentage of patients in the categories II-IV (more complex nursing care) than it was established for the other patients at the Institute of Oncology (87.8 % vs. 63.7 %, chi-squared test, P < 0.0001).
Conclusions: With the proposed categorization of patients, the number of hospital beds at the Department of Radiation Oncology could be reduced by 39.1 % (54/138): a large percentage of the patients hospitalized at the Department (on average 36.8 %) should be referred to the unit for »palliative care«, whereas lower percentage (16.5 %) to the »hostel«. Furthermore, it was also established that palliative care in oncology meets the criteria of the »acute hospital management« and should therefore be included in the system of Diagnosis-Related Groups.
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