Hospital
A hospital is a healthcare institution providing patient treatment with specialized
Specialized hospitals include
A
Hospitals are typically funded by
Hospitals are currently staffed by professional physicians, surgeons, nurses, and allied health practitioners. In the past, however, this work was usually performed by the members of founding religious orders or by volunteers. However, there are various Catholic religious orders, such as the Alexians and the Bon Secours Sisters that still focus on hospital ministry in the late 1990s, as well as several other Christian denominations, including the Methodists and Lutherans, which run hospitals.[4] In accordance with the original meaning of the word, hospitals were original "places of hospitality", and this meaning is still preserved in the names of some institutions such as the Royal Hospital Chelsea, established in 1681 as a retirement and nursing home for veteran soldiers.
Etymology
During the Middle Ages, hospitals served different functions from modern institutions in that they were
Types
Some patients go to a hospital just for
General and acute care
The best-known type of hospital is the general hospital, also known as an acute-care hospital. These facilities handle many kinds of disease and injury, and normally have an emergency department (sometimes known as "accident & emergency") or trauma center to deal with immediate and urgent threats to health. Larger cities may have several hospitals of varying sizes and facilities. Some hospitals, especially in the United States and Canada, have their own ambulance service.
District
A district hospital typically is the major health care facility in its region, with large numbers of beds for
In California, "district hospital" refers specifically to a class of healthcare facility created shortly after
Specialized
A specialty hospital is primarily and exclusively dedicated to one or a few related
In Germany, specialised hospitals are called Fachkrankenhaus; an example is Fachkrankenhaus Coswig (thoracic surgery). In India, specialty hospitals are known as super-specialty hospitals and are distinguished from multispecialty hospitals which are composed of several specialties.[9]
Specialised hospitals can help reduce
Teaching
A
Clinics
Clinics generally provide only
Departments or wards
A hospital contains one or more wards that house
A hospital may also have a
Many units have both a nursing and a medical director that serve as administrators for their respective disciplines within that unit. For example, within an intensive care nursery, a medical director is responsible for physicians and medical care, while the nursing manager is responsible for all the nurses and nursing care.
Support units may include a
-
Hospital beds per 1000 people 2013[12]
-
Hospital beds per inhabitants
-
traumaintervention, showing the highly technical equipment of modern hospitals
Remote monitoring
The
History
Early examples
In early
-
View of the Askleipion of Kos, the best preserved instance of an Asklepieion
-
Ruins of a two thousand-year-old hospital were discovered in the historical city of Anuradhapura Mihintale Sri Lanka.
Middle Ages
The declaration of Christianity as an accepted religion in the Roman Empire drove an expansion of the provision of care.[21] Following the First Council of Nicaea in AD 325 construction of a hospital in every cathedral town was begun, including among the earliest hospitals by Saint Sampson in Constantinople and by Basil, bishop of Caesarea in modern-day Turkey.[22] By the twelfth century, Constantinople had two well-organised hospitals, staffed by doctors who were both male and female. Facilities included systematic treatment procedures and specialised wards for various diseases.[23]
The earliest general hospital in the Islamic world was built in 805 in
In India,
In China, during the
Early modern and Enlightenment Europe
In Europe the medieval concept of Christian care evolved during the 16th and 17th centuries into a secular one. In
In 1682,
The voluntary hospital movement began in the early 18th century, with hospitals being founded in London by the 1720s, including Westminster Hospital (1719) promoted by the private bank C. Hoare & Co and Guy's Hospital (1724) funded from the bequest of the wealthy merchant, Thomas Guy.
Other hospitals sprang up in London and other British cities over the century, many paid for by private subscriptions. St Bartholomew's in London was rebuilt from 1730 to 1759,[39] and the London Hospital, Whitechapel, opened in 1752.
These hospitals represented a turning point in the function of the institution; they began to evolve from being basic places of care for the sick to becoming centers of medical innovation and discovery and the principal place for the education and training of prospective practitioners. Some of the era's greatest surgeons and doctors worked and passed on their knowledge at the hospitals.[40] They also changed from being mere homes of refuge to being complex institutions for the provision and advancement of medicine and care for sick. The Charité was founded in Berlin in 1710 by King Frederick I of Prussia as a response to an outbreak of plague.
Voluntary hospitals also spread to
When the Vienna General Hospital opened in 1784 as the world's largest hospital, physicians acquired a new facility that gradually developed into one of the most important research centers.[42]
Another
The Royal Naval Hospital, Stonehouse, Plymouth, was a pioneer of hospital design in having "pavilions" to minimize the spread of infection. John Wesley visited in 1785, and commented "I never saw anything of the kind so complete; every part is so convenient, and so admirably neat. But there is nothing superfluous, and nothing purely ornamented, either within or without." This revolutionary design was made more widely known by John Howard, the philanthropist. In 1787 the French government sent two scholar administrators, Coulomb and Tenon, who had visited most of the hospitals in Europe.[45] They were impressed and the "pavilion" design was copied in France and throughout Europe.
19th century
English physician
Florence Nightingale pioneered the modern profession of nursing during the Crimean War when she set an example of compassion, commitment to patient care and diligent and thoughtful hospital administration. The first official nurses' training programme, the Nightingale School for Nurses, was opened in 1860, with the mission of training nurses to work in hospitals, to work with the poor and to teach.[48] Nightingale was instrumental in reforming the nature of the hospital, by improving sanitation standards and changing the image of the hospital from a place the sick would go to die, to an institution devoted to recuperation and healing. She also emphasised the importance of statistical measurement for determining the success rate of a given intervention and pushed for administrative reform at hospitals.[49]
By the late 19th century, the modern hospital was beginning to take shape with a proliferation of a variety of public and private hospital systems. By the 1870s, hospitals had more than trebled their original average intake of 3,000 patients. In continental Europe the new hospitals generally were built and run from public funds. The
20th century and beyond
The examples and perspective in this section deal primarily with the United States and do not represent a worldwide view of the subject. (August 2020) |
By the late 19th and early 20th centuries, medical advancements such as anesthesia and sterile techniques that could make surgery less risky, and the availability of more advanced diagnostic devices such as X-rays, continued to make hospitals a more attractive option for treatment.[51]
Modern hospitals measure various efficiency metrics such as occupancy rates, the average length of stay, time to service, patient satisfaction, physician performance, patient readmission rate, inpatient mortality rate, and case mix index.[52]
In the United States, the number of hospitalizations grew to its peak in 1981 with 171 admissions per 1,000 Americans and 6,933 hospitals.[51] This trend subsequently reversed, with the rate of hospitalization falling by more than 10% and the number of US hospitals shrinking from 6,933 in 1981 to 5,534 in 2016.[53] Occupancy rates also dropped from 77% in 1980 to 60% in 2013.[54] Among the reasons for this are the increasing availability of more complex care elsewhere such as at home or the physicians' offices and also the less therapeutic and more life-threatening image of the hospitals in the eyes of the public.[51][55] In the US, a patient may sleep in a hospital bed, but be considered outpatient and "under observation" if not formally admitted.[56]
In the U.S., inpatient stays are covered under Medicare Part A, but a hospital might keep a patient under observation which is only covered under Medicare Part B, and subjects the patient to additional coinsurance costs.
The Catholic Church is the largest non-government provider of health careservices in the world.[61] It has around 18,000 clinics, 16,000 homes for the elderly and those with special needs, and 5,500 hospitals, with 65 percent of them located in developing countries.[62] In 2010, the Church's Pontifical Council for the Pastoral Care of Health Care Workers said that the Church manages 26% of the world's health care facilities.[63]
Funding
Modern hospitals derive funding from a variety of sources. They may be funded by private payment and
In the United Kingdom, the National Health Service delivers health care to legal residents funded by the state "free at the point of delivery", and emergency care free to anyone regardless of nationality or status. Due to the need for hospitals to prioritise their limited resources, there is a tendency in countries with such systems for 'waiting lists' for non-crucial treatment, so those who can afford it may take out private health care to access treatment more quickly.[64]
In the United States, hospitals typically operate privately and in some cases on a for-profit basis, such as HCA Healthcare.[65] The list of procedures and their prices are billed with a chargemaster; however, these prices may be lower for health care obtained within healthcare networks.[66] Legislation requires hospitals to provide care to patients in life-threatening emergency situations regardless of the patient's ability to pay.[67] Privately funded hospitals which admit uninsured patients in emergency situations incur direct financial losses, such as in the aftermath of Hurricane Katrina.[65]
Quality and safety
As the quality of health care has increasingly become an issue around the world, hospitals have increasingly had to pay serious attention to this matter. Independent external assessment of quality is one of the most powerful ways to assess this aspect of health care, and hospital accreditation is one means by which this is achieved. In many parts of the world such accreditation is sourced from other countries, a phenomenon known as international healthcare accreditation, by groups such as Accreditation Canada in Canada, the Joint Commission in the U.S., the Trent Accreditation Scheme in Great Britain, and the Haute Autorité de santé (HAS) in France. In England, hospitals are monitored by the Care Quality Commission. In 2020, they turned their attention to hospital food standards after seven patient deaths from listeria linked to pre-packaged sandwiches and salads in 2019, saying "Nutrition and hydration is part of a patient's recovery."[68]
The World Health Organization reported in 2011 that being admitted to a hospital was far riskier than flying. Globally, the chance of a patient being subject to a treatment error in a hospital was about 10%, and the chance of death resulting from an error was about one in 300. according to Liam Donaldson. 7% of hospitalised patients in developed countries, and 10% in developing countries, acquire at least one health care-associated infection. In the U.S., 1.7 million infections are acquired in hospital each year, leading to 100,000 deaths, figures much worse than in Europe where there were 4.5 million infections and 37,000 deaths.[69]
Architecture
Modern hospital buildings are designed to minimise the effort of medical personnel and the possibility of contamination while maximising the efficiency of the whole system. Travel time for personnel within the hospital and the transportation of patients between units is facilitated and minimised. The building also should be built to accommodate heavy departments such as radiology and operating rooms while space for special wiring, plumbing, and waste disposal must be allowed for in the design.[70]
However, many hospitals, even those considered "modern", are the product of continual and often badly managed growth over decades or even centuries, with utilitarian new sections added on as needs and finances dictate. As a result, Dutch architectural historian Cor Wagenaar has called many hospitals:
"... built catastrophes, anonymous institutional complexes run by vast bureaucracies, and totally unfit for the purpose they have been designed for ... They are hardly ever functional, and instead of making patients feel at home, they produce stress and anxiety."[71]
Some newer hospitals now try to re-establish design that takes the patient's psychological needs into account, such as providing more fresh air, better views and more pleasant colour schemes. These ideas harken back to the late eighteenth century, when the concept of providing fresh air and access to the 'healing powers of nature' were first employed by hospital architects in improving their buildings.[71]
The research of British Medical Association is showing that good hospital design can reduce patient's recovery time. Exposure to daylight is effective in reducing depression.[72] Single-sex accommodation help ensure that patients are treated in privacy and with dignity. Exposure to nature and hospital gardens is also important – looking out windows improves patients' moods and reduces blood pressure and stress level. Open windows in patient rooms have also demonstrated some evidence of beneficial outcomes by improving airflow and increased microbial diversity.[73][74] Eliminating long corridors can reduce nurses' fatigue and stress.[75]
Another ongoing major development is the change from a ward-based system (where patients are accommodated in communal rooms, separated by movable partitions) to one in which they are accommodated in individual rooms. The ward-based system has been described as very efficient, especially for the medical staff, but is considered to be more stressful for patients and detrimental to their privacy. A major constraint on providing all patients with their own rooms is however found in the higher cost of building and operating such a hospital; this causes some hospitals to charge for private rooms.[76]
-
The medical center at the University of Virginia shows the growing trend for modern architecture in hospitals.
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The National Health Service Norfolk and Norwich University Hospital in the UK, showing the utilitarian architecture of many modern hospitals
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Hospital chapel atFawcett Memorial Hospital (Port Charlotte, Florida)
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Hinduja National Hospital, Mumbai
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An intensive care unit (ICU) within a hospital
-
Uniklinikum Aachen in Germany
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Tampere University Hospital in Tampere, Finland
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All India Institute of Medical Sciencesin Delhi, India
See also
- Burn center
- History of hospitals
- History of medicine
- Hospice
- Hospital network
- Lists of hospitals
- Hospital information system
- Trauma center
- The Waiting Room
- Walk-in clinic
Notes
- ^ "Although Philadelphia General Hospital (1732) and Bellevue Hospital in New York (1736) are older, the Philadelphia General was founded as an almshouse, and Bellevue as a workhouse."
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- innovation rooted in the monastic virtue and practise of hospitality. Arranged around the monastery were concentric rings of buildings in which the life and work of the monastic community was ordered. The outer ring of buildings served as a hostel in which travellers were received and boarded. The inner ring served as a place where the monastic community could care for the sick, the poor and the infirm. Monks were frequently familiar with the medicine available at that time, growing medicinal plants on the monastery grounds and applying remedies as indicated. As such, many of the practicing physicians of the Middle Ages were also clergy.
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Another lasting advancement made during this time period was that of physician licensure. In 931 AD Caliph Al-Muqtadir learned that a patient had died in Baghdad as a result of a physician's error. Consequently, he ordered Sinan ibn Thabit to examine all those who practiced the art of healing. Of the 860 medical practitioners he examined, 160 failed. From that time on, licensing examinations were required and administered in various places. Licensing boards were set up under a government official called Muhtasib, or inspector general. The chief physician gave oral and practical examinations, and if the young physician was successful, the Muhtasib administered the Hippocratic Oath and issued a license to practice medicine.
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Bibliography
History of hospitals
- Brockliss, Lawrence, and Colin Jones. "The Hospital in the Enlightenment", in The Medical World of Early Modern France (Oxford UP, 1997), pp. 671–729; covers France 1650–1800
- Chaney, Edward (2000), "'Philanthropy in Italy': English Observations on Italian Hospitals 1545–1789", in: The Evolution of the Grand Tour: Anglo-Italian Cultural Relations since the Renaissance, 2nd ed. London, Routledge, 2000.
- Connor, J.T.H. "Hospital History in Canada and the United States", Canadian Bulletin of Medical History, 1990, Vol. 7 Issue 1, pp. 93–104
- Crawford, D.S. Bibliography of Histories of Canadian hospitals and schools of nursing.
- Gorsky, Martin. "The British National Health Service 1948–2008: A Review of the Historiography", Social History of Medicine, December 2008, Vol. 21 Issue 3, pp. 437–60
- Harrison, Mar, et al. eds. From Western Medicine to Global Medicine: The Hospital Beyond the West (2008)
- Horden, Peregrine. Hospitals and Healing From Antiquity to the Later Middle Ages (2008)
- McGrew, Roderick E. Encyclopedia of Medical History (1985)
- Morelon, Régis; Rashed, Roshdi (1996), Encyclopedia of the History of Arabic Science, vol. 3, Routledge, ISBN 978-0-415-12410-2
- Porter, Roy. The Hospital in History, with Lindsay Patricia Granshaw (1989) ISBN 978-0-415-00375-9
- Risse, Guenter B. Mending Bodies, Saving Souls: A History of Hospitals (1999); world coverage
- Rosenberg, Charles E. The Care of Strangers: The Rise of America's Hospital System (1995); history to 1920
- Scheutz, Martin et al. eds. Hospitals and Institutional Care in Medieval and Early Modern Europe (2009)
- Wall, Barbra Mann. American Catholic Hospitals: A Century of Changing Markets and Missions (Rutgers University Press, 2011). ISBN 978-0-8135-4940-8
External links
- WHO Hospitals https://www.who.int/hospitals/en/
- "Global and Multilanguage Database of public and private hospitals". hospitalsworldguide.com.
- "Directory and Ranking of more than 17.000 Hospitals worldwide". hospitals.webometrics.info. Archived from the original on 21 April 2010. Retrieved 7 November 2008.