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hospital
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{{other uses|Hospital (disambiguation)|General hospital (disambiguation)}}{{pp-move-indef}}{{Use dmy dates|date=January 2015}}







factoids
File:Intensivstation (01) 2007-03-03.jpg|thumb|right|A standard intensive care unitintensive care unitFile:KlinikumAachen.jpg|thumb|The Uniklinikum Aachen in GermanyGermanyFile:AIIMS central lawn.jpg|thumb|right|All India Institute of Medical Sciences in DelhiDelhi{{Public Infrastructure}}A hospital is a health care institution providing patient treatment with specialized medical and nursing staff and medical equipment.WEB,weblink Hospitals, World Health Organization, en-GB, 2018-01-24, The best-known type of hospital is the general hospital, which typically has an emergency department to treat urgent health problems ranging from fire and accident victims to a sudden illness. A district hospital typically is the major health care facility in its region, with many beds for intensive care and additional beds for patients who need long-term care. Specialized hospitals include trauma centers, rehabilitation hospitals, children's hospitals, seniors' (geriatric) hospitals, and hospitals for dealing with specific medical needs such as psychiatric treatment (see psychiatric hospital) and certain disease categories. Specialized hospitals can help reduce health care costs compared to general hospitals.WEB,weblink India's 'production line' heart hospital, bbcnews.com, 1 August 2010, 13 October 2013, Hospitals are classified as general, specialty, or government depending on the sources of income received.A teaching hospital combines assistance to people with teaching to medical students and nurses. The medical facility smaller than a hospital is generally called a clinic. Hospitals have a range of departments (e.g. surgery and urgent care) and specialist units such as cardiology. Some hospitals have outpatient departments and some have chronic treatment units. Common support units include a pharmacy, pathology, and radiology.Hospitals are usually funded by the public sector, health organisations (for profit or nonprofit), health insurance companies, or charities, including direct charitable donations. Historically, hospitals were often founded and funded by religious orders, or by charitable individuals and leaders.JOURNAL, Hall, Daniel, Altar and Table: A phenomenology of the surgeon-priest, Yale Journal of Biology and Medicine, December 2008, 81, 4, Although physicians were available in varying capacities in ancient Rome and Athens, the institution of a hospital dedicated to the care of the sick was a distinctly Christian 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., 2605310, 19099050, 193–98, Currently, hospitals are largely staffed by professional physicians, surgeons, nurses, and allied health practitioners, whereas in the past, 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.BOOK, Lovoll, Odd, A Portrait of Norwegian Americans Today, 1998, U of Minnesota Press, 978-0-8166-2832-2, 192, In accordance with the original meaning of the word, hospitals were originally "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.{{TOC limit|3}}

Etymology

File:Hospital.svg|alt=White H on blue background, used to represent hospitals in the US.|thumb|During peacetime, hospitals can be indicated by a variety of symbols. For example, a white 'H' on a blue background is often used in the United States. During times of armed conflict, a hospital may be marked with the emblem of the red cross, red crescent or red crystal in accordance with the Geneva ConventionsGeneva ConventionsDuring the Middle Ages, hospitals served different functions from modern institutions. Middle Ages hospitals were almshouses for the poor, hostels for pilgrims, or hospital schools. The word "hospital" comes from the Latin hospes, signifying a stranger or foreigner, hence a guest. Another noun derived from this, hospitium came to signify hospitality, that is the relation between guest and shelterer, hospitality, friendliness, and hospitable reception. By metonymy the Latin word then came to mean a guest-chamber, guest's lodging, an inn.Cassell's Latin Dictionary, revised by J. Marchant & J. Charles, 260th. thousand. Hospes is thus the root for the English words host (where the p was dropped for convenience of pronunciation) hospitality, hospice, hostel and hotel. The latter modern word derives from Latin via the ancient French romance word hostel, which developed a silent s, which letter was eventually removed from the word, the loss of which is signified by a circumflex in the modern French word hôtel. The German word 'Spital' shares similar roots.The grammar of the word differs slightly depending on the dialect. In the United States, hospital usually requires an article; in the United Kingdom and elsewhere, the word normally is used without an article when it is the object of a preposition and when referring to a patient ("in/to the hospital" vs. "in/to hospital"); in Canada, both uses are found.{{citation needed|date=January 2011}}

{{anchor|Types}} Types

File:Lehigh-Valley-Hospital.x.jpg|thumb|right|Lehigh Valley Hospital in Allentown, PennsylvaniaAllentown, PennsylvaniaSome patients go to a hospital just for diagnosis, treatment, or therapy and then leave ("outpatients") without staying overnight; while others are "admitted" and stay overnight or for several days or weeks or months ("inpatients"). Hospitals usually are distinguished from other types of medical facilities by their ability to admit and care for inpatients whilst the others, which are smaller, are often described as clinics.

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 intensive care, critical care, and long-term care.In California, "district hospital" refers specifically to a class of healthcare facility created shortly after World War II to address a shortage of hospital beds in many local communities.WEB, Our Background,weblink District Hospital Leadership Forum, 10 July 2014, WEB, Knox, Dennis, District Hospitals' Important Mission,weblink Payers &–° Providers, 10 July 2014, Even today, district hospitals are the sole public hospitals in 19 of California's counties, and are the sole locally-accessible hospital within nine additional counties in which one or more other hospitals are present at substantial distance from a local community. Twenty-eight of California's rural hospitals and 20 of its critical-access hospitals are district hospitals. They are formed by local municipalities, have boards that are individually elected by their local communities, and exist to serve local needs. They are a particularly important provider of healthcare to uninsured patients and patients with Medi-Cal (which is California's Medicaid program, serving low-income persons, some senior citizens, persons with disabilities, children in foster care, and pregnant women). In 2012, district hospitals provided $54 million in uncompensated care in California.

Specialised

File:Starship Children's Health Auckland.jpg|thumb|upright=0.45|Starship Children's Health is a children's hospital in Auckland, New ZealandNew ZealandTypes of specialised hospitals include rehabilitation hospitals, children's hospitals, seniors' (geriatric) hospitals, long-term acute care facilities and hospitals for dealing with specific medical needs such as psychiatric problems (see psychiatric hospital), certain disease categories such as cardiac, oncology, or orthopedic problems, and so forth. In Germany specialised hospitals are called Fachkrankenhaus; an example is Fachkrankenhaus Coswig (thoracic surgery).A hospital may be a single building or a number of buildings on a campus. Many hospitals with pre-twentieth-century origins began as one building and evolved into campuses. Some hospitals are affiliated with universities for medical research and the training of medical personnel such as physicians and nurses, often called teaching hospitals. Worldwide, most hospitals are run on a nonprofit basis by governments or charities. There are however a few exceptions, e.g. China, where government funding only constitutes 10% of income of hospitals. (need citation here. Chinese sources seem conflicted about the for-profit/non-profit ratio of hospitals in China)Specialised hospitals can help reduce health care costs compared to general hospitals. For example, Narayana Health's Bangalore cardiac unit, which is specialised in cardiac surgery, allows for significantly greater number of patients. It has 3000 beds (more than 20 times the average American hospital) and in pediatric heart surgery alone, it performs 3000 heart operations annually, making it by far the largest such facility in the world.WEB,weblink Narayana Hrudayalaya Hospitals, fastcompany.com, 7 February 2012, 13 October 2013, dead,weblink" title="web.archive.org/web/20131003195219weblink">weblink 3 October 2013, Surgeons are paid on a fixed salary instead of per operation; thus, the costs to the hospital drops when the number of procedures increases, taking advantage of economies of scale. Additionally, it is argued that costs go down as all its specialists become efficient by working on one "production line" procedure.

Teaching

File:McMasterUMedical.jpg|thumb|right|McMaster University Medical Centre is a teaching hospital in Hamilton, OntarioHamilton, OntarioA teaching hospital combines assistance to people with teaching to medical students and nurses and often is linked to a medical school, nursing school or university.In some countries like UK exists the clinical attachment system that is defined as a period of time when a doctor is attached to a named supervisor in a clinical unit, with the broad aims of observing clinical practice in the UK and the role of doctors and other healthcare professionals in the National Health Service (NHS).

Clinics

The medical facility smaller than a hospital is generally called a clinic, and often is run by a government agency for health services or a private partnership of physicians (in nations where private practice is allowed). Clinics generally provide only outpatient services.

Departments or wards

File:ER room after a trauma.jpg|thumb|Resuscitation room bed after a trauma intervention, showing the highly technical equipment of modern hospitals]]Hospitals consist of departments, traditionally called wards, especially when they have beds for inpatients, when they are sometimes also called inpatient wards. Hospitals may have acute services such as an emergency department or specialist trauma center, burn unit, surgery, or urgent care. These may then be backed up by more specialist units such as the following: In addition, there is the department of nursing, often headed by a chief nursing officer or director of nursing. This department is responsible for the administration of professional nursing practice, research, and policy for the hospital. Nursing permeates every part of a hospital. Many units or wards have both a nursing and a medical director that serve as administrators for their respective disciplines within that specialty. For example, in an intensive care nursery, the director of neonatology is responsible for the medical staff and medical care while the nursing manager/director for the intensive care nursery is responsible for all of the nurses and nursing care in that unit/ward.Some hospitals have outpatient departments and some have chronic treatment units such as behavioral health services, dentistry, dermatology, psychiatric ward, rehabilitation services, and physical therapy.Common support units include a dispensary or pharmacy, pathology, and radiology. Hospitals also have a mortuary, where the dead are stored. On the non-medical side, there often are medical records departments, release of information departments, information management ({{aka}} IM, IT or IS), clinical engineering (a.k.a. biomed), facilities management, plant ops (operations, also known as maintenance), dining services, and security departments.

History

{{see also|Timeline of hospitals}}

Early examples

{{Further|Ancient Iranian medicine|Byzantine medicine}}File:Kos_Asklepeion.jpg|right|thumb|View of the Askleipion of KosKosThe earliest documented institutions aiming to provide cures were ancient Egyptian temples. In ancient Greece, temples dedicated to the healer-god Asclepius, known as Asclepieia functioned as centres of medical advice, prognosis, and healing.Risse, G.B. Mending bodies, saving souls: a history of hospitals. 1990. p. 56 In early India India, Fa Xian, a Chinese Buddhist monk who travelled across India c. CE 400, recorded examples of healing institutions.BOOK, A Record of Buddhistic Kingdoms: Being an Account by the Chinese Monk Fâ-Hien of his Travels in India and Ceylon (CE 399–414) in Search of the Buddhist Books of Discipline, Legge, James, 1965, {{Publisher missing|date=August 2013}}{{Page needed|date=August 2013}} According to the Mahavamsa, the ancient chronicle of Sinhalese royalty, written in the sixth century CE, King Pandukabhaya of Sri Lanka (r. 437–367 BCE) had lying-in-homes and hospitals (Sivikasotthi-Sala).Prof. Arjuna Aluvihare, "Rohal Kramaya Lovata Dhayadha Kale Sri Lankikayo" Vidhusara Science Magazine, November 1993. A hospital and medical training centre also existed at Gundeshapur, a major city in southwest of the Sassanid Persian Empire founded in CE 271 by Shapur I.The American Journal of Islamic Social Sciences 22:2 Mehmet Mahfuz Söylemez, The Gundeshapur School: Its History, Structure, and Functions, p. 3.File:Sri_Lankan_Traditional_Medicine.jpg|right|thumb|Ruins of a two thousand-year-old hospital were discovered in the historical city of Anuradhapura Mihintale Sri LankaSri Lanka(File:Nabz pezeshk.jpg|left|thumb|A physician taking the pulse of a patient. From a 17th-century copy of Avicenna's Canon of Medicine. Wellcome Library, London.)The declaration of Christianity as an accepted religion in the Roman Empire drove an expansion of the provision of care. Following the First Council of Nicaea in CE 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.Catholic Encyclopedia – weblink (2009) Accessed April 2011. 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.Byzantine medicine

Medieval Islamic world

(File:Door of the Moristan of Kala'oon (1878) - TIMEA.jpg|thumb|Entrance to the Qalawoon complex which housed the notable Qalawoon hospital.)The earliest general hospital was built in 805 in Baghdad by Harun Al-Rashid.Husain F. Nagamia, [Islamic Medicine History and Current practise], (2003), p. 24.{{citation|last=Sir Glubb|first=John Bagot|author-link=John Bagot Glubb|year=1969|title=A Short History of the Arab Peoples|url=http://www.cyberistan.org/islamic/quote2.html#glubb|accessdate=25 January 2008}} By the tenth century, Baghdad had five more hospitals, while Damascus had six hospitals by the 15th century and Córdoba alone had 50 major hospitals, many exclusively for the military.WEB,weblink The Islamic Roots of the Modern Hospital, aramcoworld.com, 20 March 2017, Compared to contemporaneous Christian institutions, which were poor and sick relief facilities offered by some monasteries,{{citation needed|date=October 2019}} the Islamic hospital was a more elaborate institution with a wider range of functions. In Islam, there was a moral imperative to treat the ill regardless of financial status. Islamic hospitals tended to be large, urban structures, and were largely secular institutions, many open to all, whether male or female, civilian or military, child or adult, rich or poor, Muslim or non-Muslim. The Islamic hospital served several purposes, as a center of medical treatment, a home for patients recovering from illness or accidents, an insane asylum, and a retirement home with basic maintenance needs for the aged and infirm.Islamic Culture and the Medical Arts: Hospitals, United States National Library of Medicine {{PD-notice}}Hospitals in this era were the first to require medical diplomas to license doctors, and compensation for negligence could be made.JOURNAL, From Jami'ah to University: Multiculturalism and Christian–Muslim Dialogue, Syed Farid, Alatas, Current Sociology, 54, 1, 112–32, 10.1177/0011392106058837, 2006, harv,weblink {{additional citation|date=August 2018}}Hospitals were forbidden by law to turn away patients who were unable to pay.BOOK, Gale, 978-0-7876-4503-8, Rise and spread of Islam, 2002, 419, {{request quote|date=September 2019}} Eventually, charitable foundations called waqfs were formed to support hospitals, as well as schools. Part of the state budget also went towards maintaining hospitals.

Early modern and Enlightenment Europe

(File:Ancien-Hopital.jpg|thumb|A hospital ward in sixteenth century France.)In Europe the medieval concept of Christian care evolved during the sixteenth and seventeenth centuries into a secular one. In England, after the dissolution of the monasteries in 1540 by King Henry VIII, the church abruptly ceased to be the supporter of hospitals, and only by direct petition from the citizens of London, were the hospitals St Bartholomew's, St Thomas's and St Mary of Bethlehem's (Bedlam) endowed directly by the crown; this was the first instance of secular support being provided for medical institutions.File:Guy's Hospital00.jpg|thumb|left|1820 Engraving of Guy's Hospital in LondonLondonFile:Ruinas San Nicolas de Bari CCSD 09 2018 1414.jpg|thumb|Ruins of the Hospital San Nicolás de Bari in Santo Domingo, Dominican Republic, recognized by UNESCO for being the oldest hospital built in the Americas.WEB,weblink Colonial City of Santo Domingo. Outstanding Universal Value, UNESCO World Heritage Centre website, WEB,weblink Lonely PlanetLonely PlanetFile:Pennsylvania_Hospital_(Highsmith).png | thumb | Pennsylvania Hospital (now part of University of Pennsylvania Health System). Founded in 1751, it is the earliest established public hospital in the United States.BOOK, America's First Hospital: The Pennsylvania Hospital, 1751-1841, Haverford House, Williams, William Henry, 1976, 9780910702027, {{Citation| url =weblink| title = NPGallery Digital Asset Management System: Pennsylvania Hospital| work = National Register of Historic Places| publisher = accessdate = July 30, 2019| ref = none}}{{efn|"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."}} It is also home to America's first surgical amphitheatre and its first medical library.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 1730-1759weblink and the London Hospital 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 centres 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.BOOK, Reinarz, Jonathan, Brain, Mind and Medicine: Essays in Eighteenth-Century Neuroscience, 43–52, 10.1007/978-0-387-70967-3_4, 2007, 978-0-387-70966-6, Corpus Curricula: Medical Education and the Voluntary Hospital Movement, They also changed from being mere homes of refuge to being complex institutions for the provision 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.The concept of voluntary hospitals also spread to Colonial America; the Bellevue Hospital opened in 1736 (as a workhouse, then later becoming a hospital); the Pennsylvania Hospital opened in 1752, New York HospitalWEB, General Acute Care Hospital in New York,weblink in 1771, and Massachusetts General Hospital in 1811.When the Vienna General Hospital opened in 1784 (instantly becoming the world's largest hospital), physicians acquired a new facility that gradually developed into one of the most important research centres.Roderick E. McGrew, Encyclopedia of Medical History (Macmillan 1985), p. 139.Another Enlightenment era charitable innovation was the dispensary; these would issue the poor with medicines free of charge. The London Dispensary opened its doors in 1696 as the first such clinic in the British Empire. The idea was slow to catch on until the 1770s,JOURNAL, 5308110, 28126876, 10.3399/bjgp17X689281, 67, Books: The Dispensaries: Healthcare for the Poor Before the NHS: Britain's Forgotten Health-care System: Dispensaries: An Alternative to General Practice?, 2017, Freeman GK, Br J Gen Pract, 81, when many such organisations began to appear, including the Public Dispensary of Edinburgh (1776), the Metropolitan Dispensary and Charitable Fund (1779) and the Finsbury Dispensary (1780). Dispensaries were also opened in New York 1771, Philadelphia 1786, and Boston 1796.BOOK, Michael Marks Davis, Andrew Robert Warner, Dispensaries, Their Management and Development: A Book for Administrators, Public Health Workers, and All Interested in Better Medical Service for the People,weblink 1918, MacMillan, 2–3, 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.Surgeon Vice Admiral A Revell inweblink They were impressed and the "pavilion" design was copied in France and throughout Europe.

19th century

File:'One of the wards in the hospital at Scutari'. Wellcome M0007724 - restoration, cropped.jpg|thumb|right|A ward of the hospital at Scutari where Florence NightingaleFlorence NightingaleEnglish physician Thomas Percival (1740–1804) wrote a comprehensive system of medical conduct, Medical Ethics; or, a Code of Institutes and Precepts, Adapted to the Professional Conduct of Physicians and Surgeons (1803) that set the standard for many textbooks.JOURNAL, Waddington Ivan, 1975, The Development of Medical Ethics - A Sociological Analysis, Medical History, 19, 1, 36–51, 10.1017/s002572730001992x, 1095851, 1081608, In the mid-19th century, hospitals and the medical profession became more professionalised, with a reorganisation of hospital management along more bureaucratic and administrative lines. The Apothecaries Act 1815 made it compulsory for medical students to practise for at least half a year at a hospital as part of their training.BOOK, 316–17, Porter, Roy, Roy Porter, The Greatest Benefit to Mankind: A Medical History of Humanity from Antiquity to the Present, W.W. Norton & Company, New York, 978-0-393-31980-4, 1997, 1999, 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.BOOK,weblink Fundamentals of Mental Health Nursing, Kathy Neeb, 2006, Philadelphia: F.A. Davis Company, 978-0-8036-2034-6, 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.BOOK,weblink Florence Nightingale: Measuring Hospital Care Outcomes, August 1999, 13 March 2010, 978-0-86688-559-1, Nightingale, Florence, 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 National Health Service, the principal provider of health care in the United Kingdom, was founded in 1948. During the nineteenth century, the Second Viennese Medical School emerged with the contributions of physicians such as Carl Freiherr von Rokitansky, Josef Škoda, Ferdinand Ritter von Hebra, and Ignaz Philipp Semmelweis. Basic medical science expanded and specialisation advanced. Furthermore, the first dermatology, eye, as well as ear, nose, and throat clinics in the world were founded in Vienna, being considered as the birth of specialised medicine.Erna Lesky, The Vienna Medical School of the 19th Century (Johns Hopkins University Press, 1976)

20th century and beyond

By the late 19th and the beginning 20th century, medical advancements such as anesthesia and sterile techniques that could make surgery less risky, and availability of more advanced diagnostic devices such as X-rays, continued to make hospitals a more attractive option for treatment. The number of hospitalizations in the United States continued to grow and reached its peak in 1981 with 171 admissions per 1,000 Americans and 6,933 hospitals.NEWSPAPER,weblink Opinion | Are Hospitals Becoming Obsolete?, The New York Times, 2018-02-25, Emanuel, Ezekiel J., This trend, however, has been reversed since then, 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.WEB,weblink Fast Facts on U.S. Hospitals, 2018 | AHA, Among the reasons for this are the increasing availability of more complex care elsewhere such as at home or at the physicians' offices and also the less therapeutic and more life-threatening image of the hospitals in the eyes of the publicweblink which range from eight beds to fifty, are expanding in the United States.WEB,weblink 5 common questions about micro-hospitals, answered, Staff, www.beckershospitalreview.com, en-gb, 2018-11-25, Similarly, freestanding emergency rooms, which can handle emergencies and possibly transfer patients to hospitals, began to become popular in the 1970sWEB,weblink When the tiny hospital can't survive: Free-standing EDs with primary care seen as new rural model, 2011-09-07, Modern Healthcare, en, 2019-05-14, and have since expanded rapidly across the United States.Modern hospitals measure various efficiency metrics such as occupancy rates, average length of stay, time to service, patient satisfaction, physician performance, patient readmission rate, inpatient mortality rate, and case mix index.WEB,weblink Hospital Industry's 10 Most Critical Metrics – Guiding Metrics, guidingmetrics.com, en-US, 2018-11-25, Modern hospitals are in part defined by their ability to admit patients into inpatient care, which affects reimbursement. In the US, a patient may sleep in a hospital bed, but be considered outpatient and "under observation" if not formally admitted. In the US, 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.In the United States, occupancy rates dropped from 77% in 1980 to 60% in 2013.NEWS,weblink As admissions have slumped and outpatient care booms, hospitals closing or shrinking, Modern Healthcare, 2018-11-25, en-us, US hospital-based healthcare systems reported poor financial results in 2016 and 2017 as they adapted to healthcare reform and continued decline in admissions.NEWS,weblink How U.S. Hospitals and Health Systems Can Reverse Their Sliding Financial Performance, 2017-10-05, Harvard Business Review, 2018-11-25, Hospitals were also affected by the Center for Medicare and Medicaid Services (CMS) rules, including in 2013 included a controversial "two-midnight" rule for inpatient admissions.NEWS,weblink CMS drops two-midnight rule's inpatient payment cuts, Modern Healthcare, 2018-11-25, en-us, The rule was intended to reduce long-term "observation" stays, which increased from 3% to 8% of all cases between 2006 and 2011.WEB,weblink Two-Midnight and Observation Rule — Chicago Medical Society, www.cmsdocs.org,weblink" title="web.archive.org/web/20181125023815weblink">weblink 2018-11-25, live, 2018-11-25,

Funding

File:KB Dubrava Zagreb.jpg|thumb|Clinical Hospital DubravaClinical Hospital DubravaModern hospitals are either funded by the government of the country in which they are situated, or survive financially by competing in the private sector (a number of hospitals also are still supported by the historical type of charitable or religious associations).In the United Kingdom for example, a relatively comprehensive, "free at the point of delivery" health care system exists, funded by the state. Hospital care is thus relatively easily available to all legal residents, although free emergency care is available to anyone, regardless of nationality or status. As hospitals prioritise their limited resources, there is a tendency for 'waiting lists' for non-crucial treatment in countries with such systems, as opposed to letting higher-payers get treated first, so sometimes those who can afford it take out private health care to get treatment more quickly.WEB,weblink Surgery worries create insurance boom, Johnston, Martin, 21 January 2008, The New Zealand Herald, 3 October 2011, In some countries such as the USA, hospitals typically operate privately and in some cases on a for-profit basis; for example, the multinational corporation Hospital Corporation of America operates hospitals across the country. The list of procedures and their prices is called a chargemaster; however, these prices don't reflect the typical cost of the procedure, which is typically lower due to in-network negotiation.WEB,weblink Battling the Chargemaster: A Simple Remedy to Balance Billing for Unavoidable Out-of-Network Care, AJMC, 2018-12-10, Where for-profit hospitals in such countries admit uninsured patients in emergency situations (such as during and after Hurricane Katrina in the USA), they incur direct financial losses,Hospitals in New Orleans see surge in uninsured patients but not public funds – USA Today, Wednesday 26 April 2006 ensuring that there is a clear disincentive to admit such patients. In the United States, laws exist to ensure patients receive care in life-threatening emergency situations regardless of the patient's ability to pay.WEB,weblink Emergency Medical Treatment & Labor Act (EMTALA), 17 May 2013, centres for Medicare & Medicaid Services, 2012-03-26,

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 from Canada, the Joint Commission from the USA, the Trent Accreditation Scheme from Great Britain, and Haute Authorité de santé (HAS) from France.The World Health Organization noted in 2011 that going into hospital was far riskier than flying. Globally the chance of a patient being subject to an error was about 10% and the chance of death resulting from an error was about 1 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 USA 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.NEWS, Going into hospital far riskier than flying: WHO,weblink 27 January 2019, Reuters, 21 July 2011,

Buildings

File:UVa Medical Center.jpg|thumb|The medical center at the University of VirginiaUniversity of Virginia

Architecture

File:NHS NNUH entrance.jpg|upright=0.8|thumb|right|The National Health Service Norfolk and Norwich University HospitalNorfolk and Norwich University HospitalFile:Fawcett Memorial Hospital Chapel.jpg|right|upright=0.8|thumb|Hospital chapel at Fawcett Memorial Hospital (Port Charlotte, FloridaPort Charlotte, FloridaModern 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.Annmarie Adams, Medicine by Design: The Architect and the Modern Hospital, 1893–1943 (2009)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."Healing by design {{webarchive|url=https://web.archive.org/web/20071017220150weblink |date=17 October 2007 }} – Ode Magazine'', July/August 2006 issue. Accessed 10 February 2008.
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.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. 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.NEWSPAPER,weblink Open hospital windows to stem spread of infections, says microbiologist, Sample, Ian, 2012-02-20, The Guardian, en, 2018-03-12, NEWS,weblink Closed windows 'increase infection', Bowdler, Neil, 2013-04-26, BBC News, 2018-03-12, en-GB, Eliminating long corridors can reduce nurses' fatigue and stress.WEB, The psychological and social needs of patients,weblink British Medical Association, 14 March 2011, 7 January 2011, dead,weblink" title="web.archive.org/web/20110314184736weblink">weblink 14 March 2011, 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.Health administrators go shopping for new hospital designs {{webarchive|url=https://web.archive.org/web/20081226075348weblink |date=26 December 2008 }} – National Review of Medicine, Monday 15 November 2004, Volume 1 No. 21

See also

Notes

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References

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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.weblink
  • 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)
  • {hide}Citation


|last1=Morelon
|first1=Régis
|last2=Rashed
|first2=Roshdi
|year=1996
|title=Encyclopedia of the History of Arabic Science
|volume=3
|publisher=Routledge
|isbn=978-0-415-12410-2
{edih}
  • 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

{{wiktionary|hospital}}{{commons|Hospital}}
Database
  • WEB,weblink Global and Multilanguage Database of public and private hospitals, hospitalsworldguide.com, en, live,
  • WEB,weblink Directory and Ranking of more than 17.000 Hospitals worldwide, hospitals.webometrics.info, en,
  • JOURNAL,weblink Medical History, Open Access Scholarly Journal, en,
{{Health care}}{{Public infrastructure topics}}{{Authority control}}

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