Hospital
From Encyclopædia
{hahs'-pit-ul} The modern hospital has three major functions: patient care,
education, and medical research. In contrast, the earliest church-run medieval hospitals served primarily as havens for the homeless, the destitute, and those with diseases regarded as hopeless. The same purposes prompted
Philadelphia Quakers to establish (1751) the first American general hospital: it was built to care for the sick whose home conditions were considered too deficient to allow for proper care.Although some of today's hospitals existed physically in the 18th century, they began to take their present form only in the last quarter of the 19th century. Biological and medical discoveries such as germ theory, antisepsis, and anesthesia led
medicine to safer and less traumatic models of practice. Hospital
surgery had become possible by the 1880s, when the first operating suites were constructed. The institution, however, still retained its image as a place for the poor, and most sick people of any means continued to choose to be treated at home.The rapid
growth of cities was a powerful stimulus to the
growth of the modern hospital. Medical facilities and skills were increasingly centralized in the late 1800s, partially in response to the urgent need of crowded urban populations for medical care. Between 1873 and 1923 the hospital system grew from a small group of about 170 institutions (many of which were mental asylums) to over 4,500 facilities, most of them offering general medical care. This
growth, combined with the need of the medical profession for
teaching and research facilities, led to the modern, voluntary (not-for-
profit)
teaching hospital, almost always located in a
city.In the 1930s, major advances in
medicine stimulated the further
growth of hospitals. The introduction of the antibiotic SULFADRUGS in the mid-1930s and PENICILLIN in the early 1940s reduced the excessive morbidity and mortality associated with surgical infection. When the
technology necessary for blood storage was developed, blood transfusion became a matter of course, making
surgery even safer. Finally, X-ray examination permitted the successful treatment of many diseases and injuries that had previously been almost impossible to diagnose.
Central ROLE OF THE HOSPITAL IN MEDICAL CAREFollowing
world War II a rapidly advancing medical
technology, aided by large injections of government funds, persuaded physicians that the treatment of many ailments and diseases could be accomplished more efficiently and safely in a hospital than at their patients' homes. Hospital facilities and staffs were expanded. As the old public charity wards were augmented, and eventually replaced, by smaller rooms for paying patients, the hospital began to serve all social and economic classes, and the institution now took responsibility for two processes that had previously occurred almost exclusively in the home: being born and dying.Federal health insurance for the elderly and the poor was provided with the passage of MEDICARE and MEDICAID in 1965. Both public and private insurance coverage favored payment for hospital inpatient care rather than outpatient visits, giving new impetus to the continued
growth of hospital facilities (although visits to outpatient clinics and emergency wards also expanded--from 65 million in 1954 to over 180 million in 1970).In recent years, advances in medical
technology have increased the range of potential medical cure. For the most part, these new technologies are available only in hospitals. New surgical facilities have encouraged the development of cardiac and vascular
surgery; there are now innovative intensive-care units for patients with heart attack,
stroke, and chronic lung disease, as well as for those who have suffered severe injuries, especially burns, and for neonatal diseases.
organ transplants and synthetic implants have become almost commonplace. Diagnostic imaging and scanner procedures, ultrasound, and angiography have vastly improved diagnostic techniques, but they have also required even greater use of hospital facilities.TYPES OF HOSPITALSIn the mid-1980s there were over 7,500 hospitals in the
United States. Most of these were general medical- and surgical-care facilities. Half had fewer than 100 beds. Academic
teaching hospitals--which are usually attached to medical schools and have internship and residency programs--accounted for about 10 percent of all hospitals; they were often larger institutions, controlling about 25 percent of the
nation's hospital beds.Hospitals operate under one of three types of ownership: they are either voluntary, conducted as nonprofit public enterprises under private management; government, supported by taxes and sponsored by federal, state, county, or
city agencies; or proprietary,
profit-making institutions financed by investors. The federal government operates hospitals through the Veterans Administration, the Department of Defense, and the armed services as well as administering
public health Service and Indian Health Service facilities,
prison hospitals, and special institutions run by the
alcohol,
drug Abuse and Mental Health Administration. Every state operates one or more hospitals providing care of the mentally ill, the retarded, and
tuberculosis patients.Nonprofit hospitals may be run by religious groups or associations of citizens.
profit-making hospitals may be owned by individuals, by groups--often of physicians--or by investor-owned corporations and hospital chains. Since the mid-1970s, hospital chains have proliferated, often through buying or leasing financially pressed municipal or county facilities and
university-attached
teaching hospitals. The chains have the capital to improve often run-
Down physical and technological facilities. Questions remain, however, about whether they will freely admit uninsured patients, and whether their need to demonstrate
profits for their stockholder can be reconciled with their responsibility to provide top-quality medical care and, at the
teaching hospitals, medical
education.Hospitals may also be classified by the kinds of services they offer. General hospitals are equipped to treat a variety of common diseases and injuries. Special hospitals are established to treat specific diseases or special groups of patients: psychiatric, maternity, orthopedic, juvenile, and so forth. Short-term hospitals are defined by the American Hospital Association, the industry's
Central organization, as those with over half of all patients admitted for less than 30 days.All hospitals must be licensed by the states where they are located and must meet state-set standards of cleanliness and safety. A hospital may seek accreditation from the Joint Commission on Accreditation of Hospitals (JCAH), the industry's official accrediting body. To receive accreditation, it must comply with JCAH standards and pass inspection and investigation by a JCAH survey team. Other accrediting organizations evaluate the hospital's clinical laboratories and
blood banks.HOSPITAL ORGANIZATIONThe hospital's board of trustees represents the public's
interest and bears legal and moral responsibility for all activities that occur within the institution. The trustees set hospital policy and see to the provision and safeguarding of hospital assets. The administrator, the
chief of the medical staff, and the
chiefs of the various medical services are directly responsible to the trustees who also approve the medical-staff bylaws, the rules that govern the behavior of staff physicians.The medical staff is usually subdivided into inpatient departments such as
medicine,
surgery,
pediatrics, obstetrics, and?
psychiatry. Each department has a
chief of service, and all medical services are overseen by a
chief of staff, who may be appointed by the trustees or elected by the medical staff.
teaching hospitals maintain a paid staff of physicians, residents, and interns. Otherwise, physicians are not usually hired by a hospital, but instead are granted the privilege of practicing there once their professional qualifications are approved.In addition to the standard medical and nursing services, a
number of special services have become vital to patient care. Dietetics, the planning of meals based on the knowledge of special dietary requirements for every type of illness, is a major department within a hospital. Special alcoholism and
drug units treat the physical and psychological aspects of addiction. PHYSICAL THERAPY is essential in the
Rehabilitation of accident victims. Emergency
medicine has become a specialty with established procedures for keeping alive victims of poisoning,
drug abuse, heart attacks, and severe injuries from accidents and disasters. In addition, the emergency rooms of many hospitals now provide basic medical care for large
numbers of people who use this service, usually, because they do not have access to a physician.Hospital administration is concerned with such matters as finances,
plant management, and labor policies.THE ISSUE OF HOSPITAL COSTSThe passage of Medicare and Medicaid initiated the explosive increase in hospital costs that has occurred over the past two decades. Hospital reimbursement is Medicare's largest expenditure,
accounting for almost 70 percent of its total outlays. Between 1966 and 1982 Medicare payments to hospitals increased at an annual rate of about 20 percent, in large part because of the
growth in the
number of elderly patients and the increased volume of services provided them. With continued
growth in the proportion of the elderly relative to the total population, health-care planners must expect continued increases in over-all medical costs.
