The boundaryless hospital

Everyone in the western world has a clear idea of what a hospital is. People think of a series of large multi-storeyed buildings filled with highly skilled and professional people (the ‘ologists’) offering sophisticated services amid an impressive array of high technology equipment. Over the past century the development of the hospital has involved cramming more and more services, staff and resources into the one location. Many large hospitals today have a staff of several thousand and are like a small city. But will hospital development continue in this direction? We think not. We believe the hospital has reached an evolutionary branch. The fundamental nature of hospitals is about to change because of the application of information and clinical technology, changing medical practices and economic rationalism. To understand why requires an excursion into a number of disciplines including the history of the hospital, organisation behaviour, medical practice, management and health care policy. And this is no mere epistemological exploration: it is vital for society generally and those who work in health care particularly to understand that the existing structure of the principal organisation which delivers health care is coming to an end. Our principal focus is the teaching hospital, but the analysis applies to a substantial degree to the many kinds of hospitals found throughout the industrialised world.     

Estimating hospital admissions due to rotavirus gastroenteritis from hospital episode statistics

OBJECTIVES: To determine the proportion of hospital admissions, in children < 5 years old, coded for intestinal infectious disease or non-infectious gastroenteritis, using ICD-10 codes, that were due to rotavirus infection. To assess how many children admitted with rotavirus gastroenteritis were given the specific ICD-10 code (A080) for this disease. METHODS: Sixteen-month prospective, observational study of children < 5 years old, admitted to district general hospital with: acute gastroenteritis (> or =3 loose stools/day), proven rotavirus infection and those coded as intestinal infectious disease or non-infectious gastroenteritis. RESULTS: Four hundred and twenty children < 5 years old were admitted with acute gastroenteritis. Rotavirus was detected in 170 children's stools. Acute rotavirus gastroenteritis accounted for 81/397 (20%) children coded as having non-infectious gastroenteritis and 32/81 (40%) coded for intestinal infectious disease. Only 18 children were coded for rotavirus gastroenteritis. Potentially preventable rotavirus gastroenteritis occurred in 122 children; 78 coded as non-infectious gastroenteritis (20%) and 26 coded for intestinal infectious disease (34%). CONCLUSIONS: The proportion of children coded with diarrhoeal diseases and found to have rotavirus is less than previously estimated. Using the specific code for rotavirus infection to estimate hospital admissions would be a gross underestimate. Hospital episode statistics cannot reliably estimate the burden of disease due to rotavirus.