J Ayub Med Coll Abbottabad 2015;27(2)

ORIGINAL ARTICLE
BED OCCUPANCY RATE AND LENGTH OF STAY OF PATIENTS IN
MEDICAL AND ALLIED WARDS OF A TERTIARY CARE HOSPITAL
Gulzar Usman, Khalida Naz Memon, Shazia Shaikh
Department of Community Medicine, Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro-Pakistan

Background: A good hospital management includes an effective allocative planning for beds in a
hospital. Bed-occupancy rates and length of stay are the measures that reflect the functional ability
of a hospital. Methods: A cross sectional study of two months’ duration was carried out in eight
medical and allied wards of Liaquat University Hospital (LUH) Jamshoro with objective to
estimate the bed occupancy rate and the average length of stay of patients. Data was collected by
filling a pre-designed check list and bed occupancy rate and average length of stay were
computed. Associations were analysed by using SPSS version 16. The p-value ≤0.05 was taken as
level of significance. Results: One hundred & seven admissions were recorded against 235
available beds. Average bed occupancy rate was 51.33%. The 51.4% of the patients in medical
wards except paediatrics ward were of the age >50 years; the mean age was 45 years and standard
deviation±6.4 years. Mean age in paediatrics was 3.89 years and standard deviation of±0.8 years.
55.1% patients had infectious diseases. The 32.7% patients stayed in hospital for up to 3 days
showing significant association between nature of diseases and duration of stay (p=0.03). There
was male preponderance, i.e., 54.2% males against 45.8% females. Showing significant
association between gender and length of stay (p=0.01). Conclusions: Bed occupancy rate and
average stay in hospital were found within recommended range; more improvement may be
brought by doing further research on this issue.
Keywords: Bed occupancy, Length of stay, gender, tertiary care hospital
J Ayub Med Coll Abbottabad 2015;27(2):367–70

INTRODUCTION been proposed as measures that reflect the ability of a

hospital to provide proper care for patients. This
Allocative planning is process of making decisions
measure can be considered useful in guiding the
about how resources should be spent in an
planning and operational management of hospital
organization.1 An effective allocative planning for
beds in a way that improves how well patients fare
beds in a hospital is an effective tool for good
while admitted in hospital.6 The current study was
management in a hospital. The optimization of equity
designed with the objectives to estimate the bed
requires attention to optimum resource allocation,
occupancy rate and the average length of stay of
besides other issues.2 Management is the efficient use
patients in medical and allied wards of LUH
of resources, i.e., the different types of resources used
Jamshoro and to determine the association of the bed
for achieving objectives in a health care facility, must
occupancy and average length of stay with various
be carefully balanced. The successful performance of
demographic factors in medical and allied wards of
activities and achievements of objectives in a health
LUH Jamshoro.
care providing facility depends upon the application
of knowledge and skills to problem-solving, using all MATERIAL AND METHODS
the necessary resources in the most efficient way.3
It was a descriptive cross sectional study of two
The hospital administration is therefore referred to as
months’ duration from 1st January to 28th February
both a science and art; the right patient should receive
2009. It was carried out in eight medical & allied
the right care at the right time in the right place at the
wards in Liaquat University Hospital, Jamshoro
right cost.4 The rapid increase in population
(LUH) including four medical, two paediatrics, one
constrains economic losses stretch the already
Dermatology ward and one chest medicine wards.
overburdened health facilities.1 Health care provision
LUH is a tertiary care teaching hospital situated in
in Pakistan involves the private and public sectors.
Hyderabad, provided with 1300 beds and it caters a
The public sector is comprised of a large network
huge population of almost whole of Sindh except
exceeding 10,000 health facilities, in addition to
Karachi.
around 3000 family welfare canters run by the
All patients who remained admitted in any
Ministry of Population Welfare with limited
of the designated medical and allied wards during
functional integration. Pakistan also has a flourishing
specified study period were registered for the study.
network of private health care providers with a larger
It comprised of a total 235 beds. Data was collected
utilization base.5 Hospital bed-occupancy rates have
by convenient type of sampling. The casualty wards,

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isolation wards & non-medical wards including
paediatrics surgical wards were not enrolled in the
study.
After taking informed departmental consent,
a pre-designed check list containing all relevant
information was filled in by the principle researcher
with the help of information provided by
registrars/head nurses of the respective wards. To
make classification of the admitted patients into
logical, systematic and acceptable groups, all unit’s
incharges and registrars were consulted repeatedly.
Another source of information used, for classification
of diseases was WHO publication ICD-10. During
daily visit for purpose of follow up, hospital records
were reviewed- age, gender, disease profile, duration
of hospital stay were recorded and bed occupancy
rate was calculated and average length of stay was
computed. Data were presented as number,
percentage, mean and standard deviation. The
variables of special interest were total beds available,
total days of admission, duration of stay, age and
gender. The data were managed by SPSS-16. The
p≤0.05 was taken as level of significance.
RESULTS
There were total two hundred & thirty five beds
available in medical and allied wards while the total
patients admitted during the study period of two
months were one hundred and seven. The bed
occupancy rate was 51.33% in all medical and allied
wards varying from 66.2% in medicine wards,
54.05% in paediatrics wards, 19.3% in chest
medicine and 17.5% in dermatology ward. 51.4% of
the patients in our study area of medical wards except
paediatrics ward, belonged to the age group >50
years. The mean age of the patients admitted in
medical wards was 45 years with standard deviation
of±6.4 years. There was male preponderance among
total admissions in all medical and allied wards, i.e.,
54.2% males against 45.8% females .There was no
association between bed occupancy rate and gender
(p=0.1), however, there was significant association
between gender and length of stay in hospital
(p=0.01). There were 55.1% patients in medical,
dermatology and chest medicine wards who had
infectious health problems while 42.1% were
admitted because of non-infectious diseases while
only 2.8% remained undiagnosed. Regarding the
length of stay in medical wards, 32.7% patients
remained stayed in hospital for up to 3 days, 29.9%
patients stayed in hospital for up to 7 days, 14% up to
10 days while 23.4% patients remained admitted for
period varying from 10–30 days (Figue-1). A
statistically significant association was seen between
nature of diseases and duration of stay (p=0.03). In
the paediatrics ward, there were sixty three patients
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J Ayub Med Coll Abbottabad 2015;27(2)
registered during the study period with majority
(44.5%) of the patients belonging to the age group <1
year, followed by 28.6% patients in age 1–4 years
and 26.9% patients were found in age group 5–14
years. The mean age of admitted patients in
paediatrics was recorded as 3.89 years with standard
deviation of±0.8 years. There were 69.8% patients in
paediatric ward who had infectious diseases while
32.2% had diseases of non-infectious origin.
Figure-1: Average length of hospital stay
DISCUSSION
Providing a necessary care to a sick person outside
home, i.e., in a hospital dates back to nearly 300
century BC7; therefore with such an old history, the
level and distribution of beds among various wards in
a health facility are a matter of continued public
interest8. A hospital bed is both a scarce and
expensive commodity in healthcare. Administrators
running hospitals are in a dire need of objective
measures and methods for efficient management of
their material resources in the light of limited
financial resources. Bed utilization rates can be of
immense help in realistic and effective decision
making.9 The present study was undertaken to
explore utilization of beds in a tertiary care hospital
in Jamshoro. The health care facilities in Pakistan can
be divided into public and private sectors. It is
estimated that in 77% of all health care facility visits,
people prefer to approach private health facilities.10
According to 2009 government statistics, there were
about 14,000 health institutions nationwide with a
total of more than 100,000 hospital beds.10 The
occupancy rate is a calculation used to show the
actual utilization of an inpatient health facility for a
given time period. This information is also very
useful for health planning purposes.11 It also helps in
calculating the cost allocation. The cost allocation
/bed /day in local currency were estimated by World
Health Organization (WHO) as being six hundred &
sixty six rupees.12 The bed occupancy rate & average
length of stay in hospital are the two most important
indicators of the health services utilization.
Empirically, the average occupancy rate is positively

related to the admission rate in a hospital.8 Bed
Occupancy Rate (BOR) is the percent of occupancy
obtained by dividing the average daily census, i.e.,
the number of available beds in a particular ward.
The average length of stay in a ward is an indicator
which measures the average duration of hospital stay
of admitted patients. In our study the bed occupancy
rate was 51.33% in all medical and allied wards.
Keegan A cited in his article that in the department of
health in United Kingdom had studied that bed-
occupancy rates exceeding 85% in acute care
hospitals were associated with problems in handling
both emergency and elective admissions.5 A very
high bed occupancy rate damages the quality and
safety of in-patient care. Bed utilization is at its most
efficient when it is not allowed to exceed 85
percent.13 A study with the same objective concluded
that risks were discernible when average bed
occupancy rates exceeded about 90%, and an acute
hospital can expect regular bed shortages and
periodic bed crises if average bed occupancy rises to
90% or more.14 In our study, the bed occupancy
varied from 66.2% in medicine wards, 54.05% in
paediatrics wards, 19.3% in chest medicine and
17.5% in dermatology ward. The reason for higher
bed occupancy in medicine wards could not be pin
pointed but it was seen that there were more number
of infectious cases admitted in the medicine wards.
There were 55.1% participants in medical ward have
had infectious health problems, The concomitant
higher rates of bed occupancy and infectious cases
reporting in medicine ward had an associative link
(p=0.01). This was endorsed by another research
which concluded that hospital overcrowding (high
bed occupancy) contributes significantly to the rate of
hospital-acquired infections, and hand-hygiene
compliance falls as the indications for hand washing
increase during periods of understaffing and high
workload.15
Tariq M et al reported that infections
including septicaemia and pneumonia were the
leading causes of hospital admissions and mortality
in our setting, followed by non-communicable
diseases.16 We found 42.1% patients admitted in
medicine wards diagnosed as non-infectious cases.
Regarding the length of stay in medical and allied
wards, the maximum number of the patients (32.7%)
remained admitted in hospital for up to 3 days,
29.9% up to 7 days, 14% up to 10 days and 23.4%
patients remained admitted for period varying
from10–30 days. Statistically significant association
was observed between length of hospital stay and the
nature of diseases (p=0.03). Chiswick Br stated that
eliminating inappropriate hospital stay decreased the
hospital costs and the risks of nosocomial infection
and spared available resources for patients reporting
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J Ayub Med Coll Abbottabad 2015;27(2)
with more critical conditions.8 Our study revealed a
little male preponderance among total admissions in
all medical and allied wards, i.e., 54.2% males
against 45.8% females. Rahman M et al also reported
that male’s admission rate was higher than female
admissions in the hospitals throughout the year.17 We
however did not find any significant association
between these two variables (p=0.1).
However, there was however significant
association between gender and length of stay in
hospital (p=0.01). We found average length of stay in
all medical wards as 10.6 days with the highest
length of stay in paediatrics ward (15.1 days)
followed by medicine wards (8.4 days). In one of the
study conducted by Clements A, the average length
of stay in hospital was reported as 4.74 days.15 It was
in contrast to our findings, the reason for this gross
difference in length of stay was not obvious but lesser
availability of diagnostic work ups for the in-patients
in our set up could be one of the reasons.
Regarding age of the patients, excluding the
paediatrics wards, 51.4% of the patients in our study
area of medical wards belonged to the age group >50
years. The mean age of the patient admitted in
medical wards was 45 years and it varied around
standard deviation of±6.4 years. In the paediatrics
ward, the mean age was 3.89 years with standard
deviation of±0.8 years.
Usman M et al in their research found the
mean age of admitted patients as 56.6 years with
average length of stay 5.4 days. The highest length of
hospital stay was seen among patients age groups 40–
60 years.18 We found that among medical wards the
more the age of patient, the higher was the admission
rate (p=0.03) and longer stay in hospital (p=0.001).
Our finding was also endorsed by Majeed M U et al19
and Homas T H20.
CONCLUSIONS AND
RECOMMENDATIONS
The present data suggested that in terms of bed
occupancy rate the medical and allied wards were
found to run in optimal capacity which, however the
average length of stay of patients appeared to be
relatively longer which needs a separate research that
may lead the management to take appropriate
measures to reduce patients long hospital stay and
make the tertiary care hospital to further improve the
quality of services.
REFERENCES
1. Green A. An introduction to health planning in developing
countries; 2nd ed. Oxford: Oxford University Press, 1999: pp
318.
2. Lucas AO. Health policies in developing countries. Oxford Text
Book of Public Health. 4th Edition. Ed:Detels R,Mc Ewen J,
Beaglehole R & Tanaka H (2009) p: 292.
369

3. McMahan R, Barton E, Piot M. On being Incharge: A guide to
Management in Primary Health Care. 2nd Edition. Geneva: World
Health Organization. 1992.
4. K. Park. Hospitals and Community. Park’s Textbook of
Preventive and Social Medicine, Ed 18th (2007-08): p: 43
5. Keegan A D. Hospital bed occupancy: more than queuing for a
bed. Med J Aust 2010; 193(5):291–3.
6. Manual procedures for District Health Information System
(DHIS) NHIRC, MoH, Indicators; 2008, DHIS-28(M): 185-186.
7. Rahman H, Haque SME, Hafiz MA. Percent Bed occupancy rate
in a selected specialized tertiary care hospital in Dhaka city
Bangladesh J Med Sci 2012;11(1)18–24.
8. Chiswick BR. Hospital Utilization: An Analysis of SMSA
Differences in Occupancy Rates, Admission Rates: and Bed
Rates: In: Explorations in Economic Research: Chiswick
1976;3(3) p.24–76.
9. Federal Bureau of Statistics, PSLM 2004–05 and 2009–10.
http://www.statpak.gov.pk/fbs/sites/default/files/social_statist
ics/health_statistics/health1.pdf. Accessed on 06.02.2013.
10. Federal Bureau of Statistics, Social Statistics Wing,
Hospitals/Dispensaries and Bedsby Province. 2009.
http://www.statpak.gov.pk/fbs/sites/default/files/social_statist
ics/health_statistics/health1.pdf).Accessed on 10.02.2013.
11. Occupancy rates in health facilities. Tools for the trade.
www.portal.state.pa.us/portal/server.Accessedon 03.02.2013.
12. WHO-CHOICE. Estimates of unit costs for patient services
for Pakistan. Choosing interventions that are cost effective
www.who.int/choice/country/pak/cost/.Accessed 10.02.2013
13. Looking Ahead – Future development of UK mental health
Address for Correspondence:
Dr. Khalida Naz Memon, Department of Community Medicine LUMHS, Jamshoro-Pakistan
Cell: +92 306 357 2147
Email: knazmemon63@hotmail.com
370 http://www.jamc.ayubmed.edu.pk
J Ayub Med Coll Abbottabad 2015;27(2)
services: Royal College of Psychiatrists. Recommendations
from a Royal College of Psychiatrists’ Enquiry:(Occasional
Paper OP75). Royal College of Psychiatrists, (2010).
14. Bagust A, Place M, Posnett JW. Dynamics of bed use in
accommodating emergency admissions: stochastic simulation
model. BMJ 2009;319(7203):155–8.
15. Clements A, Halton K, Graves N, Pettitt A, Morton A, Looke
D, et al. Overcrowding and understaffing in modern health-
care systems: key determinants in meticillin-resistant
Staphylococcus aureus transmission. Lancet Infect Dis
2008;8(7):427–34).
16. Tariq M, Jafri W, Ansari T, Awan S, Ali F, Shah M, et al.
Medical mortality in Pakistan: experience at a tertiary care
hospital. Postgrad Med J. 2009;85(1007):470–4.
17. Rahman H, Haque SME, Hafiz MA. Percent Bed occupancy
rate in a selected specialized tertiary care hospital in Dhaka
city. Bangladesh J Med Sci 2012;11(11)18–24.
18. Usman M, Jamal S, Tabassum S, Zafran M. Length of stay
of patients in a tertiary care hospital. Gomal J Med Sci
2011;9(1)55–8.
19. Majeed MU, Williams DT, Pollock R, Amir F, Liam M,
Foong KS, et al. Delay in discharge and its impact on
unnecessary hospital bed occupancy. BMC Health Serv Res
2012;12 p:410.
20. Holmas TH, Kjerstad E, Kristiansen F, Luras H. Long term
care and hospital length of stay for elderly patients.
heb.rokkan.uib.no/publications/files/224-
HEBrapport0607.pdf.