Types of Hospitals‐General Hospitals, Specializing Hospitals

Types of Hospitals‐General Hospitals, Specializing Hospitals:

Some 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 often are described as clinics. Likewise, Hospitals may be compared and classified in various ways: by ownership and control, by type of service rendered, by length of stay, by size, or by facilities and administration provided. Examples include the general hospital, the specialized hospital, the short‐stay hospital, and the long‐term‐care facility.

·             General hospitals:

The best‐known type of hospital is the general hospital, which is set up to deal with many kinds of disease and injury, and normally has an emergency department to deal with immediate and urgent threats to health. Larger cities may have several hospitals of varying sizes and facilities. Some hospitals have their own ambulance service.

General hospitals may be academic health facilities or community‐based entities. They are general in the sense that they admit all types of medical and surgical cases, and they concentrate on patients with acute illnesses needing relatively short‐term care.

Community general hospitals vary in their bed numbers. Each general hospital, however, has an organized medical staff, a professional staff of other health providers (such as nurses, technicians, dietitians, and physiotherapists), and basic diagnostic equipment. In addition to the essential services relating to patient care, and depending on size and location, a community general hospital may also have a pharmacy, a laboratory, sophisticated diagnostic services (such as radiology and angiography), physical therapy departments, an obstetrical unit (a nursery and a delivery room), operating rooms, recovery rooms, an outpatient department, and an emergency department. Smaller hospitals may diagnose and stabilize patients prior to transfer to facilities with specialty services.

In larger hospitals there may be additional facilities: dental services, a nursery for premature infants, an organ bank for use in transplantation, a department of renal dialysis (removal of wastes from the blood by passing it through semi permeable membranes, as in the artificial kidney), equipment for inhalation therapy, an intensive care unit, a volunteer‐services department, and, possibly, a home‐care program or access to home‐care placement services.

The complexity of the general hospital is in large part a reflection of advances in diagnostic and treatment technologies. Such advances range from the 20th‐century introduction of antibiotics and laboratory procedures to the continued emergence of new surgical techniques, new materials and equipment for complex therapies (e.g., nuclear medicine and radiation therapy), and new approaches to and equipment for physical therapy and rehabilitation.

The legally constituted governing body of the hospital, with full responsibility for the conduct and efficient management of the hospital, is usually a hospital board. The board establishes policy and, on the advice of a medical advisory board, appoints a medical staff and an administrator. It exercises control over expenditures and has the responsibility for maintaining professional standards.

The administrator is the chief executive officer of the hospital and is responsible to the board. In a large hospital there are many separate departments, each of which is controlled by a department head. The largest department in any hospital is nursing, followed by the dietary department and housekeeping. Examples of other departments that are important to the functioning of the hospital include laundry, engineering, stores, purchasing, accounting, pharmacy, physical and occupational therapy, social service, pathology, X‐ray, and medical records.

The medical staff is also organized into departments, such as surgery, medicine, obstetrics, and pediatrics. The degree of departmentalization of the medical staff depends on the specialization of its members and not primarily on the size of the hospital, although there is usually some correlation between the two. The chiefs of the medical‐staff departments, along with the chiefs of radiology and pathology, make up the medical advisory board, which usually holds regular meetings on medical‐administrative matters. The professional work of the individual staff members is reviewed by medical‐staff committees. In a large hospital the committees may report to the medical advisory board; in a smaller hospital, to the medical staff directly, at regular staff meetings.

General hospitals often also have a formal or an informal role as teaching institutions. When formally  designed  as  such,  teaching  hospitals  are  affiliated  with  undergraduate  and postgraduate education of health professionals at a university, and they provide up‐to‐date and often specialized therapeutic measures and facilities unavailable elsewhere in the region. As teaching hospitals have become more specialized, general hospitals have become more involved in providing general clinical training to students in a variety of health professions.

Another method of providing health care in a hospital for those able to pay for it, in both developed and developing countries, is the provision of a limited number of beds for private patients within a large general hospital otherwise financed to some degree by public funds. In the United Kingdom and, for example, in West Africa, these beds usually form part of the ward unit, the patient being required to pay for certain amenities such as a measure of privacy, unrestricted visiting, attractively served food, and a more liberal routine. Alternatively, many large general hospitals are able to offer much more costly accommodations in so‐called private blocks—that is, in a part of the hospital specially designed and equipped for private patients. Patients in a private block pay a large portion of the total cost of their medical care, including that of surgery.

·             Specializing hospitals:

Hospitals that specialize in one type of illness or one type of patient can generally be found in the developed world. In large university centers where postgraduate teaching is carried out on a large scale, such specialized health services often are a department of the general hospital or a satellite operation of the hospital.

Types of specialized hospitals include trauma centers, rehabilitation hospitals, children's hospitals, seniors' (geriatric) hospitals, and hospitals for dealing with specific medical needs such as psychiatric problems, certain disease categories such as cardiac, oncology, or orthopedic problems, and so forth. In Germany specialized hospitals are called Fachkrankenhaus; an example is FachkrankenhausCoswig (thoracic surgery).

Changing conditions or modes of treatment have lessened the need or reduced the number of some types of specialized institutions; this may be seen in the cases of tuberculosis, leprosy, and mental hospitals. On the other hand, specialized surgical centers and cancer centers have increased in number.

·              Tuberculosis and leprosy hospitals:

Between 1880 and 1940, tuberculosis hospitals provided rest, relaxation, special diets, and fresh air, and even if the tuberculosis was in an early stage, a stay of more than two years was thought necessary to effect a healing of the disease; a permanent cure was not considered entirely feasible. Today the use of antibiotics, along with advances in chest surgery and routine X‐ ray programs, has meant that the treatment of tuberculosis need not be carried out in a specialized facility.

·              Leprosy :

Leprosy has been known for centuries to be contagious. Lazar houses (hospitals for individuals with infectious disease) were established throughout Europe in the Middle Ages to isolate those with leprosy, at that time a common disease, from the community. In the 14th century there may have been some 7,000 leper houses in France alone, and some of the earliest hospitals in England were established for lepers. An intense campaign for leprosy elimination begun in the early 1990s, leprosy is now relatively rare. The purpose of the modern leprosarium is not so much isolation as it is treatment. The chronic form of the disease is treated by surgical correction of deformities, occupational therapy, rehabilitation, and sheltered living in associated villages. Acute leprosy is treated in general hospitals, clinics, and dispensaries.

·              Mental health facilities:

Psychiatric patients traditionally have been cared for in long‐stay mental health facilities, formerly called asylums or mental hospitals. Today the majority of large general hospitals have a psychiatric unit, and many individuals are able to maintain lives as regular members of the community. There are still facilities that specialize in the treatment of mental illness. The hospital stay of many persons with chronic mental illness has been shortened by modern medication and better understanding on the part of the public. Patients are encouraged to participate in facility‐based activities and programs. They may be encouraged to return to the community, beginning with trial visits at home, or they may be placed in assisted‐living or group homes. Every effort is now made, through the use of appropriate medication and support services, to have the patient integrated into the community.

Even those individuals who require custodial care are no longer isolated from contact with their relatives, friends, and the community at large. In addition, the strong correlation between mental illness and addiction has been noted and has given rise to numerous programs incorporating the simultaneous treatment of both conditions. Such programs are prevalent in developed countries in particular. In some cases special hospitals addressing both mental illness and addiction have been established—for instance, the Centre for Addiction and Mental Health in Toronto.

Long‐term‐care facilities are a special feature of specializing hospitals. Historically, long‐term‐ care facilities were homes for the elderly, the infirm, and those with chronic irreversible and disabling disorders, especially if the patients were indigent. Medical and nursing care was minimal. Today, however, long‐term‐care facilities have a more active role in health care. Some facilities are transitional from an acute hospital setting to the community. Others have residents who have a need for professional health care but do not need the intensive care found in an acute‐care facility. As a result, long‐term‐care facilities often are staffed with health professionals and are equipped to care for patients with extensive needs for daily living or to help patients prepare to live at home or with a member of the family. Long‐term‐care facilities represent a significant extension of the hospital health care system, helping to conserve expensive facilities for the acutely ill and improving the prospects of the chronically disabled.

Many countries have private hospitals that specialize in the treatment of specific diseases. For example, private facilities may be designed specifically for cataract or joint surgery. Small private hospitals are often called nursing homes, many of which provide little more than accommodation and simple nursing, the patient being under the care of a general practitioner or of a visiting consultant physician. Medical practice in the towns of developing countries is characterized by a proliferation of many small private hospitals, usually owned by doctors that have developed to meet the widespread need for hospital care not otherwise available.

Specialized hospitals can help reduce health care costs compared to general hospitals. For example, NarayanaHrudayalaya's Bangalore cardiac unit, which is specialized 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. 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

Specialized hospitals vary widely in the services they offer and therefore, in the departments (or "wards") they have. Each is usually headed by a Chief Physician. They may have acute services such as an emergency department or specialist trauma centre, burn unit, surgery, or urgent care. These may then be backed up by more specialist units such as:

·              Emergency department

·              Cardiology

·              Intensive care unit

·              Pediatric intensive care unit

·              Neonatal intensive care unit

·              Cardiovascular intensive care unit

·              Neurology

·              Oncology

·              Obstetrics and gynecology

Some of the specializing hospitals will have outpatient departments and some will have chronic treatment units such as behavioral health services, dentistry, dermatology, psychiatric ward, rehabilitation services, and physical therapy.

Common support units of these hospitals include a dispensary or pharmacy, pathology, and radiology, and on the non‐medical side, there often are medical records departments, release of information departments, Information Management, Clinical Engineering, Facilities Management, Dining Services, and Security departments.