Hospital is an institution that provides medical services for a community. The doctors, nurses, and other personnel of a hospital work to restore health to sick and injured people. They also try to prevent disease and maintain health in the community. Some hospitals serve as centers for medical education and research.
Every year, about 15 per cent of the people of the United States spend some time as hospital patients. Millions of others visit hospitals as outpatients. They receive treatment but do not stay in the hospital.
The United States has about 6,700 hospitals and over 1,200,000 hospital beds. Most of the hospitals have fewer than 200 beds. About 500 hospitals have over 500 beds. In Canada, there are about 1,200 hospitals and about 180,000 beds.
Each state has laws that a hospital must follow to receive a license to operate. Most U.S. hospitals are also approved by the Joint Commission on Accreditation of Health Organizations. Accredited hospitals must meet basic national standards set by the commission. They must also undergo periodic inspections.
In the mid-1970’s, the U.S. government set up professional standards review organizations (PSRO’s). In 1984, groups of medical professionals called peer review organizations (PRO’s) replaced PSRO’s. These groups review the quality of hospital care given to patients covered by Medicare and other federal medical assistance programs. Some PRO’s also review care paid for by businesses and private insurance companies.
Some form of institution for the care of the sick has existed longer than recorded history. The first centers for the ill were probably operated together with religious temples. Priests served as healers.
How hospitals are classified
Every hospital is classified according to (1) length of stay, (2) kinds of services, and (3) type of ownership.
Length of stay.
Most hospitals are short-term hospitals in which the majority of patients stay less than 30 days. Patients spend an average of 4 to 8 days in a short-term hospital. In long-term hospitals, most patients stay more than 30 days. People having their tonsils removed would go to a short-term hospital. Those with severe mental illnesses may stay in a long-term institution because of the time needed to treat their condition.
Kinds of services.
A general hospital provides services for most people and illnesses. A special hospital cares for certain people or certain illnesses. For example, pediatric hospitals treat only children. Rehabilitation hospitals provide services to help people adjust to mental and physical disabilities.
A hospital may perform other services besides treating the sick. For example, research hospitals conduct medical research. Teaching hospitals educate future physicians, nurses, laboratory specialists, and others planning a health-care career. A teaching hospital may form part of a university medical center, or it may be a general hospital associated with a medical school.
Type of ownership.
Most hospitals are owned by their community. A board of trustees consisting of local residents manages such community hospitals in the public interest. A nonprofit voluntary hospital is owned by such organizations as charitable or religious groups. Community and nonprofit hospitals almost always spend more money for patient care than they receive in fees. Such hospitals must depend on donations to cover their costs.
A private, or proprietary, hospital is operated like a business to make a profit for the owners. Several corporations own chains of short-term general hospitals and psychiatric hospitals.
A government hospital is owned by the federal, state, or county or local government. The federal government operates hospitals that serve members of the armed forces and their dependents, veterans, American Indians, and certain other groups. Many state hospitals care for the mentally ill. Some county and local hospitals serve all the people in the area, especially the poor. Others offer special services, such as the treatment of contagious diseases.
Hospital departments and personnel
The professional services staff
consists of the people directly concerned with the care of patients. The medical staff, made up of physicians, provides guidance to all other members of this team. Most physicians have an office practice and send their patients to the hospital when necessary. They then supervise the treatment.
In many hospitals, some physicians work directly for the institution and do not have a private practice. In some hospitals, many or all members of the medical staff work directly for the hospital. This arrangement occurs chiefly in government and university hospitals and in hospitals operated by labor unions or other groups for the benefit of their members.
The medical staff also includes physicians in training. These residents have graduated from medical school and work in a hospital for additional required experience (see Medicine (Residency) ).
The nursing staff forms the largest group on the patient care team. Professional nurses, generally called registered nurses, have graduated from a school of nursing operated by a hospital, university, or community college. They carry out much of the patients’ care under the guidance of physicians. They also direct other members of the nursing staff, including practical nurses, nurse’s aides, and nurse attendants. These men and women do many tasks to free the registered nurses for work requiring their special skills.
Professional services departments
work with the physicians and nurses. The hospital pharmacy provides medicines that physicians order for patients. The central service department maintains medical supplies. The food service department prepares meals for patients and staff members. A dietitian directs this department and plans the menus. The dietitian also develops special diets for patients when ordered by a physician.
The hospital laboratories conduct tests that help doctors diagnose and treat illnesses. The radiology department makes X rays to help physicians diagnose diseases and injuries. Doctors also use X rays to treat cancer.
Many hospitals have a rehabilitation department that works with disabled patients to help them return to normal life. There are two basic types of rehabilitation therapy, physical and occupational. Physical therapy treats diseases or injuries. Occupational therapy helps overcome or reduce disabilities by teaching various skills. See Occupational therapy ; Physical therapy .
The medical records department keeps a record on every patient. If former patients return to the hospital, their medical record helps the physician diagnose and treat their illness.
Administrative departments.
Most hospitals have an administrator who is responsible for the operation of the entire institution. The board of trustees or the owner appoints this official. In some cases, a private management firm provides the administration of the hospital.
Various departments handle a hospital’s business affairs. The admitting office schedules patients for admission at the request of their physician and assigns them to a room. The business office lists each patient’s charges, prepares a bill, and records payments received. The purchasing department manages a hospital’s stockroom and buys supplies and equipment.
A hospital maintains a personnel department to hire employees and handle employee relations. A large institution may have a public relations office to inform employees, patients, and the public about the hospital’s operation. Some hospitals employ patient representatives to deal with patients’ complaints.
The volunteer services department organizes the activities of a hospital’s volunteers. These unpaid workers operate the coffee and gift shops in most hospitals. They also help raise funds for the institution.
Other employees
also help a hospital run smoothly around the clock. Cooks prepare meals in the hospital kitchen. Housekeepers and janitors keep the institution clean to help prevent the spread of infection. Workers in the laundry department clean, sort, and press the hundreds of pounds of linens used daily. Such experts as electricians and engineers maintain a hospital’s complex machinery. Security personnel protect hospital patients and property.
Hospital care
Hospital units.
Most hospitals are divided into various units, each of which cares for certain groups of patients. The number of units varies according to the size and type of a hospital.
Most general hospitals have several basic units. For example, the maternity unit helps protect mothers and newborn babies from infection by keeping them apart from other patients. Except in extremely small hospitals, children stay in a pediatric unit. Some hospitals also have a teen-age unit. Men and women who do not require surgery stay in the adult medical unit.
Most hospital units are intermediate care units, in which the professional staff gives patients constant care and observation. Intensive care units serve critically ill patients. Some hospitals have minimal care units for patients who are well enough so that they or their families can provide much of the nursing care needed. A few institutions have parent care units for children. There, a parent stays with the child and provides all nursing care except technical treatments. In addition, a hospital may have a psychiatric unit for mentally ill patients, and units for burn victims, heart patients, premature babies, and others who require special care.
A hospital’s surgical unit cares for patients awaiting surgery or recovering from an operation. Most hospitals have a recovery unit in which a patient who has received a general anesthetic can be watched closely after surgery. Many hospitals also have an ambulatory surgical center (ASC), or same day surgery unit. Patients usually go to the ASC in the morning and return home in the early evening. About 35 to 48 per cent of a hospital’s surgical operations are performed in the ASC. These surgical procedures are usually uncomplicated ones, such as the removal of tonsils or the repair of knees and elbows.
A hospital also has an emergency unit that provides care for accident victims and people who have suddenly become ill. Since the early 1960’s, services for outpatients have become a major function of the emergency unit. As a result, the use of emergency units has increased about 80 per cent. Less than a fifth of the patients treated in emergency units actually have an urgent problem. They go to a hospital rather than a physician’s office because the hospital provides care at any hour.
Nonmedical services.
Hospitals provide many services not directly connected with a patient’s medical needs. Relatives and friends may visit patients or talk with them by telephone. Many hospitals have lounges and sunrooms for patients who do not have to stay in bed. Hospitals furnish radios and television sets for patients, and many have lending libraries. Social workers and chaplains on the hospital staff try to help patients and their families solve personal problems.
Children have many special needs while hospitalized. Hospitals try to make pediatric units as pleasant as possible. These units provide playrooms and special activities for children. Child life workers give youngsters special attention and help them adjust to the hospital. Some hospitals arrange for children to visit the institution before being admitted. Some hospitals also let parents stay with their children and sleep in their room.
History
Early hospitals.
The word hospital comes from the Latin word hospitalis, which means a house or institution for guests. As early as the 200’s B.C., Buddhists had set up hospitals in India. Early in the Christian Era, hospitals were established for sick or weary travelers, and for the poor, the blind, and the crippled. Religious orders operated most of these early hospitals. For hundreds of years, hospitals chiefly cared for people who were too poor or too sick to be treated at home. Doctors did not work in the hospitals. They treated most patients in the patients’ homes or in their own offices.
The oldest hospital still in existence is the Hotel Dieu in Paris, founded during the A.D. 600’s. The Spanish governor of Hispaniola built the first hospital in the Western Hemisphere in 1503. The ruins of the hospital still stand in Santo Domingo, Dominican Republic. The Spanish explorer Hernán Cortés founded a hospital in Mexico City that has existed since 1524. The first Canadian hospital opened in Quebec in 1639. The first incorporated hospital in the United States was the Pennsylvania Hospital. The hospital was established in Philadelphia with the assistance and support of Benjamin Franklin. The Pennsylvania Hospital, still in existence today, received its charter in 1751.
In the early 1700’s, European cities and towns began to build hospitals. These hospitals served mainly the poor or the victims of contagious diseases. They operated as charity hospitals. The wealthy did not go to hospitals. They usually received medical care at home.
Early hospitals were dirty, crowded, and dark. The principles of sanitation were unknown. Diseases spread rapidly throughout hospitals because of lack of knowledge about the importance of cleanliness.
The 1800’s.
Medical discoveries in the 1800’s helped begin the improvement of hospitals. In 1842, Crawford W. Long, a Georgia physician, became the first doctor to use ether as an anesthetic. Four years later, William T. G. Morton, a Boston dentist, arranged the first hospital operation using ether as an anesthetic. It was performed at the Massachusetts General Hospital in Boston.
During the late 1800’s, doctors began to observe the principle of antisepsis (cleanliness to reduce infections). This principle made surgery much safer. It started the continuing trend of caring for patients in hospitals instead of at home. Doctors could not establish the necessary cleanliness at home. The use of X-ray equipment in hospitals began in the late 1890’s.
Another feature of the late 1800’s was the growth of hospital schools of nursing. Nursing schools in the United States were patterned after one founded in London by the famous English nurse Florence Nightingale (see Nightingale, Florence ). The Massachusetts General Hospital, Bellevue Hospital in New York City, and the New Haven (Conn.) Hospital established the first American nursing schools in 1873. With trained nurses caring for the patients, standards of hospital care improved very rapidly and the number of patients increased.
Also in the 1800’s, hospitals began to establish rooms for private patients. The idea of the charity hospital started to diminish. Patients began to pay for part of the cost of their hospitalization.
The 1900’s.
Many hospitals were built in the United States during the early 1900’s. As the number of patients increased, the cost of hospital care rose because of the need for more equipment and personnel. Many people could not afford the cost of hospital care, especially during the Great Depression of the 1930’s. Hospitals often faced financial problems.
The Blue Cross plan, developed in 1929, offered a form of prepayment insurance to help patients pay their hospital bills. During the 1930’s and 1940’s, more and more people purchased such insurance to protect themselves against the expense of hospitalization. Insurance helped put hospitals on a sounder financial basis because they could be sure of immediate payment.
Hospitals became overcrowded during the 1940’s. To assist them, Congress passed the Hill-Burton Act in 1946. This law authorized government grants to help the states pay the cost of building new hospitals and enlarging and modernizing existing ones.
Recent developments.
In the 1960’s, hospitals became increasingly interested in serving the community. Many of them set up outpatient clinics that offered general family or pediatric care. A number of hospitals began to provide laboratory tests, X rays, and therapy for outpatients. Some hospitals set up neighborhood health clinics, and a few started programs in which staff members visit patients at home. Hospitals also sponsored programs to help people with such problems as alcoholism or narcotics addiction. In 1965, the U.S. government established Medicare, a program to help pay for the medical care of people age 65 and over. Another program, called Medicaid, was created at the same time to pay for the health care needs of poor people.
Many advances helped improve patient care. For example, surgical and intensive care units now use electronic equipment to keep a continuous record of a patient’s blood pressure, heart rate, respiration, and temperature. Hospitals also use many disposable items for convenience and safety, including plastic thermometers and hypodermic syringes and steel needles.
During the 1970’s, the services of many hospitals became available over a wide area as a result of regional planning. Under the direction of regional or community councils, several hospitals may cooperate with one another to avoid duplication of equipment and personnel. Small or rural hospitals without certain facilities may transfer some patients to regional hospital centers for special care. In some areas, for example, premature or sick infants are transferred to regional newborn centers. Specially equipped vehicles transport patients to regional hospital centers. Some states also have regional hospital centers that treat serious trauma (injury). Emergency vehicles, including helicopters, transport injured people to the nearest trauma center. These hospitals have specialized equipment, and many of their personnel are skilled in emergency lifesaving techniques.
During the 1980’s, many people became concerned over the high cost of hospital care. The federal government developed a special program in which hospitals are paid fixed rates for treating specific diseases of Medicare patients. This system of payment is called DRG’S (diagnostic-related groups). If the hospital bill exceeds the fixed payment, the hospital loses money. As a result, many hospitals have tried to better manage patient care. In the 1990’s, the U.S. Congress debated many proposals to improve the management of hospitals. See Medicare ; Medicine (Government aid) .
Career opportunities
A hospital offers a large variety of careers for people interested in helping the sick. Large institutions have over 200 kinds of jobs. Many of these jobs may also be found in small hospitals. The training necessary for various hospital jobs differs widely. Many technical positions require a college degree, but other hospital careers involve on-the-job training.
