Hospitals

A hospital provides care for patients who cannot be nursed and treated effectively at home, either because they have no one to give them nursing care, or because their condition requires special nursing or facilities that are not available at home. Patients who have potentially dangerous and highly infectious diseases should also be nursed in hospital, so that they can be kept in isolation; and sometimes people whose mental state is very disturbed have to be admitted to hospital for their own safety or that of those around them.

Modern Western hospitals are descendants of the medieval God’s houses or hospitals where everybody in need of care, the poor, the ill and vagrants were taken in on a charity basis. The more well-to-do were nursed in their own homes. At the beginning of this century hospitals began to concentrate more and more on curing the sick instead of taking care of the poor and needy. Gradually, hospitals became involved in training doctors and nurses. The modern hospital evolved at the time of World War II.

General hospitals

The majority of hospitals in most Western countries are general hospitals. These provide facilities and nursing care for the treatment of most medical conditions and deal with most medical emergencies. Larger hospitals have accident and casualty departments to deal with sudden admissions necessitated by accidents or medical emergencies. Smaller general hospitals may run a limited casualty service that is unable to deal with major emergencies, and that may not be open 24 hours a day.

Usually, patients are referred to a particular hospital specialist (consultant) by their family doctor, and their first visit will probably be to an out-patient clinic so that their case can be assessed. It may be possible for treatment to continue on an out-patient basis, with regular visits to the hospital, or the consultant in charge of the case may decide that the patient should be admitted to hospital for in-patient treatment. Hospital wards are usually organized so that medical and surgical cases are separate. Further wards are often set aside for maternity cases, for children, and occasionally for adolescents. There may also be special wards for acute psychiatric and geriatric cases. General hospitals have their own operating theatres, laboratories, X-ray and often ultrasound departments; although not all have specialized equipment such as CAT scanners and they may not have the facilities to carry out some highly specialized procedures, for instance heart surgery or neurosurgery. These specialized operations are normally carried out at centres serving a wide area. Some of the larger general hospitals are also teaching hospitals, that is, they have medical schools attached to them. These hospitals usually have a wide range of large, specialized departments. Often, medical re- search is carried out in these departments, and many teaching hospitals have units that perform particularly sophisticated procedures impossible in a normal general hospital, such as renal units that carry out kidney transplants.

There are, in addition, many types of single-speciality hospitals. Each type deals entirely with one area of medicine, for example chest or cardiac complaints, or neurology or cancer. Patients are usually sent to single-speciality hospitals as a ‘tertiary referral’. These often-called ‘centres of excellence’ are generally attached to universities and are centres for postgraduate teaching and research. Because they offer expertise that may not be available in a large general hospital, they may draw patients from a wide area.

Decline of single-speciality hospitals

The need for some single-speciality hospitals has decreased in many countries. For instance, there are far fewer isolation hospitals, because it is current practice to house infectious disease wards within general hospitals. Another example concerns tuberculosis. Now that there is a much lower incidence of tuberculosis, which can often be treated with drugs without the necessity of hospital admission, many of the chest hospitals and sanitoriums built in the last century have closed down.

Hospitalization of children

Children are nursed in special wards within a general hospital or in a special children’s hospital. Many modern children’s units have parent’s rooms where a parent can stay overnight while their child is in hospital. This is part of a general relaxation of rules and regulations regarding visiting hours in many hospitals today. Hours are still limited, but more for the patient’s sake rather than the staffs.

Organization

Because much modern high-technology medical equipment is expensive in terms of both money and expertise, it makes sense to concentrate resources as much as possible in a few large hospitals that can cater for most medical and surgical conditions. One drawback of this approach is that out-patients, and friends and relatives visiting in-patients, may have to travel considerable distances. In some countries the cost of travelling is subsidized, in deserving cases, by the hospital’s social service or by local authority assistance. Unusual visiting hours can also often be arranged in advance to take the travel factor into account.

The mentally ill and the mentally handicapped are still cared for in separate hospitals; and a few special, secure, hospitals exist for the criminally insane. In a hospital there are usually twice the number of people working as its bed capacity. This means, for a hospital of average size, some 600 people. Managing the smooth operation of the various departments is a demanding task. Apart from doctors and nurses there are a great number of professional people at work, the first concern of whom is the patient. The organization of a hospital has become so complex that the special field of hospital sciences has been created in many universities.

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