Hospital beds in the corridors is not a new phenomenon. It is the direct result of consistently lowering the ratio of standardized hospital beds to population in recent decades. Compared to 1970 when there were over 3.27 beds per 1,000 persons, today there are fewer than two beds per the same number.
In our opinion, this decrease is not coincidental but rather the result of deliberate policy. According to the agreements, adding beds to a hospital necessitates additional standardized positions for hospital staff, and this is something that the State apparently wants to prevent for budgetary considerations – even at the expense of patients’ lives. In reality, beds are added to the wards beyond the fixed standards, while human resources are not increased accordingly, since staff is determined by the number of standardized beds. The staffing ratio has thus become a fiction: workforce standards are linked only to approved beds, while the reality of all the extra, unapproved beds is not recognized. As a result, doctors are responsible for many more patients, and instead of each doctor being accountable for five or six patients (in a ward of 38 beds), each doctor is actually responsible for 11 patients or more. Sometimes we find one or two doctors in charge of 50 patients, some of them on respirators.1 The State’s management of hospital admissions has created an intolerable reality within the healthcare system, manifested as follows:
- According to Ministry of Health data, in the first quarter of 2010 official occupancy rates in the internal medicine wards of Israel’s hospitals ranged from 104% to 115%. According to the Knesset Research and Information Center’s calculations, this percentage was even higher, between 112% and 119%.2
- Data collected from the hospitals in the winter of 2011 indicates that the overload in the internal medicine wards has increased. Occupancy rates exceed 100% in nearly all hospitals (see chart). In the Hillel Yaffe, Poriya, Haemek and Barzilai Medical Centers, overload is especially high, exceeding 130%. Considering the imparity between regions due to neglect of the healthcare infrastructures in the southern and northern peripheries (as discussed below), it is no wonder that in these hospitals the strain on the internal medicine wards is the highest in the country.
3Occupancy Rate in Internal Medicine Wards in Hospitals
- An investigation made at the beginning of 2010 by the Knesset Research and Information Center in 25 hospitals in Israel, revealed a shortage of 620 beds in these hospitals’ internal medicine wards. Adding these beds would entail the addition of another 176 physician slots and at least 527 nurse slots. This is based on the current staffing ratio, which is insufficient in any case.4
- The general ICUs in most hospitals report 100% occupancy or more. Because of the overload in the general ICU’s, the hospitals are compelled to admit respirator patients to various wards other than the emergency wards, thus putting their lives at risk. Particularly in the early days of hospitalization, a patient in need of intensive care who is not hospitalized in an ICU, will face a higher risk (up to 40%) of death than a respirator patient in the ICU. 5
- In January 2011, only 278 of the 787 respirator patients in the hospital, were kept in ICUs. The rest were admitted into various wards, mostly internal medicine. This implies that over 500 patients were put at a heightened risk of death due to shortage of beds in the ICU6.
1 Israel Medical Association, Position Paper: The Hospital System – the Extreme Shortage, (Heb) January 2007, p.2.
2 The Knesset Information and Research Center, The Occupancy Crisis in Internal Medicine Wards, (Heb) Shelly Levi, May 2010, p. 14.
3 Israel Medical Association, Position Paper: Above and Beyond – The Hospital Crisis in Israel, (Heb) January 2011, p.5.
4 ibid, 3. Ninety three percent of internal medicine hospital beds in Israel are concentrated in these hospitals.
5 E. Simchen et al., "Survival of critically ill patients hospitalized in and out of intensive care units under paucity of intensive care unit beds", Critical Care Medicine 2004; 32 (8): 1659.
6 inistry of Heath, Daily Report on Respirator Patients from January 9, 2011.