Hospital

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For other uses, see Hospital (disambiguation). Hospital_sentence_0

Hospital_table_infobox_0

HospitalHospital_header_cell_0_0_0

A hospital is a health care institution providing patient treatment with specialized medical and nursing staff and medical equipment. Hospital_sentence_1

The best-known type of hospital is the general hospital, which typically has an emergency department to treat urgent health problems ranging from fire and accident victims to a sudden illness. Hospital_sentence_2

A district hospital typically is the major health care facility in its region, with many beds for intensive care and additional beds for patients who need long-term care. Hospital_sentence_3

Specialized hospitals include trauma centers, rehabilitation hospitals, children's hospitals, seniors' (geriatric) hospitals, and hospitals for dealing with specific medical needs such as psychiatric treatment (see psychiatric hospital) and certain disease categories. Hospital_sentence_4

Specialized hospitals can help reduce health care costs compared to general hospitals. Hospital_sentence_5

Hospitals are classified as general, specialty, or government depending on the sources of income received. Hospital_sentence_6

A teaching hospital combines assistance to people with teaching to medical students and nurses. Hospital_sentence_7

A medical facility smaller than a hospital is generally called a clinic. Hospital_sentence_8

Hospitals have a range of departments (e.g. surgery and urgent care) and specialist units such as cardiology. Hospital_sentence_9

Some hospitals have outpatient departments and some have chronic treatment units. Hospital_sentence_10

Common support units include a pharmacy, pathology, and radiology. Hospital_sentence_11

Hospitals are usually funded by public funding, health organisations (for profit or nonprofit), health insurance companies, or charities, including direct charitable donations. Hospital_sentence_12

Historically, hospitals were often founded and funded by religious orders, or by charitable individuals and leaders. Hospital_sentence_13

Currently, hospitals are largely staffed by professional physicians, surgeons, nurses, and allied health practitioners, whereas in the past, this work was usually performed by the members of founding religious orders or by volunteers. Hospital_sentence_14

However, there are various Catholic religious orders, such as the Alexians and the Bon Secours Sisters that still focus on hospital ministry in the late 1990s, as well as several other Christian denominations, including the Methodists and Lutherans, which run hospitals. Hospital_sentence_15

In accordance with the original meaning of the word, hospitals were originally "places of hospitality", and this meaning is still preserved in the names of some institutions such as the Royal Hospital Chelsea, established in 1681 as a retirement and nursing home for veteran soldiers. Hospital_sentence_16

Etymology Hospital_section_0

During the Middle Ages, hospitals served different functions from modern institutions in that they were almshouses for the poor, hostels for pilgrims, or hospital schools. Hospital_sentence_17

The word "hospital" comes from the Latin hospes, signifying a stranger or foreigner, hence a guest. Hospital_sentence_18

Another noun derived from this, hospitium came to signify hospitality, that is the relation between guest and shelterer, hospitality, friendliness, and hospitable reception. Hospital_sentence_19

By metonymy the Latin word then came to mean a guest-chamber, guest's lodging, an inn. Hospital_sentence_20

Hospes is thus the root for the English words host (where the p was dropped for convenience of pronunciation) hospitality, hospice, hostel and hotel. Hospital_sentence_21

The latter modern word derives from Latin via the ancient French romance word hostel, which developed a silent s, which letter was eventually removed from the word, the loss of which is signified by a circumflex in the modern French word hôtel. Hospital_sentence_22

The German word 'Spital' shares similar roots. Hospital_sentence_23

The grammar of the word differs(American English and British English) slightly depending on the dialect. Hospital_sentence_24

In the United States, hospital usually requires an article; in the United Kingdom and elsewhere, the word normally is used without an article when it is the object of a preposition and when referring to a patient ("in/to the hospital" vs. "in/to hospital"); in Canada, both uses are found. Hospital_sentence_25

Types Hospital_section_1

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"). Hospital_sentence_26

Hospitals usually are distinguished from other types of medical facilities by their ability to admit and care for inpatients whilst the others, which are smaller, are often described as clinics. Hospital_sentence_27

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  • Hospital_item_0_1
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  • Hospital_item_0_4

General and acute care Hospital_section_2

"General hospital" redirects here. Hospital_sentence_28

For the American soap opera, see General Hospital. Hospital_sentence_29

The best-known type of hospital is the general hospital, also known as an acute-care hospital. Hospital_sentence_30

These facilities handle many kinds of disease and injury, and normally have an emergency department (sometimes known as "accident & emergency") or trauma center to deal with immediate and urgent threats to health. Hospital_sentence_31

Larger cities may have several hospitals of varying sizes and facilities. Hospital_sentence_32

Some hospitals, especially in the United States and Canada, have their own ambulance service. Hospital_sentence_33

District Hospital_section_3

A district hospital typically is the major health care facility in its region, with large numbers of beds for intensive care, critical care, and long-term care. Hospital_sentence_34

In California, "district hospital" refers specifically to a class of healthcare facility created shortly after World War II to address a shortage of hospital beds in many local communities. Hospital_sentence_35

Even today, district hospitals are the sole public hospitals in 19 of California's counties, and are the sole locally-accessible hospital within nine additional counties in which one or more other hospitals are present at substantial distance from a local community. Hospital_sentence_36

Twenty-eight of California's rural hospitals and 20 of its critical-access hospitals are district hospitals. Hospital_sentence_37

They are formed by local municipalities, have boards that are individually elected by their local communities, and exist to serve local needs. Hospital_sentence_38

They are a particularly important provider of healthcare to uninsured patients and patients with Medi-Cal (which is California's Medicaid program, serving low-income persons, some senior citizens, persons with disabilities, children in foster care, and pregnant women). Hospital_sentence_39

In 2012, district hospitals provided $54 million in uncompensated care in California. Hospital_sentence_40

Specialized Hospital_section_4

A specialty hospital is primarily and exclusively dedicated to one or a few related medical specialties. Hospital_sentence_41

Subtypes include rehabilitation hospitals, children's hospitals, seniors' (geriatric) hospitals, long-term acute care facilities and hospitals for dealing with specific medical needs such as psychiatric problems (see psychiatric hospital), certain disease categories such as cardiac, oncology, or orthopedic problems, and so forth. Hospital_sentence_42

In Germany specialised hospitals are called Fachkrankenhaus; an example is Fachkrankenhaus Coswig (thoracic surgery). Hospital_sentence_43

In India, specialty hospitals are known as super specialty hospitals, and are distinguished from multispecialty hospitals which are composed of several specialties. Hospital_sentence_44

Specialised hospitals can help reduce health care costs compared to general hospitals. Hospital_sentence_45

For example, Narayana Health's cardiac unit in Bangalore specialises in cardiac surgery and allows for a significantly greater number of patients. Hospital_sentence_46

It has 3,000 beds and performs 3,000 in paediatric cardiac operations annually, the largest number in the world for such a facility. Hospital_sentence_47

Surgeons are paid on a fixed salary instead of per operation, thus when the number of procedures increases, the hospital is able to take advantage of economies of scale and reduce its cost per procedure. Hospital_sentence_48

Each specialist may also become more efficient by working on one procedure like a production line. Hospital_sentence_49

Teaching Hospital_section_5

A teaching hospital delivers healthcare to patients as well as training to prospective medical professionals such as medical students and student nurses. Hospital_sentence_50

It may be linked to a medical school or nursing school, and may be involved in medical research. Hospital_sentence_51

Students may also observe clinical work in the hospital. Hospital_sentence_52

Clinics Hospital_section_6

Clinics generally provide only outpatient services, but some may have a small number of inpatient beds and a limited range of services that may otherwise be found in typical hospitals. Hospital_sentence_53

Departments or wards Hospital_section_7

A hospital contains one or more wards that house hospital beds for inpatients. Hospital_sentence_54

It may also have acute services such as an emergency department, operating theatre, and intensive care unit, as well as a range of medical specialty departments. Hospital_sentence_55

A well-equipped hospital may be classified as a trauma center. Hospital_sentence_56

They may also have other services such a hospital pharmacy, radiology, pathology and medical laboratories. Hospital_sentence_57

Some hospitals have outpatient departments such as behavioral health services, dentistry, and rehabilitation services. Hospital_sentence_58

A hospital may also have a department of nursing, headed by a chief nursing officer or director of nursing. Hospital_sentence_59

This department is responsible for the administration of professional nursing practice, research, and policy for the hospital. Hospital_sentence_60

Many units have both a nursing and a medical director that serve as administrators for their respective disciplines within that unit. Hospital_sentence_61

For example, within an intensive care nursery, a medical director is responsible for physicians and medical care, while the nursing manager is responsible for all of the nurses and nursing care. Hospital_sentence_62

Support units may include a medical records department, release of information department, technical support, clinical engineering, facilities management, plant operations, dining services, and security departments. Hospital_sentence_63

History Hospital_section_8

Main article: History of hospitals Hospital_sentence_64

Early examples Hospital_section_9

See also: Ancient Egyptian medicine, Ancient Greek medicine, Medicine in ancient Rome, and Medical community of ancient Rome Hospital_sentence_65

In early India, Fa Xian, a Chinese Buddhist monk who travelled across India c. AD 400, recorded examples of healing institutions. Hospital_sentence_66

According to the Mahavamsa, the ancient chronicle of Sinhalese royalty, written in the sixth century AD, King Pandukabhaya of Sri Lanka (r. 437–367 BC) had lying-in-homes and hospitals (Sivikasotthi-Sala). Hospital_sentence_67

A hospital and medical training centre also existed at Gundeshapur, a major city in southwest of the Sassanid Persian Empire founded in AD 271 by Shapur I. Hospital_sentence_68

In ancient Greece, temples dedicated to the healer-god Asclepius, known as Asclepeion functioned as centres of medical advice, prognosis, and healing. Hospital_sentence_69

The Asclepeia spread to the Roman Empire. Hospital_sentence_70

While public healthcare was non-existent in the Roman Empire, military hospitals called valetudinaria did exist stationed in military barracks and would serve the soldiers and slaves within the fort. Hospital_sentence_71

Evidence exists that some civilian hospitals, while unavailable to the Roman population, were occasionally privately built in extremely wealthy Roman households located in the countryside for that family, although this practice seems to have ended in 80 AD. Hospital_sentence_72

Middle Ages Hospital_section_10

See also: Byzantine medicine, Medieval medicine of Western Europe, and Medicine in the medieval Islamic world Hospital_sentence_73

The declaration of Christianity as an accepted religion in the Roman Empire drove an expansion of the provision of care. Hospital_sentence_74

Following the First Council of Nicaea in AD 325 construction of a hospital in every cathedral town was begun, including among the earliest hospitals by Saint Sampson in Constantinople and by Basil, bishop of Caesarea in modern-day Turkey. Hospital_sentence_75

By the twelfth century, Constantinople had two well-organised hospitals, staffed by doctors who were both male and female. Hospital_sentence_76

Facilities included systematic treatment procedures and specialised wards for various diseases. Hospital_sentence_77

Medical knowledge was transmitted into the Islamic world through the Byzantine Empire. Hospital_sentence_78

The earliest general hospital in the Islamic world was built in 805 in Baghdad by Harun Al-Rashid. Hospital_sentence_79

By the 10th century, Baghdad had five more hospitals, while Damascus had six hospitals by the 15th century, and Córdoba alone had 50 major hospitals, many exclusively for the military. Hospital_sentence_80

The Islamic bimaristan served as a center of medical treatment, as well nursing home and lunatic asylum. Hospital_sentence_81

It typically treated the poor, as the rich would have been treated in their own homes. Hospital_sentence_82

Hospitals in this era were the first to require medical diplomas to license doctors, and compensation for negligence could be made. Hospital_sentence_83

Hospitals were forbidden by law to turn away patients who were unable to pay. Hospital_sentence_84

These hospitals were financially supported by waqfs, as well as state funds. Hospital_sentence_85

Early modern and Enlightenment Europe Hospital_section_11

In Europe the medieval concept of Christian care evolved during the sixteenth and seventeenth centuries into a secular one. Hospital_sentence_86

In England, after the dissolution of the monasteries in 1540 by King Henry VIII, the church abruptly ceased to be the supporter of hospitals, and only by direct petition from the citizens of London, were the hospitals St Bartholomew's, St Thomas's and St Mary of Bethlehem's (Bedlam) endowed directly by the crown; this was the first instance of secular support being provided for medical institutions. Hospital_sentence_87

The voluntary hospital movement began in the early 18th century, with hospitals being founded in London by the 1720s, including Westminster Hospital (1719) promoted by the private bank C. Hospital_sentence_88 Hoare & Co and Guy's Hospital (1724) funded from the bequest of the wealthy merchant, Thomas Guy. Hospital_sentence_89

Other hospitals sprang up in London and other British cities over the century, many paid for by private subscriptions. Hospital_sentence_90

St Bartholomew's in London was rebuilt from 1730 to 1759, and the London Hospital, Whitechapel, opened in 1752. Hospital_sentence_91

These hospitals represented a turning point in the function of the institution; they began to evolve from being basic places of care for the sick to becoming centres of medical innovation and discovery and the principal place for the education and training of prospective practitioners. Hospital_sentence_92

Some of the era's greatest surgeons and doctors worked and passed on their knowledge at the hospitals. Hospital_sentence_93

They also changed from being mere homes of refuge to being complex institutions for the provision of medicine and care for sick. Hospital_sentence_94

The Charité was founded in Berlin in 1710 by King Frederick I of Prussia as a response to an outbreak of plague. Hospital_sentence_95

The concept of voluntary hospitals also spread to Colonial America; the Bellevue Hospital opened in 1736 (as a workhouse, then later becoming a hospital); the Pennsylvania Hospital opened in 1752, New York Hospital in 1771, and Massachusetts General Hospital in 1811. Hospital_sentence_96

When the Vienna General Hospital opened in 1784 (instantly becoming the world's largest hospital), physicians acquired a new facility that gradually developed into one of the most important research centres. Hospital_sentence_97

Another Enlightenment era charitable innovation was the dispensary; these would issue the poor with medicines free of charge. Hospital_sentence_98

The London Dispensary opened its doors in 1696 as the first such clinic in the British Empire. Hospital_sentence_99

The idea was slow to catch on until the 1770s, when many such organisations began to appear, including the Public Dispensary of Edinburgh (1776), the Metropolitan Dispensary and Charitable Fund (1779) and the Finsbury Dispensary (1780). Hospital_sentence_100

Dispensaries were also opened in New York 1771, Philadelphia 1786, and Boston 1796. Hospital_sentence_101

The Royal Naval Hospital, Stonehouse, Plymouth, was a pioneer of hospital design in having "pavilions" to minimize the spread of infection. Hospital_sentence_102

John Wesley visited in 1785, and commented "I never saw anything of the kind so complete; every part is so convenient, and so admirably neat. Hospital_sentence_103

But there is nothing superfluous, and nothing purely ornamented, either within or without." Hospital_sentence_104

This revolutionary design was made more widely known by John Howard, the philanthropist. Hospital_sentence_105

In 1787 the French government sent two scholar administrators, Coulomb and Tenon, who had visited most of the hospitals in Europe. Hospital_sentence_106

They were impressed and the "pavilion" design was copied in France and throughout Europe. Hospital_sentence_107

19th century Hospital_section_12

English physician Thomas Percival (1740–1804) wrote a comprehensive system of medical conduct, Medical Ethics; or, a Code of Institutes and Precepts, Adapted to the Professional Conduct of Physicians and Surgeons (1803) that set the standard for many textbooks. Hospital_sentence_108

In the mid-19th century, hospitals and the medical profession became more professionalised, with a reorganisation of hospital management along more bureaucratic and administrative lines. Hospital_sentence_109

The Apothecaries Act 1815 made it compulsory for medical students to practise for at least half a year at a hospital as part of their training. Hospital_sentence_110

Florence Nightingale pioneered the modern profession of nursing during the Crimean War when she set an example of compassion, commitment to patient care and diligent and thoughtful hospital administration. Hospital_sentence_111

The first official nurses' training programme, the Nightingale School for Nurses, was opened in 1860, with the mission of training nurses to work in hospitals, to work with the poor and to teach. Hospital_sentence_112

Nightingale was instrumental in reforming the nature of the hospital, by improving sanitation standards and changing the image of the hospital from a place the sick would go to die, to an institution devoted to recuperation and healing. Hospital_sentence_113

She also emphasised the importance of statistical measurement for determining the success rate of a given intervention and pushed for administrative reform at hospitals. Hospital_sentence_114

By the late 19th century, the modern hospital was beginning to take shape with a proliferation of a variety of public and private hospital systems. Hospital_sentence_115

By the 1870s, hospitals had more than trebled their original average intake of 3,000 patients. Hospital_sentence_116

In continental Europe the new hospitals generally were built and run from public funds. Hospital_sentence_117

The National Health Service, the principal provider of health care in the United Kingdom, was founded in 1948. Hospital_sentence_118

During the nineteenth century, the Second Viennese Medical School emerged with the contributions of physicians such as Carl Freiherr von Rokitansky, Josef Škoda, Ferdinand Ritter von Hebra, and Ignaz Philipp Semmelweis. Hospital_sentence_119

Basic medical science expanded and specialisation advanced. Hospital_sentence_120

Furthermore, the first dermatology, eye, as well as ear, nose, and throat clinics in the world were founded in Vienna, being considered as the birth of specialised medicine. Hospital_sentence_121

20th century and beyond Hospital_section_13

By the late 19th and the beginning 20th century, medical advancements such as anesthesia and sterile techniques that could make surgery less risky, and availability of more advanced diagnostic devices such as X-rays, continued to make hospitals a more attractive option for treatment. Hospital_sentence_122

Modern hospitals measure various efficiency metrics such as occupancy rates, average length of stay, time to service, patient satisfaction, physician performance, patient readmission rate, inpatient mortality rate, and case mix index. Hospital_sentence_123

In the United States, the number of hospitalizations in the United States continued to grow and reached its peak in 1981 with 171 admissions per 1,000 Americans and 6,933 hospitals. Hospital_sentence_124

This trend subsequently reversed, with the rate of hospitalization falling by more than 10% and the number of US hospitals shrinking from 6,933 in 1981 to 5,534 in 2016. Hospital_sentence_125

Occupancy rates also dropped from 77% in 1980 to 60% in 2013. Hospital_sentence_126

Among the reasons for this are the increasing availability of more complex care elsewhere such as at home or at the physicians' offices and also the less therapeutic and more life-threatening image of the hospitals in the eyes of the public. Hospital_sentence_127

In the US, a patient may sleep in a hospital bed, but be considered outpatient and "under observation" if not formally admitted. Hospital_sentence_128

In the US, inpatient stays are covered under Medicare Part A, but a hospital might keep a patient under observation which is only covered under Medicare Part B, and subjects the patient to additional coinsurance costs. Hospital_sentence_129

In 2013, the Center for Medicare and Medicaid Services (CMS) introduced a "two-midnight" rule for inpatient admissions, intended to reduce an increasing number of long-term "observation" stays being used for reimbursement. Hospital_sentence_130

This rule was later dropped in 2018. Hospital_sentence_131

In 2016 and 2017, healthcare reform and a continued decline in admissions resulted in US hospital-based healthcare systems performing poorly financially. Hospital_sentence_132

Microhospitals, with bed capacities of between eight and fifty, are expanding in the United States. Hospital_sentence_133

Similarly, freestanding emergency rooms, which transfer patients that require inpatient care to hospitals, were popularised in the 1970s and have since expanded rapidly across the United States. Hospital_sentence_134

Funding Hospital_section_14

Modern hospitals derive funding from a variety of sources. Hospital_sentence_135

They may be funded by public expenditure, charitable donations, or private payment and health insurance. Hospital_sentence_136

In the United Kingdom, the National Health Service delivers health care to legal residents funded by the state "free at the point of delivery", and emergency care free to anyone regardless of nationality or status. Hospital_sentence_137

Due to the need for hospitals to prioritise their limited resources, there is a tendency in countries with such systems for 'waiting lists' for non-crucial treatment, so those who can afford it may take out private health care to access treatment more quickly. Hospital_sentence_138

In the United States, hospitals typically operate privately and in some cases on a for-profit basis, such as HCA Healthcare. Hospital_sentence_139

The list of procedures and their prices are billed with a chargemaster; however, these prices may be lower for health care obtained within healthcare networks. Hospital_sentence_140

Legislation requires hospitals to provide care to patients in life-threatening emergency situations regardless of the patient's ability to pay. Hospital_sentence_141

Privately funded hospitals which admit uninsured patients in emergency situations incur direct financial losses, such as in the aftermath of Hurricane Katrina. Hospital_sentence_142

Quality and safety Hospital_section_15

As the quality of health care has increasingly become an issue around the world, hospitals have increasingly had to pay serious attention to this matter. Hospital_sentence_143

Independent external assessment of quality is one of the most powerful ways to assess this aspect of health care, and hospital accreditation is one means by which this is achieved. Hospital_sentence_144

In many parts of the world such accreditation is sourced from other countries, a phenomenon known as international healthcare accreditation, by groups such as Accreditation Canada from Canada, the Joint Commission from the US, the Trent Accreditation Scheme from Great Britain, and Haute Authorité de santé (HAS) from France. Hospital_sentence_145

The World Health Organization noted in 2011 that going into hospital was far riskier than flying. Hospital_sentence_146

Globally the chance of a patient being subject to an error was about 10% and the chance of death resulting from an error was about 1 in 300 according to Liam Donaldson. Hospital_sentence_147

7% of hospitalised patients in developed countries, and 10% in developing countries, acquire at least one health care-associated infection. Hospital_sentence_148

In the USA 1.7 million infections are acquired in hospital each year, leading to 100,000 deaths, figures much worse than in Europe where there were 4.5 million infections and 37,000 deaths. Hospital_sentence_149

Architecture Hospital_section_16

Modern hospital buildings are designed to minimise the effort of medical personnel and the possibility of contamination while maximising the efficiency of the whole system. Hospital_sentence_150

Travel time for personnel within the hospital and the transportation of patients between units is facilitated and minimised. Hospital_sentence_151

The building also should be built to accommodate heavy departments such as radiology and operating rooms while space for special wiring, plumbing, and waste disposal must be allowed for in the design. Hospital_sentence_152

However, many hospitals, even those considered "modern", are the product of continual and often badly managed growth over decades or even centuries, with utilitarian new sections added on as needs and finances dictate. Hospital_sentence_153

As a result, Dutch architectural historian Cor Wagenaar has called many hospitals: Hospital_sentence_154

Hospital_description_list_1

  • "... built catastrophes, anonymous institutional complexes run by vast bureaucracies, and totally unfit for the purpose they have been designed for ... They are hardly ever functional, and instead of making patients feel at home, they produce stress and anxiety."Hospital_item_1_5

Some newer hospitals now try to re-establish design that takes the patient's psychological needs into account, such as providing more fresh air, better views and more pleasant colour schemes. Hospital_sentence_155

These ideas harken back to the late eighteenth century, when the concept of providing fresh air and access to the 'healing powers of nature' were first employed by hospital architects in improving their buildings. Hospital_sentence_156

The research of British Medical Association is showing that good hospital design can reduce patient's recovery time. Hospital_sentence_157

Exposure to daylight is effective in reducing depression. Hospital_sentence_158

Single-sex accommodation help ensure that patients are treated in privacy and with dignity. Hospital_sentence_159

Exposure to nature and hospital gardens is also important – looking out windows improves patients' moods and reduces blood pressure and stress level. Hospital_sentence_160

Open windows in patient rooms have also demonstrated some evidence of beneficial outcomes by improving airflow and increased microbial diversity. Hospital_sentence_161

Eliminating long corridors can reduce nurses' fatigue and stress. Hospital_sentence_162

Another ongoing major development is the change from a ward-based system (where patients are accommodated in communal rooms, separated by movable partitions) to one in which they are accommodated in individual rooms. Hospital_sentence_163

The ward-based system has been described as very efficient, especially for the medical staff, but is considered to be more stressful for patients and detrimental to their privacy. Hospital_sentence_164

A major constraint on providing all patients with their own rooms is however found in the higher cost of building and operating such a hospital; this causes some hospitals to charge for private rooms. Hospital_sentence_165

See also Hospital_section_17

Hospital_unordered_list_2


Credits to the contents of this page go to the authors of the corresponding Wikipedia page: en.wikipedia.org/wiki/Hospital.