Changes in the pattern of work in a rural community hospital 1987-1997.

Objectives: To examine time trends in clinical activity at a rural community hospital, and to assess associated changes in the complexity of the care received by inpatients.

Design: Descriptive study utilising routine Scottish Morbidity Records data (SMRO1) and locally collected data, along with a retrospective review of admission case notes to quantify clinical inputs to patient care.

Setting: Portree community hospital on the island of Skye.

Subjects: Patients admitted to Portree community hospital in 1987, 1992 and 1997.

Results: We found an 80 per cent rise in total annual admissions between 1987 and 1997 and a 34 per cent rise in annual casualty attendance between 1992 and 1997. There was a significant reduction in the median duration of in-patient stay, from 8.5 days in 1987 to 6.0 days in 1997. The case-mix of admissions altered significantly between 1992 and 1997. We also demonstrated significant changes in the proportion of patients receiving blood transfusions or intravenous (i.v.) fluids during this time period.

Conclusions: There have been significant changes in the pattern of use of this community hospital over the past 12 years. The rise in total admissions and casualty attendances, combined with the fall in duration of stay reveal an overall increase in activity at the hospital. This has been associated with changes in the clinical spectrum of admissions. Taken together with the results of the workload analysis, it seems likely that the complexity of the clinical input required at the hospital has increased, and that the role of this community hospital is increasingly the provision of intermediate care to acute cases.