HEALTH-CARE FACILITIES
The largest and most complex form of health-care facility is the hospital, which deals with
the critically ill and with patients who need complex diagnostic procedures or must undergo major surgery. Care given to patients not confined to a hospital, called out-patient or ambulatory care, is ordinarily dispensed in a clinic or office. A clinic may either be free-standing or attached to a hospital; in either case, clinic practice includes the availability at the same location of specialists in most of the major medical fields.
The Hospital Team
Treatment in a hospital necessarily is a team effort, led by the physician or
physicians directly responsible for a patient's welfare. Other physicians who may be involved in the care of a patient include anesthesiologists, pathologists, and radiologists, and, in teaching
hospitals, the resident physicians. All of the hospital personnel support the work of the physicians in charge. Of these personnel, the nursing staff is the largest component. The most skilled are the registered nurses (RNs), who undergo two to four years of general college-level education in addition to their nursing education, frequently obtaining a college degree; they are licensed by examination. The licensed practical nurse (LPN) takes formal training for one academic year and is examined for licensure. Nurse's aids carry out the least skilled components of nursing care. The size of a hospital's nursing staff is approximately equal to the average number of patients.
As new machinery and new procedures are introduced into a hospital, members of the technical staff also must be increased in order to operate the equipment. Besides this, a hospital operates like a small village and must have cooks, cleaners, laundry personnel, carpenters, plumbers, bookkeepers, a police staff, and a cadre of administrators, as well.
Kinds of Hospitals
Hospital in-patient care devolves into either acute or chronic care. Acute-care hospitals are classified as primary, secondary, or tertiary institutions. The low-technology primary hospitals are usually located in rural areas and generally deal with emergencies and therapies that do not involve complex procedures. The secondary hospitals are more typical of hospitals in general, providing a greater range of physician skills and modern technology than the primary hospitals. Tertiary institutions are typified by the teaching hospitals of the major medical schools and are also called referral centers. Usually they are large, often with more than a thousand beds, and they provide most or all of the latest medical equipment available. Even more important, they have physicians and technicians on their staffs who are highly trained in all types of investigation and treatment. Most of the patients found in tertiary-care hospitals are similar to those in secondary centers, but the rest have been referred to such hospitals for special care such as therapy for severe burns, open-heart surgery, premature births, and hip replacement. Tertiary-care hospitals are quite expensive, partly because of the advanced technology being employed but even more because of the size of the staff required. The ratio of employees to patients in a tertiary-care hospital may exceed five to one.
Other types of hospitals, called specialty hospitals, admit only those patients who fit a restricted group of diagnoses and, usually, who are due for a medium to long stay. Psychiatric hospitals are the most numerous specialty hospitals and the ones with the largest patient population. Others include hospitals for the severely mentally retarded and rehabilitation hospitals that treat severe injury involving loss of function.
Chronic-disease hospitals, also called long-term-care facilities, are typically the hospitals of last resort for persons too ill for any other alternative but for whom no known therapy exists that could justify their presence in expensive acute-care hospitals. Finally, hospice movement, devoted to caring for the terminally ill, generally makes use of the home environment but sometimes involves so-called hospice dwellings, commonly located within a hospital.