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British Journal of Medicine and Medical Research

British Journal of Medicine and Medical Research, ISSN: 2231-0614,Vol.: 17, Issue.: 9


Achieving Economy of Scale in Critical Care, Planning Information Necessary to Support the Choice of Bed Numbers


Neeraj Beeknoo1* and Rodney P. Jones2

1Kings College University Hospital, London, UK.

2Healthcare Analysis and Forecasting, Worcester, UK.


Article Information


(1) Georgios Tsoulfas, Assistant Professor of Surgery, Aristoteleion University of Thessaloniki, Thessaloniki, Greece.


(1) Sanjay Kumar Gupta, Peoples university Bhopal, MP,  India.

(2) Molobe Ikenna Daniel, International Institute of Risk and safety Management (IIRSM),  Nigeria.

(3) Rajashree Panigrahy, IMS & SUM Hospital, SOA University, Bhubaneswar, Odisha, India.

Complete Peer review History:




Aims: To investigate the need for additional critical care beds, the potential for economy of scale in larger units, including ratios to support the choice of bed numbers.

Study Design: Time trend analysis and construction of useful ratios to assist planning.

Place and Duration of Study: Operational data for English NHS hospitals (2011 to 2016) obtained from NHS agencies. Analysis of critical care data at King’s College Hospital from April 2013 to February 2016.

Methodology: Analysis of time trends and/or calculation of averages and ratios of critical care beds per total hospital beds in different categories.

Results: In England, demand for critical care beds is growing at around 2.6% per annum. In 2015/16, the ratio of critical care beds to total hospital beds ranges from an average of 1:5 in tertiary/specialist hospitals to a minimum of 1:50 in general hospitals. Ratio of neonatal beds to maternity beds is around 1:5. Critical care units with more than 35 beds (adult, pediatric or neonatal) operate at around 85% annual average occupancy. Average monthly occupancy across the whole of England correlates with total monthly cancelled urgent operations.

Conclusion: Smaller units require far higher levels of flexibility in staffing and will suffer the unavoidable consequences of higher costs and the knock-on effects of periods of 100% occupancy. Smaller units must become part of a larger network in order to compensate for the higher volatility in CCU demand as size reduces.


Keywords :

Critical care; bed numbers; bed occupancy; economy of scale; turn-away.


Full Article - PDF    Page 1-15    Article Metrics


DOI : 10.9734/BJMMR/2016/28736

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