Hospital

The best-known type of hospital is the general hospital, also known as an acute-care hospital. 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. Larger cities may have several hospitals of varying sizes and facilities. Some hospitals, especially in the United States and Canada, have their own ambulance service.

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.

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.[6][7] Even today, district hospitals are the sole public hospitals in 19 of California's counties,[6] and are the sole locally accessible hospital within nine additional counties in which one or more other hospitals are present at a substantial distance from a local community.[6] Twenty-eight of California's rural hospitals and 20 of its critical-access hospitals are district hospitals.[7] They are formed by local municipalities, have boards that are individually elected by their local communities, and exist to serve local needs.[6][7] 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).[6][7] In 2012, district hospitals provided $54 million in uncompensated care in California.[7]

Starship Children's Health is a children's hospital in Auckland, New Zealand.

A specialty hospital is primarily and exclusively dedicated to one or a few related medical specialties.[8] 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), cancer treatment, certain disease categories such as cardiac, oncology, or orthopedic problems, and so forth.

In Germany specialised hospitals are called Fachkrankenhaus; an example is Fachkrankenhaus Coswig (thoracic surgery). In India, specialty hospitals are known as super-specialty hospitals and are distinguished from multispecialty hospitals which are composed of several specialties.[9]

Specialised hospitals can help reduce health care costs compared to general hospitals. For example, Narayana Health's cardiac unit in Bangalore specialises in cardiac surgery and allows for a significantly greater number of patients. It has 3,000 beds and performs 3,000 in paediatric cardiac operations annually, the largest number in the world for such a facility.[2][10] 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.[10] Each specialist may also become more efficient by working on one procedure like a production line.[2]

A teaching hospital delivers healthcare to patients as well as training to prospective medical professionals such as medical students and student nurses. It may be linked to a medical school or nursing school, and may be involved in medical research. Students may also observe clinical work in the hospital.[11]

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  McMaster University Medical Centre is a teaching hospital in Hamilton, Ontario.
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  All India Institute of Medical Sciences, New Delhi, a large teaching hospital in India

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

The COVID-19 pandemic stimulated the development of virtual wards across the British NHS. Patients are managed at home, monitoring their own oxygen levels using an oxygen saturation probe if necessary and supported by telephone. West Hertfordshire Hospitals NHS Trust managed around 1200 patients at home between March and June 2020 and planned to continue the system after COVID-19, initially for respiratory patients.[13] Mersey Care NHS Foundation Trust started a COVID Oximetry@Home service in April 2020. This enables them to monitor more than 5000 patients a day in their own homes. The technology allows nurses, carers, or patients to record and monitor vital signs such as blood oxygen levels.[14]

In early India, Fa Xian, a Chinese Buddhist monk who travelled across India c. AD 400, recorded examples of healing institutions.[15] 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).[16] A hospital and medical training center also existed at Gundeshapur, a major city in southwest of the Sassanid Persian Empire founded in AD 271 by Shapur I.[17] In ancient Greece, temples dedicated to the healer-god Asclepius, known as Asclepeion functioned as centers of medical advice, prognosis, and healing.[18] The Asclepeia spread to the Roman Empire. 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.[19] 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.[20]

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  View of the Askleipion of Kos, the best preserved instance of an Asklepieion
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  Ruins of a two thousand-year-old hospital were discovered in the historical city of Anuradhapura Mihintale Sri Lanka.

The declaration of Christianity as an accepted religion in the Roman Empire drove an expansion of the provision of care.[21] 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.[22] By the twelfth century, Constantinople had two well-organised hospitals, staffed by doctors who were both male and female. Facilities included systematic treatment procedures and specialised wards for various diseases.[23]

Entrance to the Qalawun complex in Cairo, Egypt, which housed the notable Mansuri hospital

The earliest general hospital in the Islamic world was built in 805 in Baghdad by Harun Al-Rashid.[24][25] 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.[26] The Islamic bimaristan served as a center of medical treatment, as well nursing home and lunatic asylum. It typically treated the poor, as the rich would have been treated in their own homes.[27] Hospitals in this era were the first to require medical diplomas to license doctors, and compensation for negligence could be made.[28] Hospitals were forbidden by law to turn away patients who were unable to pay.[29] These hospitals were financially supported by waqfs,[29] as well as state funds.[26]

A hospital ward in sixteenth century France

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

In 1682, Charles II founded the Royal Hospital Chelsea as a retirement home for old soldiers known as Chelsea Pensioners, an instance of the use of the word "hospital" to mean an almshouse.[30] Ten years later, Mary II founded the Royal Hospital for Seamen, Greenwich, with the same purpose.[31]

1820 engraving of Guy's Hospital in London, one of the first voluntary hospitals to be established in 1724

Ruins of the Hospital San Nicolás de Bari in Santo Domingo, Dominican Republic, recognized by UNESCO for being the oldest hospital built in the Americas.[32][33] Built between 1514 and 1541.

Pennsylvania Hospital (now part of University of Pennsylvania Health System). Founded in 1751, it is the earliest established public hospital in the United States.[34][35][lower-alpha 1] It is also home to America's first surgical amphitheatre and its first medical library.

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. Hoare & Co and Guy's Hospital (1724) funded from the bequest of the wealthy merchant, Thomas Guy.

Other hospitals sprang up in London and other British cities over the century, many paid for by private subscriptions. St Bartholomew's in London was rebuilt from 1730 to 1759,[36] and the London Hospital, Whitechapel, opened in 1752.

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 centers of medical innovation and discovery and the principal place for the education and training of prospective practitioners. Some of the era's greatest surgeons and doctors worked and passed on their knowledge at the hospitals.[37] They also changed from being mere homes of refuge to being complex institutions for the provision of medicine and care for sick. The Charité was founded in Berlin in 1710 by King Frederick I of Prussia as a response to an outbreak of plague.

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 (now Weill Cornell Medical Center)[38] in 1771, and Massachusetts General Hospital in 1811.

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 centers.[39]

Another Enlightenment era charitable innovation was the dispensary; these would issue the poor with medicines free of charge. The London Dispensary opened its doors in 1696 as the first such clinic in the British Empire. The idea was slow to catch on until the 1770s,[40] 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). Dispensaries were also opened in New York 1771, Philadelphia 1786, and Boston 1796.[41]

The Royal Naval Hospital, Stonehouse, Plymouth, was a pioneer of hospital design in having "pavilions" to minimize the spread of infection. 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. But there is nothing superfluous, and nothing purely ornamented, either within or without." This revolutionary design was made more widely known by John Howard, the philanthropist. In 1787 the French government sent two scholar administrators, Coulomb and Tenon, who had visited most of the hospitals in Europe.[42] They were impressed and the "pavilion" design was copied in France and throughout Europe.

A ward of the hospital at Scutari where Florence Nightingale worked and helped to restructure the modern hospital

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.[43] 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. 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.[44]

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. 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.[45] 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. She also emphasised the importance of statistical measurement for determining the success rate of a given intervention and pushed for administrative reform at hospitals.[46]

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. By the 1870s, hospitals had more than trebled their original average intake of 3,000 patients. In continental Europe the new hospitals generally were built and run from public funds. The National Health Service, the principal provider of health care in the United Kingdom, was founded in 1948. 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. Basic medical science expanded and specialisation advanced. 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.[47]

By the late 19th and early 20th centuries, medical advancements such as anesthesia and sterile techniques that could make surgery less risky, and the availability of more advanced diagnostic devices such as X-rays, continued to make hospitals a more attractive option for treatment.[48]

Modern hospitals measure various efficiency metrics such as occupancy rates, the average length of stay, time to service, patient satisfaction, physician performance, patient readmission rate, inpatient mortality rate, and case mix index.[49]

In the United States, the number of hospitalizations continued to grow and reached its peak in 1981 with 171 admissions per 1,000 Americans and 6,933 hospitals.[48] 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.[50] Occupancy rates also dropped from 77% in 1980 to 60% in 2013.[51] Among the reasons for this are the increasing availability of more complex care elsewhere such as at home or the physicians' offices and also the less therapeutic and more life-threatening image of the hospitals in the eyes of the public.[48][52] In the US, a patient may sleep in a hospital bed, but be considered outpatient and "under observation" if not formally admitted.[53] 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.[53] In 2013, the Center for Medicare and Medicaid Services (CMS) introduced a "two-midnight" rule for inpatient admissions,[54] intended to reduce an increasing number of long-term "observation" stays being used for reimbursement.[53] This rule was later dropped in 2018.[54] In 2016 and 2017, healthcare reform and a continued decline in admissions resulted in US hospital-based healthcare systems performing poorly financially.[55] Microhospitals, with bed capacities of between eight and fifty, are expanding in the United States.[56] Similarly, freestanding emergency rooms, which transfer patients that require inpatient care to hospitals, were popularised in the 1970s[57] and have since expanded rapidly across the United States.[57]

The Catholic Church is the largest non-government provider of health careservices in the world.[58] It has around 18,000 clinics, 16,000 homes for the elderly and those with special needs, and 5,500 hospitals, with 65 percent of them located in developing countries.[59] In 2010, the Church's Pontifical Council for the Pastoral Care of Health Care Workers said that the Church manages 26% of the world's health care facilities.[60]

• Brockliss, Lawrence, and Colin Jones. "The Hospital in the Enlightenment", in The Medical World of Early Modern France (Oxford UP, 1997), pp. 671–729; covers France 1650–1800
• Chaney, Edward (2000), "'Philanthropy in Italy': English Observations on Italian Hospitals 1545–1789", in: The Evolution of the Grand Tour: Anglo-Italian Cultural Relations since the Renaissance, 2nd ed. London, Routledge, 2000.
• Connor, J.T.H. "Hospital History in Canada and the United States", Canadian Bulletin of Medical History, 1990, Vol. 7 Issue 1, pp. 93–104
• Crawford, D.S. Bibliography of Histories of Canadian hospitals and schools of nursing.
• Gorsky, Martin. "The British National Health Service 1948–2008: A Review of the Historiography", Social History of Medicine, December 2008, Vol. 21 Issue 3, pp. 437–60
• Harrison, Mar, et al. eds. From Western Medicine to Global Medicine: The Hospital Beyond the West (2008)
• Horden, Peregrine. Hospitals and Healing From Antiquity to the Later Middle Ages (2008)
• McGrew, Roderick E. Encyclopedia of Medical History (1985)
• Morelon, Régis; Rashed, Roshdi (1996), Encyclopedia of the History of Arabic Science, vol. 3, Routledge, ISBN 978-0-415-12410-2
• Porter, Roy. The Hospital in History, with Lindsay Patricia Granshaw (1989) ISBN 978-0-415-00375-9
• Risse, Guenter B. Mending Bodies, Saving Souls: A History of Hospitals (1999); world coverage
• Rosenberg, Charles E. The Care of Strangers: The Rise of America's Hospital System (1995); history to 1920
• Scheutz, Martin et al. eds. Hospitals and Institutional Care in Medieval and Early Modern Europe (2009)
• Wall, Barbra Mann. American Catholic Hospitals: A Century of Changing Markets and Missions (Rutgers University Press, 2011). ISBN 978-0-8135-4940-8