Providing Beds for All Inward Patients Admitted in Medical Units in the Teaching Hospital Batticaloa. A Strategic Approach

Introduction: Teaching Hospital Batticaloa (THB), the only tertiary care center in the Eastern Province of Sri Lanka, serves over two million people across six districts. The hospital has a total bed capacity of 1,257, with the medical specialty comprising four units, including a professorial unit (242 beds). Despite this allocation, inequitable patient distribution resulted in persistent overcrowding in casualty and post-casualty wards (BOR >100%), while nonadmission wards remained underutilized (BOR <65%).
Objective: To ensure that all inward patients admitted to medical units were allocated an inpatient bed by implementing a revised admission policy, and to evaluate its effect on BOR distribution across wards.
Methods: This was an interventional before-and-after study designed to evaluate the impact of implementing a revised admission policy on bed occupancy rate (BOR) in medical wards of THB. Secondary data on BOR were analyzed alongside key informant interviews with the Director, Consultant Physicians, and Emergency Physicians. A focus group discussion with nursing officers further informed the design of a “Revised Admission Policy for Medical Wards.” The strategy directed daytime admissions (8.00 am–4.00 pm) based on patient category: Categories I–II to the casualty ward, and Categories III–IV alternately to non-admission (Sub-casualty wards) wards using two time slots. From 4.00 pm–8.00 am, all categories were admitted to the casualty ward.
Results: One-month post-implementation, BOR data showed a marked improvement in patient distribution. BOR in casualty and post-casualty wards, previously exceeding 100%, declined to 91.0% and 69.4% respectively, while sub-casualty and non-admission wards maintained BOR around 61–74%. Overall, all medical units operated below 100%, eliminating overcrowding and ensuring equitable bed allocation.
Conclusion: A structured admission policy improved equity in patient distribution, optimized bed utilization, and reduced overcrowding. Sustained implementation with periodic review is recommended, with potential applicability to other specialties facing similar challenges.