Difficulties in admitting patients to metropolitan public hospitals: The view of medical practitioners

Objective: To investigate difficulties in public hospital admissions from the perspective of referring medical practitioners. Methods: Referring surgeons, physicians and general practitioners (GPs) were randomly selected from three metropolitan (Sydney) health areas and formed into focus groups. Thematic analyses were undertaken of the groups' discussion transcripts to explore the problems of securing patient admissions, practitioners' perceptions of the reasons for these problems and the strategies they used to overcome them. Results: Surgeons in two health areas reported major constraints affecting patient admissions. Physicians experienced fewer difficulties as this group was able to utilise outpatient services but was not always satisfied with such arrangements. GPs reported difficulties in communicating with full-time hospital medical staff. All practitioners felt that limited bed availability, restricted operating times, redefinition of many conditions as ''non-urgent'' and hospital budgetary constraints resulted in long waiting times for admission to public hospitals. This has led to an increasing move to use private hospitals for elective admissions, and to investigate patients in the community. Conclusions: Medical practitioners experienced difficulty in having their patients admitted to metropolitan public hospitals for both elective and non-elective procedures, and this was perceived to result in clinical and personal costs to patients.