Bed

You may think my major concern on delaying antibiotic treatment is the potential threat to some critical patients. That's not (entirely) correct.

In fact, our friends outside the solar system would say clinicians could always ask for urgent dispensing of a drug when they really feel necessary. (Of course I could not imagine what would happen if we say 80% of our patients are urgent and have a necessity.)

But, let's assume they are sincere and that few critical patients were safe, there remains the problem of indirect cost that may skip your eyes.

Let's consider the following estimation:

• The average increase in time lag for antibiotic is around 6 hours.
• The time lag would be translated into an equivalent prolongation of hospital stay. (Let's assume there's no detrimental effect of the lag.)
• Let's assume we admit 60 patients each day, and 40% of them need antibiotics. (Both are highly conservative estimations.)
• The prolong in hospital stay would become 6 extra patients staying in ward (60 times 40% times 0.25 day).
• Assuming daily hospital stay costs HK$3000, the extra cost is $18,000 per day.

Sophisticated administrators would argue that hospital beds are fixed cost and would not disappear even if that 6 patients were not staying. Yes, that's true if we have plenty of empty beds. On the other hand, if the hospital is always full, six extra patients for this particular reason inevitably means that the same number of other patients in need would not receive the care.

There's something more than the dollar sign.