This is the Healthcare Delivery Providers, part of the Healthcare Marketplace Specialization. This is Module 2.1.1, Overview of Hospitals. The learning outcomes for this particular lecture will be to provide an overview of hospitals and also of acute care. And then, I will discuss how I have laid this module out for you. Short-term acute care hospitals, long-term acute care hospitals, critical access hospitals. So welcome to module two. This is all about the acute care hospital. And I'm excited to get started on this module with you. So remember, the acute care hospital is at the top of the food chain when it comes to the acuity of patients. What that means, is the hospital takes care of the most acute, the most sick patients. And obviously as a result of that, the hospital gets the most cost and the most payment. So, it sits at the top of the roadmap that we have been discussing. We'll look at it again. And the way that this module has been laid out, and I wanted to start with acute care hospital, a little bit about what is the function, what are the services within it, what are the staff and the physicians like. Then, we will look at how do hospitals get paid. Then we will look at how hospitals get measured. So what are the various triple aim and quadruple aim metrics that hospitals have to look at. And then finally, we will look at a few special types of hospitals. For example, a long-term acute care hospital or a critical access hospital, or single service line hospitals, like psychiatry or children's hospitals. And then throughout the course, I have been looking at some of the transformations and innovations happening, but all have a section at the end with a brief lesson about some of the challenges that lie ahead for hospitals. And also some of the innovations that are happening within the four walls of an acute care hospital. So, this is an excited part of the continuum, fast-paced paced, fast moving, very exciting. And so, let's get started. So, here's another look at the delivery road map we have been using. And again, on the vertical axis is dependency. So, here we are with the hospital, the patients that are the most dependent. Sometimes unconscious lying on their back in a bed. This is where the highest acuity is found in the operating rooms in the emergency departments. And as a result of the sickest of the sick patients, the cost for the hospital is also at the highest level in the care continuum. The other thing I wanted to do for you right off the bat here, so you can get a glimpse and a visual in your mind about what a hospital looks like. If you have availability of YouTube, I will like you to go and Google acute care hospital in the United States, and there'll be quite a few different visuals of what hospital looks like. Instead of putting one of them into here, I thought I would give you a glimpse through my words of what a hospital looks like and feels like. So in the two past decades, I've worked in many different hospitals, usually they are spick-and-span, very, very clean. So a large building usually would go in through the emergency department. It's bustling with activity, nurses and physicians, and technicians, and pharmacists, and volunteers all around. If you're going through the main entrance, there's typically a desk with a staff person or volunteer, smiles all around, very helpful staff that will take you to where you want to go. If unfortunately, you have to be a patient, a room of a patient typically in the US, there's a move towards going to private rooms. So in a large private room, there would be a bed that can go up and down. There'll be a lot of equipment around. There's a move towards reducing wires and cannulas so that patients do not trip and fall. So again, a lot of quality improvement things happening across the hospital. So the units or floors of the hospitals are divided up into medical units and surgical units with private rooms. And again, nursing stations where nurses join together have rounds and then typically, the nurses are out and about in the patients room accessing them, talking with them and taking care of them. Physicians are making rounds, there are radiology suites where x-rays can be done. There's a lab where the blood or other specimens that are taken and sent, and those are analyzed. So again, large building, very busy place, you can enter as a guest through the main entrance, or you can, if something happens, you can be brought in through the emergency department. Brought in by an ambulance and into the emergency department. Also, there are surgical suites where operations and surgeons abound so they do operations there with help from nurses and technicians. So again, I wanted to give you a brief visual of what a hospital building in the United States looks like, just through my words and through my description. I would encourage you to look at a couple of the YouTube videos to get a better flavor, if you have not had a chance to come into one of the US hospitals, and that will give you a great idea of what one hospital feels, looks like. So let's continue with our lesson. Some fast facts. There are approximately 5,600 hospitals in the US. The number changes slightly, and 4,900 are community hospitals with almost a million staffed beds. And the timeline, the public hospitals really emerged in the late 19th century and have been changing and evolving ever since, especially in the 1960s with the payment changes with Medicare and Medicaid. I wanted to give you a quick glimpse about how the hospitals and outpatient clinics are changing. This is a charge from Medpack, where we have gotten a lot of data from and as you can see, the inpatient trajectory is going down and the outpatient visits are going up. So, again, there is a distinct movement from inpatient to outpatient in taking care of patients. In case you are wondering how long patients stay in a hospital. Again, this chart is from Metpack and also looks at non-Medicare insurances. And from 2006 to 2013, the average inpatient length of stay was 4.94, has gone down to 4.61 days. So again, this is considerably shortened over the last many, many years and now patients are only staying for about three to four days in a hospital. So a couple of important points, again, to remember. Things are moving from inpatient to outpatient, so the hospitals are slowly decreasing their capacity. And also, the other very important point of how long patients stay, it's about three to four, to five days. So again, very, very short compared to about 20, 30 years ago. A couple of quick comments about how I have laid out the module, so we'll start with the structure and the function of hospitals. Then, we will look at how hospital performance is measured. We will then look at some special types of hospitals. And then finally, we'll end with what are the innovations and transformations happening in hospitals as a result of some opportunities and challenges in the marketplace. So in summary, hospitals as a healthcare provider of delivery, have continuously evolved and adapted and continue to do so even now. And many of the stakeholders in market forces are leading to ongoing transformation year by year, month by month is this particular provider.