ANALYSIS OF INPATIENT ACTIVITY AND HEALTHCARE STAFFING UNDER CONTEMPORARY REFORMS: EXPERIENCE OF THE VOLODYMYR TERRITORIAL MEDICAL ASSOCIATION

Abstract

Introduction. Transformation of healthcare financing and hospital networks in Ukraine requires assessment of how changes in inpatient capacity are associated with bed utilization and workforce availability. Aim. To evaluate trends in inpatient care volume, hospital bed utilization, and staffing at the Municipal Enterprise “Volodymyr Territorial Medical Association” of the Volodymyr City Council from 2021 to 2025. Materials and methods. A single-center retrospective longitudinal observational study used aggregated annual data from official statistical reporting Form No. 20. The calendar year was the unit of analysis. Staffing rates, bed occupancy, average length of stay, bed turnover, and in-hospital mortality were calculated. Temporal dynamics were assessed using Pearson and Spearman correlation coefficients; the linear mortality trend was tested with the Cochran–Armitage test, and heterogeneity of annual proportions with the Pearson χ² test. Statistical significance was set at 0.05. Results. From 2021 to 2025, the average annual number of beds increased from 280 to 520, admissions from 9,150 to 16,971, discharges from 8,833 to 16,634, and bed-days from 75,075 to 135,257. The corresponding increases were 85.7%, 85.5%, 88.3%, and 80.2%. Average length of stay ranged from 7.2 to 8.2 days, bed turnover from 27.5 to 32.9 patients per bed annually, and bed occupancy from 55.6% to 73.5%; no statistically significant monotonic trend was identified. In-hospital mortality was 3.35% in 2021, 1.27% in 2024, and 1.81% in 2025. The Cochran–Armitage test identified a negative linear component (z=−8.004; p<0.001), and the Pearson χ² test showed between-year heterogeneity (p<0.001), whereas the rank trend across the five annual proportions was not statistically significant. The physician staffing rate increased from 81.73% to 91.38%, while the staffing rate for nursing personnel did not change materially. Conclusions. Expansion of inpatient capacity was accompanied by a proportionate increase in patient flow without sustained deterioration in bed utilization indicators. Positive workforce dynamics primarily concerned physician positions. Analyses by department, diagnosis, case severity, and episode of care are required to support more specific managerial decisions.