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Scheduled admissions and high occupancy at a children's hospital
Evan S Fieldston1, Meera Ragavan, Bhuvaneswari Jayaraman
1Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA. fieldston@email.chop.edu
Insights
Scheduled admissions significantly increase hospital occupancy variability and mid-week crowding. Optimizing patient flow requires managing these predictable admission patterns to improve resource utilization and reduce risks.
Area of Science:
- Healthcare Operations
- Hospital Management
- Patient Flow Optimization
Background:
- High hospital occupancy impacts care quality and access.
- Low occupancy can lead to inefficient resource utilization.
- Variability in hospital occupancy is influenced by scheduling decisions.
Purpose of the Study:
- To describe variability in admission, discharge, and occupancy patterns at a children's hospital.
- To assess the relationship between scheduled admissions and hospital occupancy.
Main Methods:
- Retrospective analysis of administrative data from a tertiary-care children's hospital.
- Examined admission, discharge, and transfer (ADT) data for one fiscal year.
- Analyzed 22,310 consecutive patient admissions.
Main Results:
- Scheduled admissions (22%) showed high day-of-week variability (CV 65.3%) compared to emergent admissions (78%, CV 12.0%).
- Mondays and Tuesdays accounted for 45.2% of scheduled patient hours for stays ≤ 7 days.
- High occupancy frequently occurred on Wednesdays and Thursdays.
Conclusions:
- Scheduled admissions are a major driver of occupancy variability and mid-week crowding.
- Predictable admissions create imbalanced capacity, necessitating proactive management.
- Hospitals should analyze admission patterns to optimize patient flow and resource use.
Background:
High hospital occupancy is a challenge for quality of care and access, while low levels of occupancy may be inefficient in terms of resource utilization. Variability from scheduling decisions may affect occupancy and be amenable to alteration.
Objective:
Describe variability in admission, discharge, and occupancy patterns at a large children's hospital and assess the relationship between scheduled admissions and occupancy.
Design:
Retrospective administrative data analysis.
Setting:
One urban, tertiary-care children's hospital.
Patients:
A total of 22,310 consecutive patients admitted from July 1, 2007 to June 30, 2008.
Measurements:
Admission-discharge-transfer (ADT) data for 1 fiscal year were abstracted for analysis of admission and occupancy patterns.
Results:
Among 22,310 admissions, 78% were coded as emergent and 22% as scheduled. Variation in admission volume by day of week was high for scheduled admissions (coefficient of variation [CV] 65.3%), while it was more consistent for emergent admissions (CV 12.0%). For patients with length of stay (LOS) ≤ 7 days (84%), Mondays and Tuesdays generated 45.2% of scheduled patient hours. Wednesdays and Thursdays had the highest frequency of high occupancy.
Conclusions:
Scheduled admissions contribute significantly to variability in occupancy and risk of mid-week crowding. Predictable patterns of admissions lead to high occupancy on some days and unused capacity on others, which can be addressed with proactive management of admissions (eg, greater use of unused capacity on weekends and in summer). Hospitals interested in optimizing patient flow should assess their admission and occupancy patterns. Further studies should link variation in occupancy to outcomes including quality of care, educational activities, and staff satisfaction.
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