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Addressing inpatient crowding by smoothing occupancy at children's hospitals
Evan S Fieldston1, Matthew Hall, Samir S Shah
1Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, USA. fieldston@email.chop.edu
Insights
Smoothing inpatient hospital occupancy can reduce crowding. Children's hospitals have unused capacity, and adjusting admissions could significantly lower high occupancy rates, benefiting patient care.
Area of Science:
- Pediatric Healthcare Management
- Hospital Operations Research
- Healthcare Systems Engineering
Background:
- Children's hospitals often experience significant weekday versus weekend inpatient occupancy variations.
- High occupancy levels can lead to hospital crowding and negatively impact patient care.
- Understanding occupancy patterns is crucial for optimizing resource allocation and patient flow.
Purpose of the Study:
- To quantify the disparity in weekday versus weekend inpatient occupancy in children's hospitals.
- To assess the potential for smoothing weekly occupancy to mitigate hospital crowding.
- To model the impact of occupancy smoothing on patient exposure to high census levels.
Main Methods:
- Analysis of daily inpatient census data from 39 tertiary-care children's hospitals.
- Calculation of occupancy rates and modeling of smoothing impacts on patient numbers and exposure.
- Determination of the proportion of weekly admissions requiring rescheduling for smoothing.
Main Results:
- Weekday occupancy was higher than weekend occupancy, with a median difference of 8.2% points.
- Smoothing occupancy reduced the mean weekly maximum occupancy by 6.6% points across hospitals.
- Occupancy smoothing could remove 39,607 patients from exposure to >95% occupancy levels, requiring a median 2.6% of admissions to be rescheduled.
Conclusions:
- Children's hospitals possess substantial underutilized capacity.
- Smoothing inpatient occupancy throughout the week is a viable strategy to reduce crowding.
- Implementing occupancy smoothing can protect patients from the adverse effects of crowded hospital conditions.
Objective:
To quantify the difference in weekday versus weekend occupancy, and the opportunity to smooth inpatient occupancy to reduce crowding at children's hospitals.
Methods:
Daily inpatient census data for 39 freestanding, tertiary-care children's hospitals were used to calculate occupancy and to model the impact of reducing variation in occupancy and the change in the number of patients, patient-days, and hospitals exposed to high occupancy pre- and post-smoothing. We also calculated the proportion of weekly admissions that would require different scheduling to achieve within-week smoothing.
Results:
Overall, hospitals' mean occupancy ranged from 70.9% to 108.1% on weekdays, and 65.7% to 94.9% on weekends. Weekday occupancy exceeded weekend occupancy with a median difference of 8.2% points. The mean post-smoothing reduction in weekly maximum occupancy across all hospitals was 6.6% points. Through smoothing, 39,607 patients from the 39 hospitals were removed from exposure to occupancy levels >95%. To achieve within-week smoothing, a median 2.6% of admissions would have to be scheduled on a different day of the week; this equates to a median of 7.4 patients per week (range: 2.3-14.4).
Conclusion:
Hospitals do have substantial unused capacity, and smoothing occupancy over the course of a week could be a useful strategy that hospitals can use to reduce crowding and protect patients from crowded conditions.
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