Finding the time: Hourly variation in average daily census on a hospital medicine service

Area of Science:

• Hospital Medicine
• Healthcare Operations Management
• Patient Flow Analysis

Background:

• Effective management of hospital patient flow and resource allocation relies on accurate monitoring of the average daily census (ADC).
• Traditional methods of measuring ADC, often at midnight, may not reflect peak daily patient loads.
• Understanding hourly ADC variations is essential for optimizing staffing and mitigating physician burnout.

Purpose of the Study:

• To analyze hourly fluctuations in the average daily census (ADC) within a hospital medicine service.
• To determine the impact of measurement timing on perceived patient census and workload.
• To provide evidence-based recommendations for optimizing ADC measurement for resource allocation and staffing.

Main Methods:

• Retrospective analysis of patient data, including 8342 encounters and 6178 unique patients over one year.
• Hourly tracking of average daily census (ADC) on a hospital medicine service at an academic medical center.
• Comparison of ADC values at different times of the day to identify peak and trough periods.

Main Results:

• The average daily census (ADC) exhibited significant hourly variation, peaking at 11 a.m. (164.1 patients/day) and reaching its lowest at 7 p.m. (155.0 patients/day).
• The difference between peak and lowest ADC reached 9.1 patients, representing a 5.5% variation relative to the peak census.
• Midnight ADC measurements may underestimate the actual patient census and associated workload.

Conclusions:

• Hourly ADC monitoring reveals significant daily fluctuations, challenging the assumption of a static patient census.
• Measuring ADC at its peak, specifically between 7 a.m. and 11 a.m., is recommended to accurately reflect patient load.
• Adopting peak ADC measurement can improve resource allocation, ensure adequate staffing, and help prevent physician burnout in hospital medicine.