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Beyond Annual Averages: Rethinking Metrics For Emergency Department Crowding And Capacity Planning.

JeongWook Lim1, Jisun Lee2, Song-Hee Kim2

  • 1Industrial Engineering Department, Seoul National University, Seoul, Republic of Korea.

The Journal of Emergency Medicine
|November 16, 2025
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Summary

Hourly Peak Bed Occupancy (HPBO) accurately estimates emergency department bed needs by capturing short-term fluctuations, unlike the Annual Average (AA) method. This improves resource allocation and addresses overcrowding.

Keywords:
ED crowdingbed capacity planningmetricsoccupancy ratesvariability in ED demand

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Area of Science:

  • Healthcare Management
  • Operations Research
  • Public Health

Background:

  • Emergency department (ED) crowding negatively impacts patient safety and care efficiency.
  • The Annual Average (AA) occupancy method is commonly used but fails to account for short-term fluctuations, leading to inaccurate capacity assessments.
  • Accurate estimation of ED bed needs is crucial for effective resource allocation.

Purpose of the Study:

  • To compare six methods for estimating emergency department bed needs.
  • To evaluate Hourly Peak Bed Occupancy (HPBO) as a superior alternative to the Annual Average (AA) method.
  • To identify a practical and accurate approach for determining optimal ED bed capacity.

Main Methods:

  • Analysis of the National Emergency Department Information System (NEDIS) database from South Korea (408 EDs, 7,678,743 hospitalizations in 2022).
  • Comparison of five methods (AA, Monthly Average, Daily Average, Daily Peak Bed Occupancy, HPBO) against the Real-Time Occupancy (RTO) gold standard.
  • RTO defined bed shortage as occupancy >100% for >20% of the time.

Main Results:

  • 9.1% of EDs (37/408) experienced bed shortages based on the RTO method.
  • HPBO estimated a median of 9 additional beds needed for shortage EDs (IQR 5-16), closely matching RTO's 7 beds (IQR 3-14).
  • The AA method underestimated bed needs in 7 EDs, estimating a median of 7 beds (IQR 1-14).

Conclusions:

  • Hourly Peak Bed Occupancy (HPBO) effectively addresses the limitations of Annual Average (AA) by capturing critical short-term occupancy variations.
  • HPBO provides a reliable tool for healthcare administrators to accurately estimate additional bed requirements.
  • Implementing HPBO can lead to optimized resource allocation and improved management of emergency department overcrowding.