Pediatric hospitals can employ several techniques to alleviate crowding, but often fail to implement ways to better manage patient flow, according to research by The Children's Hospital of Philadelphia.
The study, which appears in the journal Pediatrics, evaluated how 39 children's hospitals responded to high volume and found that most employ techniques that don't do enough to significantly lower occupancy rates. The most common approach was to reduce the time a patient stays in the hospital, but the effect was minimal.
"For most hospitals, the first course of action is try to decrease the length of stay," said study leader Evan Fieldston, MD, a pediatric researcher at The Children's Hospital of Philadelphia. "Hospitals might want to take extra steps to mitigate occupancy. There are techniques to reduce crowding, such as scheduling elective admissions when there is known to be lighter emergency volume or trying make greater use of weekends."
The researchers used 2006 data obtained from the Pediatric Health Information System (PHIS), a national administrative database that contains information from 39 freestanding children's hospitals. As a whole, PHIS hospitals were often at high occupancy, with 70 percent of all midnights above 85 percent occupancy, including 42 percent of midnights above 95 percent.
When occupancy was above 95 percent, no more than 8 percent of the hospitals took steps to reduce admissions, while 58 percent reduced the patient's length of stay.
"Occasionally, hospital response to crowding was counterintuitive," said Samir S. Shah, MD, the senior author of the study. For example, the number of patients with milder illnesses who were hospitalized after emergency department evaluation increased at some hospitals during times of extreme crowding.
"This paradoxical response may temporarily ease the workload of emergency department physicians and likely reflects the complexities of managing patient flow in a busy emergency department," said Shah. High hospital occupancy may lead to crowding in emergency departments and inpatient units, having an adverse impact on patient care.
The authors suggest hospitals should schedule elective admissions to accommodate days or months when there are known spikes in patient volume. Hospitals could also create extended-care emergency department units and short-stay inpatient units or offer extended hours at primary care practices to try to offload demand on emergency departments and inpatient areas for lower-acuity patients.