Too many admissions at a hospital at one time can put patients at risk, but a new study suggests that "controlled entry" of patients can reduce variations in occupancy rates and boost patient safety.
Researchers at the Children's Hospital of Philadelphia discovered that “smoothing” occupancy over the course of a week could help hospitals reduce crowding and protect patients from crowded conditions. The strategy involves controlling the entry of patients, when possible, to achieve more even levels of occupancy instead of the peaks and troughs that are commonly encountered.
The study, published in the Journal of Hospital Medicine, analyzed inpatient information from 39 children’s hospitals during 2007 and used it to compare weekday vs. weekend occupancy and to model the impact that smoothing inpatient occupancy has on reducing variations in occupancy.
Lead researcher Evan S. Fieldston, MD, said it was obvious that smoothing over the whole week would reduce peaks and raise troughs to average levels, but his team sought to quantify just how large these differences are – and thereby quantify the potential of smoothing to reduce inpatient crowding. If smoothing does not significantly reduce crowding, then other strategies might be of more value.
The analysis revealed that weekday occupancy exceeded weekend occupancy – hospitals’ average occupancy ranged from 70.9 percent to 108.1 percent on weekdays and 65.7 percent to 94.9 percent on weekends. After smoothing, each week’s maximum occupancy within the hospitals was reduced by an average of 6.6 percentage points. Through smoothing, 39,607 patients from the 39 hospitals were removed from settings where occupancy levels exceeded 95 percent. To achieve within-week smoothing, a median of only 2.6 percent 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.
“Scheduled admissions contribute significantly to variability in occupancy at hospitals and raise the risk of mid-week crowding,” said Fieldston. “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.”
He suggested that by smoothing out variation and spacing scheduled admissions over the week, hospitals can reduce crowding without delaying admissions or investing in expensive new beds. Also, patients who are admitted on weekends experience more delays in treatment and have worse outcomes, so increasing the capability of hospitals to function more fully seven days a week would make the system better and safer.