Patient Safety and Quality

Adjusting hospital admissions by day can help with overcrowding in children's hospitals

Depending on the day of the week, children's hospitals can experience high or low occupancy levels. Both extremes can affect the quality of health care delivered to children, whose hospital stays are often 2 to 3 days long. A recent study looked at the differences in weekday and weekend inpatient occupancy rates at children's hospitals to see if the practice of "smoothing" could help with overcrowding. Smoothing is when a hospital proactively controls admissions to achieve more even census levels over days of the week. The researchers collected daily inpatient census data for 1 year from 39 children's hospitals located in 23 States.

Among the 39 hospitals, occupancy rates varied from 70.9 percent to 108.1 percent during weekdays and 65.7 percent to 94.9 percent on weekends. Overall, only 12.4 percent of scheduled admissions came in during weekends.

A hypothetical smoothing algorithm was applied to each week's census to achieve a more even distribution of patients admitted to each hospital. Had the hospitals smoothed their census over days of each week, they would have been able to prevent occupancy rates reaching higher than 95 percent.

In order to achieve effective smoothing during the week, the researchers found that a median 2.6 percent of hospital admissions would have to be scheduled on different days. This amounts to 7.4 patients needing rescheduling each week—or just under one-tenth of scheduled admissions. The study was supported in part by the Agency for Healthcare Research and Quality (HS16418).

See "Addressing inpatient crowding by smoothing occupancy at children's hospitals," by Evan S. Fieldston, M.D., M.B.A., M.S.H.P., Matthew Hall, Ph.D., Samir S. Shah, M.D., M.S.C.E., and others in the October 2011 Journal of Hospital Medicine 6(8), pp. 462-468.

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