Patient Safety and Quality

Going "smooth" can help relieve weekday crowding at children's hospitals

Children's hospital beds are often filled to or beyond capacity during the week and under-utilized on the weekend. At least some of this weekday/weekend difference can be reduced by rescheduling elective (prescheduled) admissions, a new study finds. This approach, smoothing inpatient occupancy, would affect the 15 to 30 percent of admissions to children's hospitals that are scheduled days—or even months—in advance, with arrival usually on a weekday.

The researchers analyzed resource-utilization information from 39 freestanding, tertiary-care children's hospitals across the United States. They then applied a retrospective smoothing algorithm to set each hospital's daily occupancy during a week to the hospital's weekly mean occupancy. Scheduled admissions (23.6 percent of hospital admissions in the dataset) represented 26.6 percent of weekday admissions, but only 12.4 percent of weekend admissions. Mean occupancy levels ranged from 70.9-108.1 percent on weekdays and 65.7-94.9 percent on weekends.

After smoothing occupancy over the course of a week using the hypothetical algorithm, the calculated weekly maximum occupancy for the participating hospitals was reduced by 6.6 percentage points. This meant that 39,607 patients at the 39 hospitals would not have been exposed to occupancy rates greater than 95 percent. The researchers calculated that the change would require a median 2.6 percent of patients to be scheduled on a different day of the week. The study was funded in part by the Agency for Healthcare Research and Quality (HS16418).

More details are in "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 May 2011 Journal of Hospital Medicine (Epub ahead of print).

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