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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