Children's Hospitals Can Take New Steps to Reduce Crowding

Published on in CHOP News

May 25, 2010 — Pediatric hospitals can employ several techniques to alleviate crowding and improve patient safety, but often fail to implement ways to better manage patient flow, according to new research by The Children’s Hospital of Philadelphia.

Techniques children's hospitals use to reduce crowding not effective

The study, which appears this month in the journal Pediatrics, evaluates how 39 children’s hospitals responded to high volume and found 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, MBA, MSPH, 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.”

Admissions not reduced during times of high occupancy

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. 

Some responses to crowding are counterintuitive

“Occasionally, hospital response to crowding was counterintuitive,” said Samir S. Shah, MD, MSCE, the senior author of the study.

For example, the number of patients with milder illness 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 Dr. Shah, a fact that ultimately compounds the problem of hospital crowding.

High hospital occupancy may lead to crowding in emergency departments and inpatient units, having an adverse impact on patient care. 

Recommendations for reducing crowding in children's hospitals

The authors offer several suggestions that hospitals can use to reduce crowding:

  • Better schedule elective admissions to accommodate days or months when there are known spikes in patient volume
  • Create extended-care emergency department units
  • Create short-stay inpatient units
  • Offer extended hours at primary care practices to try to offload demand on children’s hospitals’ emergency departments and inpatient areas for lower-acuity patients

Funding for the children's hospital occupancy study

Dr. Fieldston received support from the Robert Wood Johnson Foundation’s Clinical Scholars program. Dr. Sills received support from the Emergency Medicine Foundation and the Agency for Healthcare Research and Quality. Dr. Shah received support from the National Institute of Allergy and Infectious Diseases and the Robert Wood Johnson Foundation under its Physician Faculty Scholar Program.

More information

Study authors

Other study authors are Susmita Pati, MD, MPH of Children’s Hospital; Matthew Hall, PhD, of the Child Health Corporation of America in Shawnee Mission, KS; Marion R. Sills, MD, MPH, of Children’s Hospital in Aurora, CO; Anthony D. Slonim, MD, DrPH, of the Carilion Clinic Children’s Hospital in Roanoke, VI; Angela L. Myers, MD, MPH, of Children’s Mercy Hospital in Kansas City, MO; and Courtney Cannon, MBA, of Children’s Hospital Boston, Boston, MA.

Find the study online

“Children’s Hospitals Do Not Acutely Respond to High Occupancy,” Pediatrics published online April 19, 2010. 

Read the abstract.


Juliann Walsh, Public Relations, 267-426-6054