Patient Crowding Reduced by Smoothing Occupancy Levels

Published on in CHOP News

May 25, 2011 — Children’s hospitals can reduce higher patient occupancy rates most often experienced during weekdays by scheduling more patients to be admitted on days with lighter schedules, according to a study published by researchers from The Children’s Hospital of Philadelphia and other pediatric institutions.

The study, which appears today in the Journal of Hospital Medicine, evaluated inpatient information from 39 children’s hospitals during 2007 and found high midweek occupancy and substantial unused weekend capacity. Hospitals can use a “smoothing” approach to reduce peaks and troughs in census over the course of the week in order to protect patients from crowded conditions, the study found.

High and low patient volumes each present problems

Hospitals typically have uneven patient volume over days of the week. High occupancy levels, often referred to as “crowding,” may compromise patient safety and access to care. Meanwhile, low levels are often considered inefficient. In the study of 39 children’s hospitals, weekday occupancy ranged between 71 percent and 108 percent while weekends had occupancy of 66 percent to 94 percent. Smoothing involves spreading the week’s volume of patients more evenly.

Timing the entry of patients is key

“Children’s hospitals have substantial unused capacity that could be used to smooth occupancy,” said study leader Evan Fieldston, MD, MBA, MSHP, a pediatric researcher at The Children’s Hospital of Philadelphia. “The concept is to proactively control the entry of patients, to achieve more even levels of occupancy instead of peaks and troughs.”

How the study was conducted

The researchers used 2007 data obtained from the Pediatric Health Information System (PHIS), a national administrative database that contains information from 39 freestanding children’s hospitals. The researchers retroactively calculated each hospitals’ average occupancy for the week and created a formula to alleviate times when patient census peaks.

Study findings

About 15 percent to 30 percent of patient visits are scheduled weeks or months in advance, and most often on weekdays. Only about 12 percent of scheduled admissions occurred during the weekends. The study forecast a reduction in weekly occupancy of more than 6 percent by smoothing out admissions. To achieve this, an average of about 7 patients per week would have to be scheduled on a different day, the study authors said.

Smoothing does not necessarily require weekend admissions. For example, patients could enter on a Friday with an anticipated discharge of Monday, the authors said. Further studies should look at child, family and staff preferences for scheduling admissions around school and work, as well as local circumstances that vary at each hospital.

Study authors

Other study authors are Susmita Pati, MD, MPH, and Samir S. Shah, MD, MSCE, of Children’s Hospital of Philadelphia;  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, VA; Angela L. Myers, MD, MPH, of Children’s Mercy Hospital in Kansas City, MO; and Courtney Cannon, MBA, of Children’s Hospital Boston.

Funding for the study

Dr. Fieldston received support from the Robert Wood Johnson Foundation’s Clinical Scholars program. Dr. Sills received support from 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

Fieldston ES, Hall M, Shah SS, Hain PD, Sills MR, Slonim AD, Myers AL, Cannon C, Pati S; Addressing Inpatient Crowding by Smoothing Occupancy at Children’s Hospitals; Journal of Hospital Medicine, 2011, DOI: 10.1002/jhm.904

Read the abstract.