Children's hospitals do not acutely respond to high occupancy

Creator(s)

Evan S. Fieldston, University of Pennsylvania Perelman School of Medicine
Matthew Hall, Child Health Corporation of America
Marion R. Sills, University of Colorado Health Sciences Center
Anthony D. Slonim, Virginia Tech Carilion School of Medicine
Angela L. Myers, Children's Mercy Hospital
Courtney Cannon, Children's Hospital Boston
Susmita Pati, The Children's Hospital of Philadelphia
Samir S. Shah, The Children's Hospital of Philadelphia

Document Type

Article

Publication Date

5-2010

Identifier

DOI: 10.1542/peds.2009-1627; PMCID: PMC2913552

Abstract

OBJECTIVE: High hospital occupancy may lead to overcrowding in emergency departments and inpatient units, having an adverse impact on patient care. It is not known how children's hospitals acutely respond to high occupancy. The objective of this study was to describe the frequency, direction, and magnitude of children's hospitals' acute responses to high occupancy.

METHODS: Patients who were discharged from 39 children's hospitals that participated in the Pediatric Health Information System database during 2006 were eligible. Midnight census data were used to construct occupancy levels. Acute response to high occupancy was measured by 8 variables, including changes in hospital admissions (4 measures), transfers (2 measures), and length of stay (2 measures).

RESULTS: Hospitals were frequently at high occupancy, with 28% of midnights at 85% to 94% occupancy and 42% of midnights at ≥95% occupancy. Whereas half of children's hospitals used occupancymitigating responses, there was variability in responses and magnitudes were small. When occupancy was >95%, no more than 8% of hospitals took steps to reduce admissions, 13% increased transfers out, and up to 58% reduced standardized length of stay. Two-day lag response was more common but remained of too small a magnitude to make a difference in hospital crowding. Additional modeling techniques also revealed little response.

CONCLUSIONS: We found a low rate of acute response to high occupancy. When there was a response, the magnitude was small.

Copyright © 2010 by the American Academy of Pediatrics.

Journal Title

Pediatrics

Volume

125

Issue

5

First Page

974

Last Page

981

Keywords

Bed occupancy; Elective surgical procedures; Hospital bed capacity; Hospitalization; Hospitalized child; Length of stay; Patient admission; Patient discharge; Patient transfer; Pediatric hospital

Comments

Grant support

• R03 HS016418/HS/AHRQ HHS/United States
• K01 AI073729/AI/NIAID NIH HHS/United States
• 5R03HS016418/HS/AHRQ HHS/United States
• K01 AI73729/AI/NIAID NIH HHS/United States
• K01 AI073729-02/AI/NIAID NIH HHS/United States

Recommended Citation

Fieldston, E. S., Hall, M., Sills, M. R., Slonim, A. D., Myers, A. L., Cannon, C., Pati, S., Shah, S. S. Children's hospitals do not acutely respond to high occupancy Pediatrics 125, 974-981 (2010).