Addressing inpatient crowding by smoothing occupancy at children's hospitals

OBJECTIVE: To quantify the difference in weekday versus weekend occupancy, and the opportunity to smooth inpatient occupancy to reduce crowding at children's hospitals. METHODS: Daily inpatient census data for 39 freestanding, tertiary‐care children's hospitals were used to calculate occupancy and to model the impact of reducing variation in occupancy and the change in the number of patients, patient‐days, and hospitals exposed to high occupancy pre‐ and post‐smoothing. We also calculated the proportion of weekly admissions that would require different scheduling to achieve within‐week smoothing. RESULTS: Overall, hospitals' mean occupancy ranged from 70.9% to 108.1% on weekdays, and 65.7% to 94.9% on weekends. Weekday occupancy exceeded weekend occupancy with a median difference of 8.2% points. The mean post‐smoothing reduction in weekly maximum occupancy across all hospitals was 6.6% points. Through smoothing, 39,607 patients from the 39 hospitals were removed from exposure to occupancy levels >95%. To achieve within‐week smoothing, a median 2.6% of admissions would have to be scheduled on a different day of the week; this equates to a median of 7.4 patients per week (range: 2.3–14.4). CONCLUSION: Hospitals do have substantial unused capacity, and smoothing occupancy over the course of a week could be a useful strategy that hospitals can use to reduce crowding and protect patients from crowded conditions. Journal of Hospital Medicine 2011;6:466–473. © 2011 Society of Hospital Medicine