ID both crowding and under-utilized capacity

'Smooth out' admissions

Smoothing" occupancy over the course of a week can protect patients from crowded conditions, according to a study involving 39 children's hospitals during 2007.1 Researchers compared weekday versus weekend occupancy to determine just how much "smoothing" can reduce inpatient crowding. Their findings:

• After smoothing, 39,607 patients from the 39 hospitals were removed from settings where occupancy levels exceeded 95%.

• To achieve within-week smoothing, a median of only 2.6% of admissions — 7.4 patients per week — would have to be scheduled on a different day of the week.

The fact that this amount of variation existed wasn't surprising, according to Evan S. Fieldston, MD, MBA, MSHP, the study's lead author and assistant professor of pediatrics at The Children's Hospital of Philadelphia. "What was surprising, however, was the relatively small number of patients that would have to be scheduled differently to bring down the census for very high levels and make better use of resources over the days of the week," says Fieldston.

Fieldston recommends that patient access leaders meet with clinicians to explore ways to address admission and occupancy patterns. "The first step is for hospitals to analyze their own data," he says.

If you find patterns of scheduled admissions and occupancy clustered on some days but not others, and you are concerned about crowding and/or under-utilized capacity, consider steps to proactively manage scheduled admissions patterns, says Fieldston. "This may not necessarily mean admitting patients, or many patients, on weekends, but it may mean altering the weekdays on which patients enter," he says.


1. Fieldston, ES, Hall M, Shah, SS, et al. Addressing inpatient crowding by smoothing occupancy at children's hospitals. J Hosp Med 2011; 6. Doi: 10.1002/jhm.904.