Using capacity alert calls to reduce overcrowding in a major public hospital
Sankalp Khanna A C , Justin Boyle A and Kathryn Zeitz BA CSIRO Australian e-Health Research Centre, Level 5, UQ Health Sciences Building 901/16, Royal Brisbane and Women’s Hospital, Herston, Qld 4029, Australia. Email: Justin.Boyle@csiro.au
B Central Adelaide Local Health Network, Royal Adelaide Hospital, Level 4, Margaret Graham, Building, North Terrace, SA 5000, Australia. Email: kathryn.zeitz@health.sa.gov.au
C Corresponding author. Email: Sankalp.Khanna@csiro.au
Australian Health Review 38(3) 318-324 https://doi.org/10.1071/AH13103
Submitted: 24 May 2013 Accepted: 27 January 2014 Published: 12 May 2014
Journal Compilation © AHHA 2014
Abstract
Objective To investigate the efficacy of capacity alert calls in reducing acute hospital overcrowding through addressing rising occupancy, high patient throughput and increased access block.
Methods Retrospective analysis of 24 months of in-patient, emergency department, and capacity alert call log data from a large metropolitan public hospital in Australia. The analysis explored statistical differences in patient flow parameters between capacity alert call days and other days including a control case set of days with statistically similar levels of occupancy.
Results The study identified a significant (P < 0.05) reduction in occupancy, patient throughput and access block on capacity alert call days. Capacity alert call days reversed rising occupancy trends, with 6 out of 7 flow parameters reporting significant improvement (P < 0.05) over the 48 h following the call. Only 3 of these 7 flow parameters were significantly improved 48 h after control case days, confirming value in the alert mechanism and that the results are not a regression toward the mean phenomenon.
Conclusions Escalation processes that alert and engage the whole hospital in tackling overcrowding can successfully deliver sustained improvements in occupancy, patient throughput and access block. The findings support and validate the use of capacity alert escalation calls to manage overcrowding, but suggest the need to improve the consistency of trigger mechanisms and the efficiency of the processes initiated by the capacity alert call.
What is known about the topic? Hospitals use various capacity management protocols to combat rising occupancy and the resulting poor patient care outcomes. However, there is little or no empirical evidence based on real hospital data to validate the efficacy of these approaches.
What does this paper add? This study suggests that capacity alert call days result in a significant reduction in occupancy, throughput and access block, thereby arresting and reversing rising occupancy trends and returning a greater improvement in patient flow parameters over the following 48 h than is observed on a set of control case days with statistically similar levels of occupancy. The study also identifies aspects of the protocol in need of improvement.
What are the implications for practitioners? The study provides valuable insight into the ability of capacity alert calls to tackle rising occupancy and reduce overcrowding in hospitals. It makes a good case for hospitals to conduct similar reviews of their capacity management protocols to help identify and address suboptimal aspects of the protocols to support delivery of improved patient flow and better patient outcomes.
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