Does hospital occupancy impact discharge rates?
Gary Harrison A , Kathryn Zeitz B C G , Robert Adams D , The Health Observatory and Mark Mackay E FA College of Charleston, Charleston, SC 29424, USA. Email: harrisong@cofc.edu
B Central Adelaide Local Health Network, North Terrace, Adelaide, SA 5000, Australia.
C School of Nursing, The University of Adelaide, Adelaide, SA 5000, Australia.
D Discipline of Medicine, The University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, SA 5011, Australia. Email: robert.adams@adelaide.edu.au
E School of Psychology, The University of Adelaide, Adelaide, SA 5005, Australia.
F Health Care Management, Flinders University, Bedford Park, SA 5042, Australia. Email: mark.mackay@flinders.edu.au
G Corresponding author. Email: kathryn.zeitz@health.sa.gov.au
Australian Health Review 37(4) 458-466 https://doi.org/10.1071/AH12012
Submitted: 3 December 2012 Accepted: 16 May 2013 Published: 10 July 2013
Abstract
Objective. To understand what impact hospital inpatient occupancy levels have on patient throughput by analysing one hospital’s occupancy levels and the rate of patient discharge.
Methods. A four-stage model was fit to hospital admission and separation data and used to analyse the per-capita separation rate according to the patient load and the impact of hospital over-census actions.
Results. Per-capita separation rates are significantly higher on days when the hospital declares an over-census due to emergency department crowding. Per-capita separation rates are also higher or lower on days with 8−10% higher or lower patient loads, respectively, but the response is not nearly as strong as the response to an over-census declaration, and is limited to patients with an elapsed stay of 10 days or more. Within the medical division there is an increase in per-capita separation rates on over-census days, but no significant difference in per-capita release rates for different patient loads. Within the surgical division there is no significant difference in per-capita separation rates on over-census days compared with other days, but the patient load does make a significant difference.
Conclusion. Staff do discharge a greater proportion of long-stay patients when the hospital is experiencing high demand and a lower proportion when occupancy is low, but the reasons driving those changes remains unclear.
What is known about the topic? The evidence regarding safe and efficient levels of hospital occupancy is limited. There is minimal empirical evidence that confirms the relationship between occupancy and discharge rates.
What does the paper add? Per-capita separation rates increase strongly on over-census days. The hospital increases per-capita separation rates on days of high occupancy and reduces it on days of low occupancy, mostly for long-stay patients with over 10 days of elapsed stay. The response to high occupancy is not as strong as the response to over-census. The medical division responds strongly to the over-census and the surgical division does not. The surgical division responds more to occupancy levels within its own division than does the medical division.
What are the implications for practitioners? The implementation of over-census-type responses to periods of high occupancy may result in increased per-capita separation rate. Using mathematical analysis to understand patient load on per capita separation is important to create a better understanding of health service delivery, thereby aiding hospital managers, and has the potential to guide system improvement. The clinical drivers for these changes and the service design implications require further investigation.
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