Annual Bed Statistics Give a Misleading Picture of Hospital Surge Capacity

doi:10.1016/j.annemergmed.2006.01.024

Annals of Emergency Medicine

Volume 48, Issue 4, October 2006, Pages 384-388.e2

Presented at the Academy Health annual research meeting, June 2005, Boston, MA.

https://doi.org/10.1016/j.annemergmed.2006.01.024 Get rights and content

Study objective

I describe how annual hospital surge capacity is affected by within-year variation in patient volume and bed supply.

Methods

Surge capacity was measured as the percentage and total number of hospital beds that are not occupied by patients. Administrative data were used to calculate these bed statistics for 78 hospitals in New Jersey—statewide and by emergency planning regions—in 2003. Annual bed statistics were compared to more refined calculations for each day of the year. Calculated numbers of empty beds were compared to federal disaster planning benchmarks.

Results

Annual bed statistics showed no major limitations on surge capacity. Statewide occupancy rates were well below 80% (ie, more than 20% of beds were empty), and the number of empty beds that were set up and staffed (ie, maintained) was well above federal disaster planning benchmarks. In contrast, daily bed statistics reveal long periods in 2003 when regional and statewide surge capacity was severely strained. Strained capacity was most likely to occur on Tuesdays through Fridays and least likely to occur on weekends. On 212 days, statewide occupancy of maintained beds met or exceeded 85%. This occupancy rate met or exceeded 90% and 95% on 88 and 4 days, respectively. On 288 days, the statewide number of empty maintained beds fell below the federal planning benchmark.

Conclusion

Annual bed statistics give a misleading picture of hospital surge capacity. Analysis of surge capacity should account for daily variation in patient volume and within-year variation in bed supply.

Introduction

Emergency department crowding is a well-documented problem in the United States.1, 2 This problem raises concern about the adequacy of hospital surge capacity to respond to mass casualty events such as natural disasters and terrorist attacks. Hospital surge capacity is often measured in terms of inpatient occupancy rates and the number of empty beds that would be immediately available in an emergency.

Although more detailed measures of surge capacity are under development,³ hospital bed statistics will continue to be used for a variety of planning and research purposes. The advantages of these statistics include wide availability of data and ease of calculation. A major disadvantage is that these statistics are usually reported annually, which ignores day-to-day variation in patient volume and within-year changes in bed supply. As a result, annual bed statistics can give misleading information about hospital surge capacity.

This investigation aims to improve analyses of hospital surge capacity using administrative records. Surge capacity is measured by occupancy rates and the number of empty beds relative to disaster planning benchmarks recommended by the federal government (described below). Large occupancy rates and small numbers of empty beds are viewed as indicators of limited surge capacity. The key hypothesis is that surge capacity appears more limited when measured on a daily basis instead of annually. The addition of daily measures is considered meaningful if they reveal long periods (eg, several weeks or months) in which hospitals are extremely full (eg, above 90% occupancy) or the number of empty beds is below recommended levels.

Section snippets

Study Design and Outcome Measures

Because of space constraints, this section provides an abbreviated description of study methods and data sources. A more thorough description is found in Appendix E1 (available online at http://www.annemergmed.com).

The study is based on administrative data for 78 out of 82 total hospitals in New Jersey in 2003. Four hospitals were excluded because of incomplete data. As shown in Appendix E1 (available online at http://www.annemergmed.com), the 4 missing hospitals do not appear substantially

Results

When measured annually, hospital occupancy rates throughout New Jersey showed no major limitations on surge capacity (Table 1). All regions had annual occupancy rates below 85% for both licensed and maintained beds.

There is a difference when occupancy rates are calculated daily. Average daily occupancy rates were higher than annual versions for both types of beds. For maintained beds, 2 regions exceeded the 85% average occupancy threshold, and 1 exceeded the 90% threshold. Two other regions

Limitations

The analysis above is limited by the availability of data from only 1 state. Because of differences in regulation and population characteristics, constraints on surge capacity may be different in other states. Nevertheless, the distinction between annual and daily measures of surge capacity is likely to be important for hospitals across the nation. Specifically, annual bed statistics are often derived from the American Hospital Association Annual Survey of Hospitals or the Medicare Cost Report.

Discussion

This article shows how annual bed statistics give misleading information about the availability of hospital surge capacity. When measured daily, these statistics show much less availability than one could infer from annual data. Also, surge capacity in New Jersey almost always meets federally established guidelines when measured in terms of “licensed” beds but usually does not meet these standards when measured in terms of “maintained” beds. This distinction is important because the conversion

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: Supervising editor: Jonathan L. Burstein, MD

: Funding and support: The research in this paper received financial support from the New Jersey Department of Health and Senior Services (contract no. 4-27464) and the Robert Wood Johnson Foundation (grant no. 034067).

View full text

Disaster medicine/brief research reportAnnual Bed Statistics Give a Misleading Picture of Hospital Surge Capacity

Study objective

Methods

Results

Conclusion

Introduction

Section snippets

Study Design and Outcome Measures

Results

Limitations

Discussion

Emergency department crowding as a health policy issue: past development, future directions

Ann Emerg Med

Emergency room diversions: a symptom of hospitals under stress

Issue Brief Cent Stud Health Syst Change

Optimizing Surge Capacity: Hospital Assessment and Planning: Bioterrorism and Health System Preparedness, Issue Brief No. 3

Bioterrorism and Health System Preparedness Issue Brief No. 4

Disaster medicine/brief research report
Annual Bed Statistics Give a Misleading Picture of Hospital Surge Capacity