Sunday, January 4, 2009

Hospital Bed Shortages

I thought perhaps a discussion of the availability of hospital beds and, secondarily, resources, might be apropos this evening. This is extremely important in light of discussion of 47 million uninsured americans beginning to use health resources if and when "Universal Healthcare" becomes a reality. Most people in this country are not aware of the bed shortages, and difficulty finding placement that occur daily. Most people operate under the assumption that if you are very ill, you can present to your hospital, and be admitted for further care there. Well, not necessarily.

"After nearly two decades of concern about excess inpatient capacity in U.S. hospitals, the business media and some industry observers are beginning to suggest that some hospitals are near their capacity limits in providing patient care.1 Concerns have arisen especially about emergency services and the increased frequency with which hospitals have gone on emergency department (ED) diversion (requesting that ambulances bypass their EDs) in recent years.2 Some studies suggest that ED diversion might be the most obvious sign of more widespread capacity problems in certain hospitals. In particular, some hospitals may go on diversion because their ED is crowded with patients who are boarded there because regular floor and intensive care unit (ICU) beds are full.3
These issues have generated discussion in public and private policy circles largely because of impending demographic changes as the baby-boom generation enters retirement and needs more health care. Should the United States now be considering increased investment in hospital capacity? The Health Care Advisory Board recently suggested that based on a moderate-growth scenario, hospital in-patient days will rise 3.5 percent each year through 2010, which implies the need to increase inpatient bed capacity by 40 percent.4 Also, a 2003 study of the Chicago health market, commissioned by its local hospital association, suggested that 4,500 more beds (approximately a 20 percent increase) would be needed there by 2020.5"


"Number of hospitals. These data suggest a consistent downward trend in the number of hospitals from 1975 to 2001. The number of staffed hospital beds also declined between 1985 and 2000, with a small increase in 2001. The number of hospitals declined 14.4 percent from 1985 to 2001, as a result of hospital closures and mergers. The decline in staffed hospital beds between 1985 and 2001 was about 17.5 percent, the result not only of closures and mergers but also of hospitals’ decisions to downsize bed complements or their difficulties keeping beds staffed because of labor shortages.
Hospital use. In relation to hospital use, between 1975 and 1980 admissions rose about 11 percent, and average length-of-stay was stable. This likely influenced the hospital bed expansion observed in this period. After 1980, though, inpatient admissions declined 14.4 percent, as did average length of hospital stay (14.5 percent).

Several factors were instrumental to these changes, including advances in medical technology that expanded the types of procedures that could be provided in an outpatient setting. Further, the introduction of the Medicare prospective payment system (PPS) also contributed, given its payment incentives that encouraged reductions in inpatient lengths-of-stay and a shift of some care to outpatient settings.9 Finally, managed care was a strong force between 1980 and 1995, and health maintenance organizations (HMOs) in particular focused on utilization management to reduce unnecessary hospitalizations and hospital days.10

Some of these trends took an interesting turn after 1995 (Exhibit 1). Most notably, hospital admissions rose 9.4 percent from 1995 to 2001. Despite a decline in average length-of-stay of 0.8 days over this period, average hospital occupancy rates rose to 64.4 percent in 2001. Meanwhile, the growth in outpatient visits continued unabated, rising about 30 percent between 1995 and 2001."

Also, Massachusetts looked at this, and found this:



This study found that the most significant driver of ED diversions in the two hospitals studied is the lack of sufficient inpatient capacity. This is supported both by observational data and by stochastic modeling. Capacity shortfalls may result from either an absolute lack of staffed hospital beds, a periodic bed shortage revealed during peaks of demand, or a combination of the two."

Just wondering what others thoughts might, or might not be.

1 comment:

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