Hospital Bed Occupancy Rate Linked to Death Rate

Lower bed occupancy is linked to a lower hospital death rate and improved accident and emergency (A&E) waiting target performance, according to a new study.

Researchers at Royal Derby Hospital (United Kingdom) reported the results of a range of interventions that were undertaken to reduce medical bed occupancy as part of an effort to meet the UK national 4-hour A&E waiting target, which stipulates that at least 95% of acute care hospital patients in England must be seen within 4 hours of arrival. The interventions implemented included the creation of daily senior doctor ward rounds, additional availability of beds in community facilities, and planned use of surgical beds for medical patients.

Daily data on medical bed occupancy and percentage of patients meeting the 4-hour target was collected from hospital records. Hospital standardized mortality ratio (HSMR), summary hospital-level mortality indicator (SHMI), and crude mortality were also compared both before and after the interventions. The results showed that mean medical bed occupancy decreased from 93.7% to 90.2%. The interventions were also associated with a mean reduction in all markers of mortality by 4.5%–4.8%. The study was published on September 17, 2015, in Emergency Medicine Journal.

“The tagline that ‘crowding kills’ is emotive, but important,” concluded lead author Dan Boden, MD, and colleagues. “If our access systems fail and patient harm results then we have a responsibility to monitor and report the data that demonstrates potential causes and associations, such that the profession, healthcare systems, and patients can explore, understand, and improve care.”

“Increased bed availability might have led to less seriously ill patients being admitted who might otherwise have been cared for at home, and although the death rate data were adjusted to take account of influential factors, illness severity was not one of them,” cautioned Profs. Steve Goodacre, PhD, and Mike Campbell, PhD, of the University of Sheffield (United Kingdom) in a linked editorial. “Measures that reduce bed occupancy use up precious health service resources. If this saves lives, then it may be worthwhile, but if it just increases admissions then resources would be better spent elsewhere.”

The four-hour target in in England set a target that stipulated that by 2004, at least 98% of patients attending an A&E department must be seen, treated, admitted, or discharged in under four hours. In 2006, 98.2% of patients were seen, diagnosed and treated within four hours of their arrival at A&E. Falling results caused the target to be revised by the Department of Health in June 2010 to 95%. By December 2014, the number of patients being treated within four hours in England had fallen to 91.8%

Related Links:
Royal Derby Hospital
University of Sheffield