title: Scheduled admissions and high occupancy at a children's hospital.
abstract: BACKGROUND
  High hospital occupancy is a challenge for quality of care and access, while low levels of occupancy may be inefficient in terms of resource utilization. Variability from scheduling decisions may affect occupancy and be amenable to alteration.
  
  
  OBJECTIVE
  Describe variability in admission, discharge, and occupancy patterns at a large children's hospital and assess the relationship between scheduled admissions and occupancy.
  
  
  METHODS
  Retrospective administrative data analysis.
  
  
  METHODS
  One urban, tertiary-care children's hospital.
  
  
  METHODS
  A total of 22,310 consecutive patients admitted from July 1, 2007 to June 30, 2008.
  
  
  METHODS
  Admission-discharge-transfer (ADT) data for 1 fiscal year were abstracted for analysis of admission and occupancy patterns.
  
  
  RESULTS
  Among 22,310 admissions, 78% were coded as emergent and 22% as scheduled. Variation in admission volume by day of week was high for scheduled admissions (coefficient of variation [CV] 65.3%), while it was more consistent for emergent admissions (CV 12.0%). For patients with length of stay (LOS) ≤ 7 days (84%), Mondays and Tuesdays generated 45.2% of scheduled patient hours. Wednesdays and Thursdays had the highest frequency of high occupancy.
  
  
  CONCLUSIONS
  Scheduled admissions contribute significantly to variability in occupancy and risk of mid-week crowding. Predictable patterns of admissions lead to high occupancy on some days and unused capacity on others, which can be addressed with proactive management of admissions (eg, greater use of unused capacity on weekends and in summer). Hospitals interested in optimizing patient flow should assess their admission and occupancy patterns. Further studies should link variation in occupancy to outcomes including quality of care, educational activities, and staff satisfaction.
authors.affiliation: Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA. fieldston@email.chop.edu
authors.forename: Evan S
authors.initials: ES
authors.lastname: Fieldston
authors.forename: Meera
authors.initials: M
authors.lastname: Ragavan
authors.forename: Bhuvaneswari
authors.initials: B
authors.lastname: Jayaraman
authors.forename: Kelly
authors.initials: K
authors.lastname: Allebach
authors.forename: Susmita
authors.initials: S
authors.lastname: Pati
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Metlay
mesh_terms: D001071:Appointments and Schedules; D001509:Bed Occupancy / Q000706:statistics & numerical data*; D002648:Child; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014481:United States