title: Lowering levels of bed occupancy is associated with decreased inhospital mortality and improved performance on the 4-hour target in a UK District General Hospital.
abstract: OBJECTIVE
  To evaluate whether there is an association between an intervention to reduce medical bed occupancy and performance on the 4-hour target and hospital mortality.
  
  
  METHODS
  This before-and-after study was undertaken in a large UK District General Hospital over a 32 month period. A range of interventions were undertaken to reduce medical bed occupancy within the Trust. Performance on the 4-hour target and hospital mortality (hospital standardised mortality ratio (HSMR), summary hospital-level mortality indicator (SHMI) and crude mortality) were compared before, and after, intervention. Daily data on medical bed occupancy and percentage of patients meeting the 4-hour target was collected from hospital records. Segmented regression analysis of interrupted time-series method was used to estimate the changes in levels and trends in average medical bed occupancy, monthly performance on the target and monthly mortality measures (HSMR, SHMI and crude mortality) that followed the intervention.
  
  
  RESULTS
  Mean medical bed occupancy decreased significantly from 93.7% to 90.2% (p=0.02). The trend change in target performance, when comparing preintervention and postintervention, revealed a significant improvement (p=0.019). The intervention was associated with a mean reduction in all markers of mortality (range 4.5-4.8%). SHMI (p=0.02) and crude mortality (p=0.018) showed significant trend changes after intervention.
  
  
  CONCLUSIONS
  Lowering medical bed occupancy is associated with reduced patient mortality and improved ability of the acute Trust to achieve the 95% 4-hour target. Whole system transformation is required to create lower average medical bed occupancy.
authors.affiliation: Emergency Department, Royal Derby Hospital, Derby, UK.
authors.forename: D G
authors.initials: DG
authors.lastname: Boden
authors.affiliation: Division of Medicine, Royal Derby Hospital, Derby, UK.
authors.forename: A
authors.initials: A
authors.lastname: Agarwal
authors.affiliation: Division of Medicine, Royal Derby Hospital, Derby, UK.
authors.forename: T
authors.initials: T
authors.lastname: Hussain
authors.affiliation: Division of Medicine, Royal Derby Hospital, Derby, UK.
authors.forename: S J
authors.initials: SJ
authors.lastname: Martin
authors.affiliation: Department of Operations, Royal Derby Hospital, Derby, UK.
authors.forename: N
authors.initials: N
authors.lastname: Radford
authors.affiliation: Emergency Department, Royal Derby Hospital, Derby, UK.
authors.forename: M S
authors.initials: MS
authors.lastname: Riyat
authors.affiliation: Emergency Department, Royal Derby Hospital, Derby, UK.
authors.forename: K
authors.initials: K
authors.lastname: So
authors.affiliation: Dr Su Statistics, Consulting firm, Kaunakakai, Hawaii, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Su
authors.affiliation: Information Services, RDH, Derby, UK.
authors.forename: A
authors.initials: A
authors.lastname: Turvey
authors.affiliation: Division of Medicine, Royal Derby Hospital, Derby, UK.
authors.forename: C I
authors.initials: CI
authors.lastname: Whale
mesh_terms: D001509:Bed Occupancy / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D004739:England; D017052:Hospital Mortality; D006767:Hospitals, District / Q000458:organization & administration; D006769:Hospitals, General / Q000458:organization & administration; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D009936:Organizational Innovation; D009937:Organizational Objectives; D010043:Outcome and Process Assessment, Health Care; D058996:Quality Improvement
keywords: death/mortality; emergency department; quality assurance