Variation of Daily Care Demand in Swiss General Hospitals: Longitudinal Study on Capacity Utilization, Patient Turnover and Clinical Complexity Levels.

Narayan Sharma,Olga Endrich,René Schwendimann,Dietmar Ausserhofer,Michael Simon

doi:10.2196/27163

Abstract

BackgroundVariations in hospitals’ care demand relies not only on the patient volume but also on the disease severity. Understanding both daily severity and patient volume in hospitals could help to identify hospital pressure zones to improve hospital-capacity planning and policy-making.ObjectiveThis longitudinal study explored daily care demand dynamics in Swiss general hospitals for 3 measures: (1) capacity utilization, (2) patient turnover, and (3) patient clinical complexity level.MethodsA retrospective population-based analysis was conducted with 1 year of routine data of 1.2 million inpatients from 102 Swiss general hospitals. Capacity utilization was measured as a percentage of the daily maximum number of inpatients. Patient turnover was measured as a percentage of the daily sum of admissions and discharges per hospital. Patient clinical complexity level was measured as the average daily patient disease severity per hospital from the clinical complexity algorithm.ResultsThere was a pronounced variability of care demand in Swiss general hospitals. Among hospitals, the average daily capacity utilization ranged from 57.8% (95% CI 57.3-58.4) to 87.7% (95% CI 87.3-88.0), patient turnover ranged from 22.5% (95% CI 22.1-22.8) to 34.5% (95% CI 34.3-34.7), and the mean patient clinical complexity level ranged from 1.26 (95% CI 1.25-1.27) to 2.06 (95% CI 2.05-2.07). Moreover, both within and between hospitals, all 3 measures varied distinctly between days of the year, between days of the week, between weekdays and weekends, and between seasons.ConclusionsWhile admissions and discharges drive capacity utilization and patient turnover variation, disease severity of each patient drives patient clinical complexity level. Monitoring—and, if possible, anticipating—daily care demand fluctuations is key to managing hospital pressure zones. This study provides a pathway for identifying patients’ daily exposure to strained hospital systems for a time-varying causal model.

Highlights

Hospitals are constantly challenged by changing patient care demands
Monitoring—and, if possible, anticipating—daily care demand fluctuations is key to managing hospital pressure zones
This study explored all 3 measures, showing that capacity utilizations and patient clinical complexity levels were highest but patient turnovers were lowest in university hospitals

Summary

Introduction

Hospitals are constantly challenged by changing patient care demands. If this outweighs available resources, it can affect the quality of care and patient safety [1]. Most health care systems’ capacity utilization has increased, while total numbers of available beds have decreased [3,8]. This trend mainly reflects policies to reduce health care costs and to increase efficiency (eg, by the use of diagnostic-related groups [DRGs]) [8,9]. Variations in hospitals’ care demand relies on the patient volume and on the disease severity. Understanding both daily severity and patient volume in hospitals could help to identify hospital pressure zones to improve hospital-capacity planning and policy-making

Methods

Results

Discussion

Conclusion