Smooth Moves


A recent study in the Journal of Hospital Medicine concluded that by rescheduling fewer than 10 elective admissions per week from a weekday to a weekend, hospitals can reduce overcrowding. The report should encourage hospitalists to reconsider their own scheduling strategies, the lead author says.

"If they notice that on certain days their unit or their hospital is very crowded and on other days it's less so, it may be worth working with their organization's quality and safety or operational leadership to learn more about those patterns and see if they can improve on them," says Evan S. Fieldston, MD, MBA, MSHP, pediatric hospitalist at the Children's Hospital of Philadelphia.

The study examined 2007 daily inpatient census data from 39 tertiary-care children's hospitals. The average weekday occupancy ranged from 70.9% to 108.1%, while the average weekend occupancy ranged from 65.7% to 94.9%. After rescheduling, or "smoothing," elective admissions from days with "thresholds of high occupancy," defined as >85% occupancy, to less busy days, 39,607 patients were removed from exposure to occupancy levels greater than 95%.

Eugene Litvak, MD, president and CEO of the nonprofit Institute for Healthcare Optimization and adjunct professor of operations management at the Harvard School of Public Health in Boston, says the issue goes beyond U.S. hospitals. Dr. Litvak says he's discussed overcrowding with more than 100 hospitals in Europe, Japan, Australia, and the U.S. "In talking with their leadership in healthcare, I saw the same problem," he says.

The solution, Dr. Litvak suggests, lies with queueing theory, a mathematical formula that addresses random demand for a fixed capacity. Based on average census data, hospitals can apply queueing theory to determine how many beds and staff they need for ED admissions throughout a typical week.

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