High bed occupancy
and emergency department (ED) overcrowding are bad for patients, staff and the
system itself, according to an editorial in the Medical Journal of
In the editorial, Dr
Sally McCarthy, President of the Australasian College for Emergency Medicine
and Director of Emergency Medicine at, Prince of Wales Hospital, Sydney,
discusses hospital occupancy levels and ED overcrowding.
Dr McCarthy said
that reducing the number of hospital beds, and increasing occupancy above 85
per cent in the name of operational efficiency, has clearly had a negative
effect, as the demand for hospital beds in Australia exceeds supply.
"The root cause of
the problem will remain unless hospital capacity is addressed in an integrated
approach at both national and state levels," Dr McCarthy said.
In an accompanying
article in the MJA,
Dr Andrew Keegan, Adjunct Associate Professor at the
Sydney Medical School, University of Sydney, said that high bed occupancy rates
have been shown to be associated with greater risks of hospital-associated infection
and to have a negative impact on staff health.
observational data have suggested that bed occupancies above 85 per cent could
adversely affect safe, effective hospital function," Dr Keegan said.
"There is an urgent
need to develop meaningful outcome measures of patient care that could replace
the process measures currently in use."
In a second
accompanying article in the MJA,
Dr Rodney Jones, Statistical Advisor at
Healthcare Analysis and Forecasting, Camberley, Surrey, UK, said that occupancy
and hospital size are linked and, therefore, hospital size is important when
examining occupancy levels.
used to calculate the required size of hospitals are underestimating the true
capacity needed for operational efficiency," Dr Jones said.
"Trends in occupied
bed-days, rather than admissions and length of stay, give better estimates of
future bed requirements."
Dr McCarthy said
that failure to acknowledge the causes and consequences of high bed occupancy
is seen in well-publicised health system responses to incidents that have
occurred in overcrowded EDs.
proposed in response to these incidents so far have not included fixing the
underlying reason for the patient being stuck in the waiting room - lack of
The Medical Journal of Australia
is a publication of
the Australian Medical Association.