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.
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.
"Clinical 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.
"Current methods 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.
"The solutions 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 hospital capacity."
The Medical Journal of Australia is a publication of the Australian Medical Association.