Hospitals Operations Research

Does hospital crowding matter?

As the rates of COVID-19 increased the burden on hospitals in the early months of the pandemic, hospitals were decry a lack of beds and pressure on staff. While COVID-19 is of course a very acute case of over-crowding, a more general question is how much does hospital crowding impact health outcomes.

A paper by Hoe et al. (2022) aims to answer this question. The author uses 2006-2013 United Kingdom (UK) administrative data on medical records for inpatient and emergency department (ED) visits from the Hospital Episode Statistics (HES), to examine outcomes for trauma and orthopedic patients. The study focuses on emergency trauma patients requiring hip or knee replacements as hospitals likely have less ability to select healthier individuals for unscheduled, emergency patients compared to those undergoing elective surgery. The outcomes of interest were 7-day unplanned readmission and 30-day in-hospital mortality.

Based on this approach, the authors find that:

…a one-standard-deviation admission shock increases the unplanned readmission rate by 4.1 percent. Nonparametric and heterogeneity analyses suggest that “quicker and sicker” discharges contribute to the additional readmissions. The crowding impacts are larger in hospital departments with fewer beds, sicker patients, and stronger incentives to admit nonemergency patients.

In short, the outcry from hospital administrators during COVID certainly is also echoed in non-pandemic times. Overcrowded hospitals have to discharge patients faster which leads to an increase in readmission rates.

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