PDF(Pubmed)
Abstract：
Background Hospital overcrowding compromises patient safety. The contribution of variability in admissions and discharges to overall hospital capacity needs to be quantified. This study describes the statewide day-to-day fluctuation in the volume of hospitalized patients, the variability and pattern of hospital admissions and discharges throughout the week, and the contribution of Emergency Department (ED) vs. elective (non-ED) admissions and discharges to the overall variability in the system across the week. Methodology This is a retrospective analysis of the New York State Statewide Planning and Research Cooperative System database, in which all New York healthcare facilities submit patient-level data monthly. The study period was from January 01 to December 31, 2015. Outcomes included total volumes of admissions and discharges and length of stay sorted by patient origin (ED vs. non-ED admits (elective)) and service type (medicine vs. surgery) by day of the week. Results We studied 1,692,090 hospital admissions. Admissions were highest on Mondays and Tuesdays and steadily decreased throughout the week. There was little variability in the ED admissions throughout the week. Surgical elective admissions had significant variability throughout the week, with higher admissions at the beginning of the week. There was a significant difference (p < 0.01) between admissions on weekdays vs. weekends. Discharges increased from Monday to Friday, with a dramatic drop on the weekends, for both ED and elective pathways. Systemwide, on Monday, hospitals were 21% above the mean volume, and on Fridays, hospitals were 32% below the mean volume. Conclusions Overall hospital capacity shows dramatic variability throughout the week, driven primarily by elective admissions and discharges from any source throughout the week. Because elective admissions are schedulable, hospitals can reduce variability by smoothing scheduling. Increased weekend discharges will also improve capacity.
摘要：
背景医院过度拥挤危及患者安全。入院和出院的可变性对整体医院能力的贡献需要量化。这项研究描述了全州范围内住院患者数量的日常波动，整周入院和出院的可变性和模式，以及急诊科(ED)的贡献与选修(非ED)入院和出院到整个系统的整体变化。方法这是对纽约州全州计划与研究合作系统数据库的回顾性分析，所有纽约医疗机构每月提交患者水平的数据。研究期间为2015年1月1日至12月31日。结果包括入院和出院的总量以及按患者来源分类的住院时间(ED与非ED承认(选修))和服务类型(医学与手术)按星期几。结果我们研究了1,692,090例住院患者。周一和周二的入学率最高，一周内稳步下降。整个星期的ED招生几乎没有变化。整周手术选择性入院有显著的变异性，在本周初录取率较高。工作日入院与入院之间存在显着差异（p<0.01）。周末。从星期一到星期五，放电增加，周末急剧下降，对于ED和选修途径。全系统范围，周一,医院比平均容量高21%，在星期五，医院比平均容量低32%。结论整个医院的整体容量在一周内显示出巨大的变化，主要由整周任何来源的选择性录取和出院驱动。因为选修招生是可安排的，医院可以通过平滑调度来减少变异性。周末放电的增加也将提高容量。
