Background: Lack of hospital capacity, a function of length of stay (LOS) and daily volume of admissions and discharges, can lead to Emergency Department (ED) boarding and overcrowding. Although ED admissions can vary daily, elective admissions are subject to far greater variability, with the majority historically scheduled early in the week. Hospital discharges are crucial to open beds for newly admitted ED patients. This study’s objective was to determine the variability throughout the week in hospital admissions, discharges, and the potential impact on mean LOS (mLOS) for ED vs. non-ED pathways in New York hospitals.
Methods: The New York State SPARCS (Statewide Planning and Research Cooperative System) database was evaluated. The number of admissions, number of discharges, and mLOS across New York was compared by the day of the week. The study period was Jan 01 to Dec 31, 2015. Adult hospital admissions were included and pediatric, obstetrics, and psychiatry admissions were excluded
Results: 1,479,654 hospital admissions met inclusion criteria; 1,035,430 (70%) admissions originated from the ED, 761,431 (51%) went to a medicine service, and 718,217 (48.5%) went to a surgical service. The average number of patients admitted on weekdays (Monday through Friday) was significantly higher (p = 0.0004) than on weekend days (Saturday and Sunday). Similarly, the average number of discharges was significantly higher on weekdays vs weekends (p = 0.002). Overall, the mLOS was 5.8 days. There was no significant difference overall between the mLOS for patients admitted on weekdays vs those admitted on weekends. However, the mLOS was significantly longer (p = 0.003) when patients were admitted to a surgical service on weekend days vs weekdays (8.15 vs 6.46 days respectively). Finally, mLOS was significantly longer (p = .0003) for patients discharged on weekdays vs weekend days (6 vs 4 days respectively).
Conclusion: This study demonstrates system wide variability which is known to impact available capacity. The largest variability involves scheduled elective admissions and differences between weekday and weekend discharges. Reducing these sources of variability can improve capacity, reduce length of stay, and reduce or eliminate ED boarding.