Background: Most large academic medical centers across the United States have been facing hospital-capacity strain and hospital census fluctuations for years, though these fluctuations of inpatient census have significantly increased with the COVID-19 pandemic. Hospitalists and hospital leaders are uniquely capable of identifying innovations to improve patient flow. Prior research has been insufficient to consistently mitigate daily patient surges. We aimed to identify the various surge methods (pre-COVID) utilized by hospitalists and their patient flow teams to determine which interventions have been useful for the reduction and management of hospital-capacity strain.

Methods: We conducted semi-structured interviews with a total of 13 hospitalist leaders and 14 hospital administration leaders from 13 large academic medical centers in the United States. The interviews discussed three domains: (1) impacts of hospital-capacity strain; (2) interventions utilized to mitigate hospital-capacity strain; and (3) perception of the impact of these interventions. Interviews were recorded and professionally transcribed. Using Dedoose software, the interviews were coded by teams of two researchers who were blinded to the other’s codes. Analysis was conducted using an inductive method at the semantic level, allowing themes to emerge from the interviews. [1]

Results: In preliminary analysis, we identified multiple themes and subthemes from the semi-structured interviews including: (1) Drivers of hospital-capacity are complex and difficult to predict, which often means that management of patient surges is prioritized above all other missions but often without sufficient resources, (2) Hospital-capacity strain negatively impacts patients, providers, and ultimately their systems, and (3) Proactive, data-driven approaches to capacity were perceived as the most helpful, while multiple pages and multiple meetings were perceived as leading to distractions and further delays.

Conclusions: All participating hospitals faced hospital-capacity strain, and hospitalist and hospital administration leaders believed that this strain negatively impacted all other key mission areas. Institutions have taken multiple similar approaches to capacity management, with certain approachesperceived as more effective and others as less so. This study offers insights into what approaches may be helpful in planning for hospital-capacity strain situations.

IMAGE 1: Table 1. Impact of capacity strain

IMAGE 2: Table 2. Intervention themes that were found to be helpful