Background: We previously reported an estimate of the national pediatric (ped) bed census that demonstrated a 4% loss of total med/surg/PICU beds from 2002 to 2011. A deeper look revealed -7% med/surg beds, +12% PICU beds, a loss in beds at small (sm) and medium (med) sized hospitals as well as non-freestanding children’s (nonCH) hospitals and gains in beds in large (lg) hospitals and free standing children’s hospitals (FSCH). This data mirrored the shift in hospitalization demographics over the same time frame toward children’s hospitals and suggests regionalization of ped care. However bed capacity is not the same as bed occupancy so that shifts in capacity or hospitalization demographics may not reflect changes in access to ped inpatient care. Our objective was to estimate changes in national pediatric bed occupancy and look for trends over time.

Methods: We used our estimate of the national ped bed census in 2002 and 2011. We used the closest year AHRQ Kids’ Inpatient Database (KID), 2003 and 2012 respectively, for total discharges (d/c), length of stay (LOS), hospital type and seasonal variables. KID provides better accuracy and granularity than the same year’s National Inpatient Sample. Bed occupancy rate (BOR) = patient days (total d/c x LOS)/(bed census x total calendar days).

Results:

Using the bed census from 2002 the 2003 national annual ped BOR was 68%. Using the 2011 bed census the 2012 national annual ped BOR was 62%.
Table 1 shows the difference by hospital type. 

Hospital type:

Sm

Med

Lg

nonCH

FSCH

2003

150%

51%

94%

75%

103%

2012

103%

53%

96%

80%

87%

Table 2 shows the differences by calendar quarter. 

 All (FSCH)

Jan-Mar

Apr-Jun

Jul-Sep

Oct-Dec

2003

79% (FSCH 111%)

67% (FSCH 101%)

64% (FSCH 97%)

72% (FSCH 102%)

2012

77% (FSCH 91%)

70% (FSCH 80%)

65% (FSCH 82%)

71% (FSCH 88%)

Conclusions: Although our findings are based on low year-to-year variability in bed census the numbers represent reasonable estimates of BOR. Despite a loss of pediatric beds from 2002-2011 and an increase in LOS the overall drop in ped d/c has actually dropped the national annual BOR. Sm and FSCH had a large drop in BOR for very different reasons: SM due to large drop in d/c and FSCH due to increased capacity. Other hospital types remained stable. Not surprising was the large seasonal variation in BOR in all hospitals. It is unclear what effect this has on access to inpatient care although hospitals operating at or near full capacity may struggle with daily fluctuations in providing access.