Background: Like all large academic medical centers (AMCs), we face capacity challenges. On most days, bed occupancy is often greater than 90% and long boarding times in the Emergency Department (ED) leads to poor patient experience, care delays and risk for adverse outcomes. While many AMCs have approached this problem by acquiring new facilities or [...]

Background: Like all large academic medical centers (AMCs), we face capacity challenges. On most days, bed occupancy is often greater than 90% and long boarding times in the Emergency Department (ED) leads to poor patient experience, care delays and risk for adverse outcomes. While many AMCs have approached this problem by acquiring new facilities or [...]

Background: Academic medical centers and other quaternary hospitals struggle with capacity challenges that manifest in longer ED wait times, delayed or cancelled elective surgical procedures, and delayed transfers from community hospitals[1]. The Hospital at Home model is an obvious and elegant solution to increase capacity[2], but its nationwide implementation has been limited due to lack [...]

Background: Emergency Department (ED) overcrowding and lack of hospital bed capacity are pervasive problems made worse by the Covid-19 pandemic. Bed capacity is a significant concern at Academic Medical Centers (AMCs), as patients depend upon AMCs for specialized in-hospital care not available at other regional hospitals. Bed capacity shortage is acutely felt at rural AMCs, [...]

Background: Limited hospital capacity continues to be one of the major challenges to health care in hospitals in the US and the developed word. This problem manifests in a variety of ways in multiple settings starting with prolonged emergency room wait times and left without being seen rates, prolonged ED boarding time, and elective surgery [...]

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 [...]

Background: COVID-19 has placed an unprecedented strain on healthcare systems worldwide, increasing demand for critical care beds1. To address shortage of critical care beds, innovative methods to increase capacity are needed. At our large, urban academic safety-net hospital, patients with diabetic ketoacidosis (DKA) are admitted to critical care units for intravenous (IV) insulin administration and [...]

Background: Specialty wards (e.g., cardiology or oncology wards) group clinically similar hospitalized patients in efforts to improve outcomes and costs. When these wards exceed capacity, subsequent patients overflow to “geographically dispersed” alternate wards. Geographic dispersion has been associated with care inefficiency and worse outcomes on specialty wards, but has not been studied in a large, [...]

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 [...]

Background: Capacity constraints are a common problem at many academic institutions.  At Duke University Hospital (DUH) , capacity constraints continue to result in critical bed shortages.  Our affiliated hospital, Duke Regional Hospital (DRH) which is less than 5 miles away, has the capacity and capability to provide care to these general medicine patients. Shifting general [...]