EL: That is absolutely correct. So what is the alternative today? Let’s build more beds. The average hospital bed occupancy in the United States is much lower than in any industrialized countries. In the US, it’s about 66 percent on average. One-third of our hospitals are empty, and yet we are overcrowded. That’s everyday life compared to Canada, for example, when their average bed occupancy is 90 percent. We have this luxury of having a lot of beds, and yet we are overcrowded. Building more beds would not solve the problem.
Explore This IssueACEP Now: Vol 35 – No 11 – November 2016
PV: Some hospitals reading this will say, though, that they run at an average occupancy of 85–90 percent. Would this apply to them?
EL: Cincinnati Children’s census is about 90 percent. That’s the same as in Canada. In Canada, when we started working with the Ottawa Hospital on these issues, they reported their census in excess of 100 percent. If your average bed occupancy is 85 or 90 percent, then every peak in census hits the ceiling. Every peak means that emergency patients are going to be boarded, quality of care is diminished, and yet the next day’s valley will result in waste. In short, hospitals lack capacity because of the way they choose to do business.
PV: What does it take to make this happen? Why isn’t every place adopting this?
EL: That’s a key question. The answer is multifactorial. First and foremost, if the hospital does not have an inspired and committed leadership, it’s not going to happen. If the hospital CEO, personally, is not supportive of this intervention, it’s not going to work. Second, surgeons do not realize that if they agree to smoothing, they would increase their volume, reduce their overtime, and improve their and patient satisfaction. At Cincinnati Children’s, despite a one-third reduction in waiting time for emergent and urgent surgery, they increased the number of cases and yet the overtime dropped by 57 percent.
“When I say that Cincinnati Children’s was able to improve their margin by $100 million a year, hospitals of similar size that do not do that will waste $100 million a year. In terms of safety, cost, readmission rates, and mortality rates, it’s dangerous to the patient and the financial wellbeing of the hospital to ignore these peaks and troughs. I consider this an absolutely essential part of any effort to address crowding. Without it, you will not solve your problem.” —Eugene Litvak, PhD
PV: I think the principle could be said, by a surgeon, that you don’t cure constipation by adding more colon.