Assessing Immediate Bed Availability and Barriers to Discharge in a United States Children’s Hospital

Abstract

Objectives: The aim of this study was to quantify immediate bed availability (IBA) in a United States children’s hospital and treatment needs of hospitalized patients whose needs could be met outside a traditional hospital setting. Methods: Using a novel tool to capture census, scheduled discharges, and resource needs for hospitalized patients, we surveyed our hospital’s 5 non-neonatal inpatient pediatric units on 4 d over 1 y. Results: Median ward occupancy was 81% (range, 58-79), median intensive care unit occupancy was 80% (range, 7-19), and median IBA was 42% (range, 34-59). A median of 14 patients per day (13% of total capacity) had treatment needs that could be met by providing limited support in a nontraditional setting; the most common reason for requiring ongoing hospitalization in this group of patients was a safe discharge plan. Conclusions: Our median IBA of 42% exceeds federal recommendations, but varies widely between days surveyed. Even on days when IBA percentage is high, our total number of available beds is unlikely to meet pediatric population needs in a large-scale public health emergency.

Primary Health Care and Disasters: Applying a “Whole-of-Health System” Approach through Reverse Triage in Mass-Casualty Management

“…Most of the articles described a simulated MCI scenario without specifying the type, except one describing a gas attack. [14][15][16][17][18][19][20][21][22] Satterthwaite (2012) was the only one describing the response to a real event. Seven out of ten studies involved one hospital.…”

“…22 Almost all studies aimed at investigating RT efficacy in creating hospital surge capacity by discharging patients to primary care early in an MCI response. [14][15][16][17][18][19][20][21]23 Among them, one investigated what resources were needed at the primary care level. 19 Finally, the purpose of the study by Pollaris (2018) was to test a tool to guide clinical decision making in the RT process.…”

“…The studies' patients were discharged based on the following criteria: (1) by assessing patients' risk of facing a consequential medical event (CME) after early hospital discharge; 15,16,22 (2) by using discharge tools addressing barriers to discharge home; 17,18 (3) through HCW clinical evaluation; 20,21,23 and (4) by assessing the potential patient disposition based on the level of care required at a variable number of hours after MCIs. 14,19 In the first group, Kelen developed a classification system based on the patients' likelihood of developing a CME (ie, unexpected death or irreversible impairment within 72 hours from discharge) for which an in-hospital critical intervention (CI; eg, defibrillation or airway management) would be necessary to stabilize patient conditions.…”

“…Four articles explicitly mentioned discharging patients to lowacuity nursing facilities as a way to increase bed availability while at the same time providing on-going follow up to low-intensity patients. 14,17,18,23 Seven articles reported discharging patients home. [15][16][17][18][19][20]23 However, no article made explicit mention of referral pathways existing across the primary-hospital care continuum to grant continuity of care for the patients that were discharged home.…”

“…14,17,18,23 Seven articles reported discharging patients home. [15][16][17][18][19][20]23 However, no article made explicit mention of referral pathways existing across the primary-hospital care continuum to grant continuity of care for the patients that were discharged home.…”