JMIR Publications

ABSTRACT

Background:

Variations in hospitals care demand relies not only on the patient’s volume but also on the disease severity. Understanding both daily severity and patients’ volume in hospitals could help to identify pressure zones in hospitals for better hospital capacity planning and policymaking.

Objective:

This longitudinal study explores daily care demand dynamics in Swiss general hospitals for three measures: 1) capacity utilization; 2) patient turnover; and 3) patient clinical complexity level (PCCL).

Methods:

A retrospective population-based analysis was conducted with one-year routine data of 1.2 million inpatients from 102 Swiss general hospitals. Capacity utilization was measured as a percentage of the daily maximum number of inpatients. Patient turnover was measured as a percentage of the daily sum of admissions and discharges per hospital. PCCL was measured as the average daily patient disease severity per hospital from the clinical complexity algorithm.

Results:

There was a pronounced variability of care demand in Swiss general hospitals. The average daily capacity utilization ranged between 57.8% (95% CI 57.3–58.4) and 87.7% (95% CI 87.3–88), patient turnover ranged from 22.5% (95% CI 22.1–22.8) to 34.5% (95% CI 34.3–34.7) and mean PCCL from 1.26 (95% CI 1.25–1.27) to 2.06 (95% CI 2.05–2.07) among hospitals. Moreover, both within and between hospitals, all three measures varied distinctly between days, between days of the week, between weekdays and weekends, and between seasons.

Conclusions:

While admissions and discharges drive capacity utilization and patient turnover variation, disease severity of each patient drives PCCL. Monitoring—and if possible, anticipating—daily care demand fluctuations is key to managing hospital pressure zones. This study provides a pathway for identifying patients’ daily exposure to strained hospital systems for a time-varying causal model. Clinical Trial: Not applicable