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Berta Ortiga, Albert Salazar contributed equally to this work.
There are not any financial and non-financial competing interests in relation to this manuscript.
BO contributed to conception and design, acquisition of data, performed the statistical analysis and interpretation of data, as well as drafting the manuscript and adding all the comments from other authors; AS contributed to conception of the study as well as to the interpretation of data and to drafting the discussion of the manuscript; AJ and JE contributed to revising the manuscript critically for important intellectual content; GM participated in the conception, program design and in revising the draft manuscript; XC participated in revising the manuscript critically for important intellectual content. All authors read and approved the final manuscript.
The aim of this study was to evaluate how hospital capacity was managed focusing on standardizing the admission and discharge processes.
This study was set in a 900-bed university affiliated hospital of the National Health Service, near Barcelona (Spain). This is a cross-sectional study of a set of interventions which were gradually implemented between April and December 2008. Mainly, they were focused on standardizing the admission and discharge processes to improve patient flow. Primary administrative data was obtained from the 2007 and 2009 Hospital Database. Main outcome measures were median length of stay, percentage of planned discharges, number of surgery cancellations and median number of delayed emergency admissions at 8:00 am. For statistical bivariate analysis, we used a Chi-squared for linear trend for qualitative variables and a Wilcoxon signed ranks test and a Mann–Whitney test for non-normal continuous variables.
The median patients’ global length of stay was 8.56 days in 2007 and 7.93 days in 2009 (p < 0.051). The percentage of patients admitted the same day as surgery increased from 64.87% in 2007 to 86.01% in 2009 (p < 0.05). The number of cancelled interventions due to lack of beds was 216 patients in 2007 and 42 patients in 2009. The median number of planned discharges went from 43.05% in 2007 to 86.01% in 2009 (p < 0.01). The median number of emergency patients waiting for an in-hospital bed at 8:00 am was 5 patients in 2007 and 3 patients in 2009 (p < 0.01).
In conclusion, standardization of admission and discharge processes are largely in our control. There is a significant opportunity to create important benefits for increasing bed capacity and hospital throughput.