The 24/7 hospital and smoothing

A number of studies have documented the dangers of weekends and off-hours in the hospital.  Staffing is typically less, particular services may be nonexistent, and the doctor responsible for you may be a covering physician who knows little about you.

Furthermore, the 5 day a week focus leads to filling the hospital with electives early in the week, so work can be done by the end of the week.  This leads to peaks and flows in scheduling, which leads directly to sometimes dramatic fluctuations in census, with resultant crowding and boarding.

A nonprofit group in Boston, Massachusetts, the Institute for Healthcare Optimization, has focused on the relationship between boarding and these peaks and valleys of elective admissions.  (By the way, emergency admissions have only small variations in the number of admissions from day to day, so are minor contributors to these fluctuations.)

Led by Eugene Litvak, they have demonstrated the profoundly postive consequences of “smoothing” of elective admissions, with improvements in hospital, emergency, and operating room flow. Given the benefits of smoothing to the patient, the physician, and the hospital, it is rather puzzling that these processes have not been univerally adopted.

A brief description of the importance of this work is described in the New England Journal of Medicine in 2013, as well as another insightful article with the wonderful title, “Sleep faster! Someone else needs your blanket.”   

Some of my own thoughts on the 24/7 hospital and smoothing are included in "Queueless vs. clueless," from EM News, 2011.  Also, you might find something of use in the article on the "24-7 ED in the 9-5 hospital.”

Also, please read the Health Affairs blog by Michael Long and Sandeep Green Vaswani, “Just another hospital weekend, or life and death?"


© Viccellio 2014