Hospital Capacity, Patient Flow, and Emergency Department Use


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The Institute for Health, Health Care Policy and Aging Research

Hospital Capacity, Patient Flow, and Emergency Department Use in New Jersey

Derek DeLia, Ph.D.
A Report to the New Jersey Department of Health and Senior Services
September 2007
June 2007

Hospital Capacity, Patient Flow, and Emergency Department Use in New Jersey

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Rutgers Center for State Health Policy, September 2007

The Institute for Health, Health Care Policy and Aging Research

Hospital Capacity, Patient Flow, and Emergency Department Use in New Jersey

Derek DeLia, Ph.D.
A Report to the New Jersey Department of Health and Senior Services
September 2007
June 2007

Hospital Capacity, Patient Flow, and Emergency Department Use in New Jersey

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Rutgers Center for State Health Policy, September 2007

Acknowledgements
The author gratefully acknowledges helpful comments and contributions received from a number of officials and staff within the Department of Health and Senior Services including David Gruber, Barbara Montana, Vince Yarmlak, and John Hazel. The report also benefited from comments and conversations with Bruce Siegel at George Washington University. Finally, important contributions were made by Cecilia Huang, Karen Jaffee, Joel Cantor, and Jeff Abramo at the Rutgers Center for State Health Policy.

Hospital Capacity, Patient Flow, and Emergency Department Use in New Jersey

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Table of Contents
Executive Summary ..................................................................................................................................ix Introduction ......................................................................................................................................... .…..1 Literature Review ……………………………………………………………………………………… ..2 Data Analysis …………………………………………………………………………….... …………....14 Case Studies……………………………….…………………………………………………..………....35 Discussion ………………………………………………………………………………………………..46 Conclusion ................................................................................................................................................ 54 Appendix ................................................................................................................................................... 55 Endnotes.................................................................................................................................................... 59 References................................................................................................................................................. 61

Hospital Capacity, Patient Flow, and Emergency Department Use in New Jersey

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Rutgers Center for State Health Policy, September 2007

Hospital Capacity, Patient Flow, and Emergency Department Use in New Jersey
Derek DeLia, Ph.D.

Executive Summary

In response to concern about growing utilization of hospital emergency departments (ED’s) and its implications for hospital surge capacity, the New Jersey Department of Health and Senior Services (NJDHSS) commissioned the study “Emergency Department Utilization and Surge Capacity in New Jersey” to be conducted by the Rutgers Center for State Health Policy (CSHP). This document is the third and final project report. It includes quantitative analysis of recent trends in ED utilization, hospital occupancy, ambulance diversion, and potentially avoidable hospital use in New Jersey (NJ). Using a case study approach, it also provides qualitative analysis of patient flow management and surge capacity planning for hospitals in the state.
After a slight drop in 2004, total ED visits in NJ resumed their previously rising trend in 2005, ending the year with 3.36 million visits statewide (compared to 2.67 million in 1998). ED visits per capita followed a similar pattern and ended 2005 with 385 visits per 1,000 residents (compared to 329 visits per 1,000 residents in 1998). Growth in ED visits is more rapid in regions of the state that have experienced more rapid population growth, especially the Central West. But on a per capita basis, the South and Northeast regions of the state had the highest rates of ED use throughout the study period, 1998-2005.
Part of the rise in ED utilization is attributable to conditions and medical episodes that may have been avoided through better access to primary care. A growing number of inpatient admissions through the ED are for ambulatory care sensitive (ACS) conditions, such as asthma and congestive heart failure. These admissions, which grew from 158,480 in 2003 to 186,284 in

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2005, accounted for 31% of all ED admissions in 2005. In 2004, the state began collecting detailed data on ED visits that did not lead to admission. Based on these data, the number of potentially avoidable treat-and-release ED visits grew slightly from 1.15 million in 2004 to 1.24 million in 2005, accounting for 47% and 48% of all treat-and-release ED visits, respectively.
Following the national trend, the hospital sector in NJ experienced declines in capacity (i.e., maintained beds) and inpatient utilization (i.e., inpatient days) from 1998 to 2005. Annual occupancy rates at the state and regional levels fluctuated around 70% during this time. Annual occupancy rates for intensive care and critical care units were higher than overall hospital occupancy during this period but usually remained below 85% leaving at least 15% of capacity available for unexpected patient volume.
However, these annual occupancy figures give a misleading picture of the alignment between the supply and demand for hospital services. Every year, individual hospitals as well as groups of hospitals within the same geographic region experience recurring periods of very high occupancy followed by periods of low occupancy. During peak periods, hospital capacity in NJ appears to be extremely constrained. On 47 days in 2005, more than 95% of all maintained beds in the state were occupied. This number increased from 29 days in 2004 and 11 days in 2003. On these days, there would be almost no immediate surge capacity available to respond to a major emergency such as a natural disaster or terrorist attack without displacing existing patients. On more than ¾ of the days in 2003 through 2005, the state had less than 500 empty staffed beds available per million residents, which is a surge capacity benchmark developed by the federal Health Resources and Services Administration. Failure to meet the benchmark is more common in some parts of the state than others. The Northwest region of NJ stands out as being the most likely to have a limited number of empty beds relative to population.
The likelihood of experiencing high occupancy is quite varied among hospitals in the state. In 2005, for example, 26 facilities spent more than half of the year at or above 95% occupancy of staffed beds. Other facilities experienced very high occupancy much less

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Hospital Capacity, Patient Flow, and Emergency Department Use