UMD logistics studies link bed shortages and hospital readmissions
Revenue-driven surgery and poor planning drive some surgical patients home too early, concludes a pair of logistical studies conducted by researchers at the University of Maryland's Robert H. Smith School of Business.
The studies show a correlation between readmission rates and how full the hospital was at the time of discharge, suggesting that patients went home before they were healthy enough.
The researchers recommend better planning and other logistical solutions to avoid these problems.
The studies appear in the two most recent issues of the peer-reviewed journal Health Care Management Science:
*"The impact of hospital utilization on patient readmission rate" http://ter.ps/sj
*"Examining the discharge practices of surgeons at a large medical center" http://ter.ps/sk
"Discharge decisions are made with bed-capacity constraints in mind," says University of Maryland Professor Bruce Golden, the Smith School's France-Merrick Chair in Management Science, who conducted the research with Ph.D. student David Anderson and other colleagues.
"Patient traffic jams present hospitals and medical teams with major, practical concerns, but they can find better answers than sending the patient home at the earliest possible moment," Golden adds.
In the studies, Golden and Anderson tracked patient movement at a large, academic medical center located in the United States.
They found that patients discharged when the hospital was busiest were 50 percent more likely to return for treatment within three days. This indicates recovery was incomplete when patients were first released, the researchers say. The study tracks occupancy rates, day of the week, staffing levels and surgical volume.
Surgeons and hospitals are incentive-driven to perform as many surgical procedures as feasible, Golden says.
"The hospital has to maintain revenue levels to meet its financial obligations. Surgeons are working to save lives and earn a livelihood. It's what they do," he explains. "If the hospital says 'sorry there are no beds available,' there's a lot of tension and pressure from both sides to keep things moving."
These problems are much more likely at large hospitals, which tend to provide more advanced, specialized surgeries not accessible at smaller, community institutions,the researchers say. Patients often have to travel a great distance for the procedures, so hospital delays become expensive for both them and the care providers.
The study findings cover surgical discharge data from fiscal year 2007 covering more than 7,800 surgery patients who collectively spent 35,500 nights at the facility.