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Cutting bed occupancy to 90% 'saves lives', suggests study

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Reducing hospital bed occupancy could help save lives, according to researchers who studied efforts to cut occupancy rates at Derby Teaching Hospitals NHS Foundation Trust.

Bringing down medical bed occupancy to around 90% also helped the trust do better on accident and emergency waiting times, suggest study findings published in the Emergency Medicine Journal.

“The tagline ‘overcrowding kills’ is emotive but important”

Study authors

The study was carried out after the trust decided to introduce the 90% target for medical beds in an effort to reduce pressure on emergency care.

With the vast majority of people admitted to hospital from A&E needing acute medical care, lack of capacity on medical wards can lead to long waits on trolleys and increase the risk of poor care and harm to patients.

The trust took various steps to reduce medical bed occupancy including introducing daily consultant ward rounds to speed up discharge, freeing up surgical beds for medical patients and making use of extra community beds.

As a result, the occupancy rate fell from 93.7% to 90.2% after the new target was brought in.

Researchers studied hospital data from before and after the changes. They found death rates dropped while performance against the national four-hour A&E waiting time target improved.

They looked at three different indicators for mortality and found all three had gone down by between 4.5% and 4.8%.

“Measures that reduce bed occupancy – increasing bed and senior doctor availability – use up precious health services resources”

Steve Goodacre and Mike Campbell

The researchers said the findings back up other studies that suggest a link between overcrowding in A&E departments and poor patient experiences and care, prompting some to claim “overcrowding kills”.

However, they said it was still hard to make a direct connections, as other factors may have been at play – including the fact the trust increased nursing staffing levels in emergency care around the same time.

“This paper provides statistical evidence to support the beliefs and experiences of UK and international physicians,” said the authors.

“The tagline ‘overcrowding kills’ is emotive but important,” they said. “If our access systems fail and patient harm results then we have a responsibility to monitor and report the data that demonstrates potential causes.”

Other emergency care and healthcare data experts sounded a note of caution, however.

In a comment article published alongside the research paper, professors Steve Goodacre and Mike Campbell, from Sheffield University, said there was a risk that having more hospital beds available could simply mean more less seriously ill people being admitted when they could be cared for at home.

“Measures that reduce bed occupancy – increasing bed and senior doctor availability – use up precious health services resources,” they said.

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