Researchers at Columbia University’s Mailman School of Public Health and Columbia Business School studied bed capacity --measured by the number of staffed beds -- in New York City hospital obstetrics units and found a significant excess number of beds, which overall cost the city an estimated $26.4 million each year. The findings, coupled with the current trends of an aging population and the declining birth rate, suggest that many obstetrics units could reduce their bed capacity and still assure timely access to care. Study findings are published in the journal Medical Care Research and Review.
Inpatient beds constitute the single largest fixed cost for a hospital. Although the estimated cost of an unused bed varies, from $80,951 to $205,105, these estimates all point to a significant amount of wasted resources due to excess hospital bed capacity, according to the study’s authors.
“In obstetrics units, there is a nearly universal mismatch of bed capacity and patient demand in all types of hospitals in New York City,” said Nan Liu, PhD, assistant professor of Health Policy and Management at the Mailman School of Public Health. “Thirty percent of the units are heavily congested; in these units, at least one patient out of ten was delayed in getting an obstetrics bed after giving birth to her baby. In contrast, more than a fifth of the units are significantly underutilized with beds empty almost at all times, wasting a lot of medical resources.”
The study looked at obstetrics capacity in 40 New York City hospitals during 2008-2009. Overall excess was 184 beds per year, and the total number of insufficient beds citywide amounted to 55 beds per year, resulting in a net excess of 129 beds or approximately 9 percent of the entire city’s obstetrics capacity. The average capacity of the 40 obstetrics units was 34.5 beds or a total capacity of 1,381 beds. These hospitals collectively handled around 240,000 maternal admissions in 2008 and 2009.
“If obstetrics beds were allocated appropriately citywide, the financial savings due to this reallocation alone could amount to $26.4 million per year,” noted Linda V. Green, PhD, Cain Brothers & Company Professor of Healthcare Management at Columbia Business School. “This financial saving may be conservative as it does not account for potential savings due to improved patient outcomes and reduced complications as a result of improved patient access to care.”
The researchers used a dataset from the Statewide Planning and Research Cooperative System (SPARCS) with all births in New York City hospitals across the five boroughs from 2008 to 2009, or approximately 120,000 deliveries per year. The data set also provides patient admissions date and time and discharge date and time in each hospital, and methods of delivery.
To identify the number of excess/insufficient obstetrics beds in each of the hospitals, the researchers used a systems modeling methodology, specifically queuing theory—an easy-to-use tool for capacity planning—to estimate the number of beds needed to provide the desired level of access to care. The use of queuing models as a tool to plan bed capacity echoes the recommendations of a recent Institute of Medicine report.
“While hospital beds are not all the same, we used obstetrics units as an example to study capacity utilization because an obstetrics unit is like an isolated ‘island’ in the hospital, restricted to a specific patient population and its capacity can be evaluated and planned independently, ” said Liu.
“The variation we find in obstetrics capacity utilization in New York City likely reflects conditions nationally. Excess capacity in obstetrics units is likely to increase if no adjustments are made to address the aging population, the decline in the birth rate, and current efforts to reduce the rate of elective Cesarean sections,” noted Green. The overall C-section rate in New York City during 2008 to 2009 was about 33 percent, close to the national level.
During the study period, daily patient demand was on average 43 percent higher on weekdays than on weekend days. Substantially more scheduled C-sections were performed during weekdays than weekends. Manhattan had the highest rate of scheduled deliveries compared with the other boroughs.
C-Sections and Excess Beds
The study found that for every 1 percent reduction of C-sections in New York, the city could save approximately seven beds citywide per year. For example, if the overall C-section rate were reduced to 25 percent, 54 beds could be cut citywide.
“Given emerging healthcare delivery and payment models that will likely decrease demand for other types of hospital beds, our study suggests that these methodologies should be used by hospitals and policy makers to identify opportunities for reducing excess bed capacity in other inpatient units as well,” said Green.
The authors declare no potential conflicts of interest.
About Columbia University’s Mailman School of Public Health
Founded in 1922, Columbia University’s Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Mailman School is the third largest recipient of NIH grants among schools of public health. Its over 450 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change & health, and public health preparedness. It is a leader in public health education with over 1,300 graduate students from more than 40 nations pursuing a variety of master’s and doctoral degree programs. The Mailman School is also home to numerous world-renowned research centers including ICAP (formerly the International Center for AIDS Care and Treatment Programs) and the Center for Infection and Immunity. For more information, please visit www.mailman.columbia.edu.