Short-Stay Hospitalizations and Hospital Capacity Constraints

Abstract

Study objective: Mismatches in the supply and demand for hospital care are important causes of emergency department (ED) crowding. The extent to which short-stay hospitalizations contribute to overall hospital capacity constraints has not been well described.

Methods: Retrospective cross-sectional analysis of hospitalizations at 4 US EDs (January 2018 to June 2024). Total occupancy hours were calculated by subtracting hospital departure from ED disposition timestamps. Short stays were defined as lengths of stay less than or equal to 48 hours, inclusive of hospital-based observation stays. We reported, as a percentage of ED-related total hospital occupancy hours, the proportion made up by short stays, in addition to reporting hospital boarding in the ED by total hours.

Results: We examined 625,233 total hospitalizations across 2,147,525 ED visits and 4 sites, representing 85,508,996 hospital occupancy hours. Short-stay hospitalizations made up 33.6% of hospitalizations through the ED. From 2018 to 2024, short-stay hospitalizations statistically significantly decreased as a proportion of ED hospitalizations (annualized percent change -1.2% [95% confidence interval (CI) -2.0% to -0.4%]), but the change was not statistically significant for inhospital occupancy hours contributed by short stays (-0.4% [95% CI -0.9% to 0%]). Hospital boarding in the ED increased (+0.6% [95% CI 0.3% to 0.9%]). Overall, short stays made up 7.6% of total inhospital occupancy hours related to ED hospitalizations.

Conclusion: Short-stay hospitalizations comprise a small fraction of ED-related hospital occupancy hours and do not explain increasing hospital boarding in the ED. Targeting short-stay hospitalizations may be useful in some cases but will have little impact overall on mitigating acute care capacity constraints.

Keywords: ED boarding; ED crowding; Short-stay hospitalizations.