By Flemming Madsen, Steen Ladelund, and Allan Linneberg High Levels Of Bed Occupancy Associated With Increased Inpatient And Thirty-Day Hospital Mortality In Denmark ABSTRACT High bed occupancy rates have been considered a matter of reduced patient comfort and privacy and an indicator of high productivity for hospitals. Hospitals with bed occupancy rates of above 85 percent are generally considered to have bed shortages. Little attention has been paid to the impact of these shortages on patients’ outcomes. We analyzed all 2.65 million admissions to Danish hospitals’ departments of medicine in the period 1995–2012. We found that high bed occupancy rates were associated with a significant 9 percent increase in rates of in-hospital mortality and thirty-day mortality, compared to low bed occupancy rates. Being admitted to a hospital outside of normal working hours or on a weekend or holiday was also significantly associated with increased mortality. The health risks of bed shortages, including mortality, could be better documented as a priority health issue. Resources should be allocated to researching the causes and effects of bed shortages, with the aim of creating greater interest in exploring new methods to avoid or reduce bed shortages. H igh bed occupancy rates in hos- pitals have been shown to be associated with increased mor- tality. For example, a linear rela- tionship between mortality and the combined effect of emergency department (ED) overcrowding and a shortage of hospital beds was found at an Australian tertiary medical center. 1 The increased mortality during periods of bed shortages probably resulted from an in- creased patient-to-staff ratio that developed when the number of patients increased but the number of staff did not. Chronic shortages of hospital beds are com- mon in North America, 2,3 the United Kingdom, 4 and Australia. 1 They are also common in Den- mark, where bed occupancy rates average 100 percent—a statistic that is praised as a sign of a highly productive and efficient system. 5 Danish hospitals also have high patient turnover rates. These rates are partly the result of improved treatment modalities such as non- invasive ventilation of patients with chronic ob- structive pulmonary disease and invasive cardiac procedures that result in quicker patient recov- ery. However, they have also been driven by a steady reduction in the number of hospital beds during the past three decades, even as the num- ber of admissions has remained relatively con- stant. The combination of high patient turnover, fewer beds, and improved treatments has re- sulted in a decrease in the average length-of-stay in Denmark’s hospitals. That length-of-stay was 6.0 days in 2003, down from 7.4 days in 1998. 6 High rates of hospital bed occupancy can be a sign of efficient care. However, they can also have negative consequences for patient safety. Another measure of patient safety can be found in the staffing levels of a hospital and particular departments within it. Department staffing levels are usually reduced during nights and on weekends and holidays to reduce costs. doi: 10.1377/hlthaff.2013.1303 HEALTH AFFAIRS 33, NO. 7 (2014): 1236–1244 ©2014 Project HOPE— The People-to-People Health Foundation, Inc. Flemming Madsen (flem-mad @dadlnet.dk) is a pulmonary physician at and director of the Allergy and Lung Clinic, in Helsingør, Denmark. Steen Ladelund is a statistician at the Clinical Research Centre, Hvidovre University Hospital, in Hvidovre, Denmark. Allan Linneberg is a professor in the Research Centre for Prevention and Health, Glostrup University Hospital, in Glostrup, Denmark. 1236 Health Affairs July 2014 33:7 Global Health Downloaded from HealthAffairs.org on May 30, 2020. Copyright Project HOPE—The People-to-People Health Foundation, Inc. For personal use only. All rights reserved. Reuse permissions at HealthAffairs.org.