Developing Additional Hospital Capacity at the Community Level

Hospitals in the United States are being challenged to provide the capacity for adult medicine and surgery care. The study suggested that the hospitals of Syracuse, New York have generated additional inpatient capacity through a number of efforts. One program involved moving some low severity of illness inpatient procedures to ambulatory care. A different approach has also avoided inpatient utilization by diverting incoming ambulances to different providers. The third program evaluated in the study, length of stay reduction, was a different type of initiative. It has generated additional inpatient capacity by reducing the amount of inpatient care provided. In effect, it has increased inpatient capacity by addressing the efficiency of care. These programs illustrate the potential for improving hospital capacity at the community level. Each of them was developed by acute care providers using local services.


Introduction
In the United States, increasing efforts are focusing on the development of hospital inpatient bed capacity. The need for additional inpatient beds has become a major challenge during recent years [1].
One of the most important causes of this need has been the onset of the coronavirus epidemic during 2020 and 2021. The virus has generated the need for additional hospital inpatient capacity to serve adult medicine inpatients. Hospitals in most areas of the nation have been unable to meet this need with existing staff resources [2] [3].
Part of this challenge has been generated by the changing nature of incidence of the virus. At least two waves of virus incidence have developed during 2020 and 2021. Each of them has been accompanied by substantial increases in the need for inpatient bed capacity.
Reductions in the availability of nursing staff have also challenged the ability of hospitals to operate inpatient capacity. Available evidence suggests that substantial demands on nursing staff time have caused many nurses to reduce their workloads or leave the profession entirely. These problems have apparently not been alleviated by increases in compensation or other benefits [4] [5].
The need for hospitals to provide inpatient acute care has also challenged the operation of other health care services at the community level. These include emergency services through emergency departments and long term care in nursing homes and home health care [6] [7] [8].
This study reviewed examples of efforts to address the need for inpatient care in the hospitals of Syracuse, New York. It identified efforts to improve this situation at the community level, where most inpatient care is delivered. These hospitals provide inpatient acute care services to an immediate service area with a population of approximately 600,000. They also provide referral center services to the eleven county Central New York Health Service Area.

Population
In order to develop additional capacity, the Syracuse hospitals worked with the Hospital Executive Council. This was the planning organization developed by the three providers.

Method
The programs described in this study comprised a variety of approaches to the development of inpatient hospital capacity. The study focused on results of these programs in the Syracuse hospitals between July and September 2021 compared with the same months in previous years.
The study was based on simple descriptive statistics. Each of the data was

Results
The initial component of the study involved increasing hospital capacity by moving utilization to outpatient services. Relevant data are summarized in Table   1.  Information related to the study data suggested that most of these changes resulted from the movement of hospital inpatients to ambulatory care by orthopedic surgeons. Regardless of the source of the changes, they made additional inpatient capacity available in the hospitals.
The second component of the study involved the development of additional inpatient capacity through ambulance diversion from emergency departments in the Syracuse hospitals. Related data are summarized in Table 2.
This information demonstrated that the use of ambulance diversion in the Syracuse hospitals increased substantially between July and September 2017 and 2021. The number of hours on ambulance diversion rose by 2474 between these time periods.  Of the total hours on diversion, 1670, 67.5 percent involved one of the hospitals. This hospital employed the mechanism to shift adult medicine inpatients to other facilities. By increasing the use of ambulance diversion, the hospital increased capacity available for other services, such as elective surgery and treatment of patients with the Covid virus.
The impact of this change on inpatient utilization was limited by the fact that this hospital continued to admit some patients for services such as stroke and burn care. It was also limited somewhat by the fact that patient demands for each transport to each of the hospitals continued to support existing utilization patterns.
The third component of the study involved the use of length of stay reduction to increase inpatient capacity in the Syracuse hospitals. Relevant data are summarized in Table 3.
The comparisons of inpatient lengths of stay among the three hospitals demonstrated that these initiatives could generate substantial differences in utilization. All of these differences produced increased inpatient utilization. They could be translated into capacity for additional inpatient services.

Discussion
Hospitals in the United States are being confronted with epidemics, staffing shortages, and the increased referrals from other services. They are being challenged to provide the capacity for adult medicine and surgery care. This study provided examples of efforts to address these needs in one community.
The study suggested that the hospitals of Syracuse, New York have generated additional inpatient capacity through a number of efforts. The most basic programs involved addressing the need by moving some low severity of illness inpatient procedures to ambulatory care. In the examples provided in this study, this approach was supported by physicians who developed their own programs to treat orthopedic patients.
A different approach has also avoided inpatient utilization by diverting incoming ambulances to different providers. These initiatives have created capacity for additional inpatients by moving some of them to other settings.
The third program evaluated in the study, length of stay reduction, was a different type of initiative. It has generated additional inpatient capacity by reducing the amount of inpatient care provided. In effect, it has increased inpatient capacity by addressing the efficiency of care. It has reduced numbers of inpatient acute care days without reducing numbers of hospital inpatients.
In the Syracuse hospitals, length of stay reduction was supported by cooperative efforts with area nursing homes. These programs shifted patient days from hospitals to long term care facilities.
These programs illustrate the potential for improving hospital capacity at the community level. Each of them was developed by acute care providers using lo-R. Lagoe, S. Littau