Global Health Update: High Bed Occupancy Rates And Increased Mortality In Denmark

High levels of bed occupancy are associated with increased inpatient and thirty-day hospital mortality in Denmark, according to research published in the July issue of Health Affairs.

Authors Flemming Madsen, Steen Ladelund, and Allan Linneberg received considerable media attention in Denmark for their research findings. For one major Television channel, it topped Germany's victory in the World Cup finals.

In another story from the Danish newspaper, Information, Councillor Ulla Astman, Chairman of the North Denmark Regional Council and second highest ranking politician, who runs all of the Danish public hospitals, reportly stated that "we have to live with it [the increased mortality]," since Denmark cannot afford to reduce bed occupancy.

"Or die with it," said lead author Madsen, a pulmonary physician and director of the Allergy and Lung Clinic in Helsingør, Denmark, at the July 9 Health Affairs briefing, "Using Big Data To Transform Care." Madsen, who left his position as director of the Department of Internal Medicine at Frederiksberg Hospital in Copenhagen to pursue this research, believes that Astman's statement explains why Denmark has a bed shortage problem and supports his argument that bed shortage is a result of planning.

"It is dangerous to focus on productivity without looking at the consequences," says Madsen.

What's the Research?

Currently, in the United States, emergency departments are often crowded with patients seeking acute care. But emergency medicine is not yet a specialty for Denmark. While hospital bed shortages are common in North America, the United Kingdom, and Australia, bed occupancy rates in Danish hospitals' departments of medicine average 100 percent, report Madsen and his Health Affairs coauthors.

For their research, they decided to study bed occupancy and mortality rates to see if there was an association between the two. They looked at more than two million admissions from 1995 to 2012 from 322 departments of medicine at 72 hospitals in Denmark (excluding pediatric, psychiatric, and surgical departments).

Because Danish citizens have national health insurance, the authors used data from the National Health Database. They found high bed occupancy rates were associated with a 9 percent increase in both in-hospital mortality and thirty-day mortality rates. Admissions outside of normal working hours in addition to admissions during January, February, March, and July (possibly due to staff reduction, a result of vacation timing in Denmark) were also associated with increased mortality.

source: http://healthaffairs.org