The winter bed crisis - quantifying seasonal effects on hospital bed usage

Winter bed crises are a common feature in NHS hospitals, and have given ris e to great concern. We set out to determine the relative contribution of se asonal effects and other factors to bed occupancy in a large teaching hospi tal over one year. There were 190 804 occupied bed-days, which we analysed by specialty groupings. There was considerable variability in bed occupancy in each specialty. A significant winter peak occurred for general medicine and orthopaedics together with a significant increase on 'take-in' days. V irtually all specialties showed a significant variation in occupancy betwee n weekdays. Geriatric Medicine had a high and fairly constant occupancy, wi th some seasonal effect. We conclude that seasonal trends in bed occupancy occur in 'front door' specialties and are predictable. In these specialties , admission policies also make a contribution to bed usage and are amenable to modification. There is no surge in occupancy in the immediate post-Chri stmas period, except that attributable to the seasonal trend. In the 'elect ive' specialties, bed occupancy fluctuates widely, with reduced occupancy a t weekends and at Christmas. These differences are entirely amenable to mod ification. More effective bed management would make a very significant cont ribution to avoiding winter bed crises.