Unanswered questions from the international trends in hospital bed occupancy and its potential impact on hospital planning

The ongoing rise in medical emergency admissions seen around the world over the past four to five decades has never been fully explained. Long term trends in hospital bed occupancy in England, Canada and Australia are examined to show that a recurring pattern of time-specific increases appears to apply. The possibility of a common infectious source is discussed. Whatever the cause the needs to future-proof acute hospitals against unexpected increases in bed demand is demonstrated to be more important than has hitherto been appreciated. Introduction A series of recent articles has been instrumental in highlighting the issue of the hospital bed occupancy required for optimum function and efficiency, and hence the wider issues around planning for adequate hospital size (Bain et al 2010, McCarthy 2010, Keegan 2010, Jones 2009 c-e, 2010n, 2011c-f, Wilson et al 2010). Part of the wider panorama will involve trends in hospital admission and in this respect the unusually high growth in medical admissions has been an enduring international enigma over the past four to five decades (Hobbs 1995, Kendrick 1995, Capewell 1996, Parker et al 1997, NZHTA 1998, Hilder et al 2000, Morgan et al 1999, LAIA 2001, Kendrick & Conway 2003, NSW Health 2007, MacDonald et al 2008, Trotter et al 2008, Roberts et al 2008, Pallin et al An edited version of this paper has been published as: Jones R (2011) Bed occupancy: The impact on hospital planning. British Journal of Healthcare Management 17(7): 307-313. Please use this to cite. 2008, Jones 2009a-d,2010a-b,d,g-h,l-n, Blunt et al 2010). Up to the present these trends have been largely attributed to health care consumerism and failings in the processes and organisation of health and social care. No one seems to have asked the obvious question; could it be that there is a general trend to increasing poor health? Indeed, why have illnesses such as diabetes, allergies, asthma and other immune syndromes apparently increased in parallel with increases in emergency admissions for a wider range of illness (Hyams 1998, Anderson et al 2007, Moorman et al 2007)? Examination of the long-term trends in medical admissions in the UK, USA, Canada (Jones 1997, Jones 2009a-d, 2010a-n) and in Europe and New Zealand (unpublished analysis) has revealed curious cyclic patterns which are reminiscent of the behaviour that would characterise an infectious disease outbreak. An excellent example of such cyclic behaviour is the observation that the incidence of syphilis (which has an element of acquired immunity) follows an approximate nine year cycle while that for gonorrhoea (no acquired immunity) does not exhibit cyclic behaviour (Grassley et al 2005). All infectious diseases involving acquired immunity have their own unique time cycle (Andersen et al 1984, Flemming et al 1991, Dushoff 1996, Dowell 2001, Koelle & Pascual 2004, Grassley & Fraser 2006). For a comprehensive review see Altizer et al (2006). Interestingly, the pattern of surplus and deficit, accident and emergency attendance, bed occupancy and the size of the inpatient elective waiting list (a knock on effect from bed occupancy and the cycle in surplus and deficit) also appear to conform to such a cyclic pattern (Jones 2010c,h-j,l-n, 2011a). This paper will examine wider international evidence for patterns in bed occupancy which cannot be explained by demographic changes, funding or wider differences in health care organisation, policy or implementation.