The U.S. healthcare system will reach a “dangerous threshold” of hospital bed occupancy by 2032 should population growth and workforce trends persist, University of California, Los Angeles (UCLA) School of Medicine researchers warn.
Their findings, published this week in JAMA Network Open, show that the country’s hospitals have already shifted from mean occupancy of about 64% through 2009 to 2019 to 75% in the year following the end of the COVID-19 public health emergency (May 2023 to April 2024).
They found the shift was largely fueled by a 16% reduction in the number of staffed hospital beds, suggesting that hospital workforce shortages were the main culprit for the increase as opposed to patient hospitalizations, which were roughly unchanged before and after the pandemic.
“We’ve all heard about increased hospital occupancy during the height of the COVID-19 pandemic, but these findings show that hospitals are as full, if not more so, than they were during the pandemic, even well into 2024 during what would be considered a post-pandemic steady state,” Richard Leuchter, M.D., assistant professor of medicine at the school and lead investigator of the study, said in a release.
Leuchter and colleagues made their characterization using data from the Centers for Disease Control and Prevention’s (CDC’s) COVID-19 data tracking dashboards, for which nearly all hospitals were required to report daily census and weekly occupancy.
Combining that post-pandemic baseline with U.S. Census Bureau population projections and age-adjusted hospitalization rates obtained from the CDC’s 2019-20 National Inpatient Sample, the researchers found that national hospital occupancy will reach 85% by 2032 for adult beds, and by 2035 for adult plus pediatric beds, should the trends remain unchanged. The threshold could come even sooner for states with strained healthcare systems.
“For general hospital beds that are not ICU-level, many consider a bed shortage to occur at an 85% national hospital occupancy, marked by unacceptably long waiting times in emergency departments, medication errors and other in-hospital adverse events,” Leuchter said. “If the U.S. were to sustain a national hospital occupancy of 85% or greater, it is likely that we would see tens to hundreds of thousands of excess American deaths each year.”
Additionally, national intensive care unit occupancy of 75% is enough to trigger 12,000 excess deaths in the subsequent two weeks, Leuchter said in reference to CDC data.
The researchers wrote that a 10% increase in staffed hospital bed supply, a 10% reduction in hospitalization rates or some combination of the two would be necessary to offset the demographic-based hospitalization increases over the next decade.
In the study and in UCLA’s release, the authors said that more attention should be paid to factors influencing healthcare workforce supply and hospital closures as well as to different models of care that direct patients to other settings for acute care that could lessen the strain.