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News — U.S. hospital occupancy after the end of the Covid-19 pandemic is significantly higher than it was before the pandemic, setting the stage for a hospital bed shortage as early as 2032, new research suggests.

In the decade leading up to the pandemic, U.S. average hospital occupancy was approximately 64%. In a study to be in the peer-reviewed journal JAMA Network Open, the team of UCLA researchers found that the new post-pandemic national hospital occupancy average is 75% -- a full 11 percentage points higher than the previous average.

“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,” said Dr. Richard Leuchter, assistant professor of medicine at the David Geffen School of Medicine at UCLA and the study’s lead investigator.

For their study, the researchers repurposed the Centers for Disease Control and Prevention’s (CDC) Covid-19 data tracking dashboards to obtain hospital occupancy metrics from nearly every U.S. hospital between August 2, 2020 and April 27, 2024. They then combined these data with national hospitalization rates and the U.S. Census Bureau’s official population projections to model future hospital occupancy scenarios through 2035.

Hospital occupancy is calculated by dividing hospital census by the number of staffed hospital beds. The researchers examined both of these metrics over time, showing that the newly increased baseline in hospital occupancy is primarily driven by a 16% reduction in the number of staffed hospital beds rather than by an increase hospitalizations, which remained relatively unchanged from the pre- to post-pandemic years.

“Our study was not designed to investigate the cause of the decline in staffed hospital beds, but other literature suggests it may be due to healthcare staffing shortages, primarily among registered nurses, as well as hospital closures partially driven by the practice of private equity firms purchasing hospitals and effectively selling them for parts,” Leuchter said.

A national hospital occupancy of 75% is dangerously close to a bed shortage because it does not provide enough of a buffer against factors such as daily bed turnover, seasonal fluctuations in hospitalizations, and unexpected surges. According to the CDC, when national ICU occupancy reaches 75%, there are 12,000 excess deaths two weeks later, Leuchter said.

To model future hospital capacity and determine if the U.S. is at risk of experiencing a national bed shortage, the authors calculated the number of expected hospitalizations for each year between 2025 and 2035 by adjusting for an expected jump in hospitalizations due to an aging U.S. population. They found that if the hospitalization rate and staffed hospital bed supply do not change, average national hospital occupancy could reach 85% by 2032 for adult hospital beds.

“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.”

Steps to avert a hospital bed crisis include preventing more hospital bankruptcies and closures, partly by revamping hospital reimbursement schemes and regulating private equity involvement in healthcare; addressing factors driving staffing shortages such as provider burnout, and changing policy to expand the pipelines of healthcare professionals.

An example of a government move that blocked that pipeline was the June 2024 decision by the U.S. State Department to freeze all new visas for international nurses, a potentially catastrophic decision that may harm Americans by precipitating staffing shortages, Leuchter said.

 “In the slightly longer term, we need more innovative care delivery models that can reduce hospitalizations by diverting would-be admissions to specially-designed acute care clinics,” he said.

For instance, such a model is the Next Day Clinic, a program launched at Olive View-UCLA Medical Center within the Los Angeles County Department of Health Services (LAC-DHS) to avoid hospitalizations.

“The Next Day Clinic model pioneered at Olive View avoids hundreds of hospitalizations per year, and has been so successful that it has been adopted at UCLA Health’s flagship medical center,” Leuchter said. “If these types of care delivery models become widespread enough, that could help offset the projected increase in hospitalizations arising from an aging U.S. population.”

Additional study authors are Dr. Benjo Delarmente, Sitaram Vangala, Dr. Yusuke Tsugawa, and Dr. Catherine Sarkisian, MD of UCLA. Sarkisian is also affiliated with the VA Greater Los Angeles Healthcare System Geriatric Research Education and Clinical Center.

The study was funded by the National Heart, Lung, and Blood Institute (1K38 HL164955-01), the National Institute on Aging, (5K24AG047899, P30AG021684-16, R01AG068633, R01AG082991), the National Center for Advancing Translational Science (UL1TR001881), and the National Institute on Minority Health and Health Disparities. (R01MD013913).