Hospitals are facing a 'tsunami' of patients

Currently, leaders at several major health systems say that their inpatient facilities are either at, near, or over capacity. Many of the patients they treat are also increasingly sicker, and they often use the ED to access care.

According to Anthony Stahl, president of White Oak Medical Center, ED visits have increased 25% since the hospital originally opened in 2019, and it is currently at 102% occupancy. The hospital is also on diversion, which means the ED must turn away ambulances, around 70% of the time.

"We are overrun," Stahl said. "It's like a tsunami hitting our front door."

Many hospitals are also seeing increases in ED volumes as more patients resume care after delaying treatment during the COVID-19 pandemic and metropolitan areas continue to grow. For example, Scripps Health saw a 6.1% increase in ED volumes over the last year. Similarly, Northwell Health saw a 3% increase in ED volumes.

"Emergency department utilization is higher than I have ever seen it," said Jeoff Will, COO of Fairview Health Services. He compared day-to-day ED operations to air traffic control as workers try to direct a constant stream of ED patients and inpatient transfers.

How hospitals are tackling capacity challenges

1. Helping healthier patients avoid ED care

According to Ghazala Sharieff, chief medical and operating officer at Scripps Health, the health system has expanded its HealthExpress network of urgent care clinics to help patients with less severe conditions out of the ED.

Separately, Adventist HealthCare has created a "U-Turn" program, which is designed to connect ED patients with non-urgent ailments with nurses, social workers, and community health workers to help them access home care, as well as community resources. 

3. Expanding hospital-at-home programs

Several hospitals are also looking at expanding their hospital-at-home programs to help ease capacity restraints. So far, around 150 health systems have secured a Medicare Acute Hospital Care at Home waiver, and providers hope Congress will extend the waiver beyond the current March 31 deadline.

Currently, a dozen hospitals across Advocate Health's North Carolina division offer hospital-at-home services, which treat around 90 patients per day. According to Daniel Davis, Advocate's senior medical director, early results from the program show that home hospital care has led to fewer readmissions and higher patient satisfaction compared to treatment in inpatient settings.

"Hospital at home is a key component of our capacity decompression strategy," Davis said. "We certainly have to increase our bed capacity in all our markets as time goes on given the aging population and increasing demand for hospital beds."

Fairview Health Services currently has a home infusion program for patients with autoimmune diseases and plans on growing its hospital-at-home program this year. The health system has also changed its ED intake process to help free up capacity by sending some patients home without being admitted. Clinicians in the ED triage patients in the lobby so they can either send low-acuity patients home with a prescription or admit them as short-stay observation patients.

4. Increasing partnerships with outside organizations

According to hospital leaders, they cannot solve capacity issues on their own, and many are partnering with other organizations to streamline their care processes.

Currently, Northwell Health is working with federally qualified health centers, skilled nursing facilities, and post-acute providers to streamline the discharge process. The health system has also created a command center that coordinates environmental services workers and other staff to speed up the discharge process.

Northwell has also set up a centralized team to manage insurance authorization and is working to automate some of that work through a partnership with an artificial intelligence-backed company.

"We're now putting resources at the point of the acute care discharge process to do a warm handoff," said John D'Angelo, Northwell's chief of integrated operations.

According to Erik Swanson, SVP of data and analytics at Kaufman Hall, organizations that own post-acute facilities or have strong relationships with post-acute providers often have lower lengths of stays, as well as better operating margins.

"The ability to do early and active discharge planning and placement of patients in the appropriate sites of care is critical, especially as the acuity of patients is going to rise," Swanson said.

How to get ready for the coming bed shortage 

By Vidal Seegobin, Vice President, Advisory Board, Jennifer Puzziferro, Senior Director, Optum Advisory, Ted Karniewicz, Senior Director, Optum Advisory, and Tiffany Steffen, Vice President, Optum Advisory

Advisory Board has been tracking the capacity crunch at hospitals and health systems for a while now, and these findings should be a warning sign for healthcare leaders. Although it's easy to feel discouraged by significant and persistent headwinds, there are still strategies that can help leaders ensure enterprise success.

1. Consider capacity management and growth together.

To start, leaders must accept that capacity management and growth are now interrelated concepts, even though they're separated by time horizons. It's important to have your planning, ops, and finance teams all in the same scenario planning sessions (if they're not already).

2. Find ways to improve the patient journey.

The patient journey is also an important area for health systems. Advisory Board's ambulatory research has shown that the common patient experience is not a track, but a plinko board. This means that there are clear opportunities for developing a path of least resistance for different patient populations.

To improve efficiencies in patient throughput, leaders should focus on developing high performance hospital case management and transitions of care programs, which will help create capacity for new patient revenue.

Proactive discharge planning, focused care transitions (including handoff to providers at the next site of care), and relationships with post-acute care facilities will drive reductions in length of stay, create better systems of care for patients, improve communication, and contribute to an organization's quality and financial goals.

3. Improve clinical effectiveness and efficiency.

Focusing on clinical effectiveness and efficiency can also help hospital systems tackle capacity challenges. Clinical variation reduction initiatives that establish and implement care standards for targeted conditions improve quality, patient and provider experience, and lead to reduced cost per patient day.

4. Turn to international peers for guidance.

Hospital leaders in the United States could also look toward their international peers for guidance on this issue. Based on the study's modeling, the projected bed shortage in the United States looks a lot more like the hospital sector overseas.

International health systems have employed more aggressive care standardization work, increased coordination with partners across the care journey, and better management of complex patients to combat capacity issues.

For more insights on the future of hospital services, check out our new brief "17 things CEOs need to know in 2025", which can help leaders craft an effective strategy that aligns with their local demand trajectory, competition, and capabilities.