SHM Student Scholar Project: Hospital Capacity Strain

Hi All,

I have had an amazing experience working on the Study of Hospital Capacity Strain (SHoCS) under the leadership of Dr. Marisha Burden. She introduced me to a new research methodology, showed me a field of medicine I had not observed, and demonstrated how to lead a happy and productive team.

This project aimed to identify solutions to hospital capacity strain. We specifically inquired about the impact of hospital capacity strain on various hospital stakeholders. These stakeholders included frontline staff, clinicians, and patients. We also asked about the impact of hospital capacity strain on the hospital’s mission components such as education, research, and clinical care. Other questions aimed to find out how the hospital deals with surges in patient volume. We specifically asked about successful and unsuccessful interventions to ensure safe patient volumes for clinicians. After some interventions were discussed, we asked how various stakeholders, including administrators, clinicians, frontline staff, ancillary staff, and patients perceived the interventions. We were particularly interested on the impact of interventions on the well-being of staff, clinicians, and hospital leaders. Finally, we asked which solutions the interviewee would recommend to other hospitals facing hospital capacity strain.

In order to find these solutions, we performed qualitative interviews with hospital leaders and hospitalist leaders at 13 institutions across the United States. The questions asked were designed to be open-ended with opportunities to ask for elaboration as needed to ensure a detailed analysis. Most interviews were conducted with more than one interviewer and all interviews were recorded and professionally transcribed with identifying details removed. We then had two researchers code each interview and are in the process of reviewing the codes to ensure they agree. Once the codes are finalized, the results will be analyzed.

Although the final results of the study are not available yet, the preliminary findings indicate that capacity strain is an issue faced by most large, academic medical centers. They appear to be functioning at or near capacity and have interventions they can use when there is an influx of patients. Many institutions employ different interventions depending on the extent of capacity strain, often using a tiered color system to indicate the extent of capacity strain. Some of the interventions that have been attempted include boarding patients in hallways and using discharge lounges. Other interventions include diverting patients to other hospitals when at capacity and opening new care areas when needed. It appears that while some institutions tried the same solutions, they sometimes found different results.

Our final results will provide concrete suggestions to hospitals around the country to mitigate the pressures of capacity strain. We plan to identify interventions that have been unsuccessful as well as interventions that have been successful. We will provide recommendations for solutions based off the interviews. One piece of advice that stood out from multiple leaders was to be proactive rather than reactive.

Future research could investigate a particular intervention that had mixed results and outline best practices for that intervention. Additional research could also explore how busy hospitals in the country that are not academic institutions are impacted by and deal with hospital capacity strain.

In the future, I hope to continue to be involved with finding solutions to system level issues. Oftentimes, I hear the solution to burnout being to increase resilience, but I believe there is a system issue at play that can be worked on and eventually mitigated. My career goals include improving the healthcare system, not only in my hospital, but also beyond. I would love to have the opportunity to work with Dr. Burden again because she motivates everyone on her team to work hard through her passion and dedication.

I am grateful to the whole research team for teaching me, and I am especially thankful to my mentor Dr. Marisha Burden for also inspiring and encouraging me continuously. And thank you to Society of Hospital Medicine for providing the grant that made it possible for me to learn from Dr. Burden. I am so grateful – I learned more and enjoyed myself more than I could have ever imagined!

Wishing you and yours good health and happiness,

Sagarika Arogyaswamy