Researcher: “Shortage of hospital beds and crowded emergency departments associated with increased mortality”

This report is based on unique studies covering a large data material that combined covers over four million visits at a total of 14 Swedish emergency departments. In Region Stockholm, 125 potentially preventable deaths can be linked to crowded emergency departments during the period of 2012–2016. In some of the studied hospitals, however, crowding cannot be associated with increased mortality.

“These results are troubling, but a positive aspect is that it seems to be possible to avoid this link between crowding and mortality. My hypothesis is that the combination of a shortage of hospital beds and emergency department crowding is particularly dangerous, as severely ill patients who need to be admitted are instead treated in a crowded emergency department. To improve patient safety, it is necessary to ensure access to hospital beds when an emergency department is crowded,” says Björn of Ugglas, PhD in medical science, Karolinska Institutet, and author of this SNS report.

This figure illustrates how the mortality risk increases when an emergency department is crowded at the same as there are few available hospital beds.

The lowest number of hospital beds per capita in Europe

The number of hospital beds has gone down in almost all European countries since the turn of the millennium, which is largely due to medical developments. Sweden has seen the greatest reduction and now exhibits the lowest number of hospital beds per capita in Europe. This has resulted in increased bed occupancy rates (i.e., an increasing portion of hospital beds being occupied) and more crowding in emergency departments.

It needs to be clarified who is responsible for capacity shortages in hospitals

The SNS report shows that a lack of capacity not only represents a work environment problem for healthcare professionals, but also a measurable risk to patient safety. Björn af Ugglas argues that follow-ups of the quality in emergency departments must focus more on the ability to avoid crowding and maintain patient safety, while focusing less on the time waiting and receiving care based on an accessibility perspective. More and better data are also needed for following up the work carried out in emergency departments across Sweden.

In particular, it needs to be clarified who is responsible for crowded emergency departments.

“The hospital director is responsible for ensuring that the entire hospital has a sufficient number of beds, but the question is whether policy makers offer the right conditions for solving the problems that arise. In order to break the trend of fewer hospital beds, higher occupancy rates and increased crowding in Swedish emergency departments, the first step is determining who is responsible for leading these efforts,” says Björn af Ugglas.

This report is published as part of the SNS research project Health care in the 21st century.

SNS Research Brief 76. Hospital bed capacity and ED crowding – The impact on patient safety