The winter bed crisisquantifying seasonal effects on hospital bed usage

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Abstract
Winter bed crises are a common feature in NHS hospitals, and have given rise to great concern. We set out to determine the relative contribution of seasonal effects and other factors to bed occupancy in a large teaching hospital over one year. There were 190 804 occupied bed-days, which we analysed by specialty groupings. There was considerable variability in bed occupancy in each specialty. A significant winter peak occurred for general medicine and orthopaedics together with a significant increase on `take-in' days. Virtually all specialties showed a significant variation in occupancy between weekdays. Geriatric Medicine had a high and fairly constant occupancy, with some seasonal effect. We conclude that seasonal trends in bed occupancy occur in `front door' specialties and are predictable. In these specialties, admission policies also make a contribution to bed usage and are amenable to modification. There is no surge in occupancy in the immediate post-Christmas period, except that attributable to the seasonal trend. In the `elective' specialties, bed occupancy fluctuates widely, with reduced occupancy at weekends and at Christmas. These differences are entirely amenable to modification. More effective bed management would make a very significant contribution to avoiding winter bed crises.

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