Which Occupancy Figure Goes Into the Report?
A 500-bed government hospital is preparing two documents: its annual report, and a proposal to the State for a new 120-bed block. In September, a 30-day month, the hospital admitted 1,320 inpatients and recorded 11,000 inpatient bed-days. Of the sanctioned 500 beds, 60 have stood in a block closed for renovation since the start of the year; the remaining 440 are staffed and in use. The new statistics assistant counted all 1,320 admissions as inpatients, but 180 of them were day-care cases - patients who came in the morning and went home the same evening - and the hospital's own manual records each of these as one bed-day inside the 11,000 figure. The director wants one occupancy number for each document, and the finance officer separately wants an average length of stay to justify the new block.
1. Compute occupancy on every defensible basis and say which figure belongs in which document.
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Three denominators are available:
- Sanctioned strength: 500 × 30 = 15,000 bed-days available, so 11,000 ÷ 15,000 = 73.3%.
- Staffed beds: 440 × 30 = 13,200, so 11,000 ÷ 13,200 = 83.3%.
- Staffed beds with day-care stripped out: (11,000 − 180) ÷ 13,200 = 10,820 ÷ 13,200 = 82.0%.
The annual report should carry the staffed-bed figure, 83.3%, with a one-line note that 60 sanctioned beds were out of service throughout the year. Beds locked for renovation cannot be occupied by any patient, so including them measures the estate rather than the workload; and a reader comparing this hospital with another that has no closed block would be misled.
The expansion proposal uses the same 83.3% and the same note. Quoting 73.3% there would understate the pressure and invite the obvious reply that a third of the shortfall is the hospital's own unused building; quoting 83.3% with the note is both stronger and checkable. What must not happen is 73.3% being presented as the occupancy of a working hospital - it is a statement about buildings, not about patients.
2. Compute average length of stay with and without the day-care cases, and explain the direction of the bias.
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Including day-care: 11,000 ÷ 1,320 = 8.33 days. Excluding day-care: 10,820 ÷ 1,140 = 9.49 days.
The gap is 1.16 days, and it is not a rounding artefact. A day-care patient contributes one admission and, under this manual, one bed-day. He adds a full unit to the denominator and almost a full unit to the numerator for a stay of a few hours, so he drags the mean down sharply - 180 of 1,320 admissions is nearly 14% of the count.
The bias runs one way and it is not stable. As day-care surgery expands, the included figure falls even if no inpatient stays a day less, so year-on-year comparison becomes meaningless and the hospital can appear to be discharging people faster when it is not. For bed planning the finance officer needs the 9.49-day figure, because the new block will be filled by inpatients who occupy beds overnight. The 8.33-day figure should be reported only as a mixed-activity average, clearly labelled, and reconciled to the manual's counting convention in a footnote.
3. The director says the higher figure should be used everywhere because 'everyone does it'. Advise him.
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The advice should separate the legitimate choice from the illegitimate one.
Choosing 83.3% over 73.3% is legitimate, and the justification is technical: closed beds are not available capacity. Saying so in one line is enough, and the figure survives scrutiny.
Presenting 83.3% without that line, or using the day-care-inclusive 8.33 days for planning while quoting the day-care-exclusive occupancy in the same note, is not legitimate. The two numbers would then rest on inconsistent treatment of the same 180 patients, and any reviewer who unpicks them can reasonably describe the whole submission as selective. The State's appraisal cell asks for bed-days available and bed-days occupied precisely because occupancy can be moved by changing the denominator.
A practical formula: one table, three rows - sanctioned, staffed, staffed excluding day-care - with the recommended basis flagged, and a sentence saying why. That takes a paragraph, protects the director if the proposal is queried, and is also the version that will read well if the hospital later has to explain a low occupancy to an audit team. The 'everyone does it' defence is unavailable once the correct working is on the file.