Research

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Emergency medicine
Volume 224 - Issue 2

The Impact of Hospital Bed Occupancy on Patient Flow and Emergency Department Access: A 25-Hospital Cohort Study

Authors:  Vahid Riahi, Justin Boyle, Hwan-Jin Yoon, Hamed Hassanzadeh, Ibrahima Diouf, Sankalp Khanna, Andrew Staib, Mahnaz Samadbeik, Clair Sullivan, Emma Bosley, James F. Lind

Correspondence: vahid.riahi@csiro.au

Med J Aust 2026 || doi: 10.5694/mja2.70143
Published online: 26 February 2026
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Abstract

Objectives

To evaluate the effect of hospital occupancy levels on inpatient and emergency department (ED) flow rates, ED length of stay (ED) and access block, and identify critical occupancy thresholds above which patient flow deteriorates.

Design

Retrospective cohort study using routinely collected administrative data.

Setting

Twenty-five public hospitals in Queensland, Australia, over a 5.5-year period (1 April 2017 to 31 August 2022).

Main Outcome Measures

ED presentation and discharge rates, inpatient admission and discharge rates, hospital occupancy levels, length of stay, access block and 4-h rule compliance.

Results

The analysis reveals a significant performance shift as hospital occupancy levels increase and identifies site-specific critical ‘choke points’ where patient flow deteriorates. Notably, as occupancy rises, we observed a growing divergence between ED presentations and discharge rates, and between inpatient admissions and discharges, indicating system congestion. Additionally, when assessing flow across the 25 hospitals, the data demonstrates that a 10% increase in bed occupancy rate correlates with a 0.32-h (19-min) extension in ED length of stay (or 33min for patients admitted from the ED). Also, significant disparities in hospital operations were observed between weekends and weekdays, with weekday admissions and discharges up to three times higher than weekends, highlighting the increased operational pressure during the work week.

Conclusions

The investigation challenges the traditional 85% occupancy target, demonstrating that optimal occupancy levels vary by hospital. The study also underscores the strong correlation between hospital bed occupancy and ED access performance, with higher hospital occupancy correlating with longer ED stays and decreased adherence to performance indicators. As hospitals approach full capacity, the pressure on ED resources intensifies, resulting in longer wait times and delays in care.

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