Changes in critical care beds and occupancy in the United States 1985-2000: Differences attributable to hospital size.

OBJECTIVE: To determine the relationship between hospital size and changes in the number of critical care medicine (CCM) beds, proportion of hospital beds allocated to CCM, and CCM occupancy in acute care hospitals in the United States from 1985 to 2000.

DESIGN: A 16-yr (1985 to 2000) retrospective analysis was performed using the Hospital Cost Report Information System (Centers for Medicare and Medicaid Services, Baltimore, MD) on U.S. acute care hospitals that provided CCM. Hospitals were stratified into four groups (small, 1-100 beds; medium, 101-300 beds; large 301-500 beds; and extra large, >500 beds).

SETTING: Nonfederal, acute care hospitals with CCM units in the United States.

SUBJECTS: None.

INTERVENTIONS: None.

MEASUREMENTS: Changes in the number of hospitals, non-CCM and CCM beds, the proportion of CCM to hospital beds, and their occupancy rates.

MAIN RESULTS: Between 1985 and 2000, the number of hospitals providing CCM decreased overall (4,150 to 3,581, -13.7%). The greatest decreases were seen in large (-39%) and extra-large (-40%) hospitals. Small hospitals increased minimally (3.3%). The number of non-CCM beds decreased (820,300 to 566,900, -30.9%), most prominently in large (-44.2%) and extra-large (-46.1%) hospitals. In contrast, CCM beds increased overall (69,300 to 87,400, 26.1%), especially in small (27%) and medium (44.2%) hospitals. The proportion of total hospital beds assigned to CCM increased (71.8%), most markedly in large (93.5%) and extra-large (85.7%) hospitals. Non-CCM occupancy decreased (-6.4%), particularly in small (-7.5%) and extra-large (-5.8%) hospitals. However, regardless of hospital size, CCM occupancy changed negligibly (0.4%). At every time point studied, CCM occupancy was greater than non-CCM occupancy within each size group. As hospital size increased, occupancy rates increased.

CONCLUSIONS: Across hospitals of all sizes, CCM bed numbers are increasing, whereas non-CCM bed numbers are decreasing. Although the CCM bed capacity is increasing at a greater percentage rate in smaller hospitals, the assignment of hospital beds to CCM remains higher in the larger hospitals. In addition, CCM bed occupancy is greater in larger institutions. These findings may help guide the future development of hospital size-based CCM benchmarking standards and guidelines.