Changes in Bed-Based Measures of Surge Capacity from 2018 to 2022 among Rural and Urban Hospitals

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The COVID-19 pandemic showed that hospital closures and other reductions in inpatient capacity can limit a hospital’s ability to respond to sudden surges in demand. To help policymakers and stakeholders consider trade-offs between cost-saving reductions and emergency preparedness, the NC Rural Health Research Program describes how rural inpatient capacity has changed over time in the brief – Changes in Bed-Based Measures of Surge Capacity from 2018 to 2022 among Rural and Urban Hospitals .

Summary and Key Findings

Hospital surge capacity refers to the ability to handle sudden and possibly dramatic increases in health care demand, such as the increase in demand experienced during the COVID-19 pandemic, a natural disaster, or a mass casualty event. One method of assessing surge capacity is to examine a hospital’s typical number of unoccupied beds. On an average day in 2022, the average rural hospital had 24 unoccupied acute care beds, accounting for approximately 66% of the hospital’s total acute care beds. Although these numbers have decreased slightly from 2018 (26 unoccupied beds accounting for approximately 67% of total beds), the findings suggest that surge capacity, as measured by unoccupied beds, has not dramatically changed in recent years. Additional analyses show no consistent differences in surge capacity trends by local community characteristics, including community resilience score and social vulnerability score, or by the hospital’s geographic remoteness. Of course, overall surge capacity is a function of other factors beyond the number of beds, notably the health workforce.

• Among both rural and urban hospitals, the percentage of acute care beds that were unoccupied increased slightly in 2020 before falling slightly below pre-pandemic levels in 2021. From 2018 to 2022, rural hospitals consistently reported a higher average percentage of acute care beds that were unoccupied, as compared to urban hospitals.
• The average percentage of rural hospital acute care beds that were unoccupied from 2018 to 2022 remained above 60% when stratifying hospitals by community characteristics and geographic remoteness.