Protected Week Strategy and Hospital Flow Recovery in an Overcrowded Brazilian Public Hospital: A Quasi-Experimental Health Systems Evaluation

Objective: To evaluate the operational effects of the “Protected Week” public policy on hospital inflow pressure and overcrowding indicators in a public hospital in Goiás, Brazil. Methods: This quasi-experimental policy evaluation analyzed routinely collected operational indicators from the Hospital Estadual de Aparecida de Goiânia Cairo Louzada (HEAPA), an 81-bed public hospital integrated into the regional emergency care network. Thirteen consecutive weeks of operational data were analyzed, including three cycles of the Protected Week intervention. Indicators included regulated admissions, emergency department visits, corridor patients, and patients awaiting intensive care unit (ICU) beds. Mean values were compared between protected and non-protected weeks, and relative percentage changes were calculated. Non-parametric Mann-Whitney tests and simple linear regression were applied to estimate the effect of protected weeks on operational indicators. Results: Protected weeks were associated with substantial reductions in hospital inflow pressure. Regulated admissions decreased from a mean of 249.6 to 67.3 per week (− 73%). Emergency department visits declined from 300.1 to 120.0 (− 60%). Indicators of hospital overcrowding also improved, with corridor patients decreasing from 23.5 to 16.6 (− 29.5%) and ICU bed pending requests decreasing from 2.49 to 1.60 (− 35.7%). Statistical analysis confirmed a significant reduction in regulated admissions (p = 0.014). Linear regression estimated an average reduction of 182 regulated admissions during protected weeks (p = 0.001; R² = 0.63). Conclusions: The Protected Week policy was associated with improvements in operational indicators of hospital flow and overcrowding. Rotational redistribution of emergency demand may represent an effective operational strategy to enhance resilience in regional public hospital networks.