Research Alert: December 16, 2025

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

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. This research examines how rural inpatient capacity has changed over time.

Key Findings:

• 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.

Additional Resources of Interest:

• More FORHP-funded research on Emergency preparedness and response
• More information about the North Carolina Rural Health Research and Policy Analysis Center
• More information from the Rural Health Information Hub's topic guide: Emergency Preparedness and Response