Device-measured movement behaviours and cancer incidence in a population sample of UK adults: Dual 24-hour analyses of postural and intensity compositions.

Hospital capacity strain reflects the mismatch between available resources and institutional demand, commonly measured by bed occupancy rates or staffing levels []. It poses a significant challenge for modern healthcare systems, especially in high-acuity settings like emergency departments (EDs) and intensive care units (ICUs), where it leads to treatment delays, adverse outcomes, and increased mortality []. However, differences in staffing models, skill-mix, and monitoring structures in general wards limit their transferability, making ward-level strain a comparatively understudied phenomenon. Ward strain occurs when demand for care, clinical monitoring, bed availability, or equipment exceeds a ward’s operational capacity. Unlike ICUs and EDs, which have continuous electronic monitoring, general wards rely on intermittent manual observations, making the effects of strain harder to capture and more likely to manifest as missed observations, delayed escalation, or reduced care coordination. These effects may significantly impact the quality and safety of patients’ care []. Studies show that inpatients with hospital-acquired sepsis experience treatment delays up 3.6 hours as ward census rises [], and missed vital sign monitoring is common in over 17% of overstretched wards []. Higher registered nurse (RN) staffing levels are significantly associated with lower failure-to-respond rates among patients with the most abnormal vital signs []. Increased RN staffing is significantly associated with lower patient mortality [, ]. Strain has been shown to impact not only patient outcomes but also workforce well-being, contributing to burnout and turnover []. The COVID-19 pandemic intensified these pressures globally, exposing the vulnerability of ward strain structures [].