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PATIENT CARE
The problems with patient delays within the NHS, especially at peak times, have been well documented. The latest performance statistics have shown that 55,000 patients spent at least four hours on a trolley while they waited to get a hospital bed in 2018,6
while in the last quarter of
2018, 1% of elective operations were cancelled on the day for non-clinical reasons.7
Moreover, with beds being allocated on a ‘time waited’ rather than ‘care needed’ model in order to meet targets (according to King’s Fund research, 8% of patients spent between three hours 50 minutes and four hours in A&E in 2016/17),8
bed managers are
constrained in their ability to match bed availability to patient needs. The result is growing numbers of outliers – patients in the wrong ward – who will, by default, fail to receive the specialist care required for a particular condition and are likely to then require longer lengths of stay which compounds the pressure on beds and impacts staff morale.9 Fortunately, with the growing focus on Aggregated Patient Delay in ED,10
and the
work undertaken by Getting it Right First Time (GIRFT),11
better bed management and
utilisation provides a chance to reduce the number of patients waiting more than four hours for admission, with the attendant implications on short and long term health outcomes.
There is already enough capacity in the system; something else needs to change. It is all about measuring what matters - idle bed time.
Understanding the delays
To gain a better understanding of the causes of idle bed time, it is important to analyse the inherent delays within the process: Delay One: Patients still occupying beds and not being fully discharged (despite the investment in discharge facilities like discharge lounges). Delay Two: When a patient is discharged, nurses need to clean and prepare the bed area.
By changing current processes, the need to constantly field questions about which patients have been discharged becomes negated. Furthermore, the centralised approach provides a platform for an optimised bed management model that removes the burden of bed cleaning from nursing staff.
Given the multitude of other tasks undertaken by nursing staff – caring, ward rounds and so on – changing a bed will never be a top priority. Delay Three: In wards struggling to manage workload, even if the bed is cleaned and prepared, there may be a temptation to delay declaring the bed available. This is understandable but causes delay Delay Four: Even once a bed is ready, the availability of that bed may not be discovered until a bed manager undertakes a routine walk around the hospital or reconciles compiled lists of potential availability. Delay Five: Once the bed is recorded as available, bed managers will then need to compare notes – typically on paper – to determine the current bed capacity and then match patients to beds. The bed manager needs to challenge and interrogate ward teams to determine a true picture of capacity. Delay Six: Once the bed manager allocates a patient to a bed, from ED or intake area, there will be a delay while a porter is found to move the patient to the ward. Delay Seven: Once the porter arrives in the intake area, patients are often not ready to move to their allocated bed. This leads to delays in transporting the patient and delays a porter unnecessarily. Delay Eight: The allocation of patients based on wait time rather than care needs creates high numbers of outliers – patients in the wrong ward. Attempts to repatriate these patients to the correct wards are time
consuming and create an additional burden in bed preparation and management. Outliers also have average lengths of stay that are one to two days longer, which increases the pressure on beds. Cumulatively, these delays result in an average idle bed time of between six and eight hours.
Adapting roles and processes
The key to change is to gain visibility of bed status – and that requires measurement. In today’s digital world, more and more people are immersed in technology and are open to using digital solutions in their place of work. It therefore, seems logical to implement solutions, such as RFID, to overcome the bed blocking problem that we know all too well. Using technologies that fall within the remit of everyday tech is a seamless way to reinvent the running of a hospital and the way in which healthcare professionals deliver a care service. For example, using RFID-enabled badges at the point of admission provides a complete and immediate view of bed capacity. Tracking patient flow in real-time and automating processes – such as automatically notifying a dedicated bed cleaning team at the point of discharge, or automated porter requests when a bed is alerted as being clean - provides hospitals with clear and accurate insight into bed availability at any time.
When brought together centrally, this new model has the capability to light up the entire bed estate and provides clear, visual information that can be used to drive improvements at every stage of the utilisation process and reduce idle bed time.
Innovating the workforce
Moreover, when it comes to improving patient flow the benefits do not end with the patient. Poor management of the bed estate reduces nursing time to care and can play a significant role in poor staff morale and absence due to workplace stress. There are currently 41,000 nurse vacancies in the NHS in England and applications to study nursing have fallen by a third since 2016. What’s more, managing admissions and discharges as a major activity of care, notifying bed availability, and supervising or carrying out bed cleaning preparation on
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