PATIENT CARE
already overtaxed nursing staff goes against the pledges of Time to Care.
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. Dedicated teams to support the readying of beds are dispatched immediately once an empty bed notification arrives and as soon as the bed is prepared, the portering team can be alerted to collect and transfer the next patient to the ward. There is no longer any need for nurses to spend time cleaning or preparing bed areas. Nurses regain valuable time for care. In addition, hospitals can also leverage patient specific requirements to drive better bed allocation and reduce outliers. With doctors and nurses then working primarily with the right patients, in the right place, staff can feel far more confident in their day to day activity – essentially, they will be primarily using their core skills and expertise, improving morale and job satisfaction – which in turn has a positive net contribution to patient experience and outcomes. Morale improves – as does patient flow. Finally, with confidence in the accuracy and timeliness of bed availability information, hospitals can also look for further improvements in bed utilisation and patient flow. For example, rather than reserving beds for elective surgery patients – an approach that can result in a bed left empty for several hours - with full visibility of patient flow and demand, the adoption of dynamic allocation will further minimise idle bed time.
Looking at the wider picture
There is no doubt that the effective changes that come with implementing RFID and IoT technologies will also have an incremental impact on the wider team. Facilities managers will be better positioned to track the hospital environment and stock control. Management teams can adjust their internal schedules dependent on real-time hospital data and - as indicated - patient treatment plans can be better formulated. All important factors for reducing the amount of appointments that are cancelled and operations that are rescheduled. The benefits don’t stop there: the wider healthcare ecosystem can also feel the impact of a revitalised and efficient bed management model. Unnecessarily long hospital stays are detrimental to an older patient’s health.
The risk of hospital-acquired infections is higher and immobility can lead to a host of long-term problems, not forgetting what impact this could have on a patient’s mental health. Additionally, it could be argued that elderly people are more likely to suffer from falls in an unfamiliar hospital environment, and if they suffer from dementia are more likely to be disorientated. Remove the root of
the cause, from overcrowding in A&E departments to a complicated discharge process, and this generation of patients will have a much more beneficial experience. Receiving a better level of care also means these patients are less likely to require step- down health or social care services on discharge. Not only will this mean that they don’t have to experience a delayed transfer from one facility to another, but those working within social care can embrace a less pressurised work environment - as a positive knock-on effect of better patient flow, the care sector is likely to see a similarly much-needed reduction in demand. For those patients who still require care following their hospital visit, leaving in a better frame of mind will help their carer to continue on with providing an efficient care service. A happy patient equals a happy carer, who will feel fulfilled in their role. Finally, creating a shorter stay and an overall more positive experience will reduce the possibility of readmittance. A positive that can’t be ignored, tackling the problems that occur at both the start and the end of the cycle. In time the provision for the elderly will evolve and move away from acute hospitals and towards more retirement and “wellness” villages. Having better management systems in place will help these facilities to grow successfully and to relieve the pressures of an ageing population.
Conclusion
It is too easy for NHS Trusts to blame shortfalls in social care and lack of investment for the endemic problems that lie with current bed management processes and the knock-on effect on ED performance. Assuming the only option is to open more beds is both short sighted and wasteful. The reality of bed management is far more complex: delays in admission and inadequate bed allocation models measurably contribute to patients’ duration of stay, exacerbating not only the problem within hospitals but actually adding to social care demands.
The benefits of better bed management are significant, affecting not only patients and nurses but also the bottom line. Reducing idle bed time from six hours to less
50 I
WWW.CLINICALSERVICESJOURNAL.COM
than two would not only eradicate the need to create temporary wards – saving as much as £7 m per Trust per year - but each 600 - 700 bed hospital could create 60 beds of additional capacity and increase the number of patients treated.
Hospitals need to better utilise the existing NHS bed estate but tinkering at the edge of this problem makes little or no difference; what is required is a fundamental shift in bed management - from cleaning to allocation and portering - and complete, real- time visibility of the bed estate.
By measuring and subsequently tackling - and reducing - idle bed time and implementing a care based rather than time based admissions model, hospitals can improve patient outcomes, boost staff morale and reduce the end to end demand on services, including social care, as well as avoiding unnecessary cancellations of elective surgery. Better bed management delivers benefits throughout the entire acute care ecosystem.
References
1
https://www.theguardian.com/society/2018/dec/ 13/nhs-hospitals-in-red-zone-with-record- numbers-of-ae- patients
2
https://www.england.nhs.uk/statistics/wp- content/uploads/sites/2/2018/06/2017-18- Delayed-Transfers-of-Care-Annual-Report-1.pdf
3 BMA – NHS Bed Occupancy Report 2017 4
https://improvement.nhs.uk/documents/1069/AE_ delay_main_report.pdf
5
https://www.nhsconfed.org/resources/key- statistics-on-the-nhs
6
https://www.theguardian.com/society/2018/dec/ 13/nhs-hospitals-in-red-zone-with-record- numbers-of-ae- patients
7
https://www.england.nhs.uk/statistics/wp- content/uploads/sites/2/2019/02/NHS-cancelled- elective- operations-commentary-Q3-2018-19- 1.pdf
8
https://www.kingsfund.org.uk/projects/urgent- emergency-care/urgent-and-emergency-care- mythbusters
9 McKnight JA and Espie C. Managing acute medical admissions: the plight of the medical boarder. Scot Med J 2012; 57: 45–47
10
https://www.kingsfund.org.uk/publications/nhs- england-review-waiting-times-accident-emergency 11
https://gettingitrightfirsttime.co.uk/
OCTOBER 2019
CSJ
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