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Last winter it was reported that bed occupancy was dangerously high at about 99% of capacity, raising calls for additional funding and support to address the knock-on effects of ‘bed-blocking’ on patient care, yet not much has changed which raises concerns as we draw closer to winter. While it is easy to point at patient experience and outcomes, there is a silent epidemic of waste created by poor management of the bed estate that is reducing nursing staff’s time to care and is a significant contributor to poor staff morale and absence due to workplace stress.
How can a modern health service justify the continued reliance on teams of nurses roaming wards in the hunt for an empty bed? Why are highly skilled and motivated staff comparing paper-based notes three, even six times a day in a desperate bid to match patient needs to bed availability? Why are these staff, whose primary role is patient care, expected to find the time to clean beds? And how are they expected to provide exemplary care to patients when the patients themselves are on the wrong ward?
Today the NHS is reliant on an out-dated bed management model that can readily be transformed by using real-time measurements. The results are not only improved patient care and the realisation of significant financial benefits; they include a revitalised and energised nursing staff fulfilling the role they entered the profession to fill.
Every year the NHS opens 3,500-4,000 escalation beds over winter to accommodate additional demand. Every year, NHS Trusts spend between £2 million and £7 million adding capacity. Yet, this is in a scenario where the average bed in the NHS is left ‘idle’ between a patient being discharged and a new patient being admitted for six to eight hours, when proven best practice shows that it should be significantly less and as little as one hour and 45 minutes.
The problem lies in the fact that most current bed management teams have no idea how many beds they have available, let alone where those beds are located. They have no idea when a patient is discharged and a bed becomes immediately available for cleaning; instead nursing staff are only expected to declare a bed available once they have found time – in amongst their primary duties of care – to clean it.
Staff are reliant on roaming the wards in a bid to find a bed – which is then allocated not on the basis of suitability, or appropriateness of care, but on time: the patient closest to breaching the access target or the patient waiting the longest receives the bed. The result is a large number of outliers, patients located in the wrong ward for their clinical needs – a problem that affects both staff morale and long term patient outcomes.
Moreover, information is only shared through frantic phone calls and at numerous bed meetings, often attended by twenty to thirty people. This is a daily occurrence relying on the good will of staff to “save the day” – heroes in a flawed system.