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This article was first published on Health Tech Digital | Read Now.
The NHS has a problem with bed management; this is nothing new. However, current thinking around the issue is flawed. The problem is not one of bed blocking; it lies in the way patient flow is managed from the point of admission. The fundamental measure of bed utilisation – idle bed time – is not tracked, providing the NHS with no insight into the effectiveness, or lack of it, of bed management processes. Despite the accessibility of new technologies that can automate bed management and drastically reduce idle bed time, Trusts remain reliant on the ability of individual staff – the bed heroes – to save the day.
Fortunately, says Neil Griffiths, Managing Director, TeleTracking UK, the solution is both straightforward, easy and proven to deliver benefit at a scale few imagine.
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 take any performance measure and it is absolutely clear that this approach to bed management is flawed, potentially fatally so.
The 95% target for A&E patients to be seen within four hours has not been met since July 2015; more than 75,000 patients were forced to spend at least half an hour this winter with ambulance crews waiting to be treated by A&E staff. In January, 13 hospital trusts were forced to temporarily send patients to other nearby trusts 35 times.
Yet how would these patients feel if they knew that many of the ostensibly ‘full’ beds were actually lying empty awaiting cleaning and reallocating? Or to discover that 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 as little as one hour and 45 minutes?
There is no need for these delays. No need for additional temporary wards. There is already enough capacity in the system: better management of bed utilisation would increase capacity by 3,000 hospital beds per day.
The problem is not bed blocking or inadequate social care provision; the NHS is attempting to manage unprecedented service demand using the same bed management approach that has been in place for over five decades. And the implications extend far beyond A&E delays: poor bed management is proven to result in cancellations of elective surgery; increased mortality; incorrect clinical pathways and therefore extended issues around care in the community; and staff sickness due to raised stress levels.
Today bed management teams have no insight into the number of beds available or where; they rely on periodically roaming the wards in a bid to find a bed. With nurses tasked with bed preparation – a job that will never be prioritised over a patient’s clinical needs – bed turnaround is routinely delayed. Furthermore, with pressure to hit Emergency Department (ED) targets, beds are not allocated by 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.
It is the inherent delays at every stage in the bed allocation process that create the annual demand for temporary capacity. Hospitals need to better utilise the existing NHS bed estate but tinkering at the edges 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. It is a system led approach to transforming bed utilisation that will deliver benefits for both patient and staff welfare as well as bottom line value.