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Day to day demands on nurses has changed fundamentally over the past decade – and not for the better. A decade ago, each ward received one consultant visit per day – and one decision regarding patient discharge. Bed management information was updated just once in any 24 hour period. Now, following the Safer Patient Flow Bundle Red2Green approach, patient status can change hourly and nurses are constantly fielding questions from family members, operational teams, consultants, physios and front line staff trying to move patients through the system.
Nurses spend up to 15 minutes every hour responding to questions about potential bed availability rather than delivering patient care. Add in the need to prepare beds and clean bed areas – a role often undertaken by senior nursing staff – and upwards of 50% of nursing time is spent on non-caring tasks. With the rise in outliers – the inevitable by-product of deadline driven bed allocation – and no wonder morale is falling.
Nurses should not be bed management gatekeepers. Rebecca Boyes, Teletracking Operational Lead, Control Centre, Mid and South Essex University Hospitals Group, outlines the transformation in nursing that is being delivered by Trusts that have embraced a centralised bed management model underpinned by real-time patient flow visibility and supported by the use of dedicated domestic and portering staff.
Given the huge pressure on NHS resources, the shift towards a far more dynamic model, with multiple consultant visits and decisions regarding patient discharge occurring throughout the day, makes sense. This approach can improve patient flow and unblock the ED front door; it certainly enables patients to avoid unnecessary time in hospital. So far, so good. However, this strategy has created a huge burden on ward nurses who have become responsible for the majority of patient flow activity.
Being asked repeatedly whether a patient is ready to be discharged; whether the family is ready to collect that patient; and whether the required tests have been completed to enable the discharge is time consuming and frustrating. These questions take nurses away from the patient – affecting not only the speed with which they can respond to patient needs but also meaning they often miss important conversations between patients and consultants.
Furthermore, with so many demands on their time, tasks such as bed cleaning and declaring a bed available will inevitably slide down the priority list. A bed may lie empty but uncleaned and undeclared for some time, unless spotted by someone undertaking a physical bed audit at some point during the day. The laudable goals of dynamic patient review are being undermined by a fundamental flaw in the process: it places additional – and non-clinical – demands on nurses which result in further delays in bed turnaround, creating more calls and more stress. In addition to undermining the pledges of Time for Care, it doesn’t work: the front door is still blocked. Morale amongst both ED and ward nurses will continue to fall unless this model is radically overhauled.