Countess of Chester Hospital NHS in the News

Using digital tools to improve staff rostering and patient flow

This article was first published on Nursing Times | Read now.

The Countess of Chester Hospital Foundation Trust has created a digital coordination centre to manage nursing rotas according to patient acuity and streamline bed allocations. This initiative won the Technology and Data in Nursing category in the 2018 Nursing Times Awards


In 2016, the Countess of Chester Hospital Foundation Trust decided to develop an automated coordination centre that would help it improve its management of staff allocation and patient flow. Operational since October 2017, this digital coordination centre works in real time using both an acuity-based rostering tool and a bed management tool. Its implementation required an overhaul of work practices and culture, which was achieved by engaging with staff. The new system gives a better visibility of bed occupancy and patient flow, which allows delays in care and discharge to be reduced, thereby improving the patient journey. It also means nursing staff have more time for patient care and nurse managers have more time for clinical leadership.

Citation: Bett I (2019) Using digital tools to improve staff rostering and patient flow. Nursing Times[online]; 115: 7, 56-57.

Author: Ian Bett is director of planning and partnerships, Countess of Chester Hospital Foundation Trust.


At the Countess of Chester Hospital Foundation Trust, we have set ourselves the goal of becoming a more transparent organisation with more-visible operational processes, including workforce planning and patient flow. The trust comprises a 600-bed district general hospital in Chester and a 64-bed intermediate care service at Ellesmere Port Hospital. It employs almost 4,000 staff and, every year, provides services to more than 445,000 patients from an area covering Western Cheshire, Ellesmere Port, Neston and North Wales.

Like many trusts, we face the challenge of delivering high-quality nursing care against a backdrop of bed moves, outliers, delayed discharges, gaps in nurse staffing and difficulties in recruiting nurses who have the appropriate training. As a result, in late 2016 we decided to create an automated coordination centre that would allow us to:

  • Manage nursing rotas according to patient acuity (how ill patients are);
  • Streamline bed allocations so patients would access the right bed at the right time more often.


We were experiencing delays in discharges and sharing information about bed occupancy, partly due to old processes relying on telephone calls and paperwork. These delays had a negative effect on how quickly new patients arriving in the emergency department could be allocated an inpatient bed, and whether they could be admitted directly to the right ward. As a consequence, patient flow and the patient journey were too slow, arduous and complicated.

At that time, for example, it was taking over 4.5 hours from the moment a patient was discharged until another patient could access the available bed. Reducing that time would allow us to speed up patients’ admission to the wards and maximise the use of our beds at a time when demand for urgent care services was increasing. In the face of these delays, our aims were to:

  • Ease patient flow and get patients in the right bed the first time round;
  • Improve the patient journey from admission to discharge;
  • Have the right nursing staff on site to address patients’ needs;
  • Streamline processes to release time so nurses could focus on patient care.

To achieve these overarching aims, we wanted to:

  • Improve the sharing of information about bed availability across the trust;
  • Increase the number of discharges occurring at the right time;
  • Improve the efficiency of our portering services.


Our solution was to develop a digital coordination centre (which involved working with external partners to develop the right IT solutions) and create a ‘bed turnaround’ team covering the inpatient wards at Countess of Chester Hospital. Composed of 10 healthcare assistants, the bed turnaround team helps streamline patient flow by cleaning beds quickly and efficiently, which releases time for nursing staff to focus on patient care.

The coordination centre works in real time using two separate IT solutions: an acuity-based rostering tool (Allocate) and a bed management tool (Teletracking). It:

  • Helps us manage staff allocation and patient flow – and, therefore, the trust as a whole – more effectively;
  • Gives an accurate view of available beds;
  • Reduces the time senior nurses spend on rostering and managing annual leave, sickness absences and enhancement payments, freeing up their time so they can concentrate on providing leadership to their teams.

The coordination centre helps us make better use of our nursing resources by:

  • Publishing all nurse rotas six weeks in advance;
  • Matching nursing care hours per patient day (CHPPD) to patient acuity;
  • Allocating the right level and number of nursing staff needed to look after patients based on acuity.

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