EXCLUSIVE: Real time data rather than a “midnight census” of empty beds could help trusts tackle flow problems and reduce delays for patients, a report from the Nuffield Trust has said.
Counting beds at midnight fails to recognise the resources needed to move people in and out of beds, and how that peaks during the day, the report said. Beds are often out of action for several hours while they are cleaned and bedclothes changed, patients are transferred and handovers completed. The report suggests that trusts achieving the four hour A&E waiting time standard need around four hours to finish the process. This can take up 2-4 per cent of bed capacity.
One of the authors, Nuffield Trust visiting senior fellow Sasha Karakusevic, said understanding this flow through the hospital and what influences it is like putting together a jigsaw puzzle. He said: “You have to think about it differently and piece together the component parts. I think very few trusts have actually got to grips with this problem.”
He added the factor that would make most difference to managing patient flow was moving towards real time data. “But it would also be to involve the ward team and hotel services staff and to map out the transfer process,” he added.
He warned that if projections about the growth of the elderly population were correct, plans to close hospital beds without clear plans of how this could be achieved without increasing delays would be “potentially disasterous”. Current projections suggest without action, 9,500 more beds could be needed by 2020 and 35,000 more by 2030.
The report says if more beds are not an option then trusts could:
- Invest in systems to provide real time workflow information to improve patient care, system management and support improvements. Small changes in length of stay and the time taken to prepare beds can cause “significant disruptions”.
- Redesign assessment, diagnosis and short stay care.
- Redesign rehabilitation and discharge processes with a concentration on longer stay patients.
The report drew a parallel with traffic flow to show how small variations in length of stay for short stay patient has a big impact on the capacity needed to treat them: when this does not balance with supply, queues – patients waiting for a bed – develop very quickly. Hospitals struggle to cope at times of peak flow such as during winter. When beds are used for short stay patients, a higher proportion of bed time is taken up by “turnover”, meaning the hospital’s need for beds increases.
Hospitals also struggle to deal with the peak times of day for admissions and discharges such as in the afternoon – something which may not be picked up in the midnight census.