11.10.16
Nuffield Trust: Better flow management needed to free up hospital beds
NHS trusts and health systems will need to rethink how they manage patient flow in order to free up more capacity, the Nuffield Trust has said in a new briefing.
The briefing says that current bed modelling techniques are based simply on counting patient numbers at midnight.
But it argues that this does not supply enough information because it does not accommodate for patients who are being moved in and out as well as existing patients. Between 2% and 4% of bed capacity is needed to manage patient flow.
The report says that bed occupancy is on the rise because demand has increased but bed numbers have not. Bed occupancy increased from 98,000 in 2011 to 102,000 in 2014, but acute bed capacity stayed fixed at 105,000.
The Nuffield Trust said that breaches of the target of seeing A&E patients within four hours, which trusts have failed to reach for over a year, are “inevitable” if hospitals do not have enough bed capacity.
It estimated that 5.5% of beds need to be free for cleaning and preparation if patients are to be moved through quickly enough to meet the high-profile commitment to admit or transfer emergency patients within four hours. Yet many hospitals are unable to provide this much of the time.
There have been increases in day surgery, short stay, and admission on the day of surgery, which reduce midnight occupancy but increase daytime pressure.
The occupancy rise is also due to increasing co-morbidity and more patients being discharged to nursing and residential care, which makes delayed discharges more common.
The briefing says that “simply building more beds in existing hospitals” is not enough to solve the problem.
Instead, it suggests different policies trusts can adopt, including redesigning assessment, diagnosis and short-term care to deal with short-term patients better; redesigning rehabilitation and discharge processes; and improving control systems to reduce the time spent on patient transfers and providing better information.
The Nuffield Trust said STP areas should develop short-term plans to reduce capacity which are aligned with long-term goals, and strategic resilience groups should set targets for flow capacity.
In addition, it said the approach to resolving complex performance programmes should be reviewed to increase learning and improvement.
The Royal College of Emergency Medicine (RCEM) welcomed the report.
A spokesperson for RCEM said: “We know that patients suffer when hospitals become congested. Indeed there is good international evidence that not only is care of a poorer quality but such congestion and overcrowding is associated with a higher death rate.
“We urge policymakers to analyse this evidence, act smartly and produce robust plans that will eliminate such delays that lead to harm.”
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