Bed management

Bed management is the allocation and provision of beds, especially in a hospital where beds in specialist wards are a scarce resource.^[2] The "bed" in this context represents not simply a place for the patient to sleep, but the services that go with being cared for by the medical facility: admission processing, physician time, nursing care, necessary diagnostic work, appropriate treatment, and so forth.

In the UK, acute hospital bed management is usually performed by a dedicated team and may form part of a larger process of Patient flow management.

Contents 1 Importance of bed management 2 Specific problems 3 Bed management systems 4 References

Importance of bed management

Because hospital beds are economically scarce resources, there is naturally pressure to ensure high occupancy rates and therefore a minimal buffer of empty beds. However, because the volume of emergency admissions is unpredictable, hospitals with average occupancy levels above 85 per cent "can expect to have regular bed shortages and periodic bed crises."^{[3] [4]}

Shortage of beds can result in cancellations of admissions for planned (elective) surgery, admission to inappropriate wards (medical vs surgical, male vs female etc), delay admitting emergency patients,^[5] and transfers of existing inpatients between wards, which "may add a day to a patients length of stay".^[1]

These can be politically sensitive issues in publicly funded heathcare systems. In the UK there has been concern over inaccurate and sometimes fraudulently manipulated waiting list statistics,^[6] and claims that "the current A&E target is simply not achievable without the employment of dubious management tactics."^[7]

Specific problems

• Shortage of beds due to lack of other options. Hospitals in developed countries cannot force a patient to leave if the patient's home is reasonably believed to be unsafe. For example, if a frail, elderly patient has recovered from an acute illness, but is unable to dress himself and prepare simple meals on his own, then the hospital must ensure that the patient will have sufficient assistance with these necessary activities of daily living, or the patient must remain in the hospital. In places with a shortage of skilled nursing facilities, home health care workers, and related support organizations, beds may be unavailable for new, acutely sick patients because of the continued presence of the previous patients. This is sometimes known as a "bed blocking".^[8]
• False appearance or unnecessary creation of a bed shortage. "Bed hiding", as it is sometimes called, is the practice of delaying admissions due to a falsely claimed lack of beds in the appropriate department.^[9] Bed hiding has several causes, including scheduling so many elective procedures that there are inadequate beds left for emergency admissions; frequent changes from ward to ward; inadequate communication, so that cleaning staff don't know when a bed has become available and needs cleaning; misalignment of tasks, so that skilled nurses are expected to take time away from direct patient care to clean beds; too few nurses scheduled for a shift; and overworked staff, who may be inclined to mis-report a bed as full, especially at the end of a shift, in an effort to shift the workload to another person.^[10][11] Bed hiding can be significantly reduced by careful tracking of bed status, making cleaning after discharge the top priority for cleaning staff, and even by physically moving patients to the ward as soon as they are ready for admission rather than boarding them in the emergency department. Reducing bed hiding in regular wards can reduce wait times in the emergency department.

Bed management systems

Bed management systems are developed by software development companies specialising in the health sector to technical healthcare standards, such as HL7, ICD-10 and DMD.

It is possible for healthcare organisations to customise an 'off-the-shelf' product or solution to improve patient flow management in a hospital, which is the primary role of a bed management system. Some healthcare organisations may require a unique solution which is unlikely to exist as an off-the-shelf product.

The most recent requirement is for mobile apps for heathcare applications which can run on leading mobile platforms, such as IPhone, and Android (operating system).

Typical software products for the healthcare sector include In-Patient Management Systems to help ward staff manage patient traffic and bed allocation within a hospital. Such systems make the daily process of patient and bed management easier, improves staff efficiency by saving time and helps management meet hospital performance targets.

A Bed Request & Management System is designed to help hospital staff deliver high levels of care to patients by providing real-time information to bed managers, ward staff, doctors etc., so optimising communication efficiency between all staff. Typical features of such a system can include:

• Categorised bed requests for urgent beds, repats, electives etc., so reducing wait times.
• A view of the current state of beds in all wards.
• Direct transfer to certain wards as needed.
• Queuing patients for beds to improve patient care.

A&E Patient Monitoring Systems are based on an electronic whiteboard which allows staff to track patients in real-time as they are moved around the hospital.

System customisations can include the production of department performance statistics, storage and recall of patient details, the creation of electronic discharge letters which allows health personnel to produce patient discharge letters that can be automatically printed and sent, and a prescription system which efficiently and securely handles the prescription of controlled drugs using an electronic TTO in adherence and compliance with legislation. Ward flow is a further system customisation for handling patient arrivals or transfer to or from a ward bed, and for priority planning.

References