When there aren’t enough beds
15/08/2018by Rob Findlay
Last month I outlined how we are now able to work out the bed occupancy you need, in order to absorb emergency demand without running out of beds too often.
We have run these calculations across the main ward blocks of several hospitals now, and to the enormous surprise of absolutely nobody it has shown that last winter’s bed occupancy was far too high. The understandable response from managers was that a lower bed occupancy would be very nice, thank you, but there just aren’t enough beds.
So the next step in the analysis looks for ways to close the gap. We examine four potential interventions:
- improving weekend discharges – this reduces the variability of emergency bed use through the week and allows the hospital to run at higher bed occupancy overall;
- improving morning discharges – this reduces the variability of emergency bed use through the day and allows the hospital to run at higher bed occupancy overall;
- working flexibly with other sites to increase the effective size of the bed pool – this improves the combined hospitals’ ability to absorb variation and allows a higher combined bed occupancy; and
- reducing the very longest lengths of stay (in England these are called ‘stranded’ and ‘super-stranded’ patients) – this reduces bed occupancy directly.
You may already be involved in some or all of these interventions, and you’ll know how much effort they require. And yet, when we calculated the potential benefits of these four approaches, we were surprised to find that most of them made little difference, but one had a bigger impact than the other three put together.
We have only run the numbers across a few hospitals so far, but the results have so far been consistent. Which suggests that many managers may be wasting a huge amount of time and effort on interventions that will bring them little benefit.
Would you like to run this analysis for your hospital, as part of your preparations for the coming winter? Our offer from last month still stands, so get in touch and we’ll be happy to work with you towards a calmer winter, a less congested A&E, and no elective shutdown in January.
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