Neil Laycock, managing director of healthcare at Servelec, looks at how the NHS, with the help of technology, can pave the way for better patient flow within hospitals to free up critical bed space.
Most NHS Trusts in the UK have been facing critical bed shortages for years. As a result, the management of those scarce beds is a time consuming and complicated process which leads to a patient’s care journey often being disrupted. This in turn perpetuates the bed shortages, as stays are delayed by non-streamlined processes compounded with the use of scarce clinical time in bed management. It has become a snake eating its own tail.
Further to this, there have even been calls to scrap the NHS target of treating 95% of patients in A&E within four hours, one that’s nearly impossible to adhere to. The NHS statistics for winter, have revealed that just 84.4% of patients were treated, admitted, or discharged within four hours, despite milder weather and fewer associated winter ailments, the lowest since the 95% target was set in 2004.
Health secretary Matt Hancock recently announced a £240-million-pound injection into the Health and Social Care Sector. But is this promise enough to fix our ailing patient flow management or will it simply further cover up the real underlying issues at hand?
Bed management goes far beyond A&E
The first thing to consider is that, whilst availability of beds within emergency wards is deeply concerning, the issue stretches far beyond a patient’s admission into hospital across Acute, Primary, and Social Care. It’s a problem that faces all healthcare providers across all wards in both the biggest hospitals and the smallest community trusts. We often find that hospitals and trusts are facing constant bottlenecks when it comes to transitioning patients from A&E into inpatient beds.
This is of course driven by antiquated paper-based processes with non-integrated information, which directly impacts clinicians and ward staff doing their job. Resulting in for example patients being transferred to a bed on a different speciality ward than their diagnosis. Patients in the wrong bed significantly hinders the operational management, as the speciality clinical teams still must manage the care of these patients regardless of the bed location on whichever ward.
When I speak to Servelec’s healthcare customers, it’s not unusual for them to tell me they still use whiteboards to organise and map out all of the beds for the day, and they have regular bed meetings with numerous resources in attendance to decide where there are empty beds, patient transfer notes are recorded on post-its or scribbled on bits of paper.
With this in mind, we must ask whether more beds, and Matt Hancock’s £240 million, will solve the root cause of the issue overnight. From my perspective, absolutely not. At the very best it’s a sticking plaster, a drop in the ocean of what really needs to be done to ensure every person in need of a hospital bed has a reduced waiting time, regardless of whether they have had a serious physical accident, an ongoing health concern, or if they are suffering from a severe mental health issue.
For the NHS to improve patient flow within hospitals, I’m sure any bed management team would argue they don’t need more beds, and they certainly don’t need to rush people out of hospitals, before they are ready to be discharged. What they really need is improved access to real time bed information with all associated clinical and operational tasks, and support managing the actual patient flow within the hospital through to discharge.
Breaking the Bottlenecks
Currently, bed management teams often must either telephone all the wards to get information, and find themselves running around with clip boards to find free beds. This results in the non-effective use of resource time which directly impacts on clinical care, with clinicians not knowing which beds are free, where the capacity is, and no one having a clear oversight across the whole estate of the beds.
Internal operational and clinical processes in a ward and across a Hospital are fundamental to the optimum delivery of quality patient care and safety.
How easy is it to drop a post-it note, or for a well-meaning colleague to accidentally clear something off a white board? This could lead to incorrect information being shared, and important information being missed. Errors could result in a delay to vital treatment, in some cases increasing clinical risk.
The current processes require duplicated methods of data entry to simply understand bed capacity across wards, all adding to increased pressure on clinicians and hospital staff. The more time staff spend on data entry and the longer it takes for other teams to receive that information contributes to less time for clinicians to spend with patients.
How would hospitals benefit from a more modern technology based model?
There are already solutions on the market that aim to digitise this process, but what hospitals and trusts require is an intuitive full end-to-end solution; one that works from the patient’s first presentation right through to discharge, and one that could easily be integrated into existing EPRs and patient administration systems.
This would give hospital staff real time information to make informed decisions and eradicate a significant amount of the challenges the trusts are facing in managing one of their most valuable assets – the actual beds. A digital enabler will provide the ability for staff to view the entire hospital at a glance. From the Executive board to the bed management team responsible for reporting the bed status.
The ability to view the exact bed status detailing which patient is in which bed, right through to the cleaning staff who know instantly when beds become vacant. It allows everybody to see where the bottlenecks are, expedite operational and clinical tasks associated, to be then able to move patients through their pathways to planned discharge. It would remove the duplication of work as the information is available via digital devices, so all information is instantly shared and updated.
Bringing people together for digital care
By freeing up valuable hospital staff time, an end-to-end digital enabler such as this, would support clinicians to make real time informed decisions on each patient, which in term contributes to reducing length of stay, improving the quality of care and overall patient experience. We all understand most patients want to receive safe treatment and return home as soon as possible.
Matt Hancock increasing the budget for bed management and at the very least acknowledging the issue, it is encouraging and positive to see. However, it is important he fully understands how outdated internal processes and procedures are largely responsible for blocking beds, not a lack of ideas on how to improve.
It is the time to enable the NHS staff to have the right tools to do the right job across the entire health economy, to make available the art of the possible technology solutions for staff to work smart and effectively to enable clinicians to provide quality care for patients.