Tackling bed blocking in the NHS

Julia Clarke of Newton Europe discusses how technology can help to solve the NHS bed blocking crisis

Julia Clarke, principal consultant at operational efficiency firm, Newton Europe discusses how technology can help to solve the NHS bed blocking crisis

The issue of bed blocking in hospitals is a common concern, but it also holds the key to areas of opportunity that could help drive critical NHS savings as well as greatly improve patient experience.

As the NHS countrywide – and particularly in Wales – faces ever-mounting strain from budget cuts and a growing, ageing population; hospitals are constantly searching for efficiency strategies. Rather than cutting services, however, there is a real opportunity to drive savings through improving patient care pathways and bed capacity. By focusing on these areas, the costly issue of delayed discharges, known as bed blocking – where patients remain in hospital for longer than necessary often while waiting to be transferred to another care location – can be effectively tackled.

Rather than cutting services, there is a real opportunity to drive savings through improving patient care pathways and bed capacity

Elderly patients with complex health needs are particularly vulnerable to delayed discharges, which not only leave them in an acute setting for longer than needed, but can also have increased negative consequences for their mental and physical wellbeing. Day-to-day ward management also suffers.

Delayed discharges have a hugely-negative impact on the efficient running of wards – especially surgical and therapy wards, the running of theatre lists, and the management of elective waiting lists. Another knock-on effect is an increased number of patients being transferred to different wards – often late at night to make room for emergency admissions. Again, this is detrimental for both patients and staff, and often patients end up as outliers, residing in the wrong department for their needs, meaning they tend to get less specialist care and endure a greater length of stay.

Recent figures from Wales show a particularly-sharp increase in the number of delayed patient transfers, with approximately 49% being delayed by three weeks or more. These escalating figures are the result of a variety of factors such as increased delays in assessments, poor cross-departmental communication, and the ineffective allocation of nursing home placements. Not only does this situation negatively impact patients, but it also costs the NHS a huge amount.

Our work with many NHS organisations has led to significant improvements in bed blocking and overall length of stay, most notably through improving patient information capture, cross-departmental communication, and highlighting next steps so that services like transportation and pharmacy get booked in a timely fashion.

Perhaps most fundamental to achieving results is to improve the flow and visibility of patient information – which can shorten length of stay, and positively impact bed blocking. Often patients can remain in hospital beds because nursing staff are unsure of how far along they are in their treatment. Work we recently carried out in a UK hospital led to a 6.4% reduction in the average length of stay, freeing up capacity and achieving an annual saving of £3m. At the same time, the patients received better care and staff experienced improved working practices.

Using accurate data in the right way can allow staff to create aggregate statistics across different areas of the hospital so they know how much demand there is for certain services

Many hospitals rely on handwritten charts, Word documents and whiteboards, which inevitably often contain unclear, inconsistent and out-of-date information. This information is also solely ward-based, meaning it doesn’t extend to other hospital areas like administration, physiotherapy or radiography – which can cause delays from miscommunication or work duplication. A solution is to install a comprehensive information management system that captures, in real time, the current status of each patient in a way that is visible across the whole hospital.

We work with an inexpensive type of electronic whiteboard, similar to a large iPad, which clearly, but securely, displays patient’s information, including the next step in their care pathway. This allows each department to see one central view of which patients are waiting for what, and for how long. Similarly, the same process can be applied to nurse handover sheets, which can be electronically integrated across departments and made more secure, accurate and easier to update. Linking these two systems together can also have a hugely positive impact on improving the processes around complex discharges. As with any new tools, the key to engaging staff and ensuring uptake is to make the new systems and processes easier and less time consuming than those that went before.

The main benefit of these initiatives is that communication is greatly improved through all departments having clear visibility of processes and next steps. Communication is about knowing what’s happening and where. It’s important for hospitals to analyse any areas they feel are causing delays because often two different departments can have two very different ideas of what might be happening. For example, another area of opportunity we discovered in the same hospital was in CT scanning sessions, which appeared to be bottlenecking patient flow. After closely analysing the CT data, it turned out there were multiple gaps in allocated session times occurring throughout the day, yet the CT team didn't have visibility of which patients in which wards needed a scan so they couldn't make use of the free time. In collaboration with the radiology team, the hospital redesigned the CT templates to improve the booking process, which allowed for an additional four inpatient scans a day.

Using accurate data in the right way can allow staff to create aggregate statistics across different areas of the hospital so they know how much demand there is for certain services. This allows for informed decision-making around how to prioritise workloads to avoid bottlenecks that could keep patients in hospital for longer than necessary.

The biggest delays contributing to bed blocking occur towards the end of a patients’ hospital stay. It can be tempting for acute staff to think that once a patient has been signed off, there’s nothing more they can do to speed up the discharge process, but there are further steps that can be taken.

Perhaps most fundamental to achieving results is to improve the flow and visibility of patient information – which can shorten length of stay, and positively impact bed blocking

It’s helpful for hospitals to differentiate between a patients’ ‘predicted date of discharge’ - the date a hospital would generally expect a patient to be discharged after being admitted with a particular condition - and their actual individual ‘estimated date of discharge’, which might well change over time and is based specifically on that particular patient’s progress. This way hospitals can prepare in advance, rather than, for example, only alerting a care home when a patient is actually officially ready. This pre-empting of the transfer process reduces the time it takes.

Similarly, if a patient is to be transferred home with assistive care, hospitals can use the estimated date of discharge to ensure everything is in place. This might include installing medical equipment in the patient’s home or arranging for a visiting carer. It’s also beneficial for the internal hospital discharge team and the external care organisations they work with to record and maintain information in one central point between them. This helps reduce the number of necessary update meetings and instead directs focus towards action taking.

The reason tackling bed blocking is such a great way to make savings is that it doesn’t cost a lot of money to implement. It’s about changing working practices and giving healthcare professionals the information and communication channels to make the hospital work more effectively

The reason tackling bed blocking is such a great way to make savings is that it doesn’t cost a lot of money to implement. It’s about changing working practices and giving healthcare professionals the information and communication channels to make the hospital work more effectively.

The best part is that everyone benefits. It makes life easier for health professionals and saves hospitals money. Most importantly, it creates a far better care experience for the patients themselves.

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