Department of Human Services Toolkit Bed management Click here to continue

Department of Human Services

ToolkitToolkitBed management

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Toolkit Bed management


Introduction

Goals of the toolkit

Overview and strategy

Health service team

Processes

Data

Resources

Diagnostics and tools

Introduction

What is the bed management tool kit for?

The bed management toolkit has been designed to develop organisational wide strategic management and thinking to identify front line solutions/innovation to resolve bed management constraints identified via the rigorous diagnostics phase of the Patient Flow Collaborative.

Who should use the toolkit?

The tool kit will promote discussion and ideas around solutions to bed management constraints. Therefore, anyone responsible for patient flow will benefit from using this tool.

What are the aims of the toolkit?

The Patient Flow Collaborative aims to remove unnecessary constraints or delays within the patient process. For this to take place an effective bed management system which is underpinned by:

• right patient, right place, right resource, right time, right clinician,

• identifies patient flow and delays

• the availability of innovation tools, checklists, techniques which assist continued innovation.

How should we implement the concepts in this toolkit and change to our local context?

It is essential for innovation that the people who are involved in patient flow create systems that assist patients in their local context. The toolkits and concepts should therefore be adapted to a local context and owned by all members of the clinical team. End of

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Introduction

The bed management toolkit is based on whole system thinking and includes a whole of hospital perspective to managing bed stock.

Goals

The specific goals of the toolkit are to:

• provide possible solutions to bed constraints

• build awareness of best practice for bed management

• identify building blocks to good bed management

• provide access to mentors/improvement leads

• smooth variation in elective and emergency demand pressures.

This first version of the bed management toolkit will stimulate further development of bed tools and resources developed by the patient flow teams, case studies and good news stories, lessons learnt and provide contacts.

Your feedback

Feedback on this first version is welcome and all Patient Flow Collaborative teams are encouraged to provide feedback for subsequent versions of the toolkit.

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Introduction



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Processes

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Whole system approach

A whole system approach is needed to effectively manage the variation in capacity and demand involved in bed management. This approach can be broken down into two strands; executive strategy and frontline operational management.


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Introduction



Health service team

Processes

Data

Resources


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Data and

information

People and

processesPolicy

Rigorous diagnostics

Tracking systems and

predicting bed stock

requirements

Effective length of

stay management

Operational procedures and whole

system involvement

Patient Flow /Health Service Executive TeamBed management strategy

Patient Flow /Health Service Executive TeamBed management team

Organisational executive whole of hospital strategy for bed management

Frontline implementation of policy, systems and processes

Effective bed

usage


Introduction



Health service team

Processes

Data

Resources


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Organisational executive whole of hospital strategy for bed management

Data and

information

People and

processes

Policy

Organisational capacity and demand projections - 12 months, 3 months, 1 month timescales. Data information to predict streams of demand; elective and emergency.

Agreed organisational bed management processes that integrate people's roles and responsibilities and organisational policy.

Policy that is designed to provide an effective system for bed management which includes escalation stages, data projections and bed availability per day/night.

Data and

information

People and

processesPolicy

Patient Flow /Health Service Executive TeamBed management strategyOverview and strategy


Introduction



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Processes

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Frontline implementation of policy, systems and processes

Complete a review of existing processes, roles and responsibilities, capacity, predicted and actual demand, policy and escalation routes.

Develop a user friendly, simple tracking process which identifies delays which have occurred in the patient process.

Implement a system to predict and manage capacity and demand. These can be simple solutions/complex IT systems (see examples).




requirements




requirements

Effective length of

stay management


system involvement

Patient Flow /Health Service Executive TeamBed management team

Effective length of

stay management


system involvement

The Patient Flow Collaborative has developed a toolkit for effective length of stay management which should be used in partnership with the bed management toolkit. Recognition of integrating tracking delays and effective patient processes underpin bed management roles.

Operational procedures need to be simple and user friendly to promote real time information and whole of hospital participation in managing beds.Training and enforcement of bed management procedures are essential to smooth bed management.



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Traffic light system for delays: examples

Simple process to identify any delays which occur that stop the patients treatment/discharge.

Identified delay reasons may be complemented by actions that need to be taken once delay has been identified.

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Delay Action Simple A4 sheet to record delays and take action, thus pulling the patient to the next stage.

Delay ActionDelay Action Simple A4 sheet to record delays and take action, thus pulling the patient to the next stage.

Patient Delay reason Delay Action Simple A4 sheet to record delays and take action, thus pulling the patient to the next stage.

Delay ActionDelay Action Simple A4 sheet to record delays and take action, thus pulling the patient to the next stage.

Delay reason

Action to be taken

Simple A4 sheet to record delays and take action, used on the units each day, thus pulling the patient to the next stage.

Lee Waiting radiologyRadiology phone radiology mgr

on ext: 3256

Introduction



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Health service teamIntroduction

Essential components of effective bed management are skilled, trained and dedicated individuals and teams who have clear roles, responsibilities, support and reporting lines to executive, supportive, integrated communication paths to whole of hospital clinical teams.

Check list for effective bed management team

• Whole of organisation strategy

• Clear reporting centres

• Executive available and identified daily

• Bed management recognised at board level

• Escalation policy that has responsibility routes is effective in prevention

Roles and responsibilities

• Skilled, trained and dedicated bed managers

• Clear role description

• Empowered and given authority to manage bed stock

Bed management team

Bed management team that fits into management structure

Bed management team profile that shows leadership responsibility to manage patient flow.


Introduction



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Health service teamHealth service team

Clear reporting to health service manager/director of operations with simple escalation policy

Innovations

Agreed reporting with agreed times to meet/discuss daily status

Bed management seen to report to executive

Develop understanding and assistance with clinical teams

Train and monitor adherence to agreed escalation policy

Establish clear communication between bed managers and units; book meetings, conference calls, updates throughout the day

Issues/constraints

Unclear reporting or no one available to report to

No clear authority in role

No clear senior clinical engagement

Misunderstanding, lack of adherence to escalation policy

Lack of communication across hospital


Introduction



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Health service teamBed management role undertaken by appropriate senior person who works to clear defined role with responsibility to challenge and influence existing practice.

Innovations

Thank them for trying and appoint senior person who has effective communication skills to lead this role

Create and communicate proactive bed management role

Manage bed management only

Define and inform roles and responsibilities of bed manager

Issues/constraints

Junior or inexperienced de-skilled individual in wrong position

Role that does not allow proactive actions

Multiple roles managed by bed manager

Responsibilities change from day to day with no clear recognition of responsibility

to manage


Introduction



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Health service teamJob description for role of bed manager

It is essential for patient flow that an appropriate senior person is recruited in to the role of bed manager.

Job purpose

Senior leader who reports to executive/director of operations, responsible for the proactive management of bed occupancy for both elective and emergency admissions through to discharge.

Key responsibilities

• Establish bed management processes and systems for the organisation which are agreed by the executive team

• Develop and discriminate proactive data for bed utilisation predictability

• Develop whole of hospital system for bed management

• Develop whole of hospital escalation procedure

• Provide effective communication of bed capacity and recommendations during capacity strains

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Introduction



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Processes

Data

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Processes

Predicted emergency demand

People in beds

Discharge for beds

Elective demand

Discharge

Wait in queue

Cancel electives

Admit to bed

Bed cleanedBed not available

Understand patient flows - smooth patient flows

• Predict emergency needs for beds

• Choose elective capacity following emergency prediction

• Schedule elective activity

• Manage delays and effective length of stay

• Build a buffer (prepare patients short notice admissions)


Introduction



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Reduce variation in patient flow by smoothing processes:Innovations

Identify and organise admission times

Predict emergency admission beds needed per day and per night shifts

Identify emergency demand bed needs and elective allocation

Review 3 monthly specialty bed usage

Manage length of stay from earliest point

Understand constraints

Admission times

Not predicting emergency demand bed requirements

Demand on total bed stock

Mismatch of allocation per speciality of beds

Length of delays not being managed

Processes


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Innovation•Predict emergency: smooth elective admissions by day and length of stay•Define bed pool per speciality•Use expected length of stay timescales as targets for length of stay

Failure to predict bed stock required for

Emergency admissions

ImpactCancelled operations

Trolley waitsComplaintsLow morale

Mismatch of emergency and elective bed needs

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ProcessesIntroduction



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Length of stay management

Review Toolkit on length of stay management and change package

Establish essential daily data to be used by bed management team.

1. Emergency and Elective arrivals

Predicted & Actual

2. Discharge expected

Predicted & Actual

Data

Admission via ED Day range Mean

Cardiology 3 5 4

Medicine 8 10 9

Surgery 7 10 8

Neuroscience 2 6 4

Total beds needed for ED admits in 24 hrs

20 31 25

Example


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SLUSH ED predictionSLUSH ED prediction

SNOW Electives bookedSNOW Electives booked

I CE Buffer and total bed stockI CE Buffer and total bed stock

SLUSH ED predictionSLUSH ED prediction

SNOW Electives bookedSNOW Electives booked

I CE Buffer and total bed stockI CE Buffer and total bed stock

Long term bed management planning

Data


Introduction



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Data

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Core data set

Data

Suggested Measures Average admissions & discharges by day of week (Bar chart) Average length of stay by specialty/procedure (compare to HDM or HRT

benchmark figures) Average length of stay by day of admission (Bar chart) Number of daily cancelled operations (SPC chart) Day of Surgery Admission (DOSA) rate Number of patients who were scheduled as day cases but stayed overnight

(failed day case rate) Number of patients who were intended overnight stays but were actual day

cases Number of Critical Care beds available Number of outliers >30days (medical and surgical) Number of patients waiting for sub-acute beds Number of discharges by time of day and day of week Capacity and Demand Bed capacity

- Total bed numbers for last 3 months, and 1 year split into medical/surgical

Emergency bed projections - Total emergency admissions for last 6 months split into:

Day/Night Weekday/Weekend Medical/Surgical Specialty

- Using this data predict the profile of daily emergency admissions Then estimate elective capacity and buffer zone for fluctuation management.

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Data

Length of time

100% bed capacity based on last 2-3 years

80% of total bed capacity

Elective capacity available after emergency + 80% plotted

Emergency prediction based on last 2-3 years data

Bed Utilisation

Length of time

100% bed capacity based on last 2-3 years

80% of total bed capacity

Elective capacity available after emergency + 80% plotted

Emergency prediction based on last 2-3 years data

Bed Utilisation

Buffer zone

This will only work when the variation

is managed

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Health Service example Health Service example Stories from the Bed alignment Strategy over ChristmasStories from the Bed alignment Strategy over Christmas

Why

• Review of historic data showed an under utilisation of open bed stock/ theatres/ clinical

support services over particularly the Christmas period despite adhoc reduction in some

of these services.

Strategy

• To match service provision (beds) to demand

DataIntroduction



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Health Service example Health Service example Stories from the Bed Alignment Strategy over ChristmasStories from the Bed Alignment Strategy over Christmas

DataIntroduction



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How

• Provision of baseline meaningful data to executive to enable planned system wide reduction in service to

meet predicted and actual demand.

• Regular meeting with core senior management to plan service provision and monitor reduction over the

Christmas period.

• Close work with Bed Managers and After Hours Administrators to ensure beds remained closed, opening

only once all ward areas flexed open using the 50% rule under the Nursing EBA.

Data


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Success?

• Savings of 1.5 million over Christmas Period

Where to Now

• Identified need to continue bed alignment process as ongoing process.

• Identified need to establish accurate and consistent data collection processes across the health service.

• Identified need to establish accurate information based on bed day utilisation rather than ward occupancy for

planning.

• Development of appropriate meaningful reports to assist senior management in planning service provision

for future.

Data


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Data

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ResourcesImplement a bed management system on screen saver, that feed live information on:- Bed occupied- Bed being cleaned- Bed available Establish ‘control room’ for bed management Use conference calls to identify bed stock (minimum daily) Implement IT system which assists with planning length of stay management and occupancy Join bed management with key daily contacts in emergency department and wards Implement escalation policy for bed management Identify the number of beds which will be needed out of hours, and allocate management responsibility to maintain stock required Identify when grand rounds with managers and clinicians are needed to problem solve delayed discharges Manage delays in discharge around public holidays or special events by boosting day surgery activity to allow time for discharge rounds Bed management team and nurse unit managers to rotate as bed manager

Day case to be booked following public holidays, school holidays.End of section

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1. Bed management questionnaire

2. Rigorous diagnostic handbook

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Introduction



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Documents

Department of Human Services Toolkit Bed management Click here to continue