No waits

Nobody likes to wait. We understand the frustration that waiting can cause.  Transformation seeks to identify the causes of delays. We aim to fix the system, not the symptom. This can involve a fundamental redesign and a change in culture. We’re always looking at ways to make sure you get the right treatment at the right time from the right team. One of the ways we are doing this is to review how we organise our beds and which patients are placed in them - with the aim of reducing the numbers of clinically-appropriate non-elective (urgent) referrals that are refused admission because of insufficient bed availability.

An independent survey in Spring 2010 highlighted a degree of dissatisfaction from some external clinicians with the Trust’s inconsistent referral processes and communication. This prompted the initiation of a Bed Management Improvement Project. The high level aim of this project was that the Trust would never refuse a clinically appropriate referral due to insufficient bed availability. This would be achieved by:

1. Standardising referral procedures and acceptance criteria for both elective and non-elective admissions into the Trust.

2. To ensure all options are explored to find an admitting bed before refusing an appropriate referral to GOSH.

3. To improve information about the bed state across the Trust by introducing a real-time, electronic bed management solution.

This information did not already exist in a shareable format, indeed most clinicians held their own criteria which had never been committed to paper nor subject to any formal agreement or approval. The first priority was therefore to collate this information for all clinical specialties. Agreed admission criteria and estimated length of stay information is now published on the GOSH intranet and internet sites. This guides our referrers to the different diagnoses treated at GOSH and suggests the timeframe that patients should be admitted – that is, whether as an emergency, urgent or elective admission. These pages are intended to help manage the expectations of clinicians who refer patients to the Trust, who can in turn credibly advise their patients and families of the same.

The Bed Management Team at GOSH currently receive approximately 40 emergency bed requests per week. The Bed Managers are pivotal in managing these referrals expediently. Knowledge and  understanding of the admission criteria and information provided by the referring clinician about the individual patient’s unique presentation help to safely prioritise patients, based on greatest clinical need.

The process by which referrals are managed in the Trust is set out in the Admission and Bed Management Policy. We have revised this twice since starting the project, to be sure that it reflects the many changes that have been made. Some examples of these improvements are described below.

Daily Operational Bed Meetings are now held at an earlier time, thus ensuring bed shortages are identified early and resolved more proactively.

A new template uses information technology and integrated formulae to calculate bed numbers automatically.

When the Trust experiences pressures on bed availability, a clear escalation procedure has been designed to ensure a consistent approach to resolution. This has undergone numerous Plan Do Study Act (PDSA) cycles to ensure it achieves the aim.

Roles and responsibilities have been reviewed following large and small scale After Action Reviews (AARs). This has contributed to more efficient and effective bed meetings which start on time, are well attended, and take less time to complete. This reduces the time staff spend off the ward which is ultimately beneficial to the patient.

Small improvements continue to be introduced and tested using improvement methodology.

A web-based emergency patient referral form has been developed in partnership with an in-house analyst, bed management and clinical teams to help improve communication and support complex bed management processes. The form requires mandatory fields to be completed for each patient, which has improved the quality of information captured. This ensures that accurate records are passed on to appropriate personnel involved in the ongoing management of patients who are either admitted to GOSH or in receipt of specialist advice. This significantly increases patient safety. The form has been successfully implemented in eight specialties and continues to be rolled out across the Trust as news of its intuitive design, ease of use and benefits spread.

All the data that is captured on the electronic emergency referral form is readily available for reporting and measuring improvement. Over the past year, we have also been working with our commissioners to reduce the number of patients staying longer than clinically necessary. A web-based system has been developed to track these patients and alert staff when escalation is required. This system has improved communication about delayed discharges – both internally and externally.

Page last reviewed - 17 June 2013