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Department of Human Services
ToolkitToolkitBed management
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Toolkit Bed management
Department of Human Services
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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Toolkit Bed management
Department of Human Services
Goals of the toolkit
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.
End of section
Introduction
Goals of the toolkit
Overview and strategy
Health service team
Processes
Data
Resources
Diagnostics and tools
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Toolkit Bed management
Department of Human Services
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.
Overview and strategy
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Introduction
Goals of the toolkit
Overview and strategy
Health service team
Processes
Data
Resources
Diagnostics and tools
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Toolkit Bed management
Department of Human Services
Overview and strategy
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
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Introduction
Goals of the toolkit
Overview and strategy
Health service team
Processes
Data
Resources
Diagnostics and tools
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Toolkit Bed management
Department of Human Services
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
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Introduction
Goals of the toolkit
Overview and strategy
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Toolkit Bed management
Department of Human Services
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).
Rigorous diagnostics
Tracking systems and
predicting bed stock
requirements
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 team
Effective length of
stay management
Operational procedures and whole
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.
Overview and strategy
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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.
End of section
Overview and strategy
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
Goals of the toolkit
Overview and strategy
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Processes
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Toolkit Bed management
Department of Human Services
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.
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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
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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
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Toolkit Bed management
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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
Goals of the toolkit
Overview and strategy
Health service team
Processes
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Toolkit Bed management
Department of Human Services
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)
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Toolkit Bed management
Department of Human Services
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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Overview and strategy
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Processes
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Toolkit Bed management
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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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Toolkit Bed management
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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
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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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Toolkit Bed 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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Toolkit Bed management
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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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Toolkit Bed management
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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
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Toolkit Bed management
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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
Health Service example Health Service example Stories from the Bed Alignment Strategy over ChristmasStories from the Bed Alignment Strategy over Christmas
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Toolkit Bed management
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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
Health Service example Health Service example Stories from the Bed Alignment Strategy over ChristmasStories from the Bed Alignment Strategy over Christmas
Introduction
Goals of the toolkit
Overview and strategy
Health service team
Processes
Data
Resources
Diagnostics and tools
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Toolkit Bed management
Department of Human Services
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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Toolkit Bed management
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Diagnostics and tools
1. Bed management questionnaire
2. Rigorous diagnostic handbook
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Introduction
Goals of the toolkit
Overview and strategy
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Processes
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