NHS bed management - back to basics

It has emerged today that each year an estimated 400,000 discharges from hospital take place between 11 at night and 6 in the morning. Shocking as these figures seem, the reality is probably considerably less as some of the statistics include ward transfers, deaths, patient request and voluntary maternity related discharge. However for the patients involved with late night discharge, this must be a traumatic and upsetting experience.

 The spectre of a frail elderly person being bundled into a taxi and sent home to an empty house is something to be avoided vigorously by hospital trusts and admission targets have been blamed as a major contributory factor. This could well be true as Accident and Emergency departments race against the clock to admit patients within 4 hours of arrival. My stay in hospital last year involved a 3 hour 58 minute wait before I was whisked (literally – I’m sure the porter ‘driving’ my wheelchair created some serious G force with excess speed) up to my allocated bed at midnight. I must confess at the time, it hadn’t occurred to me that some poor soul had been ejected to make way for my arrival. I assumed that this was down to inefficient bed rotation.

Regular visitors (either as patient or carer) will know that achieving a timely discharge for a patient can involve considerable skill, some deception and an element of luck for the dischargee. Clinical staff, quite rightly, are cautious about letting patients in their care go home too soon and reducing the number of re-admissions is a worthy aim. However, getting someone to ‘sign you out’ can be frustrating and at weekends, nigh impossible. With fewer consultants around and the junior doctors rushed off their feet, a weekend discharge can be a thing of rare beauty. And what about the time it takes to actually leave? How often does a relative schlep up to the ward, with an optimistic one hour paid for in the car park, to be kept waiting for the best part of a day for their loved one to be ‘allowed’ home. I reckon checking out of prison is often simpler.

The system for delivering ‘TTO’s’ (take home drugs) is usually a weak link in the discharge chain and I have known patients to wait up to 8 hours simply for their prescription. Beds are sterilised between patients and delays in bed turnover are sometimes due to inefficient cleaning regimes.

As always, another story lies behind NHS statistics. Yes – of course late night discharges should be avoided, especially for the elderly and those who live alone. But efficient application of the basics could make such a difference. The basic principles of holistic care - thinking about the patient as so much more than a bed filler and considering their lives outside the microcosm of the hospital. Streamlining the discharge procedures, efficient bed changing, and slick pharmacy services would all make a positive contribution to ‘patient turnover’

Small changes can make a big difference and the patient pathway that needs close attention. As always, it is not rocket science but simple joined up thinking that needs to be applied.