Hospital bed pressures and its impact on elective inpatient care

Introduction:

There are already a number of urgent crises facing the NHS in the form of staff shortages, unhappy overworked staffs and unprecedented waiting lists. Add to that is the constantly present and intermittently overwhelming bed shortages that results from a wide variety of causes such as local respiratory outbreaks, trauma overload or just generally people falling ill unpredictably. The impending winter season with its flu outbreaks is only going to make things worse

Recent Experience:

I recently had an elective list and was hit with an email late in the evening before the list warning me of the potential bed situation with the risk of cancellation of cases on the day. There was very little that could be done at that hour about the "forthcoming storm" so I just decided to head into the eye of the storm!

On the morning of the theatre day, I was hoping that things would have changed but alas, things were as bleak as the evening before with the bed crisis at critical level.

I must admit, however, that I have the most amazing team and was not at all surprised at how determined the bed management team were to get the patients admitted and get their surgeries done through the day. Even though patients kept waiting for beds, they were sequentially given beds as soon as other patients were getting discharged and just prior to when they were coming up for surgery. All four patients got their surgeries done, even though there might have been a delayed start. The determined co-ordination between theatre team, management and bed coordinators was exemplary and would be a perfect example to talk about on "How teams can work well under pressure"!

Reflection:

The bed pressures are not going to get better in future and with elective NHS waiting lists hitting the roof, the situation needs some drastic measures. Fortunately the NHS England has already published some plans to boost capacity and provide extra funding, very recently. This is mainly to cover the winter pressures on the NHS.

This plan not only includes 7000 extra beds but also additional 4000+ staff, boosted 111 and 999 services, and initiatives for step down facilities.

While this may act as a temporary band-aid, long term planning needs development of infrastructure, and significant investments in staff and facilities and smarter working models including development of step down facilities and day care surgeries even for major surgeries.

Future:

A recent publication from 2021 details the use of Artificial intelligence to achieve "the right patient, in the right bed, for the right care, at the right time".

This pilot study was conducted at Kettering General hospital with very promising results and the tool and alpha code has been released on an open source model for use by other trusts.

Conclusion:

While Innovations will serve up solutions to problems as they arise, the human spirit of solving problems on a day to day basis and the team spirit with patient care at its heart, is what will keep the NHS thriving.