Understanding patient flow in hospitals

Nuffield Trust
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This briefing lays out how faster patient flow through hospitals often requires more bed space. Looking at trusts that meet the four hour target and those furthest from meeting it, it estimates that at least 5.5 per cent of beds need to be free for the standard to be met. Yet many hospitals are unable to provide this much of the time, making target breaches inevitable. The paper looks at ongoing changes driving this squeeze on bed space, including mortality, the squeeze on bed space during years of austerity, rising numbers of patients with multiple conditions, and delayed discharges. An analysis examines how bed use and patient flow change through the course of the day, drawing on Hospital Episode Statistics which track admissions and discharges. It shows that bed occupancy does not peak at midnight, when the official census of patients is carried out, but in mid-morning. Meanwhile, the highest need for patients to be moved through hospital peaks at an entirely different time of day, in the evening. With the NHS facing an unprecedented financial squeeze, the briefing looks at solutions available short of actually building enough beds to restore free space. It suggests managers should focus in particular on the minority of long-staying patients who account for a majority of bed use. Given the variation during the day, and with an increasing number of patients leaving in a matter of hours, it urges the NHS to invest in IT and management systems that can track and deal with the need for beds and patient movement in real time. (Edited publisher abstract)

Subject terms:
patients, hospital admission, hospital discharge, patient administration;
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