The crisis of post-pandemic bed availability in the NHS

Bed availability
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David Tyrrell, TeleTracking, explains why every minute counts when it comes to the NHS bed availability crisis

With providers across the National Health Service focusing on elective recovery in a post-pandemic setting, general and acute bed capacity has never been more under pressure than ever. The Royal College of Emergency Medicine has raised concerns that there is a national deficit of between 4,988 and 15,788 beds for general and acute beds (1) to safely meet expected demand in the coming winter, assuming demand exceeds 2018 levels / 19 not. The BMA states that at least 3,000 additional beds are required for trusts to avoid opening escalation beds outside the winter period (2) and commented that nine out of ten trusts had open escalation beds in use as of May 2019.

Further pressure on bed capacity comes from the longest elective surgery waiting lists ever recorded, with 4.7 million patients waiting for treatment in February 2021, 387,885 (3) of those waiting longer than 52 weeks. The NHS has provided additional funding of £ 1 billion to secure additional electoral activity (4). Even without considering the current long-term personnel crisis (the King’s Fund has reported a shortage of 84,000 FTEs nationwide (5)), the NHS faces an unprecedented set of challenges. Minutes have never been more important than in the current perfect storm.

A recent analysis of acute sector performance by TeleTracking revealed the potential to unlock the equivalent of nearly 7,000 beds per day across the NHS in England. This analysis took into account the often ignored transaction delays to report an empty bed, prepare the bed for the next patient, and the time it takes to get the arriving patient to the waiting bed. Registration, preparation and occupancy times add up to an unmeasured amount of “lost” bedtime, which in our experience amounts to an average of at least 250 minutes per entry. TeleTracking customers who use our technology and analysis tools to measure the “lost” sleep time would like to reduce these 250 minutes to 90 minutes per recording. Applying this approach to all acute care providers in England, we estimated that an average of 6,911 beds were “lost” to the system over the past year.

Given the current extraordinary pressure on inpatient beds, the opportunity to release roughly the equivalent capacity of 276 inpatient wards, 11 medium-sized hospitals or even the combined bed capacity of North West London and South East London on a daily basis is an opportunity that cannot and must not be overlooked .

The data points collected in Chart 1.0 above represent the “lost” bedtime that we typically measure in new NHS customers.

We believe and our experience has confirmed the fact that minutes do matter. You are very important. To illustrate, we have calculated the performance of the three busiest English providers in May 2021 based on the number of visitors to ED. The relative performance is shown in Table 1.0 below (6).

The third column, Attendances per Bed, is a proxy measure we used to determine how “hot” each location was during the month by dividing the reported number of ED visitors for the month by the number of Divide G&A beds reported for the same period.

According to this metric, the Mid and South Essex NHS Foundation Trust (MSE) was “busier” (with 30,674 visitors and 1,526 G&A beds) than both Trust A with 32,838 visitors and 1,803 beds and Trust B with 33,827 visitors and 2,213 G&A beds .

Despite 20 attendances per bed, 2 more per bed than Trust A and 5 more than Trust B, MSE significantly outperformed its larger peers on the national ED target of 4 hours by recording 90% performance for the month.

Trust A’s 87% utilization was the same as MSE, while Trust B struggled with 95% utilization. High occupancy, resulting in a lack of available beds, can have a very negative impact on patient safety and the patient experience.

“A lack of available beds can have far-reaching consequences in a healthcare system. For example, it can result in delays in emergency rooms, patients being placed in clinically unsuitable wards, and the rate of infections acquired in the hospital, while pressure on staff to release beds can pose a risk to patient safety. Bed availability is also closely linked to staffing levels, since beds cannot be safely occupied without the appropriate staffing levels. “(7)

High occupancy rates are often a symptom of poor patient flow, although given the post-pandemic surge in ED attendance across the country, many trusts are seeing significant and unprecedented increases in both attendance and (anecdotally) conversion rates, putting pressure on occupancy. In such test times, it is important that providers make optimal use of all available resources, especially their bed boxes.

According to the old adage, “If you can’t measure it, you can’t make it”, our deliberate view is that by measuring the time between patient ‘A’ getting out of bed and patient ‘B’ in the same bed providers can reduce their lost bedtime measure up. The use of PAS / EPR data is useful, however, unless the patient record is updated in real time (and this is rarely the case) there will be a time lag between the patient leaving the bed and the “declaration” of the bed free and therefore ready for occupancy. For this reason, we strongly recommend that real-time usage of PAS / EPR systems be mandated and closely managed. Once there is a reasonable level of confidence that this has been achieved, the data can be a useful proxy measure of “lost” bedtime, and Trust Leadership Teams can develop the most appropriate means to manage and reduce “lost” bedtime better use of financed, staffed inpatient beds.

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The NHS and the people who make up our incredible health service have come under unprecedented and, in some cases, overwhelming pressures during the pandemic. The pandemic has also devastated the conduct of elective surgery programs, which in many cases has resulted in dangerous delays in scheduled care. What this data shows, both before and during the pandemic, is that providers focused on reducing “lost” bedtime can do more with less compared to their peers.

Yes, minutes do matter, and if waiting lists are to be managed securely in the medium to long term, providers need to measure and manage the “lost” bedtime in order to make the most of the capacity available to them. We have identified nearly 7,000 “additional” funded and staffed beds that are potentially available to the system without the need for new buildings, staff, or clinical equipment. If the recovery plan you choose does not include a strategy to reduce “lost” bedtime, the question must be, why not?

References

(1) RCEM explains: Hospital beds – Parliamentary briefing: www.rcem.ac’uk

(2) www.bma.org.uk September 2020: Bed occupancy in the NHS

This report highlights the use of additional escalation beds in the NHS outside of winter. Read more about our recommendation to increase core bed inventory across the NHS.

(3) O’Dowd, Adrian, NHS waiting list reaches 14-year record of 4.7 million people BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n995 (Published April 15, 2021)

(4) NHS News – www.england.nhs.uk

(5) www.kingsfund.org.uk – NHS staff: our position, Jan.NS February 2021

(6) Data from the national NHS dataset according to the following list – aborted operations and DTOC data are from comparable periods before the Covid illness.

(7) www.nuffieldtrust.org.uk Hospital bed occupancy We analyze how the occupancy of NHS hospital beds has changed over time. 06/25/21

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