Bed Management - Specific Problems

Specific Problems

• Shortage of beds due to lack of other options. Hospitals in developed countries cannot force a patient to leave if the patient's home is reasonably believed to be unsafe. For example, if a frail, elderly patient has recovered from an acute illness, but is unable to dress himself and prepare simple meals on his own, then the hospital must ensure that the patient will have sufficient assistance with these necessary activities of daily living, or the patient must remain in the hospital. In places with a shortage of skilled nursing facilities, home health care workers, and related support organizations, beds may be unavailable for new, acutely sick patients because of the continued presence of the previous patients. This is sometimes known as a "bed blocking".
• False appearance or unnecessary creation of a bed shortage. "Bed hiding", as it is sometimes called, is the practice of delaying admissions due to a falsely claimed lack of beds in the appropriate department. Bed hiding has several causes, including scheduling so many elective procedures that there are inadequate beds left for emergency admissions; frequent changes from ward to ward; inadequate communication, so that cleaning staff don't know when a bed has become available and needs cleaning; misalignment of tasks, so that skilled nurses are expected to take time away from direct patient care to clean beds; too few nurses scheduled for a shift; and overworked staff, who may be inclined to mis-report a bed as full, especially at the end of a shift, in an effort to shift the workload to another person. Bed hiding can be significantly reduced by careful tracking of bed status, making cleaning after discharge the top priority for cleaning staff, and even by physically moving patients to the ward as soon as they are ready for admission rather than boarding them in the emergency department. Reducing bed hiding in regular wards can reduce wait times in the emergency department.