Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Evidence suggests capacity is badly managed...
- stephen black (14 February 2006)
-
Reply to Stephen Black
- Peter G. Davies (16 February 2006)
-
how can reducing admissions save money
- john sharvill (17 February 2006)
|
|
|||
|
stephen black, Management Consultant london sw1w 9sr
Send response to journal:
|
It is easy to confuse the symptoms of bad organisation with the symptoms of a lack of capacity which is why Peter Davies feels there are too few beds. But his consclusion is wrong: there is plenty of evidence that the (genuine) problem of finding a bed when you need it is caused by bad organisation and not by a fundamental lack of capacity. Here are some simple examples. The Audit Commission first pointed out several years ago, the length of stay in a bed depends strongly on the day of the week the patient arrives.[1] This is mostly because many hospitals don't do much discharging at weekends, so patients stay longer then they should for no clinical reason. Hospitals who fix this can gain about 10% extra capacity. My own work on daily patterns of arrival and discharge suggests big gains for those hospitals who manage the timing of arrival and discharge (hospitals can't control emergency admissions, but they can control most discharge and elective admission times). Discharging in the morning and moving some admissions to the afternoon can give 15% more beds avavilable at lunchtime (often the worst time to find a bed). Most hospitals appear to do the opposite creating a crisis in bed occupancy just when the beds are most needed. Perhaps the most remarkable thing is that many hospitals have no reliable data about when their patients are admitted and discharged. So they can't even hope to analyse whether organising the beds a little differently would solve problems in availability. Hospitals who choose not to bother managing the controllable processes around discharge and admission have no grounds for complaining about the lack of available beds. The real problem is not capacity it is poor organisation. Competing interests: Management Consultant working in health. [1] Audit Commission. Bed management. London: Audit Commission, 2003. www.audit-commission.gov.uk/reports/AC-REPORT.asp?CatID=PRESS-CENTRE&fromPRESS=AC-REPORT&ProdID=81EE0CB0-9FED-11d7-B304-0060085F8572 (accessed 14 Feb 2006). |
|||
|
|
|||
|
Peter G. Davies, GP Keighley Road Surgery, Illingworth, Halifax, HX2 9LL
Send response to journal:
|
Stephen Black raises an interesting point. Is what I observe as a practising doctor a reflection of lack of capacity? Or is it a reflection of poor management of the bed complement of the NHS? Firstly I am going to generalise my original observation. There have been problems with bed occupancy levels and availability of acute beds for at least the last 19 years that I have directly observed. (I started as a clinical student in Leeds in 1986 and graduated in 1989). I suspect the problems have been there far longer than this. These problems have been obvious in every hospital and speciality I have worked in, and have been obvious to me as a GP when trying to get patients into the hospitals. In other words these problems seem to be pervasive in time and place. I also think most of my colleagues would report similar observations from their hospitals and GP surgeries. Boaden (1) reports that the problem with bed occupancy may be worse than thought, especially with the lunchtime bulge. Bagust et al (2) show the need for some spare capacity if emergency admissions are to be managed well. Alan Milburn was arguing for extra hospital beds in 2000. (3) Despite his promises the bed complement was still being cut. (4) The problems with high bed occupancy rates have been clear to many intelligent and well trained doctors, nurses, managers, management consultants, civil servants and politicians for many years. Much has been thought about and tried to solve this problem with little success. Either we are collectively blind to the solution, or there is a genuine lack of capacity to meet the needs of the population for treatment. Whilst there may be some improvement to be gained from improved bed management (5) I still suspect that the real problem is a lack of capacity. 1.Boaden, R (1999) Occupancy probably already higher than thought 17 July 1999 http://bmj.bmjjournals.com/cgi/eletters/319/7203/155 2. Bagust A, Place M, Posnett J. (1999) Dynamics of bed use in accommodating emergency admissions: stochastic simulation model. BMJ 1999;319:155–8. [Abstract/Free Full Text] 3. Jones, J (2000) Milburn promises more hospital beds BMJ 2000;321:1246 ( 18 November ) http://bmj.bmjjournals.com/cgi/content/full/321/7271/1246 4. Dunnigan, M and Pollock, A (2003) Downsizing of acute inpatient beds associated with private finance initiative: Scotland's case study BMJ 2003;326:905 ( 26 April ) http://bmj.bmjjournals.com/cgi/content/full/326/7395/905 5. Proudlove, N.C., Gordon K. and Boaden, R (2003) Can good bed management solve the overcrowding in accident and emergency departments? http://emj.bmjjournals.com/cgi/content/full/20/2/149 Competing interests: None declared |
|||
|
|
|||
|
john sharvill, GP Deal
Send response to journal:
|
I am totally confused. If patients on waiting lists are not admitted this financial year who actually saves? The trust still has to pay the salaries and overheads, the PCT will end up paying extra to not fall foul of targets and the patient obviously does not benefit. Why then does this happen? Related to this is the feeling that spending money to keep patients at home also saves. For instance the modern matron is being paid for by the PCT to reduce (in theory) admissions. Where are the trust able to save as already running beyong full capacity.Who will pay these costs if the pct don't? In effect more is spent. Am I missing something? Competing interests: None declared |
|||