Coping with winter bed crises
BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7224.1511 (Published 11 December 1999) Cite this as: BMJ 1999;319:1511All rapid responses
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Dear Editor,
It seems extraordinary to me that the editorial on "Coping with winter bed
crises" by Hanratty & Robinson, p1511, 11 December, should make no
mention of the weather as a predictive factor. Any accident and emergency
department knows that the first fall of snow means dozens of patients with
fractures, some of whom will need admission. We knew in my local
geriatric unit 40 years ago that a continued fall in temperature meant a
huge increase in the referrals to the unit three weeks after the start of
the bad weather
and a lot of work has been done on the relationship between weather and
hospitals admissions since then. The cost of using this knowledge would
be trivial and the gains would be great.
Dr J L Struthers
27 Kellett Road
Southampton
SO15 7PS
Competing interests: No competing interests
Editor - The authors of this editorial note that plans for the
management of winter bed crises were not introduced until 1996. They
continue by suggesting ways in which such crises might more accurately be
predicted but appear to have totally missed the point (obvious to any
working in an acute speciality) that the crises are not primarily caused
by excesses of patients but by shortages of beds, nursing, medical and
ancilliary staff created in the years immediately leading up to 1996.
Predicting such "crises" which would in turn permit suspension of elective
work to create space for emergency patients does not seem to me to be time
or money well spent. The elective work still has to be done and tactics
such as these simply help one "crisis", namely the shortage of emergency
beds, by worsening another - the excessive period patients with painful
and / or life threatening conditions have to wait for "elective"
treatment. Rather than developing short term plans to rob Peter and pay
Paul I would suggest that disease surveillance data should be used to
highlight the fact that the NHS simply cannot cope with the demands made
upon it. I further feel that the implication that the service can be
improved to a satisfactory level by prediction of "winter crises" is
dangerous in that it has the potential to distract
attention (particularly political attention which always seems to be on
the lookout for a cheap and easy fix) from the essence of the problem -
insufficient resourses.
Geoff Anderson
Consultant Orthopaedic Surgeon
Derriford Hospital,
Plymouth
PL6 8DH
Competing interests: No competing interests
So Hanratty and Robinson think that the way to cope with the winter
bed crises is increased surveillance. I can hear the hollow laughter from
A&E staff up and down the country. This is like an Intelligence
Officer in a war zone telling the troops that they are about to be
plastered with high
explosives, and afterwards surveying the chaos and saying, "There you are,
we said it would happen!"
This weekend, apart from reading this article; I have received a huge book
about how to use NHS Direct ( endorsed by the BMA!!) and I have been
called into the A&E departments that I cover. One had 29 patients
waiting
for beds, the other had 12.
The answer to bed crises is not data to tell us it is going to happen. We
cannot pull extra beds, doctors and nurses out of a cupboard when we are
told it is going to happen. The solution is to not run hospitals which
have to have over 100% bed occupancy to break even financially. Let's not
waste any more money on data collection and an unproven telephone advice
service and give it the places where the hard slogging foot soldiers are
up to their ears in mud and gore. Data may solve the problem
in
ten years time but patients with emergency illnesses need the help now.
John Belstead
A&E Consultant
Ashford and St Peters NHS Trust
Competing interests: No competing interests
Coping with winter bed crisis
Hanratty and Robinson suggest that local data should be used to
predict crises! Our analysis of emergency admissions and discharges in
Southend for the last 3 years shows that a crisis occurs over every
Christmas and New Year and far from being unexpected is predictable2. The
total number of emergency admissions increased by 45% and each year the
pattern of admissions changes with low numbers on 25th , 26th December and
1st January and high numbers on 29th, 30th December and 2nd January. The
most important factor for the crisis is the increasing length of stay in
the Department of Medicine (63% in 1998-1999).
We estimate , by using a simple mathematical model, that 209 of our 781
beds (27%) will need to be empty on Christmas Eve to prevent a crisis.
Routine surgery is stopping in the week before Christmas, emergency
general medical clinics and increased Consultant ward rounds are planned
to try and provide enough empty beds, decrease admissions and increase
discharges. Increased Community Social Service and general practice
support has been agreed. It is hoped that these measures will prevent the
predictable crisis.
Anthony G Davison
Clinic Director of Medicine
1. Hanratty B, Robinson M. Coping with winter bed crisis. BMJ 1999;
319; 1511-1512
2. Davison A.G., Bowhay S. Winter Planning.
Health Service Journal 1999 ; 109; No 5674 ; 24-26
Competing interests: No competing interests