Pressure on hospital beds in Scotland is affecting patient care, warns royal college

BMJ 2012; 344 doi: (Published 12 June 2012) Cite this as: BMJ 2012;344:e4067
  1. Bryan Christie
  1. 1Edinburgh

Care of patients is being compromised at hospitals across Scotland because of pressure on specialist beds and medical staffing, the Royal College of Physicians of Edinburgh warned on 12 June.

It is resulting in patients who need treatment on specialist wards being “boarded out” to other wards where less specialist care can be provided. This used to be a problem confined to the busier winter months but is now becoming the norm all year, said the college.

It conducted a survey among 1356 of its fellows in Scotland, mostly senior hospital consultants, to determine the extent of the problem. Of the 290 who replied (21%), just under three quarters (71%) said that they believed levels of boarding out in Scotland to be high and going up, and 99% believed that boarding out had a negative effect on the quality of care. Most respondents believed that boarding out increases readmission rates and length of stay, while contributing to higher death rates.

The Scottish health department has said that it took the concerns very seriously and announced that the country’s chief medical officer, Harry Burns, is to meet the college to discuss the findings.

A small scale study published last year in the Scottish Medical Journal found that 74% of doctors would refuse to be boarded out themselves and that 92% would not accept this for a relative.1

The college said that there has been a significant and sustained rise in the number of seriously ill patients admitted to Scottish hospitals at a time when the consultant workforce has remained static and the number of acute beds has reduced. The number of acute hospital beds in Scotland fell from just over 18 000 in 2002 to 16 700 in March 2011. Average throughput per bed rose over this period from 45 to 56 patients a year.

The college’s president, Neil Dewhurst, said that pressure on beds meant that in most hospitals consultants have no alternative but to move seriously ill patients to less specialised wards. “There is strong evidence that this reduces quality of care for patients and increases their length of stay. Boarding, in effect, creates a vicious circle, delaying treatment and discharge for patients and adding considerably to the workload of the healthcare teams caring for them.

“What this survey shows is that boarding is becoming the norm in Scottish hospitals on a year round basis. We believe this is poor practice, places patients at risk, and is unacceptable.”

The Scottish government says that Scotland is the only part of the UK to look at the issue of boarding on a national level. It asked health boards to report on winter boarding levels from 2009, since when levels have been falling.

Derek Bell, professor of acute medicine at Imperial College London and a member of the Scottish government’s advisory group on unscheduled care, said, “Boarding has always been recognised as poor practice, but now in the work that has been driven by the Scottish government we have the potential to measure the adverse impact on the quality of care, patient experience, and costs.

“It is imperative that all clinicians now fully engage to ensure that patient care is delivered in the right place by the right person at the right time. As the boarding problem exists across the healthcare system, it requires whole system solutions.”


Cite this as: BMJ 2012;344:e4067


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