Bed Management Research Articles

Mobile-based Hospital Bed Management with Near Field Communication Technology

Bed management is one of the most crucial tasks in a hospital. A desktop-based (PC) information technology system has been widely adopted to assist this operation. The fixed location and the limited amount of available PCs shared among staff for different routine tasks can cause delays in bed information updating and therefore delays to the bed management processes. With the penetration of smartphones, a mobile-based application becomes a reliable alternative solution for bed management to complement the existing system. Smartphones offer a few benefits, especially mobility because users can update the information from any place and at any time. Our aim was to study the applicability of a mobile-based application for assisting bed management operation. The application consisted of ward-based bed information visualization, bed information updating, and ward information updating modules. Observation and interviews with expert users were performed to outline the required functions of the application. On a Likert 1-5 scale, the mobile application achieved a mean score of 3.45 for usefulness, 3.40 for ease of use, and 3.42 for satisfaction. Meanwhile, the respondents were also concerned about the mobile data consumption of the app, which took up 45.8% of the negative feedback. On the positive side, the respondents agree that the mobile application helps them in the bed management operation.

Mobile-based Hospital Bed Management with Near Field Communication Technology

Mobile-based Hospital Bed Management with Near Field Communication Technology

MALO (more activity, less overcrowding): A bed management model as a high-impact solution to the problem of hospital overcrowding

There is abundant literature that relates the overcrowding of the emergency departments (EDs) to the presence of patients admitted to the ED for want of beds in the hospitalisation area. Likewise, there is also abundant evidence on the relationship between hospital overcrowding and the deterioration of multiple indicators of healthcare quality. In this paper we present our bed management model (MALO model: more activity, less overcrowding), which we have successfully applied in three different hospitals. The three characteristic elements of this model are: 1. PREBEDA formula: this consists of a simple but useful formula for calculating the availability of beds on the basis of the scheduled activity and the activity estimated based on recent history 2. Coordinated surgical programming: surgical programming is coordinated with the bed availability forecast 3. ‘Beds czar’: a person responsible for the management of hospital beds is appointed, which acts according to the prioritization criteria established by a ‘bed management committee’, in which the medical director and the nursing director participate.

A CONTRIBUIÇÃO DA INOVAÇÃO PARA A COMPETITIVIDADE DOS SERVIÇOS ADMINISTRATIVO-OPERACIONAIS HOSPITALARES PRESTADOS ÀS OPERADORAS DE PLANOS DE SAÚDE.

Esta pesquisa teve como principal objetivo analisar como as instituições hospitalares utilizam a inovação dos processos para promover maior competitividade dos serviços administrativo-operacionais hospitalares prestados às operadoras de planos de saúde. Para a abordagem deste estudo optou-se por uma pesquisa qualitativa, com fins descritivos, por meio de estudo de casos múltiplos, tendo como procedimento técnico a análise de conteúdo. Foram realizadas entrevistas semiestruturadas em seis hospitais privados da região metropolitana de Belo Horizonte no período de dezembro/2016-janeiro/2017. Os resultados apresentados revelam que a utilização da inovação é realizada nos hospitais pesquisados de forma incipiente, não sistemática e intencional. As categorias de Custeio, de Compras, de Gestão dos leitos, de Faturamento e de Atendimento tiveram resultados satisfatórios ofertando benefícios para as operadoras de planos de saúde. Porém, as categorias de Estoques, Fluxo financeiro, Estrutura de redes e de computadores e Política de recursos humanos não foram satisfatórios, não ofertando benefícios para as operadoras de planos de saúde.
 Palavras-chave: Inovação. Competitividade. Custos.

Role of a Brief Intensive Observation Area with a Dedicated Team of Doctors in the Management of Acute Heart Failure Patients: A Retrospective Observational Study.

Background and objectives: Acute heart failure (AHF) is one of the main causes of hospitalization in Western countries. Usually, patients cannot be admitted directly to the wards (access block) and stay in the emergency room. Holding units are clinical decision units, or observation units, within the ED that are able to alleviate access block and to contribute to a reduction in hospitalization. Observation units have also been shown to play a role in specific clinical conditions, like the acute exacerbation of heart failure. This study aimed to analyze the impact of a brief intensive observation (OBI) area on the management of acute heart failure (AHF) patients. The OBI is a holding unit dedicated to the stabilization of unstable patients with a team of dedicated physicians. Materials and Methods: We conducted a retrospective and single-centered observational study with retrospective collection of the data of all patients who presented to our emergency department with AHF during 2017. We evaluated and compared two cohorts of patients, those treated in the OBI and those who were not, in terms of the reduction in color codes at discharge, mortality rate within the emergency room (ER), hospitalization rate, rate of transfer to less intensive facilities, and readmission rate at 7, 14, and 30 days after discharge. Results: We enrolled 920 patients from 1st January to 31st December. Of these, 61% were transferred to the OBI for stabilization. No statistically significant difference between the OBI and non-OBI populations in terms of age and gender was observed. OBI patients had worse clinical conditions on arrival. The patients treated in the OBI had longer process times, which would be expected, to allow patient stabilization. The stabilization rate in the OBI was higher, since presumably OBI admission protected patients from “worse condition” at discharge. Conclusions: Data from our study show that a dedicated area of the ER, such as the OBI, has progressively allowed a change in the treatment path of the patient, where the aim is no longer to admit the patient for processing but to treat the patient first and then, if necessary, admit or refer. This has resulted in very good feedback on patient stabilization and has resulted in a better management of beds, reduced admission rates, and reduced use of high intensity care beds.

The electronic medical record and COVID-19: Is it up to the challenge?

• Improvements to the electronic medical records must occur prior to the next pandemic. • During pandemics, infection preventionists’ should advise staff, not review charts. • Automation can help improve healthcare safety and quality.

The Positive Impact of Establishing an Internal Transfer Center

Health systems are facing greater pressures than ever before, with factors ranging from mergers and acquisitions and changing reimbursement models to capacity challenges and staffing shortages. A transfer center, where with 1 simple call from a referring physician, a decision to accept a critically ill patient can be made, placing them at the most appropriate level of care, the first time. Baptist Health in Jacksonville, Florida, went from an outsourced to an in-house center in 3 months—in the first 28 days alone, patient transfers increased from 900 to 1,500, growing to an average of 1,583 transfers per month.

Evaluation of a superabsorbent wound dressing, patient and clinician perspective: a case series.

The primary objective of this study was to evaluate the fluid management capabilities of a superabsorbent wound dressing (Zetuvit Plus Silicone), with secondary objectives related to parameters that support whether the dressing enables undisturbed healing. This study was an open labelled non-comparative study. Patients included in the study were selected by the clinical investigator(s) according to whether the patient required a dressing for the management of moderately to highly exuding wounds. A total of 50 patients were included in the study. Results related to the primary objective demonstrated that the superabsorbent wound dressing was able to absorb all levels of exudate across the range (low to high). At each assessment time point these results show that in 98% of assessments the superabsorbent dressing was rated as 'very good' (91%) or 'good' (7%) at exudate management. Secondary objectives relating to wound bed preparation, healing and management of pain were also positive. Additionally, at the end of each patient treatment, the dressing's fluid management capabilities were rated overall as 'excellent' (100% of cases). There was little pain associated with the wound or at dressing change throughout the study and its flexibility/conformability allowed for comfort and patient satisfaction aligned with increased quality of life. Additionally, inclusion of a silicone adhesive layer allowed painless and atraumatic removal of the dressing, increasing patient comfort, both during wear and at dressing removal, and supported the description of enabling undisturbed wound healing. The superabsorbent wound dressing achieved the primary objective relating to wound exudate management in all the assessments undertaken in this study. In addition, the silicone interface allowed for undisturbed healing as evidenced by little or no adherence of the dressing to underlying tissue, preventing damage to periwound skin. Overall, the superabsorbent wound dressing with the addition of the silicone interface could offer advantages over other superabsorbent polymer dressings (that might adhere to the wound surface) or silicone wound dressings (that might not have the absorbent properties of this type of dressing).

AB150. The use of the ambulatory care model for distal radius fractures in University Hospital Limerick

Background: The Health Service Excutive (HSE) National Model of Care for Trauma and Orthopaedics and the British Orthopaedic Association both recommend the use of an ambulatory care model for the management of distal radius fractures. The ambulatory care model recommends suitable patients should be discharged home following diagnosis and return as a planned day case admission for their definitive treatment to avoid unnecessary inpatient stays and bed blocking. We identified an issue as there is no current pathway to facilitate the ambulatory care model in University Hospital Limerick (UHL) and as such we conducted this audit to identify the impact of this service deficit on patients and the health system.

Length-of-Stay Prediction for Pediatric Patients With Respiratory Diseases Using Decision Tree Methods.

Accurate prediction of a patient's length-of-stay (LOS) in the hospital enables an efficient and effective management of hospital beds. This paper studies LOS prediction for pediatric patients with respiratory diseases using three decision tree methods: Bagging, Adaboost, and Random forest. A data set of 11,206 records retrieved from the hospital information system is used for analysis after preprocessing and transformation through a computation and an expansion method. Two tests, namely bisection test and periodic test, are designed to assess the performance of the prediction methods. Bagging shows the best result on the bisection test (0.296 RMSE, 0.831 R2, and 0.723 Acc ± 1) for the testing set of the whole data test. The performances of the three methods are similar on the periodic test, whereas Adaboost performs slightly better than the other two methods. Results indicate that the three methods are all effective for the LOS prediction. This study also investigates the importance of different data fields to the LOS prediction, and finds that hospital treatment-related data fields contribute more to the LOS prediction than other categories of fields.

Improving patient flow in acute psychiatric wards: enhanced bed management and trusted assessment

In three localities in a mental health trust in England, an enhanced bed management team was established to improve patient flow and reduce out-of-area placements. Trusted assessments were provided to support risk management and conflict resolution. Two measures of flow were compared before and after the team was established. The trusted assessment recommendation was for discharge in 70% of cases. The number of out-of-area placements was significantly reduced (P < 0.05), saving £616 876 over a 12-month period. Patient flow was significantly improved in one of the three localities as measured by patients/bed/6-month period (P < 0.05). In one of the other localities increased use of trusted assessment input and reduced numbers of patients being transferred in are recommended to improve flow. Mental health trusts should consider the establishment of an enhanced bed management team, including trusted assessment, as a safe and cost-effective approach to improving patient flow and reducing the need for out-of-area placement.

Analysis of bed occupancy data on the acute medical unit

Hospitals may struggle to operate effectively and meet quality standards when unscheduled (emergency) admission rates are high in relation to operational capacity. Understanding patterns of ward admission and discharge from acute medical units (AMU) can help inform resource allocation. Discharges early in the day are advocated as a means to improve bed management, but delays may arise from post-AMU bed availability. It is unclear whether any change in AMU discharge patterns pre-dates hospital-wide pressure or whether it is a reaction to it. Anonymous data from 1 Jan 2016 to 31 December 2017 comprising the …

Economic impact of antimicrobial-resistant bacteria outbreaks on Japanese hospitals

Economic evaluation from the perspective of hospitals is important for the optimization of resources for infection control measures. We considered outbreaks that occurred from 2006 to 2016 in Japan. Cost identification analyses were conducted using data from 23 outbreaks by antimicrobial-resistant bacteria. Linear and multivariable regression analyses were conducted to explore the association between potential factors and main outcomes. The potential factors included duration of the outbreaks, duration of bed blocking, timely public announcement, delay of external consultation, and number of patients at the time of external consultation. The largest productivity loss was 4.62 million USD. The maximum total cost for containment was 678,000 USD. After considering the overall interactions, timely public announcement was significantly associated with productivity loss (adjusted estimate of coefficient: 1.24 USD, 95% confidence interval [CI] 179,000 to 2.31 million USD, P= .02), and the number of patients at external consultation was significantly associated with containment costs (3 430 USD, 630 to 6 240 USD, P= .02). The costs of healthcare-associated infection outbreaks of antimicrobial-resistant bacteria can be significant. The productivity loss was much greater than the containment costs. Therefore, hospitals should meet the costs for prevention of these outbreaks.

Impact of Leadership of Trained Intensivist in Pediatric Intensive Care Unit in a Middle Income Country: An Uncontrolled Before-After Study.

ObjectiveTo evaluate the effects generated by an intensivist in pediatric intensive care unit (PICU) on the process of care and patient outcomes.MethodsThis study was a retrospective observational study conducted in the 16-bedded PICU of a tertiary referral center. Two years (2013–2015) period of the PICU without an intensivist and the following two years (2015–2017) when it was attended by an intensivist who was also the first ever graduate of the fellowship program in Turkey were compared.ResultsNumber of patients followed in PICU increased more than 2-fold. Number of mechanically ventilated patients increased more than 2-folds and presence of intensivist reduced the mechanical ventilation duration by 59%. Presence of intensivist reduced the mortality rates by 2.18 times. It was shown that management of PICU beds by an intensivist resulted in increased number of patients per year per PICU bed, increased care of true critical care patients who are in need of more intensive therapies and invasive procedures including extracorporeal treatment options, decreased length of stay, decreased number and rate of nosocomial infections, and decreased mortality rate.ConclusionsWhat transforms a unit full of critically ill patients to an intensive care unit is a dedicated intensivist. The current study demonstrated that intensivist is the crucial component of the PICUs.

Data-Driven Models for Capacity Allocation of Inpatient Beds in a Chinese Public Hospital.

Hospital beds are a critical but limited resource shared between distinct classes of elective patients. Urgent elective patients are more sensitive to delays and should be treated immediately, whereas regular patients can wait for an extended time. Public hospitals in countries like China need to maximize their revenue and at the same time equitably allocate their limited bed capacity between distinct patient classes. Consequently, hospital bed managers are under great pressure to optimally allocate the available bed capacity to all classes of patients, particularly considering random patient arrivals and the length of patient stay. To address the difficulties, we propose data-driven stochastic optimization models that can directly utilize historical observations and feature data of capacity and demand. First, we propose a single-period model assuming known capacity; since it recovers and improves the current decision-making process, it may be deployed immediately. We develop a nonparametric kernel optimization method and demonstrate that an optimal allocation can be effectively obtained with one year's data. Next, we consider the dynamic transition of system state and extend the study to a multiperiod model that allows random capacity; this further brings in substantial improvement. Sensitivity analysis also offers interesting managerial insights. For example, it is optimal to allocate more beds to urgent patients on Mondays and Thursdays than on other weekdays; this is in sharp contrast to the current myopic practice.

Performance of nurses in the bed management service of a teaching hospital

to analyze the performance of nurses in the Bed Management service of a public teaching hospital. descriptive, qualitative research inspired by Dubois theoretical model. 32 participants from the bed management unit and care units of a public hospital were interviewed from February to May 2018. Observations and data records from the Bed Management service complemented data collection. Theme/Category-Based Content Analysis was used. the performance of nurses was described in three analysis matrices, represented by the categories: acquisition, implementation and maintenance of nursing resources; transformation of nursing resources into nursing service and results of the work of the nurse in Bed Management. Final Considerations: understanding the performance of nurses in bed management contributes to the scenario of new practices and different roles that favor visibility and strengthening of the nurse's identity.

Physicians and management of emergency hospitals: professional power threatened?

Kanban is a technical arrangement for the organization of hospital care focused on the management of beds and clinical care, aimed at the quality and comprehensiveness of care and greater hospital bed turnover, and thus a reduction in length-of-stay and hospital costs. The system's most striking and innovative feature is constant, updated patient follow-up, shared by the professional team in systematic meetings. Characterize the probable impacts from the arrangement's adoption on physicians' professional power (autonomy and authority). Qualitative study in a municipal urgency-emergency hospital using the following data production techniques: ethnography of the hospital's routine, with observation and records in field diaries, and shared seminars with researchers and teams. Physicians value multi-professional work for qualifying their practice, as an ancillary and complementary line. Kanban tends to be controlled by "hybrids" (physicians who accumulate management and clinical functions) that express synergies between "clinical management" and "hospital bed management". Thus, in this arrangement interferences in physicians' work are not exercised from outside, and physicians' clinical decisions still condition the work of the other professional groups. Physicians do not see their authority and autonomy threatened by Kanban, given the linkage between management authority and professional authority. Still, aspects related to hybridization and internal stratification of the medical profession need to be better addressed in the debate on health professionals' power.

A heuristic approach for scheduling patient treatment in an emergency department based on bed blocking

Maximising the patient flows throughout the emergency care patient pathway is one of the most important objectives in the healthcare system. The emergency department (ED) is the critical point of this pathway in most hospitals, as the potential delays reduce the number of patients seen in the recommended time. One of the key delays in the ED is the waiting time of a patient prior to treatment, which can be reduced by optimising the patient treatment schedules with priorities. In this paper, a novel blocking patient flow (BPF) algorithm is developed and tested using the real data from a hospital in Brisbane, Australia. Initially, a simulation model of real-life ED operations is developed by characterising patient interarrival and treatment times according to different disease categories. Subsequently, a BPF heuristic algorithm is designed and benchmarked via computational experiments using two dominance rules: first come first served (FCFS) and shortest processing time (SPT). The computational results show that the proposed approach leads to a reduction of the total waiting time by more than 8 % in comparison to the current hospital practice, which implies that more patients will be served in a specified time window.

Bed management considering bed-blocking and elective patient admissions using simulation optimisation

Treatment process in health centres is mostly carried out in such a way that the patient is hospitalised in several parts of the wards during treatment. When patients are obliged to stay in a department until a bed becomes available in the next department, 'bed-blocking' occurs. Hospitals often suffer from the lack of proper planning and ineffective management of hospital beds and medical resources. In this research, we tackle this issue by introducing a multi-objective simulation optimisation model to determine the optimal number of elective admissions, the appropriate number of beds, and the number of patients who are forced to discharge in each ward. The model minimises hospital costs and the number of patients who are blocked. Due to the complexity of the issue, two meta-heuristic approaches are developed to solve the model. In this regard, five simulation optimisation algorithms have been implemented to solve the model and compare the results. By solving the presented algorithms, Pareto optimal frontiers are obtained in various states.

Bacterial concentrations in bedding and their association with dairy cow hygiene and milk quality

Comparison of bacterial counts (BCs) among common bedding types used for dairy cows, including straw, is needed. There is concern that the microbial content of organic bedding is elevated and presents risks for dairy cow udder health and milk quality. The objectives of this study were to investigate: (1) % DM and BCs (Streptococcus spp., all gram-negatives and specifically Klebsiella spp.) in different types of bedding sampled, and to investigate housing and farm management factors associated with % DM and BCs; (2) if bedding type was associated with hygiene of cow body parts (lower-legs, udder, upper-legs and flank) and housing and management factors associated with hygiene and (3) bedding types associated with higher BCs in cow milk at the farm level and bulk tank milk and management factors that were associated with highest BCs. Seventy farms (44 free-stall and 26 tie-stall) in Ontario, Canada were visited 3 times, 7 days apart from October 2014 to February 2015. At each visit, composite samples of unused and used bedding were collected for % DM determination and bacterial culture. Used bedding samples were collected from the back third of selected stalls. Data were analyzed using multivariable linear mixed models. Bedding classification for each farm were: new sand (n = 12), straw and other dry forage (n = 33), wood products (shavings, sawdust; n = 17) and recycled manure solids (RMSs)-compost, digestate (n = 8). In used bedding, across all bedding samples, sand was driest, compared to straw and wood, and RMS; higher % DM was associated with lower Streptococcus spp. count. Streptococcus spp. and all Gram-negative bacteria counts increased with increasing days since additional bedding was added. Gram-negative bacteria counts in used bedding varied with type: RMS = 16.3 ln colony-forming units (cfu)/mL, straw = 13.8 ln cfu/mL, new sand = 13.5 ln cfu/mL, and wood = 10.3 ln cfu/mL. Klebsiella spp. counts in used bedding were lower for wood products (5.9 ln cfu/mL) compared to all other bedding types. Mean cow SCC tended to be higher on farms with narrower stalls. Farms with mattress-based stalls had a higher prevalence of cows with dirty udders compared to those using a deep bedding system (often inorganic sand). Wider stalls were associated with lower bulk milk bacteria count. Lower % DM of used bedding was associated with higher bulk milk bacteria count. In conclusion, bedding management may have a profound impact on milk quality, bacterial concentrations in the bedding substrates, and cow hygiene.