Bed Management Research Articles

Impact of the Automation of Inpatient Bed Management to Reduce the Emergency Service Waiting Time.

The patient waiting time to be transferred for hospitalization is the time that the patient waits between the decision to hospitalize and the actual admission to an inpatient hospital bed. One of the difficulties encountered in qualifying waiting time for inpatient bed is the inability of hospital information systems to measure it. Hospitals in France have a specialized bed allocation team. This team must manage the bed allocation problem between different hospital departments using phone communication to assign patients to the adapted service. This kind of communication represents a lengthy additional workload in which effectiveness is uncertain. This paper presents a new approach to automate bed management in downstream service. For that, we have implemented algorithms based on artificial intelligent integrated in an inpatient web platform using IoT-Beacons, which is implemented to improve and facilitate the exchange of availability information of downstream beds within the Lille university hospital center (LUHC).

Explanation of COVID-19 Mortality Using Artificial Neural Network Based on Underlying and Laboratory Risk Factors in Ilam, Iran.

The spread of new waves of coronavirus outbreaks, high mortality rates, and time-consuming and numerous challenges in achieving collective safety through vaccination and the need to prioritize the allocation of vaccines to the general population have led to the continued identification of risk factors associated with mortality in patients through innovative strategies and new statistical models. In this study, an artificial neural network (ANN) model was used to predict morbidity in patients with coronavirus disease 2019 (COVID-19). Data of 2,206 patients were extracted from the registry program of Shahid Mostafa Khomeini Hospital in Ilam, Iran, and were randomly analyzed in two training (1,544) and testing (662) groups. By fitting different models of a three-layer neural network, 12 variables could explain more than 77% of the mortality variance in COVID-19 patients. These findings could be used to better mortality management, vaccination prioritization, public education, and quarantine, and allocation of intensive care beds to reduce COVID-19 mortality. The results also confirmed the power of a better explanation of ANN models to predict the mortality of patients.

Working with a Patient With Personality Disorder: A Case Report and Reflection on My Experience

AimsEmotionally unstable personality disorder (EUPD) accounts for up to 20% of diagnoses in the inpatient psychiatry population. The assessment, diagnosis, and treatment of any personality disorder may be challenging, and its classification remains debatable. Here I will describe a case of a dual diagnosis of EUPD and schizotypal personality disorder. Through the case report I will also reflect on my first experience of working with a patient with personality disorder, as a Psychiatry Foundation Fellowship doctor with little previous exposure to the psychiatry specialty.MethodsThe patient was a female in her thirties, previously diagnosed with EUPD, who had not benefitted from a number of psychological treatments. She had a history of suicidal behaviour and previous admissions but presented differently this time. She had short hair that was dyed in a vivid colour, was paranoid that she was being spied upon from an alternative universe and had suicidal plans to join the alternative universe. She also had auditory and visual hallucinations. On exploration it became apparent that she had similar episodes in the past, each lasting no more than a day. An additional diagnosis of schizotypal personality disorder was made, and she responded well to risperidone. Unfortunately, she was transferred to another ward for bed management reasons, whereupon the diagnosis reverted to EUPD and antipsychotics were stopped.ResultsThis case highlights how in mixed personality disorders, features of one personality disorder may be more predominant than another at different times. It also contradicts the notion that people with schizotypal personality disorder rarely present to mental health services. The inconsistency of diagnosis and lack of continuity of care caused immense distress to the patient, prolonging the acute episode. This highlights the importance of a good formulation in order to tailor care for the patient.ConclusionAs a newly qualified doctor, working with patients with personality disorders was a meaningful experience. Through ward rounds and the seemingly trivial conversations along the corridor, I thought about the effect of transference and countertransference for the first time, which is applicable to any interpersonal interaction. I witnessed the harm caused by the lack of continuity of care. I reflected on the intricate balance between the advantage of establishing a diagnosis for the patient, and the drawback of the diagnosis leading to labelling. It made me face the stereotypes I held and allowed me to learn about the patient as an individual.

Tracheal Aspirate and Bronchoalveolar Lavage as Potential Specimen Types for COVID-19 Testing Using the Cepheid Xpert Xpress SARS-CoV-2/Flu/RSV.

ABSTRACTXpert Xpress SARS-CoV-2/Flu/RSV is a rapid diagnostic test currently approved for the detection of SARS-CoV-2 using upper respiratory tract specimens. This study attempts to assess the performance of this assay using upper and lower respiratory tract specimens by comparing its results to the lab-developed PCR test. We assessed the performance of GeneXpert for the detection of SARS-CoV-2, influenza A, influenza B, and respiratory syncytial virus for upper respiratory tract specimens. In addition, the SARS-CoV-2 detection was evaluated for lower respiratory tract specimens (bronchoalveolar lavage and tracheal aspirate). Precision and reproducibility of the test were also assessed using samples with varying cycle threshold values. Xpert Xpress SARS-CoV-2/Flu/RSV shows 100% positive and negative agreements for all four targets when tested using upper respiratory tract specimens. For lower respiratory tract specimens, tracheal aspirate and bronchoalveolar lavage samples respectively show 96% and 100% positive percent agreement for SARS-Cov-2 target only. No positive flu/RSV samples were included for lower respiratory tract specimens. Both samples show 100% negative percent agreement. The precision and reproducibility assay also showed 100% correspondence. Xpert Xpress SARS-CoV-2/Flu/RSV can be potentially used for SARS-Cov-2 detection in lower respiratory tract specimens. Performance passed our study acceptance criteria and shows promising implications as a point of care detection assay.IMPORTANCE Cepheid’s Xpert Xpress SARS-CoV-2/Flu/RSV provides a means of rapid diagnosis that can help in hospital bed management and patient flow. It is also important for each microbiology lab to increase its capacity and most importantly have a different platform to overcome the anticipated reagent shortage at times of peak community transmission. There is limited evidence on using it for lower respiratory tract specimens. Here we present our validation for upper respiratory tract specimens as well as a potential use for lower respiratory specimens (BAL and TA), and we discuss some of the applications we have been using in our organization.

Identifying associations between management practices and antimicrobial resistances of sentinel bacteria recovered from bulk tank milk on dairy farms

There is increasing emphasis on the need to reduce antimicrobial use (AMU) on dairy farms to reduce the emergence of resistant bacteria which could compromise animal health and impact human medicine. In addition to AMU, the role of farm management is an area of growing interest and represents an alternative route for possible interventions. The aim of this study was to evaluate the impact of farm management practices and AMU on resistances of sentinel bacteria in bulk milk. Dairy farms from two, geographically separate locations within the British Isles were recruited as part of two study groups. Farm management data from study group 1 (n = 125) and study group 2 (n = 16) were collected by means of a face-to-face questionnaire with farmers carried out during farm visits. For study group 2, additional data on AMU was collated from veterinary medicine sales records. Sentinel bacterial species (Enterococcus spp. and E. coli), which have been reported to be of value in antimicrobial resistance (AMR) studies, were isolated from bulk tank milk to monitor antimicrobial susceptibilities by means of minimum inhibitory concentrations (MICs). MIC data for both groups was used to generate an overall “score” for each farm. For both groups, this overall farm mean MIC was used as the outcome variable to evaluate the impact of farm management and AMU. This was achieved through use of elastic net modelling, a regularised regression method which also featured a bootstrapping procedure to produce robust models. Inference of models was based on covariate stabilities and bootstrapped P-values to identify farm management and AMU practices that have significant effects on MICs of sentinel bacteria. Practices which were found to be of importance with respect to Enterococcus spp. included management of slurry, external entry of livestock to the dairy herd, use of bedding materials and conditioners, cubicle cleaning routines and antibiotic practices, including use of β-lactams and fluoroquinolones. Practices deemed to be of importance for E. coli MICs included cubicle and bedding management practices, teat preparation routines at milking and the milking procedure itself. We conclude that a variety of routine farm management practices are associated with MICs of sentinel bacteria in bulk milk. Amendment of these practices offers additional possible routes of intervention, alongside alterations to AMU, to mitigate the emergence and dissemination of AMR on dairy farms.

AB188. SOH22ABS037. A closed loop audit into the use and efficacy of the ambulatory care model for management of distal radius fractures

Background: The Health Service Executive (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 in 2018 as there was no 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. Since then Croom Orthopaedic Hospital now has capacity for ambulatory trauma care Monday to Friday and as such we reaudited to assess the effect of this new pathway on service provision in UHL.

Recent change in spatial distribution of the European flat oyster (Ostrea edulis) inferred from field data and empirical models of living oysters and empty shells.

Marine coastal areas are increasingly affected by human activities resulting in changes in species and habitat distributions. Understanding these patterns and its causes and consequences is important for conservation and restoration of such changing habitats. One habitat that has been heavily affected by human use are the North Sea oyster beds which once were abundant but have lost large parts of its coastal distribution due to overexploitation. Based on data of living and dead assemblages of Ostrea edulis collected using video transects, we used an ensemble modeling technique to model and predict current and recent distribution of O. edulis along the Swedish west coast where its distribution is, in relative terms, still rather unaffected. We could detect a recent change in the distribution of O. edulis along the coast which to a large extent could be attributed to a change in depth distribution, suggesting that the population of O. edulis have a slightly shallower distribution today than in the past. Although a potential mismatch between living and dead assemblages, caused by a complex combination of biological and environmental conditions, needs to be considered in the interpretations drawn, it may be a way around the lack of suitable background data in management decisions. This provides important information for management and conservation of the native oyster beds. Furthermore, this study illustrates a method for identifying recent changes in species distribution using dead assemblages of bivalves.

The Role of the Approved Mental Health Professional: A ‘Fool’s Errand’?

Abstract This article explores the concept of a ‘fool’s errand’ in relation to the specialist role of the Approved Mental Health Professional (AMHP). An AMHP has a duty to make an application following a Mental Health Act assessment to detain and admit an individual to a psychiatric hospital. Findings from a qualitative study of ten multiprofessional AMHPs in England suggested AMHPs were subjected to a ‘fool’s errand’, when they were asked by psychiatrists and bed managers to practice in a way, they, themselves, considered unwise or foolish and that did not make sense in the context of their role. The author will illuminate how false starts and delays in securing treatment and care outcomes for mentally unwell individuals compromised AMHP practice.

Understanding variation in patient care: A qualitative study of hospital (non-ST elevation myocardial infarction) practices

Background Variation in care is often poorly understood but has a big impact on patients. Non-ST segment elevation myocardial infarction (NSTEMI, also known as non-ST elevation acute coronary syndrome or NSTE-ACS) is the most common form of heart attack. NSTEMI is frequently hard to diagnose, its management pathway poorly defined and there is considerable variation in clinical practice. Methods A qualitative study based on site visits, observation, and interviews with managers, clinicians and patients. The setting was 10 hospitals in England and Wales selected to represent variation in 30-day mortality. 199 hospital staff and 68 patients were observed; 142 staff and 53 patients were interviewed. Analysis was thematic and guided by the principles of grounded theory. We triangulated interviews, observational data and medical records and interpreted these findings with reference to national guidelines. Results While the majority of hospitals in our sample had specialist cardiac roles, variation in their remits, specifically their involvement in close monitoring, significantly affected patient management. Close monitoring was important in the identification and prioritisation of patients. Rapid responses with diagnostic and treatment procedures were facilitated by close monitoring but also heavily dependent on effective and flexible bed and catheter laboratory management. Conclusions Close monitoring was a key area of variation. Guidelines for NSTEMI care specify what to do, but not how to do it. These findings are especially relevant for acute conditions with diagnostic and treatment uncertainty. Detailed examples of variation in care can inform quality improvement and potentially help improve patient outcomes.

Patient Harm and Institutional Avoidability of Out-of-Hours Discharge From Intensive Care: An Analysis Using Mixed Methods.

OBJECTIVES:Out-of-hours discharge from ICU to the ward is associated with increased in-hospital mortality and ICU readmission. Little is known about why this occurs. We map the discharge process and describe the consequences of out-of-hours discharge to inform practice changes to reduce the impact of discharge at night.DESIGN:This study was part of the REcovery FoLlowing intensive CarE Treatment mixed methods study. We defined out-of-hours discharge as 16:00 to 07:59 hours. We undertook 20 in-depth case record reviews where in-hospital death after ICU discharge had been judged “probably avoidable” in previous retrospective structured judgment reviews, and 20 where patients survived. We conducted semistructured interviews with 55 patients, family members, and staff with experience of ICU discharge processes. These, along with a stakeholder focus group, informed ICU discharge process mapping using the human factors–based functional analysis resonance method.SETTING:Three U.K. National Health Service hospitals, chosen to represent different hospital settings.SUBJECTS:Patients discharged from ICU, their families, and staff involved in their care.INTERVENTIONS:None.MEASUREMENTS AND MAIN RESULTS:Out-of-hours discharge was common. Patients and staff described out-of-hours discharge as unsafe due to a reduction in staffing and skill mix at night. Patients discharged out-of-hours were commonly discharged prematurely, had inadequate handover, were physiologically unstable, and did not have deterioration recognized or escalated appropriately. We identified five interdependent function keys to facilitating timely ICU discharge: multidisciplinary team decision for discharge, patient prepared for discharge, bed meeting, bed manager allocation of beds, and ward bed made available.CONCLUSIONS:We identified significant limitations in out-of-hours care provision following overnight discharge from ICU. Transfer to the ward before 16:00 should be facilitated where possible. Our work highlights changes to help make day time discharge more likely. Where discharge after 16:00 is unavoidable, support systems should be implemented to ensure the safety of patients discharged from ICU at night.

Token Economy-Based Hospital Bed Allocation to Mitigate Information Asymmetry: Proof-of-Concept Study Through Simulation Implementation.

BackgroundHospital bed management is an important resource allocation task in hospital management, but currently, it is a challenging task. However, acquiring an optimal solution is also difficult because intraorganizational information asymmetry exists. Signaling, as defined in the fields of economics, can be used to mitigate this problem.ObjectiveWe aimed to develop an assignment process that is based on a token economy as signaling intermediary.MethodsWe implemented a game-like simulation, representing token economy–based bed assignments, in which 3 players act as ward managers of 3 inpatient wards (1 each). As a preliminary evaluation, we recruited 9 nurse managers to play and then participate in a survey about qualitative perceptions for current and proposed methods (7-point Likert scale). We also asked them about preferred rewards for collected tokens. In addition, we quantitatively recorded participant pricing behavior.ResultsParticipants scored the token economy–method positively in staff satisfaction (3.89 points vs 2.67 points) and patient safety (4.38 points vs 3.50 points) compared to the current method, but they scored the proposed method negatively for managerial rivalry, staff employee development, and benefit for patients. The majority of participants (7 out of 9) listed human resources as the preferred reward for tokens. There were slight associations between workload information and pricing.ConclusionsSurvey results indicate that the proposed method can improve staff satisfaction and patient safety by increasing the decision-making autonomy of staff but may also increase managerial rivalry, as expected from existing criticism for decentralized decision-making. Participant behavior indicated that token-based pricing can act as a signaling intermediary. Given responses related to rewards, a token system that is designed to incorporate human resource allocation is a promising method. Based on aforementioned discussion, we concluded that a token economy–based bed allocation system has the potential to be an optimal method by mitigating information asymmetry.

Design of Student Bedding Management System Based on Intelligent Monitoring Bed

In order to solve the problems related to the management of students’ bedtime in vocational colleges and improve the efficiency of students’ bedtime management, an intelligent bed for students’ bedtime management is designed, which is composed of bed and sensor unit, signal processing unit, and ZigBee transmission unit. The algorithm of the collected pressure sensor data is improved, and an improved amplitude limiting lag average filtering algorithm is proposed. The management system uses the methods of composite collection of information, intelligent processing, big data analysis, etc. to upload the data to the cloud server, through the mobile phone app and other terminals to timely grasp the sleeping situation of students at night. The experiment shows that the system improves the efficiency of students’ bedtime management by 10%.

Rural hospital bed management practices during influenza season.

Rural health services face greater challenges in managing infectious patients due to lack of specialty beds and longer lengths of stay. The pressures of seasonal influxes of influenza patients with a heavy burden of chronic disease and an ageing population result in an increased demand for hospital beds. During these peak periods it is common for rural hospitals to experience bed block. The result is that patients may be placed into any available bed or ward at the time, increasing the need for transfer and the risk of spreading hospital-acquired respiratory illnesses to other patients and staff across the hospital. This further exacerbates bed block, with patients then requiring more specialised treatment and longer lengths of stay. This places additional strain on already existing workforce shortages and limited resources that must accommodate higher-than-normal patient loads. The objective of this study was to examine rural hospital bed management practices with a focus on the transfer of patients who are actively diagnosed with influenza (either on admission or during their stay in hospital) and to investigate the association of increased bed movement with the rate of nosocomial transmission and staff workload. The rates of patients admitted to a rural hospital in New South Wales, Australia, during the yearly peak influenza season (July to September) during 2016-2019 with either community-acquired or hospital-acquired influenza were examined using an infection control surveillance program. Bed management practices related to these inpatients were audited to examine their contribution towards nosocomial transmissions and staff workload during these periods. A total of 229 patients presented to this hospital with an influenza diagnosis over the study period and generated 175 bed transfers. Forty percent of community-acquired and 70% of hospital-acquired influenza inpatients experienced one or more intrahospital bed transfers during their active infection period. Half of all bed transfers involved patients being transferred to another ward (interward) and the other half consisted of those transferred within the same ward (intraward). These transfers impacted staff workload, requiring a total of 245 extra hours from nursing and cleaning staff to facilitate - time not included when allocating staff at the start of each shift. Findings from this study indicate that there is no active strategy for influenza containment during high-occupancy periods for this rural facility. This resulted in multiple bed transfers occurring during the active phase of influenza infection. This then led to an exacerbation of bed block and thus further inappropriate placement of newly admitted patients. The development of an optimal bed management plan for future surges of influenza and other highly infectious respiratory illnesses is essential to reduce nosocomial infection and staff workload, especially given the limited resources available in rural areas compared to metropolitan centres.

"Bedding Management for Young Calves: Health, Welfare and Growth Perspectives"

"Bedding Management for Young Calves: Health, Welfare and Growth Perspectives"

Use of Hospital Capacity Command Centers to Improve Patient Flow and Safety: A Scoping Review.

Delayed emergency department (ED) and hospital patient throughput is recognized as a critical threat to patient safety. Increasingly, hospitals are investing significantly in deploying command centers, long used in airlines and the military, to proactively manage hospital-wide patient flow. This scoping review characterizes the evidence related to hospital capacity command centers (CCCs) and synthesizes current data regarding their implementation. As no consensus definition exists for CCCs, we characterized them as units (i) involving interdisciplinary, permanently colocated teams, (ii) using real-time data, and (iii) managing 2 or more patient flow functions (e.g., bed management, transfers, discharge planning, etc.), to distinguish CCCs from transfer centers. We undertook a scoping review of the medical and gray literature published through April 2019 related to CCCs meeting these criteria. We identified 8 eligible articles (including 4 peer-reviewed studies) describing 7 CCCs of varying designs. The most common CCC outcome measures related to transfer volume (n = 5) and ED boarding (n = 4). Several CCCs also monitored patient-level clinical parameters. Although all articles reported performance improvements, heterogeneity in CCC design and evidence quality currently restricts generalizability of findings. Numerous anecdotal accounts suggest that CCCs are being widely deployed in an effort to improve hospital patient flow and safety, yet peer-reviewed evidence regarding their design and effectiveness is in its earliest stages. The costs, objectives, and growing deployment of CCCs merit an investment in rigorous research to better measure their processes and outcomes. We propose a standard definition, conceptual framework, research priorities, and reporting standards to guide future investigation of CCCs.

Coping with complexity in the COVID pandemic: An exploratory study of intensive care units.

Although the COVID pandemic has challenged the resilience of health services in general, this impact has been most visible in intensive care units (ICUs). This paper presents an exploratory study of how ICUs in Brazil have coped with the complexity stemming from the pandemic. Five guidelines for coping with complexity were adopted as analytical framework. The guidelines were concerned with slack resources, diversity of perspectives, visibility, work‐as‐done, and unintended consequences. There were three main sources of data: (i) a survey with respondents from 33 ICUs, which indicated their agreement with 23 statements related to the use of the complexity guidelines; (ii) semistructured interviews with seven survey respondents and two public health officials; and (iii) 20 h of observations of the meetings of a municipal bed management committee. Seventy resilience practices were identified from these data sources. Most of these practices (n = 30) were related to the guideline on slack resources, which were commonly obtained from other hospital units. As for the survey data, the statement related to the availability of extra or standby human resources obtained the lowest score, reinforcing the key role of slack resources. Five lessons learned for coping with complexity in ICUs were drawn from our data; one lesson for each guideline. Furthermore, the survey questionnaire is a potential ICU assessment tool, which can be adapted to other health services.

The New Cranberry Wisconsin Research Station: Renovation Priorities of a ‘Stevens’ Cranberry Marsh Based on Visual Mapping, Genetic Testing, and Yield Data

ABSTRACT Cultivar contamination is a common issue in commercial cranberry production. Unknown or unwanted cranberry genotypes are found in commercial cranberry beds that are intended to be a single uniform genotype. Identification of contamination and the impact of contamination remain crucial issues for the cranberry industry to maintain long-term high productivity. To address this issue, tissue samples were taken from the former commercial beds of the new Wisconsin Cranberry Research Station (WCRS) for genetic fingerprinting analysis. The goal of this collection was to analyze the 10 beds for genetic uniformity to determine if any should be maintained or replaced, and to assess the accuracy of visual perception of genetic contamination in the field. A total of 288 DNA samples were collected in the 10 cranberry beds, and the ‘Stevens’ cultivar represented 180 samples or 69% of the 261 samples expected to be ‘Stevens.’ Therefore, the genotype contamination in the ‘Stevens’ beds was 31% overall. Overall, visual differentiation was accurate in distinguishing between genotypes and detecting large areas of contamination. A yield analysis was conducted along with the genotypic uniformity assessments, and a significant correlation was found between the 2017 yield of the beds and their level of genetic contamination. This study demonstrates the usefulness of genetic uniformity testing and mapping for cranberry bed management and renovation decision-making.

Bed management system and inpatient bed availability in a public medical complex in Saudi Arabia: a comparative retrospectively study

Background: This study aims to investigate whether initiating a cross-hospital bed management system makes a difference in the number of admissions and bed occupancy rates at a selected hospital and how, if at all, the average length of stay is reduced in specific hospital departments. Methods: The study included all sequentially hospitalized patients between June 1, 2016, and June 30, 2019. Results: The total number of patients who were admitted to a referred medical complex between June 2016 and July 2019 was 20,749. The inpatient days after the initiative show a statistically significant increase compared to inpatient days before the initiative (137,630 vs. 72,930 days, respectively). Additionally, bed occupancy rates (BOR) after the initiative had a significant increase compared to BOR beforehand (50.5% vs. 26.6%, respectively). Following the bed management program, bed turnover rates (BTR) had doubled relative to BTR before (27.7% vs. 13.8%, respectively). Inpatients were more likely to be admitted in medical wards for treatment (n = 11,976, 57.8%). The most common reasons for admissions to the medical wards of a referred medical complex were internal medicine diseases (n = 6,472), followed by diseases of the cardiovascular system (n = 3,096). However, comparing the average length of stay before and after the initiative found no difference. Conclusion: This study's findings suggest that the number of patients admitted to the hospital were far greater after the bed management initiative began than before it was implemented. Additionally, the increase in BOR and BTR was significant after the initiative was implemented. In contrast, even though the overall length of stay has not changed significantly since the bed management initiative began, when departments are considered separately, a statistically significant reduction in length of stay was only seen in surgical wards since the initiative began.

Improving access to emergency urgency: bed management, patients in-flow and out-flow in a Provincial Hub Hospital

article: Improving access to emergency urgency: bed management, patients in-flow and out-flow in a Provincial Hub Hospital - Italian Journal of Emergency Medicine 2021 December;10(3):156-62 - Minerva Medica - Journals

Improving paediatric flow in an UK Paediatric Assessment Unit

The 2010 Royal College of Paediatrics and Child Health (RCPCH) guidelines for acute paediatric services set standards for time to senior review for paediatric medical admissions in the UK as...