Ward Closure Research Articles

Does Health-Care Consolidation Harm Patients? Evidence from Maternity Ward Closures

We study how closures of maternity wards affect maternal and neonatal health. Using data on all hospital births in Sweden between 1990 and 2004, we compare changes in birth-related outcomes across hospital catchment areas that were differently exposed to ward closures. Our findings show that the closures increased maternal obstetric trauma but also decreased fetal stress and infant trauma among newborns. Adverse maternal outcomes are mainly driven by ward overcrowding, whereas increases in travel distance have no distinguishable effects. Positive effects on infant health reflect a shift of births from smaller to larger wards of higher quality. (JEL D24, G34, I11, I12, I18, J13, J16)

The Effect of Hospital Maternity Ward Closures on Maternal and Infant Health

The Effect of Hospital Maternity Ward Closures on Maternal and Infant Health

An Insurance Value Modeling Approach That Captures the Wider Value of a Novel Antimicrobial to Health Systems, Patients, and the Population.

Background: Traditional health economic evaluations of antimicrobials currently underestimate their value to wider society. They can be supplemented by additional value elements including insurance value, which captures the value of an antimicrobial in preventing or mitigating impacts of adverse risk events. Despite being commonplace in other sectors, constituents of the impacts and approaches for estimating insurance value have not been investigated. Objectives: This study assessed the insurance value of a novel gram-negative antimicrobial from operational healthcare, wider population health, productivity, and informal care perspectives. Methods: A novel mixed-methods approach was used to model insurance value in the United Kingdom: (1) literature review and multidisciplinary expert workshops to identify risk events for 4 relevant scenarios: ward closures, unavoidable shortage of conventional antimicrobials, viral respiratory pandemics, and catastrophic antimicrobial resistance (AMR); (2) parameterizing mitigable costs and frequencies of risk events across perspectives and scenarios; (3) estimating insurance value through a Monte Carlo simulation model for extreme events and a dynamic disease transmission model. Results: The mean insurance value across all scenarios and perspectives over 10 years in the UK was £718 million, should AMR remain unchanged, where only £134 million related to operational healthcare costs. It would be 50%-70% higher if AMR steadily increased or if a more risk-averse view (1-in-10 year downside) of future events is taken. Discussion: The overall insurance value if AMR remains at current levels (a conservative projection), is over 5 times greater than insurance value from just the operational healthcare costs perspective, traditionally the sole perspective used in health budgeting. Insurance value was generally larger for nationwide or universal (catastrophic AMR, pandemic, and conventional antimicrobial shortages) rather than localized (ward closure) scenarios, across perspectives. Components of this insurance value match previously published estimates of operational costs and mortality impacts. Conclusions: Insurance value of novel antimicrobials can be systematically modeled and substantially augments their traditional health economic value in normal circumstances. These approaches are generalizable to similar health interventions and form a framework for health systems and governments to capture broader value in health technology assessments, improve healthcare access, and increase resilience by planning for adverse scenarios.

An Insurance Value Modeling Approach That Captures the Wider Value of a Novel Antimicrobial to Health Systems, Patients, and the Population

Background: Traditional health economic evaluations of antimicrobials currently underestimate their value to wider society. They can be supplemented by additional value elements including insurance value, which captures the value of an antimicrobial in preventing or mitigating impacts of adverse risk events. Despite being commonplace in other sectors, constituents of the impacts and approaches for estimating insurance value have not been investigated. Objectives: This study assessed the insurance value of a novel gram-negative antimicrobial from operational healthcare, wider population health, productivity, and informal care perspectives. Methods: A novel mixed-methods approach was used to model insurance value in the United Kingdom: (1) literature review and multidisciplinary expert workshops to identify risk events for 4 relevant scenarios: ward closures, unavoidable shortage of conventional antimicrobials, viral respiratory pandemics, and catastrophic antimicrobial resistance (AMR); (2) parameterizing mitigable costs and frequencies of risk events across perspectives and scenarios; (3) estimating insurance value through a Monte Carlo simulation model for extreme events and a dynamic disease transmission model. Results: The mean insurance value across all scenarios and perspectives over 10 years in the UK was £718 million, should AMR remain unchanged, where only £134 million related to operational healthcare costs. It would be 50%-70% higher if AMR steadily increased or if a more risk-averse view (1-in-10 year downside) of future events is taken. Discussion: The overall insurance value if AMR remains at current levels (a conservative projection), is over 5 times greater than insurance value from just the operational healthcare costs perspective, traditionally the sole perspective used in health budgeting. Insurance value was generally larger for nationwide or universal (catastrophic AMR, pandemic, and conventional antimicrobial shortages) rather than localized (ward closure) scenarios, across perspectives. Components of this insurance value match previously published estimates of operational costs and mortality impacts. Conclusions: Insurance value of novel antimicrobials can be systematically modeled and substantially augments their traditional health economic value in normal circumstances. These approaches are generalizable to similar health interventions and form a framework for health systems and governments to capture broader value in health technology assessments, improve healthcare access, and increase resilience by planning for adverse scenarios.

Evaluating the cost implications of integrating SARS-CoV-2 genome sequencing for infection prevention and control investigation of nosocomial transmission within hospitals

The COG-UK hospital-onset COVID-19 infection (HOCI) trial evaluated the impact of SARS-CoV-2 whole-genome sequencing (WGS) on acute infection, prevention, and control (IPC) investigation of nosocomial transmission within hospitals. To estimate the cost implications of using the information from the sequencing reporting tool (SRT), used to determine likelihood of nosocomial infection in IPC practice. A micro-costing approach for SARS-CoV-2 WGS was conducted. Data on IPC management resource use and costs were collected from interviews with IPC teams from 14 participating sites and used to assign cost estimates for IPC activities as collected in the trial. Activities included IPC-specific actions following a suspicion of healthcare-associated infection (HAI) or outbreak, as well as changes to practice following the return of data via SRT. The mean per-sample costs of SARS-CoV-2 sequencing were estimated at £77.10 for rapid and £66.94 for longer turnaround phases. Over the three-month interventional phases, the total management costs of IPC-defined HAIs and outbreak events across the sites were estimated at £225,070 and £416,447, respectively. The main cost drivers were bed-days lost due to ward closures because of outbreaks, followed by outbreak meetings and bed-days lost due to cohorting contacts. Actioning SRTs, the cost of HAIs increased by £5,178 due to unidentified cases and the cost of outbreaks decreased by £11,246 as SRTs excluded hospital outbreaks. Although SARS-CoV-2 WGS adds to the total IPC management cost, additional information provided could balance out the additional cost, depending on identified design improvements and effective deployment.

Perceived Impact of the COVID-19 Pandemic on Psychiatric Training Among Final-Year Medical Undergraduates in Sri Lanka: an Online Survey of Students from Eight Universities.

ObjectiveThis study aimed to assess the perceived impact of the COVID-19 pandemic on undergraduate psychiatry training in Sri Lanka and to explore several potentially associated factors.MethodsAn online survey was distributed among students from eight medical schools who recently faced their final exam. Their perceptions on the impact of the pandemic on the psychiatry training and exam performance were rated on a 10-point scale. Resilience was assessed using a two-item scale.ResultsA total of 644 students responded (69.5% female, mean age=27.5 years). Among them, 164 (25.5%) reported being quarantined; 25 (4%) reported becoming infected with COVID-19; and 170 (28.6%) reported ward closure for over a week during the clerkship. Greater impact was reported for patient availability (mean=7.08), mental status assessments (mean=6.3), developing rapport (mean=6.2), and diagnostic skills (mean=5.9), whereas the impact on peer-learning (mean=5.5) and self-study (mean=3.6) was relatively lower. Impact on clinical components of the final exam (mean=6) was rated higher than on theory components (mean=4.5). The majority (70.3%) reported that COVID-19-related stress affected their exam preparations. Higher resilience predicted lower perceived impact on all aspects of training/exam performance. Female gender and ward closure predicted greater impact on diagnostic skills, overall training, and clinical exam performance, whereas being quarantined predicted greater impact on peer-learning and self-study.ConclusionThe pandemic has significantly affected the undergraduate psychiatry training in Sri Lanka, particularly its clinical components. Increasing clinical exposure to patients, managing students’ stress, and building their resilience should be key concerns for medical educators during the pandemic.

Disruptions to essential health services in Kenya during the COVID-19 pandemic – February 2020–May 2021

Background: The COVID-19 pandemic disrupted essential health services (EHS) delivery worldwide; however, there are limited data for healthcare facility (HCF)–level EHS disruptions in low- and middle-income countries. We surveyed HCFs in 3 counties in Kenya to understand the extent of and reasons for EHS disruptions occurring during February 2020–May 2021. Methods: We included 3 counties in Kenya with high burden of COVID-19 at the time of study initiation. Stratified sampling of HCFs occurred by HCF level. HCF administrators were interviewed to collect information on types of EHS disruptions that occurred and reasons for disruptions, including those related to infection prevention and control (IPC). Analyses included descriptive statistics with proportions for categorical variables and median with interquartile range (IQR) for continuous variables. Results: In total, 59 HCFs in Kenya provided complete data. All 59 HCFs (100%) reported EHS disruptions due to COVID-19. Among all HCFs, limiting patient volumes was the most common disruption reported (97%), while 56% of HCFs reduced staffing of EHS and 52% suspended EHS. Median duration of disruptions ranged from 7 weeks (IQR, 0–15) for inpatient ward closures to 25 weeks (IQR, 14–37) for limiting patient volumes accessing EHS. Among HCFs that reported disruptions, the most cited reason (ie, 95% of HCFs) was fewer patients receiving services. The most common IPC-related reason for disruption was diversion of resources to accommodate physical distancing measures (76%) followed by COVID-19 outbreaks among patients or staff (34%); staff shortages due to COVID-19 illness (25%) or perceived infection risk (19%); and lack of adequate personal protective equipment (20%). Conclusions: Most HCFs reported disruptions to EHS during the pandemic, including many that were related to IPC. Some disruptions may be mitigated by strengthening IPC infrastructure and practices, including protecting healthcare personnel to prevent staffing shortages.Funding: NoneDisclosures: None

An Alternative to Traditional Bedside Teaching During COVID-19: High-Fidelity Simulation-Based Study.

BackgroundBedside teaching is integral to medical education and has been highlighted to improve clinical and communication skills, as well as clinical reasoning. Despite the significant advantages of bedside teaching, its usage within medical education has been declining, and COVID-19 has added additional challenges. The pandemic has resulted in a significant reduction in opportunities to deliver bedside teaching due to risk of viral exposure, patients declining student interactions, and ward closures. Educators have therefore been required to be innovative in their teaching methods, leading to the use of online learning, social media platforms, and simulation. Simulation-based education allows for learning in a low-risk environment and affords the opportunity for deliberated repeated practice with case standardization. The results demonstrate that simulation-based training can increase students’ confidence, increase the rates of correct clinical diagnoses, and improve retention of skills and knowledge when compared with traditional teaching methods.ObjectiveTo mitigate the impact of COVID-19 upon bedside teaching for third year students at Hull York Medical School amid closure of the cardiorespiratory wards, a high-fidelity simulation-based model of traditional bedside teaching was designed and implemented. The objectives of the teaching session were to enable students to perform history taking and a focused cardiorespiratory clinical examination in a COVID-19–safe environment using SimMan 3G.MethodsFour clinical teaching fellows with experience of simulation-based medical education scripted histories for 2 common cardiorespiratory cases, which were asthma and aortic stenosis. The simulation sessions were designed for students to take a focused cardiorespiratory history and clinical examination using SimMan 3G. All cases involved dynamic vital signs, and the simulator allowed for auscultation of an ejection systolic murmur and wheezing in accordance with the cases chosen. Key aspects of the pathologies, including epidemiology, differential diagnoses, investigations, and management, were summarized using an interactive PowerPoint presentation, followed by a debriefing session.ResultsIn total, 12 third year medical students undertook the sessions, and overall feedback was highly positive. Of the 10 students who completed the feedback questionnaires, 90% (n=9) felt more confident in their clinical examination skills following the teaching; 100% (n=10) of the students responded that they would recommend the session to a colleague; and implementation of regular simulation was frequently requested on feedback. These results are in keeping with the current literature.ConclusionsBedside teaching continues to face ongoing challenges from the COVID-19 pandemic as well as declining patient recruitment and fluctuations in clinical findings. The support for simulation-based medical education is derived from high-quality studies; however, studies describing the use of this technology for bedside teaching in the undergraduate curriculum are limited. The authors describe a highly effective teaching session amid the pandemic, which allowed for maintenance of staff and student safety alongside continued education during a challenging time for educators globally.

Healthcare-acquired clusters of COVID-19 across multiple wards in a Scottish health board

BackgroundHealthcare-acquired COVID-19 has been an additional burden on hospitals managing increasing numbers of patients with SARS-CoV-2. One acute hospital (W) among three in a Scottish healthboard experienced an unexpected surge of COVID-19 clusters.AimTo investigate possible causes of COVID-19 clusters at Hospital W.MethodsDaily surveillance provided total numbers of patients and staff involved in clusters in three acute hospitals (H, M and W) and care homes across the healthboard. All clusters were investigated and documented, along with patient boarding, community infection rates and outdoor temperatures from October 2020 to March 2021. Selected SARS-CoV-2 strains were genotyped.FindingsThere were 19 COVID-19 clusters on 14 wards at Hospital W during the six-month study period, lasting from two to 42 days (average, five days; median, 14 days) and involving an average of nine patients (range 1–24) and seven staff (range 0–17). COVID-19 clusters in Hospitals H and M reflected community infection rates. An outbreak management team implemented a control package including daily surveillance; ward closures; universal masking; screening; restricting staff and patient movement; enhanced cleaning; and improved ventilation. Forty clusters occurred across all three hospitals before a January window-opening policy, after which there were three during the remainder of the study.ConclusionThe winter surge of COVID-19 clusters was multi-factorial, but clearly exacerbated by moving trauma patients around the hospital. An extended infection prevention and control package including enhanced natural ventilation helped reduce COVID-19 clusters in acute hospitals.

A five-component infection control bundle to permanently eliminate a carbapenem-resistant Acinetobacter baumannii spreading in an intensive care unit

BackgroundCarbapenem-resistant Acinetobacter baumannii (CRAB) infection outbreaks are difficult to control and sometimes require cohorting of CRAB-positive patients or temporary ward closure for environmental cleaning. We aimed at controlling the deadly 2018 CRAB outbreak in a 12 bed- intensive care unit (ICU) including 9 beds in a 220 m2 open space. We implemented a new multimodal approach without ward closure, cohorting or temporarily limiting admissions.MethodsA five-component bundle was introduced in 2018 including reinforcement of hand hygiene and sample extension of screening, application of contact precautions to all patients, enhanced environmental sampling and the one-time application of a cycling radical environmental cleaning and disinfection procedure of the entire ICU.The ICU-CRAB incidence density (ID), ICU alcohol-based hand rub consumption and antibiotic use were calculated over a period of 6 years and intervention time series analysis was performed. Whole genome sequencing analysis (WGS) was done on clinical and environmental isolates in the study period.ResultsFrom January 2013, nosocomial ICU-CRAB ID decreased from 30.4 CRAB cases per 1000 patients-days to zero cases per 1000 patients-days. Our intervention showed a significant impact (-2.9 nosocomial ICU-CRAB cases per 1000 bed-days), while no influence was observed for antibiotic and alcohol-based hand rub (AHR) consumption.WGS demonstrated that CRAB strains were clonally related to an environmental reservoir which confirms the primary role of the environment in CRAB ICU spreading.ConclusionA five-component bundle of continuous hand hygiene improvement, extended sampling at screening including the environment, universal contact precautions and a novel cycling radical environmental cleaning and disinfection procedure proved to be effective for permanently eliminating CRAB spreading within the ICU. Cohorting, admission restriction or ICU closure were avoided.

Impact of closure of the in-house psychiatric care unit on prehospital and emergency ward length of stay and disposition locations in patients who attempted suicide: A retrospective before-and-after cohort study at a community hospital in Japan.

Suicide is an increasingly serious public health care concern worldwide. The impact of decreased in-house psychiatric resources on emergency care for suicidal patients has not been thoroughly examined. We evaluated the effects of closing an in-hospital psychiatric ward on the prehospital and emergency ward length of stay (LOS) and disposition location in patients who attempted suicide.This was a retrospective before-and-after study at a community emergency department (ED) in Japan. On March 31, 2014, the hospital closed its 50 psychiatric ward beds and outpatient consultation days were decreased from 5 to 2 days per week. Electronic health record data of suicidal patients who were brought to the ED were collected for 5 years before the decrease in in-hospital psychiatric services (April 1, 2009–March 31, 2014) and 5 years after the decrease (April 1, 2014–March 31, 2019). One-to-one propensity score matching was performed to compare prehospital and emergency ward LOS, and discharge location between the 2 groups.Of the 1083 eligible patients, 449 (41.5%) were brought to the ED after the closure of the psychiatric ward. Patients with older age, burns, and higher comorbidity index values, and those requiring endotracheal intubation, surgery, and emergency ward admission, were more likely to receive ED care after the psychiatric ward closure. In the propensity matched analysis with 418 pairs, the after-closure group showed a significant increase in median prehospital LOS (44.0 minutes vs 51.0 minutes, P < .001) and emergency ward LOS (3.0 days vs 4.0 days, P = .014) compared with the before-closure group. The rate of direct home return was significantly lower in the after-closure group compared with the before-closure group (87.1% vs 81.6%, odds ratio: 0.66; 95% confidence interval: 0.45–0.96).The prehospital and emergency ward LOS for patients who attempted suicide in the study site increased significantly after a decrease in hospital-based mental health services. Conversely, there was significant reduction in direct home discharge after the decrease in in-house psychiatric care. These results have important implications for future policy to address the increasing care needs of patients who attempt suicide.

Demanding and rewarding: Midwives experiences of starting a continuity of care project in rural Sweden.

INTRODUCTIONThe closure of a local labor ward enhanced the possibility to initiate a continuity of midwifery care model project. Continuity models of midwifery care are a cornerstone in midwifery and women-centered care, mainly accessible in metropolitan areas. Australian studies have found continuity of midwifery care to work well in rural areas. The aim of this study is to describe midwives’ experiences of developing and working in a continuity of midwifery model of care in a rural setting in Sweden.METHODSWe used a qualitative longitudinal interview with a participatory action research approach. The project was subjected to changes over time to allow the midwives to provide the best care options and to develop a model suitable for a rural area in northern Sweden.RESULTSThe overarching theme, ‘Developing a continuity model of midwifery care – demanding and rewarding with new insights’, was based on three themes: 1) A challenging but evolving start, 2) Varying views within the midwifery group, and 3) Visions for the future. It was revealed that the midwives had to handle the grief process of the closure of the labor ward alongside their enthusiasm of being part of a continuity of midwifery care model project.CONCLUSIONSThe establishment of the model in light of the labor ward closure was associated with conflict within the community and this had implications for the midwives. Midwives who are attracted to work in continuity models need to understand and incorporate the prerequisites of such models. In addition, long commuting to a labor ward requires enough midwives to maintain safety and security for the women at all times.

Care of haematology patients in an overwhelmed healthcare system.

Care of haematology patients in an overwhelmed healthcare system.

Doing distance: expectant parents’ experiences of risk following a maternity ward closure

ABSTRACTThis article explores expectant parents’ experiences of risk and distance following a maternity ward closure in Sweden’s northern inland. Interviews were conducted in 2017–2018 and the data were subjected to narrative analysis. Theoretically, the research adopts a feminist approach to space and risk, viewing both as simultaneously material and fluid, intersecting with categories such as gender, class, and centre-periphery. The longer distance to maternity care was found to engender other distances, such as social and political, which were associated with particular risks and power structures. In particular, interviewees referred to a perceived distance from staff at the new hospital that threatened to turn labour into an unsafe experience, and a perceived distance from political decision-making, prompting feelings of unworthiness and distrust. In different ways, navigating these risks reproduced gender roles, and the parents’ social position – including gender, marital status, economic, and social resources – shaped how they navigated the new situation.

(De)politicising pregnancy-related risk: gender and power in media reporting of a maternity ward closure

Following a restructuring of Swedish healthcare in the 1990s – moving from a welfare model to one inspired by New Public Management – maternity care in Sweden is increasingly centralised to bigger towns. This has led to several units being relocated or forced to close, and to a bigger distance to maternity care for women living in smaller towns and rural areas. In the present article, I analyse the media reporting on the recent closure of the maternity ward in Sollefteå, a small town in Sweden’s northern region. Using intersectional risk theory, I explore how pregnancy-related risks are articulated in Swedish newspapers, and how such articulations relate to power and ideology. Articles from three Swedish newspapers, published during a 4-month period, have been analysed using critical discourse analysis. I conclude that the newspaper articles were most likely to stress the family as the main ‘risk victim’, while the pregnant woman was rarely the focus of risk articulations. When she was, risks were described as ‘worry’ or ‘unworthiness’, and never in medical terms. When such articulations appeared within an individualist ideological discourse, they were naturalised and as such, disconnected from the political decision to close the maternity ward. My contention is that a feminist perspective is largely missing in the media articles and that a bigger focus on the effect that maternity ward closures have for women living outside urban centres is needed.

Demotivating Factors among Third Year Medical Students in a Public Medical College in Pakistan.

To identify demotivating factors among third year medical students and its possible solutions. Mixed methods approach including questionnaire and focus group interview sessions. Services Institute of Medical Sciences, Lahore, Pakistan, affiliated with the University of Health Sciences, Lahore, from January to July 2016. Nieuwhof and associates validated questionnaire strength of motivation in medical students was used for third year medical students. Focus group interviews were conducted to assess possible solutions. A total of 108 students completed the questionnaire but only 65 students gave informed consent for interviews. More than 90% of students agreed that subjects were relevant. Time constraints, ward closures and poor communication about time and place for clinical tutorial were among the issues pointed out by students. Frequent change of teachers and poor motivation on part of tutors were considered reasons for poor attendance by students. Cochrane's alpha score was 0.708. Poorly defined syllabus and topics for clinical teaching, absence of mandatory attendance for clinical teaching, and lack of proper introduction to clinical rotation were concerns for students. Students of third year get demotivated because of sudden change in subjects from basic to clinical and lack of commitment from teachers in a public medial college. These factors can be improved by mandatory attendance, introduction of pre-clinical orientation sessions before start of clinical rotations, and appointment of dedicated clinical tutors who kindle the fire for clinical learning in hearts of medical students.

Mergers and Birth Outcomes: Evidence from Maternity Ward Closures

Evidence suggests that hospital mergers can reduce costs but less is known about their effects on patient outcomes. We study how a wave of mergers that led to the shutdown of one third of all Swedish maternity wards affected the health of mothers who gave birth and their newborns. Applying a difference-in-differences approach to register data on all births in Sweden over two decades, we show that the closures negatively affected the health of mothers, while effects on infant health were small and insignificant. The adverse effects on mothers are mainly driven by crowding effects at remaining wards rather than by increased distance to the wards. Moreover, the closures reduced the use of C-sections for high-risk births.

Environmental scan of infection prevention and control practices for containment of hospital-acquired infectious disease outbreaks in acute care hospital settings across Canada

Ward closure is a method of controlling hospital-acquired infectious diseases outbreaks and is often coupled with other practices. However, the value and efficacy of ward closures remains uncertain. To understand the current practices and perceptions with respect to ward closure for hospital-acquired infectious disease outbreaks in acute care hospital settings across Canada. A Web-based environmental scan survey was developed by a team of infection prevention and control (IPC) experts and distributed to 235 IPC professionals at acute care sites across Canada. Data were analyzed using a mixed-methods approach of descriptive statistics and thematic analysis. A total of 110 completed responses showed that 70% of sites reported at least 1 outbreak during 2013, 44% of these sites reported the use of ward closure. Ward closure was considered an "appropriate," "sometimes appropriate," or "not appropriate" strategy to control outbreaks by 50%, 45%, and 5% of participants, respectively. System capacity issues and overall risk assessment were main factors influencing the decision to close hospital wards following an outbreak. Results suggest the use of ward closure for containment of hospital-acquired infectious disease outbreaks in Canadian acute care health settings is mixed, with outbreak control methods varying. The successful implementation of ward closure was dependent on overall support for the IPC team within hospital administration.

What happens when 55% of acute psychiatric beds are closed in six days: an unexpected naturalistic observational study.

ObjectiveThe sudden closure of 30 out of 54 acute psychiatric beds in Cornwall presented a stressful challenge to staff but also a natural experiment on how a service dealt with this situation. We aimed to evaluate the outcomes of patients needing to leave the closed ward, how bed occupancy rates were affected and the impact on admission rates.DesignA service evaluation of the impact of the ward closure.SettingA comprehensive secondary NHS mental health service in Cornwall serving 550,000 population.Main outcome measuresThe destination of the patients needing to leave the acute unit, the effect of the closure on bed occupancy, admission rates and serious untoward incidents.ResultsOf 26 patients needing to be moved from the acute ward, only 10 needed an acute psychiatric bed. None of the seven patients who had been on the ward longer than nine weeks needed an acute unit. Admission rates fell over the subsequent three months. There was no increase in serious incidents due to the closure.ConclusionsThis naturalistic event suggests that many patients on acute units could be cared for elsewhere, especially recovery/rehabilitation care environments, if political and financial urgency is present. Admission rates are responsive to the pressure on beds.

Age discrimination by fellow nurses is forcing me to leave.

I would like to share my upsetting experience of working in an acute hospital. I am an older, experienced nurse with a wide range of knowledge within different specialties. Due to a ward closure, I was transferred to another hospital to take charge of an acute receiving unit with a workforce of young, newly qualified nurses. Since then, I have been told to my face that I am too 'old' for the job and need to retire. Nurses seem to be sneering: 'Look at her, she is just an elderly nurse who is shockingly still working.'