The self-perpetuating problem of bed blocking
As soon as they are clinically ready to leave the hospital, patients start counting the minutes until their discharge. But can you imagine waiting days, months or even years? One UK report shows that some patients wait longer than a year; one patient stayed in hospital for an astonishing 508 days after being fit for discharge.
This phenomenon is known as “bed blocking” – a term used to describe when patients stay in the hospital for a non-medical reason, such as waiting for social services, a place in a nursing home or equipment to adapt their homes.
Unfortunately, these patients are taking up hospital resources that are desperately needed for other patients. It’s contributing to alarming bed shortages. A BBC analysis showed that nine in 10 hospitals were overcrowded this winter, limiting access to critical healthcare services.
An extra challenge is the self-perpetuating nature of the bed blocking. The longer a patient stays, the more vulnerable they are to hospital-acquired infections and other complications. Long-term patients aren’t as mobile, lose independence and quickly become dependent on staff. They become harder to discharge because they require more services, exacerbating the bed blocking issue.
Top 5 ways an electronic patient record (EPR)* can reduce bed blocking
So, what is the answer? In my experience as a hospital doctor, and now as a medical director for a company that provides fully-integrated EPR platforms, I’ve seen several ways this type of solution can help.
1) Real-time tracking boards
Even though the UK has spent hundreds of thousands of pounds on clinical systems, many struggle to keep their bed status up to date outside “9 to 5.” During the traditional work hours, when administrative staff are available, this task is easier to achieve. Consequently, “out of hours” tracking boards may not reflect changes, such as admissions, discharges or patients being moved between wards or facilities.
Boards with inaccurate information are difficult to trust, which exacerbates effective bed management. Tracking boards that are directly linked to the EPR enable clinicians to update patient locations easily and consequently help maintain the bed state.
2) Effective record of patient health and social history
As patient populations get older, chronic diseases and co-morbidities become more prevalent. This results in frequent hospital admissions for this subset of patients as they experience exacerbations of their condition. If clinicians are aware of the health and social history of the patient upon admission, it will also make discharge more efficient.
For example, if a patient has dementia and their home situation is documented consistently, that information will be available at each subsequent admission. It enables the care team to coordinate appropriate home care and reduces delays in discharge.
3) A single patient record for all disciplines
One of the biggest issues in the UK is that many organisations have a “best-of-breed” approach to technology, with data in multiple disparate clinical systems. This information is poorly linked, making it difficult for clinicians to view the entire patient record and come together as a multidisciplinary team. A quality EPR workflow can help mobilize care teams more efficiently and enhance communication.
For example, if a patient is admitted for a hip replacement, he will need an occupational therapist review before discharge. rather than waiting until after his surgery, the EPR can automate that referral upon admission to save clinicians’ time and speed up routine inpatient activities.
4) Coordinated discharge summaries
When we admit patients, we should already be planning discharge. Clinical Decision Support and pathway-specific workflow tools within an EPR can help encourage the clinician to start inputting to that discharge summary from the day of admission. This includes tools to facilitate converting inpatient drugs directly to discharge medications.
5) Identification of trends that contribute to the problem
From a patient population point of view, an EPR can enable organisations to evaluate discharge patterns and length of stay. We can analyse the data to predict how long it will be for certain conditions, procedures and even the typical length of stay under the care of individual clinical teams. This can help identify and address issues.
While technology is not the only solution for this problem, we should take every opportunity to reduce bed blocking. EPR capabilities can not only improve throughput for patients, they help improve patient safety and the experience for the patients and their families.
Many of us can relate to the worry of waiting for a loved one to come home from the hospital, or knowing a friend is waiting for an open hospital bed. The hospital bed is an expensive resource, and if managed ineffficiently, it has consequences for both the patient and organisation.
* Editor’s Note: Electronic Patient Record (EPR) is another term for Electronic Medical Record (EMR) or Electronic Health Record (EHR).