Bed management team with Kanban web-based application

Managing inpatient bed setup: an action-research approach using lean technical practices and lean social practices

PURPOSE

This article aims to introduce a guide to improving hospital bed setup by combining lean technical practices (LTPs), such as kaizen and value stream mapping (VSM) and lean social practices (LSPs), such as employee empowerment.

DESIGN/METHODOLOGY/APPROACH

Action research approach was employed to analyze the process of reconfiguration of bed setup management in a Brazilian public hospital.

FINDINGS

The study introduces three contributions: (1) presents the use of VSM focused specifically on bed setup, while the current literature presents studies mainly focused on patient flow management, (2) combines the use of LSPs and LTPs in the context of bed management, expanding current studies that are focused either on mathematical models or on social and human aspects of work, (3) introduces a practical guide based on six steps that combine LSPs and LSPs to improve bed setup management.

RESEARCH LIMITATIONS/IMPLICATIONS

The research focused on the analysis of patient beds. Surgical beds, delivery, emergency care and intensive care unit (ICU) were not considered in this study. In addition, the process indicators analyzed after the implementation of the improvements did not contemplate the moment of the COVID-19 pandemic. Finally, this research focused on the implementation of the improvement in the context of only one Brazilian public hospital.

PRACTICAL IMPLICATIONS

The combined use of LSPs and LTPs can generate considerable gains in bed setup efficiency and consequently increase the capacity of a hospital to admit new patients, without the ampliation of the physical space and workforce.

SOCIAL IMPLICATIONS

The improvement of bed setup has an important social character, whereas it can generate important social benefits such as the improvement of the admission service to patients, reducing the waiting time, reducing hospitalization costs and improving the hospital capacity without additional physical resources. All these results are crucial for populations, their countries and regions.

ORIGINALITY/VALUE

While the current literature on bed management is more focused on formal models or pure human and social perspectives, this article brings these two perspectives together in a single, holistic framework. As a result, this article points out that the complex bed management problem can be efficiently solved by combining LSPs and LTPs to present theoretical and practical contributions to the important social problem of hospital bed management.

The Effectiveness of a Multidisciplinary Electronic Discharge Readiness Tool: Prospective, Single-Center, Pre-Post Study

Background

In the face of hospital capacity strain, hospitals have developed multifaceted plans to try to improve patient flow. Many of these initiatives have focused on the timing of discharges and on lowering lengths of stay, and they have met with variable success. We deployed a novel tool in the electronic health record to enhance discharge communication.

Objective

The aim of this study is to evaluate the effectiveness of a discharge communication tool.

Methods

This was a prospective, single-center, pre-post study. Hospitalist physicians and advanced practice providers (APPs) used the Discharge Today Tool to update patient discharge readiness every morning and at any time the patient status changed throughout the day. Primary outcomes were tool use, time of day the clinician entered the discharge order, time of day the patient left the hospital, and hospital length of stay. We used linear mixed modeling and generalized linear mixed modeling, with team and discharging provider included in all the models to account for patients cared for by the same team and the same provider.

Results

During the pilot implementation period from March 5, 2019, to July 31, 2019, a total of 4707 patients were discharged (compared with 4558 patients discharged during the preimplementation period). A total of 352 clinical staff had used the tool, and 84.85% (3994/4707) of the patients during the pilot period had a discharge status assigned at least once. In a survey, most respondents reported that the tool was helpful (32/34, 94% of clinical staff) and either saved time or did not add additional time to their workflow (21/24, 88% of providers, and 34/34, 100% of clinical staff). Although improvements were not observed in either unadjusted or adjusted analyses, after including starting morning census per team as an effect modifier, there was a reduction in the time of day the discharge order was entered into the electronic health record by the discharging physician and in the time of day the patient left the hospital (decrease of 2.9 minutes per additional patient, P=.07, and 3 minutes per additional patient, P=.07, respectively). As an effect modifier, for teams that included an APP, there was a significant reduction in the time of day the patient left the hospital beyond the reduction seen for teams without an APP (decrease of 19.1 minutes per patient, P=.04). Finally, in the adjusted analysis, hospital length of stay decreased by an average of 3.7% (P=.06).

Conclusions

The Discharge Today tool allows for real time documentation and sharing of discharge status. Our results suggest an overall positive response by care team members and that the tool may be useful for improving discharge time and length of stay if a team is staffed with an APP or in higher-census situations.

Understanding the work and decision-making strategies of bed management nurses: a systematic review

The need for hospital-wide solutions to improve patient flow is broadly recognised. Bed management nurses are integral to patient flow processes, and recognition of their strengths and skills is crucial in implementing effective solutions, yet there is limited research describing their role. This article details a systematic review of the literature on bed management nurses. Six themes were identified: complexity in a context of scarcity; dealing with external pressures and conflicting priorities; need for multiple decision-making strategies; uncertainty; need for training; and unrecognised yet important work. The findings could assist nurse managers and hospital leaders to promote communication, teamwork and coordination between hospital staff and bed management nurses.