Impact of patients awaiting social care and rehabilitation on acute

Impact of patients awaiting social care and rehabilitation
on acute medical beds, boarding and bed-wait breaches
- the need for health and social care integration.
Dr Tom French, Clinical Teaching Fellow in Acute Medicine, Dr Mahanth Manuel, Consultant in Acute Medicine,
and Dr David Wilkin, Consultant in Acute Medicine, University Hospital Crosshouse, Kilmarnock Scotland.
Aim
Conclusion
To demonstrate the impact of delayed discharges due to patients in the medical directorate
(MD) awaiting social care (SC) or transfer to rehabilitation beds (RBs) on acute hospital bed
days (BDs), boarding, patient flow and bed occupancy within a Scottish DGH.
Our results demonstrate the detrimental impact of inappropriate use of acute beds by the
patients awaiting SC or RB on bed occupancy, boarding and bed-wait breaches in ED and
highlights the imperative need for efficient and effective health and social care integration2.
It has also highlights the financial implications of operating the patient flow system as it
currently stands.
Method
Over a four-week period, each day, all in-patients within the MD were assessed and the
cohort of patients awaiting SC or transfer to RBs was identified. This was compared to the
medical patients (MPs) boarded to surgical beds, the MPs who breached in the emergency
department (ED) waiting for beds and bed occupancy of the MD on those days.
Results
On average, the sampled patients occupied 16% of the MD capacity. The table illustrates
that if the patients awaiting SC were no longer occupying acute beds then the overall bed
occupancy would fall to below the national recommendation on all of those days. This would
also repatriate all surgical boarders under the MD, on all but one day. On average 268.5 BDs
were lost weekly costing £115,723 per week. There is also a statistically significant correlation
between number of patients awaiting SC or RB on a given day and the number of bed-wait
breaches in ED. It is known that lengthier ED stays contribute to increased patient morbidity
and mortality1
The health board will benefit in four ways if this group of patients are provided timely social
care or moved to rehab beds:
1. Improved capacity in downstream wards and efficient patient flow facilitating good care
for the acutely ill at front door in AMU and ED with overall reduction in length of hospital
stay. 2. A falling length of stay and improved patient flow increases patient safety; and decreases
the incidence of health care associated adverse events for all patients within the system. 3. The requirement for medical boarding will be minimal, further improving patient safety,
care, and outcomes.
4. There would be a net saving of £1,558,730 per year for NHS Ayrshire and Arran.3 These
resources could be used for improving the social service infrastructure according to the
new Scottish Government legislation for Health and Social Care Integration.
While awaiting Health and Social care integration, the next step is to coordinate a robust and
effective interaction at the interface of health and social care.
Given the aging population, this cohort of patients is likely only to increase and, therefore,
new ways of managing the situation sustainably need to be found. The data should be
re-collected to demonstrate the predicted positive impact that the Social and Health Care
Integration can have on patient welfare, morbidity and mortality.
Table 1
Figure 2
40
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
Patients
awaiting SC or 35
RB
34 31 29 33 33 33 30 29 25 25 42 42 42 45 41 50 48 57 52 51 56 53 50 35 36 35 35
Boarded into
Surgery
32 26 9
41
Bed-wait
6
breaches in ED
Total % Bed
Occupancy
within MD
Projected %
Occupancy
without SC
waits within
MD
35
30
6
1
0
8
5
6
6
5
6
4
10 31 1
4
0
4
1
6
2
3
2
3
1
3
8
10 10 13 17 23 23 12 22 22 21 12 9
14 12 0
18 13 19 8
20 36 31 14 1
0
0
Number Of "Breaches" In ED
Day
25
20
15
10
5
98
94 90 90 88 92 96 94 93 94 95 91 91 91 92 95 97 96 96 97 99 97 98 94 91 88 94 95
0
20
30
40
50
60
Number Of Patients Awaiting Social Care Or Rehab Beds
rs =0.51 (P=0.005 95% CI 0.17 to 0.74)
45
84
80 77 78 74 78 82 82 81 84 85 74 74 74 73 78 76 76 72 76 78 74 76 73 77 73 80 81
40
References
1. Singer, A. J., Thode Jr, H. C., Viccellio, P. and Pines, J. M. (2011), The Association Between Length of Emergency
Department Boarding and Mortality. Academic Emergency Medicine, 18: 1324–1329
2. Scottish Parliament. Public Bodies (Joint Working) (Scotland) Bill. http://www.scottish.parliament.uk/S4_Bills/
Public%20Bodies%20(Joint%20Working)%20(Scotland)%20Bill/b32bs4-aspassed.pdf (accessed 4/3/14)
3. http://www.isdscotland.org/Health-Topics/Finance/Costs/Detailed-Tables/Speciality-Costs/Acute-Medical.asp (accessed
12/03/14)
Number Of Surgical Boarders
35
30
25
20
15
10
5
0
20
30
40
50
Number of Patients Awaiting Social Care Or Rehab Beds
rs =0.32 (p=0.09 CI 95% 0.05-0.62)
Contact: [email protected]
60

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