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Holiday bed management success


Constant improvement is at the heart of health care, so when our friends in Patient Flow recognized an opportunity to improve bed management over the holidays, they jumped into action.

“It was incredible work done by managers and a lot of others to make this plan successful,” said Dr. David McCutcheon, VP of the Medicine Service Line, and an integral member of the plan. “Charge Nurses played an integral role in ensuring the success of bed management over the holidays, as did our front-line clinicians and physicians.”

“We started off in Nov. 2015 where we looked at our data to find historically what has been the impact of holidays and winter season on bed management,” said John Ash, Executive Director of Patient Flow. “The trend over the holidays is a reduction in occupancy leading up to Christmas, which then steadily increases between the holiday and New Years which lasts throughout January.”

To ensure the data was saying what they thought it was saying, they reached out to other jurisdictions – and the results were consistent.

“Typically, we see the increase in occupancy mainly due to length of stay of patients. Over the holidays, staff and physicians as a whole gear down, and our access to services, whether that be home care, social workers or physiotherapy services, become weekend staffing patterns and this leads to care plans not progressing as quickly as they can when staffing is at its peak,” Ash says. “What that does is create a bubble that increases length of stay which can take weeks to get through the system.”

That, coupled with normal seasonal illness in late winter, adds to this bubble leading to a decrease in available beds.

“We engaged all of the inpatient units, support services, access coordinators (social workers), community services and Primary Health Care and said we need to ensure we have baseline staffing at minimum,” Ash said as they worked through the solutions. “Some areas actually increased their staffing from typically weekend staffing to normal weekday staffing. Inpatient unit leadership was actively engaged with their staff expressing the importance of progressing the care plan throughout the holidays.”

This is not the first time holiday bed management has been evaluated. Last year, work was done to try to eliminate the late winter bubble, but with the goal of constant improvement, this year was viewed as another opportunity to do better.

“In looking at our data, we identified that high occupancy is due to medicine patient number increase. Understanding that we had a surgical slow down over the holidays, and traditionally we have a slowdown in cardioscience patients, we re-allocated beds from those places to medicine,” Ash explained.

Generally speaking the change saw a reallocation of eight beds at PH and eight at RGH. Occupancy patterns were also reviewed, so services weren’t impacted.

“We balanced things more appropriately for that period of time,” Ash said.

Starting December 28, existing capacity was allocated to medicine and daily calls were initiated until January 4, where we had Executive Directors, Directors and VPs monitoring how the plan was working and supplying support and direction to physicians and staff on daily plans.

“Dr. David McCutcheon rounded on every unit every day from December 28 to February 3 reviewing care plans and escalating issues,” Ash explained. “I think his assessment really highlighted that our planning activities were really paying off. Units were engaged, they knew what was going on with their patients, they knew what the barriers were and they were actively working to make the plan work,” Ash explained.

It was a huge team effort, with great work from many. Patient Flow, Mental Health and Addictions, Surgery Clinical Support, Home Care and the Medicine Service lines all worked together to turn the plan into success. But, as it goes in health care, they aren’t done yet.

“We need to keep working on this next year too. We had a lower degree of occupancy, and the pressure wasn’t as bad because we had mild weather. And, flu had not had a significant impact on the community at the time, so our admission volume was lower,” said Ash.