Press Release - Inpatient Admissions and Bed management in NHS
acute hospitals
24 February 2000
Sir John Bourn, head of the National Audit Office, reported to
Parliament today that many NHS hospitals have made important
improvements in the way they admit and discharge patients, and
manage their bed stock. But there are significant variations in
performance, and some trusts could do more to reduce the number of
cancelled operations and delays in discharging people from
hospital.
In 1998-99, around six million patients in England stayed at
least one night in NHS hospitals, a record level, and two thirds
were emergency cases. This record was achieved despite a fall in
the number of general and acute hospital beds in recent years, made
possible by changes in patient care practices. But there are signs
of significant pressures, with the number of operations cancelled
for non-medical reasons on the day of admission reaching record
levels, and around 20 per cent of emergency patients waiting longer
for admission than the Patient’s Charter standard of two hours. In
addition, 35 per cent of hospitals reported facing times when
demand for beds exceeds availability at least once a day, and
delays in discharge from hospital affect an average of nearly 6,000
people over 75, costing trusts about £1 million a day. Significant
numbers of patients were waiting for an outpatient consultation in
excess of the Charter standard.
In response to these pressures, Sir John found that many NHS
hospitals are making considerable efforts to improve the way they
admit and discharge patients, and manage their bed stock. In
particular:
- almost all hospital Accident and Emergency departments will
have an admissions unit or observation ward by July 2000 to reduce
patient waiting times, to accommodate patients with medical
emergencies more comfortably, and to reduce the overall level of
emergency admissions;
- there has been a 20 per cent increase in two years in the
number of trusts with bed managers, whose role is to ensure
patients are placed promptly in appropriate beds;
- almost all hospitals have strategies to respond to short-term
bed shortages; and
- around three quarters of trusts now employ discharge
co-ordinators to help overcome obstacles to patients being
discharged when ready, compared to around 40 per cent in 1997.
But, Sir John found that bed unavailability is the most common
cause of cancelled operations, with beds occupied by new emergency
cases or patients whose discharge has been delayed. He also found
that very few hospitals have systems providing up to date
information to monitor and coordinate key resources such as beds
and theatre time, and that in over 90 per cent of trusts, bed
managers obtain information on bed availability only through
physical inspection and telephoning wards several times a day. He
also found that more than a quarter of trusts did not begin to
consider discharge needs of patients as early as they could.
Based on findings from the first comprehensive survey of
hospital practices, Sir John highlights 20 areas where more NHS
acute trusts could follow the lead of others. In particular, he
concludes that more trusts could assess patients before they are
admitted; admit greater numbers of patients on the same day as
their operation; and more could begin liaison earlier with other
care agencies to plan patient discharge. In addition, Sir John
points to three areas where across-the board improvements are
necessary. These are in:
- developing significantly improved information systems to allow
hospitals to monitor and plan better the use of key resources such
as beds and theatre time;
- enhancing the role of bed managers to move away from crisis
management, and make better use of their knowledge to plan
admissions and think strategically about the use of beds; and
- improving co-ordination between different professional groups
within hospitals, and between hospitals and other external care
agencies such as social services, to minimise the risk of delays in
discharging those ready to leave hospital.
Sir John said today:
"This winter has reminded us again of how crucial it is
that hospitals manage their bed stock effectively. We have found
significant variations in performance between hospitals in
admitting and discharging patients, and managing beds. Failing to
place patients promptly in the most appropriate facilities,
cancelling their admission, or delaying their discharge from
hospital can cause enormous frustration and distress. More
hospitals should follow the good practices we have highlighted to
help improve the overall quality of service to
patients."
Notes for Editors
The Committee of Public Accounts is expected to take evidence on
this report on 29 March.
Press notices and reports are available from the date of
publication on the NAO website at http://www.nao.org.uk/ Hard copies can
be obtained from The Stationery Office on 0845 702 3474.
The Comptroller and Auditor General, Sir John Bourn, is the head
of the National Audit Office employing some 750 staff. He and the
NAO are totally independent of Government. He certifies the
accounts of all Government departments and a wide range of other
public sector bodies; and he has statutory authority to report to
Parliament on the economy, efficiency and effectiveness with which
departments and other bodies have used their resources.
Press Notice 10/00
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