The key to tackling crowded hospitals and emergency departments is to reduce length of stay. I don't mean average length of stay. I mean the length of stay of every patient. And I'm not thinking about length of stay in days. Length of stay should be thought about in terms of minutes, hours and days. Shave off 2 hours stay on the day of discharge, and you help clear the emergency department of a waiting patient earlier in the day. Many of ECIP's tools help reduce length of stay when implemented properly and at scale. The SAFER patient flow bundle tackles many of the factors that cause delays during inpatient episodes and helps reduce the length of stay of patients. Red2Green is a fabulous tool that can be used on daily ward and board rounds to galvanise teams to make sure that every day a patient is in hospital is value adding. Discharge to Assess potentially slashes the stays of frail older people who might otherwise decompensate in hospital.
ECIP has found that up to 25% of non-elective patients in hospital beds could be discharged immediately. They are waiting unnecessarily, wasting hours and contributing to crowding. A further 25% are in hospital because of delays that are entirely within the gift of acute trusts. Only a minority are delayed due to social care - a lot more are delayed due to glacial NHS processes.
So think length of stay. Don't focus on external delays before you have tackled all the internal delays that are so prevalent in hospitals. Believe that you can make a difference. If you don't, you won't.
20 Feb '18
Completely agree, look at the best performers in London and then at their performance improvement in NEL LOS. Chelsea & Westminster are a great example of this.
3 Oct '18
To attend to patient priorities and secure further elective income once the LOS is improved, using the methodologies that Russell has helpfully outlined, a sophisticated solution needs to match the bed space available and planning of priority elective work . I wonder whether there are good examples from Acute providers of optimising this?
2 Jan '19
Thanks for the discussion points. Patient flow issues and staffing challenges can be daunting even if the hospital per se is not short of beds.
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