Date: 19 December, 2012
Hospital project frees up bed space
A Waikato Hospital initiative looking at long-stay patients is freeing up bed space, lifting elective surgery numbers and getting those “stranded” patients back to their communities.
“We called them stranded patients, but in fact they were long length of stay due to a number of factors that weren’t prevalent in patients with lengths of stay closer to the norm,” says project convener, General and Specialty Surgery nurse manager Karry Durning,
By identifying common markers of long-term patients Waikato Hospital has seen more than 7000 available bed days created for other patients over the past three and a half years.
“As part of the study more than 140 cases of long-stay patients were reviewed and we saw the same barriers to progress appearing in the patients’ journeys over and over again,” says Karry. “We now track and monitor progress on all our patients who stay over 10 days.”
In 2008-09 long-stay patients took up 44,707 bed days (23 per cent) but accounted for only 2 per cent of inpatient throughput. “On average there were 35-40 patients daily in the hospital with a length of stay greater than 21 days. Indirectly, the long length of stay of these patients created throughput constraints at ward level that contributed to elective surgical cancellations and admission delays from the Emergency Department.”
Long-term stay patients now make up 1 per cent of patients and the bed-days used on these patients has been steadily declining now for nearly four years.
The study has found the quality of care decreases, and risk of hospital-acquired infections, skin pressure wounds and falls increases the longer patients stay in hospital.
Karry has also been instrumental in developing an early identification tool which defines the risk indicators for long length of stay patients. There are 24 indicators defined on the tool and if six or more are present at the time the patient is assessed, the risk of long length of stay becomes real. That puts into play a number of processes to ensure the risks are monitored and patient progress is measured and interventions occur to improve patient progress and get better outcomes.
Clinical nurse specialist Angela Mortimore spends half her weekly time on the project and soon the project will bring together senior nurses from other inpatient services and district nursing services to form the core of the team to support progress for these patients.
“We’re also placing quite a bit of focus in
supporting the discharge of these people back into the
community, or their local district hospital, as soon as they
are able to be discharged safely,” Karry
“We’re doing that by bringing senior district nurses into the inpatient event and assisting the discharge. We’re able to stream the patient back with equipment, clinical and personal care services that we can deliver in the community setting. Anything that gets these patients back into their own environment quicker is better for them.
“The district nursing service works with Allied Health staff – social workers, occupational therapists, physiotherapists and dietitians, meals on wheels, disability support services – and supports discharge back to the GP setting and other health providers.
“We also recognise that some of these patients already have contact with our district nursing service and occasionally with other services such as disability support, aged care and mental health, so we’re also trying to bring consistency into the long-stay patients’ experience by maintaining the care programmes through the inpatient stay.’’
For Waikato Hospital freeing up those beds has had great benefits.
“We have eliminated cancellations for elective surgeries in General and Specialty Surgery even when we are in the middle of full winter occupancy. We are completing more elective surgeries and seeing more patients through our beds than ever before,” Karry says.
“And we are still making bed day gains.”
The project has a key role in reducing the hospital’s acute care target of no more than six hours in the Emergency Department. “We start the day with empty beds so can pull patients out of ED and critical care,” Karry says.
“It allows us to ring-fence 14 elective short-stay beds where we have guaranteed bed capacity. So we don’t need to cancel any elective surgeries in my service cluster [General and Specialty Surgery] due to bed block.”
Waikato’s work with stranded patients is being looked at by hospitals throughout Australasia. “A number of Australian and New Zealand hospitals are doing this work now but we are the only one taking it this far,” Karry says.
Others involved in the project are nursing director Suzanne Lawes, group manager Mark Spittal, assistant group manager Kevin Harris, group manager rural and community Jill Dibble and a number of resources across Waikato Hospital’s Rural and Community services.
“We have some skilled and talented people from the hospital and community teams working on this and we’re bringing new ways of joining up our services to support this initiative,” Karry says.