Summary: Centre For Clinical Effectiveness

LITERATURE REVIEW
ON
INTEGRATED BED AND PATIENT MANAGEMENT

Centre for Clinical Effectiveness
Monash Institute of Public Health
&
Planning & Development Unit
Southern Health

Jeremy Anderson
Vivienne Bernath
Jan Davies
Louise Greene
Sam Ludolf

January 2001

CONTENTS
TITLE ........................................................................................................................................... 1
CONTENTS ................................................................................................................................. 2
SUMMARY: FINDINGS OF THIS REVIEW ................................................................................. 3
Increasing demand for acute inpatient hospital admissions is universal ....................................
3
CHAPTER ONE: MANAGING HOSPITAL ADMISSIONS........................................................... 4
Why is demand increasing?........................................................................................................ 4
Strategies to manage demand.................................................................................................... 4
Organisational strategies ............................................................................................................ 5
Patient level strategies ................................................................................................................ 6
CHAPTER TWO: PRE-ADMISSION PROCESSES ................................................................... 7
Pre-admission clinics, admission on day of surgery and day surgery ........................................ 7
Pre-admission clinics .................................................................................................................. 7
CHAPTER THREE – INITATIVES IN EMERGENCY DEPARTMENTS....................................
Currently there is concern about the appropriateness of acute hospital care for certain conditions, and increasing interest in providing care in settings that may better meet
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patient needs, and perhaps be cheaper .

Literature Review on Integrated Bed and Patient Management

4

“Substitute care” is receiving increasing attention. Such substitutes include substitution for a hospital admission (eg. home care) and substitution for hospital stay (eg early discharge, including the use of intermediate care for patients in acute hospital beds who no longer require intensive care). The organisational purpose of such strategies must be clear. If the aim is to treat a constant level of demand at lower cost, then the introduction of “substitutes” must be accompanied by closure of acute capacity, otherwise there will be increased supply and increased costs. If alternatively, the aim is to treat increased demand, then “substitutes services”
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may do this more efficiently than opening more acute beds .
The focus of demand management strategies is on the acute admission threshold. Edwards and