The author will discuss within the essay, the introduction of the Emergency Care Standard and the effects on patient flow within the NHS. Also, the many changes which have implications for the author professional practice and how if possible they maybe overcome. Background
Queuing is feature of our daily life, whether in an airport, a post office or Emergency Departments(ED), few of us wishes to wait too long for service. The clinical cost of waiting too long for urgent treatment in an ED is all too long for service. Following media headlines, pooled with powerful political agenda lead to, in the late 1990s and the early 2000s many ED in the UK were struggling with high demand and poor patient flow. During this period it was commonplace for emergency care patients to be kept on trolleys awaiting hospital admission for over 12 hours, and sometimes up to 72 hours. The NHS plan (Department of Health 2000), states that no-one should wait more than 4 hours in the ED. High profile negative press coverage and public opinion meant this issue became a priority for the government. This gave rise to the development of the post in which the author currently finds himself, namely Inpatient Placement coordinator (IPC), or, more commonly referred to as “Bed Manager”, within the Trust. Consequently with the health and social care environment is rapidly transforming there are many changes which have implications for the author professional practice.
The author will now continue to analyse and discuss some of these changes.
Bed management can be defined as:
Keeping a balance between flexibility for admitting emergency patients and high bed occupancy (which) has been an indicator of good hospital management since before the establishment of the NHS
(Green and Armstrong, 1994, p.20)
Bed management is an area of nursing management which has expanded significantly over the last decade or so, Proudlove N, Boaden R, Jorgenson J (2007). According to Proudlove N, Gordon K, Boaden R (2003), bed management forms an important of operational capacity, planning and control, in particular bed management, plays and could play, improving service delivery and deliver government’s emergency care standards. The role of the IPC can play an important part in on-going efforts to improve a Trusts ability to admit, treat and discharge patients appropriately. According to Proudlove et al (2007), there is increase awareness that effective management of the flow of inpatients through acute hospitals is essential to good quality inpatient care and to achieving the relevant NHS Plan (DH, 2000) targets.
The consequence of patient flow does not always seem to be fully appreciated, Haraden & Resar (2004), and consequently bed management is often negatively reported leaving IPCs to feel undervalued and under-supported. The consequences of poor flow management is often detrimental to quality of patient care although evidence about this is not conclusive as concluded by Clarke & Rosen (2001).
The author was unable to complete a systematic review of the literature as most literature on bed management is ‘grey’ and there are few academic studies of this area, as noted by Proudlove N, et al (2007). The only article of note is Lying in Wait, Audit Commission (1992), who highlights that there are no national protocols for best practice in this area. Bed management and patient flow are a new phenomenon brought about by the introduction of the new Government targets and the NHS plan (DH, 2000). There is plethora of literature on patient flow and how to achieve and maintain the Government targets (Mortimore A, Cooper S 2007). Largely, from the literature found using CINAHL and Government websites, it can be established that most IPC’s had not received training on issues such as managing patient placement, bed availability, let alone on the principles of patient flows or organisational change. These skills generally...
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