Continuous flow models in urgent and emergency care

Vaughan, Louella; Bruijns, Stevan R.

doi:10.1136/bmj.o2751

Cited by 7 publications

(6 citation statements)

References 13 publications

(15 reference statements)

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“…[71], [72] These can result in more patients placed on wards with any available space, increasing atypical transfers. [73] While our findings show that atypical transfers do not increase mortality or readmission, their relationship to increased LOS suggests that such strategies may exacerbate exit-block in the long-term, as patients remain in hospital for longer. From a systems perspective, minimising atypical transfers helps to sever the cycle of bed-blocking that occurs when patients on the wrong ward spend extra days in hospital, thereby further diminishing access to beds.…”

Section: Discussioncontrasting

confidence: 56%

The impact of atypical intrahospital transfers on patient outcomes: a mixed methods study

Mendelsohn

Honeyford

Brittin

et al. 2023

Preprint

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BackgroundThe architectural design of hospitals worldwide is centred around individual departments, which require the movement of patients between wards. However, patients do not always take the simplest route from admission to discharge, but can experience convoluted movement patterns, particularly when bed availability is low. Few studies have explored the impact of these rarer, atypical trajectories.MethodsUsing a mixed-method explanatory sequential study design, we firstly used three continuous years of electronic health record data prior to the Covid-19 pandemic, from 55,152 patients admitted to a London hospital network to define the ward specialities by patient type using the Herfindahl-Hirschman index. We explored the impact of ‘regular transfers’ between pairs of wards with shared specialities, ‘atypical transfers’ between pairs of wards with no shared specialities and ‘site transfers’ between pairs of wards in different hospital site locations, on length of stay, 30-day readmission and mortality. Secondly, to understand the possible reasons behind atypical transfers we conducted three focus groups and three interviews with site nurse practitioners and bed managers within the same hospital network.ResultsWe found that at least one atypical transfer was experienced by 12.9% of patients. Each atypical transfer is associated with a larger increase in length of stay, 2.84 days (95%CI: 2.56-3.12), compared to regular transfers, 1.92 days (95%CI: 1.82-2.03). No association was found between odds of mortality, or 30-day readmission and atypical transfers after adjusting for confounders. Atypical transfers appear to be driven by complex patient conditions, a lack of hospital capacity, the need to reach specific services and facilities, and more exceptionally, rare events such as major incidents.ConclusionOur work provides an important first step in identifying unusual patient movement and its impacts on key patient outcomes using a system-wide, data-driven approach. The broader impact of moving patients between hospital wards, and possible downstream effects should be considered in hospital policy and service planning.

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Section: Discussioncontrasting

confidence: 56%

The impact of atypical intrahospital transfers on patient outcomes: a mixed methods study

Mendelsohn

Honeyford

Brittin

et al. 2023

Preprint

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“…Experiences of navigating the hospital landscape with MLTC, which are associated with functional impairment [ 105 ] remain underexplored. In the context of greater centralisation of hospital services [ 106 ], and overcrowding in emergency departments leading to care being undertaken in corridors [ 107 ], there is an opportunity for future studies to illuminate the experience of the physical environment in which care takes place.…”

Section: Discussionmentioning

confidence: 99%

Experiences of hospital care for people with multiple long-term conditions: a scoping review of qualitative research

Bellass,

Scharf,

Errington

et al. 2024

BMC Med

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Background Multiple long-term conditions—the co-existence of two or more chronic health conditions in an individual—present an increasing challenge to populations and healthcare systems worldwide. This challenge is keenly felt in hospital settings where care is oriented around specialist provision for single conditions. The aim of this scoping review was to identify and summarise published qualitative research on the experiences of hospital care for people living with multiple long-term conditions, their informal caregivers and healthcare professionals. Methods We undertook a scoping review, following established guidelines, of primary qualitative research on experiences of hospital care for people living with multiple long-term conditions published in peer-reviewed journals between Jan 2010 and June 2022. We conducted systematic electronic searches of MEDLINE, CINAHL, PsycInfo, Proquest Social Science Premium, Web of Science, Scopus and Embase, supplemented by citation tracking. Studies were selected for inclusion by two reviewers using an independent screening process. Data extraction included study populations, study design, findings and author conclusions. We took a narrative approach to reporting the findings. Results Of 8002 titles and abstracts screened, 54 papers reporting findings from 41 studies conducted in 14 countries were identified as eligible for inclusion. The perspectives of people living with multiple long-term conditions (21 studies), informal caregivers (n = 13) and healthcare professionals (n = 27) were represented, with 15 studies reporting experiences of more than one group. Findings included poor service integration and lack of person-centred care, limited confidence of healthcare professionals to treat conditions outside of their specialty, and time pressures leading to hurried care transitions. Few studies explored inequities in experiences of hospital care. Conclusions Qualitative research evidence on the experiences of hospital care for multiple long-term conditions illuminates a tension between the desire to provide and receive person-centred care and time pressures inherent within a target-driven system focussed on increasing specialisation, reduced inpatient provision and accelerated journeys through the care system. A move towards more integrated models of care may enable the needs of people living with multiple long-term conditions to be better met. Future research should address how social circumstances shape experiences of care.

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“…Vaughan and Bruijns evaluate use of the continuous flow model in the face of critical hospital and emergency department overcrowding 1…”

mentioning

confidence: 99%

Continuous flow models in emergency care: trusts must reassure junior doctors that they are safe to work in substandard conditions

Chivers

2023

BMJ

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Continuous flow models in urgent and emergency care

Abstract: An inadequate response to the deep problems within the NHS?

Cited by 7 publications

References 13 publications

The impact of atypical intrahospital transfers on patient outcomes: a mixed methods study

The impact of atypical intrahospital transfers on patient outcomes: a mixed methods study

Experiences of hospital care for people with multiple long-term conditions: a scoping review of qualitative research

Continuous flow models in emergency care: trusts must reassure junior doctors that they are safe to work in substandard conditions

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