Intrahospital transfers and the impact on nursing workload

Blay, Nicole; Roche, Michael; Duffield, Christine; Gallagher, Robyn

doi:10.1111/jocn.13838

Cited by 43 publications

(65 citation statements)

References 27 publications

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“…For example, a relatively recent trend in hospitals hasincreased the number of bed moves for an individual patient during their hospitalisation. 10,11 For the purposes of this paper, the definition of bed moves used by Ranasinghe et al was used -"all bed changes throughout a patient's admission, including changes between or within a given ward". 12 Patients may be moved from their initial ward location for numerous reasons, including the need to accommodate another patient, transfer to "home ward", transfer to another specialist team, patient infection, transfer to intensive care, patient behaviours, need for closer observation, changing care needs of acutely ill, clinically deteriorating patient, and patient requiring palliative care.…”

Section: Introductionmentioning

confidence: 99%

<p>Bed Moves, Ward Environment, Staff Perspectives and Falls for Older People with High Falls Risk in an Acute Hospital: A Mixed Methods Study</p>

Toye¹,

Slatyer²,

Kitchen³

et al. 2019

CIA

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Background: Falls remain an important problem for older people in hospital, particularly those with high falls risk. This mixed methods study investigated the association between multiple bed moves and falls during hospitalisation of older patients identified as a fall risk, as well as safety of ward environments, and staff person-centredness and level of interprofessional collaboration. Methods: Patients aged ≥70 years, admitted through the Emergency Department (ED) and identified at high fall risk, who were admitted to four target medical wards, were followed until discharge or transfer to a non-study ward. Hospital administrative data (falls, length of stay [LoS], and bed moves) were collected. Ward environmental safety audits were conducted on the four wards, and staff completed person-centredness of care, and interprofessional collaboration surveys. Staff focus groups and patient interviews provided additional qualitative data about bed moves. Results: From 486 ED tracked admissions, 397 patient records were included in comparisons between those who fell and those who did not [27 fallers/370 non-fallers (mean 84.8 years, SD 7.2; 57.4% female)]. During hospitalisation, patients experienced one to eight bed moves (mean 2.0, SD 1.2). After adjusting for LoS, the number of bed moves after the move to the initial admitting ward was significantly associated with experiencing a fall (OR 1.56, 95% CI 1.11-2.18). Ward environments had relatively few falls hazards identified, and staff surveys indicated components of person-centredness of care and interprofessional collaboration were rated as good overall, and comparable to other reported hospital data. Staff focus groups identified poor communication between discharging and admitting wards, and staff time pressures around bed moves as factors potentially increasing falls risk for involved patients. Patients reported bed moves increased their stress during an already challenging time. Conclusion: Patients who are at high risk for falls admitted to hospital have an increased risk of falling associated with every additional bed move. Strategies are needed to minimise bed moves for patients who are at high risk for falls.

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Section: Introductionmentioning

confidence: 99%

<p>Bed Moves, Ward Environment, Staff Perspectives and Falls for Older People with High Falls Risk in an Acute Hospital: A Mixed Methods Study</p>

Toye¹,

Slatyer²,

Kitchen³

et al. 2019

CIA

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“…Rather than growing bed capacity to meet rising patient demand, a variety of bed management strategies have focussed on improving the efficiency of existing bed stocks through maximizing throughput by reducing patients’ length of stay and making use of every available bed (Blay, Roche, Duffield, & Gallagher, ). Running hospitals with limited spare bed capacity means patients may be admitted to any available bed or general ‘surge beds’ that open and close in response to fluctuating demand, then transferred to an appropriate ward when possible (Blay, Duffield, & Gallagher, ).…”

Section: Introductionmentioning

confidence: 99%

“…Running hospitals with limited spare bed capacity means patients may be admitted to any available bed or general ‘surge beds’ that open and close in response to fluctuating demand, then transferred to an appropriate ward when possible (Blay, Duffield, & Gallagher, ). These bed management strategies have increased and intensified nurses’ work, primarily through increased patient movements (described as churn; Blay, Roche, Duffield, & Gallagher, ; Duffield, Diers, Aisbett, & Roche, ) and greater variability in casemix (Diers et al, ).…”

Section: Introductionmentioning

confidence: 99%

Harnessing ward‐level administrative data and expert knowledge to improve staffing decisions: A multi‐method case study

Duffield

Roche

Wise

et al. 2019

Journal of Advanced Nursing

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Aim:The aim of this study was to investigate the impact of changes to bed configuration and patient mix on nurses' workload in a single ward.Design: Multi-method case study. Method:The study was undertaken in an acute 28-bed ward in a tertiary referral public hospital in Queensland, Australia. Ward-level administrative data were obtained for a 2-year period, 12 months before bed configuration changes in October 2015 and 12 months after. These data included patient activity (bed occupancy, transfers, length of stay and casemix) and nurse staffing (budgeted and actual staffing levels, employment status and skillmix). Semi-structured interviews were conducted with ward nurses (N = 17) to explore the impact of the bed configuration changes on their workload. Results:Administrative data showed that the bed configuration changes resulted in more complex and dependent patients, increased patient transfers and greater variability in casemix. The interview data found these changes to patient complexity and activity intensified workloads, which were further increased by staffing decisions that resulted in greater reliance on temporary staff. Conclusion:Hospitals already possess the data and expert knowledge needed to improve staffing and bed management decisions without the need for additional, costly workload systems. Impact: Determining appropriate nurse staffing in light of the complexities and variation of patient needs at the ward level remains a challenge. This study identified increases in patient complexity, dependency, variability and churn that increased workload. Staffing grew but hidden factors associated with temporary staffing and skillmix further intensified nurses' workload. Harnessing existing data and the expertise and experience of nursing unit managers (NUMs) would help staff wards more efficiently and effectively, providing reasonable workloads and appropriate skillmix that can enhance the safety and quality of patient care. To facilitate this, NUMs

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“…This, together with ongoing issues in retention (Hayes et al., ), has led to challenges in staffing hospitals with an appropriate number and mix of staff (Australian Nursing Federation, ). Nurses’ workloads have increased as a result of these staffing issues and other factors, such as a growing ageing population, greater complexity of care required by hospitalised patients (Duffield, Roche, Dimitrelis, Homer, & Buchan, ; Krichbaum et al., ) and increased movement of patients through wards (Blay, Roche, Duffield, & Gallagher, ). These staffing and workload issues limit the time nurses have for patient contact (Duffield & Wise, ; Duffield et al., ; Williams, Dawson, & Kristjanson, ) and may be further compounded by ward instability (Duffield et al., ), difficult practice environments (Halpin, Terry, & Curzio, ) and violence towards staff (Phillips, ).…”

Section: Introductionmentioning

confidence: 99%

Adding unregulated nursing support workers to ward staffing: Exploration of a natural experiment

Duffield

Roche

Twigg

et al. 2018

Journal of Clinical Nursing

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Intrahospital transfers and the impact on nursing workload

Abstract: Nurses at the site hospital spend over 1700 hr each month on activities associated with transferring patients, meaning that less time is available for nursing care.

Cited by 43 publications

References 27 publications

<p>Bed Moves, Ward Environment, Staff Perspectives and Falls for Older People with High Falls Risk in an Acute Hospital: A Mixed Methods Study</p>

<p>Bed Moves, Ward Environment, Staff Perspectives and Falls for Older People with High Falls Risk in an Acute Hospital: A Mixed Methods Study</p>

Harnessing ward‐level administrative data and expert knowledge to improve staffing decisions: A multi‐method case study

Adding unregulated nursing support workers to ward staffing: Exploration of a natural experiment

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