Understanding the work and decision-making strategies of bed management nurses: a systematic review

Benjamin, Ellen

doi:10.7748/nm.2021.e2016

Cited by 2 publications

(1 citation statement)

References 16 publications

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“…It is also important to consider that a suboptimal patient transfer for one patient may be crucial for the care of the individual taking their bed space. Qualitative exploration to elucidate the challenges that bed managers face, around which literature is limited 83 . Our analysis therefore provides a starting point for identifying clusters of patients who have moved between unexpected pairs of wards, with a view to optimise pathways for future patients.…”

Section: Discussionmentioning

confidence: 99%

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

Mendelsohn,

Honeyford,

Brittin

et al. 2023

Sci Rep

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The 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. Using 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 in-depth interviews with site nurse practitioners and bed managers within the same hospital network. We 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. Our 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: Discussionmentioning

confidence: 99%

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

Mendelsohn,

Honeyford,

Brittin

et al. 2023

Sci Rep

View full text Add to dashboard Cite

show abstract

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.

show abstract

Understanding the work and decision-making strategies of bed management nurses: a systematic review

Cited by 2 publications

References 16 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

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

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