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Why do we manage beds instead of patients?

By Marcia Peterson

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"The ED needs 12 beds now and three have had requests in for over six hours! Who is on that?"

This is an actual quote overheard recently in a large Midwestern hospital but could have been heard in almost any acute care facility throughout North America and likely other countries as well. "Bed management" is a critical operational activity in any acute care environment. Needing a "bed" isn't the whole story. The real issue is finding the right bed at the right time for the right patient. The challenge is driven primarily by patient-specific clinical requirements often resulting in competition for the same bed at the same time. How does one decide who gets the bed? In hospitals bed assignments are typically handled one patient at a time. The decision is grounded in clinical requirements but often influenced by preferences, some of which may not be clinically relevant.

Let's use my friend Judy as an example. Judy visited her doctor after several weeks of symptoms that could have driven her to the ED. She chose to see her physician in the office to avoid the potential wait and exposure in the ED and was promptly scheduled as a "direct admit" patient. Judy's physician requested a private room with a view of the lake, which was communicated to admitting from her doctor's office and confirmation was received. Judy is well insured (as well as any of us can be today) and expected to have a bed ready and waiting. When she arrived, she was escorted to "admissions" and was placed in a waiting room until an admissions assistant could accommodate her. She was quite ill but no one seemed to recognize that and she sat in a chair for almost two hours before she inquired how long it would be before she could go to her room. She was told that "bed management" was moving as fast as possible and that if she was "really sick" she should have gone to the ED. Was the implication that she was not really "sick enough" to need a bed?

After almost 5 hours, she was informed that be management could facilitate a private room but not the view. Although she was happy with the private room, she thought that if she had the view, she would indeed rest more peacefully and recover faster. After waiting in an uncomfortable chair for over 5 hours she was indeed feeling sicker by the minute. Resting peacefully is certainly a challenge in hospitals. And does "recover faster" result in an earlier discharge? There may not be hard evidence to support this but it may, indeed, have some truth to it.

Judy was finally admitted to a private room without the view and her physician arrived a few minutes later. She was very unhappy that none of the admission orders had been executed and Judy's care had been delayed at least 5 hours. Let's just say that Judy had been compromised somewhat and when her physician questioned why it had taken so long to get her admitted after her admission had been arranged, she was told that Judy should have come through the ED if she wanted a bed faster. Judy and her physician were trying to act responsibly by not using the ED and her care was compromised. She asked a nurse about this and this nurse told her that she made a good decision because so many people in the ED did not need to be there and it might have been more risky to take that route. They referred to the bed management system as the constant "bed shuffle."

Judy was left wondering why hospitals manage beds instead of patients. Good question. Is there a better way to do this? Stay tuned for "The Myths of Bed Management". And ... this is a true story.


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