Our program admits approximately 15,000 patients a year. Bed assignment depends on availability and level of care required. Incorrect placement occurs frequently, leading to delays in patient care and causing a drain on nursing, physician, and housekeeping resources.
In spring 2010, our hospital contacted a consultant group to examine its efficiency and throughput. Our group was charged with improving bed assignment practice.
We examined the admission process. The ER attending would decide on admission and page the admitting hospitalist. They discussed patient presentation, admitting diagnosis, and correct status (observation vs. inpatient). A patient placement manager (PPM) then received this information electronically and found a bed. We hypothesized that by involving the PPM earlier, we would improve getting patients to the right bed the first time. In our pilot, we had the ER doctor page the PPM with the patient name, medical record number, and admitting diagnosis. The PPM then took a look at the patient's record to see if he or she had issues that affected the placement. For example a patient with pneumonia but also on peritoneal dialysis should be booked to the renal floor with nurses trained to handle peritoneal dialysis and not placed based on the diagnosis of pneumonia. After this initial triage, the PPM paged the hospitalist with the same information, with an expected call‐back time of 15 minutes. Then the ER doctor, the PPM, and the hospitalist had a 3‐way conversation about patient presentation, working diagnosis, and inpati‐ent versus observation status.
For the 3 weeks prior to and the 3 weeks of the pilot, the PPMs tracked how often they had to change a patient's bed assignment. The daily rate of incorrect placement fell from 8 (9.4%) before the pilot to 2 (3.1%) during the pilot (P < 0.001). A conservative estimate of the expense for housekeeping, PPM, and nursing time as well as supplies totaled $106 wasted for every error. Thus, if the pilot were implemented and success rate stayed the same, the annualized institutional savings would be $232,140. Including physician time, pharmacy time, and messenger and other ancillary staff time would make the savings even greater. Lastly, although we did not measure the effects on patient safety and satisfaction, these were likely to have improved as well. We encountered a number of barriers. Technology problems such as pagers and computer systems going down were experienced. PPMs were variably familiar with admission criteria in regard to inpatient and observation status, leading to incorrect status designation and placement. Subopti‐mal staffing of PPMs and large volumes of calls at once to the hospitalist led to delays in call‐backs to the ER doctors. The ER doctors perceived this as adding delays to patient care and ER flow, and a waste of ER doctor time may have been a hidden cost as well. The next steps include a future pilot with increased PPM staffing.
C. Bryson ‐ none
To cite this abstract:Bryson C. Right Patient, Right Bed. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 157. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/right-patient-right-bed/. Accessed March 28, 2020.