Today our topic of discussion is Elective Admissions .
Elective Admissions
Achieving the correct balance between the competing demands for hospital beds by elective and emergency cases of varying complexity is likely to remain a considerable challenge for the future. In order to improve the experience of patients waiting for elective admission, the following priorities have been identified:
- Local clinical consensus on the ratio of emergency admissions to planned elective procedures
- Measures to review and monitor criteria for hospital
admission and for lengths of stay - Greater emphasis on ensuring that in admitting elective patients, consideration is given to the length of time they have been waiting since the decision to admit was taken-taking account of their clinical needs
- Greater standardization of waiting list administration with consistent monitoring of cancellations, suspensions and removal from lists without treatment
- Emphasis on planning discharge from day of admission
- The adoption of a whole systems approach to bed management
- The appointment of a manager or clinician with sufficient authority and support to balance and monitor the competing demands of emergency and elective pressures ensuring all bed and theatre resources are fully utilized.
A patient’s episode of care should be planned before his/her admission and should take account of the entire “journey” up to and after discharge from hospital. Patients and their carers should be partners in this planning.
Bed management should be overseen by a Hospital Bed Manager who has the authority to implement the bed management policy and to coordinate the bed management team. The bed management service should operate on a permanent basis, L.e. for 24 hours on everyday of the year.
The bed manager reports to a senior member of management. Part of their role would include continuous analysis and the provision of reports and forecasts. The function of allocating beds to patients should be centralized and the Hospital Bed Manager should have authority over the access to all hospital beds.
There should be an awareness of the bed designation ratio as set out by the Department of Health and Children. The Hospital Bed Manager should work within the notional allocation of beds to each speciality to ensure that patients are accommodated in the most appropriate bed available at the time of their admission, and to ensure that patients are cared for by staff with the appropriate expertise.
The following key requirements have been identified to facilitate effective elective admission practices:
- Centralized waiting list management and agreement on the parameters for scheduling theatre lists with clinicians
- Pre-admission assessment should be a standard
requirement for all elective admissions to ensure appropriate planning of the entire patient journey - The anticipated length of stay (this should be indicated as early as possible to facilitate scheduling) for elective admissions should be indicated as early as possible to facilitate scheduling
- Increased day surgery can also be supported by before admission assessment to ensure appropriate scheduling and to minimize transfer to in-patient beds.
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