Better care: reducing length of stay and bed occupancy on an older adult psychiatric ward

Adlington, Katherine; Brown, Juliette; Ralph, Laura; Clarke, Alan; Bhoyroo, Tim; Henderson, M. Todd; Boora, Farai; Aurélio, Marco; Fawzi, Waleed

doi:10.1136/bmjoq-2017-000149

Cited by 13 publications

(16 citation statements)

References 4 publications

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“…2 40–55 The majority of information sharing initiatives included team meetings and huddles to facilitate communication through in-person interactions between staff, and less often between staff and patients/families. 40 41 43 44 46 Information sharing was promoted between multidisciplinary teams and patients to improve length of stay and continuity of care. For example, Adlington et al implemented Plan Do Study Act cycles during weekly quality improvement meetings, in which driver diagrams (visual displays) were used to share information with the multidisciplinary project team on issues affecting length of stay and hospital bed occupancy.…”

Section: Resultsmentioning

confidence: 99%

“…For example, Adlington et al implemented Plan Do Study Act cycles during weekly quality improvement meetings, in which driver diagrams (visual displays) were used to share information with the multidisciplinary project team on issues affecting length of stay and hospital bed occupancy. 40 This information was used to guide practice changes aimed at improving communication during the discharge process (daily rounds, focusing on long-stay patients), bed management (nursing support to prevent deterioration) and community services (email updates and involvement of care coordinators). The majority of initiatives shared information though in-person communication; however, some used technology.…”

Section: Resultsmentioning

confidence: 99%

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Initiatives for improving delayed discharge from a hospital setting: a scoping review

et al. 2021

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ObjectiveThe overarching objective of the scoping review was to examine peer reviewed and grey literature for best practices that have been developed, implemented and/or evaluated for delayed discharge involving a hospital setting. Two specific objectives were to review what the delayed discharge initiatives entailed and identify gaps in the literature in order to inform future work.DesignScoping review.MethodsElectronic databases and websites of government and healthcare organisations were searched for eligible articles. Articles were required to include an initiative that focused on delayed discharge, involve a hospital setting and be published between 1 January 2004 and 16 August 2019. Data were extracted using Microsoft Excel. Following extraction, a policy framework by Doern and Phidd was adapted to organise the included initiatives into categories: (1) information sharing; (2) tools and guidelines; (3) practice changes; (4) infrastructure and finance and (5) other.ResultsSixty-six articles were included in this review. The majority of initiatives were categorised as practice change (n=36), followed by information sharing (n=19) and tools and guidelines (n=19). Numerous initiatives incorporated multiple categories. The majority of initiatives were implemented by multidisciplinary teams and resulted in improved outcomes such as reduced length of stay and discharge delays. However, the experiences of patients and families were rarely reported. Included initiatives also lacked important contextual information, which is essential for replicating best practices and scaling up.ConclusionsThis scoping review identified a number of initiatives that have been implemented to target delayed discharges. While the majority of initiatives resulted in positive outcomes, delayed discharges remain an international problem. There are significant gaps and limitations in evidence and thus, future work is warranted to develop solutions that have a sustainable impact.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Initiatives for improving delayed discharge from a hospital setting: a scoping review

et al. 2021

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“…After the implementation of IBRC, the number of urgency and elective hospitalizations increase from 5,241 to 7,457 and from 1,171 to 1,914 individuals, respectively. This increase in the number of clinical and surgical services was observed in other health institutions after the implementation of bed regulation strategies or services (3,25) .…”

Section: Discussionmentioning

confidence: 69%

Indicators of surgical patients after the implementation of an Internal Bed Regulation Committee in a university hospital

Maldonado

Feijó

Balsanelli

et al. 2021

Rev. esc. enferm. USP

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Objective: To analyze the indicators of surgical patients after the implementation of an Internal Bed Regulation Committee in a university hospital. Method: Longitudinal, quantitative, and retrospective study. The data collection was conducted in the Hospital Management Information institutional system, from which the information of patients submitted to surgical procedures from January 2015 to June 2018 were obtained. To verify the data trends, a simple linear regression model was used. Results: The predominance of patients aged 20 to 39 and hospitalized on an emergency basis was observed. An ascending trend for structure indicators was verified regarding the number of surgical procedures and patients per surgical room. The process indicators were stagnant. An ascending trend was presented by the result indicators related to the number of surgical patients, hospitalized surgical patients, surgical procedures, and patients with Hospitalization Authorization. Conclusion: A change in the mean values of the process indicators was observed, showing the performance of this service. Organizational changes were also observed regarding the establishment of norms, processes, and flows.

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“…Bed occupancy has been used as a measure of quality of care in the NHS, and The Royal College of Psychiatrists [ 65 ] has a recommended maximum occupancy level of 85%. AI solutions can be used to enhance efficient bed allocations as they could help in ‘preventing avoidable admissions, reducing variation in LOS (length of stay) and improving discharge of patients’ [ 66 ].…”

Section: Resultsmentioning

confidence: 99%

Applications of artificial intelligence to improve patient flow on mental health inpatient units - Narrative literature review

Cecula

Dawoodbhoy

et al. 2021

Heliyon

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Background Despite a growing body of research into both Artificial intelligence and mental health inpatient flow issues, few studies adequately combine the two. This review summarises findings in the fields of AI in psychiatry and patient flow from the past 5 years, finds links and identifies gaps for future research. Methods The OVID database was used to access Embase and Medline. Top journals such as JAMA, Nature and The Lancet were screened for other relevant studies. Selection bias was limited by strict inclusion and exclusion criteria. Research 3,675 papers were identified in March 2020, of which a limited number focused on AI for mental health unit patient flow. After initial screening, 323 were selected and 83 were subsequently analysed. The literature review revealed a wide range of applications with three main themes: diagnosis (33%), prognosis (39%) and treatment (28%). The main themes that emerged from AI in patient flow studies were: readmissions (41%), resource allocation (44%) and limitations (91%). The review extrapolates those solutions and suggests how they could potentially improve patient flow on mental health units, along with challenges and limitations they could face. Conclusion Research widely addresses potential uses of AI in mental health, with some focused on its applicability in psychiatric inpatients units, however research rarely discusses improvements in patient flow. Studies investigated various uses of AI to improve patient flow across specialities. This review highlights a gap in research and the unique research opportunity it presents.

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Better care: reducing length of stay and bed occupancy on an older adult psychiatric ward

Cited by 13 publications

References 4 publications

Initiatives for improving delayed discharge from a hospital setting: a scoping review

Initiatives for improving delayed discharge from a hospital setting: a scoping review

Indicators of surgical patients after the implementation of an Internal Bed Regulation Committee in a university hospital

Applications of artificial intelligence to improve patient flow on mental health inpatient units - Narrative literature review

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