Use of a risk analysis method to improve care management for outlying inpatients in a university hospital

Abstract

Using FMECA, we were able to identify the most critical failure modes of the complex process of care provided for outlying patients and to suggest subsequent improvement measures. Follow-up indicators were defined to assess implementation.

Patient safety in patients who occupy beds on clinically inappropriate wards: a qualitative interview study with NHS staff

“…The findings of this study concord with a study that suggested that lack of input from specialist doctors and poor communication between wards may compromise safety,2 with studies that suggested the knowledge of nursing staff may be compromised,20–22 and with a study that suggested that having patients on inappropriate wards creates excess demand on physicians' time 5. Furthermore, the contributory factors identified in this study are easily encapsulated within frameworks which have been devised to investigate and analyse patient safety incidents in healthcare, for example, the London Protocol,31 and human factors frameworks 32.…”

“…This phenomenon is also evident in other countries with publicly funded healthcare systems, including France,2 Spain3 and New Zealand 4 5. Such patients are commonly called ‘outliers’, ‘sleep outs’ or ‘boarders’.…”

“…For example, nursing staff become specialised by virtue of working on specific wards and may at times lack the expertise required to provide optimal care for patients with unfamiliar diagnoses 20–22. Additionally, patients on inappropriate wards may be vulnerable to safety issues as a result of lack of input from specialist doctors, poor communication between wards and insufficient detail and standardisation within patient notes 2. Bed management policies formulated by NHS trusts across the UK frequently recognise the potential threat to safety created by placing patients on unsuitable wards and seek to minimise the perceived risks 23–27.…”

Hospital out-lying through lack of beds and its impact on care and patient outcome

“…Few studies have been undertaken of outlying patients [16-18]. There have been some studies highlighting the risk exposure of outlying patients but these only took into account paramedical care and only studied patients in surgery and traumatology [16,17].…”

“…In the U.K., it has been shown that there is a lack of knowledge among nurses in medical wards about caring for surgical patients compared to nurses in orthopedic or traumatology wards [16,17]. A study in France has emphasized the need for designating a contact doctor in wards that have outlying patients in other wards, as well as a nursing care coordinator and making sure medical files are standardized throughout the hospital [18]. Previous studies only looked at medical care delivered by paramedics on surgical or traumatology patients and did not give any description of the outcomes of those patients [16,17].…”