Can good bed management solve the overcrowding in accident and emergency departments?

The NHS Plan1 makes the commitments that a patient’s total time in accident and emergency (A&E) will be no more than four hours. Many trusts are currently struggling to reduce four hour trolley waits (the time from the decision to admit (DTA) to leaving A&E). A recent survey conducted by the BMA and the British Association for Accident and Emergency Medicine2 suggests that official figures give an over-optimistic picture of the current pressures in A&E departments, and long patient waits are still common. The ability to move patients with a DTA out of A&E depends on the ability of the hospital to accommodate them (or to accommodate patients from the MAU, etc, to make room available). This movement is normally the responsibility of the bed management (BM) function, according to the National Audit Office (NAO),3 and this is the case in all trusts with which we are familiar. BM forms an important part of operational capacity planning and control, a wider activity concerned with the efficient use of resources. Outside the health context, the production/operations function of an organisation is concerned with activities such as scheduling and work flow to enable throughput to meet demand, and minimise work in progress and maximise resource utilisation. Despite the obvious analogies, very few acute hospitals have an operations management function. The objective of this paper is to demonstrate the part that operational capacity planning and control, in particular BM, plays, and could play, in improving service delivery. It starts by describing the typical function and structure of BM in acute hospitals, patterns of hospital activity, and their effects, particularly on A&E. Developments in operational capacity planning are then considered. These aim to improve planning and management of supply and demand, and moving towards and maintaining lower bed occupancy in medicine. …