The provision of inpatient beds is central to the acute hospital service. Together with the staff and supplies required, it accounts for much of the most complex and expensive activity in the trust. It is therefore essential that beds are managed well and used efficiently.
The way the beds are managed affects the way other hospital departments, such as operating theatres, perform since many are dependent on bed availability. These other hospital departments impact, in turn, upon bed usage. Those that are inefficient or have insufficient capacity can lengthen hospital stays and use up beds unnecessarily. Bed management issues therefore warrant consideration at the highest level within an NHS trust. The Government has recognised this and is supporting trusts in improving bed management as part of the provision of emergency services: the Emergency Services Collaborative - part of the NHS Modernisation Agency - is working with all trusts in England in a rolling programme throughout 2003 and 2004.
Many trusts could improve patient outcomes without the provision of more beds if they managed their existing beds better. This includes ensuring that only the right patients are admitted and that unnecessary delays in diagnosis, treatment and discharge are avoided. Some delays to discharge, though, stem from a shortage of 'intermediate' or of other care in the community. This is beyond the power of acute trusts to remedy and requires input from the whole local health economy. In some trusts it can affect a considerable proportion of the available beds. This review though, focuses on the factors that acute trusts themselves can influence.