For this Q&A, we spoke with Pedro Da Silva, Clinical Site Manager, Maidstone and Tunbridge Wells (MTW) NHS Trust, to get his insight into the day-to-day operational challenges of bed management and patient flow.
Pedro Da Silva has been a nurse for nine years, since he graduated back in Portugal. With a specialism in respiratory conditions, Pedro has worked as a charge nurse at three NHS Trusts: Brighton General Hospital, Royal Sussex County Hospital and MTW. For the last two years, he has been the clinical site manager at Maidstone, responsible for bed management and patient flow.
He has held this responsibility both prior to, and after MTW’s go-live, with TeleTracking’s capacity management and patient flow platform.
When we talk about ‘bed management’, what does this mean to you?
Clinical site management is a different type of responsibility and demands a different set of skills to being a ward nurse. The last two years have been incredibly interesting, as I’ve learned another dimension to the inner workings of our hospital. And bed management is critical to this.
Bed management is, in effect, a constant monitoring of hospital admissions and discharges; of patient flow within the hospital. It’s about identifying available beds across all the wards, and then balancing the needs of patients being admitted with that availability to make sure each patient gets the right care, in the right place, ideally first time.
There is also an element of understanding what staffing levels are, and working with the different hospital teams (the Emergency Department (ED); matrons; charge nurses; porters, etc.) as well as managing physical resources such as wheelchairs and speciality equipment, and internal systems within the Trust to manage patient flow.
At its heart, we have to aim for ED operational and care performance standards, while juggling patient needs and available beds and resource.
How did MTW manage the bed estate prior to implementing TeleTracking? What sort of processes were involved?
Depending on the patient and staffing numbers on the floor, MTW has one clinical site manager on each site, in Maidstone and Tunbridge Wells. We act as the link between the ED Nurse in Charge and the matrons and wards themselves.
We are constantly monitoring ED patient flow: the entrance of admission; all the patients present in ED and how long they’ve been waiting.
Before TeleTracking, from the moment we knew a patient had been referred to a speciality or there was a decision to admit, we would physically run around the wards, find out how many discharges they were going to have on that day and thereby how many beds we would have available across all departments and specialities – and then allocate different patients to different beds according to that availability.
It was basically all done on paper: from who’s going home and who might be a possible discharge, to knowing how many people were in ED and how many patients were at risk of breaching the four-hour access standard.
How have these processes changed since going live with TeleTracking?
To be fair, even before TeleTracking, MTW had a really good ED performance.
With the use of the technology, we have real-time, 24/7 visibility of the live bed status across the whole Trust. We know exactly how many available beds we have and where those beds are; the facility or status of turnaround beds (beds that are being cleaned between a patient having been discharged and one being admitted) and we can communicate with ED through the system to facilitate the allocation of the right patient to the right bed.
One of the most important things is the amount of time the technology saves for staff on the ward. From time spent making or receiving phone calls; ordering things – cleaners, porters, equipment, etc. – and general paper-based communication, TeleTracking gives back so much time to care. And ultimately, that is what staff really want – to care for patients. They don’t want to spend half their time on the phone. Now, everything is done by a click.
Of course, it’s still challenging, because if you don’t have beds, you don’t have beds. But now we have a true picture of what we’ve got. If a patient is discharged and goes home but the ward doesn’t tell us, we still know because the system tells us the bed has turned dirty.
TeleTracking has also helped hugely during the pandemic, because we’ve been able to identify patients that were Covid-19 positive or suspected. It’s helped us to give a bed most appropriate to their Covid status as well as by speciality.
What benefits are you seeing as a result?
With our Care Coordination Centre, we have got live updates on all our performance standards across the Trust. When we went live, in the midst of the pandemic, we were admittedly struggling. But those standards are now all green. Patient transfer; bed turnaround / cleaning; ED performance, all have seen significant improvements.
We have been able to reduce the number of outlying patients, because we can filter patients by speciality and identify which patients might be outliers because at the time of admission there wasn’t a better bed available. Or, if a patient was admitted as a medical patient but the surgical team has taken over, wards can identify that on the system and automatically request patient moves accordingly. We used to do outliers lists at night time, by paper. Now again, it’s just a click.
And of course, in addition to giving time back to care, it’s improved staff morale.
Do you now have a different view on what ‘bed management’ means or entails?
The job itself and the responsibilities haven’t changed but it has definitely got better with TeleTracking. Having worked on the other side, on the wards, I now know how much time they spend requesting things when they don’t need to. And I understand why, using traditional methods, it’s so difficult to turn around a bed from dirty to clean.
From my perspective, we now have so much more data that can help us identify other areas for operational improvements, and really work together as a hospital – rather than a suite of individual wards – to improve patient flow and ultimately patient care.
Really, all hospitals should have a system like this.