Transforming Urgent and Emergency Care with Real-time Electronic Bed Management Systems (EBMs) 

The Urgent and Emergency Care Services Recovery Plan has been introduced in response to the endemic challenges facing the NHS.  

The NHS is facing a perfect storm of financial pressures, operational performance challenges, lack of visibility, and a burned-out and diminishing workforce as the pressures to recover from the pandemic remain persistently, and understandably, complex. To address these challenges, the NHS has developed the Delivery Plan for Recovering Urgent and Emergency Care Services, which aims to transform Urgent Care and improve operating performance.  

High bed occupancy throughout general and acute hospital beds is a key driver of worsening A&E performance, which in turn has a direct impact on ambulance ‘handover’ and response times. With around 95% of beds filled on average throughout 2022 and 133,446 job vacancies across NHS England – the equivalent of 9.7% of the total full-time workforce, Emergency Department (ED) performance cannot be resolved without urgent, significant and systemic change.  

The Delivery Plan for Recovering Urgent and Emergency Care Services states: “NHS England will work with systems to support implementation of digital tools that support decision making in near real time, including electronic bed management systems both in hospitals and across other health and care settings. We expect the vast majority of trusts to have electronic bed management capabilities by summer 2023 and we will support all trusts to have implemented appropriate solutions by the end of the year.” 

Real-Time Electronic Bed & Capacity Management Systems

Real-time EBM systems are at the heart of the transformation outlined in the Recovery Plan. With a centralised view of bed availability, real-time bed management leverages a centralised Co-ordination Centre model, process change and automation to release existing bed capacity that is currently under-used due to manual processes. The result is not only better ED performance but improvements for both staff and patients throughout the wider integrated care ecosystem, including reduced length of patient stay and less idle bed time (time between one patient leaving and the next patient occupying a hospital bed).  

• Optimising bed utilisation and reducing the length of stay can improve patient flow and decrease the time patients spend in the ED, resulting in a reduction in potential harm to patients  
• Improving the components of patient throughput, such as by implementing a data-driven real-time hospital bed management system, can reduce bed turnaround times and improve patient flow, leading to reduced costs and improved patient satisfaction
• Effective communication and collaboration between healthcare teams are critical to improving patient flow and reducing length of stay
• The real-time information provided by electronic bed management can help form part of the learning process for creating sustainable change.   

These benefits translate to direct financial and operational gains to a Trust: 

• An average hospital gains an additional 10,000 bed days per year. 
• Financial contribution is significant, delivering at least triple the investment back in cost avoidance/savings. 
• Staff gain time to care through the elimination of the unnecessary administrative currently burden placed on clinical staff, equivalent of providing an additional 15 WTE. 

Real-time electronic bed and capacity management is a solution to many of the challenges facing the NHS. It can help transform the NHS and help modernise the organisational operating models that help improve keep patients safe and care quality high.

Carl Davies, Solutions Director, TeleTracking 

Creating transformational change in healthcare is notoriously difficult, and many digital transformations fail.

Individuals tasked with digital transformation throughout the NHS face an enormous challenge in leveraging essential innovation without destabilising the organisation or reducing performance. Further, since many NHS clinicians and administrative staff have already endured one or more technology projects – and have the scars to prove it – there is an understandable scepticism regarding the proposed benefits.  

At the same time, however, NHS staff across the board are frustrated by the status quo that puts them under significant and unnecessary pressure. They acknowledge the delays created by the lack of real-time information. They recognise the impact on the entire healthcare system of slow patient discharges, which are often due to nursing staff or management waiting for updates from other parts of the system. Staff, especially nurses, are also constantly interrupted from their core tasks to field phone calls chasing for bed availability as well as multiple bed discussions daily. Add in the calls from friends and family trying to find out when a patient will be discharged, or the need to chase tests or diagnostic status, and the entire process is compromising patient outcomes and staff well-being. 

The number of inpatients who do not clinically need to be in hospital increased by more than 10% over the last year – accounting for around 13% of occupied beds. The knock-on effect on urgent care is unavoidable – from patients waiting to be admitted to ambulances queuing at the front door. 

Manual bed management leads to continuous interruptions to staff that inevitably compromise the quality of care, the patient experience and staff morale.

Carl Davies, Solutions Director, TeleTracking 

Transforming Operational Performance

Successful digital transformation of the bed management process will remove these interruptions and support more seamless relaying of critical information. This therefore changes the day-to-day experience throughout a Trust, providing those tasked with introducing new technology with a strong and compelling message to engage staff in the process from day one. 

Real-time bed management combines information about real-time bed state with integration and automation around staffing workflows. It integrates seamlessly with EPR/EMR systems to standardise and automate operational workflows across a hospital and system. This includes bed requests, bed cleaning, portering, ward flow management, and the discharge process, as well as creating real-time data insights to enable better site management, capacity planning, staffing workflow optimisation and overall operational effectiveness. Importantly, it maximises the accessibility and use of existing bed capacity to improve patient flow.  

This process requires operational and cultural change across several areas: 

• Care Co-ordination Centres 

The creation of a central ‘heartbeat’ within a Care Co-ordination Centre is the foundation of effective bed management. Site teams and coordinators work closely alongside the Director of Operation, nursing leads, facilities managers and administrators – even ambulatory managers – within one central location using real-time information to provide complete situational awareness. Bed meetings are supported by both accurate information and workflow to automate the entire process of bed allocation as well as cleaning and portering.  

• Ward Level 

At ward level, a series of core processes are built into the ward and board rounds, meaning information is captured in real-time and without duplication, removing the need for nursing staff to provide manual updates on possible bed availability or chase down the status of imaging, prescriptions, transport etc.  

• Support Services 

Automated and dispatcherless portering and bed cleaning processes are a fundamental component of an efficient, centralised model. It ensures efficient workflow and allows patient prioritisation as required.  

This approach allows for a comprehensive and coordinated approach to bed management, reducing the likelihood of miscommunication or delays in patient care.  

Leveraging Digital Solutions to Deliver More Effective Care

While NHS organisations have struggled to achieve digital transformation at scale, there are also many Trusts that have achieved highly effective change that is delivering tangible benefits. Successful transformation initiatives share common characteristics, such as senior oversight and embedding functions [such as real-time bed management] within the day-to-day operations of the organisation. In addition, NHS organisations gain significant value from solutions that can be delivered with a light touch, providing rapid improvements in both patient and staff experience without requiring extensive and on-going disruption and distraction. 

Any successful IT implementation within the NHS is a two-way process. Successful transformation cannot be achieved in isolation – few, if any, transformative digital solutions are ‘drop in and leave’. To be truly effective, technologies will, by default, become core foundations of a streamlined operational process.  As such, NHS organisations and staff must play a central role within the implementation process. 

The benefits that an Operational Platform and electronic bed management software provides extend to both patients and staff across the entire hospital – from improved bed turnaround time; reduced ED waiting times and length of stay and improved bed capacity. Not only does this new way of working help to reduce waiting times, but it also means clinical staff have more time to care and spend with patients.

Nick Sinclair, Chief Operating Officer, Medway NHS Foundation Trust 

Key Steps to Successful Digital Transformation

The implementation of EBCMS to meet the goals of the Urgent and Emergency Care Services Recovery Plan can be achieved within a 20-week timeframe with the right approach that blends expert technology skills from an experienced partner with strong management commitment and leadership from the Trust.  

• Real-time bed management can be successfully implemented by building strong partnerships between the provider and the vendor and focusing on a user-centred design approach.  
• Involving stakeholders from across the organisation and ensuring their buy-in and commitment is critical to the success of any transformation initiative.   

Strong Leadership

Strong leadership is at the heart of successful digital transformation. Individuals need to be both engaged and dynamic as well as truly committed to achieving change. While one strong, committed leader can inspire change, this person will need to be supported by a senior team that shares the vision and goals of the digital transformation. The best results are the result of key stakeholders across the organisation – from an Executive Sponsor to a Director of Operations to Matrons and Porters.  

• Engage Stakeholders: Bed management touches a number of different disciplines and parts of the organisation making it vital to identify and engage stakeholders from day one. When stakeholders are united in their vision for improvement, consensus and commitment will help to overcome the inevitable challenges and avoid the ever-present risk of the goals being compromised by confusion and delays. 
• Set Metrics and Goals: The creation of clear objectives plays a vital role in creating a clear roadmap and demonstrating how the organisation can use real-time bed management to gain incremental benefits. This process also helps stakeholders to better understand the implications for their specific areas of operation and highlights the engagement requirements.  

The key to success in implementing real-time bed management is senior oversight and embedding the function within the day-to-day operations of the organisation. That is, a genuine commitment to People, Process & Technology.

Carl Davies, Solutions Director, TeleTracking 

Management of Change

The implementation of real-time bed management is relatively light touch, especially when compared to the big digital transformation projects that many NHS Trusts have initiated over recent years. The process will, however, have a radical impact on day-to-day operations and it is essential to manage expectations and put in place clear strategies to deliver understanding of and engagement with the digital change. 

Every part of the Trust affected by the shift to effective bed management – from clinicians to bed managers – needs to be committed to the success of this process. The management of change, which includes engagement, education and training, is a fundamental component of digital transformation and the requirements are clearly defined through each stage of the 20-week process. 

• Engagement: Most NHS staff will have used a digital platform that offers some elements of the bed management model, yet by failing to deliver a complete, end to end solution, has actually made their job more difficult, for example by requiring the use of multiple systems to source information. It is therefore vital to highlight the power and benefits of real-time bed management from the outset to overcome natural resistance to change.  
• Education: Stepping each individual throughout the workload, from staff/ clinician and/or patient perspective will explain how a real-time bed management model will affect their specific role and day to day experience. This approach helps to remove barriers to change and provides individuals with a chance to engage and truly understand what the solution will deliver. 
• Training: Providing each team with specific training plans, including technology demonstration, will ensure that staff know both their role and how to use the technology at go live. 

Real-time Electronic Bed & Capacity Management Systems deliver benefits across the board. By delivering on a genuine commitment to improving the workflows that support patient flow, these systems seek to improve both the working experience of staff in a range of roles across the healthcare system and also the patient journey as they move through the hospital.

Carl Davies, Solutions Director, TeleTracking

Process Change & Automation

A fundamental aspect of the implementation of real-time bed management is process simplification and digitisation. Replacing linear processes with a concurrent model that uses real-time information changes roles and transforms responsiveness. For example, there is no longer any need for 20 plus people to attend a room four times a day to discuss possible bed availability. Though bed meetings are still needed, time spent in them is focused on solutions rather than on bed status or fact finding, which in turn drives effective bed management. Tasks can be undertaken simultaneously and information relayed instantly. This reduces dependency on people, avoiding taking staff away from their patient contact time and has a direct impact on waiting times and delays in patient care. 

• Automation of hospital processes can improve patient outcomes and reduce healthcare costs. 

The right technology supplier will work with a Trust’s IT team to handle both process change and integration while also delivering user training around individual functions such as ward management and site management.   

Conclusion

The demands of the Urgent and Emergency Care Services Recovery Plan are unequivocal: it is now essential to move away from inefficient manual processes for bed management and leverage real-time information to transform performance and release existing bed resources. Failing to leverage technologies is creating pressures for both patient and staff alike, and the solutions to help improve processes are now well established.   

While real-time bed management is a far less onerous implementation than EPR solutions, it will require a change to day-to-day operational practices. Achieving cultural change is a core part of the implementation process. It is vital to involve stakeholders from across the organisation, build strong partnerships, and embed the function within the day-to-day operations of the organisation.  

Embracing People, Process & Technology, managers, clinicians and patients can reap benefits that not only help improve the quality of care, but also give time back to clinicians and managers to support improvements elsewhere in the system. With a commitment to genuine partnership, commitment, and expertise in implementation, real-time bed management can be a transformative solution to improve Urgent Care in the NHS.