Reducing ward moves

Scottish Government/RCPE Press Release

14 December 2012

Reducing ward moves

Plans to reduce ‘boarding’ in Scotland’s hospitals

A plan has been put in place to address unnecessary patient moves in hospitals.

A new collaborative work programme between the Royal College of Physicians of Edinburgh (RCPE) and NHS Scotland will address the practice – known as ‘boarding’.

Over the next year this work will involve reviewing the number and speciality type of beds for acute care, ensuring that there are enough medical consultants and nurses and having daily reviews of patients by consultants.

Boarding is shown to have negative outcomes on patients including increased length of stay, re-admission and the development of medical complications including healthcare acquired infections and blood clots.

Health Secretary Alex Neil said:

“Our hospitals are safer than ever before and the time people have to spend in hospital has been drastically reduced. Now, over 80 per cent of people who have surgery don’t need to stay overnight.

“Despite this I want to make sure that the care we provide to our most critically ill patients is the very best it can be. Moving patients from one ward to another when they don’t need to be moved can delay their treatment and even cause medical problems – that’s not good for patients and it puts a greater burden on our NHS.

“We need to ensure that NHS Boards’ have world class planning for the number and type of beds, nurses and consultants that are needed - so that the need to move patients unnecessarily is reduced.

“Scotland is the first country in the UK to deal with the issue of boarding and I am sure that it will further improve the quality of care in our hospitals.”

Dr Neil Dewhurst, President of the RCPE, said:

“The RCPE is deeply concerned about boarding. This results in poorer quality patient care and increases the pressure on medical teams. 

”In order to assist the Scottish Government to respond to these problems we have made a number of key recommendations which we believe will provide a framework for tackling boarding. We recognise that these changes cannot be delivered overnight, require to be reviewed and will undoubtedly have resource implications for the NHS.

“The RCPE has a national and international reputation for setting clinical standards and in building consensus. We look forward to bringing this experience to bear in a range of practical projects as part of this joint initiative with the Scottish Government.”

Background

Both Scottish Government and RCPE recognise the need to reduce the level of boarding in Scottish hospitals, particularly due to changes in demography in Scotland. Between 2012 and 2035, the number of people over 65 is projected to rise by 63 per cent. This is especially significant for the hospital sector as the emergency admission rate is strongly related to patient age.

Rates of admission rise with increasing age group with patients aged 75+ having 6.6 times more emergency admissions per 100,000 than 15 to 29 year olds and 4.3 times more than 45 to 59 year olds.

The nine key areas which will be investigated as part of the programme to reduce boarding are:

1. Ensuring an adequate number of appropriate beds for acute care and the whole health and social care system works together to optimise patient flow.
2. Ensuring that workforce planning recognises the number of medical consultants and nurses required to provide safe acute medical care.
3. Developing new ways of working for medical consultants to optimise patient flow by ensuring early, daily, review of patients by consultants.
4. Reviewing the numbers of generalist physicians in Scotland and increasing training in general medicine for all doctors.
5. Ensuring adequate resources in social services to develop efficient integrated working with acute care and effective discharge.
6. Reviewing the inter-related issues (including training, recruitment and retention) which are contributing to the problems faced in the acute medical specialties in Scotland and exacerbating boarding.
7. Develop and implement an Unscheduled Care Action plan which will give direction to the NHS in preparing for the future demands on health and social care services.
8. Ensuring NHS Boards are immediately supported by a £3m Winter Surge Fund to alleviate any pressure on the system over winter and to test new ways of working that improve patient flow.
9. Ensuring a continuing focus on Health & Social Care integration and that delayed discharges continue to be reduced in line with HEAT targets.

Boarding is only ever intended to offer a short-term solution to managing patient flow during times of acute pressure on the NHS, such as during temporary ward closures. 

Contact

Scottish Government: Emma Davis 0131-244-3092

RCPE: Graeme McAlister on 0131-247-3693