My organizations is a non-profit specialist care (secondary and tertiary care) hospital consisting of four main hospitals and smaller satellites. Three of the main hospitals have and ER treating multidisciplinary patients and primary care patients needing acute care or care during hours when primary care clinics are not open. Roughly half of the patients need hospital care for a few days or longer, about half the patients return home or to their elderly care home/nursing home after receiving treatment in the ER. The majority of the patients returning home are primary care patients and the majority of those taken in for hospital treatment are specialist care patients. However, there is a significant number of patients whose condition (impacted often by their age) requires treatment at primary care level hospital but who end up staying in our hospitals. This happens because the primary care hospitals lack free beds for these patients. Every day, many patients have to wait in the ER for much longer than our goal (8 hours) due to lack of free beds of the wards. Thus, the ER becomes quite crowded, and in the worst case patients end up staying in the ER more than 24 hours or even longer before there is a bed available and they get to the ward.
The wards and beds in our hospital are allocated to medical specialties. There is a ward for medicine, lung diseases, cardiology, neurology, orthopedics, GI-surgery, urology, oncology, hematology etc. Each ward receives both elective patients and acute patient, mainly from the ER, as well as patients from the ICU, CCU, and operating theatres. It happens often that for example the orthopedic ward does not take a new patient from the ER in the evening as they have new elective patients coming the next morning. Or a neurological patient has to remain waiting in the ER as the neurological ward is full while there are free beds in the pulmonary ward. The patients released from the hospital tend to leave the hospital after noon, and not very efficiently during weekends, further challenging the patient flow. We have put some effort trying to speed the release process but with quite limited results so far.
Thus, we have a challenge how to make the patient flow from the ER to the wards flow better. I would like to achieve this flow without compromising elective care. Any ideas or experience with solving this kind of a problem? Any experience of more generalized wards than we have? Do you have bed managers in your hospitals? How is that organized? Any experience on an incentive system for the personnel that would facilitate the flow?