New hospital scheme could prevent ‘bottleneck’ and free up beds in A&E

A new study at Royal Stoke could free up hospital beds quicker and tackle A&E pressures, writes with staff piloting a ‘risk calculator’ developed with Staffordshire University...

ANEW pilot study could significantly reduce the time it takes to discharge hospital patients and free up beds for people in overcrowded A&ES.

Royal Stoke University Hospital is trialling a ‘risk calculator’ developed in partnership with Staffordshire University.

It means doctors can identify patients most at risk of taking up hospital beds longer than needed. These discharge delays are often linked to problems in arranging community care in time.

But with the more proactive approach, patients can be flagged up to reviewing teams earlier so planning can start on sorting out any therapy or care needs.

Hold-ups in discharging patients are among the major challenges facing the NHS and these pressures have intensified during the pandemic. Nationally, ‘delayed bed days’ are estimated to cost the equivalent of £27,000 each hour.

Dr Andrew Davy, GP lead for research and development in A&E at Royal Stoke, said: “A delayed transfer occurs when an adult inpatient is medically ready to go home, but is unable to because other necessary care, support or accommodation is unavailable.

“These delays can have serious implications such as mortality, infections, depression and reductions in patients’ mobility and their ability to undertake daily activities.

“It also has a knock-on effect on patients in A&E departments who cannot move into ward beds until current patients are discharged.

“This bottleneck effect on flow causes significant overcrowding.”

In September, just 66 per cent of those attending A&ES at Royal Stoke and County hospitals were admitted, discharged or transferred within the target of four hours.

And this also had an impact on ambulance crews dropping off patients at the Hartshill complex. They were held up for an hour or more 618 times that same month.

The University Hospitals of North Midlands NHS Trust has now teamed up with university researchers to test out the predictive model, which uses eight main variables.

It has been developed through analysing data from Royal Stoke’s A&E between 2018 and 2020.

Associate Professor Md Asaduzzaman, from Staffordshire University, said: “The researchers used information routinely collected when patients are admitted to hospital from A&E to identify several demographic, socioeconomic and clinical factors associated with patients experiencing a delayed transfer of care.”

Significant factors include age, gender, deprivation, a national ‘early warning’ score, arrival by ambulance and previous admission within the last year.

For the pilot, the new scoring system is displayed on ‘live’ dashboards in Royal Stoke’s emergency department. Patients at high risk of transfer delays can then be identified more quickly.

If the pilot results prove a success, the model could be used across the country.