Bed blocking, more appropriately known as “Delayed Discharge”, refers to a situation in healthcare systems where patients who are medically fit to be discharged from the hospital – in that they no longer require acute care – are unable to leave for a variety of reasons.
At the King Edward VII Memorial Hospital (KEMH), a Delayed Discharge most often occurs when a patient, particularly the elderly or those with complex care needs, is unable to return to their home safely or be transferred to an appropriate care facility, such as a nursing home.
I sat down with chief of nursing, Judy Richardson and operations performance manager, Maurizio Privatelli, to get a better understanding of the current situation at KEMH:
“The number one thing that everyone needs to understand is that the hospital itself never blocks beds,” said Ms Richardson. “We are a continuum that operates on a non-stop basis. When it comes to Delayed Discharges, what people seem to have lost sight of is the fact that behind every person is a story of complex illness, social or financial issues, or the required incidental services being unavailable. But when these stories reach the media, the hospital can never comment on individual cases for reasons of patient confidentiality.”
“On average, KEMH receives 32,000 visits a year and about 40 percent of the people currently coming through the door in need of care are over the age of 65,” said Mr. Privatelli. And, as is too often the case in these tough economic times, many of these seniors have limited incomes, are underinsured, or without insurance, which causes them to delay seeking medical treatment until they are seriously unwell.
It is important to keep in mind that Bermuda has an aging population – and this situation will likely increase if nothing changes.
Unlike what often happens in the American and British healthcare systems, “In Bermuda, it is not the hospital’s policy to wheel people out to the curb simply because the hospital has done its part,” said Ms Richardson. “Equally, the hospital is the one place that never says no. We never turn anyone away regardless of the situation.”
The island does not currently have an acute rehab facility for long-term rehabilitation so even though a patient may be ‘well enough’ to leave the hospital, they often wind up continuing to occupy a hospital bed if it is not safe for them to return home and there are no suitable care home beds available.
“The hospital has 110 beds, and they are full all the time,” said Mr Privatelli.
On average, there are 12 new admissions a day so when discharges are delayed for any reason, this directly contributes to longer wait times for Emergency Department patients who need to be transferred to a ward, which in turn impacts the amount of time that new in-coming patients must wait to be seen.
In a small community, all of this has an impact on public perception, but more importantly, it impacts patient well-being and healthcare outcomes. It goes without saying that the hospital works tirelessly to ensure that every patient has the earliest, safe discharge but this is only possible when partners inside and outside the hospital work together to achieve this goal.
As part of their ongoing initiative to improve patient flow, KEMH now has three geriatric specialists on staff who assess every person over the age of 65 who comes to the hospital.
“Regardless of what acute geriatric episode brought them through the door, the discharge plan starts at admission,” explained Ms Richardson. “Our geriatricians can consult with the emergency room staff, create daily exercise goals for patients on the ward, or advise family members on making immediate adjustments to make going home more feasible”.
The geriatric team is also available to provide round-the-clock telemedicine to help nursing homes and other care facilities determine whether a resident needs to be sent to the hospital immediately or whether a physician can see them where they reside and avoid taking a bed at the hospital.
The hospital also works with a large range of dedicated social workers, community services and integrated healthcare stakeholders for better patient outcomes including, but not limited to: Ageing and Disability Services (ADS) within the Ministry of Social Development and Seniors, the hospital auxiliary, medical gas suppliers, Meals on Wheels, PALS, Age Concern, TB Cancer & Health, Agape House, and Government and private nursing homes.
“Early intervention is the key to moving the goalposts,” said Ms Richardson. “The hospital is only one part of the island’s healthcare community. We need everyone, and everything in the community to work together seamlessly on all aspects of pre-hospital care, as well as post-discharge care.”
One of the greatest ways that members of the public can help is simply to help ensure that their loved ones are having their health assessed and visiting the doctor regularly to help them stay healthy in the first place.
Never lose sight of the fact that while the hospital is critical for acute illness, it is not the best place for seniors mentally, emotionally or physically once they are medically fit, and it is essential to make every effort to ensure that loved ones are picked up on time on the day of discharge so that people being admitted through the emergency department can receive a bed in a timely manner.
When it comes to follow-up care, anyone who is under-insured or non-insured can also take advantage of The Patient-Centered Medical Home (PCMH) programme which is an out-patient service originally established for those living with chronic diseases such as asthma, diabetes, and hypertension, who are not currently seeing a GP. The PCMH is headed by a nurse practitioner who co-manages treatment plans with the patient with the goal of achieving holistic care for complex needs.
Our hospital may continue to be a very busy place but by working together we can ensure that all patients receive the appropriate care in a timely manner.
