Effectiveness of an hospital bed management model: results of four years of follow-up.

BACKGROUND Several experiences of Bed Management have been published, most of them focusing on Emergency Department organization. Aosta Hospital is 70 km away from the nearest Hospital, so that ambulance diversion is not feasible and patients' admissions from ED need to be managed at the local level solely. Aim of this study was to test efficacy of an innovative Bed Management model. SETTING AND METHODS Bed Management procedure consisted of an algorithm of both rational outward allocation of patients and support to "difficult" discharges. Hospital indicators of the pre-intervention period (years 2008-2011) were compared with those of the post-intervention period (years 2012-2015), splitting data into ten medical wards mostly admitting patients form ED and seven surgery wards mostly admitting "planned" patients. RESULTS In the before-after analysis, mean length of stay decreases from 7.84 to 7.41 days (p= 0.000), and bed occupancy from 81% to 77%. Outlier days fell from 6.3% to 5.4% (p= 0.000), and the same did long stay patients (from 5.8% to 5%, p = 0.000). By contrast, ED admissions increased from 16.5% to 17.8%, as very short stays (23.9 to 25.3%, p= 0.000) and the 30 days unplanned readmissions (9.9% to 11.9%, p =0.000). The observed variations were more significant in the medical wards. Finally, waiting times in ED significantly decreased during the study period in the medical wards. CONCLUSIONS We propose a comprehensive BM model, including governance of difficult discharges within a general hospital perspective. Further organization research on Bed Management is needed, also to propose BM standards, to be adopted in any Hospital.