Access department takes action to avoid bed crunch
Communication with the ED is key
Like many hospitals, Philadelphia’s Presbyterian Medical Center actively is engaged in the challenges of bed management, particularly with the cold-and-flu season putting an extra strain on resources, says Anthony M. Bruno, MPA, MEd, director of patient access and business operations.
"This is our busy season, and we are in the same boat as many others who don’t have enough nurses to manage all of our beds all of the time," he says. "Some of the beds are closed because there are not enough nurses to provide the care."
To help ease the bed crunch, Bruno says, his department is involved in three specific initiatives.
• Hiring an admissions nurse facilitator.
"That person’s job will be to manage the beds on a day-to-day basis, Monday through Friday," he explains. "She will work closely with physicians, nurses, the emergency department [ED], the catheterization lab, in an effort to coordinate the use of beds and the placement of patients."
This new "bed czar," Bruno notes, will report to the manager for admissions and to one of the hospital’s directors of nursing. "We’ll have a clinically trained professional up in the nursing units, directing and coordinating admissions and discharges."
• Working with the ED to improve communications.
In late January, he says, patient access staff began giving confirmation numbers — like those used by hotels — to ED personnel any time they call in for an admission. "This is so there will be no question as to whether or not they called us, and whether or not we received the information that a patient is coming from the ED," Bruno adds.
"Sometimes [ED personnel] will say, I called in the bed an hour ago,’ when they really didn’t," he says. The department also will be keeping more stringent logs to go along with those confirmation numbers, Bruno notes.
• Placing discharge reminder cards in patients’ rooms.
Tent cards, such as those restaurants put on tables to advertise specials, will be used to encourage patients to begin preparing for discharge as soon as they arrive, he says. The information on the card starts out with the phrase, "We know you’ve just arrived, but soon you will be homeward bound." It emphasizes — with words in bold type and again in a list of suggestions — that patients should make plans to have someone pick them up before 11 a.m. on the day of discharge.
The following suggestions also are made:
— Ask your doctor or nurse about diet, exercise, prescriptions, and when to see the doctor after you go home.
— Arrange to have flowers and personal items you won’t need overnight sent home.
— Arrange for someone to be at home when you arrive, if you’ll need help.
"Late discharges are always a problem," Bruno notes. "We used these [tent cards] at a couple of other hospitals where I worked and they were very well received by patients. They didn’t cure everything, but what we’re trying to do is use a multifaceted approach, to come up with a number of things that will all help amend a bed crunch."
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