25 ideas for improving bed control programs
Participants at a meeting between representatives from the Alexandria, VA-based National Association of Children’s Hospitals and Related Institutions and those from Medical Management Planning in Bainbridge Island, WA, brainstormed on the issue of bed control. Here are 25 ideas they came up with:
- Use a single multidisciplinary database and assessment form at the point of entry. This form follows the patient through each phase of care, from the emergency department (ED) to inpatient, etc.
- Initiate RN treatment protocols in the ED, including which patients will most likely require admission. Notify admitting office of the probability of an admission.
- Establish an area for initiating treatment for direct admits and transfers while waiting for a bed on the preferred unit. This area could be adjacent to the ED, but would not be an ED bed.
- Identify and document discharge criteria and home needs at the time of admission or upon confirmation of diagnosis.
- Have referring physicians contact a specific RN who is responsible for 20 to 25 specific physicians to arrange for admission of his or her patients to the hospital.
- Employ a "bed manager" who walks through every morning to assess bed availability.
- Negotiate managed care contracts with specific protocol conditions for admissions that won’t require pre-authorization.
- Assemble a team that does discharge planning rounds daily.
- Put discharge criteria on the same forms as the physician orders.
- In a crunch time, hold daily bed meetings. Work on discharging patients who don’t need inpatient care, creative staffing resources, etc.
- Review all forms and/or computer screens with this question: What data do you need? Elim-inate all other data.
- Involve the referring physician’s office in the admissions process. Have the office give the family the packet of pre-certification and preregistration papers to fill out and send in.
- Install a system that automatically pages the housekeeping office with a room number that needs cleaning at discharge.
- Housekeeping notifies admitting office directly of ready beds.
- Hold joint meetings between pre-admission, admission, and case management to improve communication and develop discharge-planning procedures.
- The day before admission, staff put together a business packet for the scheduled patient, which includes chart, ID bracelet, insurance forms, pre-certification forms, registration forms, and consent forms.
- Appoint the person most responsible for discharging patients as the person responsible for bed placement.
- Use advance chart preparation — patient chart prepared and sent to the department that will care for the patient. That department completes forms and obtain consents, etc.
- Merge the functions of scheduling, pre-certification, admitting, medical records, and billing into one care process department with a maximum of three job classifications.
- Make observation area a place for aggressive, short-term treatment with a defined set of procedures and practices.
- Appoint a flying squad nurse who is solely responsible for administrative duties ignored during the day, moving from floor to floor depending on demand. That allows RNs to tailor their days based on patient needs, including admission turnover needs, and to disregard time-consuming administrative work.
- Q shift: Change the shift of one RN for three general units to cover 10 a.m. to 7 p.m. Three RNs solely perform admitting, discharging, and transferring tasks for the unit.
- Establish an observation unit to locate 23-hour patients in one area, rather than being "sprinkled" throughout the hospital in available beds.
- Develop patient advocates who serve as points of contact for all patients, and coordinate all nonclinical functions from preregistration through billing. Advocates may be account representatives, patient financial representatives, etc. Advocates may be assigned to patients alphabetically, by department from which the patient is receiving treatment, or by type of insurance covering the patient.
- Hire a patient-placement RN coordinator to do pre- and postoperative education, conduct preadmission orientation and education, obtain preoperative anesthesia check, and retrieve EKGs. Floor nurses aren’t likely to question his or her authority, her clinical background helps get information from physicians, and she can take admit orders from physicians.
[For more information, contact:
- Paul Ocón, RN, Critical Care Administrator, Childrens Memorial Hospital, Chicago. Telephone: (773) 880-3947.
- Sharon Lau, Senior Consultant, Medical Management Planning, Los Angeles. Telephone:
(323) 644-0056.
- Judy Baker, RN, Consultant, Medical Management Planning, Pasadena, CA. Telephone: (626) 345-1301.
- Lynne Lostocco, RN, MSN, Field Director of Focus Group Initiatives, National Association of Children’s Hospitals and Related Institutions, Alexandria, VA. Telephone: (401) 723-8111.
- Judy Blaufuss, RN, MSN, Assistant Administrator for Patient Care Services, Primary Children’s Hospital, Salt Lake City. Telephone: (801) 588-2312.]
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