Operational Policy
Surgical Bed Management
1. Introduction
As of 4th October 2010 surgical beds will be ring-fenced for surgical patients. This
policy is intended to support the satisfactory placement of patients within the surgical
bed stock and the management of Trust bed capacity. It aims to provide a common
understanding of surgical bed allocation and to promote the safe and clinically
appropriate placement of patients within the Trust.
2. Scope of Document
This document covers all aspects of the Surgical Elective and Emergency Pathway
management thus ensuring that surgical patients are cared for in the most suitable
ward by the appropriately skilled staff, risks are minimised and patient safety and
quality of care is maintained at all times.
The specialties that this document covers are Orthopaedics, Major Trauma, Urology,
General Surgery, ENT, Maxillo-Facial, and Plastic Surgery. The wards that this
document covers are Gunning, Holdsworth, Vernon, Cavell, Florence Nightingale,
Keate and Gray (the surgical bed stock).
As of 29th November 2010 Moorfields Ophthalmology patients will also have access
to Surgical beds.
This document does not cover Medicine, Renal, Vascular or Gynaecology. These
areas will not have access to Surgical beds. Surgical patients will not be placed in
these areas, outside of the surgical bed stock.
3. Roles and Responsibilities
3.1 Surgical Patient Flow Co-ordinator (SPFC)
 Day to day operational responsibility for bed utilisation, ensuring that
demands of emergency and elective admissions are balanced across
Surgery
 Co-ordination and support of Surgical bed manager and Surgical
discharge teams
 Key link person between Specialties, A&E, and Directorate Management
Teams
 Ensure issues regarding bed management are communicated in a timely,
effective and constructive manner.
 Lead for the development of policies and action plans (in collaboration
with surgical specialities) to ensure that patient pathways work effectively
and in the best interests of patients
 Regular audit and review of effectiveness of the Directorate to meet
capacity demand
 Responsible for coordinating inter hospital transfers
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3.2 Surgical Bed Manager (Rotating)
 Day to day operational responsibility for bed utilisation, ensuring that
demands of emergency and elective admissions are balanced across
Surgery
 Responsible for transfers of patients within the hospital
3.3 Consultant Staff and the Medical workforce
 Ensure EDD is identified and documented for all patients
 Ensure Merlins and TTO are completed to prevent delayed discharges
 Daily morning ward rounds
 Liaison of senior ward nursing staff re bed availability
3.4 Senior Ward Nursing staff
 Daily management of ward beds
 Actioning discharges in line with nurse led discharge policy
 Ensure Patient Pathway Co-ordinator is informed of any out of hours
elective cancellations / alterations
 Daily identification of appropriate number of beds for A&E referrals
3.5 Discharge Co-ordinator
 Actioning discharges in line with Trust Discharge policy and Repatriation
policy
 Liaising with referring Trusts re transfer and repatriation of patients
 As appropriate, reviewing trauma referrals
3.6 Pre-Assessment Nurse
 Ensure all elective patients are informed of their expected discharge date
 Identify patients with extended length of stay
3.7 Directorate Management Team
 Accountable for bed management within own Directorate
 Accountable for making decisions on temporary bed closures /
Attendance at weekly admissions planning meeting
 Operational support
 Organisation of workload to reduce variations in demand
3.8 Patient Pathway Co-ordinator
 Ensuring TCI cards contain expected length of stay information
 Attendance at weekly admissions planning meeting
4. Bed Management
Each specialty team is responsible for proactively managing their admissions and
discharges to ensure all anticipated elective and emergency patients can be
accommodated within their available capacity. Processes must be in place to ensure
that effective management of patient flow and bed capacity is carried out 24 hours
per day, 7 days per week.
Specialty teams will work collaboratively with the Patient Flow Co-ordinator and
Surgical bed manager who will provide the overview, co-ordination and support for
effective bed use across the Surgical bed stock. This will be done in a way that
balances the risks to accommodate patients’ clinical and social needs whilst ensuring
single sex and infection control requirements.
To reduce the Length of Stay (LOS) in an inpatient bed, effective discharge planning
is critical. Discharges should be managed within specialties, in line with the Trusts’
discharge policy.
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Specialties are expected to adopt a flexible approach to the needs of Surgical
patients as a whole, reallocating resources, as required, to accommodate surgical
needs.
The number of patients selected for elective admissions must be realistic; taking into
account that bed provision must be made for both elective and emergency
admissions. The allocation of emergency and elective patients to beds must be
balanced to meet the demands of both pathways mindful of clinical urgency and
national targets.
At times, priority will have to be given to emergency admissions but every effort will
be made to avoid the cancellation of elective admissions. The cancellation of
elective admissions must only occur once all other avenues for creating capacity
have been explored and must be agreed at Divisional Director of Operations level or
through a nominated deputy.
The patient’s safety and clinical need must be given priority.
Patients who become medically ill whilst on a surgical ward should be referred to the
appropriate Medical team. On acceptance of the referral it is anticipated the patient
will be transferred to the appropriate medical ward within 24 hours. It is the Senior
Ward Nurses responsibility to ensure the documentation of this acceptance has been
made in the medical notes.
4.1 Elective Admissions
All elective admissions should normally be admitted to the appropriate Specialty
beds or to the Surgical short stay ward. However, when there is pressure on
beds within the Trust, any available appropriate surgical beds will be considered
in order to prevent cancellation of admissions. Discussion must take place
between the Patient Flow Co-ordinator and appropriate Matrons when
considering alternative surgical beds for placement.
Some elective admissions are recognised as priorities:
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Urgent elective admissions (e.g. for cancer surgery) may be a priority
because of the clinical urgency of the case
Patients whose elective inpatient admission has previously been cancelled
Patients who have waited a long period for admission
Daily discussion will take place between the Patient flow co-ordinator and
Surgical matrons to prevent cancellation of elective admissions wherever
possible. No patient should be cancelled without discussion with the appropriate
Consultant.
All patients will have an Estimated Date of Discharge (EDD) set by clinical staff
which will be proactively tracked and implemented by medical and ward nursing
staff. This date should be identified at pre-assessment.
Discharge summaries must be dispatched to the patients GP within 24 hours of
discharge
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4.2 Emergency Admissions
All emergency admissions should normally be admitted to the appropriate
Specialty beds or to the Surgical short stay ward. Use of the short stay ward
must be in line with the infection control policy and should only be used in
exceptional circumstances. However, when there is pressure on beds within the
Trust, any available appropriate surgical beds will be considered in order to allow
timely admission. Discussion must take place between the Patient Flow Coordinator and appropriate Matrons when considering alternative surgical beds for
placement.
Patients who require admission following an A&E attendance must be notified to
the Surgical Bed Manager who will subsequently inform the ward of the need to
accommodate the patient.
Patients who need to be admitted from Outpatient clinics should be notified to the
Surgical Bed Manager, who will then liaise with the appropriate surgical ward. If
a bed cannot be found on the ward, the SPFC should be informed. It will be their
responsibility to ensure an appropriate bed within the surgical bed stock is
identified.
Orthopaedic Pelvic cases are recognised as being a priority for admission due to
ensuring an effective clinical outcome. All cases should be notified to the Pelvic
Nurse Practitioner on bleep 7064.
All patients will have an Estimated Date of Discharge (EDD) set by clinical staff
which will be proactively tracked and implemented by medical and ward nursing
staff. This date should be identified within 12 hours of admission.
4.3 Inter Hospital Transfers
Time Critical transfers will continue to be admitted via A&E. Attendance must be
notified to the Surgical Bed Manager who will communicate with the appropriate
specialty ward.
Non urgent transfers will be accepted by the admitting specialty. The SPFC
should be informed of the transfer and be provided with the following information:
 Location of patient
 Patients home address and postcode
 GP address and postcode
 Priority e.g. admission within specified time (e.g. 24/48 hours)
The SPFC will be in a position to balance transfers of patients with known
repatriations and will take responsibility for housing the patient on the appropriate
ward. They will ensure the Surgical bed manager is kept fully informed of all
actions.
5. Capacity Meetings
In order to meet emergency and elective demand, specialty led weekly capacity
meetings will routinely take place on Friday lunchtimes. These meetings will review
all elective patients with a TCI in the next week to determine which patients should
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be admitted to the specialty ward, which are suitable for Gray and which patients
could be pre-cancelled / postponed.
Initially a daily capacity meeting will be held at 08.00-08.30 Monday to Friday. The
role of the meeting is to agree actions to be taken over the prospective 24 hour
period, in order to accommodate emergency admissions, and if necessary prioritise
elective patients. Patient safety and robust risk management must be at the core of
all decisions taken. Required attendance at this meeting is: Divisional Director of
Operations (DDO) / General Manager (GM) (Chair), Divisional Director of Nursing
(DDN) / Head of Nursing (HoN) (Deputy Chair), Matron of the Day, General Manager
of the Day, SPFC and Surgical Bed Manager.
Out of hours the site manager will inform the Manager on call about capacity issues
who will advise, support and escalate to Director level where necessary. Escalation
will be required if the number of surgical beds is insufficient for emergency activity
and the next 24 hours elective activity.
6. Moorfields
As of the 29th November, Moorfields Ophthalmology patients will also have access to
the Surgical bed stock. These patients will be treated as surgical emergencies and
will follow the appropriate pathway. It is expected that the majority of these patients
will, where possible, be accommodated on Gray Ward. A separate operational policy
is currently being developed to support the timely admission and satisfactory
placement of these patients.
7. Use of Side Rooms
Side rooms should continue to be managed as per the Trust bed management policy.
It is recognised that a level of flexibility regarding the use of surgical side rooms will
need to occur. If a medical patient requires the use of a surgical side room for
infection control purposes, the SPFC should be contacted and asked for use of a
side room. It is expected that this arrangement would be time limited and an
appropriate facility in a Medical ward would be expedited.
8. Escalation Area Usage
At times it may be necessary to open additional surgical beds in order to create
capacity for unprecedented short term emergency and / or elective surgical demand.
This should not be the norm and should ideally be avoided by expediting actions to
increase discharges, prioritising patients for admission and utilising admission and
discharge on the day facilities thereby creating additional capacity.
Surgical wards will have agreed bed spaces that they will flex into to deal with short
term pressure and these bed spaces will be closed again once this pressure has
eased. In most cases this will be fully utilising the 8 bedded bays on wards rather
than using only 6 bed spaces. Escalation beds will only be opened for Surgical
patients if clinically appropriate and safely staffed.
The planning and utilisation of this additional capacity will be overseen by the SPFC.
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