Patient Flow Old

In a nutshell: Mapping a patient’s in-patient journey shows that the majority of time is spent waiting. The Improvement Academy, through this project aims to show that when we design processes to provide what patients need when they need it, they’re satisfied, and length of stay reduces making patient flow much easier for us to manage.

The Challenge

Meeting daily demand for admissions is a challenge faced by all NHS organisations with an inpatient bed base.  Also, in acute trusts achievement of the 4 hour A&E standard can be put at risk when patients breach whilst awaiting a bed. 

There are a number of reasons why patients have to wait for a bed but some of the major reasons are:

  1. Most discharges happen in the afternoon or early evening whilst admissions happen throughout the day resulting in patients waiting until the latter part of the day to get a bed.
  2. There will be a significant proportion of patients who do not need to be in a bed and whilst this has not been formally quantified observations at a number of hospitals suggest that this is generally about 30%.  These are patients ready to move to their next destination who, if everything were sorted and in place would not be occupying the bed. 

What are we doing about it?

The book Making Hospitals Work (Marc Baker and Ian Taylor) describes how by taking action to tackle these issues the resulting length of stay reductions mean that patient flow becomes more controlled, beds are available when needed, and in acute trusts the A&E target is protected from breaches caused by waiting for a bed.

The methodologies employed have been successfully tested in a number of NHS hospitals and in this project we will work with a small number of trusts to implement some specific parts of Making Hospitals Work to demonstrate the art of the possible with regard to patient flow.

Our future plans

The results of this work will be evaluated, written up and made available to other trusts in the region. 

It is our intention also to conduct a point prevalence audit in those trusts in the region willing to participate to highlight the number of patients who would be ready to move to their next destination if everything were in place.  We anticipate that this will show a quite different picture to that seen in the Delayed Transfers of Care (DTOC) SITREP submitted monthly by trusts being in the order of 30% of all patients as documented above.  By doing this we would hope to demonstrate to trusts the potential for managing patient flow more successfully.

Quality Improvement Training

Have you seen our Quality Improvement Training? Read all about our Bronze, Silver and Gold level training for staff at all levels in Yorkshire and Humber in our Training and Events section.

Further Information

Impact Case Study: Patient Flow



Tania King


07974 991031