Inappropriate bed usage in a district general hospital

Background: The inappropriate usage of acute hospital beds in the NHS is well documented but there is no effective strategy in place to reduce the problem. The present study explores the reasons for inappropriate bed usage and the need for change. Methods: The Oxford Bed Study Instrument was completed by three trained screeners as a prospective study in a district general hospital over 25 days. Results: Five thousand six hundred and twenty beds-days were analysed, of which 30% per patient were designated inappropriate. There were 1139 patient admissions in the study and 51% were aged 65 years or over (older patients). This age group accounted for 70% of the inappropriate bed days, and inappropriate bed usage in older patients was 37% compared with 22% for younger patients. Following emergency admission inappropriate bed usage was 38% compared with 18% for elective admission. Rehabilitation, or lack of it, accounted for 609 (29%) of inappropriate patient bed days, receiving non-acute nursing or waiting for a non-acute facility (22.5%), waiting for a consultant ward round or opinion (20%), waiting for a test or the result of a test (20%) and premature admission for surgery (approximately 9%). Waiting for social aftercare (5%) or transport (5%) were less of a problem than had been expected. There were fewer than expected discharges at the weekend. Conclusion: A third of days spent by patients in an acute district general hospital are inappropriate and this is readily identifiable by use of the Oxford Bed Study Instrument. Its use should be the first step in a strategy to reduce a problem which could be partly achieved by improved management and change of practice within existing resources.