Designing a Supporting System for Hospital Bed Control



A method for bed control in ICU (Intensive Care Unit)

for quality and safety assurance of healthcare

Takahiro Yoshida1, Shogo Kato2

Satoko Tsuru3, Yoshinori Iizuka4

1 The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, JAPAN

tyoshida@tqm.t.u-tokyo.ac.jp

2 The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, JAPAN

kato@tqm.t.u-tokyo.ac.jp

3 The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, JAPAN

tsuru@tqm.t.u-tokyo.ac.jp

4 The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, JAPAN

iizukay@tqm.t.u-tokyo.ac.jp

ABSTRACT

Recent reforms in healthcare social system have led to changes such as reduction in the period of inpatient hospitalization and rapid turnover of sickbeds. In this situation, it is essential to improve the method of “bed control” for the best use of healthcare resources, that is, how the medical staff can allocate the limited healthcare resources to each patient appropriately.

A previous study developed a method for bed control; however, it did not address bed control for severely diseased patients admitted to ICU (intensive care unit). The present study describes a method for ICU bed control.

A survey was carried out in a hospital with about 1,000 beds to identify the issues regarding ICU bed control. On the basis of analysis of these issues, 4 bed control modules were developed, including “control of bed availability,” “control of existing patients in ICU,” “control of incoming patients to ICU with vacant beds,” and “control of incoming patients to ICU with unavailable beds.” We elaborated these modules to resolve the identified issues and developed a method of bed control in ICU for quality and safety assurance in healthcare. Further, this method was presented to the hospital staffs for their review to determine its effectiveness in actual clinical situations.

Keywords: ICU bed control, quality and safety assurance in healthcare, bed control module

INTRODUCTION

Background

In Japan, recently, there is a considerable debate on the need for the quality assurance in healthcare. A medical care reformation was implemented in 2002. Since then, the average period of inpatient hospitalization has decreased from 23.8 days to 17.1 days, and the number of sickbed has decreased from 8,738 to 6,717 (from 2002 to 2008)[1]. This resulted in a rapid turnover of sickbeds. As a result, the number of inpatients who are highly dependent on medical treatment increased in acute hospitals. Thus, it becomes essential to determine how to allocate the limited medical and human resources to each patient appropriately.

Sickbed is not just a bed where the patients lie down but where they receive medical treatment. By considering the attributes of inpatients, medical staffs allocate these patients to the sickbed in the hospital. For example, nurses allocate severely diseased patients to the sickbed that is near to the staff workstation.

They much say the importance of bed control. Most of them are, however, provide advice to use the resources, and there are hardly any specific methods. This is why the bed control has complex relationships with many elements, and the principle is not clear.

Previous study

In a previous study[2], Nitta developed a support system for bed control in hospitals for quality and safety assurance. In this study, the concept and method of bed control was established. We thought that the bed control in ICU had common concept as base, and introduced in this study that concept; as will hereinafter be described in detail.

Problems

The previous study focused on general beds. These beds comprise a majority of beds in a hospital. There are also other types of beds in a hospital, for example, beds in an ICU. ICU has some prominent features.

1. It employs a considerable amount of medical and human resources in the hospital.

2. It is used only for severely diseased patients who require intensive medical treatment and constant nursing.

3. Medical staff can always actively treat and nurse patients admitted in ICU. Moreover, they possess a high level of technical skills.

4. It has a very high running cost. ICU beds are 10 times more costly than general beds.

5. The number of ICU beds is limited.

From these features, it is clear that the attributes of patients admitted in ICU are different from those of patients put on general beds; hence, we need to establish a different method for bed control in ICU. In addition, there have been some recent incidents wherein severely diseased patients were refused admission into some hospitals because of no availability of beds and were kept in a high-risk situation for a long time.

OBJECTIVE

To solve the abovementioned problem, the ultimate purpose of this study is to develop a method for bed control in ICU for quality and safety assurance in healthcare.

In this study, we aim to

• survey and analyze the present situation and issues regarding ICU bed control in hospital A

• develop an ICU bed control model to allocate each patient to ICU appropriately

In the future, we aim to develop a comprehensive bed control system, which includes all the beds in a hospital, i.e., ICU, high care unit (HCU), general beds, and so on.

THE CONCEPT OF BED CONTROL

Here, we introduce the concept of bed control. This concept comprises 4 parts as shown in Figure 1.

1. To clarify the needs of a patients according to his/her attributes

To figure out what information is necessary to allocate and control the bed for each patient according to the characteristics of age, sex, severity of disease, ADL (Activities of Daily Living), etc.

2. To clarify the function of a bed

To figure out what information is necessary for each bed to accept patients, i.e., equipment, positioning, requirement of a private room, etc.

3. To develop a logic for deciding a bed

To figure out how to decide a bed function that is tailored to patients on the basis of information of points 1 and 2.

4. To develop the bed control process

To figure out how to allocate each patient to the bed and to adjust the actual hospital work appropriately by considering point 3.

[pic]

Figure 1- Conceptual diagram of bed control

DEVELOPING THE MODEL

Investigation of the issues of bed control for severely diseased patients in hospital A

To clarify the actual status and issues of bed control in details, we interviewed healthcare workers concerned with the nursing of severely diseased patients.

• Case hospital: Hospital A (this is a regional core hospital)

This hospital has approximately 1,000 sickbeds and 11 ICU beds.

• Method: We filled the data for the discussion of bed control for severely diseased patients in a form of 5W (what, why, where, who, and when) and considered that the issues of bed control originated from the section of “why.” We collected and classified these issues from the forms.

Table 1 shows the contents of analyses. Table 2 shows the collected issues.

Table 1- Contents of analyses of discussion data (partial view)

[pic]

Table 2- The collected issues of bed control for severely diseased patients

[pic]

We interpreted these issues as the function of a process model for ICU bed control. In Table 2, the issues represented in gray are beyond the scope of this model.

Classification of the types of patients

We interviewed nurses who worked in ICU and figured out the entering and leaving paths of patients admitted in ICU. We classified the types of these patients. Figure 2 shows the paths of patients, and Table 3 shows the content of classification of these patients.

[pic]

Figure 2- The paths of patients

Table 3- Classification of types of patients

[pic]

Setting the control modules

As shown in the previous subsection, bed control involves a large number of complex factors. It is very difficult to appropriately control all these classified patients in the same process. Therefore, we set 4 control modules (module 0~module 3) similar to cells according to the simplistic flow of bed control shown in Figure 3.

First, we set module 0 to clarify the ideal state of ICU for bed occupancy. Second, with regard to the ideal state, we set module 1 to control the existing patients in ICU. Third, we set modules 2 and 3 as bed availability and bed unavailability (unavailable), respectively, to control the patients entering ICU.

We developed the processes and contents for these control modules to solve the issues described in Table 2 and to control each classified patient as described in Table 3. These modules are explained in details in Results.

[pic]

Figure 3- The simplistic bed control flow in ICU

RESULTS

Figure 4 shows the constructed model as a method for bed control in ICU for quality and safety assurance in healthcare. The explanation of each module is given below.

[pic]

Figure 4- The constructed model as a method for bed control in ICU

Module 0: control of bed availability

Module 0 analyzes the past state of ICU and clarifies the ideal state of ICU in the hospital by considering the capability of the hospital to accept patients.

•The beds with the past state:

This is the date of the past state of ICU. It includes the day the patient entered ICU, the period of stay in ICU, etc. By analyzing this parameter, we can determine the number of available ICU bed to save, for example, 4/1 - save 2 available beds.

•The capability of each hospital:

This includes the medical and human resources available with the hospital in order to accept new entering patients. It determines how to save the available beds. If the medical staff can transfer the existing patients in ICU to other wards at any time, then the beds occupied by such patients become available. However, if the medical staff cannot perform such transfer, they must save the unoccupied bed as the available bed. In other words, this defines the concept of available bed.

Module 1: control of existing patients in ICU

Module 1 controls the patients who currently exist in ICU with no new entering patients, with regard to the determined ideal state in module 0. Here, we should determine the suitability of patients for ICU admission. Next, we clarified the elements based on the concept of bed control (Figure 1), such as the date of patient attributes, the date of ICU bed function, and suitability assessment.

•The date of patient attributes:

On the basis of the concept of bed control, we clarified the items for assessing patients to determine suitability for admission in ICU. We extracted important requirements for ICU bed control from an earlier study and broke down them into the assessment items, as shown in Table 4.

Table 4- The assessment items for a patient

[pic]

•The date of ICU bed function:

On the basis of the concept of bed control, we clarified the items of ICU bed function. In the same manner as described above, we extracted important requirements for ICU bed control from an earlier study and broke down them into the items of bed function, as shown in Table 5. This enabled us to define the bed function.

Table 5- The items of the bed function

[pic]

•Suitability assessment:

By considering the results of assessment (Table 4), we classified the weight of these items and developed a suitability assessment flowchart to judge whether the patient is suitable for admission to ICU. The outputs are “technical bed,” “inevitable admission,” “preferable admission (ranks A~E),” and “high cared general bed.” The higher the rank of the patient, the greater was the requirement for admission in ICU; thus, patient with Rank A has greater requirement for admission in ICU than patients with rank E.

[pic]

Figure 5- The suitability assessment flowchart

Module 2: control of incoming patients to ICU (available)

Module 2 controls the new entering patients in ICU in the case of bed availability. The case of bed unavailability in module 3 is discussed later.

Case 1: For patients planned to enter ICU

First, the suitability assessment is performed in the same manner as that in module 1. If the patient requires ICU admission, we judge whether it is an emergency. If it is an emergency, the patient is treated as an inside unplanned patient. If it is not an emergency, the schedule to enter ICU is determined by considering the state of ICU.

Case 2: For patients unplanned to enter ICU

First, it is assessed whether the patient can be treated in hospital A. If not, the inpatient is sent to another hospital, and the outpatient is refused admission to the hospital. If the patient can be treated in hospital A, the suitability assessment is performed in the same manner as that in module 1.

Module 3: control of incoming patients to ICU (unavailable)

Module 3 controls the new entering patients in ICU in the case of bed unavailability.

Case 1: For patients planned to enter ICU

In the case of these patients, the medical staff can delay the schedule of patients entering ICU. Therefore, there is no process involved in this case for the staff.

Case 2: For patients unplanned to enter ICU

First, in the same manner as that in module 2, it is assessed whether the patient can be treated in hospital A, and the suitability assessment is performed. For outpatients, the staff considers the possibility of “pushed out.” “Pushed out” is to accept the new entering patient by immediately transferring the existing patient in ICU to other bed in the case of unavailability. This approach has some risk, which must be considered. If possible or in the case of inpatients, the staff compares the suitability output of each existing patient in ICU (“inevitable admission,” “preferable admission rank C,” etc.), transfers the least number of existing patients, and accepts new patients.

DISCUSSION AND FUTURE PLANS

In conclusion, in the present study, we developed a method for bed control with a focus on ICU, in particular, those ICUs that employ a considerable amount of medical and human resources.

The nurses of hospital A were interviewed, and the bed availability was confirmed because there is no general direction for studying bed control. The rough framework of this model was not very different from the actual criteria, and it is able to deal with issues such as differences in criteria, bed functions, patients’ needs, and bed unavailability. Further studies are required to include some omitted elements (deliria, opinion of the family, etc.) to decide bed availability and involve the conceptual framework of a doctor.

In addition, this model did not address some issues. With regard to the prediction of issues, this model is just a framework, and further studies are required to develop a more accurate analyzing method. With regard to the shortage of resource, the quality and quantity of nursing care should be evaluated. Evaluation of the amount of work performed by nurses and doctors can enable us to clarify the shortage of resources in the social world.

This model generally aims to serve as a base for ICU bed control. Nonetheless, we need to separate and recognize the general part and the customized part for each hospital.

In conclusion, in the future, further studies are required to apply the model in actual clinical situations. Thus, the following points must be addressed:

•We must refine the suitability assessment of the items and logic of flowchart on the basis of investigation of the actual method of work.

• We must refine the method and principle in module 0 more finely, i.e., how to analyze and determine.

If the model progresses, then, it has the possibility to apply the unsolved issues of Table 2, “cooperation” and “work”. Moreover, by combining this model with the model for general beds, we can develop a unified model of the hospital for quality and safety assurance in healthcare.

REFERENCES

[1] Health, Labour and Welfare Ministry, (2005): -iryo shisetsu (seitai･doutai) tyosa･ byoinn houkoku no gaikyo-(Medical facilities (static and dynamic) investigations･General condition of hospital report) (in Japanese),

[2] Japan Association for Medical Informatics･ Nursing departmental Association, (2008, 7): -9th nihon iryo zyoho gakkai kango gakujutsu taikai ronbunsyu- (Japan Association for Medical Informatics Society･ Nursing Science Society thesis collection) (in Japanese)

ACKNOWLEDGEMENT

This study was supported by a grant from the Japan Ministry of Health, Labor and Welfare (No.19143101）and the Japan Standard Association.

Special thanks are extended to Ms. Inoue and Ms. Moriyama of the Iizuka Hospital for their invaluable contribution to this study.

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download