Hospitals Have Thermostats Too

Dear Colleague

Over the course of the last six weeks I’ve been watching the pattern of activity across the hospital.

Here’s what I’ve noticed.

The level of demand in our emergency stream has been constant at about 600 attendances each day. Over the course of the last few weeks however, our occupancy (how many patients are occupying beds overnight) has fallen from 93-95% to nearer to 85%.

There are many possible explanations for this. Possibly the patient attending ED were less sick and fewer required admission. Possibly the patients who have been admitted were less complex. This is possible but not very likely to have suddenly changed over a period of a few short weeks. 

We have had fewer ambulance diverts from HGH. Although this has happened less frequently, it is not so different that it could have caused a fall in occupancy of this size.

We can speculate about the reasons for lower occupancy levels, but here’s what we do know.

The paediatric division has worked out how it can reliably and safely discharge more than 60% of their patients before 11.00am. Well done to them – this was a serious piece of work which mapped out what was happening, and then with everyone’s help, re-designed the way things worked. It means that the next patient get be admitted more quickly, so that treatment can start earlier. 
 
The medicine division, has been paying particular attention to ensuring there is a good plan for the weekend. This means that patients are continuing to be discharged over the weekend, which means the hospital starts the week in a better position, with fewer patients in hospital. Well done to the medicine team – this is making a big difference.

We have now achieved a hospital occupancy level which the evidence shows is  safer. Occupancy levels at 85% of less are associated with lower levels of health care acquired infections, lower rates of medicine errors, lower complications and fewer deaths.

That sounds like the kind of hospital we want to see.

I think hospitals develop their own ‘temperature setting’. What I mean by this is the equilibrium point that people working in the hospital regard as ‘normal’. 

We’ve been running a hospital where it feels ‘normal’ to have occupancy at 95%. Today our hospital is running at 85%.

We need to find a way of making this feel like the new ‘normal’. It’s like setting the temperature on the air conditioning.

Over the next few weeks we will watch the situation carefully. When – I’m sure it will happen – our occupancy starts to rise again, we need to look at why.

Then, once we work out why it’s happening, just like the air conditioning, we need to work out how to cool things down again.

I’ll keep you posted.

For now however, let me wish you and your family good health and happiness for the week ahead.

Best wishes

Adam