Understanding patient flow in hospitals

Karakusevic, S. Nuffield Trust. Published online: 11 October 2016

Image source: Nuffield Trust

This briefing lays out how greater speed through a system often requires more space. Looking at trusts that meet the four hour target and those furthest from meeting it, it estimates that at least 5.5% of beds need to be free for the standard to be met. Yet many hospitals are unable to provide this much of the time, making target breaches inevitable.

The paper looks at ongoing changes driving this squeeze on bed space, including mortality, the squeeze on bed space during years of austerity, rising numbers of patients with multiple conditions, and delayed discharges.

An analysis examines how bed use and patient flow change through the course of the day, drawing on Hospital Episode Statistics which track admissions and discharges. It shows that bed occupancy does not peak at midnight, when the official census of patients is carried out, but in mid morning. Meanwhile, the highest need for patients to be moved through hospital peaks at an entirely different time of day, in the evening.

Read the full summary here

Read the full report here


Active Intervention Can Decrease Burnout In Ed Nurses

Wei, R. et al. Journal of Emergency Nursing. Published online: September 16 2016


Introduction: The aim of this study was to evaluate whether active intervention can decrease job burnout and improve performance among ED nurses.

Methods: This study was carried out in the emergency departments of 3 hospitals randomly selected from 8 comprehensive high-level hospitals in Jinan, China. A total of 102 nurses were enrolled and randomly divided into control and intervention groups. For 6 months, nurses in intervention groups were treated with ordinary treatment plus comprehensive management, whereas nurses in the control group were treated with ordinary management, respectively. Questionnaires were sent and collected at baseline and at the end of the study. The Student t test was used to evaluate the effect of comprehensive management in decreasing burnout.

Results: All ED nurses showed symptoms of job burnout at different levels. Our data indicated that comprehensive management significantly decreased emotional exhaustion and depersonalization (P < .01).

Discussion: The findings suggest that active intervention with comprehensive management may effectively reduce job burnout in ED nurses and contribute to relieving work-related stress and may further protect against potential mental health problems.

Read the abstract here

The effect of timing of antibiotic delivery on infection rates related to open limb fractures: a systematic review

Whitehouse, M.R. et al. Emergency Medicine Journal. Published Online: 15 September 2016


Objective: To examine whether the timing of delivery of intravenous antibiotics following open limb fractures has an effect on deep infection rates and other outcomes.

Design: We published an a priori study protocol in PROSPERO. Our search strategy combined terms for antibiotics, timing of administration and fractures. Two independent reviewers screened, selected, assessed quality and extracted data from identified studies.

Data sources: We searched five electronic databases with no limits and performed grey literature searches.

Eligibility criteria for selecting studies: Randomised and non-randomised controlled studies, prospective and retrospective observational studies in which the effect of the timing of delivery of antibiotics on the outcome of deep infection in open fractures was considered were included.

Results: Eight studies were included according to the above criteria. There were no randomised or non-randomised controlled trials. None of the included studies provided data on patient reported or health-related quality of life. The overall deep infection rate ranged from 5% to 17.5%. All of the studies were at substantial risk of bias. One study reported a reduced infection rate with the delivery of antibiotics within 66 min of injury and seven studies reporting no effect.

Conclusions: Sufficiently robust evidence is not available currently to determine whether the timing of delivery of intravenous antibiotics has an effect on the risk of deep infection or other outcomes following open limb fractures. There is therefore a need for a randomised controlled trial in this area before policy changes should be instigated.

Read the article here

Why are we waiting?

Maria Unwin, Leigh Kinsman, Scott Rigby. Why are we waiting? Patients’ perspectives for accessing emergency department services with non-urgent complaints  International Emergency Nursing. published online September 13, 2016


•A large number of non-urgent emergency department (ED) patients would prefer to be seen by their general practitioner.

•The young (those under 25 years of age) have a disproportionately high attendance rate for non-urgent conditions.

•Perceived need and convenience are the most commonly cited reasons for choosing to attend ED with non-urgent complaints.

•Musculoskeletal symptoms were the most common presenting complaint amongst non-urgent patients.

•Cost was not a significant factor in the decision to attend the ED.



Emergency departments world-wide report service demands which exceed resource availability. Themes such as crowding, non-urgent presentations, ambulance diversion and access block have been linked to complications in care, poorer patient outcomes, increased morbidity and staff burnout. People attending the emergency department with problems perceived as non-urgent are frequently attributed blame for increased service demand, yet little is known from the patients’ perspective.


This project utilised a descriptive cross-sectional waiting room survey of non-urgent patients to identify factors contributing to their decision making process to access ED services at a regional hospital in Tasmania, Australia. Data were analysed using a statistical software package and comparison made between the sample and population groups to determine broad representation.


Patients’ decision making processes were found to be influenced by convenience, perceived need and referral by a health care provider. Cost did not present as a significant factor. A high incidence of patients under 25 years of age were identified and musculoskeletal complaints were the most common complaint across all age groups.


Further consideration is required to determine how to best meet service demand to facilitate the provision of the right service at the right time to the right patient.