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Real time data rather than a “midnight census” of empty beds could help trusts tackle flow problems and reduce delays for patients, a report from the Nuffield Trust has said.

Counting beds at midnight fails to recognise the resources needed to move people in and out of beds, and how that peaks during the day, the report said. Beds are often out of action for several hours while they are cleaned and bedclothes changed, patients are transferred and handovers completed. The report suggests that trusts achieving the four hour A&E waiting time standard need around four hours to finish the process. This can take up 2-4 per cent of bed capacity.

One of the authors, Nuffield Trust visiting senior fellow Sasha Karakusevic, said understanding this flow through the hospital and what influences it is like putting together a jigsaw puzzle. He said: “You have to think about it differently and piece together the component parts. I think very few trusts have actually got to grips with this problem.”

He added the factor that would make most difference to managing patient flow was moving towards real time data. “But it would also be to involve the ward team and hospital services staff and to map out the transfer process,” he added.

He warned that if projections about the growth of the elderly population were correct, plans to close hospital beds without clear plans of how this could be achieved without increasing delays would be “potentially disasterous”. Current projections suggest without action, 9,500 more beds could be needed by 2020 and 35,000 more by 2030.

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