Audit of orthopaedic bed utilisation

Blockage of beds on an orthopaedic ward causes multiple problems; it can result in cancellation of patients or elective surgery, longer waiting lists and a crisis with emergency admissions. This often necessitates 'boarding out' of patients, which is not ideal for optimal patient care. Not all patients on an orthopaedic ward need continuing orthopaedic medical or nursing care and it may be more appropriate for these patients to be managed in a rehabilitation environment. From 1/09/98-30/11/98 data were collected on all patients admitted to an adult orthopaedic ward. Information recorded included the reason for admission, age, diagnosis, surgical procedure, family and social circumstances. In addition, the date when discharge was deemed appropriate was recorded as well as the actual date of discharge. We defined the length of overstay as the time spent in an orthopaedic bed after discharge had been deemed appropriate. There were 621 patients admitted for a total of 3159 bed days. There were 253 elective admissions and 368 emergency admissions. A total of 255 bed days were blocked by 46 patients (41 emergency and 5 elective) accounting for eight per cent of the total bed days. Of these 236 (93%) were due to emergency admissions and 19 (7%) were due to elective admissions, most blocked beds were due to patients who required rehabilitation in either a unit for the young disabled or a geriatric rehabilitation ward.