Even though the Spanish national elections, this Sunday November 20, might bring a change of government, hospital management knows that tight budgets and over-crowding will not change. David Willis, managing director of the Advisory Board Company, says that this "combination of economic and political uncertainty" only makes it more crucial that hospitals look for creative solutions to shared problems.
The economic crisis opens a greater opportunity for the unique multinational medical best practices research group to share their research on efficiency of time, money and bed-usage. On Monday, administrators from 16 Spanish hospitals met in Madrid to discuss how to improve the perpetual problem of bed scarcity.
According to "New Scientist" magazine, as of 2010, "Of all the people in human history who ever reached the age of 65, half are alive now." With an older population with worse lifestyle habits making up the vast majority of patients in hospitals worldwide, it is no wonder that hospitals are facing over-crowding and bottle-necking at most registration and discharge counters. Hospitals are constantly expanding and adding new beds, but their efforts cannot keep up with the demand. Madrid has 56 hospitals and approximately five physicians per 1,000 residents. Spain only has approximately 2.6 beds for that same population.
ABC presents the logic that, facing this scarcity, "the earlier you get them into bed, the earlier you get them out."
Willis says that most hospitals do have programs and objectives geared towards greater efficiency, but that they are "siloed" from department to department and problems often feel a "domino effect." Emergency departments are "bursting with patients waiting for beds." ABC offers solutions for determining if patients need to be treated on the spot or checked into a bed.
One of these solutions is to treat patients with common illnesses like pneumonia by employing Standard Order Sets. Essentially, for common diagnosis, eighty percent of the time, hospitals can assure efficiency and accuracy by following set protocol for using a standard treatment procedure.
Three of the 18 hospitals present--and a third of hospitals in general--use assessment and observation units to try to filter patients between the emergency department and the beds. These units treat patients "deemed appropriate for acute medical admission or assessment," like those with chest pain or acute asthma. These units are placed near to the emergency room and, according to the Hospitals & Health Networks, acute patients who report to the emergency department are admitted to these units for testing and observation for eight and 48 hours, with the average time being ten hours. However, one of the hospital managers at Monday's meeting said these departments tend to function as simply another waiting room for patients because they are inadequately staffed.
ABC also recommends assigning and displaying an expected discharge date, while the patients are registering. "Many patients see it as a challenge to beat the official dates," Willis said. He said that this should not push the patients out sooner than necessary, but it should be used as a way "to engage the patient as an ally in the discharge process." Also, patients and family can better coordinate transportation and caregivers ahead of time, so as to not delay the discharge due to lack of organization.
Fernando Carracedo is the quality manager of the Hospital de Madrid, a private five-hospital group, which includes a university. They are considering the possibility of contracting ABC because they wish to innovate using modern processes and technologies. When one of their hospitals reaches capacity, they can transfer patients to one of their four other hospitals. However, since Spanish ambulance corps are private and separately-owned from the hospitals, Carracedo says the schedule "doesn't depend on our time." Transfers within the city that should take about an hour can take up to three.
Another hurdle is that, besides emergencies, Spanish hospitals shut down Friday afternoon until the busiest time of Monday morning, often keeping patients there two days longer than necessary. After congestive heart failure, the most popular cause of a longer length of hospital stay is simply the fact they were admitted on a Friday. ABC's research states that there is a 46-percent reduction in "avoidable days per month" when weekend support is provided to hospitals.
The medical director of the private Madrid Hospital Moncloa, Carlos Zarco described some services of hospitals functioning on the weekends as a great idea, but essentially "imposible" and very expensive in Spain. He said that profitability would go down, but he does think departments like radiology should be open on weekends.
Only time will tell if ABC's advice will be taken by the Madrid hospitals and if patients will have to wait less time.
Go here to read Part 2 in this series on hospital innovation in Madrid, focusing on lowering re-admission rates.