Matter for Discussion: Patient flow – is it patient-focused?

Last year Congress resolved to tackle corridor care (RCN, 2023); this discussion goes beyond corridor care to question whether health care’s preoccupation with patient flow impacts patient care.

Maintaining patient flow through the hospital is necessary to avoid overcrowding in wards, and patients waiting in emergency departments and ambulance bays which we know leads to poorer patient outcomes (Bacler-Silva et al, 2021). It is therefore said to promote efficient, safe, and effective care of patients. However, as pressure on services across health and social care increases and hospitals become more overcrowded (RCN, 2020), so does the burden on staff to speed up patient flow. This pressure to move patients on within hospitals, or discharge them out, is passed from department to department which can result in health care staff being so focused on patient flow that they lose focus on the patient.

The need to maintain patient flow can have troubling consequences for patient care; we know that it can result in corridor care, which can put patient safety and dignity at risk. It also risks the provision of safe and effective care in a myriad of other ways too. 

For example, the risk of delirium increases when a patient is moved between units or even different bed spaces (Goldberg et al., 2015). Frequent changes in staff surrounding a patient (NICE, 2023) and disturbed sleep, which is likely to occur if a patient is moved at night (Kuroda et al., 2022), also increase delirium risk.

Frequently moving patients, and moving them from hospitals to non-acute settings, can make it harder for relatives and friends to visit; something which is recommended by NICE (2023).

Moving patients may also create infection control issues if they come into contact with more people and surroundings, resulting in them spreading these infections (Boncea et al., 2021) around and between health care facilities (Donker et al., 2017).

Wanting to make space for patients could also lead to inappropriate and unsafe discharges where the required community nurses or package of care is not yet in place or there has not been a medical review.

All this and more may, of course, negatively impact the already threatened physical and mental health and wellbeing of staff, including moral injury from not being able to provide high levels of patient care. 

The reading list for this debate is available here.

References

Bacelar-Silva G, Cox JF, Baptiata HR and Pedro PR (2021) Identifying and Addressing the Underlying Core Problems in Healthcare Environments: An Illustration Using an Emergency Department Game, International Journal of Environmental Research and Public Health, 18(19), pp.10083. doi.org/10.3390/ijerph181910083

Boncea, E, Expert, P, Honeyford, K, Kinderlerer, A, Mitchell, C, Cooke, G, Mercuri, L, and Costelloe, C (2021) Association between intrahospital transfer and hospital-acquired infection in the elderly: a retrospective case–control study in a UK hospital network, BMJ Quality & Safety, 30(6), pp.457-466.

Donker T, Smieszek T, Henderson KL, Johnson AP, Walker AS and Robotham JV (2017) Measuring distance through dense weighted networks: The case of hospital-associated pathogens, PLoS computational biology, 13(8), p.e1005622. doi.org/10.1371/journal.pcbi.1005622

Goldberg A, Straus SE, Hamid JS and Wong CL (2015) Room transfers and the risk of delirium incidence amongst hospitalized elderly medical patients: a case–control study, BMC Geriatrics, 15 (69). doi.org/10.1186/s12877-015-0070-8 

Kuroda Y, Sugimoto T, Satoh K, Suemoto CK, Matsumoto N, Uchida K, Kishino Y and Sakurai T (2022) Factors Associated with Behavioral and Psychological Symptoms of Dementia During COVID-19, International Journal of Environmental Research and Public Health, 19(16), pp.10094. doi.org/10.3390/ijerph191610094

National Institute of Health and Care Excellence (NICE) (2023) Delirium: prevention, diagnosis and management in hospital and long-term care Clinical Guideline [CG103] Available at: https://www.nice.org.uk/guidance/cg103 (accessed 13 March 2024).

Royal College of Nursing (2020) Corridor care’ in hospitals becoming the new norm warns RCN. Available at: https://www.rcn.org.uk/news-and-events/Press-Releases/corridor-care-in-hospitals-becoming-the-new-norm-warns-rcn (Accessed 13 March 2024).

Royal College of Nursing (2023) Treatment in Corridors and Waiting Rooms ‘degrading’ for Patients Say A&E Nurses. Available at: https://www.rcn.org.uk/news-and-events/news/uk-treatment-in-corridors-and-waiting-rooms-degrading-for-patients-say-a-and-e-nurses-150523 (Accessed 13 March 2024).