Some hospitals in Beijing are piloting a new management model of "one bed per hospital". How can "shared beds" break through the last mile of patient hospitalization?
2024-06-27
According to the China Radio and Television Corporation's Voice of China News, on one hand, efforts are being made to meet the medical and inpatient needs of patients as much as possible, and on the other hand, there is a shortage of beds in major hospitals, which is currently a practical challenge faced by major hospitals. It is not uncommon for a single bed to be difficult to obtain, leading to difficulties in hospitalization. The traditional hospital bed management model is clearly inadequate. On one hand, there are patients waiting for hospital beds, and on the other hand, there is an imbalance in the busyness of different disease zones. Therefore, breaking down the barriers of difficult allocation of beds between different departments has become a positive way to alleviate the difficulty of hospitalization for patients. In March of this year, the "Beijing 2024 Improvement of Medical Services Work Plan" was issued, which officially proposed for the first time that a pilot "one bed management for all hospitals" will be launched this year, with a focus on municipal tertiary hospitals. Hospitals with conditions will be encouraged to unify the management of inpatient beds, ensuring that limited bed resources are fully utilized and alleviating the difficulty of hospitalization for patients. The so-called "one bed for the whole hospital" means that patients can stay wherever there are beds in any department of the hospital, allowing doctors to follow patients, and the beds in each department become a "mobile" shared resource. While providing convenient medical treatment for patients, it also poses significant challenges for doctors and nurses in their care. How can "shared beds" break through the "last mile" of patient hospitalization under the new management model? Beijing Tsinghua Changgeng Hospital currently has a total of 1079 beds. On the basis of ensuring the availability of beds in special departments such as obstetrics and gynecology, pediatrics, and ICU, all 855 ordinary beds will be included in the scheduling platform. Nie Guangmeng, Administrative Assistant of Beijing Tsinghua Changgeng Hospital, stated that the original intention of exploring "one bed for the whole hospital" is to maximize the efficiency of using open beds. Nie Guangmeng said, "In the early stage of hospital opening, although our hospital had a staffing of over 1000 beds, they would not open together. First, 200 beds were opened, and then increased to 300, 400, and 500 beds. In this opening process, the hospital's beds were uniformly managed, which can keep the utilization rate of open beds close to full beds. The biggest benefit is that it can save medical resources and maximize the efficiency of using existing medical resources. In fact, Tsinghua Changgeng Hospital has been implementing the" one bed for the whole hospital "management model for 10 years.". Nie Guangmeng said that in 2019, the full bed rate reached 100%, which posed significant challenges to the hospital's work. The focus and difficulty were on how to screen hospitalized patients more finely and reasonably. Nie Guangmeng said, "Previously, we only needed to fill the bed, but now we need to make it more in line with the positioning of a third level public hospital. How to admit patients who should be admitted to a third level hospital? Patients who are critically ill will be given priority treatment to avoid emergency bed pressure. Even so, emergency consultations often have full beds, but we can ensure that patients in the emergency department can be admitted to the ward on the same day or the next morning as long as they have an admission form. These indicators set a limit for them. Some of these patients still need to be admitted, but if they wait for a long time in bed, we will also give priority consideration to them and ensure that patients who meet the admission criteria are fully admitted." Changgeng Hospital is coordinated by the Medical Affairs Department to manage the regular beds throughout the hospital, Yang Xiaoyan, the grassroots supervisor, is skillfully allocating beds in front of the computer. Every day before work, they check in the system to see if there are any beds available. Yang Xiaoyan said, "For example, there are patients in Ward 13A who will be discharged tomorrow. I will check the department's waiting time for tomorrow's patients from the list to match their beds. However, before admitting patients, I also need to communicate with the department. Although the beds are arranged by us, we still do not interfere with clinical practice when admitting patients. We should prioritize admitting patients with clinical communication." Zhang Yan, the head of the hospital's medical affairs department, said that patients who cannot move in are prone to anxiety. When allocating beds, they will fully inform these patients and give them feedback as soon as possible. Zhang Yan said, "As long as the patient asks us, (we) will give him a rough range. If he cannot move in, we will also give feedback to the department that the patient is in a hurry to be admitted as soon as possible. We will definitely give feedback again to make the patient not anxious." Zhang Yan admitted that the better the patient's experience, the higher the requirements for medical work. The hospital piloted "one bed for the whole hospital", and they all experienced "labor pains". Zhang Yan said, "It's not necessarily the same department that lives in this ward, but everyone seems to be familiar with it because nurses are not the kind of patients who are not in our department. They don't care, and all patients who come here are my nurses. Even doctors have a habit of seeing where patients live in the morning, setting up a movement line, and starting to check (the room)." Nie Guangmeng added that the allocation of "shared beds" follows the principle of "similar specialties and floors", allowing doctors to ensure medical quality with the most reasonable movement line. Nie Guangmeng said, "Our clinical departments are not fixed. The iron camp is a nursing camp, and the doctors actually follow the patients. The doctors go wherever the patients are. Of course, we also have a priority area, such as receiving treatment nearby. There is a relatively fixed area in his ward, and most of these patients are in this ward. Perhaps we will take him to some similar floors or departments for treatment, which can not only ensure medical quality but also enable the doctors to provide services to patients in the shortest possible time." Yao Jielin, the deputy nursing director of 12A ward, has worked in the hospital for 8 years and has experienced "comprehensive care." The changes since the pilot program of "one bed in the hospital". Yao Jielin said, "After coming to Changgeng (Hospital), I went through a process of cross departmental and cross professional admission of other patients in the ward. Although it was indeed a challenge for us nurses, it was beneficial for patients. Cross disciplinary and cross disease types were still quite difficult in the early stages. Firstly, we would organize a lot of disease learning and training in the department, with on-the-job education and training at various levels every year. The training would include learning about surgical related diseases, and the types of surgical related diseases would also be included in ward rounds. (Hospital) has a standard process, and when nurses encounter problems, they will handle patients proficiently according to this standard." Nie Guangmeng revealed that this year. By the end of the year, the second phase of Tsinghua Changgeng Hospital will be put into use, and some "shared beds" will be added at that time, Further maximize the efficiency of hospital bed utilization. Nie Guangmeng said, "In the future, it should be more conducive to patients who meet the requirements of tertiary public hospitals to receive treatment as soon as possible. At the same time, in the process of promoting the second phase, we are also accelerating the construction of medical consortia and promoting the homogenization of medical treatment in surrounding hospitals. We will also expand the scale of around 100 beds in the surrounding areas, which can accelerate the turnover rate of beds and ultimately achieve the maximization of hospital bed efficiency." Daxing District People's Hospital in Beijing is also actively piloting the "one bed per hospital" model. According to Yuan Jinglin, the deputy director of the hospital, there are currently 1100 beds in the hospital, with 20 to 30 beds per day used for shared beds. Last year, the entire hospital solved the hospitalization needs of 1900 patients through unified bed scheduling. Yuan Jinglin said, "We need to ensure that no matter which ward you are in, the service is not neglected. The main thing is to make the medical team treat patients like they do in their own ward. Not being in this ward means doctors have to run errands more, so that our nursing team can master the nursing knowledge of patients with diseases. This may require higher training in the early stage of nursing, and we are not afraid to admit any type of patient, breaking through the bottleneck from a technical perspective." Yuan Jinglin said that by implementing "shared beds", we have strengthened the training of nurses in specialized diseases, allowing nurses to cooperate with multiple specialized doctors at the same time. Yuan Jinglin said, "In the early stages, there will definitely be resistance, doctors will have difficulties, and nurses will also have fear when facing patients with a new disease. As we gradually deepen our understanding, everyone has become accustomed to it and their abilities have improved. Now the operation is relatively smooth." Yuan Jinglin admitted that with the deep intervention of technologies such as artificial intelligence and big data, hospital information systems will become more intelligent and efficient, which will also help the management of "one bed for the whole hospital" to be more refined. Yuan Jinglin said, "From the perspective of informatization, improving the accuracy and timely updating of information data will improve the efficiency of management. Further optimizing the bed space in each ward, allowing patients to be hospitalized as soon as possible, reducing waiting time, and fully utilizing resources through this sharing method can also solve the actual problems of the people." (Li Xinshe)
Edit：Xiong Dafei Responsible editor：Li Xiang
Source：CNS.cn
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