Psychiatric bed management

Psychiatric bed management is critical in the care of mentally ill patients (Phelan, Stradins, and Morrison 2001), because it ensures patients are admitted and provided with the right care, thus minimising the possibility of harm to self and others. In the UK, about 25% of the population experience some form of mental disorder such as dementia, depression, delusions, delirium, and schizophrenia (Gask, 2009). According to the Mental Health Foundation (2013), the UK has the highest number of self-harm cases in Europe at 400 per 100, 000 of the population (Mental Health Foundation, 2013). However, as noted by various studies (Lintern, 2013; Gask, 2009), bed shortages are a worrying trend in the UK with patients forced to travel long distances to seek admission, which can lead to worsening of their condition.

1.1. A brief Review of the Literature

A review of the available literature shows a disparity on the number of bed across the UK and patients seeking admission. According to Lintern (2013), availability of beds has become a worrying trend in the UK as hospitals are forced to decline to admit even acutely ill patients. Because of the shortage of beds, patients seeking admission into mental hospitals are forced to travel long distances to seek admission, which can worsen their situation. According to Gillam (2010), acutely sick patients require urgent attention in order to prevent further and minimise harm that might occur to the patients. The model of providing care shifted significantly in the 1980s when it became increasingly clear that providing care through hospital beds and undifferentiated community services, especially for people with severe and enduring mental illness. This led to the Care Programme Approach (CPA) to provide a framework for effective mental healthcare for people with severe mental problems (Mental Health Foundation, 2013).

According to the National Health Service (2014), mental health beds dropped by 31% between 2003 and 2004. On the other hand, the number of patients seeking mental health admissions has increased by 6% (NHS 2014). One reason as identified by Bhugra (2007) for shortage of beds is “because patients who are no longer acutely ill, remain on admission wards because of lack of long term facilities for them to move on to” (Bhugra, 2007, p. 33). Therefore, finding a solution to bed shortages could ensure that acutely ill patients are not denied admission, thus minimising the possibility of harm to self and others (Bhugra, 2007). From the literature review, there is evidence that there is an acute shortage on the number of beds to admit psychiatric patients. However, the relationship between bed shortages and patient wellbeing has not been covered in previous studies. In addition, there is a need to explore the barriers and potential solutions to bed shortages in hospitals across the UK.

1.2. Purpose of the Study

The purpose of this study is to explore the relationships between bed management and the quality of care for psychiatric patients and the barriers to bed management across the UK. To maintain an effective bed management system is more important in making sure that the patients are given the right care and minimize the possibility of harm to self or others. negative outcomes.

1.3. Research Questions

This study is intended to answer the following questions;

  1. What is the relationship between bed shortages and the mental wellbeing of psychiatric patients?
  2. What are the barriers and potential solutions to bed shortages in hospitals?

1.4. Objectives of the Study

This study will be guided by the following objectives;

  1. To explore the relationship between bed management and psychiatric care in the UK
  2. To examine barriers and possible solutions to bed shortages in hospitals

1.5. Justification of the Study

Psychiatric bed management is a critical aspect in the provision of efficient mental health care to patient with acute needs. According to Lintern (2013), the number of beds has been decreasing over the years, forcing patients to travel long distances to get admission. Mostly, health care providers have limited space due to the increasing numbers of health care patients. This study will increase  awareness of how bed shortages affect psychiatric treatment and how patients’ wellbeing is affected as they travel from one hospital to another seeking treatment in hospitals across the UK (Boardman and Hodgson, 2000). In addition, by exploring this topic, it will be possible to understand the context of bed shortages for psychiatric patients, and this will form the foundation for identifying the viable options for dealing with the issue in order to lessen the burden that patients and parents go through while seeking treatment. Therefore, this study is of great significance since it will help families, healthcare providers, and the government in understanding the extent of the problem of bed shortages and how they can influence policy changes to come to the aid of the mentally-ill patients.

1.6. Definition of Terms

Bed shortages

This term will be used to refer to the lack of enough beds to admit patients seeking psychiatric treatment in hospitals (Lintern, 2013).

Mental health

This term will be used to refer to the psychological as well as the emotional well-being of a person (NHS, 2014).

Psychiatric patient

This term will be used to refer to someone who suffers from psychological or emotional disorders such as dementia, depression, delusions, delirium, and schizophrenia and is seeking acute care in a hospital (NHS, 2014).

Bed management

Bed management will be used to refer to the allocation and provision of beds for psychiatric patients (Lintern, 2013).

1.7. Methodology

The researcher will undertake a comprehensive narrative review as the methodology for this study. The narrative review will examine secondary material in order to allow for a wide exploration on the experiences that psychiatric patients, their families, as well as healthcare providers encounter in seeking admission for mentally ill patients and the barriers to effective bed management. According to Baumeister and Leary (1997), a narrative review helps the researcher in addressing a broader question that is beyond the scope of one study. A narrative review will provide an elaborate examination of recent literature on the issue under investigation and helps in covering a wide range of topics “at various levels of completeness and comprehensiveness” (Moule and Goodman, 2013, p. 144). However, the major shortcoming of this research design is that it relies on published literature, and therefore, can be subject to selection bias of the literature. By using this research methodology, the researcher will be able to undertake the subsequent exercises that will satisfy the study objectives. First, by review of the related literature, the study will search for themes that relate to bed management problems, as well as the barriers to effective bed management across the UK (Green, H., et al 2005). The identified themes relate to the problems that psychiatric patients face while seeking admission in healthcare facilities. The conclusion in the presented literature will form the basis for the analysis and discussion in order to understand the extent of bed shortages across the UK as well as the barriers to effective bed management in the hospitals.

 

Chapter 2: Dissertation methodology

2.1. Introduction

The purpose for this study is to explore the relationships between bed management and the quality of care for psychiatric patients and the barriers to bed management across the UK. The research will focus on the aspects of bed management in health facilities across the UK. Secondary research will be used as the basis for this study. Although primary research could offer new and better insights on the topic, resource limitations and time would not allow this method to be used in this study.

In searching for the literature, narrative review will be used to describe the current state of bed management within the UK. The advantage of using narrative review is that it adds new insights or applications that are not available in the existing literature. In addition, a narrative review will provide a critical review of the existing literature on the subject under study. Further, by using a narrative review, it is possible for the research to identify the literature that is relevant for the area under investigation. It is easy for the researcher to exclude literature that does not add any value to the topic. As noted by Baumeister and Leary (1997), a narrative review is helpful since it helps the researcher to deal with a broader question that goes beyond the confines of the study. In addition, the researchers argued that validity of results could be greatly enhanced irrespective of the methodology employed. This is possible where the results of the studies come to the same conclusion (Baumeister & Leary 1997).

2.2. Preliminary literature scoping exercise

According to (Levac, Colquhoun and O’Brien, 2010), researchers can use a scoping study to determine the “extent, range and nature of research activity, determine the value of undertaking a full systematic review, summarize and disseminate research findings or identify gaps in the existing literature” (p. 12). Accordingly, scoping studies are used to clarify a complex concept or refine subsequent research inquiries” (par 13). The rationale for using scoping reviews is because they are ideal as researchers can integrate a range of study designs in both published and grey literature and address questions beyond those related to the current study. Arksey and O’Malley (2005) developed a framework for undertaking a scoping review that consists of the following stages:

  • Identification of the research question
  • Identification of the relevant studies
  • Selection of the studies
  • Collating, summarising and reporting the results and
  • Consultation (Arksey and O’Malley 2005, p. 22).

The identification of the research question is critical since it helps the researcher to identify which aspects of the research are most important. These subsequently guide in the choice of the search strategies (Grant and Booth, 2009). The search strategy should be broad as possible in order to identify all the possible relevant literature (Coughlin, Cronin and Ryan, 2013).

A structured search began with inputting a general search into the PubMed database with search terms “mental health and admission,” which produced 5338 results. Adding bed management to the search terminology reduced the number of hits to 189, which indicated that there was a lot of information on the subject. The search was repeated with Google Scholar which produced 166,000 hits in the first search. The second search produced 136, 000 hits. The Worldcat Library search for grey literature yielded 5,146 hits. The initial screening and selection process reduced the number of records from the initial 141,335 to 2,345 records, which were based on the initial exclusion criteria, thus locating the most relevant articles.

 

2.3. Inclusion and Exclusion criteria

Inclusion Criteria

Articles are eligible to be included in the review only if they meet the following criteria;

  • Articles that deal with bed management within the UK and relate to patients aged 18 to 65 years. Conducting a literature search should be thorough in order to identify all the relevant literature relating to the research question. This also helps in minimising the potential bias in the review process.
  • In addition, peer-reviewed journals: According to Polit and Beck (2010), before undertaking literature search, researchers should decide whether their reviews should be confined to published results only or if it should include unpublished materials. Further, Polit and Beck (2010), argue that some people restrict their reviews to reports in peer-reviewed journals because “peer review system is an important, tried-and-true screen for findings worthy of consideration” (p. 519).
  • Grey literature: Although grey literature might not be peer reviewed, it nonetheless provides a useful source of information since it emanates from researchers and practitioners who are experienced in their fields. As noted by Auger (1990), the sources of grey literature includes any information that is not available in normal book selling channels, which includes reports, trade literature, and ad hoc publications. As argued by Farace (1997), the growth of grey literature has been phenomenal with estimates putting it as high as four times that of conventional literature. Sources of grey literature will include “brochures, pamphlets, internal reports, memoranda, reports, and assignments” (Coad et al 2006, p. 35). In addition, the sources of grey literature can also be through oral presentations, in print formats or electronic forms. Therefore, in this study, the researcher will search for grey literature because it provides helpful information, or even better information compared to conventional literature.
  • Recent research integration studies in the field will be investigated and reviewed. These research studies will be grouped according to the type of review, its function, the topic addressed as well as the type of evidence that is included in the studies.
  • Finally, only articles published since 1997 and available in the English language are eligible for the review.
  • The articles that score above 60% on the CASP score will be considered moderate and will be included in the review.

Excluded literature

  • Articles that does not deal with bed management within the UK
  • Articles that address bed management but from other countries as they might not reflect the situation prevailing in the UK
  • Articles that do not relate to the specified age range 18-65
  • Articles published before 1997
  • Articles not available in the English language
  • Any article that scores below 60% will be considered low quality and will therefore be excluded from the review.

 

Search Strategy

When selecting studies for the review, “the aim of the researcher is to identify those article that address the question being posed” (Gerrish and Lacey, 2013, p. 292). Therefore, it is important to check all the references retrieved and get the full text of studies that investigate the relationships between bed management and the quality of care for psychiatric patients and the barriers to bed management across the UK. Therefore, criteria for inclusion stem from the question being addressed and relate to the core aspects of the question. For example, the participants or people targeted for the study, outcomes and the study design. The search for the studies will follow the criteria proposed by the researcher for the included literature and will be applied consistently throughout the review process (Gerrish and Lacey, 2013).

The researcher refined the search process using the following MeSH terms in searching for the right literature “Bed shortages” “mental health,”  “psychiatric patient” “delayed admission”  “mental health services,” “length of stay” “admission” “patient readmission.”  The Boolean logic will be used because it defines the relationship between search terms. The Boolean search operators AND and OR will help in broadening the focus of the search results. For example, the operator AND combines search terms so that each contains all the terms, for example, mental health and bed management. The literature search will commence on 21st November 2014 and end on 30th November 2014 in line with NHS guidelines.

To ensure that the search produced consistent results, the researcher developed the PICO to clarify the search (Table 1). By using the PICO model, key words deduced from the research questions were placed into categories. If a string yielded more than 50 references, the researcher added the Outcome string to focus the research in a more accurate manner.

PICO

Question: does acute admission among psychiatric patients improve quality of life?

Population/people/participants Intervention

(or exposure)

Comparator Outcome
Psychiatric patients aged 18 to 65 years and seeking acute admission in hospitals. Psychiatric patients is used here to refer to someone who suffers from psychological or emotional disorders such as dementia, depression, delusions, delirium, and schizophrenia and is seeking acute care in a hospital

 

Urgent admission in order to improve quality of life. Availability of beds has become a worrying issue in the UK as hospitals  and psychiatric patients are forced to travel long distances to seek admission, which worsens their situation Comparison could be delayed admission, long walk to seek admission, miles away, which leads to more harm to patient, or no admission at all Outcome is the expected results if the right intervention is carried out. In this case urgent admission would lead to improved quality of life, reduced hospital stay, reduction in re-admission as well as more bed capacity for other patients seeking acute admission. Delay in admission could lead to more harm to patient, long stay in hospital, increased re-admission and lack of beds for other psychiatric patients seeking acute admission

 

PICO helps in the identification of major elements of the research question helps translate natural language terms to subject descriptors. Using the PICO, the researcher will start with P and I and keep the search results broad.

 

2.6. Citation Searching and Scanning Reference Lists of the included studies

Searching citations of included studies will be undertaken. This will be done by selecting several key papers that are already included in the study for review and then searching the articles that have cited these papers. This process will help the researchers to generate a cluster of related and most relevant papers on bed management within the UK. Searching citations is a search forward strategy through time. Therefore, it is not suitable in identifying recent studies since they could not have been identified in the previous studies. Citation searching was previously limited to using the indexes such as the Social Sciences Citation Index, but other resources such as the CINAHL and Google Scholar nowadays include cited references in their records. Therefore, these databases can now be used for citation searching for the current study. Finally, the researcher will browse the reference lists of papers that have been identified for inclusion

2.7. Quality assessment

Any research is prone to potential bias and in some instances; these biases do affect the results of the study. Recording to the strengths as well as the weaknesses of the studies included for the present study will provide an indication as to whether the results of the study will be affected by aspects of the research design or conduct.  Quality assessments are important in carrying out the study because they provide an indicator of the strength of evidence provided by the review. In addition, quality assessment can form the standards required for future research. The researcher will use the CASP tool (Appendix 1) to access both the included and excluded studies.

2.8. Data extraction

Data will be extracted into tables documenting the reference number, which will make it easy for retrieval in the bibliography. In addition, documentation will also focus on the study population, method of study, country of origin, themes and sub-themes as well as the focus of the study. Further, a separate table will document the primary findings of the paper. This will be done for studies that are retrieved from medical databases. This important information will be from abstracts and summaries as opposed to the whole paper. If the abstracts or summaries are extremely thin or ambiguous, the full paper will be read and reviewed accordingly.

2.9. Data Synthesis

The figure below (PRSIMA Model) will be used to analyse the decision processes that the researcher will use to finalize the selection of the most pertinent research records for the study (Moher et al, 2009).

 

 

PRISMA 2009 Flow Diagram

Data Analysis

This study identified 7 studies, which met the inclusion criteria. The studies were numbered and coded using the system developed by the researcher for this study. According to Strydom, Fouche and Delport (2005), coding is helpful in breaking data down, conceptualizing it developed into new way. The 7 studies that met the criteria developed for this study was read several times in order to identify the main focus of each study as well as understand the context of each study.  The CAPS scoring tool was used to determine the methodological quality of each study, with those scoring above 14 out of 20 being considered for inclusion. The studies were ranked in order of methodological quality, where the study with the highest score was ranked number 1.

Data Extraction and analysis

Initially, a formal data search was carried out for published articles using keywords mental disorders” acute admission psychiatry”  “delayed patient discharge” “Psychiatric patients”, “delayed discharge”, “mental disorder”, health” and “admission”  The key terms were clearly scrutinized for extra references and the searching  process continued until saturation.

For every selected article, the following details were also extracted and tabulated: the name of the study, author (s), period of study, country of study, ethical considerations and approval, methodology and data analysis process followed by the researchers. Accordingly, data was classified according to the study approach adopted

 

 

Selection and Data extraction

A computers search generated 628 articles on topic, with 46 being from PubMed, 10 from Embase, 14 from Psychinfo, 388 from Google scholar and 170 from BMJ, while 35 were from additional searches on bibliographic data from the retrieved articles.  Out of the 628, 2 were duplicates and these were removed leaving 661 articles. The 661were further screened and a total of 178 abstracts were obtained and these were excluded because they did not meet the inclusion criteria for the study. A further 476 of full articles were removed because they did not meet the stated criteria for inclusion, leaving only seven for the researchers’ consideration.

 

PRISMA 2009 Flow Diagram

 

Qualitative analysis

All the seven studies in this analysis were taken from 1997 and 2007 and all dealt with bed management and quality outcomes. The articles chosen were reviewed by the researcher and each met the initial criteria for inclusion as well as meeting the methodological assessment. Table 4 shows the results of the methodological quality assessment of each article using the CASP scoring tool. The studies are scored from 0 to a maximum of 2. 0= not stated, 1= not explicitly stated and 2 =clearly stated.

All the factors of the methodological quality assessment checklist were rated equally and the total score for the 10 criteria items was 20. The highest score as 18, while the lowest was 15 and the minimum score was considered 12. With the minimum score at 15, it shows the studies were of high quality. Burnett et al (1999) scored high on most aspects except on criteria 2 because it is not clear from the study whether any appropriate technology was used. Most studies did not state own limitations as shown

 

Table 4: CASP Score for Included Literature

Author Criteria 1

 

 

 

 

 

 

 

 

 

 

Criteria 2 Criteria 3

 

 

Criteria 4 Criteria 5 Criteria 6 Criteria 7 Criteria 8 Criteria 9 Criteria 10 CASP quality rating
Burnett et al (1999) 2 1 2 2 2 2 2 2 1 2 18
Cole et al (1997) 2 2 2 2

 

2 2

 

2 2 2 0 18
Morgan et al (2005) 2 2 2 0 2 2

 

1 2 2 2 17
Goater et al (1999) 2 2 2 2 2 0

 

1 2 2 2 17
Corrigall and Bhugra (2013) 2 2 1 2 2 2 2 1 2 1 17
Keown, et al (2011). 2 2 2 2 1 2

 

2 1 1 0 15
Wall, S et al (1999) 2 2 2 1 1 1 1 1 2 2 15
Lewis R. and Glasby J (2006). 2 2 2 2 1 2 1 2 1 0 15
National Audit Office (2007) 2 2 1 2 1 1 1 1 1 2 15

 

 

Methodological Characteristics of the included studies

After analysing the identified studies, it was found that the methodology employed in the studies were qualitative in nature.  Burns and Grove (2006) observe that qualitative research is a systematic and subjective approach used to describe the experiences of people and give them meaning. The focus of a qualitative study is to find meaning and help in understanding the problem being investigated. Table 5 shows the authors, years of publication, aim of the study, sampling, data collection and analysis techniques.

 

 

No Author Aim Methodology Sampling Data collection Data analysis
1 Burnett et al (1999)   Qualitative Retrospective Semi-structured Content analysis
2 Cole et al (1997 The researchers aimed to determine whether ethnicity significantly affected time to presentation Qualitative Epidemiological study Semi-structured Odds ratios (ORs) were estimated using logistic regression
3 Morgan et al (2005) To determine whether African-Caribbean and black Africans ethnicity was associated with compulsory admission Qualitative Epidemiological sample Semi-structured Univariable analyses were conducted using chi-squared tests and odds ratio
4 Corrigall and Bhugra (2013) To explore whether ethnic variations in psychiatric admission and detention reported for adults also apply to adolescents Qualitative Longitudinal Semi-structured Odds ratios (ORs) were estimated using logistic regression
5 Keown, et al (2011).   Qualitative     Univariable analyses were conducted using chi-squared tests and odds ratio
6 Wall, S et al (1999) to determine the proportion of all psychiatric admissions that were compulsory Qualitative Longitudinal   Content analysis
7 National Audit Office (2007)   Qualitative Longitudinal    

 

Results of the primary studies on bed management

The results of this critical review are provided under the following 5 themes;

  • Compulsory Detention
  • Integration of acute teams
  • Barriers to bed management
  • Resource utilisation
  • Length of stay

Involuntary detention

Seven studies (Burnett et al (1999), Cole et al (1997), Morgan et al (2005), Goater et al (1999), Keown et al (2011), Corrigall and Bhugra (2013), and Wall et al (1999) provide significant information relating to involuntary admission. These studies found that one critical issue facing bed management in psychiatric wards was increased cases of involuntary admission for psychiatric patients, especially those with first episode of psychosis (FEP). In their study, Corrigall and Bhugra (2013) found that blacks were six times more likely to be detained with psychosis, although no increase in admission for non-psychotic cases was reported for this ethnic group. The study comprised a total of 435 inpatients and a mean age of 18.3 years. Ethnic composition was as follows; White (32%), Blacks (49%), Asian (13%) other (15%).The study is one of the few to focus on ethnic variations in admission and use of detention among young people. In addition, it is the only one that used non-psychotic conditions in the analysis of admission and detention based on catchment areas population.

Keown, et al, (2011) designed a study to investigate the rise in the number of involuntary admissions for mentally ill patients in England that occurred in spite of alternatives being available for taking care of such patients. The researchers used publicly available data on the provision of hospital beds for mentally ill patients in NHS facilities. Data relating to admission rates of the patients for mentally sick users was sourced from NHS information Centre. Keown, et al, (2011) study found that involuntary admissions across NHS facilities went up by 60%, while hospital beds decreased by almost the same figure within the same period. This study is relevant for various reasons, one being that it provides an understanding of key issues surrounding bed management within psychiatric wards. One factor indicated by Keown, et al, (2011) is that the reduction in bed space emanated from a corresponding increase in cases of involuntary admissions within one year. Further, Keown, et al, (2011) study provides a good analysis for understanding involuntary rates and trends besides proposing what might happen in case bed closures in hospitals continue.

However, a notable limitation of the five studies is their use of various ethnic communities for statistical comparisons, which could have led to a failure to identify some critical differences within the broad ethnic communities. The other studies reported significant differences between FEP patients from ethnic groups, as opposed to White natives.

 

Burnett R, Mallet D, Bhugra D, et al. (1999). Qualitative content analysis

 

Integration of acute teams

The National Audit Office (2007) argues that integrated acute teams, in which collaboration is executed in conjunction with inpatient staff within a well-defined structure, could be a good starting point to reduction in hospital beds. In addition, this collaboration also contributes to quality of care, besides economic savings for the hospitals.

Barriers to bed management

Inefficient use of resources

One study found that hospitals were being accused of misuse of resources. For example, a good area pointed by various studies is on personality disorders, with some beds being occupied by person with low-level personality disorders. Such disorders could be attended to in community setting, thus freeing bed for acute cases only.  The study by Dorling (2009) reported that mental health problems, including the lack of capacity for people seeking acute admission can be exacerbated by tough economic climate, which increases pressure in mental health care. The Centre for Mental Health (2010) argues that prevailing social issues that confront the UK government are closely related to mental health issues.

Length of Stay

Two studies focused on the length of stay as one of the critical factors in determining bed management within hospitals in the UK. One study examined the length of stay for in-patients ranging from one to eight days maximum of planned admission. Lewis and Glasby (2006) report the findings of a postal survey undertaken by NHS Confederation to determine the rate and causes of delayed discharges from hospitals for psychiatric patients. Some studies indicated that length of stay was a significant barrier to discharge. The NHS Confederation sent a survey to 83 trusts that were providing mental health services.  In their study Lewis and Glasby (2006) used both qualitative and quantitative analysis and found that the reasons for the delays were varied.  For instance, if the processes of transferring responsibilities to low-levels of care are not properly defined, it is likely that patients will remain in high-dependency care for longer periods. Lewis and Glasby (2006) provide evidence that delays in discharge leads to loss of beds by between 7% for adults and 16% for people aged 65 and above..

Discussion of Findings

The results of this review indicate there is a dire need to increase the number of beds or create interventions that will reduce pressure for inpatient admissions.

Bed management is an important aspect for ensuring good outcomes for patients seeking acute admission. From this review, it is evident that most of the studies show that excessive rate of bed occupancy creates numerous problems, both for the patients, staff and others seeking admission. A growing concern for bed management occurs when hospitals are forced to deny patients admission because of lack of a bed or when they are forced to discharge a patient prematurely in order to provide a bed for another patient. Further, overcrowding can also compromise the safety, dignity and privacy of patients and their treatment.

As noted in the review, the reduction in the number of beds available for acutely-ill patients has been closely associated with an increasing rate of involuntary admissions. A plausible explanation is provided by the studies that explored communities most likely to undergo compulsory admission. In this case, it is clear that minority groups are the most likely to be coerced into hospital care for psychotic interventions. Minority groups are mostly associated with psychotic and substance misuse and use of illicit drugs. These substances account for a higher percentage of mental disorders.

Discussion

From the data analysis, it can be seen that the NHS has experienced a problem of the effective management of beds (Green & Armstrong, 1994). Despite the importance of this issue, there is no optimum standard or tool that has been developed to help in effective bed management. Bed management is essentially a process that matches the demand for beds with the supply of beds (Boade, Proudlove & Wilson, 1999). However, from the literature review and results highlighted, it can be seen that the demand for beds outstrip their supply. This has created a situation of waiting time, delayed admissions, cancelled electives, staff negotiated beds, transfer to other hospitals and care facilities and a higher turnover for patients that results in work overload for staff. The total capacity of the hospital may be divided into medical and surgical beds. This division depends mainly on the policies of the care facilities (Keegan, 2010).

There are different factors that affect effective bed management in hospitals. From the study, it can be seen that the factors can be grouped into four including: system factors, healthcare professional factors, patient factors and social factors (Wong et al, 2011). The system factors include lack of clear policy guidelines on bed management and poor medication system. In addition, bed management is also affected by other system factors including heavy administrative work and manpower shortage. The healthcare professional factors include the fact that some healthcare professionals are not empowered to efficiently handle bed management. There are instances when physicians documents are not clear and their assessments are also not complete. The other factor is the lack of awareness of the social needs of the patients by the healthcare professionals. The patient factors include lack of awareness on medication treatment. The other patient factor is patient preference which may make some patients have a desire of staying in hospitals or refuse to be transferred to another care facility. This may affect bed management. The social factors include patient’s affordability, waiting time and inadequate equipment (Wong et al, 2011).

The ability move patients with psychiatric conditions depend on the ability of hospitals and care facilities to accommodate the diverse needs of the patients. The movement as has been seen in the literature review is the responsibility of bed managers (Proudlove, Gordon & Baoden, 2003).

One of the problems identified by bed managers is the flow of information within the hospital facilities. This flow of information affects delivery of services to patients. Through the study, it was also realised that there is little understanding on the issue of supply and demand of beds for most care facilities (Orendi, 2009).

One of the strengths of this study is the accuracy with which it measured bed occupancy rates. The methods used in this research were very appropriate and will go a long way in helping policy makers and researchers in instituting policies that can improve bed management practice in hospitals. It is important to note that a number of bed management practices have changed over the years. This has been occasioned by the fact that some patients have been infected while in hospital beds. This study did not measure the rate of infection of patients while in hospital beds. As a recommendation, future studies should inspect the relationship between efficient bed management and reduction in infection that patients can experience. The results of such a study can go a long way in helping hospital administrators and other healthcare professionals in improving the quality of care given to patients (Ahyow, Lambert, Jenkins, Neal & Tobin, 2013).

This study followed the ethical guidelines as required by the UK laws. There was no patient data or information obtained. This means that the study did not violate the confidentiality requirements. In addition, information was obtained rightly from the online databases.

Recommendations and conclusion

Bed management should be optimally designed to ensure that there is efficient flow of patients between the care facilities. This can be done by ensuring that there are policies, standards and procedures that are agreeable by the relevant parties and authorities on how the flow of patients should be managed. In addition, hospitals and other care facilities should have a bed management strategy that adequately determines the need for bed. This should then be communicated to the relevant authorities who will ensure that the need or gaps for beds are filled at appropriate times (Department of Health, 2008).

The hospital managers should have a good understanding of organization factors that affect delivery of services to patients. Some of these factors include skill mix and staffing levels. The implication of this is that there should be enough employees with the right cultural and ethnic balance and skills mix to ensure that patients are adequately served while they are in the care facilities.

Due to competition, healthcare providers have high financial and productivity targets. This requires that the providers improve efficiency of their operations in supporting patients and ensuring streamlined clinical outflows. One of the ways in which efficiency can be improved is by utilizing information and communication technology systems. This can help hospitals to save time and money. In addition, the IT systems will help hospitals employ the best practices in patient management. Hospitals should therefore employ the use of integrated information systems that will guide through the process of patient admission to bed management. This will help in improving accuracy because such systems will provide accurate data and reports on patient locations and bed status information. This information is very important in helping healthcare professionals make admission decisions.

The barriers to effective bed management should be eliminated. This process should be started by first eliminating the system and healthcare professional factors. Through this, the healthcare professionals will have a better understanding of the dynamic needs of patients. This understanding can help in further eliminating the patient and social factors.

In conclusion, was done with the objective of exploring the relationship between bed management and psychiatric care in UK and examining the barriers to effective bed management in hospitals. The objectives of the study were achieved as the relationship between bed management and psychiatric care in UK was determined and the barriers to effective bed management were also determined. However, as has been mentioned above, the scope of future studies should be improved to determine the relationship between bed management and reduction in disease transmission in UK hospitals (Ahyow, Lambert, Jenkins, Neal & Tobin, 2013).

The bed management system needs to be simple so that it can be easily understood by patients. Without this understanding, the results of the treatment may not improve the quality of health for the patient.  Every component of the health system has a role to play in ensuring better bed management.

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Appendix 1: CASP Tool

 

Adapted from:

Critical Appraisal Skills Programme (CASP), Public Health Resource Unit,

Institute of Health Science, Oxford.  Oxman AD, Cook DJ, Guyatt GH.  Users’ guides to the medical literature.  VI.  How to use an overview.  JAMA 1994;272:1367-1371.

 

REVIEW FOCUS

  Yes (+2) Somewhat (+1) No or can’t tell (0)
1.  Did the review address a clearly focussed issue?

Was there enough information on the population studied (patients and end-users)

The outcomes considered (how defined, measured etc.)

 

     
2.  Did the review assess a clearly focussed technology?

 

Was the technology

·         Clearly defined or described

·         If more than one technology is assessed, were the technologies and there relationship to the other technologies clearly delineated

 

     
3.  Did the authors look for the appropriate sort of papers?

The ‘best sort of studies’ would

·         Address the review’s question

·         Have an appropriate study design

 

     

 

 

VALIDITY OF REVIEW RESULTS

  Yes (+2) Somewhat (+1) No or can’t tell (0)
4.  Do you think the important, relevant studies were included?

 

Look for

·         Which bibliographic databases were used

·         Follow up from reference lists

·         Personal contact with experts

·         Search for unpublished as well as published studies

·         Search for non-English language studies

·         Comprehensive search string demonstrating awareness of the myriad of MeSH terms available

 

     
5.  Did the review’s authors do enough to assess the quality of the included studies?

 

The authors need to consider the rigour of the studies they have identified. Lack of rigour may affect the studies results.  Particular attention should be paid to methodological issues surrounding evaluations of health informatics such as unit of analysis and allocation discrepancies, measurement of variables, contamination, transparency of results, etc.

 

     
6.  Were the studies accurately described?

 

Such as the functional capacity of the technology(ies), the way in which the end-user interacted with the technology(ies) and degree of compliance, organisational setting and degree of computerisation etc.? When and where the study was conducted and why technology was implemented. Individual study results related back to those elements?

 

     
7.  Are the results of individual studies reported in a clear and meaningful way or just listed with no real flow?

 

Consider whether studies with similar characteristics such as organisational setting, outcomes measured and functional capacity of technology(ies) were grouped together

 

     
8.  If the results of included have been combined, was it reasonable to do so?

 

(overall result presented from more than one study or meta-analysis)

 

Consider whether

·         The technologies were similar in functionality, integratedness, how output was presented, end-user training, level of compliance, etc

·         The results were similar from study to study, ie how measured and defined

·         The results of all the included studies are clearly displayed

·         The results of the different studies are similar

·         The reasons for any variations are discussed

 

     
9.  Did the review demonstrate awareness of its own limitations?

 

Consider whether the review

·         Quality, quantity and consistency of included studies

·         Presented its findings in light of other similar reviews

·         Future research indicated?

 

     

 

RESULTS

  Yes (+2) Somewhat (+1) No or can’t tell (0)
10.  Does the review present an overall result?

 

Consider

·         If you are clear about the reviews ‘bottom line’ results, ie is an answer to study question(s) is ascertainable

·         What these are (numerically or verbally if appropriate)

·         How were the results expressed (NNT, OR, etc.)

 

     
11.  How precise are the results?

 

Are the results presented with confidence intervals if expressed numerically? What words are used to describe effect size? Consistency of findings?

 

     

 

 

 

 

APPLICABILTY

  Yes (+2) Somewhat (+1) No or can’t tell (0)
12.  Implications for policy makers and or those considering implementing such technologies? Appropriate based on findings?      
13.  Are the results generalisable beyond the confines of the setting in which the work was originally conducted?

 

Consider whether

·         The patients covered by the review could be sufficiently different from your population to cause concern

·         Your local setting is likely to differ much from that of the review in terms of degree of computerisation and end-user skills, etc

·         Similar functionality will be employed

 

     
14.  Were all important outcomes considered?

 

Such as workflow, patient outcomes, practitioner performance, economic and negative outcomes.

 

     
15.  Are you able to assess the benefit versus harm and costs?

 

Even if this is not addressed by the review, what do you think? This is important as A.  studies concerning cost-benefit are rarely performed in HI, B.  negative outcomes are rarely assessed in studies of HI.  Dependent on #14!