Unnecessary ward moves - bad for patients; bad for healthcare systems
Unnecessary ward moves are becoming increasingly common and have adverse consequences both for patients and for hospitals argue the authors of an editorial published today in Age and Ageing, the scientific journal of the British Geriatrics Society
Prof. McMurdo and Dr Witham from the University of Dundee, are drawing attention to the practice of ‘boarding’ patients – moving individuals from their own base specialty ward to other wards to accommodate influxes of new patients. This practice is increasingly common, especially amongst older patients, despite the fact that changes of environment increase the risk of falls and delirium, problems that are associated with risk of serious injury and increased death rates.
Furthermore, boarding patients off dedicated Medicine for the Elderly units deprives them of receiving Comprehensive Geriatric Assessment (CGA) – a method of care which has been shown to reduce future hospital admissions and the requirement for future institutional care. The evidence shows that when frail older people are admitted to hospital they are 25% more likely to be alive and living independently at home when they are looked after in a specialist unit for older people with a dedicated multi-disciplinary team.
Boarding is sometimes viewed as a necessary evil – at least compared to the alternative of having no bed in which to admit patients from the overflowing acute admissions unit. Yet at a systems level, boarding appears to be a false economy – every ward move increases length of stay thus exacerbating the very problem that boarding attempts to circumvent. Worse still, frequent moves around a hospital are likely increase the risk of infection transmission, a factor trusts have been advised to incorporate into bed management policies.
The majority of patients being boarded are frail, elderly and cognitively impaired because most patients admitted acutely to hospital have these characteristics, and because such patients are likely to stay in hospital long enough to fall victim to boarding. In the wake of the Francis report, the authors stress that health professionals need to be honest and open with patients and their families and explain the risks associated with unnecessary ward moves.