Nearly half of acute care beds filled with patients medically fit for discharge

Thursday 19 December 2024: Bermuda Hospitals Board today revealed that analysis undertaken on Wednesday 18 December showed that 42 of its 90 beds on the acute care inpatient units were filled with people who were medically fit for discharge. That is 46% of all inpatient beds in the Acute Care Wing (ACW). The average length of stay of these patients was 70 days (over two months) with longest stay patient being over nine months.

Medically fit for discharge refers to patients who no longer require acute medical care but remain in the hospital due to barriers to safe and appropriate discharge.

In the General Wing, where beds are used as acute care overflow, there are an additional 24 patients medically fit for discharge, with the longest stay being almost 2 years (23 months).

Minister of Health, the Hon. Kim Wilson JP MP, comments: “These figures will understandably concern the community, as behind each patient is an individual in need of assistance. We continue to support BHB’s efforts to enhance hospital capacity and remain committed to developing long-term solutions to improve care availability in the community.

“While healthcare systems must invest in these long-term solutions to address patients who are medically fit for discharge, families play a crucial role in the immediate response. By recognising the challenges faced by hospitals and the needs of their loved ones, families can make a significant difference by stepping up to assist in the discharge and care process.

“Ultimately, addressing this issue requires a collaborative effort among families, healthcare providers, and policymakers. By working together, we can ensure hospital resources are used effectively and patients receive the appropriate care in the most suitable setting.”

CEO & President Scott Perman noted that the number of patients medically fit for discharge in the acute care wing had increased over 50% since figures were last publicly shared in June 2023, when there were 25 patients in acute care inpatient beds.

“This is something we have been experiencing over the last few months,” he says. “Its biggest impact has seen rising waits for emergency patients needing an inpatient bed.”

The issue is mostly caused by patients who need either a nursing home or more care support at home in order to be safely discharged.

Mr Pearman noted, “We obviously implore families to take their loved ones home as soon as they are ready to be discharged, when possible. We know Bermuda needs more affordable nursing home placements and affordable care support for people at home, but the impact on hospital services of these delayed discharges is detrimental to others needing acute, surgical* and emergency services**, and those patients trying to return from medical institutions overseas. It also increases hospital costs that the healthcare system overall has to bear.”

Data from 18 December shows:

Acute Care Inpatient Units (ACW)
• 42 of the 90 acute care inpatient beds had people medically fit for discharge in them (46%)
• The average age of the patients whose discharge is delayed is 76 years
• The average length of stay for these patients is over 2 months (70 days)
• Of the 42 patients, 24 % have been in hospital 3 months or more and 12% have been in hospital 6 months or more
• The longest stay patient has been in an acute care bed for over 9 months.

Acute Care Overflow Beds in the General Wing
• 24 medically fit for discharge patients are staying on units in the General Wing
• The average age of patients is 78 years
• The average length of stay of these patients is over 9 months (262 days)
• 88% of these patients have been in hospital over 3 months and 58% of these patients have been in hospital over 6 months
• The longest stay patient has been in hospital for nearly two years (23 months)

“Our longest stay patients whose discharge is delayed will find themselves eventually on a bed on the General Wing side. These patients do not need BHB’s long term care service, which is for seniors with higher care needs than a community nursing home can offer. This means they are still using beds that others need. Most importantly, they are not in the environment best suited for their needs, impacting their quality of life and putting them at risk of unnecessary physical deterioration.”

A 100-day challenge undertaken at the beginning of 2024 had helped identify internal efficiency improvements relating to bed flow and some solutions were implemented. A task force was recently established to follow up on the improvements and work on some of the more complex solutions highlighted from this effort. But the increasing number of medically fit for discharge patients in hospital is something BHB cannot control.

Mr Pearman urged the community to use emergency services wisely and ensure relatives ready for discharge are supported to go home as soon as possible. These actions will help relieve some of the pressure.

He added, “While we are focusing on the impact of delayed discharges, we should also be wise about our own health and care. We have had as many as 30 people waiting for admission in our Emergency Departments and this impacts everyone coming in. So please use your GP in the weekday or go to the Lamb Foggo Urgent Care service between 9am and 9pm on Saturday and Sunday if it is not a true emergency. Avoid the need of emergency services by taking any medications for chronic conditions, getting available vaccines that safely prevent flu, measles and other diseases, and don’t drink or do drugs and drive. Make sure the emergency services can focus on the true emergencies, such as strokes, heart attacks and other life-threatening conditions.”

Related data:
*Below is a year’s data on surgical cancellations. Highlighted in the table is the number of surgeries rescheduled due to no beds being available. The highest cause of surgical cancellation, however, remains patients themselves not turning up or cancelling.

** Emergency wait times are posted monthly to the BHB Statistics page, and real-time wait times are available on a screen in the Emergency Department.

Sterile processing department at KEMH to be upgraded

Thursday 7 November 2024: Bermuda Hospitals Board today announced that it is starting a major renovation project for its sterile processing department that will run from February to July 2025.

Sterile processing is the sanitisation of equipment and items used in clinical care. The highly specialised cleaning process ensures items are completely safe for use. All surgical tools are cleaned and packaged in this area to support the over 9,000 surgeries undertaken at KEMH per year. Any items that are re-used across the hospitals are also processed through this department.

Chief Operating Officer Preston Swan comments: “This is a long overdue upgrade project that will remedy the issues that have impacted SPD over the last few years, such as equipment failure and floods.  The equipment is over 14 years old and the area is in the older part of the General Wing so the infrastructure is in urgent need of work. A failure in SPD could impact our ability to deliver life saving procedures and deliver safe care across our inpatient and outpatient service. This is a priority project for us that will enable us to deliver the safest, most efficient sterile processing service in the support of patient care.”

The project will cost about $4.5 million in total and will include the replacement of equipment, furniture and the floor as well as an upgrade of the infrastructure.

Mr Swan continues: “We anticipate the upgrade work in SPD will start in February and be completed by July 2025. While the department is upgraded, we will use a temporary sterile processing area that is currently being constructed in the old surgical area of the General Wing, just opposite the existing location.

“The capacity of the temporary area will be enough to meet most of our needs during the upgrade, but there will be some patient impact. We anticipate there will be a reduction in the number of major elective surgeries undertaken in any one day, such as hips and knee replacements, as these are very instrument intensive. I would stress, however, that we will be able to complete all emergency and time-sensitive surgical needs, for example trauma, emergency caesarians or cancer surgeries, and there will be less impact on procedures that don’t need much instrumentation, such as pain management, some cardiology procedures, endoscopy and urology procedures.”

Once complete, the upgrade will ensure a much more consistent sterile processing service, optimising safety, quality and efficiency.

“We apologise that there will likely be fewer major elective surgeries during the first half of year,” Mr Swan says. “We will continue to do all we can to minimise the patient impact across all our services. Certainly the upgrade of this critical area is required to ensure that the sterile processing service is as robust and efficient as possible to meet the long term needs of Bermuda patients for the years ahead.”