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Ambulatory Care Quarterly
How ED managers can find those elusive beds
One of the issues constantly plaguing emergency departments (EDs) is the hidden bed — a precious commodity when a crunch is on. But there are a number of methods that can help identify those beds sooner, says Marty Karpiel, FACHE, FHFMA, president of Karpiel Consulting Group in Long Beach, CA.
"There are several bed tracking systems available," says Karpiel, adding that the BedTracking software from Pittsburgh-based TeleTracking Technologies is the only one he has seen in action.
"They are designed to clearly identify those beds. This way, you take the nurse who may have an incentive to hide the bed out of the loop."
The systems work like this: As soon as staff arrive in the rooms to transport the patients, they key the vacancy into the phone system, which accesses the bed tracking system. This pages housekeeping, so someone is sent to clean the bed.
"When the housekeepers arrive, they punch in that they are on-site," Karpiel says. "Then, when the room is clean, they punch that as well."
In addition to identifying available beds sooner, these systems can help monitor the housekeeping team’s efficiency and performance. "This way, the staff have an incentive to get that bed clean, because it shows up in the reports," he adds.
Some hospitals have placed their bed control computers in the ED, so when there is an ED admission, they know what kind of bed they need.
"The charge nurse in the ED can access the control system if they have a terminal, identify a bed, and immediately contact that floor charge nurse," says Karpiel.
The system costs about $50,000, including hardware and software plus training, says Ray Ricci, MD, FACEP, an ED physician at Hoag Memorial Hospital Presbyterian in Newport Beach, CA. (An additional annual licensing fee is based on the number of beds.) "When you look at the cost and benefit, it’s very small," he says.
The challenge for any bed tracking system, he adds, is the old GIGO (Garbage in; garbage out) adage. "The issue is who puts the data in. You can’t have the nurse on the floor do it. It’s like having the fox guard the hen house." The Code EST (emergency saturation triage) at Hoag Memorial also helps uncover hidden beds, says Ricci.
"[When the code is called], the housing supervisor contacts admitting and finds out what beds they have listed as open, then matches them with what the charge nurses on floor report," he says. "When admitting says there are no more beds, and we’re about to go on diversion, we call a Code EST, and lo and behold, the housing supervisor finds four beds. Somehow, beds become available."