Maximizing Bed Utilization: Strategies for Improved Patient Flow in Europe

At CW1, we believe that hospital beds are not being managed to their fullest potential. We hear about problems in German ERs where there are no beds available due to overnight outpatients. Portugal is suffering a huge problem with maternity wards, and in general, there are long waiting lists for surgeries in Europe just because national healthcare systems were not idealized and optimized from the beginning.
 

How does the European Hospital Bed panorama looks like?

 

 

Hospital bed use varies widely among European countries due to different healthcare systems and population needs. In 2020, the average number of hospital beds in European Union (EU) countries was 5 for every 1,000 people. Germany had the highest number of hospital beds per capita (8.0 per 1,000) in 2018, while Sweden had the lowest (2.1 per 1,000). However, when comparing waiting times for surgery or treatment of inpatients, Germany has a longer waiting list than Sweden. Why? To understand this dynamic, we need to examine certain parameters.
 

 

Occupancy Rates

1. The average occupancy rate for acute care beds in the EU was 77% in 2018.

2. Finland has implemented a new system to manage beds across the country, which has reduced unnecessary hospital stays by 15%.

3. Ireland had the highest occupancy rate at 94.9%, followed by Denmark at 90.1%, while in Greece, they're only about 62% full.
4. Netherlands had the lowest at 45.4%, partly due to its strong emphasis on community-based care.

5. United Kingdom's National Health Service (NHS) aims to keep their hospitals at 85% capacity, but they're often more than 90% full during busy times.
 

 

Length of Stay

1. The average length of stay for all causes in EU hospitals decreased from 8.5 days in 2000 to 7.5 days in 2018.

2. Finland had the shortest average length of stay at 5.9 days, while Hungary had the longest at 9.8 days.

3. Netherlands has reduced the average length of hospital stays from 7.5 days in 2000 to 4.5 days in 2018, while maintaining patient satisfaction with their care.

4. The length of hospital stays varies among countries. In Japan, patients stay for an average of 16 days, while in Turkey, it's only 4 days.

5. Some countries are using technology to care for patients at home instead of in hospitals. In Spain, this approach has reduced hospital stays for some patients with lung diseases by 30%.

 

 

Admission Rates

1. The EU average was 11.7 admissions per 100 population in 2018.

2. Denmark has found a way to have fewer hospital beds (fewer than 3 per 1,000 people) while still providing good healthcare.

3. Germany has many more critical care beds (for very sick patients) than other countries. They have 29 beds for every 100,000 people, while Portugal only has 4.

4. Hospital admission rates varied widely, from 6 per 100 population in Portugal to over 17 per 100 in Austria and Germany in 2018.
 

This shows a very irregular working system across different European countries but one thing is evident, the nordics are ahead. Why? Both Sweden, Finland, Denmark and Norway use a centralised booking bed system, which makes the communication flow better and works as the hotel booking systems, thus allowing to maximise the booking of surgeries.

 

Which strategies can CW1 recommend to maximise bed usage?

 

1. Implement real-time bed management systems

Real-time bed management systems help hospitals work more efficiently. These computer systems show which beds are available, occupied, or about to become available. This helps place patients in appropriate beds faster, reducing waiting times by up to 50%. They also help identify and resolve issues in patient flow throughout the hospital. This can shorten hospital stays by 10-15%.

Additionally, these systems improve patient satisfaction, raising scores by 20%. They also help hospitals treat more patients and increase revenue by up to 15%. The systems provide detailed information about bed utilization, patient flow, and operational efficiency. This helps hospitals make informed decisions and continuously improve their processes.
 

• In the UK, real-time bed management systems reduced patient waiting times by up to 30% and improved bed utilization rates by 15-20%.

• Adoption of digital bed management systems in German hospitals increased from 48% in 2017 to 66% in 2021.

 

 

2. Optimize discharge planning

To improve the discharge process and patient flow in hospitals, it is important to start planning for discharge within 24 hours of a patient’s admission. This involves using standard criteria to assess when a patient will be ready to leave. Hospitals should also involve patients and their families from the beginning, complete all necessary paperwork on time, and coordinate with post-hospital care providers. Care coordinators can help with planning and connecting patients to follow-up care and support services.

Hospitals should also track key metrics like discharge delays, readmission rates, and patient satisfaction to identify areas needing improvement. By doing these things, hospitals can provide better care, manage resources more effectively, and ensure smoother transitions for patients.

• A study across 15 EU countries found that structured discharge planning protocols reduced average length of stay by 1.3 days.
 

• In the Netherlands, a national program focused on discharge planning reduced 30-day readmission rates from 15.9% to 12.1% between 2016 and 2021.

 

 

3. Utilize predictive analytics

Predictive analytics is becoming more important in European healthcare, with the market projected to grow from USD 18.5 billion in 2022 to USD 53.23 billion by 2030, at a CAGR of 15.3%. Hospitals and clinics use predictive analytics to identify high-risk patients, manage resources better by predicting the demand for services, target chronic diseases to improve population health, speed up drug research by analyzing large amounts of data, and enhance patient communication and support.

• A pilot program in Spain using AI-driven predictive analytics improved bed allocation efficiency by 18% and reduced ED waiting times by 25%.

• 38% of European hospitals were using predictive analytics for capacity management by 2023, up from 22% in 2018.

 

 

4. Enhance emergency department flow

Key strategies include effective triage, quick assessment and treatment, better patient organization, improved bed management, using technology and data, and promoting a culture of efficiency. These methods help reduce crowding and improve ED operations, which is essential for a sustainable healthcare system. 

Optimizing ED flow requires a team effort, focusing on triage, treatment, patient management, technology, and continuous improvement. Reducing ED crowding not only benefits patients but also enhances the overall efficiency of the healthcare system.

• Fast-track systems for minor injuries in French EDs reduced average waiting times by 37% and decreased unnecessary admissions by 15%.

• Hospitals with dedicated ED observation units had 22% lower admission rates compared to those without.

 

 

5. Expand telehealth services

The COVID-19 pandemic led to a significant increase in the use of telehealth services across Europe. In 2020, all eHealth professionals surveyed from Nordic countries and Italy reported using telehealth. By 2022, more than half of the countries in the WHO European region had established teleradiology services. 

A WHO/Europe study, analyzing data from over 20,000 studies and 20,000 patients, found telemedicine beneficial for chronic disease management. The telehealth market revenue per inhabitant is highest in Scandinavia, with Denmark at €6.22 and Sweden at €5.05, compared to the EU-24 average of €3.05. Estonia, Denmark, Croatia, Sweden, and Iceland lead in the use of remote technologies by general practitioners to transfer prescriptions to pharmacists, with nearly all GPs using these services by 2013.

• Telehealth consultations in the EU increased by 1500% in 2020 compared to 2019.

• 60% of European healthcare providers plan to increase telehealth investment over the next five years.
 

6. Implement bed turnover protocols

 

Standardized protocols for bed turnover can significantly reduce the time between patient discharge and new admissions:

• A study in a UK hospital found that implementing a rapid bed turnover protocol reduced the average time between patient discharge and new admission from 210 minutes to 90 minutes, a 57% improvement.

 

• In a US hospital, streamlined cleaning processes increased bed turnover by 27% and reduced average turnover time from 75 minutes to 30 minutes.

 

7. Conduct regular capacity reviews

To optimize bed utilization and identify areas for improvement, hospitals should conduct regular capacity reviews at a consistent frequency, such as daily, weekly, or monthly. These reviews should gather relevant data on bed capacity, occupancy rates, and patient flow metrics from various sources, including electronic health records and bed management systems. The data should be analyzed to identify trends and patterns, and key stakeholders, such as nursing leadership and case managers, should be engaged to provide input and insights.

Based on the review findings, specific action plans should be developed to optimize bed utilization, which may include adjusting staffing levels, implementing new patient flow processes, or enhancing discharge planning. The impact of these action plans should be regularly monitored, and adjustments should be made as needed. Finally, capacity review findings and action plans should be communicated to key stakeholders and leadership to drive decision-making and resource allocation.

• A 2022 European Hospital Survey found that hospitals conducting monthly capacity reviews had an average bed occupancy rate of 85%, compared to 78% for those conducting annual reviews.

 

• Hospitals using data analytics for capacity planning reported a 12% reduction in patient length of stay and a 9% increase in bed turnover rate.

 

8. Promote collaboration with community services

 

Partnerships with community health services and primary care providers can reduce unnecessary admissions and facilitate timely discharges:

• A UK study showed that hospitals with strong community partnerships reduced readmission rates by 18% and decreased average length of stay by 1.5 days.

 

• In the Netherlands, a community care integration program resulted in a 22% reduction in hospital admissions for chronic conditions over a 3-year period.

 

9. Develop clinical pathways

 

Standardized clinical pathways for common conditions can streamline patient care and improve bed turnover:

 

• Implementation of a clinical pathway for pneumonia in a Spanish hospital reduced average length of stay from 7.2 to 5.8 days, a 19.4% improvement.

 

• A multi-hospital study in Germany found that clinical pathways for hip and knee replacements increased bed turnover rates by 15% and reduced costs by 11%.

 

10. Invest in staff training

 

To make sure hospital beds are ready for the next patient as quickly as possible, hospitals need to train their staff really well. This training should cover everything from how to get a bed ready after a patient leaves, to how to plan for when patients will be discharged, to how to make sure there are enough beds available. The training can happen in different ways, such as workshops, online classes, or quick lessons right when staff need them.

Hospitals should also use technology to make the training as effective as possible. It's important to check in regularly to see if the training is working and if staff are using what they learned. Hospitals should also give rewards to staff who are really good at getting beds ready, so everyone knows how important this is. By doing all of this, hospitals can get patients into beds faster, which means less waiting and better use of their resources.
 

• Hospitals that invested in bed management training for staff saw an average increase in bed turnover rate from 48 to 52 patients per bed per year.

 

• A Canadian study reported that after implementing a comprehensive staff training program on patient flow, participating hospitals reduced their average length of stay by 0.6 days and increased bed turnover rate by 8%.
 

 

References:

 

European Hospital and Healthcare Federation. (2023). Hospital Bed Management: Best Practices and Future Trends. Retrieved from https://hope.be/wp-content/uploads/2023/04/hope-publication_hospital-bed-management.pdf

European Health Information Gateway: https://gateway.euro.who.int/en/indicators/hfa_477-5051-total-number-of-hospital-beds/
OECD iLibrary: Health at a Glance: Europe 2020: https://www.oecd-ilibrary.org/sites/898c9182-en/index.html?itemId=%2Fcontent%2Fcomponent%2F898c9182-en
OECD iLibrary: Health at a Glance: Europe 2022: https://www.oecd-ilibrary.org/sites/518727bb-en/index.html?itemId=%2Fcontent%2Fcomponent%2F518727bb-en
Statista: Number of hospital beds in Europe 2014-2029: https://www.statista.com/forecasts/1141987/hospital-bed-count-forecast-in-europe
https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Healthcare_resource_statistics_-_beds
https://postprint.nivel.nl/PPpp1975.pdf
https://www.hilarispublisher.com/open-access/strategies-for-inpatient-bed-management-2157-7420-1000308.pdf