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Practice comment

"Moving patients is far more than just inconvenient"

Moving patients from ward to ward and bay to bay is a common activity in the NHS.

We justify it as releasing beds where and when they are most needed, but do we consider its impact on patients? Can we ever justify it from a patient’s perspective?

I am often told by patients, and more recently by a family member, that packing and unpacking their property between these moves is “utterly exhausting”. It can also lead to property being lost - when my relative recently experienced a series of ward moves over the space of a few days, false teeth, walking aids and medication were all lost.

Repeated moves can lead to more significant problems: disorientation and confusion over the whereabouts of ward facilities may lead to patient dependency and iatrogenesis. Patients may prefer to stay in bed to “keep out of the chaos” created by multiple bed moves.

My relative, who is not confused, told me: “I woke up and didn’t know where I was… then I looked for my walking frame and it had vanished, so I just pressed the buzzer for the nurses to take me to the toilet instead.”

What is more, moving patients contributes to a lack of continuity and communication between clinical teams as patients pass from one to another. Often important information is lost as a result of this communication failure breakdown.

This is not only detrimental to patient care but can also affect NHS finances, particularly in discharging patients with complex needs after they have been moved around a hospital. New teams have to get to know these patients and may repeat discharge planning processes already completed by previous teams, or set up entirely new plans. All of this is likely to increase patient anxiety as well as delay discharge.

So, what is the justification for such a poor patient experience? Many reasons are given for moving patients, including the need to put newly admitted patients in highly visible areas, the demands of single-sex accommodation requirements and the need for side rooms for infectious or dying patients.

Multiple patient moves is a safety issue - and it won’t be solved by developing protocols or transfer checklists.

Perhaps the situation might improve if, before we move our patients, we actively consider whether the move is entirely necessary.

The NHS is engaged in monitoring patient experiences of care, with medication side-effects and notification of discharge dates being the most recent areas of focus.

I believe it is time we monitored how patients, carers and relatives feel about patients being moved repeatedly during their hospital stay.

It often seems we are keen to get things right for patients from the perspective of medical interventions. But how can we demonstrate that we are equally interested in the patient’s personal perspective?

Liz Lees is consultant nurse and clinical dean, Heart of England Foundation Trust, Birmingham

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Readers' comments (21)

  • I don't 'move' patients without good reason. I have to move infective patients to side-rooms, I have to move some patients into an obs bay if they need monitoring, I have to move patients to another ward if they become another 'speciality'.

    If a relative said they did not want a patient with C Diff or something similar moved to a side-room because it was disruptive, I would be failing in my duty to that patient, other patients, staff and visitors by putting people at risk of infection.

    Patients are admitted to our ward from either casualty or admissions unit so they are in their specialist ward, the alternative would be for them to stay in admissions which would not work.

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  • Yes, moving patients can be justified from a patients perspective. we 'deomstrate' it by explaining the reason for the move. Perhaps we should ask patients and relatives for an alternative suggestion that benefits all concerned?

    I would prefer my family (or any patients I have ever looked after) be nursed in an appropriate ward, in a side-room if needed, nearer to the nurses desk if needed.

    Things do go missing unfortunately, if they cannot be immediately retrieved we have to get a replacement. I don't recall every knowing a patient to bring in their own zimmer frame, if one goes missing we just get another one from the physio.

    It is important that staff try and keep patients property safe, we should not forget that sometimes teeth go missing because a patient has wrapped them up in a tissue which gets thrown away.

    We should also not forget that patients/relatives should be asked to sign a disclaimer for their property and be given the choice of having it locked away. I, like many of my colleagues, have experienced patients/relatives who have outright lied and accused staff of 'stealing' or 'losing' their property.

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  • There is a time and a place for moving patients. I have no objection when I need to move a patient on clinical grounds such as: Infection control and needing to be nursed in a side room; needing to be moved either to a different bay or ward to enable closer observation either due to medical issues or because they are a falls risk etc; being taken over by a different speciality (medical to surgical etc).
    What I object to is being made to move patients late at night, to different wards, purely because of a lack of beds. I have had some nights when, after 9pm, we have had to move up to 8 patients off the ward to create medical beds....this really annoys me. On some occasions I have refused on the basis that to move some patients would be very detrimental to their health (elderly, confused, just recovered from major illness, not well etc) but generally, even if I object, the Night Manager tells me that I have no choice.
    In my previous job, the rule was simple: No patient moves after 10PM unless it was clinically indicated. In my current job, the Night Managers think nothing of telling us to wake patients at 1AM to move them to create a bed. And what really angers me even more is that the situations are, more often than not, predictable during the day shift and yet the Managers during the day just leave it for the Night shifts to sort out.
    We are busy enough as it is at night, particularly at the start of the shift, without having to arrange to transfer X number of patients out of the ward, clean the bed areas and then accept new patients. Unfortunately, especially at the Trust where I work, finance is the over-riding priority, even if it is at the expense of patients' health.

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  • Oh, and also, in my previous post, we had a 3 moves policy: If a patient had moved 3 times, that was more moves...even if it meant we had no beds in the hospital.....never once in 5 years was that rule breached. In my current post (not for much longer though), I have had patients who have been moved 7 or 8 times in less than a week!!! No wonder then that we get so many patients being in hospital longer than expected.

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  • I have been a patient on the receiving end of moves. It is most disconcerting to go to theatre from a surgical admissions unit not knowing where you are going to leaving you totally disorientated on a new ward, with relatives not knowing who to contact for information.
    I am disabled, and equipment like expensive custom built wheelchairs can not simply be replaced. Another disabled woman lost her special crutches making her totally dependent and unable to walk. Drugs to manage chronic conditions fail to be given, and those that you brought in with you vanish. I even got supplied with medications for another patient with the similar name. Contact with specialist nurses is hit or miss.
    When a patient you except some moves on the same ward may be needed and hopefully bed, and locker get moved together but any move increases infection risk.
    It is vital that managers ensure adequate bed numbers so that any move is purely for the patient's own clinical reasons.

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  • "...any move increases infection risk.

    It is vital that managers ensure adequate bed numbers so that any move is purely for the patient's own clinical reasons."

    these two issues and that of property which you raise are vitally important and must be properly managed in order to keep errors to the minimum and with consideration of the safety and well-being of patients at all times.
    Any lost property through hospital negligence must be replaced.

    Teams cannot monitor patients adequately if they are always moving wards and it is very unreassuring and harmful if patients are unable to have some consistency in their contact with the staff looking after them, although it seems the days of personalised care and a named nurse and doctor and effective case management are numbered and increasingly replaced by a conveyor belt system akin to the processing of goods through the manufacturing industry!

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  • It all went wrong with the implementation of MEA/SEA units. Certainly in our hospital, the majority of patients go to A&E, then MEA/SEA, occasionally an in an overnight short-term bed, before they arrive on a ward with the specialist skills to care for them.... and that is without some of them going somewhere else as 'an outlier'. (I do hate all these terms we call patients!!! Grrr!, but that's another topic). That is 3-5 moves before you start, and where a medical patient is in a surgical ward, and vice versa!
    Once upon a time patients were admitted directly to the appropriate ward. Todays system moves patients instead of moving Drs. Some may ague that it is a better use of Drs time to have them all in one place. That certainly could be a valid argument. However, balance that against the increased length of stay, that multiple moves so often incur (not to mention a decrease in ability, medical and surgical complications and the probability of not returning back home, in the case of the elderly, in particular. ... and there is all the extra staff and time required to move patients. Has anyone ever analysed this, I wonder? It seems targets and statistics are based on the short term fixes.

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  • re: above - line 6 should read 3-5 different wards/depts, not moves. However, it is still too much disruption for patients.

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  • I am a nurse and last year my elderly mother was admitted for the last time as she had atrial fibrillation and this became out of control - as a result her leg became necrotic and she suffered a major heart attack - we were told to expect the worse this time. She was sent to the admissions unit and placed in a bay even though the staff knew that my mother was dying. One staff nurse did however move her to a side room as my sister knew her. After being in the side room for two days and being treated very well by the staff, one staff nurse was sent in the room by the manager to say that they were going to move my mother to another ward as the unit got very busy at the weekends. My mother was semi conscious by this time and in a great deal of pain. I knew the staff nurse was very reluctant to broach the subject with us but appeared to have no choice - my two sisters and myself looked at her and said no thank you, my mother was used to the staff here and that as she was dying it would be quite a disrespectful and undiginified thing to do at this time. She said she agreed with us and promptly relayed this to her manager. I was very shocked and dismayed that the manager could have such disregard for a very sad and stressful situation and feel that she has probably lost all emotion and care for the patients sent to her ward. Had my mother been sent to the correct ward in the first place she and her family would not have had to suffer the indignity of being told we were to be moved to make way for other patients. It made us feel like we were a nuisance and the manager wanted us out of the way so she did not have to deal with it. I have never moved a patient under these circumstances and nor would I consider doing so.

    I am in agreement that yes some patients need to be moved to side rooms and to the appropriate specialist area but there are circumstances when the system fails and this was one of them.

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  • @Anonymous | 18-Sep-2012 11:16 am

    That is absolutely awful and, frankly, disgusting that they would have so much disregard for both your mother and yourself and your family in that time of extreme distress and emotional turmoil. The Manager was completely out of order to a) want to move your mother in that situation and b) send the other nurse to broach the subject. The manager clearly knew how upset you would be about it and didn't have the courage to talk to you themselves.....someone like that should not be a manager.
    This is not an excuse but I wonder if the manager may have been having pressure applied from above? Knowing the unit would get busy, they may have been pushing them to clear as many beds as possible.
    Personally, if my manager tried to do that, I would have just point blank refused to do it....I have enough issues with moving patients (just in case the unit gets busy), let alone move someone who is dying. But, I guess I am confident enough to stand up for my patients and refuse to do things if needed. My guess is the nurse either wasn't confident enough or just didn't want to aggravate the manager.
    As far as I am concerned, anyone who tries to move someone who is dying without an exceptionally good reason (and there's not many of those), should not be working in a Health Setting.....simple as. To do that shows that they have no respect, no compassion and clearly are not concerned with patient dignity. Doing that breaks every tenet of our profession.
    It breaks my heart when patients and their families are treated this way and it re-enforces to me that there are a lot of nurses in the Health Service who need to find their voices and start representing the patients and ensuring their needs are met, even if it means annoying management.

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  • One final thought is that, every time a family member of mine is admitted to hospital, I always make sure that they know I am a nurse or, if I can't visit, others make sure they know there is a nurse in the family. While all patients should be treated equally, whether they have a health care member of the family or not, I do find that Nurses are less likely to try this sort of thing or other unsatisfactory things if they know a nurse may be involved, as I guess they will be less likely to get away with some things.
    While I generally trust nurses to do the right thing, I have just seen too much in my career to take that chance

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  • Hi as a bed manager it saddens me to hear these stories. It is grossly unfair to be moving patients especially very late at night. I will ask though what is the solution?
    I hear ppl saying the patient should be in the right place in the first place, what happens when this isn't possible?
    Unfortunately hard decisions have to be made, the patient experience start when they step in the door be it through A&E or GP arrival, if the amount of beds in the correct place are not available where does that patient go?

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  • My wife was admitted to hospital for 3 days and she was moved 5 times. As a visitor I would turn up and not be able to find her. I'd then have to pin down one of the nurses to find out where she had been moved to, inevitably traipse along to another ward and pin down another nurse to find out where she was on the ward. It seems to me it was just a waste of everyones time. My wife is not the sort of person to get upset by the moves but at least one of them was in the early hours of the morning. We never received any explanation as to why the moves were necessary, it just seemed to be 'the done thing' like a conveyor belt that you moved along.

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  • Anonymous | 19-Sep-2012 11:25 am
    since general management was introduced by the Thatcher government, modelled on Sainsburys which was considered highly successful but designed for entirely the different purposes of manufacturing and sales, and they saw no reason why the NHS could not be run in the same efficient manner. it soon became very clear, however, that patients are also considered as manufactured goods to be processed through a system along a series of conveyor belts. this was very apparent to nurses working in large hospitals even before the public started ccomplaining or anything was written about it but it changes nothing.

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  • As someone who works out-of-hours, and who regularly has to make decisions about bed allocation and accommodation of patients in an organisation where there are not enough beds to support not only the changing complexities of healthcare needs, but also the increasing population of the area covered, I have one question to ask you all.... where would you like me to accommodate the new admissions overnight? A trolley in ED perhaps?
    We don't make it our mission to upset as many patients and staff as possible on a shift, but that's all we seem to do!
    Any suggestions as to how to do things differently will be greatly appreciated!!!

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  • nurses don't like moving patients unneccessarily, we don't do it for fun. Like the previous poster has said any suggestions would be gratefully received.

    perhaps if we had more beds in hospitals and in the community,and if relatives looked after the elderly at home then we wouldn't have to keep moving people about.

    there are not enough beds, how many more times are we going to have this discussion?

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  • Anonymous | 20-Sep-2012 5:53 pm

    I may be wrong, but you may be a relative in the future who you suggest to look after your elderly. I hope you can manage to do it with your work/life balance. We have been conditioned to work in the system we have now and sadly those of us who have seen a better system (more beds) eroded will soon be leaving the NHS. I have no children to call upon, any suggestions, other than shutting me away from society in a care home? This discussion will be continued.... and why are there not enough beds, ...should there not be? I always care for my patients how I would like my relatives and myself would like to be cared for.

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  • Anonymous | 21-Sep-2012 1:05 am

    what are you suggesting?

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  • there are too many people needing hospital/care beds, the nhs is not going to survive much longer and the people that are going to have to start paying for care are us, not those already in nhs care.

    the nhs will not survive at all without taxpayers paying more in, that is obvious, it is not a bottomless pit of money.

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  • according to OECD 2011 figures the UK, despite being one of the largest European economies, paid the lowest GDP 9.6% towards health services. To continue meeting the rising costs to provide adequate care this needs to be increased.

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