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Unnecessary ward moves 'harm elderly patients', warn academics

The health and wellbeing of older hospital patients is being put at risk when they are shipped from ward to ward, experts have said.

Unnecessary ward moves are becoming “increasingly common” and have adverse consequences for patients, according to an editorial in Age and Ageing - the scientific journal of the British Geriatrics Society.

The article, written by Professor Marion McMurdo and Dr Miles Witham from the University of Dundee, states that more and more consultants are moving patients from their own specialty ward to other areas of the hospital to accommodate new patients - a practice known as “boarding”.

But the experts say that the changes in environment can increase the risk of falls or delirium - problems that are associated with risk of serious injury and higher death rates.

And if older patients are shipped away from specialist elderly wards, they are less likely to receive established geriatric assessments - which can reduce future hospital admissions.

“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,” said Prof McMurdo.

“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.”

Dr Witham added: “We cannot escape the fact that hospitals face increasing pressure on bed availability as hospital bed numbers contract and emergency admissions rise.

“However, a recent survey of medical staff found that 92% of doctors would refuse to have a relative of theirs boarded out - this hardly inspires confidence in the quality of care received by patients who are moved around the hospital environment.

“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. “

Michelle Mitchell, charity director general of Age UK, said: “Older people are among the most frail in hospital and often have the most complex needs. So it’s very disturbing to hear that they are regularly being moved from ward to ward to make space for new patients - putting their care and recuperation at risk.

“This practice only makes it more likely that older patients will spend longer in hospital and be rapidly readmitted because they have not received the proper care and attention they need.

“It’s in the interest of both hospitals and patients that older people are not shifted around to solve bed shortages but get carefully planned care.”

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Readers' comments (8)

  • I would imagine this happens in all hospitals, its common practice in the hospital where I work. And nurses are expected to know how to care for all specialities, which is not good or safe practice as we do not! I work on a general surgical ward but my background is Gynae, Breast Surgery & the only reason I'm on a surgical ward is because our ward was closed! And now its a free for all for every speciality you can imagine! Not good for patients or staff but that's how it is in the NHS today....

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  • Oh and another thing, it would be nice if we could get the "medical teams" to actually come to the ward & actually care for their patients, because very often you spend hours on the phone trying to get the allocated team to review their patients who had been transferred on the weekend & somehow get lost in the system..so their teams are not aware where they are & even if they still need reviewing !...

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  • This 'recent' piece of research coming from 'academics' has been well known and reported at ward level by, 'mere' hands on Nurses for many years.

    The elderly are famously predisposed to confusion, especially if in a hospital setting, through their presenting medical condition and or their medication.

    Thankfully this presentation by our well educated and well connected academics has brought this previously well acknowledged and reported fact to the notice of our hospital managers, who previously turned Nelsonian eyes to what is a plainly disturbing situation for both patients and their loved ones.

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  • Just to remind you all.

    Many (most) of "bed managers" are (or were) nurses.

    As nurses they are supposed to adhere to the "code of conduct" and always have the best interest of patients at the forefront of their minds. Right ?

    Wrong!

    These people are the sycophants of "management". They do not care about patients. They just move numbers on a computer screen. There is no humanity or consideration associated with their actions.

    You, as a pleb clinical nurse are forced to do what these "managers" demand.

    Time for change !

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  • I agree with you Jenny Jones...they are on our backs 24/7 when you are on duty, how many beds, how many going home??? How quick can you get the bed empty..etc..etc...For goodness sake! We or the patients are human beings!...

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  • Yes time for change
    Nurses in management position need to keep in touch with reality by doing some shifts on the wards.
    They are sometimes worse than managers who are not nurses when it comes to shifting patients about without a feeling for the patients or the overworked nurse having to do as they command.




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  • My Auntie is currently in hospital followig a fall in her RH resulting in a fractured hip. She was admitted to the admissions ward, transferred to the othopaedic ward, went from surgery to ITU(acceptable), back to ortho ward, transferred to Maternity, sharing a ward with young women who had miscarriages, then to the 'private wing' isolated in a room on her own. She has subsequently had a fall and TG, no injuries.She has been in 6 different locations in 2 weeks, enduring a several of infections, wound, urine and chest. At almost 86 years of age, I am surprised she has survived, so far anyway! I live over 200 miles away, so visits have been rare, but I will be putting in a complaint, for all the good it does!!! What is the point of this research, and like other posts, it goes on, managers looking at quick fixes and to hell with the consequencies. If there is a death, it will go on the statistics against the surgeon. It must add, despite all the moves, the nursing staff have done what they can under the circumstances, but it means they live with not being able to do their job, as they would wish. In my Trust, the bed managers are only band 4, not nurses at all, but are steered by band 8 matrons to do the dirty work. Aren't matrons the ones that were supposed to 'care' for patients - I must be delusional.

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  • This research has only confirmed what nurses have been saying for a long time. When wards took it in turn to admit patients, doctors and nurses worked together to provide care. This has now been abandoned with doctors doing their own rounds because there are so many different teams visiting the wards. Not surprisingly, this leads to poor communication and care. If patients remained on the ward they were admitted to, everyone would benefit.

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