A clinical audit of neurosurgical bed usage

Aim: To investigate inefficiencies during patients' stay in neurosurgical beds. Methods: A prospective audit of neurosurgical inpatients was conducted over approximately 2 months. We recorded the causes and duration of inappropriate delays, defined as actions requiring more that 24 h from initiation until completion. Results: One-hundred-and-thirty-eight patients were studied (61 elective and 77 emergency admissions). The audited patients were in hospital for a total of 1665 days. Of these, 482 days (29%) were due to delays. 92.5% of these wasted days involved emergency admissions. The main categories of delay were transfer back to referring hospital (46% of all delays), operative (26%) and radiological (19%). Our own hospital was responsible for the longest transfer delays (6.3 days patient compared with an average of 2.8 for all hospitals). Operative waits arose because of problems with both the timing and capacity of lists. Radiological delays resulted in particular from waits for MRI scans and neuroradiologist-performed procedures. The effect of eliminating all these inappropriate delays would be equivalent to liberating 10.7 of our 37 neurosurgical beds at any one time. Conclusions: Clinician-led analysis of organizational aspects of patient care has revealed serious structure, process and capacity problems in efficient bed usage, We have made proposals to address the cause of the inappropriate delays.