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At the heart of general practice since 1960

Why discharge stats flummox NHS managers

For some time we've known for definite that NHS management don't really understand statistics ('Early discharge a false economy', pulsetoday.co.uk/news).

In the old days, when I was a junior dresser and length of stay was longer, it was well-known that the optimum bed occupancy on a general ward was about 72%. This sort of occupancy at the start of an on-call period for the ward allowed us to admit anybody needing it.

If there was some sort of excessive influx of patients needing admission there were usually a couple who were close enough to being fit, who could have their discharge brought forward very slightly to enable us to fit in an extra patient here or there in the hospital (a city hospital, not a little rural backwater with 100-200 beds).

As patients have got discharged earlier and earlier in the course of their recovery we have lost the leeway to send some home slightly early, because none of them is fit enough.

At the same time, some political management boffins have been trying to pressure clinical staff to increase bed occupancy to a target of approaching 100%.

There is some misguided management idea 100% occupancy equates to 100% efficiency, which clearly is not necessarily so. In fact, the ability to have smooth admission and discharge has drastically reduced as we have approached 100% occupancy and our working practices have become less and less efficient.

Patients report that the ability of domestic staff to clean the bed-space between discharge and next admission has greatly reduced at the same time.

From Dr David Church in Machynlleth, Powys

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