What Is A Bed Manager?

Band 7 Bed Manager, Laura Pueyo, explains her role as Haematology Bed Manager in one of the UK’s Largest hospitals, outlining key challenges and what makes the role so rewarding.

Topics covered in this article

Introduction

What Does A Bed Manager Do?

What Are The Main Challenges Of Being A Bed Manager?

How Do We Deal With These Challenges?

Working Well With Other Departments Is Essential

Imposing A Discharge Is A Last Resort

What Skills Are Needed To Be A Bed Manager?

A Day In The Life Of A Bed Manager

Being A Bed Manager Is Challenging, But Very Rewarding

Introduction

Hi guys! My name is Laura, I am the Haematology Bed Manager in one of the largest hospitals in the UK.

My hospital has 950 beds so, imagine for a second how hard is to coordinate the patient movements in such a big hospital, in that process the Bed Managers are key workers.

What Does A Bed Manager Do?

So! What is a Bed Manager?

Let me illustrate: We ́ve got Max.

Max is our haematology patient that had his treatment in this hospital.

He was feeling unwell, so, he went to the emergency department and after being reviewed he needs to be admitted.

Okay! So now what? I can see here a little bit amount of problems and you will understand why...

The situation is that we have 40 beds in the Haematology Department in this hospital.

This morning we had 8 confirmed discharges but, guess what?

By the time that Max arrived at the hospital, 3 of those confirmed discharges got cancelled!

And we have already admitted 2 other patients!

So... if my math is right, we just have 3 beds left!

What Are The Main Challenges Of Being A Bed Manager?

But we haven’t counted with the elective list.

Those are patients that are waiting to be admitted for their elective treatment.

That list is prioritised by the doctors every day, and today we have to admit 2 other patients.

So we actually have 1 bed! But another unexpected problem came up, we’ve got another haematology patient in ITU that needs to step down to the haematology wards.So... We actually have no more beds!

But we cannot go through the night shift with the department full, we have to leave at least 1 bed empty just in case we have another haematology emergency.

So, the situation is that we have -1 bed, but actually are -2 because we have Max as well coming.

You can see that we need someone to deal with this situation, right?

That’s the Bed Manager.

How Do We Deal With These Challenges?

Ideally, we try to solve this problem, before it happened and I'd do 3 three things.

First thing, I try to plan ahead, I try to think that this might happen; so I create a “just in case” plan. 

I study all of the bed organisation for all of the wards of the department, and I try to think which bed movements I would do to allocate a female patient or a male patient with an infection, or how I would isolate someone.

Second, what I do is try to facilitate any repatriation, for example, if there is a patient from Brighton that came to this hospital to have her treatment and that treatment is over, we try to facilitate her journey back to Brighton, if it’s needed.

Third, I try to gather the most information that I can about the discharges.

Like that, I try to stop any unexpected problem at the time of the discharge but sometimes, even doing all of these 3 things doesn’t solve all of my problems.

So what do we do in this case?

Working Well With Other Departments Is Essential

We chase everyone, we negotiate with other departments or the last one we impose the discharge chase.

Like if the discharge is not happening because we have a late blood result and the blood are deranged, the patient cannot go home, we cannot do anything about it.

But, if the package of care is not ready, or the transport doesn’t arrive, or the Pharmacy is delayed, we can escalate all of that and try to solve all of these problems, so the discharge can happen eventually that day.

Negotiate: As in negotiate with other departments, you can try to speak with the liver Bed Manager for example, and explain:

“Okey! this patient is going to be discharged tomorrow, maybe this patient can sleep in your department...”

So you create another space in yours, or speak with the ITU like in the previous example and see if they can hold the patient there one more night, obviously everything depends on their capacity.

Imposing A Discharge Is A Last Resort

Or Impose, is our 3rd way to try to solve it, and this is our last resource.

When the patient is fit to be discharged but there is nothing stopping the patient to go home, is just the patient that is saying no, because I say no.

That’s when we impose the discharge, and we basically force the patient to move or to another department or basically home, and, when they see that they have to pack everything and they don’t have any other choice, that’s when the patients usually go home.

So, as you can see my job is not always very easy, this leads me to my next question.

What Skills Are Needed To Be A Bed Manager?

I would say Communication skills are so important, to deal with complex situations, verbal and not verbal, like imagine me, with my accent I always have to make myself super clear.

Dealing with uncertainty, we have to be very flexible, because in this job this is like a puzzle, where the pieces are moving so fast, because sometimes you think:

“Okay! This, is going to happen for sure, is like written in a stone” - but eventually it never happens.

Or things that you are like, “okay, no no no this is not going to happen, this is impossible”, guess what!Eventually, it will happen so you have to be ready and be really really flexible and ready to adapt yourself to all of the situations.

And the third skill is to be very organised because in your head you will have 2000 plans like you will have the plan for the female patient, the plan for the patient with the viral infection, the male patient.

And then one will be confirmed but the other one will be discharged and the other one will get cancelled.

So, you will mix all of them, but you cannot mix the plans, because you cannot place the female patient in the male bed, for example, that would be a mess.

A Day In The Life Of A Bed Manager

Now I am going to walk you through my normal day.

Arriving At The Hospital

At 7.30am I arrive at the hospital, and the first thing that I do, is going to all of the haematology wards, I check on the staffing, the acuity and the planned discharges for the day.

Is very important to check on the acuity, as sometimes during the night shift some people call of sick, the staff, and we have to move the staff accordingly to make the shift safe for the patients and for the Nurses.

After that, I have my first meeting at 9 am with Clinical Site Managers and the rest of the Bed Managers from the other departments.

They inform us how is the emergency department doing and we give accurate figures of our department.

Rounds & Referrals

After that, we go to the board rounds and that’s when we do all of our plans, we gather all of the information about the discharges, we try to facilitate any repatriations and we prioritise the elective list.

Straight after I have my second meeting with Clinical Site Managers which is more or less the same one as the first one but a bit more accurate.

Straight after I Try to do any chemotherapy referrals, if there is a patient in ITU that needs chemotherapy I try to give it.

Discharges

And then I come back to the wards and I check on them, how are they doing with the discharges and if I can help with anything or if there is any problem with the staffing.

After, at around 4 pm that is when I have my last two meetings, one is with my matrons, my bosses and with Site Managers the last one.

That is when I have to have a clear plan of the admissions and the discharges and that’s when I explain if I have any problems that I could be facing and how I am going to solve them.

Around 5pm, That Is When My Day Goes Crazy

Then around 5pm that is when my day goes crazy and I need 12 hands to attend to everyone, to answer the bleeps, and the phone calls...

And that’s obviously when the discharges get failed, the transport doesn’t arrive, the TTAs are not ready and the staff is calling sick as well, so that’s is when everything goes super super crazy.

Being A Bed Manager Is Challenging, But Very Rewarding

But as well, after that is when I realise how fulfilling my job is.

Because at the end of the shift you go ward by ward and you see that your puzzle finally is solved, and you have used your cards in the right way.

All of the patients are in the right place, at the right time.

Everyone is safe and wards are well-staffed.

You actually feel really really good and you will feel that you did actually very well your job because everything eventually happened as you were planning in the first place, so, bed management can be very challenging but as well very rewarding.