The impact of patient transfers and bedspace moves on nurse workload

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This multiple methods study explores the impact of moving patients between and within wards on nursing workload. While patient transfers (between clinical units) and bedspace moves (between beds on the same ward) are a routine part of nursing practice in acute hospitals, the rate of transfers has increased in recent times, due primarily to a shortage of hospital beds and an increasing demand for health services. The organisation and preparation of the patient prior, during and post transfer or bedspace move and the related communication processes forms a component of nursing work that has not been comprehensively explored. As a consequence, the impact of patient moves on nursing workload has not been fully realised nor captured in staffing models. A three-stage, sequential approach was used in this study. Stage 1 retrospectively examined 2008-2009 financial and patient administrative data to explore the incidence and destination of patient moves in one Australian metropolitan hospital over a financial year. Results identified that the majority of patient movements involved medical-surgical wards (n=12) and were therefore suitable contexts for more in-depth investigation. Stage 2 consisted of a direct observational-timing study conducted over a seven week period. Based on Stage 1 results, one medical and one surgical ward with a high rate of patient moves were selected for observation. A purpose-designed data collection tool was used to record and time nursing activities associated with observed patient moves (n=75). From these observational records and field notes, two case studies were developed in Stage 3 to demonstrate in detail the sequence of nursing activities, the role of the nurse and the factors that can impact on the time taken to transfer a patient to another ward. The results of Stage 1 identified that at the selected hospital, 10,733 patients who remained in hospital for 48 hours or more experienced 34,715 transfers and bedspace moves in the selected year. The largest single group (48.6%, n=16,861) of these moves involved medical-surgical wards. The results from Stage 2 indicated that the average patient transfer took 65.8 minutes and bedspace moves 29.2 minutes to complete. Of this time, over 40 minutes of nurses’ time was spent on patient transfers and 11 minutes on bedspace moves. This means that for medical-surgical wards alone, 3.9 FTE nurses are necessary for all the moves that occur each month. The impact of patient transfers and bedspace moves on nurses’ workload is considerable. Time spent moving patients means that less time is available for other patients and their care needs. In addition, many transfer activities could be performed by other members of the team. Given the impact on nurses’ workload, it is timely for hospitals to consider strategies to minimise the frequency and improve the efficiency of patient transfers.
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