Analysis: A practice that has to end

CURRENT figures would suggest the number of patients in acute medical units is increasing, at a time when the number of acute medical consultants has not increased and acute bed numbers have been reduced.

We are also seeing increased pressure on GPs to refer patients directly to acute medical receiving units rather than to A&E departments. 

The introduction of four- and six-bedded bays, instead of larger wards, has significantly improved patient dignity and privacy, but has meant there is no option of temporarily increasing bed capacity within one ward. As such, at peak times, the medical receiving units are full to overflowing.

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The only way of dealing with the situation is to move patients to beds in other units, often at short notice. The “decanting wards” are often within surgical wards. Patients recovering from medical conditions such as a chest infection now also find themselves in, for example, either gynaecology or orthopaedic wards. This process, medical boarding, has become standard practice in UK hospitals, and takes patients away from specialist teams. Nursing staff may not be immediately familiar with the medical protocols in place and individual nurses cannot have a close, consistent relationship with the parent medical team involved.

The term “safari ward round” has been coined to describe the challenge of overseeing patients spread widely beyond the medical unit. Such medical cover from a distance benefits no-one; evidence has shown that boarding can increase patients’ length of stay and their likelihood of re-admission to hospital.

Boarding has also affected morale in junior doctors; low morale and inefficient team-working must at some stage impact on the standard of care which boarded patients receive.

Although boarding was limited to times of peak referral, our survey data shows it has now become a year-round phenomenon. This situation requires urgent review, and we ask MSPs to raise this matter in the Scottish Parliament and with the Cabinet Secretary.

• Dr Neil Dewhurst is president of the Royal College of Physicians of Edinburgh.