In the latest in our hospital series, STEPHEN LEWIS meets the bed managers who make sure there will be a hospital bed waiting for you.
UP IN the little cubby-hole that passes for the bed managers’ office at York Hospital, the phones are ringing off the hook.
Lynne Burbidge and Judith Gibbon are working them expertly: fielding calls from GP surgeries and the hospital’s own A&E department, who are desperate to find beds for patients; cajoling ward sisters into accepting just one more person.
“Hello, it’s Judith, bed manager, how can I help you?” says Judith, picking up a shrilling phone. It is a call about a woman coming in with gynaecological problems. “Okay, no problem,” says Judith. “Have you spoken to the gynae people yet? Could I have the lady’s name?” She scribbles a note, transfers the call to the operator. “Could you put this through to Ward 38 please? Thank you! ‘Bye!”
On the other phone, Lynne is speaking to a ward sister, trying to find a bed for a patient admitted through A&E. “Hello, it’s Lynne,” she says. “Can I tell you about a patient coming in? He’s a 39-year-old coming in with chest pains from A&E. Yes, he’s only 39. All right, thank you. ‘Bye!”
Judith is also trying to sort out a bed for a man arriving for an operation. He is due in at 10am: about now. She calls the admissions ward where he will be kept before going into surgery.
“Hello, it’s Judith again. Mr XXX, I hope he hasn’t arrived yet? Good, because there’s no bed yet.” She listens, then explains. “At the moment there’s no bed. But we will find something.”
Welcome to a typical Monday morning for the bed managers. In many ways, this cubby-hole is the nerve centre of York Hospital. Yes, surgeons do the glamorous, life-saving stuff; and ward nurses have the most day-to-day contact with patients. But without Lynne and Judith working their magic behind the scenes, the whole thing would grind to a halt.
It is the bed manager’s job to ensure that, when a patient comes into hospital, there is a bed available. It is a huge responsibility. Without a bed, a patient cannot be admitted. And if they can’t be admitted, the operation they have been waiting for cannot go ahead.
There are about 750 beds at York hospital. It sounds like a lot, but at any one time, more than 90 per cent of them are full – it simply doesn’t make sense to keep beds lying empty.
So there is constant pressure on beds. And every day there can be as many as 100 new patients arriving – patients coming in for a long-planned hip or knee or gall-bladder operation; elderly people who have suddenly fallen ill and need to be looked after in hospital; emergency patients brought into A&E by ambulance, such as the 39-year-old with chest pains.
A constant game of musical chairs, in other words – and it is the job of bed managers such as Lynne and Judith to keep things moving: to chivvy wards along to make sure beds are freed up; to juggle things around so that a bed which had been allocated to someone due to arrive at 4pm goes to someone coming in at 11am.
There will be time to find a bed for the 4pm arrival later.
Monday mornings are usually busy. The weekend has just finished and patients have been turning up at their GP surgeries. Sometimes, it can be absolute bedlam, says Lynne. “From about 11am, we get an awful lot of calls from GPs.”
And not only from GPs. There are patients who have been anxiously waiting for an operation for weeks or months, who need to know there will be a bed for them – and patients being rushed critically ill into A&E who also need a bed.
At 11am every Monday, there is a bed managers’ meeting. One of the duty bed managers meets up with the administrative heads of various hospital departments – surgery, head and neck, gynaecology, urology – to find out how many beds they have available, how many patients they expect, and how many others will be leaving.
Then, five times a day, there are regular ward rounds, to check what beds have become available, and see if, by a bit of judicious juggling, another bed can be found somewhere.
Lynne leads me on a whirlwind tour of wards 14 and 15, where she scrutinises the bed boards – the lists saying which patient is in which bed.
“Do you know if this bed is empty?” she asks a junior nurse on ward 14. The nurse doesn’t, and goes in search of someone more senior.
The ward sister hurries up. “There’s nothing,” she says. “There is one empty male bed, but we’ve got two men coming in. I think the Nurse Enhanced Unit has four beds until this afternoon.”
It is on to ward 15, where two beds that had been allocated to patients coming in at 4pm are given to patients arriving at 11am instead. And what about the 4pm patients? “I’ll worry about that later,” Lynne says.
It’s a stressful and responsible job, and the shifts are back-breaking – more than 12 hours at a stretch, so a bed manager can follow a whole day through from start to finish.
The job calls for real diplomatic and organisational skills, as well as a thorough knowledge of how the hospital works.
That is why Lynne and Judith, in common with most of the hospital’s other 12 bed managers, are fully trained nurses with years of experience. Judith is a 59-year-old mother of three grown-up children, who worked as a nurse in A&E for 25 years before taking on this job. Lynne is 45, with three children still at school, who first began working as a nurse in Leeds in 1982.
Neither of them have lost their nursing instincts.
At one point, a confused elderly man in pyjamas walks towards the bed managers’ office from ward 22, looking for the way out.
Judith takes him gently in hand, leading him back on to the ward. “Who does this gentleman belong to?” she asks, guiding him to a seat before bustling off to find someone to look after him.
Don’t they miss the daily contact with patients? I ask, when she comes back.
Not really, says Judith. “People say it must be the worst job in the world. But it isn’t. It is very stressful, but extremely interesting. No two days are ever the same – it’s never boring. And people say don’t you miss the patient contact? But it is all about the patients. They are the point of it all.
“Some mornings you come in and it can be absolute bedlam. But as the day wears on, everything falls into place and you think ‘Yes! I did it!”
They do, every day. So next time you or a loved one go into York Hospital for an operation, you know who to thank for the fact there is a bed available.
THERE are 759 beds at York Hospital. To manage them, the hospital employs 14 bed managers – some of them full time, some part time.
Between them, they are responsible for ensuring beds are available for incoming patients 24 hours a day, day in, day out.
The bed managers also act as hospital duty managers after hours. That entails taking responsibility at evenings and weekends for everything from the hospital’s response to a major accident, to health and safety, complaints – and even press inquiries.
Their key role, however, is always about patients, and making sure there is a bed for them.
“There is nothing worse than sitting in A&E waiting for a bed,” says Lynne Burbidge.
Mandy McGale, the hospital’s head of patient flow, has no doubt about the importance of the bed manager’s job.
“They have a central role in ensuring patients are placed in the right place at the right time to be looked after by the right person,” she said. “Their contribution is noticeable every day.”