RESULTS

Data for Reconfiguration

Given that the ALC population used approximately 54 beds per year at KGH in 2010/2011, it was

determined that there was a significant need for a dedicated medical ALC inpatient unit. Based on

historical data, there was also an opportunity to change one of the mixed medical/surgical units to

a surgical unit to improve bed utilization and aim to reduce the number of surgical cancellations

due to lack of an inpatient bed.

Engagement and Design

Two different options for bed reconfiguration were proposed. Both of these options included a

medical ALC unit, but in different geographical locations at the site. These options were presented

to 14 separate medical and nursing groups throughout the hospital over a period of one month

and a preferred option – a 24-bed medical ALC Unit - was endorsed. The proposed location was

in a recently vacated medical inpatient unit. As part of the Bed Reconfiguration project it was

proposed that the unit be renovated to include a dining/lounge area and a rehabilitation/exercise

space to assist with the care of the patients.

Implementation Plan

Based on the preferred option, the User Group developed the Implementation Plan to operate the

unit, including changes to staffing ratios and scheduling, operational budgets, renovations

requirements, and equipment needs. The Implementation Plan also included the process to

physically relocate all of the patients between the six different inpatient units that were involved in

the relocation to open the 24-bed unit.

On September 5th 2012, the 24-bed F-I-T (Function-Independence-Transition) inpatient unit

officially opened. This ALC inpatient medical unit delivers Patient and Family Centred Care that

supports individuals to maximize their functional independence and overcome challenges in order

to support transition to home from acute care.

Kelowna General Hospital Bed Reconfiguration Project

Ensuring the Right Patient is in the Right Bed

Andrew Hughes - Health Service Director , Aaron Miller - Project Manager Tertiary Services, and Danielle Cameron – Nurse Manager

METHODS

The project was divided into three stages: Data for Reconfiguration, Engagement and Design,

and Implementation Plan.

Stage 1: Data for Reconfiguration

An analysis of baseline utilization, occupancy, and patient flow statistics of all of the major

inpatient categories (medical, surgical, maternal/child, rehabilitation, psychiatry, and ALC) was

conducted in order to examine utilization and bed days in comparison to bed allocation. In

addition, working with the various medical, surgical, physician, union, and administrative leaders

at the hospital, the inpatient bed priorities were developed for the patient populations served by

KGH. Based on this analysis, there was a distinct need for an ALC type medical unit, and to

convert an existing mixed medical/surgical unit into a surgical only unit.

Stage 2: Engagement and Design

A Steering Committee was formed to use the historical bed utilization data (from Stage 1) and

provide recommendations for the inpatient Bed Reconfiguration. Based on the data and Steering

Committee direction, two different options for Bed Reconfiguration were created and presented to

14 different stakeholder groups across the hospital for feedback and endorsement. These

stakeholder groups represented all of the nurses, physicians, and managers in the hospital.

Stage 3: Implementation Plan

Using the endorsed option from Stage 2, an Implementation Plan was developed. This plan was

completed in collaboration with a User Group of Nurse Managers, Human Resources, Business

Consultants and Hospital Administration. The Implementation Plan outlined the key deliverables

and requirements for the successful reconfiguration of the inpatient beds.

Throughout each stage, the patient was the central focus with the overarching goal to

“Ensure that the Right Patient was in the Right Bed”

DISCUSSION

The Bed Reconfiguration Project began as opportunity re-examine the bed allocation at KGH.

The key feature of the project was the Engagement and Design stage. A similar initiative was

conducted a few years earlier but did not succeed because staff and physicians were not

engaged in the process. By presenting the two options for reconfiguration prior to decision

making allowed for engagement throughout the project including a forum to gather comments

and feedback and eventually buy-in and support of the creation of the F-I-T Unit. Furthermore,

basing decisions on data and Patient and Family Centred Care allowed for collaborative

decision making by all stakeholders involved.

Once the location of the F-I-T Unit was determined, the operational plan also included the

screening criteria for patients to be admitted on the unit and how the care delivery model and

physical environment could support the patients in a Patient-Family Centred model. One of the

four-bed patient rooms was converted into a dining room lounge and the sun-room renovated

into a rehabilitation/exercise space. These spaces support patient function and mobility by

providing a destination that patients mobilize for meals or entertainment. This supports

maintenance and recovery of functional mobility. All patients admitted to the F-I-T Unit now

receive their meals in the dining room and the physiotherapists are active with rehabilitation to

support a safe transition home.

CONCLUSIONS

The Bed Reconfiguration Project began as an opportunity to impact bed utilization but through

the engagement activities allowed for an integrated process to reconfigure the bed allocation at

KGH. With a goal to ensure that the Right Patient is in the Right Bed, the project developed

the F-I-T Unit and created dedicated medical and surgical inpatient units to optimize patient flow

in the hospital.

This project demonstrated that inclusive planning using a team approach with active stakeholder

engagement allowed for success within a Patient and Family Centred care model. Future work

will investigate the impact of the F-I-T unit on site access and flow as well as the ALC patient

experience.

ABSTRACT

The volume of healthcare services at Kelowna General Hospital (KGH) in Kelowna, British

Columbia, has rapidly expanded over the past several years. This is driven by population

growth and shifting in demographics with approximately 18% of the population over the age

of 65 years. These factors have impacted inpatient hospital bed utilization and patient flow.

KGH’s commitment to Patient and Family Centred Care is to improve the quality of the

patient’s hospital experience. This experience is impacted by the inpatient bed

configuration, service provision, and utilization. Through a hospital capital expansion, there

was the opportunity to look at the bed allocation to address utilization and quality care to

ensure that the Right Patient is in the Right Bed.

The goal of the Bed Reconfiguration Project was to better align patient populations within

different inpatient units. Through a collaborative process involving detailed stakeholder

engagement with 14 separate departments and medical divisions, an appropriate bed

allocation was determined including the need for an Alternative Level of Care (ALC) unit.

This resulted in the medical/surgical inpatient beds reorganized and a medical ALC unit

created. These changes created the environment and processes for the Right Patient in

the Right Bed with the goal to improve access and flow and enhance the patient

experience.

BACKGROUND

At KGH, the allocation and locations of acute inpatient beds has been based on historical

care patterns with dedicated specialty beds for Psychiatry, Pediatrics, Obstetrics and

Rehabilitation and general inpatient beds for surgical and medical patients. As the

population has grown and is becoming increasing complex, the inpatient bed allocations

have not adapted to the changes. Complicating the inpatient care delivery is the increase

in the number of Alternative Level of Care (ALC) patients in the hospital. These medical

patients, who no longer require acute care, are located across the hospital and contribute

to approximately 16% of all total inpatient hospital days (54 inpatient days in 2010/11).

This patient population negatively impacts opportunities for inpatient acute care

admissions.

In May 2012, the Centennial Building, a new 360,000 ft2 addition to the KGH campus

opened. As part of this new addition, two inpatient units - one medical and another surgical

unit on the existing campus - had to relocated to accommodate the site’s new Cardiac

Surgery Program. These inpatient unit relocations provided the opportunity to relook at the

bed allocation and location of medical and surgical inpatient beds in the hospital to ensure

that the Right Patient was in the Right Bed.

REFERENCES/ACKNOWLEDGEMENTS

KGH Senior Leadership Team

KGH Medical Advisory Committee

Project Working Group including: Loyd Busby, Lori Jakins, Sharon Wilkinson, Dan Goughnour,

Wes Noppers, Dan Macafee, Jackie Vleeming, Danielle Cameron, Aaron Miller, and Andrew

Hughes Kelowna General Hospital

F-I-T Dining Room