Understanding patient flow in hospitals

27 Understanding patient flow in hospitals
Figure 11: Cumulative beds by age band, 2015–2030
160000
140000
Bed use rate per 1000 people (days)
120000
100000
80000
60000
40000
20000
2015
2020
2030
Source: HES (2016)
0
0–4 5–14 15–44 45–64 65–74 75–85 85+
Age group
Increasing comorbidity
It will not be news to clinicans or managers that patients are presenting with increased
comorbidity. The data confirm this. Figure 12 shows the percentage of patients scoring
from 0 points (i.e. no comorbidity) through to 20–49 points (i.e. multi-system disease)
on the Charlson Index of Comorbidity. The percentage of patients in the highly
comorbid groups has grown over the last 6 years.
Figure 13 shows that there have been length of stay reductions in each age bracket.
However, the most complex patients spend almost three times as long in hospital as
those admitted with no comorbidity, and the increasing number of these patients
outweighs the improvements across the board. The net result is equivalent to a 6,500-
bed increase in demand over the last 6 years. It is unlikely that a peak has yet been
reached, and it therefore it seems reasonable to plan for the impact of further increases
in comorbidity.
Increasing illness is a precursor of death. Population projections suggest that, having
reduced over the last 40 years, death rates are now expected to increase every year
for the next 40–50 years. This will drive ongoing increases in clinical workload and
demand. The capacity required to manage this needs to be planned for.