1.1 Problem Definition

Gen Bed Information

• Currently 529 beds owned and kept at RGH, of these there are about 6 sub-types of beds. (RGH has reached 600 patients)
  
  • Hill-Rom Beds: general use/surgical beds, 300+, hospital staff are familiar with these
    • Advanta: 300 of these. most common bed at RGH
    • Versa-care: just a handful of these beds, hospital staff DO NOT LIKE these
  • Stryker Beds: roughly 200 of these beds in circulation, kept in separate departments than Hill-Roms although they are often interchanged
    • Stryker-Zooms: worst bed at RGH, impossible to move without a charge, needs to charge, no alarm system, unfamiliar to staff
  • Linet: French manufactured bed, only 25, staff can be confused because there are so few of them, mattress is not interchangeable
  • Enterprise: The rental bed, amount varies frequently based on the hospital census numbers
  • Bariatric Beds: obese patients

• Starts in the Morning (every M-F)
  • Ed receives a list, via email, from nursing of 5~25 beds that will be needed for that day post surgery. Mondays and Tuesdays are busiest
  • This is his "standard work process" as he put it
  • Beds are prepped and delivered for patients post surgery
  • Once out of surgery they are moved to their room
  • If a patient is moved to a room that has a clean bed in it, they are moved in, the clean bed is often moved into the hall
  • It is dangerous and not worth the risk to move a patient from bed to bed, so these clean beds are often left in the hall until environmental stumbles across them.
• There are around 10-15 departments within RGH. Scott and Ed try to keep ~10 of these departments completely Hill-Rom and the remaining 5~7 of these as Strykers (there is no way to track)
  • When a patient transfers departments for whatever reason, they are not taken off of there bed and many times that bed will not come back to its origin.
  • When a transfer is moved into a new room the clean bed in there is put into the hallway
  • The only tracking of beds that occurs is for the rental beds, but this can get tricky with transfers and surgeries.
  • When the hospital population decreases, the patients on the rentals do not come off even though there are other non-rental beds available. This ties money up for environmental as they can not return them to the rental company
• There are certain "dumping grounds" / "unofficial collection points" that have developed over time that nurses/transporters will use to leave beds for environmental to pick up and clean
• Nursing does not move empty beds
• Transporters or Environmental staff will move dirty and clean beds to final location

• With such a varying census it is hard to gauge how many rental beds to order or when/if to return them.
  • Example: if we are going into the weekend and we are projected to have a lull in patients, then we should return the rentals right? However, the census also predicts that the following monday/tuesday will be very very busy and we will likely need rentals for these days. So, why should we return the rentals when we will just have to get them delivered again on Monday. It inconveniences everyone, but costs money to keep them longer
• Due to shortages of beds, they have had to open the 'gym' and accommodate up to 12 patients in this room (NOT IDEAL AT ALL)
• Post Op patients are assigned a room, but often times the person in the room has not been discharged yet, and "Who is to tell a patient that they need to leave? Their family might be with them, and even though they are due to discharge that day, they will often take their time, which keeps a bed that should be free tied up."
• TRANSFERS TRANSFERS TRANSFERS

• There is a strategy used where a room will be "blocked" over the weekend. That is, it will not be used at all over the weekend in the hopes that it can be saved for patients coming off of surgery the following monday/tuesday
• Example of Ed's Standard Work Morning Email:
  "Ed: 2800 needs 2 beds, 4500 need 2 beds, 6800 needs 6 beds."
  • These numbers correspond to one of the 10~15 departments in the hospital
• 6800 is one of the few departments capable of handling a variety of beds
• Passing worker in office mentioned that "it would be nice to have a storage area for 20-25 extra beds"
• "Sometimes beds break, sometimes we don't have enough, sometimes we have too many"
  • The gentlemen sits directly across from the secretary, but left before I could catch his name.