Doctors’ Warning: Scottish Hospital Patients Receiving Inappropriate Care as Patient Numbers Exceed Beds
***EMBARGO: NOT FOR BROADCAST OR PUBLICATION BEFORE 00:01HRS 12 JUNE 2012***
New data produced by the Royal College of Physicians of Edinburgh (RCPE) has shown that hospitals, which are regularly under pressure during the winter months, are now routinely transferring patients around the hospital all year round to cope with the number of medical patients. This is inappropriate, places patients at risk and is difficult for the medical teams caring for them.
POOR QUALITY CARE
The RCPE believes there has been a significant and sustained increase in the number of seriously ill patients admitted to Scottish hospitals over a period of time during which the consultant workforce has remained static and that the Scottish Government has reduced the number of beds in acute hospital units. One regrettable consequence of this is a shortage of beds in some specialist wards which leads directly to an increase in the ‘boarding’ of patients into other wards where less specialist care can be provided. This practice can significantly increase patients’ length of stay and contribute to other complications resulting from delayed assessment and treatment, i.e. developing blood clots and hospital acquired infections. While ‘boarding’ traditionally increases during the winter, due to ‘flu and other seasonal infections, boarding levels experienced this year have not decreased and for some hospitals have become the norm.
NEW RCPE DATA
Following approaches from a number of hospital consultants from around Scotland who are very concerned about the level of both admissions and boarding in their areas, the RCPE conducted a survey between 22 and 30 May 2012 to obtain a snapshot of boarding in Scottish hospitals . The level of boarding would traditionally have been expected to fall off as we approach the summer months, but doctors across Scotland have reported the following –
These findings are consistent with the experiences of Scottish hospital consultants reported to the RCPE and complement an earlier small-scale study from 2011 published in the Scottish Medical Journal which reported that 74% of doctors would refuse to be a medical boarder themselves and 92% would not accept this for a relative. 
It is clear that the current complement of beds in some specialties in Scotland is failing to cope with the needs of patients admitted to hospital. The RCPE is also concerned about the commitment of policy makers to transfer care into the community and close hospital beds in the absence of strong evidence that this is either safe or cost effective. .
Dr Neil Dewhurst, President of the Royal College of Physicians of Edinburgh (RCPE), said,
“Seriously ill patients admitted to hospital require specialist medical care. While we believe there has been a steady increase in the number of patients with medical conditions admitted to hospital across Scotland, the number of hospital beds for acutely ill patients remains under significant pressure and the number of consultants has not been increased to respond to this demand. In most hospitals, consultants have no alternative but to move patients on to other wards where they will receive less specialised care and which often results in delays to their care. There is strong evidence that this reduces quality of care for patients and increases their length of stay. Boarding, in effect, creates a vicious circle, delaying treatment and discharge for patients and adding considerably to the workload of the healthcare teams caring for them.
“What this survey shows is that boarding is becoming the norm in Scottish hospitals on a year round basis. We believe this is poor practice, places patients at risk and is unacceptable”.
Dr Jean Turner, Executive Director, Scotland Patients’ Association, said,
“Scotland Patients’ Association is extremely concerned, yet not surprised at the RCPE findings. Over the past twenty years the unintended consequences of reducing NHS beds throughout Scotland has contributed to patients being processed from bed to bed within wards and between numerous wards before discharge. This practice is most confusing to frail and elderly people and contributes to a severe loss of continuity of care and the frequent sudden discharge of frail people back into the community, often late in the evening and sometimes without the most appropriate care plans. Inability to discharge appropriately causes the boarding of patients to become the norm which should not be tolerated since this increases inherent risks to vulnerable people with the loss of their precious quality of life. With an aging population and the increasing demands on in-patient beds due to unexpected outbreaks of infection, capacity issues need urgent attention and the Scotland Patients’ Association is pleased that the RCPE has highlighted this serious problem. “
Contact: RCPE: Graeme McAlister or Lindsay Paterson on 0131-247-3693 or 07733-263453
Scotland Patients’ Association: 0141 942 0376
Notes to Editors
 The RCPE conducted the ‘Boarding in Scotland’ survey between 22 and 30 May 2012. 1356 doctors in Scotland, primarily senior hospital consultants, were invited to complete this survey. 290 responded, giving a response rate of 21%.
 Scottish Medical Journal February 2012, vol. 57, no. 1, 45-47
 ‘Inappropriate admissions to hospital: myth versus reality’, RCPE, April 2012