Boarding Surgical Patients from Ward 4A (5B) and Ward 4B University Hospital Crosshouse standard operating procedure

ISD Scotland defines boarding as ‘a patient who occupies a borrowed bed’. A borrowed bed is a bed which is made available to a specialty/significant facility other than the specialty/significant facility to which it is allocated.

This includes patients in beds who are:

• Managed by an individual consultant or consultant team out with the main allocated inpatient area for that consultant or patient specialty.
• Transferred to any non-inpatient bedded area (for example day units)

During periods of high emergency admissions, demands for beds within Medical Speciality, Combined Assessment Unit (CAU) and Emergency Department (ED) may place the hospital under considerable pressure. In these circumstances, boarding suitably risk assessed patients is appropriate in order to reduce the overall risk. On admission, patients and their carers/relatives should be routinely informed of the possibility of transfer to another ward during their hospital stay.

Purpose

This SOP aims to provide a structured approach on the movement of patients out of standard Surgical inpatient areas (Ward 4A(5B) and Ward 4B) to appropriate identified areas within University Hospital Crosshouse (UHC) footprint.

Staff roles in identifying suitable patients are clearly defined so that staff are aware of their roles and responsibilities.

Scope

• Those patients within Surgical Inpatient areas who are suitable to board out with our substantive surgical inpatient areas will be identified.
• The roles and responsibilities of all staff involved in identifying and risk assessing patients suitability for boarding outwith substantive surgical inpatients areas.
• This SOP applies to Surgical Inpatient areas (Ward 4A (currently situated in Ward 5B) and Ward 4B)

Patient risk assessment for boarding initial steps

• Surgical team to be advised of site capacity concerns (Consultants and Nursing staff) by site duty management team.
• Surgical team to discuss patients suitable to board out with inpatient areas (Ward 4A(5B) and 4B)
• Patients to be risk assessed for suitability (Appendix 1)
• Identified patients to remain under the care of the named consultant.

Patient criteria for safe boarding

• All patients who are boarded must be routinely risk assessed according to the boarding criteria in the table below and a Boarding Criteria Checklist (Appendix 1) completed.
• All patients must have their boarding level (green, amber or red) documented in the medical notes.
• Any patient that is allocated for boarding must be agreed with Senior Medical Staff (The responsible Consultant or Middle Grade Trainee/ Specialty Doctor). A patient given RED status should be reviewed daily by Medical Staff.

• Those patients suitable for boarding should be identified on the ward round and the Nurse in Charge to highlight on the electronic whiteboard.

Discharge planning

If a patient is identified for boarding and expected to be discharged in the next 24 hours, the medical team should:

• Prepare the immediate discharge letter.
• Consider if the patient would be appropriate for criteria led discharge and complete the necessary documentation within the notes.
• If not for criteria led discharge, should review the patient in a timely manner the following morning in order to facilitate discharge.
• Should the next morning, incorporate boarded patients into a targeted ward round where sick patients, patients for discharge and new patients are prioritised.

Responsible Consultant

The responsible consultant must be clearly identified for all patients at all times with their name and specialty recorded on eWhiteboard and TrakCare. The consultant is responsible for:

• Ensuring patients under their care are reviewed daily with regard to boarding status.
• For the ongoing management and clinical care of patients under their care who are boarded.

Foundation Trainees/Surgical ANP

Are responsible for:

• Providing medical care for any patients regardless of the specialty, who are on their ward.
• Highlighting clinical concerns to the parent team.
• Completing an immediate discharge letter (IDL) for any surgical patient boarded from their surgical ward (4A(5B)/4B) to GYN / DSU / Discharge Lounge / Ward 5A.

Surgical Middle Grade Doctors

• It is expected that middle grade doctors from the responsible team will help with the care of boarded patients and provide support to the ward junior if required.

Clinical Support

• The patient’s ongoing care will be the responsibility of the appropriate AHP department and senior staff there will identify the most appropriate arrangements for ensuring continuity of care in the boarding ward. This will require timely and effective communication between different ward teams.
• The patient’s pharmaceutical care will be the responsibility of the pharmacist in the boarding ward.

Nursing Staff

• The nurse in charge should, along with the ward medical staff be responsible for the identification of boarders in line with the criteria. They should ensure that any patients identified for boarding are agreed with senior medical staff (Consultants/ Specialty doctors).
• Once the patient is received in the boarded ward, all nursing responsibilities for the patient, including discharge arrangements pass from the parent ward to the boarding ward.
• A robust handover must be provided by the transferring ward nursing staff.
• Ensure that non stock medicines should be transferred with the patient to the boarding ward.
• The patient will be introduced to the nurse providing their care within the boarding ward. This nurse will be professional accountable for their nursing care delivery.
• Nurses have a responsibility to ensure that all boarded patients and named consultants are clearly identified on the eWhiteboard and TrakCare. This facilitates identification of a patient’s consultant team in emergency situations. It also makes patient review easier for all concerned.
• If boarded patients are not reviewed by 1400hrs the Nurse in Charge of that ward will contact the patient’s specialty consultant responsible for that patient’s care. If unresolved, it should be escalated at the site safety huddle.

ANP

• Specialty based ANPs will provide clinical care for any patient regardless of specialty who is on their ward.
• ANPs on the Hospital at Night team are expected to ensure that there is ongoing care provided out of hours.

Clinical Operations Managers (COMs)

• COMs will communicate with ward staff on an ongoing basis and alert them to the requirement to board patients as early as possible.
• They should ensure that any patient to be boarded has met the boarding criteria and has agreed with senior medical staff and recorded within the patient's records.
• A boarders list to be compiled and updated on a daily basis. It is the responsibility of the COMs team boarding patients to ensure that the relevant consultants are aware of the location of their patients who have been boarded.

Management Team

• Managers are responsible for ensuring that their staff understand their roles and responsibilities and for monitoring of this policy. Clinical Nurse Managers are required to ensure safe staffing levels in line with safe staffing legislation. It is the responsibility of all managers to ensure dissemination, understanding and compliance with this guideline.

When the degree of urgency is agreed, this must be communicated to staff involved including the COM and transfer expedited. Arranged transfer can be the same degree of urgency as an emergency admission from ED, The transfer may involve ‘swapping’ to accommodate the sick patient.

It is realised that in times of extreme pressure it may be necessary to depart from this policy. In this circumstance, this should be authorised by the Duty Manager and the responsible consultant on call out of hours. A Datix must be submitted.

Any omissions of clinical care identified for a patient who has been boarded from their base ward should be recorded formally using the Datix system. This includes patients inappropriately moved or non-compliance with this guidance.

The boarding criteria checklist must be completed by parent specialty ward nursing team for every patient to be boarded.

Boarding criteria checklist