Bed Blocking by Hospitalized Patients Awaiting Admission to Intramural Aftercare: A Case Study on Transfer Coordination

Abstract

Background/Objectives: Elderly patients who require aftercare in an intramural care (IMC) facility may contribute to “bed blocking,” which occurs when patients who are ready for discharge remain hospitalized longer than medically necessary. While most bed-blocking studies focus on capacity issues, this study also investigates the coordination process. In a regional hospital in the Netherlands, we examine the extent to which bed blocking occurs due to patients awaiting IMC, and how this issue can be characterized in terms of capacity and coordination challenges. Methods: The case study employs a mixed-methods approach, analyzing system data, documents, and interviews from the hospital, IMC organizations, and a health insurance provider. The location of each patient (organization and department) was collected and reconstructed to a patient path. All patient paths together formed a network enabling data analysis both on the level of patient paths as well as on the level of the networks as they developed through time. This gave insight into the complexity of the total network that has to be coordinated. Results: In 2023, 6% of the hospital capacity was occupied by patients awaiting IMC. Delays were observed at various coordination stages. Due to a lack of data on IMC bed capacity, we were unable to establish whether capacity limitations also contributed to bed blocking. Conclusions: The coordination system is complex and includes waiting times at each coordination stage, resulting in bed blocking. The absence of a centralized capacity overview, coupled with limited data, prevents decision-makers from identifying bed blocking arising from capacity shortages. Greater insight is needed to coordinate patient flow and determine the required slack capacity.