Nurse-managed transitional beds as a method of increasing geographic placement of an academic inpatient service

Geographic placement of patients in hospitals has long been valued to bring together all healthcare members as a team focused on high-quality patient-centred care. This goal can be particularly challenging for physicians whose patients are often scattered across various hospital units. The inpatient medicine service for the Palmetto Health-University of South Carolina Internal Medicine Residency Program began attempting geographic placement when a model for team-based care was adopted in 2015, but despite various process improvements we found it very difficult to maintain a high census of our patients on the unit. We eventually came up with an innovative solution to the problem that incorporated the use of transition beds—beds dedicated for patients moving onto or out of the unit in order to make it easier for the unit to control patient flow. We saw an immediate increase in our average census from ~8 to ~15 patients as well as a major shift of the median admission time to 3.5 hours earlier in the day. Unfortunately, it was an added burden to our already stressed charge nurses, and when the pilot ended we were forced to end the use of the transition beds. Despite our challenges, we applied valuable lessons learnt that have helped us in other improvement projects, and overall we did successfully demonstrate that transition beds are a viable option for an inpatient medical unit to improve geographic placement of patients while optimising patient flow.