Managing capacity and demand across the patient journey.

Bed availability remains the main operational focus for managers and clinicians on a day-to-day basis within the NHS. There is now published research that establishes a lack of bed stock is too simplistic an explanation of the situation. Other reasons for bed shortage include the daily and weekly lack of synchronisation of admissions and discharges, the large variation in bed occupancy over time, the downtime during weekends and holiday periods, wasted time during inpatient stays and the variation in patient length of stay. So far most of what little work has been done has focused on the front end of the process, to 'buffer' unplanned admissions through the use of short-stay facilities, such as medical assessment units, as a short-term solution. This paper reviews the evidence for the hypothesis that bed availability problems can be solved by actions other than the addition of more beds to the system.