The NHS’ best kept secret: what is Reverse Bed Chain and how can it improve A&E efficiency?

Connie Moser, CEO, Navenio

A&E is where treatment times and critical care are most needed as the front-door of the hospital. But the latest figures to emerge from the NHS show that more than 1.5 million patients in England had to wait over 12 hours in A&E before being “admitted, transferred or discharged”. Given the NHS has a set a target of seeing 95% of patients within four hours, these findings show just how challenging the situation is (this target has not been met since

Staff are under pressure, and funding and resources are failing to keep up with demand. Without innovative and immediate solutions, tragic and avoidable outcomes will continue to take place. But are these waiting times a resource problem, or a flow problem?

Long waiting times in a patient’s journey often come down to inefficiencies with patient flow, staff flow and resource allocation. Even with more resources (which are needed), without
methods that can improve flow across a hospital, problems will persist.

A new strategy that is rapidly influencing how hospitals operate is Reverse Bed Chain (RBC). RBC aims to optimise patient flow by synchronising multiple patient movements while also allocating staff and equipment in the most optimal way. Through this approach, the strategy can achieve a ‘continuous flow’ of patients, staff and resources.

For now, RBC is still one of the NHS’ best-kept secrets. But the crisis needs a popular solution, and its wider adoption could help transform efficiency in A&E.

What causes delays in A&E?

It can be hard to nail down the exact reason for a given delay, as there are often a variety of contributing factors, both within a hospital and also community and social care services. However, ‘poor’ A&E performance has often been attributed to increases in patient demand, limited bed capacity and staff shortages.

Yet rather than a resource issue (such as numbers of staff and beds), Reform research from last year concluded that “A&E pressures are a system challenge and they are being driven by failures to move patients through hospital wards and back home efficiently”. Key reasons for this include longer patient stays, discharge delays and operational inefficiencies such as “internal failures of coordination”.

The idea of bettering patient flow has been gathering pace in NHS strategy: it is like focusing on getting more people to flow through a train station, rather than linking poor performance (i.e. delays) to an increase in passenger demand. The practicalities of achieving a continuous flow of patients, however, require a whole new operational strategy.

How can RBC improve A&E efficiency?

RBC aims to improve patient flow and capacity planning simultaneously. At the heart of this approach is grouping the movements of multiple patients as a ‘single task’ while also optimising the allocation of staff and resources depending on their whereabouts. This works by using real-time location services (RTLS) technology that can pinpoint the location of patients, staff and equipment in the hospital in real-time.

Staff can access this data using an intelligent workforce app on their smartphones and tasks are smartly assigned based on who and what is physically closest to the relevant location. So, instead of a porter having to walk back and forth between departments to move patients one at a time, for instance, they can pick up the next patient(s) at the location where they dropped off the previous patient(s).

Real-time data can address a range of challenges: it directly reduces patient waiting times, it allows floor nurses to access patient information and proactively drive care, and it enables managers to identify trends and enhance overall flow. This all works to improve the patient journey from entry point to discharge.

What could this mean for the NHS, its staff and patients?

Crucially, for the NHS, RBC tackles A&E waiting times head on. Enhancing patient flow increases hospital capacity without using more resources; it optimises what is in place. And by using smartphones, RBC harnesses ‘light tech’ without requiring any investment in infrastructure.

Of course, this is not to say more resources will not be needed. But if you can create as much efficiency as possible in the patient journey – seamlessly sharing data and optimising task allocation – it is far easier to understand how resources are used and if or where they are needed.

For nurses and staff, RBC allows them to focus on delivering quality care quickly without having to worry about finding patients or locating equipment (a well-known time waster). By helping to improve staff wellbeing and satisfaction, it can also help to address longer-term workforce issues and job recruitment/retention.

Finally, for patients, it allows them to be seen quicker, treated quicker and discharged quicker – an experience that could make a massive difference to someone’s life.

Getting the secret out

While NHS strategy is catching up with the notion of improving flow, there is still a major need to create widespread process change across hospitals and A&E departments.

Providing solutions for flow does not diminish the continual need for sustained investment in overall hospital operations and workforce needs. And as the Reform analysis highlights, as well as investing in NHS operational capability, for patient discharge rates to improve there also needs to be investment in community healthcare staff and services to reduce bottlenecks.

Yet discharge is just the final component of the patient journey, and RBC is a key to unlocking continuous flow throughout the patient experience: it streamlines movements, optimises capacity, builds operational efficiency and empowers staff.

To propel A&E performance change across the NHS, the RBC secret needs to get out.


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