MALO (more activity, less overcrowding): A bed management model as a high-impact solution to the problem of hospital overcrowding

Abstract

There is abundant literature that relates the overcrowding of the emergency departments (EDs) to the presence of patients admitted to the ED for want of beds in the hospitalisation area. Likewise, there is also abundant evidence on the relationship between hospital overcrowding and the deterioration of multiple indicators of healthcare quality. In this paper we present our bed management model (MALO model: more activity, less overcrowding), which we have successfully applied in three different hospitals. The three characteristic elements of this model are: 1. PREBEDA formula: this consists of a simple but useful formula for calculating the availability of beds on the basis of the scheduled activity and the activity estimated based on recent history 2. Coordinated surgical programming: surgical programming is coordinated with the bed availability forecast 3. ‘Beds czar’: a person responsible for the management of hospital beds is appointed, which acts according to the prioritization criteria established by a ‘bed management committee’, in which the medical director and the nursing director participate.