BC HOSPITAL
Saved by @Alex1Powell

A short thread about hospital bed pressures

This may surprise some people outside the healthcare bubble but for a population of c 60 million, England (pre-pandemic) only had just over 100,000 General and Acute Hospital Beds and c 4,300 ICU beds and both running close to full

 as an aside @HSJnews reported that we have perhaps 3,000 general and acute beds available than this time last year for various reasons, pandemic and "winter pressures" or not.

We struggle to staff many of those beds fully with 100,000 NHS post unfilled inc 1 in 8 in nursing
the pandemic response means we have to separate wards and admission streams into "hot" (proven or suspected covid) and "cold" (covid unlikely or excluded) areas and try to separate staff (though some have to work throughout hospital).
This takes further beds out of availability
England is already right at the bottom of the OECD league of developed nations for hospital beds per 1000 population and ICU beds per 100,000 and well below European average on both and in similar place in "doctors and nurses per 1000 " league table (even if posts filled)
Because it is comparatively rare in England to have completely separate acute/urgent (with full A&E dep and acute admissions) hospital site and elective/planned/procedure/outpatient/cold surgery site . If there are pressures on acute and general beds it impacts that planned work
A proportion of Covid-19 cases are acquired or detected once people already in hospital beds and this can then lead to outbreaks in bays of wards or across whole wards and this means wards or bays get temporarily closed to admissions (or to discharges into community facilities)
once those beds & bays get closed it further reduces the available bed pool for admissions and make the *real* bed number lower than the notional number.
And then as we run into the "festive" period (although there has been fantastic work with "discharge to assess" and enhanced funding to help people leave hospital sooner) - delayed transfers will rise
this will also reduce the number of beds effectively available

Meanwhile, infection control measures mean hospitals taking beds out of bays to keep beds further apart and care activities can take longer with all the PPE and precautions meaning staff under further time pressure
meanwhile in A&E - overcrowding and waits were already issues - and contrary to what you might read, most of this is due to sick patients who need admission to beds deeper in the hospital and flow through those beds, not walk -in patients in minors/chairs who go home the same day
as you can imagine, with covid doing the rounds again the last thing we need is more overcrowding now as it is already bad for patient health and staff morale and risks cross infection of people at or in hospital.
many older A&E departments and AMUs were built for smaller numbers than they now handle and even the new build ones were often built in assumption about smaller numbers. They were not built with streaming into infected and non infected patient groups in mind (at this scale)
A&E activity and hospital admissions and delayed transfer bed days have risen steadily year on year even as bed numbers have fallen (we have lost c 25% of general and acute beds over past 3 decades when admissions and attendances have nearly doubled)
meanwhile, since 2010, social care cuts mean c 500,000 fewer people in receipt of home care (despite rapid population ageing and growing need) and no significant increase in total care home places (just over 400,000 in england)
and social care has suffered even worse staffing gaps than NHS (1 in 8 vacancies unfilled and immigration policy making things worse as are council cuts which affect terms and conditions when other jobs with living wage are less hard)
meanwhile, no increase in GP number for a decade even though GP workload up 15% in that time and district nursing numbers have nearly halved
then on top of that, we will now face seasonal surge of other respiratory and gastrointestinal viruses which can cause outbreaks all of their own and similar issues trying to admit to wards or discharge patients to community facilities or to home care/community rehab teams
with regard to ICU - yes they did pretty much double (more in some places) capacity at pandemic peak in the spring but on borrowed staff, borrowed space and reduced staffing ratios. It is not viable to keep on doing that long term and yes they have *non* covid patients too!
You put all that together and not only are chief operating officers, site/bed manager and operational managers in frontline services an underappreciated/unsung part of workforce - one of the hardest jobs in healthcare but...
but.....it is pretty enervating having armchair critics, keyboard wariors, covid-denialists talking like they actually *want* 95% or 100% midnight occupancy and rammed ICUs and that would be a great thing - "sweating the assets". 90% is hard enough as an operating model
"what about Nightingales?" you say

A hall in an exhibition centre with beds is NOT a hospital. They are not staffed for the volume of patients they could notionally take and only 3 of the 7/8 have taken any in patients (totalling less than 400 between them).
Easy soundbites and trite rhetoric and inexpert back of a fag packet ideas are not meaningful, risk assessed logistically sound solutions

Attacks on the NHS by anti lockdowners and conspiracy theorists are not helpful and don't stand scrutiny

END

You May Also Like

Devdutta
Devdutta
@Devdutta96
Please please please take your cyber security seriously even if you don’t consider yourself a high risk person. Here are a few easy things to start with. 1/n

Switch from WhatsApp to Signal and enable disappearing messages. Most of us cannot stop using WhatsApp entirely but at least turn off back ups to Google Drive or iCloud. 2/n

Do not have private conversations using the messaging service on any social media platform like Facebook, Instagram or Twitter. 3/n

Switch from Gmail to ProtonMail or any other secure email service provider. 4/n


Switch from Google Docs to CryptPad or RiseUp Pad.
CYBER SECURITY , IT PRIVACY , CYBER SECURITY STEPS
Brian Cates
Brian Cates
@drawandstrike
Great article from @AsheSchow. I lived thru the 'Satanic Panic' of the 1980's/early 1990's asking myself "Has eveyrbody lost their GODDAMN MINDS?!"


The 3 big things that made the 1980's/early 1990's surreal for me.

1) Satanic Panic - satanism in the day cares ahhhh!

2) "Repressed memory" syndrome

3) Facilitated Communication [FC]

All 3 led to massive abuse.

"Therapists" -and I use the term to describe these quacks loosely - would hypnotize people & convince they they were 'reliving' past memories of Mom & Dad killing babies in Satanic rituals in the basement while they were growing up.

Other 'therapists' would badger kids until they invented stories about watching alligators eat babies dropped into a lake from a hot air balloon. Kids would deny anything happened for hours until the therapist 'broke through' and 'found' the 'truth'.

FC was a movement that started with the claim severely handicapped individuals were able to 'type' legible sentences & communicate if a 'helper' guided their hands over a keyboard.
CULTURE
Advertisement
The Troll Zoo
The Troll Zoo
@TrollZoo
1. This is "Hollie The Card".

She's a Doctor, Physician, PhD, MA, Clinical Psychologist, Hospital Consultant, PTSD consultant, Long Covid Consultant.

(Thread)


2. Although sometimes she’s also an AUTHOR and English Academic.


3. A Hospital Consultant and ex Gymnast.

(Pinterest public profile)


4. A Physician, Doctor, or hospital consultant.

A “Hospital Consultant”, would probably mean a senior doctor, in the UK at least.


5. Hollie changes her Twitter picture and bio so often, it’s hard to keep up with her qualifications.
TWITTER
MaMaMia \U0001f1ec\U0001f1f7\U0001f1e8\U0001f1fe\U0001f1e6\U0001f1f2 SupportGreekProducts
MaMaMia 🇬🇷🇨🇾🇦🇲 Support...
@MaMaMia73189983
Following @BAUDEGS I have experienced hateful and propagandist tweets time after time. I have been shocked that an academic community would be so reckless with their publications. So I did some research.
The question is:
Is this an official account for Bahcesehir Uni (Bau)?


Bahcesehir Uni, BAU has an official website https://t.co/ztzX6uj34V which links to their social media, leading to their Twitter account @Bahcesehir

BAU’s official Twitter account


BAU has many departments, which all have separate accounts. Nowhere among them did I find @BAUDEGS
@BAUOrganization @ApplyBAU @adayBAU @BAUAlumniCenter @bahcesehirfbe @baufens @CyprusBau @bauiisbf @bauglobal @bahcesehirebe @BAUintBatumi @BAUiletisim @BAUSaglik @bauebf @TIPBAU

Nowhere among them was @BAUDEGS to find
BUSINESS
Vibhu Vashisth
Vibhu Vashisth
@VIBHU_Tweet
🌺श्री गरुड़ पुराण - संक्षिप्त वर्णन🌺

हिन्दु धर्म के 18 पुराणों में से एक गरुड़ पुराण का हिन्दु धर्म में बड़ा महत्व है। गरुड़ पुराण में मृत्यु के बाद सद्गती की व्याख्या मिलती है। इस पुराण के अधिष्ठातृ देव भगवान विष्णु हैं, इसलिए ये वैष्णव पुराण है।


गरुड़ पुराण के अनुसार हमारे कर्मों का फल हमें हमारे जीवन-काल में तो मिलता ही है परंतु मृत्यु के बाद भी अच्छे बुरे कार्यों का उनके अनुसार फल मिलता है। इस कारण इस पुराण में निहित ज्ञान को प्राप्त करने के लिए घर के किसी सदस्य की मृत्यु के बाद का समय निर्धारित किया गया है...

..ताकि उस समय हम जीवन-मरण से जुड़े सभी सत्य जान सकें और मृत्यु के कारण बिछडने वाले सदस्य का दुख कम हो सके।
गरुड़ पुराण में विष्णु की भक्ति व अवतारों का विस्तार से उसी प्रकार वर्णन मिलता है जिस प्रकार भगवत पुराण में।आरम्भ में मनु से सृष्टि की उत्पत्ति,ध्रुव चरित्र की कथा मिलती है।


तदुपरांत सुर्य व चंद्र ग्रहों के मंत्र, शिव-पार्वती मंत्र,इन्द्र सम्बंधित मंत्र,सरस्वती मंत्र और नौ शक्तियों के बारे में विस्तार से बताया गया है।
इस पुराण में उन्नीस हज़ार श्लोक बताए जाते हैं और इसे दो भागों में कहा जाता है।
प्रथम भाग में विष्णुभक्ति और पूजा विधियों का उल्लेख है।

मृत्यु के उपरांत गरुड़ पुराण के श्रवण का प्रावधान है ।
पुराण के द्वितीय भाग में 'प्रेतकल्प' का विस्तार से वर्णन और नरकों में जीव के पड़ने का वृत्तांत मिलता है। मरने के बाद मनुष्य की क्या गति होती है, उसका किस प्रकार की योनियों में जन्म होता है, प्रेत योनि से मुक्ति के उपाय...
ALL