BHB pilot scheme tests impact on emergency department
A trial scheme has started to treat patients who attend the emergency department with minor injuries or illnesses as the Bermuda Hospitals Board continues its efforts to ease pressure on the unit.
The pilot means that people determined to be suitable for the “fast track” system will be seen in the King Edward VII Memorial Hospital, but outside of an emergency setting.
While the BHB highlighted the achievements of its emergency department — where the median time from registration to discharge for patients who did not require inpatient care beat international benchmarks in 2024-25 — it recognised that there were times when the unit was overcrowded and people waited “a long time for an acute-care bed”.
Records published on the hospitals board’s website showed that on March 17, the median time between making an inpatient bed request and departure from the emergency department was 5,404 minutes, or 3.75 days.
As recently as June 30, the figure was 3,570 minutes, or 2.48 days.
The lowest recorded median time between making the decision to admit a patient and their departure from the emergency department between January 1 and July 31 of this year was 169 minutes, or just under three hours, on May 26.
Twice this year the BHB has announced major surge issues when people waited for hospital beds while medically fit patients remained in wards.
A spokeswoman outlined last week a number of steps taken by the board to make improvements where possible.
She told The Royal Gazette: “We are piloting a move of the emergency department fast-track service for lower acuity — less ill/injured — patients within KEMH, but outside of the emergency department space.
“Fast track previously was provided within the emergency department area and used three beds.
“This pilot will test the impact on capacity within the emergency department, as well as whether this helps us treat fast-track patients more efficiently.
“At this time people should still start at the emergency department for admission and triage.
“The triage nurse will assess the patient and decide on the best place for their care following set parameters.”
The board spokeswoman said: “The BHB has continued to work to improve patient flow, ensure an earliest safe discharge for as many patients as possible from acute care units, and manage surges in emergency department patient numbers throughout this year.
“As we have shared publicly before, the time for seeking and being discharged from emergency care at KEMH is better than international benchmarks by about 25 per cent.
“The international benchmark is to be discharged within four hours and our average time is about three.
“However, we know there are times when the emergency department is overcrowded and when patients wait a long time for an acute-care bed.
“There are complex issues driving this and many of the solutions are not under the BHB’s control.
“Some issues relating to discharge need community solutions, such as available and affordable nursing home placements and home care.
“Increased service use relates to an ageing and increasingly sick population, vehicle accidents and violent incidents, people who can’t afford to pay out-of-pocket so come to the emergency department, and people using the emergency department for conditions that could be managed by their family doctor.
“However, it is our duty to do all we can to improve what we can and adjust, so that we can do our most important job of caring for people with emergency and acute-care needs when they need it.”
The BHB said it had doubled up six rooms to increase capacity on acute-care units.
“We have two 15-minute, bed-flow meetings each weekday in the morning and afternoon with representatives from across clinical and support services to assess capacity issues, and identify and resolve roadblocks,” the spokeswoman said.
“If six or more people are waiting for an inpatient bed in the emergency department, we send additional acute-care nurse and physician support so we can continue to deliver patients the care they need while they wait in the emergency department.
“We have a surge-response plan that opens up temporary beds in an outpatient location when pressure builds within the emergency department.”
She added: “We are continuing to work on programmes that help improve the patient experience in the emergency department and our hospitals, generally.
“We are working on a ‘Vision 2030’ strategy, and improving quality and patient experience is absolutely fundamental to our next five years.
“We are reaching out to the community though a survey, which is open until the end of this month, as well as our partners and staff.
“We anticipate this process will drive many more future improvement projects.”
Scott Pearman, the chief executive of the Bermuda Hospitals Board, said on a podcast released last week that to solve the challenge of delayed discharges, a new location for long-term care was required.
On an episode of The News Navigators, dated August 14, he explained: “The Bermuda Hospitals Board has an Act that mandates us to do certain services — long-term care is not one of them; it's just not on there. But we do provide that as a public service.
“Years ago, you may recall, government ministers had a call to action for persons to take over long-term care and when the entrepreneurs heard Government wouldn't be paying private rates, interest dissipated.
“So BHB is still providing that service and I would say at a high value. But it would be better placed for the system if long-term care was moved elsewhere.”
Mr Pearman added: “We’re very much in dialogue with government, or looking to see how the system could support moving long-term care out of the general wing.”
He explained that people deemed medically fit for discharge were those who had received inpatient care and were cleared by doctors to go home.
The chief executive said: “A lot of the people, although they don't have to be in hospital, they have medical conditions that may prevent them from going home.”
Mr Pearman added that “if you go and look at the medically fit for discharge, what's really needed is alternate levels of care”.
He explained on the podcast: “In Bermuda, what you have is the hospital providing acute care and then out in the community you have essentially rest homes.”
Mr Pearman said that some people who were medically fit for discharge may have needs that were too great for staff at homes to manage, “so we have nothing in between, that’s the crucial piece”.
In March, Judy Richardson, the BHB’s Chief of Nursing, acknowledged that pressure on the emergency department was evident to members of the community when they found people being cared for in corridors or visited loved ones in overflow units.
The board’s alert level was upgraded to 3 — with 4 being the highest — on March 18 in response to growing demands at KEMH, primarily driven by the number of “medically fit for discharge” patients causing a record number of people waiting for inpatient beds.
“At one point this afternoon, 34 patients were waiting for beds,” the BHB said then.
“There were over 40 patients medically fit for discharge still in hospital and all additional areas with available beds were being used.”
The alert level was raised to 3 again on July 10, owing to increased pressure on the emergency department and acute-care inpatient units at KEMH.
Ms Richardson said then that 36 patients who could be discharged remained in acute-care beds, while 21 admitted patients waited in the emergency department “for those same beds”.
She added at the time: “In some cases, there are no appropriate community placements for these patients. For others, the delay stems from a situation at home.”
The BHB noted then that the challenges were compounded by increasing numbers of patients seeking care in the emergency department.
It said that on July 7, 115 people presented at the unit — the highest number in a single day by that point this year.
“Average attendance is 85 to 87 patients a day,” the BHB added then.
• To access the Bermuda Hospitals Board survey, visitsurveymonkey.com/r/BHB2030
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