"Bed exchanger": the Italian way of swing-bed approach. A new possibility through an old tool.

‘‘Swing-bed’’ is a hospital bed usable for either acute or long-term patients. The swing-bed programme was developed in the long-term care field in the USA in the 1960s.1 The system was so efficient that a national programme was proposed.2 The university-affiliated Parma hospital has a catchment area of 400 000 persons. It has about 80 000 patients admitted through the Emergency Department (ED) yearly. Over the years, critical periods arose, which were characterised by more admissions to the ED, increasing waiting times and difficulty in finding hospital-beds. Poorly effective strategies have been adopted.3 We developed a swing-bed/‘‘bed-exchanger’’ strategy in order to: (1) increase daytime admissions, (2) decrease night-time admissions and (3) reduce ED waiting times. During the first 2 weeks of 2008, concomitant with the increase in flu and an epidemic of meningitis in the North-East of Italy, a high number ED admissions were recorded at our Hospital, averaging 12.5% above the seasonally adjusted number of visits/day. Difficulties finding beds resulted in increases in ED waiting times. To face the situation, we launched this plan. Twelve free beds were located on two elective surgery wards, and patients who were either close to being discharged or awaiting completion of arrangements to territorial facilities, were transferred there. We were able to free beds in the Long-Term Care ward to receive patients from acute departments. In turn, this decompressed the Medicine Wards to receive the admissions from the ED. The additional long-term care beds in the two Surgery departments were managed by the usual long-term care physicians and surgical nursing service. The adjustments for this process occurred rapidly (some hours), alleviating the load on the ED. The establishment of only 12 ‘‘exchangebeds’’ enabled the influx of additional ED admissions to be absorbed into the usual function of the facility. Within 7 days, we got over the crisis: daytime admissions rose considerably (80%), while shorter ED waiting times for beds (218%) allowed a reduction in night-time admissions. To our knowledge this is the first description of the successful use of a ‘‘bedexchange’’ system. This system allowed, in the situation of an ED overload, a higher number of daytime admissions and a reduction in ED waiting times. Further studies are needed to substantiate this observation.