Catherine Clarke, bed manager at the Mater Hospital, Dublin, is an expert in crisis management as there are simply not enough beds for all the patients
My working day starts at 6.45 a.m. at which time I take an overview of the day, prepare the day's working documents and familiarise myself with the details of expected admissions for the day. This includes patients from the emergency department, other hospitals and urgent cases from home.
At 7.45 a.m. I have a meeting with the night superintendent and the nursing managers to receive the night report.
One of my first jobs after this is to contact the emergency department team leader to prioritise patients waiting for beds according to clinical need and length of time waiting. The most acutely ill will usually be first to be allocated beds. I have to be constantly aware of the other areas from which emergency admissions will be necessary, for example, out-patient clinics, diagnostic services and day services.
Throughout the day I attend various meetings. At 11 a.m. and 2 p.m. I attend emergency escalation meetings to give an update on the bed situation and advise emergency department staff and hospital management of how we are managing our bed allocation issues. On crises days this requires making a request to go "off call" (this is when we request ambulances not to bring patients to the Mater Hospital for two or more hours, and is only done in emergencies) or cancellation of elective surgery.
My other daily work consists of ongoing analysis and audit and producing reports for hospital management, health boards, the Department of Health and others. I am also responsible for some policy making and implementation. A key part of my job is to maximise resources. This means encouraging the discharge of patients on the day that they are ready, and not at a later stage. In the longer term I try to look at the strategic management of our resources by preparing proposals for more efficient use of our beds.
As bed manager I am responsible for the bed management department which is open everyday open from 8 a.m. to 6 p.m during the week and from 9 a.m. to 5 p.m. at weekends. My staff and I receive and make calls from patients, relatives and staff. Most of the patients we deal with are seriously ill and there is usually uncertainty about the availability of a bed. This can sometimes result in having to deal with distressed and often tearful or angry patients. Some patients have to travel a distance or arrange childcare at the last minute.
We try to reassure them as best we can and provide the bed as early as possible.
My job is one of crisis management because there simply aren't enough beds and those that are there aren't always appropriately used.
There are some elderly patients here who no longer need acute hospital care but cannot go home due to a lack of available community facilities or nursing home beds. Similarly, there are young people who are suffering with long-term chronic illness for whom there are no appropriate care facilities.
Being bed manager is a busy job which I have been doing for four and a half years.
It's certainly a challenging job but it's very rewarding when all the patients who need beds get them even if this doesn't happen every day.
(Interview by Sylvia Thompson)