JHHA

Abstract

Background: Emergency department crowding and constrained inpatient capacity make patient-flow governance a key management priority. Bed management models—dedicated roles, teams, and digital systems—seek to optimize bed allocation, turnover, and discharge. Objective: To assess whether bed management interventions improve hospital performance and patient outcomes. Methods: PRISMA 2020 systematic review. PubMed, CINAHL, and Scopus were searched for English/Italian studies (2005–2025). Eligible hospital studies evaluated an explicit bed management intervention/model (including the Bed Manager role) and reported organizational outcomes (inpatient/ED length of stay [LOS], turnover time, occupancy, access block, diversion/overcrowding) and/or patient outcomes. Results: Seven studies, mainly observational pre–post, were included. Reported effects were consistently favorable for flow metrics: ED LOS decreased (up to 98 minutes), overcrowding and access block improved, and ED evaluation time fell in large cohorts. A flow/bed manager helped absorb a 22% rise in urgent admissions without increasing mean LOS. Digital/centralized systems reduced bed turnover time (111→49 minutes) and related delays. Conclusions: Structured bed management models may improve throughput and capacity utilization, particularly under high demand. However, evidence quality is heterogeneous and largely non-randomized; multicenter evaluations with standardized KPIs and safety measures are needed. A Kanban-supported bed team reduced overall LOS (5.6→4.9 days) and complaints about bed availability substantially.

Keywords: Bed management; Bed manager; Patient flow; Emergency department; Length of stay; Hospital performance; Capacity management.