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Patient safety in patients who occupy beds on clinically inappropriate wards: a qualitative interview study with NHS staff
  1. Lucy Goulding1,
  2. Joy Adamson1,
  3. Ian Watt1,2,
  4. John Wright3
  1. 1Department of Health Sciences, University of York, York, UK
  2. 2Department of Health Sciences, Hull York Medical School, University of York, York, UK
  3. 3Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
  1. Correspondence to Lucy Goulding, Doctoral student, Department of Health Sciences, University of York, Room 202, 2nd Floor Postgraduate Area, ARRC Building, YO10 5DD, UK; lg529{at}


Objective To explore NHS staff members' perceptions and experiences of the contributory factors that may underpin patient safety issues in those who are placed on a hospital ward that would not normally treat their illness (such patients are often called ‘outliers’ ‘sleep outs’ or ‘boarders’).

Design Qualitative study using semi-structured interviews.

Setting A single large teaching hospital in the north of England.

Participants 29 members of NHS staff (doctors, nurses and non-clinical or management staff).

Results Five themes describing contributory factors underlying safety issues were identified: competing demands on staff time created by having patients on inappropriate wards and patients who are on the correct specialty ward to care for; poor communication between the correct specialty ward and the clinically inappropriate ward; lack of knowledge or specialist expertise on clinically inappropriate wards; an unsuitable ward environment for patients on inappropriate wards; and the characteristics of patients who are placed on clinically inappropriate wards (specifically staff perceive patients on inappropriate wards to be medically fit and therefore of lower priority and moving patients between wards may disorientate confused or impaired patients). Examples of how these contributory factors may lead to safety issues are given.

Conclusions NHS staff report that placement of patients on clinically inappropriate wards is a specific patient safety concern. The application of James Reason's Swiss cheese model of accident causation suggests that placement on an inappropriate ward constitutes a ‘latent condition’ which may expose patients to contributory factors that underlie adverse events.

  • Patient safety
  • quality of healthcare
  • bed occupancy
  • qualitative research
  • mortality

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  • Funding LG received a PhD studentship awarded by the University of York/Bradford Institute for Health Research and funded by the NIHR. JA, IW and JW received no support from any organisation for the submitted work.

  • Competing interests None.

  • Ethics approval The study obtained ethics approval from York Research Ethics Committee. Interviewees gave their full informed consent prior to taking part in the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.