Bed & IPD Management Use Cases

Implementation Note: Bed management integrates with ADT (Admission, Discharge, Transfer) messages and provides real-time bed availability, allocation optimization, and housekeeping coordination.

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UC-BED-001: Check Bed Availability

Purpose: Query real-time bed availability across wards and room types.

Property	Value
Actor	Admission Desk / Doctor
Trigger	Admission request or bed query
Priority	P0

Main Success Scenario:

1. Receive availability query:
   - Ward type (General, ICU, HDU, Private)
   - Gender requirement
   - Special needs (isolation, dialysis-ready)
2. Query bed status:
   - Occupied / Vacant / Reserved / Blocked
   - Expected discharge time for occupied beds
3. Display availability:
   - Total beds per category
   - Available now
   - Expected availability (next 24h)
4. Show bed details:
   - Room number, Bed ID
   - Amenities (AC, TV, Attached bath)
   - Daily rate
5. Support ward map view:
   - Visual floor plan
   - Color-coded status

Acceptance Criteria: 1. [ ] Real-time availability (< 5 sec refresh) 2. [ ] Filter by ward, room type, gender 3. [ ] Expected discharge prediction 4. [ ] Visual ward map 5. [ ] Bed rate display

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UC-BED-002: Allocate Bed for Admission

Purpose: Assign bed to patient during admission process.

Property	Value
Actor	Admission Desk
Trigger	Admission order from doctor
Priority	P0

Main Success Scenario:

1. Receive admission request:
   - Patient details
   - Admitting doctor
   - Diagnosis/reason
   - Ward type requested
2. Check bed availability
3. Apply allocation rules:
   - Gender-appropriate ward
   - Insurance-based room eligibility
   - Doctor's preferred ward
   - Isolation requirements
4. Suggest optimal bed:
   - Nearest to nursing station (if critical)
   - Patient preference (if available)
5. Confirm allocation:
   - Update bed status to "Occupied"
   - Assign patient to bed
6. Generate admission record:
   - Admission number
   - Bed assignment
   - Estimated length of stay
7. Notify:
   - Nursing station
   - Housekeeping (bed prep)
   - Diet department

Acceptance Criteria: 1. [ ] Rule-based bed suggestion 2. [ ] Insurance-ward eligibility check 3. [ ] Isolation bed auto-flagging 4. [ ] Multi-department notification 5. [ ] Admission document generation

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UC-BED-003: Transfer Patient Between Beds

Purpose: Move patient from one bed to another (ward transfer, upgrade/downgrade).

Property	Value
Actor	Nursing Staff / Doctor
Trigger	Transfer order or patient request
Priority	P1

Main Success Scenario:

1. Initiate transfer request:
   - Reason (step-down from ICU, upgrade request, etc.)
   - Target ward/bed type
2. Check target bed availability
3. Validate transfer:
   - Clinical appropriateness
   - Insurance coverage for new ward
4. Approve transfer (if required)
5. Execute transfer:
   - Update source bed: "Vacant - Pending Cleaning"
   - Update target bed: "Occupied"
   - Update patient location
6. Adjust billing:
   - Close billing for source bed
   - Start billing for target bed
7. Notify all departments:
   - Nursing (both wards)
   - Housekeeping
   - Diet
   - Billing
8. Update medical record with transfer note

Acceptance Criteria: 1. [ ] ICU to ward step-down workflow 2. [ ] Upgrade/downgrade with billing adjustment 3. [ ] Transfer history in patient record 4. [ ] HL7 ADT^A02 message generation 5. [ ] Real-time location update

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UC-BED-004: Process Patient Discharge

Purpose: Release bed upon patient discharge with housekeeping coordination.

Property	Value
Actor	Discharge Desk / Nursing
Trigger	Discharge order from doctor
Priority	P0

Main Success Scenario:

1. Receive discharge order:
   - Discharge summary complete
   - Final bill generated
2. Pre-discharge checklist:
   - All medications dispensed
   - Follow-up appointments scheduled
   - Insurance claims initiated
   - Patient belongings returned
3. Collect payment/clearance:
   - Final bill settlement
   - TPA authorization (if cashless)
4. Complete discharge:
   - Mark bed: "Vacant - Pending Cleaning"
   - Update patient status: "Discharged"
5. Trigger housekeeping:
   - Bed cleaning request
   - Room turnaround time tracking
6. Generate discharge documents:
   - Discharge summary
   - Final bill/receipt
   - Medication list
7. Update bed availability

Acceptance Criteria: 1. [ ] Discharge checklist enforcement 2. [ ] Auto-trigger housekeeping 3. [ ] HL7 ADT^A03 message generation 4. [ ] Bed turnaround time tracking 5. [ ] Discharge document package

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UC-BED-005: Housekeeping Bed Turnaround

Purpose: Track bed cleaning and preparation for next patient.

Property	Value
Actor	Housekeeping Staff
Trigger	Patient discharge or transfer out
Priority	P1

Main Success Scenario:

1. Receive bed cleaning request:
   - Bed ID, Room number
   - Cleaning type (routine, terminal, isolation)
   - Priority flag
2. Assign to housekeeping staff:
   - Based on zone assignment
   - Workload balancing
3. Staff acknowledges task:
   - Start time recorded
4. Perform cleaning:
   - Routine: Linen change, surface wipe
   - Terminal: Deep clean, disinfection
   - Isolation: Special protocols, PPE
5. Complete cleaning:
   - End time recorded
   - Checklist completed
   - Photo documentation (optional)
6. Update bed status: "Vacant - Ready"
7. Notify admission desk
8. Track metrics:
   - Turnaround time
   - Staff productivity

Acceptance Criteria: 1. [ ] Mobile app for housekeeping staff 2. [ ] Cleaning type-specific checklists 3. [ ] Real-time status updates 4. [ ] Turnaround time SLA tracking 5. [ ] Infection control compliance

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UC-BED-006: Bed Reservation & Blocking

Purpose: Reserve beds for scheduled admissions or block for maintenance.

Property	Value
Actor	Admission Desk / Facilities
Trigger	Planned admission or maintenance
Priority	P1

Main Success Scenario:

1. Reserve bed for planned admission:
   - Patient name
   - Expected admission date/time
   - Duration (optional)
2. Block bed for maintenance:
   - Reason (repair, painting, equipment issue)
   - Expected duration
3. Update bed status:
   - Reserved: Shows in availability but not bookable
   - Blocked: Excluded from availability
4. Set auto-release:
   - If patient doesn't arrive within window
   - If maintenance completed early
5. Monitor reservations:
   - Dashboard of upcoming admissions
   - Overdue reservations alert
6. Release bed:
   - Manual release
   - Auto-release on timeout

Acceptance Criteria: 1. [ ] Time-bound reservations 2. [ ] Auto-release after no-show window 3. [ ] Maintenance blocking workflow 4. [ ] Reservation dashboard 5. [ ] Overbooking prevention

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UC-BED-007: Census & Occupancy Reporting

Purpose: Generate real-time and historical bed occupancy reports.

Property	Value
Actor	Hospital Admin / Management
Trigger	Scheduled report or on-demand
Priority	P2

Main Success Scenario:

1. Calculate real-time metrics:
   - Total beds by ward/type
   - Occupied / Vacant / Reserved / Blocked
   - Occupancy percentage
2. Generate midnight census:
   - Patients in hospital at midnight
   - Admissions and discharges today
   - Transfers in/out
3. Historical analytics:
   - Average length of stay (ALOS)
   - Bed turnover rate
   - Occupancy trends (daily, weekly, monthly)
4. Forecast demand:
   - Expected discharges (next 24-48h)
   - Planned admissions
   - Seasonal patterns
5. Export reports:
   - Dashboard view
   - PDF/Excel download
   - Scheduled email distribution

Acceptance Criteria: 1. [ ] Real-time occupancy dashboard 2. [ ] Midnight census automation 3. [ ] ALOS and turnover metrics 4. [ ] Demand forecasting 5. [ ] NABH/regulatory report formats

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UC-BED-008: ICU/Critical Care Bed Management

Purpose: Special workflow for ICU/HDU bed allocation with clinical criteria.

Property	Value
Actor	ICU Coordinator / Intensivist
Trigger	ICU admission request
Priority	P0

Main Success Scenario:

1. Receive ICU request:
   - From ED, OT, or ward
   - Clinical indication
   - Acuity score
2. Assess ICU criteria:
   - Apache II / SOFA score
   - Ventilator requirement
   - Monitoring needs
3. Check ICU availability:
   - Bed + equipment (ventilator, monitor)
   - 1:1 or 1:2 nursing ratio
4. Prioritize if multiple requests:
   - Clinical severity
   - Expected benefit
   - Waiting time
5. Allocate bed:
   - Activate monitoring equipment
   - Assign nursing staff
6. Step-down planning:
   - Daily review for transfer eligibility
   - HDU as intermediate step
7. Notify bed management:
   - Expected step-down date
   - Ward bed reservation

Acceptance Criteria: 1. [ ] ICU admission scoring 2. [ ] Equipment availability tracking 3. [ ] Nursing ratio enforcement 4. [ ] Step-down workflow 5. [ ] ICU-specific metrics (ventilator days, mortality)

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Bed Management Architecture

flowchart TB
    subgraph "ADT Events"
        A["HL7 ADT^A01 (Admit)"]
        B["HL7 ADT^A02 (Transfer)"]
        C["HL7 ADT^A03 (Discharge)"]
    end

    subgraph "Bed Engine"
        D["Availability Service"]
        E["Allocation Engine"]
        F["Housekeeping Coord"]
        G["Census Calculator"]
    end

    subgraph "Consumers"
        H["Admission Desk"]
        I["Nursing Station"]
        J["Housekeeping App"]
        K["Management Dashboard"]
    end

    A --> E
    B --> E
    C --> D
    C --> F
    D --> H
    E --> I
    F --> J
    G --> K

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Document Owner: Operations Manager / IT Lead
Last Updated: 2024-12-09
Related: Appointments | Ingestion - HL7 | Billing