NHS Patient Flow Management Platform — UK Acute Trust

Bed state

every bed (620) has a current state (occupied/vacant/cleaning/blocked/maintenance).

State changes

• discharge triggers bed cleaning request (housekeeping team mobile app), cleaning complete triggers bed available for allocation, new admission triggers bed allocated.
• Real-time sync: WebSocket connection (Socket.IO) — all 34 ward displays, 8 bed managers, and 4 flow coordinators see bed state changes within 2 seconds.

Prediction

• machine learning discharge prediction (historical PAS data + length of stay model) — predicted discharges for next 4 hours shown per ward.
• NHS PAS Integration —

FHIR R4

NHS Patient Administration System (PAS) integration: FHIR R4 Patient resource (demographics), Encounter resource (admission/discharge/transfer), and Location resource (ward/bay/bed).

PAS systems

• Meditech, System C Careflow, Cerner Millennium, Epic — each has FHIR R4 interface (HL7 FHIR Facade pattern for legacy PAS without native FHIR).
• Real-time ADT (Admission/Discharge/Transfer) events: PAS publishes HL7 v2 ADT messages → flow platform subscribes → FHIR R4 Encounter updated → bed state changed automatically.

Delayed Transfer of Care Tracking

Delayed Transfer of Care (DTOC): patients medically fit for discharge but awaiting social care, package of care, or community bed.

DTOC tracking

each patient flagged with reason code (

Code 1

awaiting assessment,

Code 2

awaiting public funding,

Code 3

awaiting care home placement,

Code 16

patient/family choice).

DTOC dashboard

live DTOC count, reason distribution, average delay duration.

NHS England DTOC reporting

automated daily submission to NHS England DTOC data collection.

ClickMasters

DTOC data pipeline from flow platform to NHS England.

Critical safety hazard

bed incorrectly shown as vacant → two admissions for same bed → patient safety incident.

Mitigation

bed state is event-sourced (every state change has a user, timestamp, and audit trail), concurrent admission prevention (bed reservation lock for 10 minutes after allocation starts), and daily bed state audit (automated reconciliation against PAS ADT data — discrepancies alerted to bed manager).

Second hazard

DTOC patient incorrectly discharged without care package in place.

Mitigation

DTOC flag must be manually cleared with a named social care worker confirmation.