The Bermuda Hospitals Board (BHB) and the Ministry of Health confirmed that strengthened patient‑flow protocols are already delivering meaningful improvements across the hospital. The enhanced discharge process now includes several coordinated steps to improve patient movement through the system. An estimated date of discharge is set by the hospitalist within 24 hours of admission, giving teams a clear target from the outset. Daily multidisciplinary rounds are embedded across the acute wards to review the clinical plan, identify barriers to discharge, and confirm the expected discharge date. Surgical ward rounds have been moved to early morning so that discharge decisions can be made and actioned earlier in the day, allowing beds to be released sooner. In addition, a 10‑bed discharge lounge has been established to ease pressure on the Emergency Department and reduce the need for bed boarding.
An expedited procurement process is underway to appoint a suitably qualified, independent third party to conduct the operational review of the Emergency Department, following a Directive from the Minister of Health to the Bermuda Hospitals Board to undertake a review of Emergency Department operations. The BHB Board will oversee the appointment process to ensure independence, integrity, and credibility. The scope and terms of reference will be published at the appropriate stage. The review will provide a clear, evidence-based assessment of current pressures and support long-term improvements that benefit patients, families, and staff.
BHB advised that the Emergency Department normally has 23 treatment spaces—15 standard beds, 4 resuscitation beds, and 4 fast‑track beds. During periods of high demand, BHB has well‑established mechanisms to safely expand capacity, including 20 hallway spaces, a 10‑bed Clinical Overflow Unit, 4 fracture clinic spaces, up to 12 contingency beds in the Gosling and Maternity wards, and a weekday evening fast‑track service for up to 12 patients.
A key area of focus continues to be improving patient flow. Approximately 40 patients each day are medically fit for discharge but remain in hospital while awaiting appropriate placement or supports. This results in an estimated 14,600 acute care bed days each year not being available for new patients and contributes to operational pressures, including approximately $2 million annually in additional staffing and infrastructure costs. BHB’s enhanced discharge planning processes are already helping to reduce these pressures.
These challenges reflect broader system needs. Bermuda currently has approximately 367 licensed long‑term care beds in the community, with a further 160 individuals with long‑term care needs being accommodated within the hospital system. Around 46% of acute care beds are regularly occupied by patients who are medically fit for discharge. Strengthening community‑based care options, expanding home‑care supports, and improving placement pathways are all contributing to better patient flow.
Demographic modelling indicates that by 2035, approximately 930 seniors will require some level of formal long‑term care support. While many lower‑acuity needs can be safely met at home, demand for higher‑acuity skilled nursing care is expected to grow. Projections estimate that Bermuda will require approximately 365 skilled nursing facility beds by 2035—an increase of roughly 40% over current levels. Continued investment in purpose‑built skilled nursing capacity will help ensure patients receive care in the most appropriate setting while protecting acute hospital operations.
“The independent review will be a valuable opportunity to strengthen how we manage patient flow, discharge processes, and overall service delivery,” said Collin Anderson, Chair of the Bermuda Hospitals Board.” Our teams remain committed to providing safe, high‑quality care for every patient, even during periods of sustained demand.”
BHB also confirmed that formal Surge Capacity and Mass Casualty Plans remain in place to respond to seasonal demand, infectious disease outbreaks, and major emergencies. These plans include emergency staffing arrangements, temporary repurposing of clinical spaces, and coordinated work with partner agencies to maintain safe care during peak demand.
To support immediate improvements, BHB has established a Patient Flow Steering Committee, which includes an independent Patient Advisor, and implemented a Bed Capacity Management Plan to improve patient movement through the hospital and reduce discharge delays.
BHB and the Ministry acknowledged that caring for patients in overflow and hallway areas during busy periods is challenging. However, care continues to be delivered in line with established safety standards and Accreditation Canada requirements. Patient dignity, privacy, and hygiene remain central priorities, supported by privacy screens, consent‑based communication, and moves to private spaces whenever possible.
Minister of Health, Kim Wilson, said, “We recognise the pressures that patients, families, and staff experience during busy periods in the Emergency Department. At the same time, we are seeing meaningful progress across the system. The new 30‑bed Transition Unit will help patients who are ready to leave hospital move into a more appropriate setting with the right support. Alongside expanded home care, stronger day services, and investments such as Lefroy House and the Sylvia Richardson Care Facility expansion, these initiatives will ease pressure on the hospital and improve quality of life for patients. We remain committed to building a stronger, more responsive health system for our community.”