The Impact of Bed Management Models on Hospital Performance and Patient Flow: A Systematic Review

Introduction: Pressure on emergency departments and inpatient wards, combined with reduced capacity and variability in patient flows, makes bed management a key management priority. Bed management (as a function/service, team, or dedicated system) aims to optimize allocation, turnover, and discharge processes, with potential impact on hospital performance indicators. Aim The aim of this review is to analyse whether the introduction of bed management interventions/models (including dedicated roles, teams, and digital systems) within hospital organizations influences system outcomes, such as length of stay and number of admissions, as well as patient outcomes, including mortality and perceived quality of hospitalization. Materials and Methods Systematic review according to PRISMA (2020). Literature search was conducted in PubMed, CINAHL, and Scopus databases, covering the time period 2005–2025, in English and Italian. Studies conducted in hospital settings with full text available and evaluating explicit bed management interventions/models or the Bed Manager role with measurable organizational outcomes (LOS, ED LOS, bed turnover time, occupancy, diversion/overcrowding, access block) were included. Results Seven studies were included, mainly observational or pre–post in design. In emergency departments, active bed management reduced ED length of stay by up to 98 minutes and overcrowding from 26.6% to 17.9%. A logistics-management program reduced ED evaluation time from 219 to 193 minutes (p < 0.001) across 28,684 admissions and reduced inpatient length of stay by 0.1 days (p < 0.001). In internal medicine, the introduction of a flow/bed manager allowed the absorption of a 22% increase in urgent admissions without increasing average length of stay. Implementation of a Bed Management System improved bed turnover time from 111 to 49 minutes, with reductions in transport times (45→26 min) and housekeeping times (63→49 min). A bed management team supported by a Kanban application reduced overall LOS (5.6→4.9 days; p = 0.001) and complaints related to bed availability (27%→0%). During the pandemic, centralized bed management supported organizational resilience, with mortality stratified by care setting (ICU 29%, wards 10%, intermediate care 4%). Conclusions The included studies suggest that structured bed management models can improve throughput and capacity utilization (LOS, turnover, overcrowding), particularly in high-pressure contexts. Methodological quality is heterogeneous and non-randomized designs prevail; multicenter studies with standardized KPIs and safety measures (readmissions, adverse events) are needed to confirm impact and guide implementation.