Addressing High Bed Occupancy in the Male Ward of Ndera Neuropsychiatric Hospital, Rwanda: A Pre-Post Interventional Study

Background: In low- and middle-income countries, high bed occupancy rates are a common concern in neuropsychiatric hospitals. This situation often results in ward overcrowding, compromised patient safety, staff burnout, and financial strain on healthcare facilities. Objective: This study aimed to reduce the high bed occupancy rate (BoR) in Male Ward of Ndera Neuropsychiatric Hospital in Rwanda through the implementation of a quality improvement intervention. Methods: A pre-post interventional study was conducted to assess the impact of developing and implementing an admission and discharge guideline. The intervention consisted of three main components: (1) developing a standardized guideline, (2) training staff and informing patients' family members, and (3) monitoring compliance with the guideline. Four key indicators were measured: (1) bed occupancy rate, (2) availability of the guideline, (3) proportion of staff trained, and (4) proportion of patient family members informed. Results: Following the intervention, the bed occupancy rate decreased from 114.8% to 89%, aligning with the WHO-recommended range of 80–90%. Staff knowledge of the guideline increased from 0% to 90% (p < .001), and the proportion of informed family members rose from 0% to 94.8% (p < .001). Conclusion: This study demonstrates that in low-resource settings, it is feasible to implement a sustainable admission and discharge guideline to effectively reduce bed occupancy rates and improve overall ward management. Keywords: High Bed Occupancy Rate, Average Length of Stay, Neuropsychiatric Hospital, Strategy of Problem Solving