A week in the ER?! - page 2

I floated down to the ER for a couple of nights to sit 1:1 (I'm a CNA) with an early onset Alzheimer's patient and much to my surprise, she had been there for 3 days and the woman next door --waiting for a court ordered... Read More

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    It is not uncommon for me to work one shift and have a psych hold pt come in the ER and then I come back for another shift two days later and the patient is still there. We do not have psych services and ambulances will take psych patients to the hospital in our city that does and has a psych "pod" in their Emergency Department. But we get a lot of psych walk-ins and we have to deal with them. Most are released, many are released and are supposed to go to detox or another place on their own the next day. The ones that are involuntarily committed go by way of the police to their psych facility. But sometimes there is no place for them to go, or waiting on judge or something like that and they spend several days in the ED. It is not a good situation and I wish that more people were aware that not all hospitals have psych facilities and to go to one that does if that is what you need.

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  2. 0
    Thanks for all the responses! I'm guessing my hospital has a kind of policy where people needing high security support stay in ER-- similarly comfort care end-of-life pts go to Oncology, regardless if it's from cancer. The available resources match the pt even if the name of the unit doesn't. It certainly doesn't feel like the best use of ER medical resources, but if there is nowhere to transfer to, at least the pts are still safe. Thank you everyone for your perspectives!
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    It varies state to state....but for the most part the psych admissions stay in the ED as it makes them high on the hierarchy of getting the next bed. If they are admitted to the hospital it drops them off the list of needing an acute psych bed. Many hospitals have closed their psych beds as the reimbursement slowed and decreased, especially for long term and found them to be money pits. Leaving psych patients in limbo.......or as the case may be the Emergency department Limbo.

    There are hospitals that have psyche units that will hold patients in the ED not placing them as the hospital is not on their coverage or the allotted medicare/medicaid beds are full.

    Sad for they are not getting the care they need in the ED...they are watched, sedated and fed to maintain the status quo and cooperation of the patient....until a bed if found. Not very therapeutic.
    sapphire18 likes this.
  4. 0
    In my ER we frequently hold IVC patients for days while trying to find placement. My facility has a 30 bed psych unit but it's always full. Usually when one is discharged and on the way down in the elevator we have one we're taking up in the other elevator. We have tons of frequent fliers who abuse the services and know just what to say to get a bed and 3 square meals for 72 hours. Had a lady last week who came in on EMS with some trivial mess, was treated and released. Middle of the night she had no ride home. She mistakenly thought EMS was a 2-way taxi service and when she found out otherwise she began to c/o chest pain. Readmitted and worked up, nothing wrong with her she goes back out to the waiting room after discharge. She then gets upset when she realizes the ER isn't an all night diner and won't feed her a meal (did give her crackers and a drink) she still has no ride home and now says she wants to kill herself and is admitted yet a 3rd time in less than 5 hours. She gets her box lunch and proceeds to waste the time of everyone for the next shift waiting for psych consult.

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