A week in the ER?!

[tigerlogic]

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 involuntary admission to the state psych hospital-- had been there over a week!

My hospital does have a pysch floor--though there is always a waiting list for beds, as well as a med-surg floor (with empty spaces, usually) where the majority of the 1:1s and people waiting for open psych beds hang out/stabilize.

Is it common for people waiting on psych transfers to spend multiple days in the ER? What happens to your in-need-of-more-security-than-a-floor-bed psych patients?

I really want to be an ER nurse and was happy I floated down there, even if it was mostly watching someone sleep all night. It seemed like a great team and I was happy to help with the "altered mental state" patient.

[Esme12, ASN, BSN, RN]

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.

[celtchick68]

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.