Do you hold patients in the ED?

Specialties Emergency

Published

Hi All,

I just wanted to ask everyone if they have the same problem that my ED is currently facing. The last three weeks we have been holding patients in our department because the hospital is full.

My department is a 34 bed Level II ed. The last three weeks we have been holding patients up to 24 at a time and some pt's sometimes stay for three days. I can see it burning the staff out because we are running a department on top of caring for these patients. Our adminstration currently has no plan and the ED nurses take care of the holdings and ED patients. I work nights and we sometimes go down to three RN's and have 20+ holding patients and a busy department. Our waits for non urgents to get seen has gone up to 12 hours+ because the hallways are literally lined with patients. A Very dangerous place for a RN to work and I see the patient care suffering; since we are emergency nurses by nature and tend to neglect the holding patients. They do get care but I also find myself caring for the MI patient or the trauma first.

Is there anyone out there in the same predicament? Any solutions? Ideas? Your experiences in dealing with such situations?

Thanks and Be Well

CEN35

Oops, I forgot to mention that we heard the unofficial scuttlebutt after one of the "administrators" spent three hours with us....................they are going to leave the EC alone for now!!ROTGLOL! Of course they haven't offered to approve MORE staff, but we can go a long way on that one day (satisfaction way);)

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Specializes in ER, PACU, OR.

yeah for sure........we held 13 again last night........took forever to move the patients. the night before, we were told things were just as crazy on the floor as in the er. somehow i really doubt that. we have no control over the flow into the er, yet they control the flow onto the floors. they also are not gonna put people in the halls of the floor. when the floors have hall patients, then tell me they are just as crazy! i know i sound a little off the wall now.....sorry.

just me :)

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no, you do not sound crazy! We were so bad the other night. The house supervisor came down and said the same thing about the floor being just as crazy. She said they did not have enough staff upstairs. I'm afraid I lost it a little. All trauma rooms were full, trauma in the halls and tele had just let us know we were have multiple GSWs coming in!! I screamed at her to find me some beds now, and "send me some help by God or get out your stethoscope and grab a patient in this hall, because until you have them overflowing in your halls upstairs, then you're not as busy as us!!!!" She looked stunned, turned and left. She sent me one nurse and one nursing assistant, who of course did not know a thing about emergency medicine! I'm surprised I still have my job

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We hold patients in our ER also! So,times up to 10 in a 30 bed ER. We try to assign a nurse to our hold, but usually don't have the nurse to spare. Sometimes we tag team our holds or each nurse keeps their hold in their own zone if possible. We try to get them a hospital bed if they are going to be held over 4-6 hours or more. The longest we have held one is 2-3 days and that was a Psy-suicidal pt with security also posted. Usually ours are overnight until AM d/c pt can be sent home.

I can't count the number of times calling floor nurse report and the c/o this is our 2nd or 3rd tonight from you guys or we're busy can you hold them awhile?? We do hold them if able for busy unit but usually we have squad awaiting for that bed or triage is full. I like to politely remind them at least when you are full that is it for you...we can't close our doors....we have them in the halls and everywhere somenights we even double use a bed if a mother and child both need seen and it is feesible. That is life in the ER!!

Karen/KKERRN

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We are beginning to hold patients, not for our own facility, but when we need to send patients to another facility because we have no ICU. I don't mind it so much, because I understand what all of you are dealing with, and what I have does not compare.

But our doctors have no idea. They are always telling me to get these patients going because "they need to be in an ICU". I try to explain that there is not way we are going to get an ICU bed for this patient any faster than the recieving facility will allow it because they probably have patients backed up in their own ER waiting for beds. The docs look at me like I am from outer space when I tell them this. One even had the gall to say to me "I will see about that", as if I am making this all up. I just said "you do that". But he must never look into these things, because we then turn around and go through the same conversation the next time I work with him. It's like a freakin broken record. THEY DO NOT LISTEN, and they don't believe me.

The other day we were trying to set up a transfer to a facility 30 miles away that offers the same level of care that we do. The transfer was per patient request. I could not find an ambulance to take th transfer and when I did the amb could not come for another three hours. This doctor wanted me, actually demanded for me to call a critical care transport team to come 80 miles and take this stable patient 30 miles to this hospital, I told him to call himself, that I would not do it. The next doctor asked nicely if I would call, I explained why this was an innapropriate request but stated that I would call for him (only because he was respectful), well guess what thier reply was.

When the manager came in that morning, we had a long talk about requesting critical care transport for a patient that only needed two basic EMT's as he did not even need an IV. I was livid.

I am the only RN on nights and I have no tech, no unit secretary. Just me. I don't have time for this. I have had it. I am ready to come to one of your hopsitals and take those 10 patients waiting for beds, than have to deal with doctors that have no idea what is going on with nursing. They are rude and have a major knowledge defecit and think they are just too smart to have an RN tell they just can't get an ICU bed this minute. I have had it.

By the end of that shift I was ready to shell out a good portion of my savings for someone who knew just what to do with a human, a concrete block and a large body of water.:devil: :(

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WOW!! Sorry about that everyone, I guess I really needed to vent.:eek:

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Specializes in ER, PACU, OR.

we held, 6 unit admits, 8 rnf's, and 4 sdu admits........which left us with 4 er rooms to work real er people with tonight. of course as far as i am concerned, the rnf's can sit in any hall, and any corrider......lol! :chuckle

me :)

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What are RNF's???

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Specializes in ED, House Supervisor, IT.

Where were some of you people for the "Taco Bell is hiring" postings.. I took a lot of slack from the floor nurses.

Interesting I don't see any of those people saying anything here?

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Specializes in Emergency Room.

WE ROUTINELY HOLD PATIENTS IN OUR SMALL 10 BED ER (13 IF YOU COUNT THE THREE BEDS LINED UP IN THE HALL). THE OTHER NIGHT, WE HAD 18 INTHE ER...IN CHAIRS, WHEREEVER WE COULD PUT THEM, BECAUSE MGMT WOULD NOT ALLOW US TO CLOSE TO EMS TRAFFIC. ONE NIGHT, WE HELD 7 ADMITS, WHICH MEANT, THEORETICALLY, THAT WE HAD 3 BEDS TO "PLAY WITH". BOY, PEOPLE SURE DO GET MAD WHEN THEY HAVE TO WAIT TO GET IN...THEN THEY GET PISSED OFF BECAUSE THEY WANT TO GET OUT!! IT IS NOT UNUSUAL FOR OUR DOWNTOWN ER'S TO HAVE ANYWHERE FROM 6-8 HR WAITS. TWO DAYS AGO, THE COUNTY HOSPITAL HAD 18 HOUR WAITS FOR TRIAGE. THE PROBLEM IS NOT THAT THERE ARE NO BEDS. THE PROBLEM IS THAT THERE ARE NO NURSES!!! NURSES ARE THE BACKBONE OF ANY HOSPITAL...AND IT IS UNBELIEVABLE THAT MGMNT DOES NOT SEE THIS.!

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Specializes in ER, ICU, L&D, OR.

Howdy yall

from deep in the heart of texas

We not only get to hold patients but we have an ed observation unit as well, with a limit of 6 assigned to that area. And guess what, limits are just made to be broken. Fortunately I have the room available here for a fair number of patients to be admit holds, plus our ed obs unit patients. What hurts is the staffing at times. Like we never heard that one before. What kills us isnt the routiners, its the ICU type patients that do us in. but I think were all in the same boat particularly this time of year. Particularly with all the peds coming through here,and not being able to get them up to peds.

It will get better summer time and allthose pedi viral syndromes will diminsh, hopefully.

Keep it in the short grass yall

teeituptom

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Specializes in ER, Hospice, CCU, PCU.

We've been holding like crazy lately, even after the hospital opened up another zone to take both PCU and M/S patients. The new ER will have a built in Holding area but what do you want to bet that we'll end up using that area for regular patients and just hold whereever they land as we do now.

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