Do you hold patients in the ED?

[shootemrn]

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

[kaycee]

Well said Rick. We are all tired and stressed and need to remember we are all there for one purpose. Caring for patients the best we can. This usally works much better if we all try to respect each others jobs and work together.

[CEN35]

thanks lynn! :) btw? i liked the sig about farting!!! lmao!!

me :)

[CEN35]

well looky looky looky!!!

yes we are still holding patients in the er! however, the good news is that for once it just didn't affect us! the hospital called an unoffical internal disaster, forcing pacu and all the other (normally only there during the day areas) to stay open 24 hours, because there were just too many patients for the hospital. heh! so much for their budgets...lol! :chuckle

i just think it's funny, because everybody else got to experience a little bit of er (holding patients, when you think they shouldn't be there, or have someplace else to be sent)

me :)

[flaerman]

If you,ve only had ER holds for a few weeks then you've been lucky. We've dealt with it from July though now with a brief respite for a day or so here and there. We have learned and taught our staff to do admissions in the computer, pull med sheets etc. For some of our staff it's been hard, especially for those who never have worked the floors, I have been an RN since Jan 1986, worked med/surg, oncology, PCU, ICU and have been in the ER since Dec 1997, have now beeen a nurse in 3 states as well. Not to mention holds tie up ER beds and make delivery of care real interesting sometimes. We have a 2nd triage room that on bad nights we set a pelvic stretcher in there and run pelvic/VB pt's from hallway beds, shuffle them in and out for pelvic exams etc. One night last week when I was in charge we had 36 pt's in a 19 ER with 21 holds. We are now working on getting a clinical decision unit to hold some of the 23 hour observation pts, we also use a cardiac marker system running initial Q 1 hours X 3 to try to R?O MI's. They are working and building a new 40 bed(10 fast track) ER but that is probably 2 yrs away. I live in the fastest growing counties in the US and during the winter see a lot of northern Snowbird pt's here to escape their cold winters. I feel bad for the hold pt's as I'd not want to be one, especially when we have to put them in the hallways for more critical pt's to be in the rooms. One thing I think we need too is a defininte criteria for PCU admission status, we have docs that tie up those beds because they think pt's get better care. Our hospital is working towards putting tele units on med/surg which may help. It would also help if when we get beds these floor nurses take report and the pt's instead of stalling and dancing around with us.

[shootemrn]

The holding situation got so bad in our hospital with consistently holding 20+ patients in our 25 bed ED that the DON did something drastic. He cancelled all elective surgeries and freed up about 15 beds a day. The surgeons were so upset about this that they went to the newspapers and threatend to leave the hospital. They didnt and the holding situation got better overnight. Now we only hold 5-10 on a average night.

[Flo1216]

How come none of these patients are diverted to other hospitals? Doesn't seem very safe to me.

[Jen911]

The problem with diverting all those patients to other hospitals is, all THOSE hospitals are in the same boat, too!

[teeituptom, BSN, RN]

Howdy yall

from deep in the heart of texas

Well currently we just had 2 new floors open up and we are not holding any down in the ED for long anyway