Do you hold patients in the ED?

  1. 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
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  2. 43 Comments

  3. by   Nittlebug
    Wow, my situation doesn't even compare to yours. I'm in a small 13 bed ER in LaCrosse, Wisconsin. We too have trouble placing patients sometimes, but not every shift or every day. Sometimes we agree to hold patients when we can for just a few hours. We tell the floors if we fill up , we need to move 'em out quick. Last night I had a patient on a dopamine gtt and there's only three nurses on the night shift. The ambulance called in with a Code Blue ETA 5min. I called ICU and they took my admission stat so I could help run the unit while the other 2 nurses were in with the code blue.
  4. by   CEN35
    this has only been a problem the last few weeks? my aren't you lucky!

    we have been doing it for months, for the same reason. our longest so far, had been a ccu patient with an mi we held for 47 hours. however, when it happens, most get a room within 24 hours........that is optimisim under the current busy times, and full hospitals. as i am sure you know, we get shoved aside, so or, surgery, pacu etc can place all their admits first. god forbid somebody else would have to stay late to watch some of their holdovers. we all have budgets and productivity to watch, but ours doesn't count i guess? (yeah right!)
    it gets even better, because as anybody knows, whether you are on diversion or not, it is a hicfa/cobra violation to refuse any patient. we still get squads, and lots of sick walk in's, even unit type admits. we are also, the only hospital in our area that is not allowed to officially divert any of the squads under our med control. the thing that makes this so teribble? well i do beleive we have more squads under our med control, than any other facility in the area.
    the hospital administrators, and med exec, etc all se the loss of revenue, instead of the safety issue. they are so worried about the public, and how they view it. we have been on diversion more than any other facility in the area. yet, while all this is publicized and ridiculed, nobody ever mentions the fact that squads still come, when we are on diversion. they (the media) does not mention how diversion works or why? nobody cares that the hospital is full.........nobody that has any say so in the matter, works in the er. they planned to build a 150 room tower plus more, that was allegedly put on hold d/t the economy after 9/11/01'. however, the fact is we avearge 150 open positions at our facility (not the system as a whole), and they can't get those filled? so............why add 150 more rooms, and double the size of the er? as they say, it doesn't take a brain surgeon to figure that one out!

    one other note.....when we have a few beds open on the floors to unload patients, the floors give us grief, and refuse them until they are willing to take them. they all complain about the damn er. yet i can promise you all one thing, when their floor is full, and there are no more rooms, they will not or be able to take another patient. we do not have that luxery, full or not, they stack in the halls. just a fact :d

    as jim rome says, "out!"

    me
  5. by   kaycee
    Here Here Rick. Couldn't have said it better. We have holds constantly and diversion is a dirty word to our administration too. All hospitals are to capacity here(plenty of beds but no one to staff them) so even a code red diversion doesn't work because everyone is diverting. Where are they supposed to go. They come even if we're closed to ambulances because we're close and everyone else is on divert.
    It's a never ending cycle. Be glad yours has only been for a few weeks instead of everyday normal!!!
  6. by   CEN35
    lynn, i was referring to the person that started this thread.......because they said, "the last three weeks we have been holding patients in our department because the hospital is full. "
    trust me...........it is a 3-5 day a week thing for us, and has been a long time. i am the one that gets yelled at and complained too, because patients are not getting rooms with real beds........and it sucks.


    me
  7. by   kaycee
    I was referring to the thread starter too. I know you have this problem weekly, we've talked about it before. Sorry about the misunderstanding and believe me I know how it feels to get yelled at by pt's and their families too when their waiting for beds. I feel your pain.
  8. by   CEN35
    thanks lynn, guess i just wasn't sure? anyways................yeah being the front line person to complain too doesn't feel to good.

    me
  9. by   EMSRN3D
    Yes, this has been a major problem here in our ER where I work in Fl. We have an 18 bed ER with another 6 beds in Fast Track. Sometimes we have as many as 20 "boarders" in the ER waiting on beds. This means we also have to utilize many hall beds. One way we deal with this is to call in extra staff and move some of the boarders over to the Staging Area for the cath pts. but if they have a full schedule the next day, as they normally do, pts are generally shipped back to the ER until other arrangements are made. I understand this is a problem in most surrounding hospitals and have heard of no solution to this problem as of yet.
    Hang in there fellow peeps.
    Last edit by EMSRN3D on Jan 27, '02
  10. by   CEN35
    call in extra staff? from where? there just are not enough bodies to help anymore.

    me
  11. by   jimminy
    Wow, I think this applies to every hospital around. I'm hoping a situation last week will help. We have been "reorganized" by a consultant company and things could not be worse. We have been telling administration and the consultants to come spend a night with us, then tell us we have too many staff. Last Friday one administrator came down at three pm. We were holding 32 patients, including four ICU, seven telementry, and the regular admits. We were balls to the wall with new ones coming in and people waiting to be seen that had already been triaged in. The truama hall were full and overflowing. It was awfu, but was not an "exception". We are always like this. She was supposed to stay the night with me, but only made it until seven pm!!!! She said she was going home, she could not take anymore and did not know how we did it. We only had four nurses in holding, a close obs nurse, a hall nurse and three shock nurses. She had that deer in the head light look. We were running strecthers to the front of the hospital for a patient actively seizing, and another code three was coming in. Heh heh....I'm still waiting to hear her report of the need to decrease staffing!!!!!
  12. by   CEN35
    hmmmmm sounds familiar........allegedly we are overstaffed.........and our productivity (however they derive it), shows us to be at 77%........thank god they haven't brought those numbers up in front of the staff. i think a few would go nuts if they were told were only at 77%. fortunately last night was a good night......although i still can't seem to be able to wake up today. i hear everything you said jimminy.....our administration does not come down through the er...........i really think they go all out to avoid coming down there.
    as far as all the crap we catch from the floor staff........and always being complained about the "damn er" as we so often hear........i think it should be mandatory to make each nurse on the floor come down and work 2 shifts a year in the er. that would help out our staffing too! they can be the hallway nurse.....lmao!!!! :d


    me
  13. by   jimminy
    CEN35

    Wouldn't they just die, probably after just three hours also!!! We have all (all er nurses) gotten used to working so short staffed at such a high acuity level, that even if they staffed us a little better it would be short staffed according to standards and we would think it was better!! Does that make any sense at all?? I'm also so tired of hearing about that "damned EC" I could scream. Upstairs they refuse to work greater that 1:7 on regular floors! I'd give my first born and my right arm to have1:15 of higher acuity!
  14. by   jimminy
    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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