Er Holds?

  1. Lately we have had numerous holds, a ICU or 2, tons of med-surg, tele and lots of baby's. We are a small hospital with 18 bed ER and 6 bed extenstion for small cases. Yesterday we had 15 holding which led to 3 beds for acute pts which never seem to open up. Pts are in the halls, Chest pains are geting worked up in the fast track, Blood is being hung in the halls! Is this common throughout the country!
    It is really unfair for the pts being held in the ED. I know they dont get the care that they should! We have lots of travelers who signed up for ED who play floor/ED RNs. We have one tech if were lucky so it is all primary care!
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  2. 14 Comments

  3. by   RNin92
    Quote from tiredfeetED
    Lately we have had numerous holds, a ICU or 2, tons of med-surg, tele and lots of baby's. We are a small hospital with 18 bed ER and 6 bed extenstion for small cases. Yesterday we had 15 holding which led to 3 beds for acute pts which never seem to open up. Pts are in the halls, Chest pains are geting worked up in the fast track, Blood is being hung in the halls! Is this common throughout the country!
    It is really unfair for the pts being held in the ED. I know they dont get the care that they should! We have lots of travelers who signed up for ED who play floor/ED RNs. We have one tech if were lucky so it is all primary care!
    I think it is a universal problem across the country. Big or small...it doesn't seem to matter!

    We are a 200 bed Level 2 Trauma Center. We have 20 beds in our ED...14 in the main ER and 6 in our fast track. We routinely hold 4-6 pts everyday...sometimes for 6-8 hours, sometimes overnight. For awhile we were holding 10 pts everyday for their entire hospitalization. It is always a combination of ICU, tele and med/surg.

    Our worst one was last month when our 20-Bed ED was holding 23 pts...4 ICU, 12 tele and the rest med/surg and peds. Oh, I think there was a couple of detoxers who were "holding" in triage as well.

    I do not know what the answer is. I only know the question.

    I am worried that we won't find any true solutions until something very bad happens.

    But I think it is happening everywhere.
  4. by   teeituptom
    Right on, it does happen everywhere.
    We have 40 beds in our er, we hold regularly as those flooor nurses cant handle it, we always do, they never do!!!
  5. by   RNKPCE
    It does happen everywhere, from city hospitals to community hospitals. I work tele and unfortunately more and more docs are wanting their patients on tele, even 95 year old no codes. We have such fast turn over on my unit, we try to take our patients as soon as we can but sometimes a patient has just been discharge and the room isn't even clean yet or we have to triage patients off to med/surg who we feel no longer need tele(with md order of course). Because of this we are opening an annex unit in April one floor below us which will just be an extension of our unit. Other things that have played into this is angioplasty patients no longer going to higher level of care post procedure and less bypass patients and more interventions, also we get carotid stent patients who previously would have needed endararectomy(sp) and gone to ICU.

    We will have a new hospital built in a few years and apparently any bed will be capable of having a monitored patient, though we still will have a dedicated tele unit for the higher risk patients, the off tele floor pts will prob be more appropriate for monitoring the no code patients in a fib etc.
  6. by   veetach
    I work in a 300 bed hospital, with 25 beds in the ED. Sunday night we had 17 holds and only 3 RN's (not including myself because I was in charge) it just keeps getting worse and worse. Friday night we had 11 ICU/CCU holds, and again 3 RNS. NOT a good ratio. Our ICU/CCU nurses have a maximum of 2 patients per RN, whats wrong with this picture? Oh, and of course, the walk ins just kept coming and coming.

    We are getting a new ED in Jan of '05. 38 beds. Just more hold beds, IMHO.
  7. by   RNin92
    I am soooooooo tired of the holding patients.

    Just got home and of course we were holding all day.

    What is wrong with the hallway UPSTAIRS...it's the same as my hallway down int he ER isn't it?!!?

    What IS the answer?

  8. by   nowplayingEDRN
    I don't know if there is even an answer. Some say well, if the hospital would go on divert....well, sure that would stop the ambulances but you still have the walk in's and you still have the problem. But like veetach said, the units have 2-3 pts per RNbut the ED has 4-5+ per nurse...toss in holds and it just gets complicated and unsafe and we are not allowed to miss a med or make a mistake. My ED is 13 beds and we have the same trouble as everyone else here has stated. If and when someone has an answewr, I sure hope that they share it!
  9. by   NurseJacqui
    We held 8 criticals recently for over 24 hours. 4 of them were vented. Not to mention that some of our ER docs tend to admit every pt that walks in the door, so we wind up holding them too. We were on full bypass...not that it makes a difference. The ambulances are lining up and hoards of pts still coming in through triage. And of course the pts and their family members don't understand why the " service" is so bad.
  10. by   NurseJacqui
    A big problem we have is that our ER docs pacify a lot of pts by admitting them, even if the million dollar work-up they receive is completely normal. Because the pt still SAYS they feel like they are dying. And if we discharge them, they will come back tomorrow anyway. And if that doesn't work, they will fake faint. That usually wins them a trip to telemetry. Or the real die-hards fake seizures.That usually buys them a ticket to ICU. And of course once they are admitted they call everyone they know to tell them how sick they are and so then not only are we holding them, we are holding their families and friends.(Our security guards are virtually useless). And why is it that as soon as someone steps foot in the ER, they are suddenly starving and they haven't eaten all day? None of them have food at home? I don't know, when I am sick, food is the LAST thing on my mind. I don't get it!
  11. by   RNin92
    You know...

    I was just reading through some of the different threads...

    And no matter what they start out as...we keep ending up venting about the SAME thing...holding and overcrowding in the ED.

    There MUST be something we can do!!!

    How many of us are there for God's sake!!!
  12. by   Spidey's mom
    Wow . . . we have a three bed ER.

    And we do have extended ER patients . . .usually they go to our acute floor which is just down the hall and has 15 beds.

    We are a truly small rural hospital.

    steph
  13. by   RNin92
    Quote from stevielynn
    Wow . . . we have a three bed ER.

    And we do have extended ER patients . . .usually they go to our acute floor which is just down the hall and has 15 beds.

    We are a truly small rural hospital.

    steph
    in these circumstances...be very happy!!!

    :chuckle :chuckle
  14. by   TinyNurse
    I'm a new nurse, and have worked in the ED since graduation 7 months ago. I work in a 25 bed ER, with 9 hall beds. It's nothing for an icu/ vent patient to sit in the ER for 2-3 days. I've hung heparin in the hallways before while we wait for a bed upstairs, not to mention people that need tubed on stepdown or medsurg and they send the patient to us to tube and hold for an icu bed.

    at times we have an ICU nurse get pulled to ER to care for these patients which is great.

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