ER nurse/pt. ratio,triage times, & EHS pt. responsibility?

tiredfeetED · Nov 06, 2004, 09:07 PM

Originally Posted by RNin92

Exactly how do you "close beds" in the ED??!!??
I'ld LOVE to know.

Cali ratio laws!!!!
We must have a min. staff, but like every ED we fill the halls and hold many MS/ICU..but we must have more staff...

nursegoodlove · Nov 07, 2004, 12:05 AM

Originally Posted by tiredfeetED

Cali ratio laws!!!!
We must have a min. staff, but like every ED we fill the halls and hold many MS/ICU..but we must have more staff...

Thank you everyone for your help! The more I read of what is "normal"...the more "abnormal" I am feeling we are in our ER dept. I am going to make some notes & take them to our nurses to help give them some idea of what's going on elsewhere! I doubt there aren't too many ER's that have pts. seeing a unit clerk 1st...and then the triage nurse? It's scary!

Thanks again - I am taking all this down - it's a great help!

needsmore$ · Nov 10, 2004, 01:47 PM

1 charge nurse ( no assignment but floats to help out)
1 triage nurse w/ a tech
1 RN for a -4-6 pt ratio- this can be dreadful-depending upon acuity- our equipment is portable so types of pt's can end up anywhere (we don't have speciality rooms)
1 LPN/RN to fast track w/ NP
occasional float RN

Anne

ERNurse678 · Nov 18, 2004, 01:36 AM

1 charge RN
1 Fast Track RN
1 triage RN
3-4 Critical Care RN's (10 bed CC unit)
5-6 Intermediate RN's (22 bed Intermediate unit)

veetach · Nov 20, 2004, 03:19 PM

Originally Posted by RNin92

Exactly how do you "close beds" in the ED??!!??
I'ld LOVE to know.

Our state average (PA) is supposed to be 5:1. In our ED we have anywhere from 6-8:1 depends on acuity of patient.

Ambulances are allowed to proceed directly to the bed (if we have them open) and if they are all full and pt is stable and ambulatory they drop them off in triage. If the pt is not stable we find a bed and line them up in the hall somewhere. Response time to the bedside by an ER nurse is usually less than 5 minutes, we try to get the EMS crew out the door and back in service.

RNin92 · Nov 20, 2004, 03:41 PM

Originally Posted by veetach

Our state average (PA) is supposed to be 5:1. In our ED we have anywhere from 6-8:1 depends on acuity of patient.

Ambulances are allowed to proceed directly to the bed (if we have them open) and if they are all full and pt is stable and ambulatory they drop them off in triage. If the pt is not stable we find a bed and line them up in the hall somewhere. Response time to the bedside by an ER nurse is usually less than 5 minutes, we try to get the EMS crew out the door and back in service.

Not sure if we have a state ratio limit (IL) but we are usually staffed for 4:1. Nights they go up to 5:1. Minor care they are 6:1.Assuming, of course, that there are no "holes" in our schedule. Managers do try pretty hard to cover those...

But when we fill our beds, we start lining up the hallways...we even gave them "room numbers"...it just got too confusing! I try VERY hard not to use "hallway" beds unless forced to do so...crushing CP, etc...but the Gods are not always so kind!

We, too, triage squads to the waiting room...just LOVE when people say" I called an ambulance so I could get treated quicker"...Yea...nice try

Our managers and TC and RNs in for meetings, etc do come out to help during those times...but we are only 14 beds in our main ED...we get backed up fast. We do try to get the squads out right away, too...Nurses are at the bedside on arrival...either the primary or the charge nurse

Some days, though, it sure does feel like a juggling act!!!

*Katnip* · Nov 20, 2004, 03:59 PM

We close ED beds. If we don't have enough nurses to cover the beds, they're closed until we can get someone in. Period.

The max a nurse takes is 6, and that is under extreme conditions, and only if those 6 are there for something very simple. We put them in the hallways. Normally our ratio is 4:1, except in our minor care unit, where it's 8:1. Peds ED is usually 3:1. Our psych ED is planned to have 6:1.

We saw 90,000 people last year in smaller than 400 bed hospital. I have worked in Baltimore where no one was allowed to go on divert, but everyone was well passed max capacity.

Our hospital tried to build a satellite ED, but was turned down by the state, mainly due to politics.

This has nothing to do with Canadian or American healthcare. It has to do with a shortage of quality nurses and administration's refusal to spend money to expand facilities.

RNin92 · Nov 20, 2004, 06:18 PM

Originally Posted by cyberkat

We close ED beds. If we don't have enough nurses to cover the beds, they're closed until we can get someone in. Period.

The max a nurse takes is 6, and that is under extreme conditions, and only if those 6 are there for something very simple. We put them in the hallways. Normally our ratio is 4:1, except in our minor care unit, where it's 8:1. Peds ED is usually 3:1. Our psych ED is planned to have 6:1.

We saw 90,000 people last year in smaller than 400 bed hospital. I have worked in Baltimore where no one was allowed to go on divert, but everyone was well passed max capacity.

Our hospital tried to build a satellite ED, but was turned down by the state, mainly due to politics.

This has nothing to do with Canadian or American healthcare. It has to do with a shortage of quality nurses and administration's refusal to spend money to expand facilities.

Amen my friend, Amen

I would only add to that that at least at our hospital, administration also refuses to take on the physicians. We are a 200-bed community hospital. Our ED has 14 beds in our main ED and 6 in our fast track. We see about 38,000-40,000/year.

The problem is so complex...it's not just a bed issue...

Most of our docs close their offices at 4...
Almost none are open on weekends
No more "sick visits" held
NO pediatrician in our ENTIRE COUNTY who accepts public aid patients
One free clinic in the county...open once a month
Guess where all those patients end up

Attendings that refuse to discharge patients along nationally accepted LOS guidelines
Attendings that inappropriately admit
Attendings that "admit thru the ER" so they do not have to come in to see their patient

Lab that is downsized so much that now we "send out" half our labs to our sister hospital...and wait for results...and delay dispositioning of patients

Psych beds closed due to lack of funding

I could go on forever...And I haven't even mentioned the nationwide Nursing shortage

RNin92 · Nov 20, 2004, 06:20 PM

Originally Posted by cyberkat

We close ED beds. If we don't have enough nurses to cover the beds, they're closed until we can get someone in. Period.

And I still want to know how you "close beds" in your ED?
You can't exactly send people away...

madi_88 · Dec 10, 2004, 12:44 AM

THAT IS PERCISELY why I am leaving the "beautiful" West coast of Canada..........by the way.....they HAVE the money - just choose to put it in Upper Mgt and Ceo's salary - my, but we truly are "polite" canadians...grrrr!