Hallways

[emtb2rn, BSN, RN, EMT-B]

Didn't want to hijack the er redesign thread so here goes:

For those who do not have hallway pts, what do you do when your rooms are full? Medics coming in with whatever they're bringing which needs a room. Or the "i'm having the big one" chest pain walks up to triage. You don't pull a stable pt out to the hallway to free up a room?

[HikingEDRN, BSN, RN]

We've pulled stable patients into the hall if they have a room ready upstairs and they are not tele. We also pulled a patient out once who was still waiting for disposition because the new patient (who turned out to be a huge head bleed) rolled in by EMS vomiting into her non-rebreather mask and required immediate intubation. We try to avoid doing things like that but sometimes you have to do what you have to do.

[emtb2rn, BSN, RN, EMT-B]

Yep, do whatcha gotta do. We've done adenosine in the hallway with the pt on a portable monitor. Have also run stemi codes in the hall.

[zmansc, ASN, RN]

code in the hallway x1, birth in the ambulance bay doorway x1. Controlled chaos. It depends on the shift personnel how much we move stable pts around to make room for those that are less stable. Both of the above cases were brought in with almost no warning, certainly not enough time for us to open up a room and were on days when we were with very limited resources. The code was our third in an hour and we are a very small community hospital. The birth, I don't recall much other than the EMT opening the doors and screaming for help! lol

[HikingEDRN, BSN, RN]

I agree - it depends on how much warning you get. I think we got little to no warning about the head bleed coming in; hence grabbing the patient in the closest room and shoving the stretcher into the hall to make room! We had an imminent birth recently and were all set up and ready but they were able to get up to L&D in time which was just fine with us And we did run a stemi from a consult room off the waiting room once because there was nowhere else to do the EKG when he walked in.

[turnforthenurse, MSN, NP]

How do you comply with HIPAA when you have hallway beds?

[That Guy, BSN, RN, EMT-B]

Trauma bay. If the poop really hits the fan we can open up fast track and our discharge area if we must. Thats a crisis/MCI level though.

[Altra, BSN, RN]

How do you comply with HIPAA when you have hallway beds?

Rock ... paper ... scissors ... EMTALA beats HIPAA? OK, I'm being silly, but ...

In all seriousness, you do what you gotta do to treat the patient. In my ED if it's between 9:30am and midnight, I can virtually guarantee that all our beds are full. Newly arrived patients who cannot wait *must* be juggled, and that means using any and every available hallway space. No more nor less a HIPAA issue than any curtained area, a chair area, a semi-private inpatient room, a pre-op holding area, PACU or open ward-style ICU environment. Or the open concept floor plan I've seen in a distressing number of dentists' offices ... (don't get me started).

The gilded age of all patient care areas being truly private may yet appear on the horizon, but it's certainly not here yet.

[Altra, BSN, RN]

I second the question of the OP, because I truly have difficulty wrapping my head around such a concept: whether your ED is 5 beds or 50 beds ... what do you do when you're full and that one more patient arrives? Inquiring minds want to know ...

[HikingEDRN, BSN, RN]

I was in triage one holiday and we were not even full but the acuity was absolutely unbelievable. Nothing super dramatic like codes or STEMIs or strokes but just multiple wickedly sick people - lots of altered mental status, septic-shock, DKA type of stuff. My charge told me to hang on to people in the waiting room and "don't send anyone back unless they are dying." I called her no less than 3 minutes later to tell her I had pulled a pale, tachypneic lady out of a car and her heart rate was 180. I sent her back - I had to. They just kept coming !!! They managed back there somehow. It's the beauty/terror of the ER - constant reorganizing of priorities.

[DayDreamin ER CRNP]

We have hall beds almost every day. If we have priority 2 patients that require a bed we just don't have much choice. I often do bed flow and hall beds get tricky; sometimes you do have to pull a more stable pt into the hall to make room for the new patient that needs a bed. We try really hard to distribute the hall beds evenly but it isn't always possible. This is what I think hospital admin and the floor just doesn't "get" about the ER sometimes. When will the unit or floor ever have hall beds?

We've run heart alerts, stroke alerts and even level 2 traumas in the hallway. It definitely is not ideal but sometimes you can't help it.

Recently, we have had huge discussions about how to handle the hall beds and how unsafe it is. It is interesting to read how other facilities manage the hall patients.

As far as HIPAA goes, you just have to keep you voice low and try not to discuss too much when others are walking by.

meredith

[MassED, BSN, RN]

HIPAA shmippa - it's all about taking care of the patient. It's less of an issue than you'd think.