We did it at my last job. Increased time to triage and incidences of re-bedding patient to and from urgent care to main er. Of course, this meant more handoffs and more choas.Of course, management loved it because it reduced Los. I have personally inquired about immediate bedding at job interviews and I will not work somewhere that does it as I think it is the devil and makes the entire day confusing and irritating and dangerous. Try telling a patient that has a nice quiet er room with a tv that they are being moved to urgent care with no tv and a curtain room and no md!! They just *love* it.Further, when I goggled, I found a single research article that confirmed my fears: it is dangerous to patient as it often delays actual triage.
We're doing it. It works great when the census is low and you have lots of beds, but at peak flow times, I've seen the same problems mentioned already. It really stinks when you end up with someone really sick on the far end of the department away from everything, in a tiny room that can barely hold all the personnel and equipment.
Also, some charge nurses will fill up every single bed in order to empty out the lobby, but then when a resus/trauma/cath alert/stroke alert comes, we have to scramble to open up a trauma bay. Some charge nurses will always leave one trauma bay open, which really helps for when someone really sick comes in.
I think the physical design of the department needs to be different in order to use this type of patient flow system, but our hospital was designed by an outfit that designs hotels. Seriously.
We do this in my ER, and as others have said, it works well when things are pretty empty and you don't really need to "triage" which patient gets seen first because there are so few patients they can basically all be seen at the same time. It can be a burden on the primary nurse though because they often get stuck doing the in-room triage and if you're working with a charge nurse who keeps in-bedding until the department is full, you might be pretty busy while receiving "blank" patients. We're also not all triage certified, but apparently able to triage when the patient is in our room...
Interestingly enough, the doctors at in our department pretty much all HATE in-bedding.