Is it just me...

Specialties Emergency

Published

Specializes in ER/Trauma.

... or does the whole concept of building "bigger EDs" seem counter productive to the problem of ED over-crowding?

The ED I work for went through just such an upgrade some years back. We increased our capacity, added on a 'Track' segment and augmented staff and equipment - all to care for the ballooning pt. population who seek our services. We are one of the busiest EDs in the country for an ED our size and pt. population.

All that is well and good - but I honestly don't think that was the problem.

See, I think the problem of 'lacking room to see people' wasn't caused in so much by the lack of any real estate space in the ED per se but more related to problems with pt. throughput.

When you have pts. who've been admitted to the hospital waiting 14-18 hrs for a bed, that's where the problem is. They end up taking an ER bed, which means one more person in the waiting room who can't be seen.

Adding more space to create ED beds sounds like a decent idea, right? I mean, if they're in the ED and not in the waiting room -at least they've been triaged and at least they're in a place where they can be more closely monitored by ED trained personnel.

But this just adds onto ED congestion - it does nothing to relieve it. Having more pts. means more tests. More blood work. More CT scans. More X-rays. But there is only a finite number of X-ray/CT machines and trained personnel to operate them. There is only so much that can be done at a time. I mean, it says something that a test ordered "STAT" takes 2 hours to complete!

To me, ideally; the unfunded and unreasonable mandate known as EMTALA should be amended.

And knowing that such a thing isn't going to happen in my lifetime, I would think that the more productive thing to do would be to create more hospital beds in the floors and ICUs... particularly mental/behavioral health (serious dearth of infrastructure here).

Any thoughts? Or am I just preaching to the choir?

cheers,

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Specializes in Nephrology, Cardiology, ER, ICU.

Totally agree with you Roy! Our level one trauma center where I worked for 10 years is going from 31 beds to 72!!!!!! Now, mind you they have 25 full time openings for RNs now for their 31 bed ER!!!! Uh - can you say duh???!!!!!

Throughput and flow processing should be the by-words, not bigger, and bigger and bigger!

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Specializes in CCRN-CMC-CSC: CTICU, MICU, SICU, TRAUMA.
Totally agree with you Roy! Our level one trauma center where I worked for 10 years is going from 31 beds to 72!!!!!! Now, mind you they have 25 full time openings for RNs now for their 31 bed ER!!!! Uh - can you say duh???!!!!!

Throughput and flow processing should be the by-words, not bigger, and bigger and bigger!

Can housekeeping suture?

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Specializes in ICU.

that's an age old problem studied over and over again. the higher ups just don't get it. getting nurses freed up enough to take another patient is the key that they don't want to see. it would mean added nursing personel to the icu's and floors and staffing by accuity and not numbers. good luck with that! :smokin:

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There's talk of expannding ours, not because of bed issues - it's very rare that we don't have one - but because the village and surrounding areas use us as an urgent care center, which is openly acknowledged and necessary.

But why we don't just keep the clinic open 24/7 is what confounds me. Oh, wait, we can't get doctors OR midlevels.

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Specializes in NICU, Infection Control.
Can housekeeping suture?

:lol:

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Specializes in Ortho, Neuro, Detox, Tele.

Maybe we could get lab personell to insert IVs, housekeepers to do the washing, and CNAs to place lines.....

Seriously, we were just told that our hospital addition next year will be moving the ICUs into a one floor system, and that my ortho/neuro floor will be adding into that section...becoming more of a surgical ortho/neuro floor....

Supposedly they will be requesting more CNAs and staff...but I don't see it happening. My current section will probably become more of a medical side...and I'm going "If I signed up to work med-surg, that's the floor I would work on..."

Supposedly, we're not adding beds, just making more rooms privates...but I'll believe it when I see it....

The issue with adding beds to the floors is having the staff for em....But that requires more salary...and more cost for equipment, and actually thinking that maybe the nurses would have a acuity based model...

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Specializes in A little of this & a little of that.

Totally agree. The flow is the problem not lack of beds. The other huge problem is patient acuity. The waiting rooms of Trauma Center ED's are crammed with indigent, uninsured patients with minor problems who have nowhere else to go. Even those with insurance often don't have coverage for urgent care centers for after-hours problems. Then there are the on-call MD's who just tell everyone that calls to go to the ED because they don't want to be liable for diagnosing and prescribing for someone they don't know. Don't forget nursing homes that can't deal with a simple UTI without sending to the ED. The system is so broken and the "fixes" the powers that be come up with never address the real problems.

Staffing: I love it, the #1 excuse for not staffing better is "the nursing shortage" which exists because more nurses are leaving the profession than entering it. #1 reason for that.... burnout from working short-staffed. :banghead:

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Specializes in Public Health, TB.

Although I don't work in the ED it seems like turnaround times have increased from 3-4 hours up to 6-7 hours, at least for pts who come up to my floor. The increased wait times seem more due to waiting for the docs to do the dispos rather than a lack of staff. I just wish the pts weren't being told the wait is due to lack of inpatient rooms when we are are sitting upstairs with empy beds and plenty of staff waiting sometimes 4 hours for pts to arrive. We try to be proactive and call for report but ED nurses say : no orders yet".

I used to hate direct admits but after seeing the wait that patients endure I would rather have those little old folks up on my unit getting their Lasix or pain meds rather than sitting on a cold, hard stretcher.

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Specializes in ICU.

They just finished building a brand new cardiac center at our University Hospital. Its huge, state of the art equipment. The only thing we keep wondering about is, who is going to staff it? Nurses arent magically gonna come out of nowhere. And if they can staff it...theres going to be a shortfall in the other hospitals ICU,s and CCU's, so what does it really acomplish?

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Specializes in Emergency & Trauma/Adult ICU.

BINGO!

And here are the conclusions of ACEP which address that very point. 100-bed EDs can be built here, there and everywhere ... but until throughput in the rest of the hospital is addressed, nothing will change.

http://www.acep.org/WorkArea/downloadasset.aspx?id=37960

Thanks to Miss Mab, who originally posted that link.

https://allnurses.com/forums/f18/great-study-about-holding-nightmare-304357.html

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