Tele or med-tele holds in the ER...

Specialties Emergency

Published

'Tis the season for holding patients in the ER d/t no beds. Are you guys required to perform the complete admission assessment ? Are there any processes that have been initiated at your hospital to make holding these type of patients an easier process ?

The admission assessment on our computer is at least a 30 minute process involving everything from advanced directives to how many stairs they must navigate at home. It is not a big deal when you just have the one patient, but really not so doable when you get 4 other ER patients at the same time. And what about the 5 pages of MARS ?

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Specializes in Emergency & Trauma/Adult ICU.

Definitely the season ... :rolleyes:

No, we don't have to do admission assessments.

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Nope. All we have to do are the orders that are time-crucial, like meds or labs.

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Same as TazziRN. And for some patients the meds alone can seem to take forever.

What's annoying is that there are times when we are holding ICU patients who require so much more attention, and trying to keep up with our other rooms as well. ICU nurses at least have a 1 or 2 patient to nurse ratio, and we don't get additional staff when we are holding high acuity patients.

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Same as TazziRN. And for some patients the meds alone can seem to take forever.

What's annoying is that there are times when we are holding ICU patients who require so much more attention, and trying to keep up with our other rooms as well. ICU nurses at least have a 1 or 2 patient to nurse ratio, and we don't get additional staff when we are holding high acuity patients.

Yep...my point exactly. The longer they are down there, the more time intensive they are. And wading thru the 5 pages of MAR's in the ER is just crazy. Then when you call report they are very intense on asking if every single little thing has been done.

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We have to start the some of the paperwork within 8 hours, and the complete database has to be finished in 24 hours. So if they're really boarding in the ER for days, yes, we do the MARs etc. But if they're only there for a few hours, I don't do it unless I really have the time.

The most frustrating thing is filling out all the MARs, doing all the paperwork while you know your other patients need attending to, getting it all finished, and then--voila!--a bed has been assigned. :angryfire

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I hate holding pts in the ER. they hate it too. Does anyone else have a problem with "time"? Time to give meds...... we don't do anything on a routine basis in the ER except come to work and go home. all else is a free for all. i have a hard time remembering when that next Ancef is due.... any tips?

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Specializes in Nephrology, Cardiology, ER, ICU.

We are all in the same boat it seems. In our ER (as in many of yours), we don't do admission assessments and we only give the stat meds or needed orders.

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Our Hospital actually brings in nurses from upstairs to take care of the holds if there are more than a couple. We try to move them to an area where they are all together. This makes it much easier on everyone. For the unit secretaries as well. The way that the floor orders things, and the way we do it in the ER are totally different. :roll

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I hate holding pts in the ER. they hate it too. Does anyone else have a problem with "time"? Time to give meds...... we don't do anything on a routine basis in the ER except come to work and go home. all else is a free for all. i have a hard time remembering when that next Ancef is due.... any tips?

No....I put a big sticky pad on front of the chart last weekend and outlined what was due when. i.e. 9:00 Metoprolol, Lovenox and ASA. EKG and morning labs. 12:00 recheck vitals, print a strip, find a tray,etc.) Of course, out of all those, finding a meal tray is the biggest PITA., LOL !

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Our Hospital actually brings in nurses from upstairs to take care of the holds if there are more than a couple. We try to move them to an area where they are all together. This makes it much easier on everyone. For the unit secretaries as well. The way that the floor orders things, and the way we do it in the ER are totally different. :roll

Rumor has it that a rival hospital has "admissions nurses" who go throughout the hospital doing the admissions assessments. That would be a DREAM come true. Someone who actually has the time to sit down and do the complete assessment, who has no other patients to care for. Sigh........

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Specializes in IMCU/Telemetry.
Our Hospital actually brings in nurses from upstairs to take care of the holds if there are more than a couple. We try to move them to an area where they are all together. This makes it much easier on everyone. For the unit secretaries as well. The way that the floor orders things, and the way we do it in the ER are totally different. :roll

Our Hospital is the same. We have a holding room if we have more then 2 (max 6), and a floor nurse is pulled. Admission assessment must be done within 24 hours.

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