triage - page 2

We've just been informed by our new er manager (an rn), that our LWBS numbers are too high. (Left Without Being Seen). Meaning the patients are not wanting to wait (sometimes 2-3 hours, not bad... Read More

  1. by   Uptoherern
    in other words, looking for a little ammo here..............
  2. by   Carotid
    our 55-bed er sees ~ 85,000 pts per year, and climing as most of you. our lwt (left w/o treatment) % is ~ <10%, with an ave. wait time of 2 hours. that's with 5 mds, 12 rns, 6 nts. wait time, imho, is directly related to adequate staffing, i.e. most of our nts (nurse techs) can start our iv lines, draw blood, and obtain eks. our door to disposition time is ~ 3 hours for any given pt.

    Carotid
  3. by   teeituptom
    we were so busy one night. I even had to make my wife wait 3 hours out front before she got back. Couldnt be helped. She still hasnt forgiven me and thats been 3 yrs now.
  4. by   traumaRUs
    Although dumb - its being mandated by JCAHO and other inspection organizations. We went through it a few months ago. We take vitals q1hr on everyone. One thing we did that helped decrease the number of left w/o treatment was that our case managers now talk with patients that are waiting to ensure they have the right resources and really need to be seen in the ER. So...this has helped. Good luck...how about asking the unit manager where this edict came from and what standard must now be fulfilled?
  5. by   Carotid
    TraumaRUs said,

    "our case managers now talk with patients that are waiting to ensure they have the right resources and really need to be seen in the ER."

    if they really don't need to be seen in the ed, what do they (case managers) do? is that decision based on "right resources", like having a pmd.?

    Carotid
  6. by   Uptoherern
    I'm sure the memo started with the head honcho's. $$$$$$$$$$$$$$..... Our nurse manager seems to be management-pleaser, not stand-up-for-your nurses type.
  7. by   teeituptom
    Quote from erdiane
    I'm sure the memo started with the head honcho's. $$$$$$$$$$$$$$..... Our nurse manager seems to be management-pleaser, not stand-up-for-your nurses type.

    Having been management in the past
    if you want to stay there
    you have to be

    Now Im just plain old staffing and I love it
  8. by   chris_at_lucas_RN
    Maybe I'm out of line here, but I would think the LWB's (left without BREATHING) ought to be the concern.

    Maybe at initial triage, one of your questions could be, "no, do you really need to be here?" Then if they say something like, well, no, you can send them on home with a hug????

    If people aren't dying, if they are well enough to get frustrated because they aren't getting seen fast enough to get to work or home to the TV show, or whatever, well?

    Sounds like the mgr is a dingbat (no offense Edith!)

    JMHO
  9. by   RNin92
    I don't know numbers but our LWBS pts are pretty low. We, too, have to fill out occurance reports each time. AMAs, too.

    We see about 35,000 pts/yearly in our ER.
    We have 20 beds-6 of them in our fast track.

    We have a 24 hr charge nurse, 20 hr triage RN, 4 RNs unitl midnoc in the main ED then drop 1 at midnoc and 1 at 0300, and 1 RN in fast track unitl 1600 then 2 RNs until midnoc there. We also have NTs (mostly EMT/medics)-1 in triage 24 hours, 2 in the main ED except from 10-1600, then only 1, and 1 in the fast track.

    Our NTs also start IVs, draw blood, do ECGs, post-molds, dressings, foleys, etc. They are a HUGE help in our ED!

    We have PAs in fast track from 0900-0100.
    We have 1 doc in the main ER from 23-1000 then we go up to 2. Our docs do 8 or 10 hour shifts...so at their shift change, when there are 3 docs in the ED, if we are hitting it usually one of them stays so we have 3 docs for awhile.

    Our wait times are usually 1-2 hours...but when we start hitting it the waits are more like 3-4 hours. But our pt population is so used to not having to wait for long..they are FURIOUS when they have to. I would love to have this website up for people to see that waiting is EVERYWHERE!!! You guys really have a POLICY to re-check VS every 1 or 2 hours...on EVERYONE?!! Man...we don't ever put times into our policies...miss one and you have got nothing to stand on if someone decides to sue over a "bad outcome".

    We use the ESI 5-tier triage system...works GREAT! We are able to see not only how many are waiting but what acuity they are. It also works well with our administration (who are still learning it) to be able to tell pretty close what potential admits we have.

    As for your manager...give him/her a stethoscope and tell him/her to get out there and help if she/he wants thing to change. Nothing like a little finger-pointing to rile up your staff!!
    :angryfire
  10. by   Speculating
    Quote from erdiane
    p.s. I believe our left without being seen percentage is 10%.
    I'm not sure how to address the AMA problem yet. I'm positive that it is a problem and needs to be addressed by management more so than it has been historically - 10% is way to much. That's just bad business. How many of those AMA's go home without seeking treatment elsewhere and end up dead on the couch? Think about it. How long would you own a vehicle that one out of every ten times you went outside in the morning to go to work just to get into it and find out it won't start? Seriously, erdiane your numbers put you at approximately 14 walk outs everyday! It's only about $6,000,000.00 that's right 6 million a year in revenue they're just flushing down the toilet. You need to tell your nurse manager, Diane that they need to come up with a better keep these people other than taking their VS every two hours. When you can show those kinds of numbers as losses you can really use some creative forces to justify promote your ER. :hatparty:
  11. by   teeituptom
    what they need to realize is most ER account for about 30% of their admissions
    therefore if 10 a day elope or ama then your losing 3 more admisssions, That accounts for even more lost revenue

    Even jewelry stores have whats called a loss leader
    something that is on sale that they take a loss on but gets you in the store to buy other stuff while your there

    Need to male ER pts happy at all times thats your loss leader in the hospital

    It will pay off.
  12. by   chris_at_lucas_RN
    Tom, that sure puts it in words that make sense to me.

    If they can't keep the doors open, the patients have nowhere to go, and I do not have a job (thinking in the optimistic future.....).

    If there is enough money, it also makes for a more pleasant working environment as well--if the bean counters ain't happy, ain't nobody happy!

    Thanks for the simple and clear perspective.

    (And before this thread gets wild with "quality nursing should be the issue" posts, let's keep in mind that we can do great nursing by being kind, caring and responsible. That takes little time, little effort--but does take attitude. Boy, I can feel the stinging PM's now!!! :kiss in advance, you guys!)
  13. by   veetach
    Quote from RNin92
    I don't know numbers but our LWBS pts are pretty low. We, too, have to fill out occurance reports each time. AMAs, too.

    We see about 35,000 pts/yearly in our ER.
    We have 20 beds-6 of them in our fast track.

    We have a 24 hr charge nurse, 20 hr triage RN, 4 RNs unitl midnoc in the main ED then drop 1 at midnoc and 1 at 0300, and 1 RN in fast track unitl 1600 then 2 RNs until midnoc there. We also have NTs (mostly EMT/medics)-1 in triage 24 hours, 2 in the main ED except from 10-1600, then only 1, and 1 in the fast track.

    Our NTs also start IVs, draw blood, do ECGs, post-molds, dressings, foleys, etc. They are a HUGE help in our ED!

    We have PAs in fast track from 0900-0100.
    We have 1 doc in the main ER from 23-1000 then we go up to 2. Our docs do 8 or 10 hour shifts...so at their shift change, when there are 3 docs in the ED, if we are hitting it usually one of them stays so we have 3 docs for awhile.

    Our wait times are usually 1-2 hours...but when we start hitting it the waits are more like 3-4 hours. But our pt population is so used to not having to wait for long..they are FURIOUS when they have to. I would love to have this website up for people to see that waiting is EVERYWHERE!!! You guys really have a POLICY to re-check VS every 1 or 2 hours...on EVERYONE?!! Man...we don't ever put times into our policies...miss one and you have got nothing to stand on if someone decides to sue over a "bad outcome".

    We use the ESI 5-tier triage system...works GREAT! We are able to see not only how many are waiting but what acuity they are. It also works well with our administration (who are still learning it) to be able to tell pretty close what potential admits we have.

    As for your manager...give him/her a stethoscope and tell him/her to get out there and help if she/he wants thing to change. Nothing like a little finger-pointing to rile up your staff!!
    :angryfire

    HOLY COW! I am coming to Illinois to work! Your staffing is very impressive. In contrast, I work in a 25 bed ER (unless you count the 10+beds in the hall) and we see approx 58,000 pts per year, here is our staffing breakdown:

    7a-7p- 4RN's 1 LPN, 2 techs and 1 charge RN and 1 triage RN
    1300 add another RN
    1500 add another RN and a tech

    7p-7a -4 RN's 1 LPN, 2 techs, 1 charge RN and 1 triage RN
    0100- lose an Rn
    0300 Lose an Rn and a tech

    final outcome from 0300 to 0700 3 RN's, 1 triage RN, 1 LPN, 1 tech and 1 charge RN.

    we dont have a fast track, EVERYONE goes through the main ER. uggggg.

close