triage - page 3

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   RNin92
    Quote from veetach
    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.
    C'mon down!!
    :chuckle

    Our staffing is really decent...we have a very supportive managment team.
    Of course everything goes you-know-where when you start throwing boarded pts into the mix. We almost NEVER get help from the floors...

    We can be boarding 20 pts-usually a LOVELY assortment of ICU/tele and med/surg...and the floor may have open beds but they won't take our pt because they don't have another nurse...OMG...makes our great staffing go right out the window!!! But ahhh...that's another thread!!
  2. by   veetach
    OMG I hear ya! 2 weekends ago, we had 17 holds in a 25 bed ED! we were out of monitors and gyne rooms and casting rooms, it was horrible. did we get help? nope.

    Day shift got 2 RN's from the m/s floor, but thats not enough....
  3. by   NYCRN16
    First of all, Id like to say...

    My favorite patients are the ones who elope (except the ones with heplocks in) :angryfire

    If I had it my way, I would have AMA papers waiting at the door.

    And secondly, I think that is ridiculous that you are getting blamed for patients leaving the waiting room. They cant be all that sick if they are sitting there (we will put less urgent patients in the waiting room and give a sicker patient a stretcher when it gets that bad), and they have the right to leave whenever they want to. Nobody except for the patient should be responsible for thier actions (except a holding order psych patient!!) Not only that, how does that effect you and the other nurses legally by filling out incident reports?? I would get out of there pronto! They are asking for a lawsuit!
  4. by   RN92
    I work in a level I er. We see 60-65,000/yr. That nurses manager is responding to recent reports involving triage from JACHO/and state inspections. We recently had a state inspection. They told us we had to have 2RNs in triage at all times; revital waiting room pts q2hrs. Somehow, "left without being seen pt." numbers would count against your score. Our management never threatened to punish the nurses though. Thats absurd!! However, I do tell pts in triage that the er and hospital are full - the wait might be 12 hrs or more. Then I conveniently give them a handout that we keep at the desk of local clinics that are open 24hrs.and I have them decide before I start the paperwork. At least if they stay-they know ahead of time that theyll be there all night. Most of our pts are homeless,penniless and appreciate the long wait. Warm waiting room, several tvs, clean bathrooms - its a hobos paradise. (almost too much so)
  5. by   RNin92
    Quote from ERslave
    I work in a level I er. We see 60-65,000/yr. That nurses manager is responding to recent reports involving triage from JACHO/and state inspections. We recently had a state inspection. They told us we had to have 2RNs in triage at all times; revital waiting room pts q2hrs. Somehow, "left without being seen pt." numbers would count against your score. Our management never threatened to punish the nurses though. Thats absurd!! However, I do tell pts in triage that the er and hospital are full - the wait might be 12 hrs or more. Then I conveniently give them a handout that we keep at the desk of local clinics that are open 24hrs.and I have them decide before I start the paperwork. At least if they stay-they know ahead of time that theyll be there all night. Most of our pts are homeless,penniless and appreciate the long wait. Warm waiting room, several tvs, clean bathrooms - its a hobos paradise. (almost too much so)
    Ahhhhh...

    It's great to see state legislatures and inspectors responding to the REAL problems being faced by ERs across the country isn't it!!?

    OMG!
  6. by   Uptoherern
    Quote from Speculating
    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:

    how do you come up with 6 million? just wondering............ I'd say at least 1/2 of our patients are on state insurance. Many don't have any at all. Those that don't usually don't plan on paying anyway. We just had an illegal alien come in for emergency dialysis. The state will not pay for routine dialysis for illegal aliens, but lo and behold, per emtala we have to treat them in the er. This poor gent usually has to have dialysis 3 days in a row by the time he shows up in the er. We don't get paid. At all. Good ol' emtala. Not sure what to do to convince people to wait in the waiting room. Plead? Give cookies? Backrubs? Just kidding.
  7. by   canoehead
    At least one in ten of the patients that come into my ER present with something they would be better off treating at home in bed with a good snort of whiskey. Perhaps she has found a way to make them come to their senses and go home, where they belong.
  8. by   parkernurse
    Quote from imagin916
    First of all, Id like to say...

    My favorite patients are the ones who elope (except the ones with heplocks in) :angryfire

    If I had it my way, I would have AMA papers waiting at the door.

    And secondly, I think that is ridiculous that you are getting blamed for patients leaving the waiting room. They cant be all that sick if they are sitting there (we will put less urgent patients in the waiting room and give a sicker patient a stretcher when it gets that bad), and they have the right to leave whenever they want to. Nobody except for the patient should be responsible for thier actions (except a holding order psych patient!!) Not only that, how does that effect you and the other nurses legally by filling out incident reports?? I would get out of there pronto! They are asking for a lawsuit!
    We live in an area with 4 er rooms in a 5 mile radius. I love the irrate pts that show up at our er after a 5 hour waiting room visit at our competerors then whine, scream, hollar, cuss about the wait. theses are the ones u hope will LWBS!!!!!!!! :hatparty:
  9. by   veetach
    at what point do we, as nurses become responsible for the actions of every person who walks out of an er at any given time? I think if they want to walk, them let them walk. Its their health and their life, not up to me to make them stay.

    People have to take responsibility for their actions, they arent punishing me me if they are sick and want to walk out especially if they are mad that they have to wait. as long as they are able to make a rational decision, It is up to them. just my opinion of course.....
  10. by   RNin92
    Like one of my docs says...

    people have the right to be stupid.
  11. by   nursebonkers
    The hospital systems , health care systems suck, they are big corporate companies who wish to take care of patients on an assembly line, they dont realize that there are far too many variables from patient to patient. The hospital administrators job doesnt get changed as much as bedside nurses. They simply dont get it, were sick and tired of sh** rolling down hill. If every bedside nurse up and quit and joined an agency today, Hospitals would sink into oblivion, we would demand higher pay for being treated like dogs. :angryfire
  12. by   Uptoherern
    We have 3 nurses quitting. One is an ICU/flight nurse/ER nurse (nights), one works 3p-3a on WEEKENDS, the other is flexible and works varied hours. Partly due to this. We have a meeting in the am (7 am, like us 3-11 folks are going to show us). To address our "issues and concerns". The mgmt is going to hear an earful from our main day charge nurse. I'd attend, but since it is now 0100, and I have to get kids up for school in 6 hours, I don't think I'll make it :angryfire .
  13. by   Uptoherern
    BTW, when I left our 10 bed er, (4 fast track). we were holding 2 ICU admits, every bed was full including 3 in the hall that we don't count. and the waiting room had 20 to come in.

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