triage to fill beds or not

  1. Hello, new to this forum but not to ED nursing ! Seeking info related to department policies regarding whether or not the triage nurses routinely fill all the beds in the dept or save a few for ambulances and or critical patients that come in through the front door.
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  2. 23 Comments

  3. by   micro
    not an er nurse, but I should think that if you could you should try to save a bed.......but then again as I have learned from my ER friends here and in the "real world", what you want and what you get in ER is not always the same......
    just like where I am.......
    but that is this nursing field where we find ourselves......

    GOOD ????
  4. by   CEN35
    saving the bed for an ambulance is more of a "cliche". in reality, we try to save a monitored bed (i.e. spacelab/lifepack with o2 and sxn), for any critical or suspected critical patient that might arrive.

    clearly, we see more critical patients walk in than arrive by squad. when the er fills up, we mark off patients on the board that can be moved out if (i.e. often) neccesary. er patients are in blue or black, admitted in red...........and..... anybody that does not need a monitor/high flow o2/sxn or a constant bedpan (i.e. gib) they become automatic hallway candidates. hallway candidates get the big orange star by their name.

    so as they say? go with the flow! unfortunately most families don't like when the flow takes their family member into the hallway..................but there are only so many rooms! what to do?


    me
    Last edit by CEN35 on Mar 29, '02
  5. by   KKERRN
    At our ER we don't save beds for squads, but we do save telemetry beds for pts that require monitored. If we use all beds the charge RN decides which pts to move.
    CEN35's ER sounds alot more organized with the use of colors and stars on the greaseboard! I plan to pass that on at ours! It would be alot faster to move 'em when needed to move fast.
    We are NOT SUPPOSED to have HALL pts according to our Joint Commission guidelines, but of course...**it happens!!!
  6. by   spaz
    Thank you for your replies - I agree with you, KKERRN that CEN35's ED sounds very well organized, I am also going to suggest that color coding for patients that are movable !
  7. by   4XNURSE
    Let's see, - officially there's 12 ER beds, and 6 fast(?) care beds. Actual count is 22 ER patients, and 12 in "fast care". Exactly where in the HEQQ are we going to hold a bed for the squad?

    Just asking.

    ken
  8. by   kaycee
    We pretty much fill all the beds if were hopping and move people into the halls if necessary. I do like to keep at least 1 monitored bed open and will not put a nonurgent pt there. The waiting room is fine for them. If they are all sick I fill em up amd hope we can admit them before something else comes in. It doesn't always work, so in the hall they go on a portable monitor.
  9. by   CEN35
    yeah well.....we all know your not supposed to have patients in the halls. nobody needs the joint commision to tell us about that one!
    we also know that per joint commision, cobra, emtala, hicfa and everybody else that has to stick their nose into it:
    we cannot refuse patients either.
    according to emtala patient treatment should not be delayed either. if i remember right, their acceptable guideline is 15 minutes, but they feel a couple of hours is realistic.
    of course once the patient codes, it's the legal eagles and ambulance chasers that determine the rules!

    so what it all comes down to is: which issue will get you in the least/minimal amount of trouble?

    1) put them in the hallway. (which is actually a patient confidentiality issue)

    2) outright refuse treatment of incoming patients.

    3) delay their treatment.

    we all know money talks.
    refusing treatment, and hicfa jumps in and medicare is gone. just for the record, medicare actually pays better than most private insurance companies. nice huh?
    delaying treatment can cost a big fine, or lawsuite. however, the patient will still be alive (hopefully :chuckle ) and the damages will not be so great.
    refuse treatment, and then hicfa pulls medicare, emtala fines you big time, and the patient and family sue.

    end result = hallway


    me


    p.s. - 56 here now, hoping for mid 60's anyways......gonna try and get outside for a while and take care of some things today. hope everybody has a great day!!! :d
    Last edit by CEN35 on Mar 30, '02
  10. by   massEDgirl
    We have two beds on our triage room....and if you are lucky enough to have the required "2" triage nurses out there...we are exspected to start lines...get blood work or urines...order minor xrays..... All this of course because inside is full to the max. Hopefully by the time the patient DOES get a bed in side the results will be back.

    If patient is sick enough they can stay in the triage bed until a spot opens inside...if not...back out to the waiting room they go (yes, with line and all).

    We use what is called an "Expediter Board" . Our old hosp used the grease board....This being a new hosp(2 yrs old) of course it has to have "modern technology". Better??? I guess you can say it keeps track of things a little better. Everything is put in by computer and the "board" shows up on a screen. You just pop someones name in an opened spot. There is a "Master Board" with all the "blinking lights" on the wall in ED.

    Sometimes if we are slow(Ha Ha Ha) The triage nurse will pop the name in after triaging and registering the patient and get them in side.

    If busy ......charts go into a "rack" inside after triage and registration and the charge nurse assigns the rooms. We like to keep a TRAUMA room open at all times....but we are...like everyone else....very resourseful at utilizing our hallway space when needed..which of course is ALL the time.

    I like the charge nurse assigning rooms better.....How does the triage nurse know what will be coming in by ambulance?? The charge nurse gets the calls...so she knows whether to fill the rooms up.
  11. by   CEN35
    well we too try to assign the rooms, but some people don't always get it.

    me
  12. by   KKERRN
    Our greaseboard is on the computer also. We had confidential problems noted because the screens would be left on and many of our computers at nurse zones are positioned where visiotrs walking by could possibly read them. We reported this and they fixed it for the screen only stays up under a minute or so and goes to a screen saver.
    Sometimes our charge nurse is even to busy when we are full and any of us can "play the musical bed" game for pt bed priority! Wr are currently remodeling for a bigger ER. Our rooms have 4-6 beds with curtains betweem pts, so confidentiality is just a joke. Usually any one in a zone can hear what is being said to each pt!We could use any great ideas for better organization!
    Currently we have 5 triage booths, but no beds. We may have one bed in the new triage. Last month a lady with the flu laid down on the floor in triage and refused to get up!! We were full and she thought this would get her a bed faster...unfortunately it didn't.
    Our unit clerks call the triage nurse and informs of ambulances and sometimes the clerk in triage is able to get chart together with a family member at triage instead of the clerk in ER doing the chart.
    Thanks for sharing. I started training for charge nurse this weekend...makes me nervous, but I'm sure my nights will fly by!! Any advise will be much appreciated!!
    Karen/KKERRN
  13. by   teeituptom
    Howdy Yall
    From deep in the heart of texas.

    The idea of saving a moitored bed or 2 for critical patients is a great Idea. Ive never seen it happen except on very slow days. I sure dont see many of those. If its open then you need to fill it and get somebody treated, even if they end up being turfed to the hallway. Once you can get them treated then you can get them dispositioned and thats all that counts. home,obs,or,admit, whatever. Get them in get them out. That is the reality.

    keep it in the short grass yalll
    teeituptom
  14. by   DanRn
    HI All

    I always try to have one open monitor bed for a critical patient that comes thru triage. on a bad day, that means filling my all the beds, but knowing one will open up soon.

    i dont care about ambulance patients. they are already being treated. they usually have iv's. are on a monitor o2 and may have had meds given.

    i broke my rule last week, and had a chest pain pt in the waiting room for 30 minutes. i did make him my priority pt in getting back, but nothing was really moving. we had plenty of sick pts, including icu admits. he ended up in the cath lab less than an hour after getting back.

    we have an infrared badge computer tracking system to know where all our pts are at

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