Ummmm..are they ALLOWED to do that?

Specialties Emergency

Published

You are reading page 6 of Ummmm..are they ALLOWED to do that?

so, then, the answer to the op's question is that yes, they are allowed to do that, provided hospital policy allows for it?

[color=#483d8b]

[color=#483d8b]of course it is a bad idea, but i can see where there are times when you don't have a good option.

[color=#483d8b]

[color=#483d8b]transferring is a nice thought, but when one local hospital is full to capacity, the rest usually are, as well. it is tough enough finding an accepting facility when we have an er patient that has out-of-network insurance but needs to be admitted. it has to be close to a nightmare to find one when the patient needs icu level care (and the house supervisor is trying to take care of the patient and make the transfer arrangements).

right,

however, one scenario...

you bring down an icu pt d/t no room upstairs, you even send a nurse with the pt:idea: ...you don't check the pt into the ed, and maintain the inpt orders, and the pt's assigned doc...everything is going well, then the pt codes...

do you think the er doc won't step in? of course he will...now you have to check the pt in, as he is in your ed...

emtala violation

Specializes in ER, ICU, Infusion, peds, informatics.
right,

however, one scenario...

you bring down an icu pt d/t no room upstairs, you even send a nurse with the pt:idea: ...you don't check the pt into the ed, and maintain the inpt orders, and the pt's assigned doc...everything is going well, then the pt codes...

do you think the er doc won't step in? of course he will...now you have to check the pt in, as he is in your ed...

emtala violation

but the er doc responds to all codes in the hospital anyway. how is this case any different? the patient is still an inpatient, even if the physical location is er. same as when we are taking care of an icu holdover in the er -- and they code fairly often.

sayrah_85

20 Posts

i think your endurance was just put to test..........lolz

but the er doc responds to all codes in the hospital anyway. how is this case any different? the patient is still an inpatient, even if the physical location is er. same as when we are taking care of an icu holdover in the er -- and they code fairly often.

good question...i anticipated it after i posted...

emtala seems to distinguish the er as an almost separate entity...

the pt that codes in the er will use the ed pyxis, the ed staff, and is in the ed...i think emtala could have something to say here...

i'd be curious to hear any other thoughts...

quick story:

we xferred a guy out of our ed (via chopper)...they got to the chopper, but the pt wouldn't fit inside (too tall)...the flight crew brought the pt back in, but the pt was maintained under the flight crew's care...

my thought was,at the time, what if he coded while under their care, but in our er?

so we signed him back in, care was xferred back to us, and we grounded him to his destination...kind of a similar situation...

there may not be an answer, as it is a murky topic

anne74

278 Posts

ICU pts are in the ICU because the nurses have the skills AND the low ratio to safely care for pts. If you send an ICU pt to the ED, they've got the skills but not the ratio. That's totally unfair and dangerous to the pt, the nurse and the hospital.

In our hospital, if a med/surg pt goes bad and the units are full, they stay on the floor until they can transfer. Usually the charge nurse steps in to help with the higher acuity until the pt can be moved. And usually the hospital manager does a pretty good job of making an ICU bed available fairly quickly. If in a real bind, the pt might go to PACU.

I've never heard of sending an ICU pt to the ED. Not a smart move.

Specializes in ER, ICU, Infusion, peds, informatics.
good question...i anticipated it after i posted...

emtala seems to distinguish the er as an almost separate entity...

the pt that codes in the er will use the ed pyxis, the ed staff, and is in the ed...i think emtala could have something to say here...

i'd be curious to hear any other thoughts...

quick story:

we xferred a guy out of our ed (via chopper)...they got to the chopper, but the pt wouldn't fit inside (too tall)...the flight crew brought the pt back in, but the pt was maintained under the flight crew's care...

my thought was,at the time, what if he coded while under their care, but in our er?

so we signed him back in, care was xferred back to us, and we grounded him to his destination...kind of a similar situation...

there may not be an answer, as it is a murky topic

yeah, there are definatly many murky areas.

imo, the murky areas would show up less often if administration would realize that patients get much better care when they don't try to push the staffing guidelines to the limit.

i was just talking with a good friend of mine who is a nm of our er. she said while it is most certainly not an emtala violation, because emtala ends once the patient is admitted. however, she said it does violate some jcaho standards because you have to have a plan for this situation, and the staff to care for the patients. sending the patient back to the er might be the plan, but then additional staff has to be brought in to take care of the patient. she said the same is true for the holdovers -- hospitals that do not staff appropriatly for holdovers, such as the op's case -- are going to be in trouble with jcaho when they are surveyed.

i hope i'm translating what she told me correctly.

about the chopper story:

they always ask for a weight, but i've never been asked for a height before. i can see why it would be a problem, though. i helped load a guy on one a few weeks ago....i never realized how small those things are! i always thought i'd like to be a flight nurse at some point. haven't pursued it because i get so motion sick. but wow, i think i'm too clausterphobic to work out of one of those!

wooh, BSN, RN

1 Article; 4,383 Posts

Right,

however, one scenario...

you bring down an ICU pt d/t no room upstairs, you even send a nurse with the pt:idea: ...you don't check the pt into the ED, and maintain the inpt orders, and the pt's assigned doc...everything is going well, then the pt codes...

do you think the ER doc won't step in? of course he will...now you HAVE to check the pt in, as he is in your ED...

EMTALA violation

Why would you check the patient in just because the ED physician sees them? At my last facility, the ED physician was part of the code team. So she stepped in even if the code was on the floor. Codes on the floor didn't get checked back in just because the ED physician came and intubated.

I'm not saying it's a good idea. (Although when hospital is full to capacity, I don't think we're looking for a good idea, rather a lesser of many evils idea.) But I just don't see how it's an EMTALA violation. Sending them down for sutures (and as such treatment by the ED doc) is entirely different than housing an inpatient in the ED with treatment from the admitting the doc.

wooh, BSN, RN

1 Article; 4,383 Posts

....emtala violation....jcaho standards...

i was thinking earlier in this thread that it's starting to sound like the er manager's answer to everything is "it's an emtala violation" where the floor manager's answer to everything is "it violates jcaho standards.";)

:balloons: (begin dreamworld) if only we could simply think, "what is best for this patient at this moment?" instead of arguing over regulations and standards... heck, we'd probably get our patients cared for and out the door so fast that we wouldn't have to worry about overflow anymore.... (end dreamworld):balloons:

I agree wooh...

The distinction is clear...

I'm looking for definitives here, when likely, none exist...

Would EMTALA see a difference between coding an inpatient that had been sent back to the ER, versus the ER doc going up to the floor...I believe so...

You mentioned "lesser of many evils"

Housing an inpt back down to the ER, is the highest (IMO) of all evils

traumalover, RN

101 Posts

Specializes in ICU/ER.

Wow. First post. Was inspired to join and post because I have been an icu nurse for 2 years. Also prn in the er and on the floor and have been floated to ms. everybody works hard, in different ways. In our Icu, we take everything from balloon pumps, open hearts, traumas, everything but transplants. sometimes we are full and no shuffle can be done. Why? So we can send an unstable pt to the floor, increasing that nurse's workload, and the pt can come back down later with people shaking their head saying we shouldn't have done that? Also, our unit responds to level 1 and 2 traumas, all codes, and are responsible for the rapid response team. er responds to codes and traumas as well. ms work their butts off as does post surg. Our hospital has people stacked in the er too. we do divert but only in last case scenarios, especially since all our neighbors are own diversion too. everyone's job seems to be getting harder and harder, but the teamwork I have with some er and floor nurses makes it a lot easier. One thing that makes it harder is anger. I will listen to anyone vent but I don't appreciate being blamed. Maybe (and please no one get angry) a committee (I hear the boos) formed of representatives from icu, er, tele, and bed coordination should meet and discuss various options. good luck and remember pt care first! If you feel unsafe say so!

Specializes in ER, ICU, Infusion, peds, informatics.
i was thinking earlier in this thread that it's starting to sound like the er manager's answer to everything is "it's an emtala violation" where the floor manager's answer to everything is "it violates jcaho standards.";)

:balloons: (begin dreamworld) if only we could simply think, "what is best for this patient at this moment?" instead of arguing over regulations and standards... heck, we'd probably get our patients cared for and out the door so fast that we wouldn't have to worry about overflow anymore.... (end dreamworld):balloons:

:lol2: yeah, it does seem that way sometimes. thing is, emtala usually goes against what it easier for the er. the other thing is that emtala violations come with huge fines.

i really do believe that most good nursing superviors do try to do what is best for the patients. they may be wrong in the end, but i think most will do what appears to be best for the patients at that particular time, with the imformation they are given at the time. i think the problem comes in when one unit perceives that they are being "dumped on."

i worked in a unit like that once. it was a sicu. the hospital had several other icus, so we really were supposed to take just surgeries. but come the weekend, there wern't as many surgeries, our patients would get txf to the floor/stepdown units, and we would have empty beds. of course, the other icus would be full, the er would get full, and they would try to send us the icu holds from the er. oh boy. you just can't imagine the fits that were thrown. i'm still astonished that the unit got away with that for so long.

veetach

450 Posts

Specializes in Emergency Room/corrections.

In our hospital we have a policy that no one goes from inpatient status to outpatient status. The solution to this problem would have been to transfer this patient out to a facility who could care for him.

+ Add a Comment