[TraumaNurse30]

Every year around October our hospital census skyrockets. Patients who need admission are sent to the ED to wait when beds are not available in the hospital. We hold anywhere from 6-40 patients a day. We even get all direct admits from doctor's offices etc. Is this a common occurance and if so how do you deal with problems (ie; staffing shortages, staff moral, etc.,..) associated with holding?

Every ER I have worked in has held pts.,I've even discharged some of them after they've rule out. One ER (with 13 rooms) had camped 22 pt.s..how they fit them in, I don't know (in addition to being a Level II), but the place I work now IS dangerous. 8 rooms, 4 have monitors. A pt. I took care of had been there for 2days waiting for an ICU bed. He had a massive PE, got TPA, then heparin then went to angio for a greenfield filter and returned to his ER bed post-procedure..that along with 7 other rooms. It seem that the only thing that hospitals respond to is bad press. Obviously, litigation isn't the issue. So....you can take your chances and talk to Channel blah blah and never work again..or move on. Not a great choice either way.

[Roach]

Guess what? The trouble happens everywhere, and the bad thing is, there are open beds at other hospitals around town. MD's don't want to drive to the other hospital so they still send them in as Direct Admits. They are told that their patient will be in the ER all night long but they don't really care. I can simpathize with the overworked MD but what about the patient who is ill and tired and in a loud crazy place for 24 to 48 hours. All you can do is try to make them comfortable and staff(if possible) an ICU or Tele nurse to care for them so ER can care for the ER cases.

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[MollyJ]

I've even heard predictions that "holding areas" in the ED are/will be a coming thing. Maybe so, but I'm not sure it adds up to good care and most of us will not cope well with the reduced capacity (bed and staff wise) on high flow nights. Can you imagine the experience of being critically ill and held in the ED for two days??? Did the patient have no family? I would have had no trouble advocating for my family member in this situation...

[D. Rowe]

I think Sarasota, Florida ER has the right idea--an admission unit. A place to hold ER admits until the floors are "ready" to take the patient, and the direct admits go to that unit and the workup begins..supposedly cuts down on lenghth of stay (something administration might listen to). The ER may have to manage the unit but you can't cut ER staffing short to staff the admission unit. Staffing issue may kill the idea at the present time, in the midst of the nursing shortage.

Actually, there's alot of places in midatlantic that already have these "observation" areas. Basically, areas for soft rule outs, but other stuff is sent there as well. They get a mini admission, 3 sets of neg. cpk's. a stress, an echo and then see ya! It's more of a reimbursement issue than lack of beds. The hospital gets more money from the insurance companies if the pt. is a 23-hour obs. pt. rather than a full admit

[julie foster]

I'm amazed to see so many places that hold pts. I just completed a travel assignment in Calif. the hospital was the first one I had ever worked in that held pts in the ED. I have since talked with several hospitals in several states and that is one of the first questions I ask. Most of them have laughed at the very idea. Not a single one has admitted to the practice -- at least not for more than 6 hours. The place I worked in Calif. frequently held ICU pts for 5-10 DAYS!!! I don't know about anyone else, but if I wanted to be a Med-Surg or an ICU nurse, I wouldn't be working in the ED!!I do not like Med-Surg and I don't feel competent to do ICU. It's not that I'm not qualified--I just don't feel competent as it's a whole different kind of nursing. For the record, this hospital did not hold for lack of beds, but for inadequate staffing in the various departments!

[AZTRAUMANURSE]

I work in a hospital that holds patients in the ED. Many times it is because no nurse on the admitting unit/ floor is available to take the patient. The intensive care nurse/ patients ratios are limited to 2-3 "stabilized" patients per nurse, whereas, the ED nurse ratios are 7+ (sometimes as many as 11) to one nurse. These patients are not "stabilized" by any means until they have been ruled out or given definitive care. If a system existed that limited the nurse/ patient ratio, and fines similar to those imposed in EMTALA violations were enacted, I don't believe there would be this burden upon the nurse.

Unfortunately, as the insurance dollar gets tighter, the admitted ER pt. is gonna be the rule rather than the exception. Hospitals would rather close floors to save money and hold a few in the ER for a day or two. One place I worked at (during the height of the flu) had 23 admits in a 15 bed ER..do the math. Until other states start following California with nurse t ratio and acuity is DEFINED, you're going to see more and more of this stuff hit

[kenny]

Originally posted by TraumaNurse30:
Every year around October our hospital census skyrockets. Patients who need admission are sent to the ED to wait when beds are not available in the hospital. We hold anywhere from 6-40 patients a day. We even get all direct admits from doctor's offices etc. Is this a common occurance and if so how do you deal with problems (ie; staffing shortages, staff moral, etc.,..) associated with holding?