[Tweety]

We never have enough ICU beds in our hospital. They fill them up with ER admits and never have enough beds for in-house emergencies. We had a patient with sepsis low blood pressure that was low all day, well after nearly 5000 cc's of fluid bolus and a bp in the 80s they md decides to transfer to ICU for frequent bp checks and montoring. The patient had a wicked case of pneumonia and was on isolation for rule out tb.

It took 12 hours to get a bed. I took care of the patient on the floor the entire time. Taking bps q1h and running fluids at 250 cc/hr. She did o.k. and eventually I got a bed, that had been open but was unstaffed. The patient wasn't crashing and burning, and I felt confident watching her, but I neglected other duties and "my" nurses, as I was in charge, and I had another patient that was stable but vented. I also felt sure because the super. knows my skills and what a nice guy I am, she felt o.k. with making me wait. But she was a bit frustrated trying all night to figure out a way to creat a bed, the big problem being she was on r/o tb.

I filled out an incident report.

So how long do you wait for critical care beds in your hospital?

[nursemaa]

We try very hard to keep an ICU/CCU bed open for that unexpected "crash and burn" (or someone like your patient) from the floors. That means getting after docs to transfer patients out who no longer need critical care nursing. It's a tough battle, and I hate when we have to go there, but as an ex-supervisor and now a unit manager, it's really uncomfortable not to have that bed available. Sometimes, if no one can transfer out, you just have to punt. But you can almost always find a patient in ICU/CCU who really doesn't need to be there, and if you tell the doc that you need to make a bed for another patient who's condition is deteriorating, he/she usually will comply. I've been successful by using the " Dr. so-and-so, we're really in a pinch and I'm hoping you can help...." approach. Our nurses are terrific about getting patients out quickly when the floor has a patient who needs to be transferred. I also try to get another nurse, or cover the patients for the nurse who is dealing with the deteriorating patient. I would say we can usually get a floor patient into ICU/CCU within an hour or two. 12 hours is WAY too long.

[unknown99]

We try to keep 2 beds open in ICU for inhouse patients, but we have to keep one open
at all times. Sometimes it gets a little crazy trying to move beds around, though.

[EastCoast]

tweety, i can sympathize. i've seen in our faciltity the floor patients waiting to be moved while the ED patient gets the bed. I think what everyone fails to realize alot of the time is that a floor patient who needs ICU is an ICU patient who is in the wrong place. A lot of times the assignments are 'lightened' for the nurse but usually the nurse is ill-prepared to care for a critically ill patient as it is beyone the scope of her current ability in a lot of the cases. We are lucky as our ICU medical director can make all decisions to move patients without calling the attending docs but when there are 'no beds' we are screwed.
The oddest case of inappropriate care was a patient i consulted with ARF and a creatinine of 9.0 who didn't have an icu bed immediatley available so she was put on the GMF and no provisions were made in the assignment. When i went in to see her in the AM and i couldn't find her in the unit or the ED i almost fell over when i found her on the wards. It just made for a lot more work for everyone to know move her to a monitored bed.

[MandyInMS]

Ohhhh how many times have we played Ring Around the Rosie..shuffling pts back and forth....~singin~...take one down,pass him around....99 bottles of beer on the wall~
totally frustrating ..not to mention dangerous :/

[bellehill]

Wow does that sound familiar...just last night we got an admission on the floor from and outlying hospital that immediately began seizing and became unresponsive. Guess what, no ICU beds in the hospital. Our neuro ICU was short staffed and couldn't take the pt even though they had two empty beds but we couldn't keep the pt on the floor. Thankfully our ICU staff sucked it up and someone tripled patients. This morning the pt was vented and they discovered a huge head bleed, not a good prognosis.

[Marie_LPN]

They're turning half of another floor into another ICU. Twenty new beds. We never had any empty beds for anyone who took a turn for the worst.

[fergus51]

You keep vented patients on med surg? This is exactly why I avoided medsurg like the plague once I finished school. I have never worked in a hospital that had enough ICU beds....

[Marie_LPN]

Originally Posted by fergus51

You keep vented patients on med surg? This is exactly why I avoided medsurg like the plague once I finished school. I have never worked in a hospital that had enough ICU beds....

(Who were you asking?)

[fergus51]

Asking Tweety or anyone who knows. I have never heard of a vented patient being on a med-surg unit. Maybe stepdown, but even that would scare me. Can you tell I admire med-surg nurses, but NEVER want to go there myself? Too scary!