Hi! I'm Tweety Your Critical Care Med Surg Nurse (Or long waits for ICU beds)

  1. 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?
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  2. 35 Comments

  3. by   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.
  4. by   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.
  5. by   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.
  6. by   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 :/
  7. by   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.
  8. by   Marie_LPN, RN
    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.
  9. 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....
  10. by   Marie_LPN, RN
    Quote from 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?)
  11. by   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!
  12. by   Marie_LPN, RN
    Our ICU/CCU is on a 2nd floor. The med-surg floor above it is a 40 bed private room floor. That floor is laid out in an H-shape, the horizontal part of that H is where the one nurse's desk is for now.

    The left side of that H will be the new 20 bed part of ICU. There will be 'minidesks' set up for each nurse (six of these) and one main ICU desk. This is also the side of the hall that has the direct elevator to ICU/CCU. The goal is to keep 5 beds reserved for the inhouse pts.

    The other side of that H, plus the horizontal part is supposed to be just med-surg, but they are thinking of turning that into part of telemetry, since they are short on space as well. And the telemetry floor is the 4th floor, so this new part would be below them too.

    IOW: The end result will be same floor, two different units. No vents on the med-surg, unless it's something like a 3 ft snowfall that keeps this place full.
    Last edit by Marie_LPN, RN on Mar 6, '04
  13. by   CCU NRS
    Quote from sagarcia210
    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.
    Same in my unit we always have one bed open for codes etc. the worst thing is when you are on divert from outpatient admits but ER continues to fill and then they need unit beds but have to wait until as above mentioned we make some moves. We always take or our inhouse Pt's tho.
  14. by   Tweety
    Quote from 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....
    In order to create critical care beds and to get chronic stable vents out of critical care. Our unit has four rooms designated vent rooms. Believe it or not all persons on vents are critical (there are vents in nursing homes and even vents at home, for people like actor Christor Reeves). Anyway, they have to meet strict criteria to come to our floor. The nurses taking care of the patient has to good to a vent class, and 24 hours of precepting in the critical care unit with vented patients.

    We've been doing this about six months now and it's working out well. So far we've only had two vents at a time. Our manager is very hesitant about having 3 or 4 vents on the floor. They are never more than a 3:1 assignment, so while they are stable they are not part of a full med-surg assignment.

    When we are short staffed, the charge nurse is usually the one assigned the vents. We were going to get a vented patient to our unit today that's been in critical care taking up a critical care bed for the last six months.

    I wish we had the budget and staff for a real step down unit. My patient really wasn't crashing and burning, or needing a vent, just hypotensive and needs q1h vital signs checks and I&Os, which can't be done on a med-surg unit. She would have been a perfect candidate for a step-down unit.

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