Whew...not really a relief to know that this happens elsewhere,but at least I know I am not alone in the frustration.
I have,indeed, asked my Buds in the Ed what takes so long for an admission and it seems to be a combination of slow docs,slow docs and slow docs...one nurse even told me that if they hold the "real" patients in the ED, the stuffy noses and constipation (victims) will eventually leave after several hours of waiting.
On our med/sug/ tele floor we have 34 beds.
Occasionally we are at maximum capacity and if possible we transfer afebrile pts to other deps like OB,PEDS to make room for admissions. If we have a late discharge,we do have environmental services to clean the rooms if they leave before 2300,but occasionally an outpatient surgery we are reacting, or an out patient blood transfusion leaves after midnight and WE clean the rooms. Another bone of contention I have with this ED is that they rush to have all of the pts admitted between 0430 and 0630...ok...if they have been there since 2000 last evening,couldn't thay have arrived before 0430??????? And God forbid thay should do anything like hang the first dose of antibiotic and starting IV's is not a problem on our unit so if a pt arrives without IV access,I fill out an incident report.
We have an automated medication dispenser however we cannot get many of the meds that are ordered and we must call the house supervisor for initial doses of meds. Pharmacy has told us that we cannot have access to everything due to JCAOH standards and I have told them that is ODD to me that we can over-ride the system and get Metoprolol and Lasix IV but cannot access the p.o. meds of the same... we can also over-ride and get all classes of controlled substances...which is ok if the pt is having pain,at least we don't have to wait on the supervisor to fetch those for us. If the doc orders a STAT dose of "whatever",we have to wait and wait and wait and wait until the supervisor can break free from whatever situation is the priority of the moment.
I also had brief employment with HH and also had a very similar situation. Called to home,pt having classic MI symptoms...
c.p.,diaphoresis...blood pressure was 100/40,heart rate was 98...I fussed at her hubby for calling me before he called 911 but she was transported to the closest ED and was given a complete GI workup...never put on the monitor,no EKG,no labs...NOTHING was done. The attending physician said within earshot of me "who was the Home Health idiot who sent this stupid S&*^
here"...and of course I identified myself as the NURSE who sent her. He proceeded to call me everything but a child of God.
It was not PRETTY!!!!!!! I returned to my pts bedside and the nurse discharged her!!!!! When I asked her to advocate for this woman,she said,"I have a whole waiting room full of people to see before I get home,yall need to leave". I took the hubby aside and told him to refuse to take her home but he said "the doc said she is ok". I tried to explain to him that she was horribly neglected but he took her home anyway. Later that night the nurse taking call,notified me that my pt had just died at home.
I was heartbroken and ANGRY.
I HAVE STRAYED FROM THE SUBJECT!!!!!!!!
Anyhoo.....I cannot fathom any justification for pts being "held
hostage" in the ED unless a critical case arrives. Just seems inhumane to keep them on a stretcher for hours,then admit them in the wee hours of the morning and then they cannot be allowed to rest because we are busy doing the admission "novel" JCAOH requires and initiating the orders.
A couple of months ago, we began recieving a faxed report from the ED in an effort to expedite the admission process...the only information we get is a general demographic picture. And do they get to the floor any sooner???????? NOPE. They have still been in the ED for most of the day...not unusual for them to arrive by the
truckload at 0500...looks like the Darlington Speedway!!!!!!!!!!!
I wonder...perhaps if there were some sort of financial reward for decreasing the ED time if the docs would get offa their thrones and step down from the pedestals. But I also wonder if the patients are being charged x # of $ for the first hour, x # of $ for each half hour of the second hour, X # of # for each quarter hour after that....hmmmmmm....that's a thought.
I have had marriages that didn't last as long as some of these ED visits!!!!!!!!!!!!! HAHAHAHAHAHA...JUST KIDDING FOLKS!!!!!
Again,thank you for your time and consideration regarding this matter!!!!!!!!