No beds available? - page 2
I was admitted to a major hospital here in Houston. I layed in the E.R. for 7 hours waiting for a bed. When I was finally settled in comfortably in my room, the lady in the bed next to me told my... Read More
Apr 29, '02well let me start by saying, i will keep this bried and short, as i have to be to work at 11am........but i guess a 100 hour paycheck is worth it right? um maybe not.
check this thread out under emergency nursing, the topic has been discussed:
"do you hold patients in the ed?"
i can tell you first hand from the er's perspective, there is nothing more we want, than to keep people moving. unfortunately, staffing, or no beds available keep us from moving people.
there are many issues that come with this topic.
1. the carts are terrible to lie on for hours on end.
2. the er does not get support from phlebotomy, linen, dietary, central transport or any other service of the hospital. which means we have to plan, transport, medicate, order tests, and follow up with inpatient care while they are down there. this all comes while trying to find hall spaces for the real er patients. why? because the admitted ones take up a lot of room. we have held patients aslong as 47 hours!
3. when we are on diversion, it is to try an deter squads somewhere else, but only works 60% of the time. unfortunately, we cannot per jacho, hicfa, emtala, etc etc tell walk ins we can't see them. 1st hand experience also tells me, we get more critical walk ins, than what comes by squad.
i know as a fact, they will close a wing, or not allow anyone to be admitted, because of staffing and/or elective surgeries and pacu etc get first dibs. there unit managers don't want to have to pay ot to keep staff late.
the bad side? the floors can refuse patients, beecause of patient volume. the er can not, which is a whole different issue.
anywyas, the possibility of no beds, or no staff is likely, (i would say 99.9% the reason for the hold. the only other thing we have found to contribute, is people failing to put dischrges in the computer. whether it's intentional or not who knows?
we had a patient dc'd from a floor, and sent back to the nh. the patient said they didn't feel good, at the hospital. they dc'd her anyways. well they arrived at the nh at 1pm. we got a call at 3pm saying they were sending the patient back to the er for eval. when we looked in the computer, the discharge was not entered until 2:30pm.
so let me ask you? how could the patient arrive at the nh 1 1/2 hours before they were discharged?
Apr 29, '02Too often, I've seen beds stay empty because Nursing is too preoccupied with wanting to maintain control... at the expense of the patient.
I agree that the ER is for emergencies,but where I live alot of people use it as their primary care. I know it's busy, I know it's uncomfortable, I know they are short staffed to. I have no solution. But I am wondering, how many of your hospitals have "Fast Tracks" or areas for 24 hour rule out MIs? These tend to clog the floor .
Apr 29, '02They've already broken ground....
couldn't get the link to go direct to the article, so here it is..if you want more, search their site for "digital hospital"
HEALTHSOUTH to Build Groundbreaking Digital Hospital
BIRMINGHAM, Ala., March 26, 2001
HealthSouth Corporation (NYSE: HRC), the nation's largest provider of outpatient surgery, diagnostic imaging and rehabilitative healthcare services, announces plans to build the world's first all-digital, automated hospital.
The hospital's technological features will include patient beds with display screens connected to the Internet, electronic medical records storage, digital imaging instead of traditional X-ray film, and a wireless communications network that will permit doctors, nurses and other healthcare professionals, armed with lightweight portable computers, to securely update and access patients' medical records from anywhere in the hospital - or around the world.
Technological improvements have increased operating efficiencies and reduced costs in many industries. The benefits, however, have been less realized in healthcare because of incompatible computer systems, lack of integration among equipment manufacturers and other obstacles. HealthSouth expects to avoid these problems by bringing on board nine of the most respected medical equipment manufacturers to work with them in the design, construction and integration of equipment that will be used in the new digital hospital.
"This will be the hospital model for the world," said Richard M. Scrushy, Chairman of the Board and Chief Executive Officer of HealthSouth. "By creating the first automated hospital, HealthSouth is taking an idea that many have talked about and making it a reality. We will demonstrate how technology can lower healthcare costs, greatly reduce human errors and provide patients with the best medical care available."
HealthSouth expects to spend $100 million to $125 million over 24 to 32 months for constructing and equipping the hospital, which will be built near HealthSouth's 92-acre campus in suburban Birmingham, Alabama. A portion of that cost will be offset by previously planned expenditures, and the total cost is expected to be well within HealthSouth's existing capital expenditure budget. Pending receipt of the necessary construction and regulatory approvals, groundbreaking for the more than 500,000 square foot, 219-bed facility is scheduled to begin in the first quarter of 2002. Construction is expected to be completed by mid to late 2003.
HealthSouth is working closely with architects and construction firms to design the new automated hospital to be a model of operating efficiency. The most-used radiology services, for example, will be located near elevators. The hospital also will be designed so that it can be upgraded easily in the future, extending its useful lifespan.
Automation will improve business processes such as record storage and retrieval, but the greatest benefits will accrue to patient care, Scrushy said. Automation will reduce human errors such as providing incorrect medication to patients. It also will reduce time spent on such labor- and time-intensive tasks as admissions, thus giving healthcare professionals more time to spend with patients.
"Our automated hospital isn't just about technology; it's about using the best technology available to provide the best medical care to patients. People deserve the highest level of care we can provide," Scrushy said.
Major manufacturers of hospital equipment, supplies and services -- including beds, surgical instruments, laboratories and pharmacies -- have signed on to work with HealthSouth to make sure that all of the technology is compatible and patient-friendly.
Other companies involved in the project include:
Carl Zeiss, an international technology leader in the fields of optics, precision engineering and electronic visualization;
Dade Behring, an international provider of quality diagnostic products and services;
Datascope, a diversified medical device company that manufactures and markets proprietary products for clinical healthcare markets in interventional cardiology and radiology, cardiovascular and vascular surgery anesthesiology, emergency medicine and critical care;
General Electric Medical Systems, the world leader in diagnostic imaging technology;
Hill-Rom, an international provider of healthcare products including beds, therapy surfaces, room furniture, modular wall systems, medical gas management systems, perinatal/neonatal products, staff/patient communication systems, stretchers, surgical columns and lighting;
Pyxis, a leading provider of medication and supply dispensing systems;
Smith and Nephew, a leading provider of medical devices principally in orthopedics, endoscopy and wound management;
STERIS, a leading marketer developer, manufacturer, and supplier of infection prevention and contamination prevention, microbial reduction, and therapy support systems, products, services, and technologies; and,
Visualization Technology, the world leader in electromagnetic image guided imagery, specializing in ENT, cranial, spine and fluoro applications.
"All of the participants have agreed to work together to ensure full integration of equipment," Scrushy said. "That is a revolutionary development, and is a major step toward overcoming the biggest obstacles in healthcare - communications gaps created by incompatible computer systems, the overdependency on paper systems for documentation and inefficiencies in daily communications."Last edit by nurs4kids on Apr 29, '02
Apr 29, '02This isn't an easy problem to fix, but I sure did get tired of being EXPECTED to fix it...keep taking patients until our 38 bed ward has every bed filled, even if we only had 2 nurses on our stepdown....get the picture?
Oh, yeah, and ICU is full and ER's intubating 2 patients, so Deb, so since you're an ICU nurse, you need to go down to ER and take 'em....get someone to watch your group, go get 'em in ER and admit 'em to PCU... set 'em up in the room closest to the desk on portable monitors and you can do all 3 jobs....(my group of 5 , charge duties, and 2 intubated ICU patients out on the floor....yeah right) Never mind calling in extra staff... "there isn't anybody". But boy oh boy that ER doc is screaming bloody murder at us to get these patients out of his ER (of course, it was HIS idea to refuse to go on divert....) Sooooo frustrating......
My favorite line is doesn't anyone realize we have to squeeze a LITTLE patient care in between all the transfering, discharging and admitting we do??
Apr 29, '02It's never as easy as it looks from the other side. Doesn't mater which side you're on. The ER is not the only area contending for each bed that comes empty. The OR/PACU think their patients get first dibs, the ICU needs to bump someone out to get another Pt from ER or OR or PACU or MS or God forbid L&D. Then, someone doesn't "bother" (that's supervisor speak for "have time") to call and update the bed needs. So, the bed for the ICU transfer sits empty because the Pt went bad and had to stay in ICU. The ICU Pt stays in the ER/PACU and the MS Pt sits in the ER waiting for another bed to open. All the time a bed is sitting "open" all day. As nurses we know we're expected to be omniscent and omnipotent, unfortunately we're just human. And as much as we try, Pts often have to suffer on gurneys. As bad as it is in the ER, it's better than the admitting waiting room or the front lobby.
Apr 29, '02So very true, Dr. Kate! We are good but not as good as management expects...we simply cannot do what cannot be done.
We can only stretch ourselves and our staff so far and then we're not effective....and have to start saying no. To do otherwise is to be unsafe, IMHO.
Apr 29, '02Dawn... I made my comments based on my own personal experiences on my own Med\Surg unit. I see the games played... Nurses who purposefully dont discharge a patient from the system (even though they were discharged hours earlier), delays in notifying housekeeping to keep a room at bay... the list is endless. On the other end of this deception are patients in pain and sickness, waiting for a bed.
I don't disagree that during those times when staffing IS short, Nursing should be able to have a say in adding another patient to an already overburdened staff.
BUT... as Jen911 pointed out, ER patients pile in one upon another... the staffing is no better and yet they are responsible for every person coming through those ER doors.
I never said the decisions to take or not accept patients were easy... but I do believe that there are many times when we on the floor unnecessarily prevent a patient admission for our (generic term) own convenience.
Apr 29, '02PRN,
Why is it safer for the ER nurses to have more patients than they can safely handle than the floor nurses?
I am sorry that you had to wait that long.
Look on the bright side, you could have been one of the lucky ones who get to wait in the waiting room or hallway for 7 hours.
Apr 29, '02Fgr8Out.......we need you in the ED!!........Not to often you hear a med/surg nurse say what you are saying........Let's face it though....people not getting discharged out of the system DOES happen ......maybe not that often where most of you work.
I absolutely HATE making admissions wait in the ED......I always make a point of knowing exactly WHY this is happening...and I always make a point of giving that reason to the patient and their family.
Go ahead and disagree with me if you want......but admissions having to be held in the ED...are NOT an ED doing...and I will NOT have the patient think it is the ED's fault in anyway that they are STUCK down there.
I love my job...I truely do....but just once i want the luxury of saying "No more patients"...."We don't have enough nurses"........my co-workers would probably call a psych eval on me.
Apr 29, '02As a telemetry nurse, I see both sides of this problem. Most of the docs in our hospital want their patients admitted to us even if they don't justify a tele bed. They will admit to us, if someone has a brief history of anything cardiac related. Then I here the horror stories of patients, who truly need monitoring spending 24-36 hours in the ER, which is shortstaffed, while I keep a chronic COPD patient who is non compliant on my floor because the doctor wants him there. In my hospital, nursing has no power to say who we get. Sometimes we get admits, only to discharge them two hours later. And the patient with real problems, syncope, ? TIA's, CVA, MI have to stay in ER. We have tried for years to get someone with authority in the ER to represent nursing who can screen the admits to tele beds so the "real patients" would come to us. Not the ortho patients who don't need tele, but the doctors like our staffing. It is disgusting and we are trying to change it, but so far nothing has worked.
Apr 30, '02I charged the other night with one other nurse - no aide and no unit clerk. Just us two. We had 6 pts. on pedi floor, then BAM! Two ICU admits and 3 floor admits in 2 hours. I called another nurse in but she was ONLY person available. ER kept calling and whining to me about how short stafffed they were and would I hurry up and accept the 2nd PICU pt (12 y/o in DKA). I refused until 3rd nurse arrived. Parents were upset because they had to wait to get admitted when "they knew I had an empty bed". It never occured to them that I was trying to prevent a situation in which their child might be at risk. EVERYBODY is shortstaffed but I can only do what I can do and I won't risk my license if it can be avoided. Thank God the first PICU (12 y/o w/grand mal sz) was stable and I could spend adequate time with DKA pt.
Apr 30, '02keep in mind here, i am not trying to stir the pot here.
however, if i had a nickel for everytime i heard........"everybody is shortstaffed but i can only do what i can do and i won't risk my license if it can be avoided."
so it brings me to this point? every goverment agency and agency r/t healthcare prohibits hospitals form refusing patients. the er gets the brunt of this situation, because we are the door into the hospital.
so makes me wonder sometimes, why some are allowed to refuse patients...because of safety? yet they pile up in the er halls, waiting room etc etc.
once they enter the waiting room, and log their complaint, seen or not, they are our responsibility.
i guess it takes a family member of someone working in the hospital to die in the wr, while having an my, pe or some other thing for anybody to see this issue.
that's why there ends up being a wait to get up to a room many times. at least patients that head upstairs have been treated and stabilized (unless it is a unit patient).
just my two cents again.....not being mean or rude :d
Apr 30, '02well then, what's the difference? They either die in the waiting room or on the floor...