A week in the ER?!

[tigerlogic]

I floated down to the ER for a couple of nights to sit 1:1 (I'm a CNA) with an early onset Alzheimer's patient and much to my surprise, she had been there for 3 days and the woman next door --waiting for a court ordered involuntary admission to the state psych hospital-- had been there over a week!

My hospital does have a pysch floor--though there is always a waiting list for beds, as well as a med-surg floor (with empty spaces, usually) where the majority of the 1:1s and people waiting for open psych beds hang out/stabilize.

Is it common for people waiting on psych transfers to spend multiple days in the ER? What happens to your in-need-of-more-security-than-a-floor-bed psych patients?

I really want to be an ER nurse and was happy I floated down there, even if it was mostly watching someone sleep all night. It seemed like a great team and I was happy to help with the "altered mental state" patient.

[ckh23, BSN, RN]

As an ER nurse you most certainly will not be watching people sleep. ER nurses run their butts off regardless of it's day shift or night shift.

It has been my experience that people will spend days waiting for pysch beds. I also think a lot has to do with how the system is set up. At my old hospital, there was a crisis center in the ER, which was a locked unit that pysch patients were taken to for evaluation after a medical clearance by the ER doc. This was the crisis center for the entire county so it could get quite crowded at times. Unfortunately patients could be there for days waiting for placement. Some of it has to do with insurance, their diagnosis, available beds, etc. People waiting for state run facilities usually wait the longest because they are essentially waiting for a bed to open up for them and that could be a long time because chances are they are not the only ones waiting.

[FlyingScot, RN]

As an ER nurse you most certainly will not be watching people sleep. ER nurses run their butts off regardless of it's day shift or night shift.

Not busting your chops but I re-read the OP several times and think she was referring to what she had to do as a sitter on that particular night. I'm quite certain she was not saying that ER nurses watch patients sleeping all night.

[ckh23, BSN, RN]

Ahh yes, I see that now.

[tigerlogic]

Yeah, I'm a CNA/nursing student and do a lot of sitting on my night shifts now (apparently that's what they like using the float pool for)... But really want to be busy and certainly know that ER nurses are run off their feet. It's part of the appeal, actually

[Altra, BSN, RN]

Not typical where I have worked, though demand for mental health services certainly outpaces supply just about everywhere. An ER stay of 10 - 20 hours is typical for our psychiatric patients -- from clearance of any acute medical issues, to evaluation by a psych RN, to voluntary consent for treatment or legal approval of an involuntary admission, to precertification to obtaining an available bed at an appropriate facility to actually transferring the patient. I'm not even sure how that length of stay could even be feasible in my state, as voluntary psych admissions are generally 72 hours or less, and involuntary admissions are often less than 5 days.

[Crux1024]

Wow. A week. Ive often said that I feel our hospitals psych services needed an upgrade, but Ive never seen a pt stay in the ER for a week! Longest stay Ive seen was maybe 38 hrs. We have a 5 bed section for our Mental Health pts, and we do get the overflow into the main ER. But our MH nurses dont take dementia pts b/c our MH IP unit does not do dementia either. So Altered mental state pts get a work up and then generally sent to the floor as an admission. 99% of the time they have comorbidities that qualify them for an admission. Then our social workers and case management take over from the floor and go from there. Now, floor stays....ive seen them range weeks to months. But makes more sense to me, for them to be on the floor than left in the ER.

[brainkandy87]

What. The. Eff. Talk about improper use of an emergency department...

I think holding pts in an ER is not only improper use, but dangerous. The ER is not meant to be a place where pts stay. You're taking up an ER nurse to monitor an admitted pt. In our ER, we use a totally different system than the floors and most of the nurses can't access their system, so neither one can see what the other has done. It's just scary, IMO. If there aren't any beds in the hospital, that pt needs to get transferred the heck out or someone needs to be discharged to make room.

[sapphire18]

The hospitals around here keep psych pts in the ER for days to slightly over a week. Mental health care here SUCKS and is few and far between. These pts are generally kept in a special section of the ER, so as not to take up a medical bed. It's a terrible system.

[ERnurseM]

Any pt in the ER for more than 12 hrs no matter what it is for shows me that there is a disfunctional unit in the hospital. Either the ER or psych unit bc any where else the p would have been out of the unit by transfer or on the floor

[mariposa311]

It is not uncommon for me to work one shift and have a psych hold pt come in the ER and then I come back for another shift two days later and the patient is still there. We do not have psych services and ambulances will take psych patients to the hospital in our city that does and has a psych "pod" in their Emergency Department. But we get a lot of psych walk-ins and we have to deal with them. Most are released, many are released and are supposed to go to detox or another place on their own the next day. The ones that are involuntarily committed go by way of the police to their psych facility. But sometimes there is no place for them to go, or waiting on judge or something like that and they spend several days in the ED. It is not a good situation and I wish that more people were aware that not all hospitals have psych facilities and to go to one that does if that is what you need.

[tigerlogic]

Thanks for all the responses! I'm guessing my hospital has a kind of policy where people needing high security support stay in ER-- similarly comfort care end-of-life pts go to Oncology, regardless if it's from cancer. The available resources match the pt even if the name of the unit doesn't. It certainly doesn't feel like the best use of ER medical resources, but if there is nowhere to transfer to, at least the pts are still safe. Thank you everyone for your perspectives!