Admissions Right Before Shift Change???***

[wife&mommyRN]

Hello Everyone,

I am finishing up my last few days of my preceptorship. I am just curious, what is everyone else's hospital policies regarding new admits. The unit that I am on will admit a postop pt as late as 6:45p. It seems very dangerous and strange considering postop pts need alot of attention within the 1st few hours. I would think they would at least wait until their vitals are stabilized to every hour and they are able to order food. Does any hospital provide a window that doesn't allow new admissions? 6p- 8p seems like a window that alot of mistakes and medical errors happen with the new admissions. Just Curious. Thanks in advance for any comments. :)

[caroladybelle, BSN, RN]

The points that you make are valid; however, most hospitals do not have a "window" for any pts. And those that do, generally refer only to true admits, not to transfers of postop pts.

PACU/OR time is very expensive frequently charged in increments of 15 minutes. It is also valuable in that the OR room and the PACU beds needed to be turned over quickly. Also, a delay of 15 minutes to two hours, may cause a backup and inconveniences many different people, not the least the surgeons and anesthetists. No pt's insurance is going to willingly reimburse for 30minutes to 2 hrs of PACU time that was not meritted. And about the time an MD has to hold up unnecessarily for 30 minutes or more for a reason such as "the floor nurse cannot receive a pt because is too close to shift change", there will be a riot among those MDs. And trust me, administration will listen to their voices more than others as they bring in the money.

You also have family members in the waiting for their loved one. Increasing that wait can cause issues.

As far as true admits from the ER. The ER has no ability to regulate what comes in and out....they must take all comers at ANY time. If they have something that is serious coming in, they need to clear beds, PERIOD! Your complaint about the safety issues of getting an admit at shift change will fall on deaf ears, when they have no choice as to when to take a pt, and what condition that the pt is coming in is in.

While you are very correct that it is problematic to receive pts at shift change, it is highly unlikely to change due to PR and financial concerns. It is problematic, but has to be dealt with.

[krstxn]

This was the problem on our unit as well-- it got so bad that we were not allowed to get admissions between 615pm and 715 pm. Our manager had to work hard for this to happen. Obviously when more critical patients are coming in they will bring them to us to make room-- but you all know what I am talking about when nurses dump patients on other units right at shift change! This is what we were trying to avoid!

[ktsummar, LPN, LVN]

Are policy states no new admits after 6:30 on our floor. But it does still happen. There are days it can be frustrating, but we take pride in getting them to floor, stable and a good report for the night shift.

[carolinapooh, BSN, RN]

All I can say is - welcome to nursing. :)

[Lunah, MSN, RN]

Unfortunately we can't lock the ER doors at 1845, or even at 0645. I try my best to not send a patient during change of shift, but sometimes it can't be helped. Welcome to nursing indeed. :)

[Music in My Heart]

The ED tries not to send up admits within 30 mins of report but, only if they've got the capacity to hold 'em.

If they do show up then, we don't do much beyond banding, getting the O's and fluids set, doing a quick assessment, and making sure they're safe. Everybody pitches in to help.