Crashing MSU pt with no ICU

[ladmire87]

Hello all!

I recently became a floor manager for an MSU after working within the ER of the same facility for a little while. We are a community hospital with no ICU beds/capabilities. That being said, I talked to the Chief Physician of the ER and he recommended that we create a mini resus room on our floor so that we could stabilize patients enough  to transport them out to a higher level of care. Going back through the ER violates EMTALA as most of you know. I am receiving from pushback regarding this idea and to further it, it was discussed that if a patient crashes on our BH unit, they would come to our resus room to be stabilized, cared for, medically cleared and sent back to BH or sent out. I am curious as to what your procedures are at your community hospital with no ICU bed availability. I think having a mini-resus room is a great idea but that may be because my heart lies in the ER still. Any thoughts/recommendations? My nurses wouldn't be required to learn a large amount of new equipment as an ER nurse would assist, RT would be there, the ER provider and eventually hospitalist. I appreciate it and appreciate all that you do!

[JKL33]

Here's one take:

 If you have a "mini resus room" you thereby have a de facto intermediate care care/ICU. Not an actual ICU, not the resources for an ICU, not the *STAFFING* for an ICU.

What you'll have is a place where the higher ups expect that you can take care of the higher acuity patient(s) without even the pretense of the resources to do so.

I think if you have no ICU and no capabilities for escalating care, then you need to have an RRT and a crash cart. And beyond that you need to keep the circumstances such that there WILL be pressure to move that patient to an actual higher level of care in a timely manner.

Also, from the ER side...it isn't appropriate for the ED doc to be dealing with that any longer than the time it takes to intubate somebody.

You need a process for RRT. If somebody needs an emergent procedure you briefly involve the ED doc. Other than that you need a hospitalist arrangement where they appear *promptly* to manage the patient, instead of a situation where people with other significant responsibilities are expected to drop everything and do the hospitalist's job.

 

[ladmire87]

JKL33, this is great. I appreciate your viewpoint and there is typically a pretty quick turn-around on patients that need a higher level of care as far as getting them out of here. I work at a government facility so EMTALA applies but doesn't apply because we don't accept Medicare but in some situations of convoluted guidance. That being said, the ER director wants to be pretty hands off with inpatient side and I agree with him other than stabilization through interventional procedures that they are more comfortable with than a hospitalist may be. Thanks for your reply, I really do appreciate it! 

[FiremedicMike, RN, EMT-P]

IMHO - you'd be better served by upping the contents of your code cart to contain any additional items you'd place in that resus room, then drag that into the patient's room and run it there.  

 

As for the ED staff running the code/rapid response, I suppose if they're the only folks in house with critical care experience, it's the best option..  That said if I was in the middle of getting crushed in the ED and had to head to the floor to run a code for an hour, that would severely impact the care and throughput in the ED..

Just my thoughts..