Published Jun 1, 2009
I'm looking for ideas to streamline our transfer of ambulatory patients to ASU for DC. We currently have horrible delays and a great difficulty getting beds over there. Our current system is basically to wait for ASU to call us and give us a bed when available. Unfortunately, we have caught them sitting on beds before, which has lead to mistrust and our part and annoyance on their part when we keep calling and asking for beds. Frankly, we have a very bad relationship with them right now. Is that common among ASU and PACU departments? I've never worked in another PACU. Also, are there any suggestions on how to improve our system to transfer patients, so that they cannot sit on beds or do "slow" discharges? We often have to put the OR on hold because we can't move patients to ASU to open up a bed for another patient. Do any of you get to tell ASU that you are just sending them a patient, and they have to take it, like we have to take the OR patients, or does everybody have to wait for permission?
In our PACU the statistics show that the most often used delay codes are for 'bed not ready' and 'post recovery lounge (phase 2) full '....we have the same issues: late discharges upstairs in the surgical wards,declassification delays of step down pts,certain units 'sitting' on beds (we have a distrust relationship here as well, and some floors are more notorious than others for playing with the truth: "Oh yes,we called housekeeping to have the bed cleaned" to be told by housekeeping when we called to double check,that they hadn't been called!)
What has just been implemented here is an Extended Observation Unit,across the hall in our PACU B (which we don't have enough RNs to open!). One experienced RN (not PACU trained) and one experienced LPN run it 9-5 M-F. When a (non StepDown) pt is ready to be discharged from PACU but their floor bed (or lazy boy chair in phase 2) is not ready,we give report to the Extended Obs RN where the pt is monitered until the receiving unit is ready to take them.We're really hoping this improves our flow. Curiously though,they haven't had a lot of work since this began in May! We're hoping it proves useful and becomes permanent though.
We still have our share of ORs on hold due to cases not being ready for discharge.Usually when too many theatres are trying to empty at 1500!
Yes, on the odd occasion,we absolutely have to send a pt "right now" -though this is the exception and not the rule. We find it's best to tread lightly,be diplomatic,and be aware that the floor nurses are often terribly short staffed and run off their feet. If all else fails,we won't hesitate to call the Bed or Nursing Coordinators and get them involved.
Btw,does ASU stand for (Something) Surgical Unit? Not familar with the acronym :)
PostOpPrincess, BSN, RN
I wish I had answers for you as my hospital has the same problem. *sigh*
ambulatory surgical unit
We have the same issues....good rapport between nursing units is sooo important....but let's be realistic...it's tough. Our situation has improved somewhat with the implementation of RN bed managers, available 24/7. They work hard to maintain rapport, walk miles in one shift, and can challenge the nurses if "slow discharge" or sitting on empty beds is discovered. Even though we have bed boards, the computers aren't always accurate.
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