Emergency Department 23 hr Observation Patients

[Rickbos]

We are about to open a new ER and the plan is to keep some patients that presently would be admitted to an inpatient unit, prior to the new hospital. The reason the ER is coming into play now is that we are a critical access facility and can only have 15 med surg beds and 10 SNIF beds. The old hospital had 31 so when we go from 31 inpat beds to 25, the frequent excess (6 patients) is going to be held in the ER. These patients will be admitted to a PCP or Hospitalist and the intent is to have our ER RNs care for them plus our Emergent patients. The Joint Commission demands that these patients get the same standard of care that they would get on an inpatient unit. We feel without additional staff, most likely additional med/surg inpat RNs to care for the OBS patients, we will not be able to care for them or our emergent patients very well. How are you handling similar situations elswhere.

Rick

[Virgo_RN, BSN, RN]

Ours is a separate unit adjacent to the ED, with its own staff.

[htrn]

Ours go to the M/S floor as ER OBS followed by the ER MD or OBS by a PCP. We do this fairly often as it's not fair to patients to keep them on these uncomfortable cots, no bathrooms, no TV, etc... for more than a few short hours. That, and we don't have the room to keep them in the ED for 12-24 hours. Things like R/O MI's with low risk factors, n/v/d that need hydration, short term pain control, etc... BTW - we are critical access as well.

[PolandM]

Ours is a separate unit adjacent to the ED, with its own staff.

As with my facility as well.

[KenzzzxzzyRNBSN]

Yup, the hospital I used to work at had a separate unit with its own staff we lovingly called purgatory, but it was the place between the ED and the inpt area where all the 23 obs went...

[Not_A_Hat_Person, RN]

The ED where I volunteered had an observation unit. It was set up like other inpatient units, with TVs and meal service.

[canoehead, BSN, RN]

They can be sent to the MS floor as OBS patients. It doesn't make sense staffing wise to change them to ED's responsibility when MS is already staffed for them.

[Tonjia]

kind of sounds like what we have been doing with "hold" patients for years. (dont get me started on that one.) I once worked at a hospital who had a separate "chest pain unit" where the patients would go to wait out their serial cardiac enzymes until cleared for discharge, but it was staffed separately. Its a lose/lose situation in my opinion. The patient loses out on consistent nursing care and attention and the nurse loses out because you feel like you arent giving good nursing care.

[galenight, BSN, RN]

We are also critical access, with a moderate ED patient volume... big fluxes some days pretty slow, others crazy. My opinion is that it is unrealistic for us to care for OBS patients adequately. There is the whole thing with a Medex, kardex, different computer system, computer charting (we chart paper) that we know nothing about. I realize we can be trained, but still. What our facility has just implemented is that we will keep ANY inpatient if census on the MED/SURG floor is zero (which does occassionally happen). Once a second patieint is to be admitted, then we can call the MS nurses and the floor will be opened up. Pity the patients if we are swamped. Their care can be severely compromised. We only have 2 nurses on staff in the ED. On midnights one is an LPN. This is not a good situation at all. Damn bean counters!

[OldnurseRN]

We keep our ED patients ( R/O MI, hydration, pain relief) that will eventually be discharged, in the ED. Any patient that needs 23 hr observation is admitted to M/S Obs. Problem with that is those Obs patients are re-evaluated every hour and the moment their presenting problem is resolved, i.e. normal enzymes, pain gone, no n/v, they have to be discharged or we don't get paid. Doesn't matter is it's 9 PM or 4 AM. We are also a critical access hospital but state accredited rather than JCAHO.