Average LOS in your ER

ALISHAJO · Dec 3, 2001

We have that problem from time to time, especially with the new ones but I have a few questions......

1. Is the ER Doc organized? We have a problem with some of our Docs being very disorganized!!! Sometimes it helps to keep them moving in the right direction!! We have a few Docs who think that they can only handle one patient at a time from beginning to discharge. You have to show them that they can do more with their time. They go see a patient , give you orders, then I quickly remove the chart from their hands (so they won't sit and ponder about this patient for several wasted minutes) and slap the next chart in their handles while pushing them gently into the next patients room, giving them a verbal report the whole time, and shut the door behind them. I give them a few minutes (while I am putting in orders in the computer and calling those departments) and then go back and check on the Doc, get the Doc anything they may need or hustle the Doc out to the next patient....you get the picture....When we are busy, I try to keep them moving or else we get bogged down very quickly!!! If you have a Doc who believes in ordering something on EVERYBODY who comes to the ER, then you will get bogged down no matter what....but sometimes I will send those nonurgent, I'm just waiting for a lab test results or xray results back out to sit in the lobby and bring the next paitent back to be assessed. Needless to say, someone has to be really organized to be able to do this. Where I work, we are staffed one RN (12 hr shift) and one MD (36-48hr shift). So when we get busy, we both have to see them anyway so why prolong the agony!! NOTE: Some Docs do rebel but I just keep them moving with promises of breaks soon and then try to give them periods when I do leave them alone for a while (everbody needs a bathroom break/supper break sometime!) They usually think I am pushy. I really don't care anymore if they do.

2. Is part of the problem the type of patients that you are getting? When we have a code, MVA/Trauma, MI, surgery patient come in, those patients do take a lot more time and assessment. I try to warn the patients that I am triaging that we are backed up or that we have serious patients in the ER at the present time. Of course, you are always going to have those patients and their family members who believe that they are the only ones who matter and that you should drop everything to care for them.

How much staff do you have working at a time and how many Docs? Even with the serious patients there is no reason that the Doc has to stay in the room the whole time(except for maybe a code), since everyone knows that the RNs are the ones doing the real work (completing the orders).

Even though it sounds like it, I am not SUPER NURSE! I just try to keep things moving even if it is at a slow pace....I don't like the complaints either and have a hard time explaining to the patients why it is taking so long when I can't see a good reason either!!! Also at our hospital, when there are complaints, administration comes down on the nursing staff since we are there all the time, not on the Docs. Sometimes I hand the patient/family member a survey sheet for them to fill out and even write the Docs name in for them!!!!

Hope this was helpful.............Lish

Bekka_Lass · Dec 5, 2001

AlishJo,

Thanks for your reply.

1. He is new and somewhat disorganized, and yes, we do try to have everything in order(labs, xrays done etc) before he sees the patient as well as grab up the carts and tell him "lets see these, they're ready for disposition".

2. Our urgent care closes at 9pm(doc quits taking pts at 8:30pm) so that isnt an option after 8:30pm...our staffing goes down to 6 to 7 nurses at 9pm and to 4 at 11pm.

3. Our patients are anywhere from a sore throat to a major trauma, we have no triage nurse after 11, so someone has to be ready to "triage" them whenever they walk in, someone has to stop and do this no mattter how busy we are and it is essential they do. We do have a PA that assists the doctor, however she is limited since he has to see each patient and she cannot discharge the patients til he has(plus his dictation seems to slow him down, I have even seen him stay over or come back for 4 hours just to dictate on pts he has seen the shift before)

The patients are informed of the wait and why things are taking so long, as well as told our scope of care ends at a certain point but that we are willing to help them with whatever we can, we do alot of PR ofcourse.

Irish Lass · Jan 8, 2002

Look for data - perhaps you need a nurse at triage after 11. Do this by tracking patients/hr - most IS systems have this info and can give it to you. Also, reevaluate your fast track hours of operation. Perhaps it needs to be open later. IF you can't pull patients by acuity you may need to do a manual tracking for a week or so.

Don't be too hard on your manager. I am certain he/she has administration providing expectations of turn around times that please the public. Unfortunately, unless the ED physicians work for the hospital, or have something in their contract, it is their medical director who needs to move them along and set the expectation for a faster patient throughput. You might appeal to their baser instincts - the more patients they see, the more money they make - if they are on an incentive. If not, suggest to the Medical Director he look at a lower base salary and incentive pay based on volume and acuity.

some days there are just more patients than room. Sad, but not unusual across the country. WE have a broken health system and no one seems to have the answer as to how to fix it.

shootemrn · Jan 9, 2002

Your department sounds identical to mine. I work as a staff nurse in a mid sized hospital which sees 45,000 (and growing!) patients a year. We have wait times that vary between 20 minutes and 12 hours. This is mostly system problems we have. We have a fast track that just expanded hours from 11am-11pm. This has eleveated some of the weight on the main department. We also do not have a dedicated triage after 11pm. We take turns dropping what we are doing and triage patients at night. The main problem we have is holding patients in the ED. Just yesterday we had 20 patients holding in our 24 bed department. Most of these patients are telemetry patients who can be down there for 2 days plus. We literally dont have the space to see patients. Flu season hasnt even hit us yet so we are in big trouble come Febuary. It seems our managment team has not adressed this problem and it literaly is a crisis.

Have any nurses out there been in similar situations and any ideas how to try to rectify this problem?

teeituptom, BSN, RN · Jan 16, 2002

Hi Yall

Right now our average LOS is 2 1/2 hours. Our Er sees about 55 to 60 k a year in volume. And our patients and administration are complaining about that. Some people are never satisfied. No matter what you do.

Thomas