I posted something on the SICU board about handling trauma resuscitation in the ICU rather than the ED and I'm beginning to think that what I'm thinking is "different" is actually the norm.
In the ED I used to work in, it was not at all unusual to keep a trauma patient in the trauma bay for an entire 12 hours or more. They'd come in, get the initial work-up, x-rays, ct, labs etc. and then stay put to get fluids, blood, etc. Neurosurg would hold them there to put in a ventriculostomy, Trauma surg would want to start all their lines (not just the emergent ones....) and all sorts of stuff would go on. Like I said, I frequently stayed one-on-one with a patient for an entire shift.
The way we worked things was, in the critical care area of the ED, a team of 2 nurses and 1 tech would have three ICU-type patients and three-four telly-type patients. So, if one RN is tied up with the unstable trauma (often having the tech in there to help or get her things), that leaves 1 RN with two ICU pts, and 3-4 telly patients. This seems like a bad thing to me.
So, is this typical of where you are? It always seemed like the best run traumas were the ones that were SO sick they needed to go to the OR within minutes of arriving. In and out. But, if you didn't need emergent surgery, you hung out in the trauma bay until you were "stable" or until another trauma came in and you HAD to be moved to make room.
Nov 19, '05
Our Trauma pts (excluding those that go right up to OR), stay in the ER waiting for a room upstairs just like any other pt, whether they're going to our trauma floor or SICU.
We have two trauma RNs assigned each shift; each nurse carries a separate assignment until a trauma is called. The Trauma 1 nurse is always assigned to a critical care room containing two beds; after CT, if the pt is still critical, the pt goes back with the Trauma 1 nurse to her assignment and takes one of those beds. The Trauma 2 nurse assignment is always 4 tele beds, and if the pt is fairly stable, the pt then goes back with that nurse to her assignment. That way, there is continuity of care for the pt, and we're not short a nurse on the floor.
We have a float RN who covers the trauma nurses' areas while they're in with the acute phase of the trauma. It actually used to be that the float position was always the Trauma 1 nurse, but then there was no reason for the pt to be moved out of the trauma room; hence you would have that one nurse sitting with that one pt for hours, when after several hours the pt didn't really require one on one care (already been admitted, just waiting on a bed)...and that took away the dept's one float nurse, who was needed to help with critical pts, relieve for lunches, etc.
Nov 19, '05
Shortest amount of time I've seen one stay in the ED was 8 minutes (our goal was to have this one en route to the OR in 5 minutes).
It depends on the bed situation and if we have other trauma's. Hopefully, when we find out a serious trauma is coming in, we can have an ICU bed saved for them before they even arrive. We stabilize them and then ship them to the floor or to where ever they are going (OR, vascular...).
If there is not a bed, or there only need an intermediate bed, they can sometimes stay in the trauma bay (we have 3 rooms). If they are the only patient and can be pulled to another room, or if there are multi trauma's coming and we need those rooms, then that patient gets assigned to another nurse. That other nurse does have a few other patients.
I've had medical ICU patients where I only had time to spend with them. I had to find another nurse (usually a floater) to come and help me with that patient or to care for my others. The MICU patients are the ones who usually don't have a bed and we wait several hours for a bed for them. :stone
Nov 20, '05
Do you guy typically have separate rooms for resuscitation? All our traumas came in and went directly to a bed. This meant that if there was someone in that bed, they had to be moved somewhere else. If the trauma went to the OR, the previous patient could then be moved back. I even worked trauma in hallways on rare occasions....
Nov 20, '05
We have a two bed trauma room for our trauma alerts- those beds are only used for traumas, otherwise they are empty. Only time we'll use these beds when its not a trauma is for a code if all the critical rooms are filled up with people that can't be moved out to the hall.
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