Number of beds and daily census

crb613, BSN, RN · Nov 28, 2011

We are a 13 bed ER seeing around 70-80 give or take a few....nothing else around for ~ 95-100 miles. It can be a little crazy at times. Like you our FT leaves at midnight, and we have no pharmacy at night. To answer your question..... yes those numbers sound pretty wild. I was wondering how ya'll are staffed after midnight? We go to one provider, and three nurses, one- two techs if we are lucky.

Editorial Team / Moderator · Nov 28, 2011

After midnight we go down to one provider, three to four nurses, and two or three medics. Sometimes we go don't go down to three nurses until 0300, and we're usually okay with that until a code or trauma rolls in -- that pretty much sucks up all our resources when that happens. No pharmacy or RT unless we call them in. On days there is one provider at 0700, another (a PA) in our urgent care/fast track at 0900, and a mid-level provider (ACNP or PA) at 1200. Our RN and medic staffing isn't bad, usually, though some nights are slim (with 3 nurses total, one is always tied up in triage because that never stops). I'm just constantly surprised at the number of patients we manage to put through our beds in a 24-hour period.

Anna Flaxis, BSN, RN · Nov 28, 2011

That does seem like high volume for the number of beds. We generally do >150/day with 27 beds, not counting our Fast Track beds.

Editorial Team / Moderator · Nov 28, 2011

That does seem like high volume for the number of beds. We generally do >150/day with 27 beds, not counting our Fast Track beds.

When I first got in touch with my head nurse and asked those standard questions -- number of beds and visits per day -- I thought for sure there were some typos in the response ... the volume is very high.

richardgleaton · Nov 28, 2011

M amazed to read this..How you people manage to do all thing when there are just 11 beds and you see more than 100 patients in a day..You should do something for it but the question is actually what to do...

Altra, BSN, RN · Nov 28, 2011

Lunah, are you really utilizing only 11 beds, or are you using "hallway" spaces? What is your typical number of admissions, out of that daily census?

I ask because this can have a tremendous impact on flow. One ER I worked in admitted only around 15% of presenting patients; another typically admitted > than 40%. Tremendous differences in flow/throughput.

It does sound as if you're staffed pretty well, if you still have 2-3 nurses for 11 beds when at the low staffing point at night, and if you're able to move that many patients through 11 beds that quickly, I'm guessing that the majority of chief complaints are fairly low acuity.

Interesting discussion. :)

thelema13 · Nov 28, 2011

Currently, our ED is in an old 15 bed transition unit and see ~100 a day, with 3 docs working 7a-7p, 11a-11p, 7p-7a. Always short on nurses, and our pts population is mostly 60+. I hate living in a retirement area.

They are currently renovating the ED and added on the old transition wing, so we will have 32 beds, 2 trauma bays and some RME chairs.

hiddencatRN, BSN, RN · Nov 28, 2011

We have 34 beds, but usually only 32 are open because 2 are specialty rooms and outside of our busy hours we staff enough doctors, nurses and mid-levels to keep 28 open. I'm not sure about daily numbers, but the last set of weekly numbers I have was just shy of 1500. We're not in the thick of our busy season yet- those numbers will go up significantly with increased respiratory issues (we're a peds ER). So I guess that averages to 210+ a day right now, with certain days being much heavier in volume than others.

I'm impressed with your medic staffing levels. We staff RNs to have 3-4 beds per nurse depending on area and time of day (except in urgent care), and a "good" day medic-wise is 2 or 3 for the entire department when it's busy. Usually we have 1 medic with 1-2 transporters to fill patient rooms.

Editorial Team / Moderator · Nov 28, 2011

Lunah, are you really utilizing only 11 beds, or are you using "hallway" spaces? What is your typical number of admissions, out of that daily census?
I ask because this can have a tremendous impact on flow. One ER I worked in admitted only around 15% of presenting patients; another typically admitted > than 40%. Tremendous differences in flow/throughput.
It does sound as if you're staffed pretty well, if you still have 2-3 nurses for 11 beds when at the low staffing point at night, and if you're able to move that many patients through 11 beds that quickly, I'm guessing that the majority of chief complaints are fairly low acuity.
Interesting discussion. :)

We aren't using hallway spaces that often at all. When we do, it's chairs in the hallway -- we don't have extra stretchers or space for hallway beds. I'm not sure what percentage we admit, but it's less than 40% for sure. Primarily our patients are ESI Level 3s, with some Level 2s (psych, some trauma) and some Level 1s from time to time (cardiac arrest/trauma code/respiratory-fixin'-to-die). It's definitely not all easy-peasy clinic fodder -- if it were, I'd understand how we're pulling those numbers! LOL

NeoPediRN · Nov 28, 2011

We see at least 100 patients a day...we have 14 beds in the core + 4 psych beds, 6 fast track beds, and 3 or 4 IV beds for patients who come in for IV meds. We also have multiple hall beds just in case. The core is usually a 50/50 split between ESI II/III, and we get at least 1-2 codes per day. The level IIs are usually true level IIs. We admit at least 50% of our cases. It gets wild from 3-11 when most of our volume hits.

Editorial Team / Moderator · Nov 28, 2011

I'm impressed with your medic staffing levels. We staff RNs to have 3-4 beds per nurse depending on area and time of day (except in urgent care), and a "good" day medic-wise is 2 or 3 for the entire department when it's busy. Usually we have 1 medic with 1-2 transporters to fill patient rooms.

Our staffing really isn't bad. With the way we never slow down we could use a second provider at night, but we make it work, mostly through a lot of triage protocols that ensure that the patient's workup is nearly complete by the time they're seen. Haha. Our medics are fabulous -- they can suture and give some meds, among other things; I adore them and tell them often how much I appreciate them! For a 68W/medic to go from a line unit (which means they are literally saving lives when deployed) to the ER where they're essentially relegated to tech status isn't easy for them, and we're trying to make sure they can use their scope to its fullest.

The difficult part on nights is when we go down to 3 nurses, leaving one for triage and only two in the back, one of whom is the charge nurse. The charge nurse has a daunting amount of paperwork to do at night to tally up everything for the day, and that takes a good chunk of time. On a typical busy night, that leaves one nurse covering 11 beds while the triage nurse triages and the charge nurse paper-wrangles. Not a great scenario.