triage to fill beds or not

DanRn · Apr 4, 2002

HI All

I always try to have one open monitor bed for a critical patient that comes thru triage. on a bad day, that means filling my all the beds, but knowing one will open up soon.

i dont care about ambulance patients. they are already being treated. they usually have iv's. are on a monitor o2 and may have had meds given.

i broke my rule last week, and had a chest pain pt in the waiting room for 30 minutes. i did make him my priority pt in getting back, but nothing was really moving. we had plenty of sick pts, including icu admits. he ended up in the cath lab less than an hour after getting back.

we have an infrared badge computer tracking system to know where all our pts are at :)

KKERRN · Apr 4, 2002

DanRN,

At our ER our protocol is for all chest pains to be taken immediatly to a bed and have an EKG with in 10 minutes of arrival. They started this about 3 months or so ago. It used to be up to the triage nurse to decide.

We currently have monitors at every bedside, except our seclusion/psyc rooms. When I first started there about 2 years ago, we had only 8 monitors and we began seeing alot of chest pains coming in with no monitor available. With much c/o from staff they finallly got monitors for every bed. Our policy is we can't give NTG SL without pt on a monitor. It seemed about 50-70% really weren't true cardiac related chest pains, but several that were went to cath lab from our minor medical zones when unable to move them to our major medical beds. We play "musical beds" when possible for these pts, but some nights everyone is high acuity!! That's just life in the ER!!

How was that pt's outcome or did you hear??

We are having remodeling now and plan on a bed in triage with EKG available to help decide if pt needs immed care. We have also notice many pt see that chest pains go right back and develop chest pain in order to get a bed faster. We have 2 known homeless frequent flyers that has now started this chest pain c/o and their workups has been negative- I just pray that they don't cry wolf once too often!!!

CEN35 · Apr 4, 2002

frequent flyers? what's that? lmao!!! :chuckle :roll :chuckle you mean you have them too? :chuckle

me :)

massEDgirl · Apr 4, 2002

EKG's are done right away on all of our chest pains also. We have computer capability of getting a old one right away to compare it to....of course i would have no problem having a young chest pain, who has had cold symptoms times two weeks (with NO cardiac Hx) , wait for an EKG...that's where your triage nurses GOOD assessment skills come into play.

We have 2 beds in our triage...but NO extra EKG machine...sometimes we have to go searching for one...not always a good situation when you have patients lined out the door waiting to be triaged.

Trauma Columnist · Apr 4, 2002

We have 20 beds in ER, 10 in minor ER and two trauma rooms. At triage, we have three rooms with beds. This for level I, with 62K visits/yr. We have hall beds which just jam up our halls. We never save beds - they are all occuped 24/78!!! I'm the night charge nurse and triage RN places people if bed is available. Otherwise, they let me know if someone needs to come right back.

We have just gone to computerized board/charting with product called EMSTAT. We have monitors in each room and also have portable monitors if needed for hall bed pts.

Its chaotic at best. The nursing shortage is getting brutal.

spaz · Apr 5, 2002

The discussion here and through out these pages is awesome... thanks so much for all your imput - much of it I will take to others in my ER and see if we can make some positive changes. I look forward to exchanging more info with you all, again, thanks !

teeituptom, BSN, RN · May 6, 2002

Howdy Yall

From deep in the heart of texas

I want to hear more about this infrared badge computer tracking system. Tell us about it Dan.

I occasional find a patient getting lost still

keep it in the short grass yall

teeituptom

traumajunkee · May 7, 2002

We more than doubled our bed space 2 years ago and also doubled our hallspace and fill both most of the time. The nursing shortage is killing us also but not because of lack of ER nurses. The telemetry floor can not keep nurses so we fill our beds with tele holds and/or ICU holds and then have to go on diversion. Of course the squads in this area think diversion means "let's see how many patients we can take there anyway". We took part of our waiting room....threw up some curtains and stuck 4 stretchers out there for non monitored patients ...i.e. abd pain patients. This gets called everything from the mash unit to the corral. At least it cuts down on complaints from the lobby. It is kind of sobering to see 4 people on stretchers in the middle of the waiting room...lol. The nurses are starting to get bytchy and we could use a break. What ever happened to the days when May rolled around and you knew the census would decrease a little until school let out and we started with summer injuries? We have been at a dead run since before Christmas. I just got home from another killer. Can't you tell? *grin*.

Goodnight.

Debs

MPHkatie · May 9, 2002

:chuckle Well, we do actually almost always have the two trauma resus. rooms one is supposedly for trauma dn the other for medical- Massive MI, etc. Other than that, good luck finding a bed when you need it. We did, however, go through and put in jacks in the hall ways so now patients can be monitored from hall beds as well. I spent more time lastnight juggling patients and moving them from hall to room to hall to room. Drove me nuts, but what can you do? nobody died, so I'm calling it a good night.

LilgirlRN, ADN, RN · May 10, 2002

We call our frequent flyers repeat offenders We do try to hold an open bed when it's possible, course I can't remember the last time that was possible. We have 14 beds, all monitored, one of them is an ENT chair and 2 pelvic rooms. We also have the extended care aread, also known as overflow, set of 6 rooms sorta attached to the ED. In my estimation (which doesn't account for much) it would be best utilized as a fast track area. We currently use it when we are holding patients in the ER who have an assigned bed upstairs but it just isn't clean yet. We send these patients to overflow and put new patients in the ER. Sounds OK unless you're the nurse in the overflow area who is expected to call report on patients she knows little about. :/

Tiiki · Jul 23, 2002

Save beds?? We are lucky to find beds!!!! We have 3 ressusitation beds off our observation area. Our obs has 11 monitored beds. Those who don't require monitoring go thru corridor, or cubicles. We also have an evaluation area for pts that we need to follow. These are the ones who may be admitted or sent home pending further investgation. We always try to keep our Recuss area clear, not always possible. It's usually a juggling act. If Recuss gets full, you wonder which of the obs pts you can put in Eval...to open a bed in Recuss in case a trauma comes in. Loads of fun. We have actually put people (stable) in geri chairs hooked to monitors to free up a bed. The biggest problem our ER is facing now is lack of hospital beds. The pts are coming in needing admitting, but there aren't any beds for them. They are kept overnight in Obs, hence back logging our beds. We end up shutting down the ER cause we have no place to put anyone. It's brutal. Walk ins are always taken, but we have what's called "ambulance by-pass" which means, if it's not critical, go somewhere else. We still get pts, but not the extreme volume we're used to.

JO-ANNE

teeituptom, BSN, RN · Jul 31, 2002

Howdy yall

from deep in the heat of teaxs

fill them, might as well