Ummmm..are they ALLOWED to do that?

Specialties Emergency

Published

OK, I have worked in about 5-6 different ERS, both as staff and agency an I have never experienced this. Right now I am doing a contract in a dinky little community non-teaching hospital. The ER is understaffed and bursting at seams because they admit everyone who rolls in the freaking door. Well the other night nursing supervisor called to say that she was sending the ER a patient from med surg with a positive troponin because ICU was full. Ummm can they do that? We only had 4 nurses first of all(no secretary, no tech), with almost every bed full most of them in a holding pattern. And the patient was going to be MINE. I already had 7 patients, ALL of them holds. Its like I am not even an ER nurse anymore. But can they do that....just turf pts from the floors BACK down to ER, especially when WE are already overwhelmed? The ER nurses say it is done all the time and when they threatned to complain they were told by supervisor that " Go ahead and when we get shut down we will all be out of a job" So there are 12 ICU beds with 6 nurses and 30 ER beds, with 4 nurses? How is that fair?

I do not understand why this would be an emtala violation. When the patient comes down to the ER, they continue under the care of their admitting physician along with their orders. The ER doc does not get involved in their care. If we need an order, we call the attending. Why is this different than say going from tele to ICU?

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hmm for your E.D. that you describe as being a "dinky little community non-teaching hospital" you seem overwhelmed. Good thing you do not work in a non-dinky big teaching hospital E.D.

Swtooth

Been there and done that...not that much difference.. teaching hospitals just have fancier equipment. I worked trauma icu in a teaching hospital for 4 years and sicu unit for 8 and have been quite happy in smallville for the last 10 years.

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Specializes in Cardio Vascular, Diabetes Educ,CCU/MSICU.

This, I agree is an internal problem, not an ED problem. Get a NM with a backbone or an ERMD with "huevos" to stand up for you. EG. We have had residents want to send a pt down for sutures after a fall upstairs- we told them to come get a lac. tray and have at it - not our problem as the pt. is an IN- patient. Same thing goes for Tele/ ICU problems- let them duke it out. The most accomodating we will be is to be "the Code bed" if ICU is full. Fight for those pt ratios ladies!!!!!!!! The law was passed years before they complied and I wouldn't work in any other state that doesn't have them- pt acuity is much too high to put your licenses on the line for people who won't back you when the you know what hits the you know what.

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Specializes in Case Management.

Mental note to self:

Never go to a "dinkly little nonteaching hospital" with chest pain. You never know where you are going to end up ;)

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Specializes in Tele, ICU, ER.

We've had this happen in our ER - we spend more than half our time filling up the ICU beds and floor beds, Lord knows! When someone on the floor goes south and there are NO ICU beds (as in, they already have the overflow full), the patient comes to the ER. Occassionally, they'll get an ICU nurse to come in and care for the patient (more likely to happen on days, than nights) and then they're just basically using our bed & monitor. But there have been times when it's a patient simply added to my zone. I treat it as an ICU hold - lord knows we have THOSE often enough!

Now the "the patient is too sick" thing does drive me nuts LOL. Too sick for WHAT? Do we need to admit to the Super-ICU on the roof? Would love to see the orientation to THAT unit! Seriously, sometimes I do wonder, when I've got 5 patients, including that "too sick" patient and the WR is full and the ICU nurse has her ONE patient (and one empty bed for my "too sick" patient) and they stall on the admit. C'mon, it's not like I LIKE having to give you report and send you a patient. That's what we DO here, yanno? Had an ICU nurse once tell me that she coud'nt take report just now cause her other pt had died earlier and she had to do the paperwork. I told her she could deal with the LIVE patient now and do the other paperwork later (which is what we have to do in the ER). Had to wait TWO hours for them to be ready for that one patient I was sending.

I've had a few nights where I've come into an admitted ICU patient where I HAVE spent 2 hours stabilizing them (with 5 ggts and nearly no bp) before I sent them up, because I didn't think they'd handle the ride up the elevator. But that's few and far between.

To all ICU and floor nurses - we KNOW you're swamped, truly we do - but WE are too and once all your beds are full, you don't get any more. Once our beds are full, they just line up and hollar at us until we find them a place. Oh and that's OUR fault, btw.

Sorry - really really peeved right now at my place. Love all the ICU nurses and floor nurses (for the most part) - you guys do a phenomenal job and take the same abuse the rest of us do. I think we need a giant worldwide nurses' happy hour! Let the suits cover the floors for us. AND foot the bill.

Marguaritas anyone?

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you guys do a phenomenal job and take the same abuse the rest of us do. I think we need a giant worldwide nurses' happy hour! Let the suits cover the floors for us. AND foot the bill.

Marguaritas anyone?

Now THAT is a great idea!:smiley_aa

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Specializes in ED/Trauma.

Where I am now is the only ER I"ve EVER worked that will take sick floor pts when ICU is full. Sometimes PACU will take them,depending on their census.But if they feel too BUSY! they will refuse!!!. This is where the house sup should step in and make an executive decision.But they don"t want to UPSET PACU!! Apparently pissing off ER staff is OK..

Luckily we now have a Director with actual ER experience[for a change],so she is trying to change that.

And if we get 3 ICU holds they have to send us an ICU nurse..YEAH..

But generally speaking the ER is the dumping ground for everything!!

They don"t seem to realise we can"t say "We"re full,can"t take any more pt"s". Don"t I wish!!!

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Where I am now is the only ER I"ve EVER worked that will take sick floor pts when ICU is full. Sometimes PACU will take them,depending on their census.But if they feel too BUSY! they will refuse!!!. This is where the house sup should step in and make an executive decision.But they don"t want to UPSET PACU!! Apparently pissing off ER staff is OK..

Luckily we now have a Director with actual ER experience[for a change],so she is trying to change that.

And if we get 3 ICU holds they have to send us an ICU nurse..YEAH..

But generally speaking the ER is the dumping ground for everything!!

They don"t seem to realise we can"t say "We"re full,can"t take any more pt"s". Don"t I wish!!!

i looked into this recently, as we have been swamped with admissions and crashing in house pts. moving an already admitted pt back to the ed IS an emtala violation. you can call in a cc nurse to take care of the pt on the floor he or she is on, or you can use a closed pacu unit with staff. but sending a pt BACK to the ed is *dumping,* and further backing up the entire ems system.

also, if you work ed and an ambulance comes in with a pt, they are not required to stay with them until we get a bed. that is also an emtala violation. the ems people and medics are not to be hold hostage by the ed. they are part of an ems system that is provided to the public....NOT hospitals. we have to accept the pt and relieve them in a timely manner. it is the HOSPITAL'S responsibility, and not the towns etc, to care for them. this may mean more staff etc, but to hold the ems system hostage in the ed hall is basically refusing the pt, which *is* an emtala violation.

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Specializes in Emergency Department.

Where I work if the ICU is full we send patients to the ED. They are a crtical care area and a med-surg unit is not. In the ED the patient can be put on tele, vent, whatever

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Specializes in ICU-Stepdown.
i looked into this recently, as we have been swamped with admissions and crashing in house pts. moving an already admitted pt back to the ed IS an emtala violation. you can call in a cc nurse to take care of the pt on the floor he or she is on, or you can use a closed pacu unit with staff. but sending a pt BACK to the ed is *dumping,* and further backing up the entire ems system.

also, if you work ed and an ambulance comes in with a pt, they are not required to stay with them until we get a bed. that is also an emtala violation. the ems people and medics are not to be hold hostage by the ed. they are part of an ems system that is provided to the public....NOT hospitals. we have to accept the pt and relieve them in a timely manner. it is the HOSPITAL'S responsibility, and not the towns etc, to care for them. this may mean more staff etc, but to hold the ems system hostage in the ed hall is basically refusing the pt, which *is* an emtala violation.

RIGHT YOU ARE! And even though back when I did work in EMS, it DID happen from time to time, we weren't oblivious to the situation, and DID try to stick around and 'babysit' long enough for things to get shuffled around -but that really WAS at the whim and permission of dispatch. If the county was hopping, we could not stick around.

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Where I work if the ICU is full we send patients to the ED. They are a crtical care area and a med-surg unit is not. In the ED the patient can be put on tele, vent, whatever

you can also put a crash cart and a vent and a cc rn anywhere, even in a m/s room.

you can not send them back to the "emergency" department. it is a federal violation of emtala and your hospital could lose its medicare and medicaid reimbursement.

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I'll admit my EMTALA knowledge is limited, but how is keeping a patient in the same hospital, under the care of the same MD, just housing them in the ER of that same hospital, rather than outside the ER of that same hospital a violation of EMTALA? They aren't being refused care, they aren't being turfed to another hospital. They just being housed in a different part of the same hospital. How does this violate EMTALA?

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