Ok, so I'm hoping to get responses as soon as possible. Today my ICU manager sent out an email to all of the ICU RN's. Stating that the ER is now facing a core measure saying that they must have the patient out of the ER within two hours of walking in the door. This would allow patients to arrive to the ICU without orders. And to be prepared that the "days of having all diagnostic test (CT SCANS) complete before the patient hits the floor are gone" My own experince is as follows. Came in one morning. Got report at the same time the patient arrived on the floor. Night nurse called ER nurse and specifically asked if the CT scan was read by the doc. The nurse said yes. We then took a look at the scan and seen the patient had a huge brain bleed. I work in a small community hospital that is not equip to handle this. This was a 50 year old man. The entire process of calling transport, preparing patient,giving report, getting copies of scans, and finally getting patient to his destination took 2 hours. Second case! Patient was sent prior to getting a CT, I received him, looked horrible, needed to be intubated within mins of arriving, after that I had to take him to CT. Guess what?! another huge bleed. Here we go again, two hour process of getting him to his destination. This man died shortly upon arriving at receiving hospital. Let me add, CT is on the first floor, right next to the ER. ICU is located on the fourth floor. Please respond and tell me how you feel about this and what your facility's policy is. I personal can not believe how dangerous this will be
As an ER nurse, I'd be terrified of sending up a pt who I suspect had any type of serious injury/illness without basic labs and imaging. It's bad practice.
Nowhere did the OP state this. The 3rd-hand quote from the OP's manager was:
... And to be prepared that the "days of having all diagnostic test (CT SCANS) complete before the patient hits the floor are gone" ...
I have bolded two descriptors that I consider to be extremely pertinent to the discussion.
I've been on both sides of this at my hospital, in the ED and in the MICU. Once upon a time, it was common practice in my world to hold the patient in the ED until seen by the intensivist, until any diagnostic imaging they *thought* that they *might* possibly want were completed, to avoid having to "road trip" the patient later on. You can imagine the impact not only on ED length of stay, but also on the continuity of care for the patient.
It is this that I think the OP and the manager were referring to, and I want to ask the OP to please come back and clarify that the head CT for the patient in this scenario was indeed done, and appropriate labs were sent ... but the patient was transferred to her ICU perhaps before these were resulted.
Altra, BSN, RN
6,255 Posts
Nowhere did the OP state this. The 3rd-hand quote from the OP's manager was:
I have bolded two descriptors that I consider to be extremely pertinent to the discussion.
I've been on both sides of this at my hospital, in the ED and in the MICU. Once upon a time, it was common practice in my world to hold the patient in the ED until seen by the intensivist, until any diagnostic imaging they *thought* that they *might* possibly want were completed, to avoid having to "road trip" the patient later on. You can imagine the impact not only on ED length of stay, but also on the continuity of care for the patient.
It is this that I think the OP and the manager were referring to, and I want to ask the OP to please come back and clarify that the head CT for the patient in this scenario was indeed done, and appropriate labs were sent ... but the patient was transferred to her ICU perhaps before these were resulted.