ER Workflow

Hi!

I am curious how other ERs run. For instance, in my ER the nurses are expected to take blood, start Ivs, meds, assess, procedures, document, etc. We have two medics for a 40 bed ER but they also transport our patients so they do not always have time to help out.

I have a be heard other ERs have phlebotomist that are assigned to the ER, etc. I would love to hear how other ERs are run because I feel like it can be unsafe at times expecting the nurses to do everything with very little time to get it done.

thanks!

What is your pt ratio? In my ER we have one tech for the whole department, but our ratio for stable pts is 1:4 so doing everything is normally not so difficult.

I've worked in two small hospitals and one large one.

(1) Tiny rural hospital... One RN and one tech... no phlebotomist... Techs did EKGs, RNs did everything else.

(2) Small community hospital... One RN, no tech... In-house RT and phlebotomy... Phlebotomists did blood draws, RT did EKGs and ABGs... RNs did everything else

(3) Large urban hospital... RNs and a few techs... RNs and techs do EKGs, RNs do everything else... RTs are there but only to manage ventilators...

In hospital #1, the medics from the local ambulance would usually provide assistance if asked... including starting lines and drawing blood. They were our surge capacity.

What's your patient ratio? We have nurses & med techs, no phlebotomists but our techs are able to start IV's, draw blood, do EKG's etc. (basically a med tech for us is an LVN with the exception that they can not give any med's, or do anything with the IV but start it) Our nurse patient ratio (stable) is 1:6 and it's very doable with the techs we have.

I'm in California so our ED ratio is 4:1.... 5:1 if they're admitted m/s boarders... 2:1 if they're admitted ICU boarders...

It's generally manageable and, in the large hospital, we've got enough nurses to tag-team patients to get stuff done as needed.

In the small joints, it was easy to get overwhelmed because there was no back-up...

Must be nice to have a nurse to patient ratio..

26 bed ER, full staff (dayshift) is 7 RN’s and 2 techs. RN’s and techs do EKG’s. Techs can draw blood and place foleys. Don’t forget about stocking, that seems to be their major responsibility most days:/

RN’s are responsible for everything else. RT to manage vents and run ABG’s and VBG’s.

Small comm hospital. 10+3 beds, ratios range from 3:1 to 6:1 depending on load, staffing, etc. One tech for unit if we are lucky. EKG is suppose to be done by RT. One day we will be told RNs can't draw blood, next day RNs have to draw all blood, next day help out if you can, it's a constantly changing situation. RNs do everything else.

When the **** hits the fan, we have a really good group that works well as a team. I've had EMTs go through the unit and start IVs on everything that moves because they knew we were slammed and needed the help. I've had my DON come down for a walk through and spend the next two hours doing tech jobs for me because we were too slammed, etc. song in my heart has it right, small hospitals can get overwhelmed quickly but that's when you learn if your crew is really a team or not. If they are it's all good!

Must be nice to have a nurse to patient ratio.

Yep, sure is.

CNA/NNOC!!!

45-bed department, midsize community hospital: An acute care team consists of one MD, three RNs, one tech and one secretary for up to 15 patients. ECGs are done by dedicated staff from Heart & Vascular Services (one always stationed at Triage, the other floats). One RT floats the department for nebs, ABG sticks and vent management. Techs can draw labs, start lines and insert Foleys. RNs do everything else. (Typically you and your tech will agree at the start of the shift what you want him/her to do for you - e.g. "I'll start my own lines if you can get my vitals" or some other such arrangement).

My first ER was 10 beds, 2 nurses and one doc, no techs and a triage nurse until midnight. Now in a level 1 PEDs trauma center it's 3:1 occasionally some of us will pick up a 4:1 if another assignment has one that critical or busy, usually have designated triage, resus and occasionally a resource.

In our ER, the nurses are 1:4 and 1:3 during peak. There is usually about 1 tech for every 2 nurses, sometimes there are more. There is always a float nurse to help the nurses with tasks. There is a unit secretary from 7am to 3am.

The techs can cath, draw blood, take vital signs, clean butts, splint limbs, dress wounds, ambulate and toilet pts, etc., and document all of that. Nurses must start IVs and usually collect blood then.

There is a dedicated triage nurse 24/7, and a triage provider (NP/PA) who puts in orders in triage to get labs and stuff going as the patient waits in the waiting room. For example, we will pull the patient back, draw blood and send it to lab, and put the patient back in the waiting room. By the time the patient gets a room, their labs are usually done speeding up their time in a room. From 10 to 10, there is a dedicated nurse to manage the patients in the waiting room and where they go in the ER.

We have 7 bed fast track with its own set of NPs/PAs that will also see pts in the hall. They see less acute pts and a lot of them to take pressure off of the main ER. At peak, there are two providers, two nurses, and a tech.

We have 4 senior beds for non-nursing home pts over 65 and 2 trauma/critical rooms. There are 40 ER beds total.

Lastly, we have a room that we place up to 5 people in who are anticipating discharge but are waiting for lab results/shot time/ride/etc. that prevents them from leaving. This room lets us move more patients instead of clogging rooms with people waiting on rides.

My ER is 22 bed and a 4 bed fast track. Fast track has 1 doc, 1 nurse (RN or LPN), and 1 tech. ER usually has 2-3 docs, 8 (all RN or 1-2 LPN), 3 techs, and a dedicated phlebotomist. The nurses are pretty much responsible for everything except blood for labs.

We have an EKG tech, phlebotomist and CP all assigned to the ER. Phleb stays there at all times during the day. We hve 4 techs that help with blood, IVs, splinting, foleys, etc etc. It helps with the flow a lot. That is if they arent stuck doing transports all day