ED is in the middle of construction at my hospital and we all just received a notice from the DON which basically states:
ED wait times are too long and too many patients are coming through so...
1. As soon as discharge orders are written/ a bed becomes available, the ED no longer has to call report ahead of time. They have new options, bring the patient and give report at hand off or send the patient and call report after they have arrived.
2. The patient will be brought up as soon as the order is written and will be allowed to stay on the stretcher in the hall until the patient is discharged and the room is clean... even if the room needs TRU-D and the new patient is on some form of precautions (contact, respiratory, etc).
So basically, my understanding is that clearing out the ED is more important than patient safety....
9/10 times the patient is transported by a paramedic tech (who knows nothing about the patient) on a required portable monitor (I work on a step down unit).
These patients will need to remain on a portable monitor until the room/monitor is available. Often, we received less than stable patients from the ED. In my opinion, it is very unsafe for a potentially unstable patient to come to the unit and sit in the hall until their room is available.
Not only that, but we often have 4-5 patients (even though the "standard" is a 3:1 ratio... this means we may temporarily have 6 patients which is highly unsafe. Especially since we may or may not have report on the new patient sitting in our hallway.
To make matters worse, several patients come up with family in tow. We will be forced to send them to the waiting room for anywhere from minutes to a couple hours as we wait for discharge and terminal cleaning... only other option is to have them standing in the halls and potentially creating a hazard for employees and patients/family as they go about their way.
I am under the understanding that it is against regulations to have anything other than people in the halls of an inpatient unit as it is a safety hazard.
ED throughput is an important issue for my hospital and I understand that changes are needed. However, I see this as a huge problem, a customer satisfaction issue, and a serious safety hazard for all involved.
If a new admit that the nurse hasn't received report on were to code in the hall, it would be a disaster and potentially cause the death of a patient as the assigned nurse may not know anything about the patient and well, we are trying to code a patient on a stretcher in the hallway.
So, question is: what are your thoughts/opinions on this new policy? Is it really worth the risk to the patient to expedite ED wait times?
Our nurses are not being given any choice in the matter and may not even know they are getting the new patient until they arrive in the hallway...
