Pt beds in the hallway

[Nurse1966]

Not to start an ER vs. Med/Surg/ICU battle, but I attended a class at work that turned ugly. What it boils down to is: ER nurses wanting to add patient beds to the (med/surg/tele/ICU) floors in the hallway, to facilitate moving patients out of the ER quicker. And the hospital is considering it. Has anyone ever heard of this? We're talking about putting sick patients in hospital beds in the hallway and providing patient care there. I see so many things wrong with that picture, but they all thought it was a perfectly acceptable solution to fixing "flow" problems in the ED. Any thoughts on the matter, without starting World War III?

[gonzo1, ASN, RN]

I'm an ER nurse and I think hallway beds on the floor would be awful. The nurses that gave you a hard time at the meeting must be totally burned out and stressed from their work condition in their ER.

The above poster is right that worse times are yet to come.

Sorry you were made to feel isolated and wrong.

[canoehead, BSN, RN]

It's wrong for the floor, but it's just as wrong for the ER. It should violate so many laws that hall beds are only an option in cases of disaster, but apparently JCAHO doesn't mind, so long as the hospitals are making money.

[Sabby_NC]

Not for me I would be so outta there you would see flames flicking off my shoes... LOL... I think part of the growing problem (especially in our local hospital, from what I hear) that the ED is used as a Drs Office for those that do not have insurance! Hence the back log of patients. This appears to be a growing problem. Maybe ED's need to be looking at some way of those that are there with problems that could be sorted out in a Drs Office of having a fast track outta there! I do not know what the answers are to this dilemma but either way it is not perfect. I just know I would hate to be laying in a flipping hallway. I see safety, fire and privacy issues to start with.

[MissJoRN, RN]

Is that not a fire code regulation? Like when you have a fire alarm you have to clear the halls..where would you put them?

Picturing myself wheeling a guy who happens to be sitting on the commode (with his hairy butt sticking out) down the hall to store him in a closet until the fire alarm is over...

Seriously, no. Not OK.

We've kept pts in the treatment room, day room, etc for a couple hours until a pending DC leaves. That's only acceptable IMO since we are expanding and should only be until the new wing opens. The hospital down the street has kept pts in the dayroom for days, but they set it up relatively nicely.

[time4meRN]

I remember the "old days " when pt's used to be in the halls all of the time. But , I was sooo, glad when that stopped. I know we put pt's in the halls in our ER, I hate that too. I don't mind when there is no room and the pt needs a bed, but we're putting them there for paper work to look good. Thay way we can say there is less wait time in triage. A bunch of BS. I wouldn't want to be asked about vag drainage, or rectal pain or have an EKG done in the hall. Hippa is so big now, it amazes me that this is allowed as general practice for non emergent cases or on the floors for that matter. Many ER's won't go on diversion these days so the inflow never ends. Your right , it woun't change until admin wakes up. I have refused to take pt's in the hall etc. It's a matter of my license. Enough is enough with pt load. I'm sure it's the same for you on the floor. I've gotten so I encourage pt's to major complain. Seem now days the only thing that makes a difference to the poweres to be is pt opinion.

[rita359]

In the first hospital I worked in from 1968-1973 we would occasionally have patients in the hallway. Haven't seen it anywhere since except did find my son, who was 4 days post MI, in the visitors lounge on a mattress with one of the phones from the unit for a "call light". His discharge orders were written and was waiting for me to pick up.

[AM-RN]

my er actually has portable call lights. they hook on the iv pole on the cart. pt pushes button on cord - yellow flashing light appears.

i hate hallway pts. however, we frequently have to pull a patient out of a room to accomodate life threatening illness. the 'pulled out' patient is usually just awating admit & is stable.

the truly sick have no problems being anywhere...if you are well enough to sign out ama...they you're well enough to be at home.

[ChocoholicRN]

Aside from all the obvious things people have pointed out such as HIPAA violations, patient privacy, and fire safety regulations, there's a few other things I thought of. Every single room at our hospital has wall attachments for air, oxygen, and suction. How would you accomodate patients who need these if they were placed in the hallway? Maybe you could keep an oxygen tank on or under their bed, but what if they need suction or have an NG tube to suction? And what if one of these patients codes? Are the doctors and nurses going to perform a code in the middle of the hallway with other patients and visitors just strolling by? Last thing, how does this work with insurance? I know the rooms on the floor where I work and very nice, and very very expensive if you don't have insurance. So if we had a patient who was placed in the hallway instead of in a room, do they still get charged for the room even though they never actually stayed in one? Will we start charging people for hallway space? This whole situation just baffles me. Sorry about the rant, I just had to get my thoughts out on this.

[SmilingBluEyes]

I think it's horrible for all the reasons already stated.

[ZootRN]

What does risk management of the hospital think about it? It's just waiting for a big lawsuit to happen, for all the reasons that PPs stated.

[mshultz]

If the hospital is completely full, if the ER is completely full (with hallway patients) and the nearby hospitals are completely full, what else can you do?

This is the fundamental issue. Even if you provided the funding today, it would still take years to train the healthcare workers and build the facilities needed to solve the problem.

[neneRN, BSN, RN]

i have worked in a hospital that would put stretchers in halls of ER, but NEVER on the floors! The ER just had to go on diversion if that was the case. and this was in a city hopsital.

The problem with going on diversion (aside from the fact that administration will do everything in their power to avoid it) is that you can only divert stable EMS patients. Anyone who is truly sick or needs trauma/stroke center still has to come whether you are on diversion or not. Also, if you are on diversion and a pt tells the ambulance crew that he wants to go to that hospital anyway, they still have to bring them to us. Finally, on diversion, you cannot turn away any pts that come in through the lobby. So basically, diversion means that ONLY STABLE EMS PTS WHO DON'T HAVE A HOSPITAL PREFERENCE are diverted...everyone else still gets to come. Kind of defeats the purpose!