Great Study about the Holding Nightmare

Published

Specializes in mostly in the basement.

The Academy of Emergency Physicians completed a really thorough and, IMHO, excellent report about the true 'why's' of the ER boarding situation and, more importantly, REAL solutions to this ever increasing issue.

http://www.acep.org/WorkArea/downloadasset.aspx?id=37960

I'll admit I also was impressed that despite what many of us hear all the time at work, ER through-put is not primarily all our fault! Lol...

I guess we would assume they wouldn't go after their compadres.

Actually, please do check it out--it's short and to the points--but some key findings:

Contrary to popular media belief, it is not the FF's or increased fast-trak appropriate patients who are bogging us down. It's not EMTALA. It generally isn't ER dept. staffing. In fact, at the crux of it, it's not really an ER problem at all. It's a hospital and floor through-put issue. (I know, many of you already know this).

It really examines how admin. and the inpatient side of the house haven't yet embraced the idea of a 24 hour/7 day a week operation. (Ugh, my previous position was in a lauded "stroke center" where after 2200 it would take about an hour for the on-call CT tech to get there)

Just good stuff...

What doesn't work?

Expanding our departments. Building a bigger, better ED, etc. Increased use of hospitalists are great for overall length of hospital stay but negatively affect ER holding times. Diverting? Not even a good short term tactic.

What does?

Dedicated "admit" nurse/team. Moving boarders up to the floors to do the hallway thing there---spread the pain as it were. No off-limit times of the day for calling report/sending patients up. More tech and support staff!! (Who knew?) EMR and perhaps hiring of physician "scribes" for dictations/charting. Oh, and this is my favorite--

"The use of

scribes for nurses is unstudied, although few

would question the burden of documentation

borne by the nursing staff."

I'm in love I tell ya....

OK, Im writing too much and forgive me if someone already posted this but it was SO refreshing to read about an issue that impacts our daily lives SO much and not only have someone 'get it' and be borne out by lots of EBR, but also be provided honest to goodness do-able solutions!

Alas, these solutions will require some $$$ so we'll see where the recommendations actually go. But here's a sobering fact:

You all know about the core measure w/abx under 4 from triage for PNA? Well, turns out, compliance with that ultra important and multiply documented care goal reduces likelihood of those who would have otherwise died to 93/100.

Having patients be seen in a non-crowded ER rather than a boarded/crowded one reduces the number of same to between 75-83/100.

That's huge people!

Anyway, hope you check it out....Lots more stuff there.....

Best!

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Specializes in ICU, CCU, Trauma, neuro, Geriatrics.

Well, possibly we need to embrace a 24/7 staffing issue too. When the floors are downsized in staffing on evenings and nights especially after 7pm when "everyone who is anyone" goes home, give same staffing from 'adminstration to housekeeping' then maybe the flow would improve.

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Specializes in Emergency & Trauma/Adult ICU.

Excellent reading.

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Specializes in mostly in the basement.

:yeahthat:

snowfreezeRe: Great Study about the Holding Nightmare

Well, possibly we need to embrace a 24/7 staffing issue too. When the floors are downsized in staffing on evenings and nights especially after 7pm when "everyone who is anyone" goes home, give same staffing from 'adminstration to housekeeping' then maybe the flow would improve.

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Have to say, just a point-on summary of what the authors found as well, Snowfreeze.

Right on!

I have to say I'm grateful to see folks taking a moment to review the relevant info before adding their own famous 2 cents into a thread.

Your post though..... I'm saying like syncronicity w/those authors.

Otherwise, we would be bordering on some spooky territory.

:stone

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Specializes in Critical Care/Teaching.

When I first started in the ER, when they told us that we would have 'borders' due to no beds, I thought literlly no beds....but I have soon come to find out it really means no nurses!!!

What I hate most about it is, the floors have their cap off. Like 6/per nurse or whatever, but in the ER I have had up to 10!! When they keep coming in and no place for them to go!!! I just think we get the shaft most of the time!!

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Specializes in ICU, Telemetry.

I really do feel for the folks in our ER; we're a rural hospital on the interstate, so basically we've got all the locals and anyone driving from up or down the coast who gets sick on the road. However, when we literally have no beds on the floor, we can't take patients no matter how long they've been in a holding pattern in the ER. I think a lot of the ER hold issue could be resolved if we had beds to put them in and staff to look after them. We know the population is aging and they are going to need more, not less care. We need to increase the bed space now, not 5 years from now.

But hey, they bought new pictures for the ER waiting room, that ought to take care of it....

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