Help, ER getting swamped.

S.T.A.C.E.Y, LPN · Dec 7, 2007

Can your triage nurses send patients for X-rays from the waiting room? Labs done in WR?

If you are holding onto admitted patients who don't have a bed, and your WR is full of people waiting to come in, maybe your hospital can institute a policy where you send them up to the floor and wait in the hallways up there to free up some bedspace in the ER.

AlabamaRN(ER) · Dec 7, 2007

Hi! Tell me a little bit about your ER. How many beds do you have? How many nurses do you staff?

Our ER is implementing a new program--it's still in its infancy, but is working quite well. Our LWOTs have been reduced to 1%.

We have 19 beds. Each nurse is assigned three beds. We have one "critical room" assignment, and that nurse has only two beds. We are staffing an MD in triage on our busiest days (Friday through Monday). The triage MD sees every pt who comes through and decides whether the pt is a "fast track" pt or should go "to the back", where the other MD will see and treat them. The MD "in the back" has 10 rooms. Many times some of these rooms are empty, because so many of our patients are "fast track" type patients. Some patients are actually discharged from triage--they only need a prescription for a minor ailment, and the triage MD does the T-sheet and writes the prescription in triage. It's amazing how many patients we can see on a busy day. Our triage MD handles all non-critical patients, and patients who will not require a big work-up. Time-consuming procedures, like sutures, will go to the back, because they would tie up the triage MD.

If you're interested in knowing more about this system, please PM me. If my email address isn't accessible, write me on this forum and I will send it to you.

Good luck!

ZippyGBR, BSN, RN · Dec 7, 2007

again one where the evil excesses of socialised healthcare chalks up some points

in the Uk we have an 98 % of patients should be seen and either admitted or discharged from the ED within 4 hours target - falilure to meet this over the quarter leads to the trust being fined

if a patient spends more than 12 hours in the ED region get involved and heads usually roll ...

ikimiwi · Dec 8, 2007

I would love to hear about it. We are trying to work it out and do a trial one of these days. Any info would be so helpful. [email protected]

nursemoons14 · Dec 12, 2007

We have had a lot of c hanges recently due to the insane amount of admitted pt.s in the ED. At one point we had 34 of our 35 ED beds filled with admitted pt's. Insane, and not safe. They put a lot of money and time into a committee made of all floors and ED staff members/CN's. We now fax report to all floors except icu/ccu, instead of getting the bs stories from medicine floors like "beds not ready, rn's on break" im sure you've heard them too, as soon as its in the computer there's a bed, we fax report, do a computerized page to the nurse who's recieveing them (they carry a phone) and send dthem up, no questions asked. The CN's do a bed huddle every shift to talk about future openings of beds and what they can do to shuffle them around. But the Faxing by far has been awesome

mmutk, BSN, RN, EMT-I · Dec 13, 2007

We have allot of protocols are RNs order or give meds prior to seeing an MD.

nursemoons14 · Dec 15, 2007

We are getting killed this season and are looking for good ideas to keep the flow moving. Do you have specific parameters for your hold patients, icu admits and other special patients-are you initiating admitting orders in full? Do you do anything special to streamline your patients through ER process? Any feedback would be appreciated. Currently management is open to suggestions, I'd be happy to provide it.
Thanks,
Maisy;)

do you have medical directives in place?

ZippyGBR, BSN, RN · Dec 15, 2007

sounds like a lot of the ideas from the 'evil ,socialised medicine' world of the NHS are making it across the water , specifically

- patient group directives or equivalent systems for medication to be adminstered at triage

- systems to allow referral for plain film imaging and for basic pathology from triage - so who ever sees the patient does so with the investigations already complete

- effective bed management systems and streamlined handover systems

there is only so much that can be done to cahnge systems with some of the illogicla restrictions on healthcare practice (AKA legalised turf wars e.g. only advanced practice RNS and DOcs can suture ... , non registered staff can't do X,Y or Z, only RNs can do p, Q or R ...)

EDBSN · Dec 16, 2007

Our ED is working with a consultant to create the number 1 ED in the region. We are starting to make changes... What you have discussed sounds interesting... How have you been able to speed patients through your ED?

Mickiswhirled · Mar 12, 2008

Our ER has recently been swamped. We have instituted a bed czar position to help with placement of the beds. It has so far relieved the stress of waiting for the inpatient floor Leads to assign a bed. We still have issues with movement from and to the floors. Has anyone worked with bed czars. This is new for our House Supervisors and were looking for ways to make this a team effort with this new position.

dortizjr1 · Mar 18, 2008

again one where the evil excesses of socialised healthcare chalks up some points
in the Uk we have an 98 % of patients should be seen and either admitted or discharged from the ED within 4 hours target - falilure to meet this over the quarter leads to the trust being fined
if a patient spends more than 12 hours in the ED region get involved and heads usually roll ...

Yeah but what happens when the hospital is full? I work in a small rural hospital. We total at 150 beds and we've ended up holding patients in the ED for three days. The ED i work in has 20 beds total. We resort to moving regular hospital beds out of storage into our treatment rooms and then half the ED gets turned into a medsurg/ICU ward. In the mean time we've still got ambulances coming in, and the front doors are still open to the public. I mean the 4 hour rule is nice but what would happen in the UK in this circumstance?