Help, ER getting swamped.

[MAISY, RN-ER]

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;)

[kmoonshine, RN]

Do you have standing orders/protocols?

We have a flow nurse whose job is to expedite discharges and improve the "flow" - if a patient is up for discharge and primary nurse is busy, the flow nurse will discharge them. An ambulance rolls in and the other nurses are busy, then they'll take report. Any tasks taking 5-min. or less can be handled by the flow nurse (IV's, simple medication administration, etc). This only works if the flow nurse is strong in skills and swift in practice. A slacker flow nurse can actually slow down the department.

Can triage order xrays (distal to elbow, distal to knees) on fast-track patients? The patient would probably be back from xray even before a doc grabbed the chart - that way ace bandages/suturing/splinting can take place during the first physician/PA/NP encounter.

[medichall]

We have a NP or PA in triage that orders meds, labs, x-rays etc from triage, then off to the waiting room for these guys and usually a quick d/c from triage when results are back.

Something our hospital is trying is sending "admitted pts" to our out pt surgery holding beds, while waiting for the pt to be d/c'd upstairs and the room cleaned etc, this is freeing up beds in the ED and cutting down on wait times.