Got a call from the House Sup to place a NH pt with HTN, gave him a bed and no sooner than I hung up ER calls to give report. They say the pt got some Clonidine in the field but only Ativan in ER. BP has been OK sonce the pt arrived, pt had refused her daily meds at the NH.
OK......then I look up the lady's labs and find out they were drawn 5 hours ago and she's been sitting down there the whole time. The whole house census has been down, so waiting on a bed wasn't the issue.
So I'm wondering, as this has happened often....are the patients waiting for the doc to figure out what to do with them? Do they drag their feet? What seems to take so long to figure out if they admit or d/c?
Also, what's up with the admits every night from 6-7pm right before change of shift? House calls for a bed at 1630 and they want to bring the pt up at 1830....every night this happens.
I'm sure there's a good explanation for this, so let's hear it!!!
Typical day in our ED we are a teaching hospital. Pt comes in lets say HTN nurses do line and lab EKG and chest per protocol. The lab takes 45-90 minutes if the blood was not hemolysed which happens often. Then you need to redo it and rewait. The PA/intern is assigned the pt and he gets around to the pt about 30 to 3 hr as he has several other patients he needs to see. He then goes to the attending, presents the case then the attending comes over in 30-1 hr to assess the pt. He may order some other test that the intern forgot. He then calls the patients doctor if he has one then the floor resident is called to admit the pt and the supervisor is called. The floor intern comes down within the hour to assess the pt then review the chart.he then calls the resident whomay or may not come down but in the patients chart it says the pt had a cardiac hx so the pt is now r/o MI status so since 4 hours have passed they order new labs and ekgs as well as medication so there is a repeat draw and a repeat EKG. Hopefully by then the supervisor has given us a bed number if not we wait. Report is faxed we call the floor then have to wait 30 minutes to bring up the pt. That is an easy pt and a typical admit without any complications.
Welcome to a typical teaching hospital:monkeydance:
Specializes in ER, Outpatient PACU and School Nursing.
:uhoh21: wow if the floor actually called it would be a act of god where I work. How many times do I have to call and finally get a nurse to take report is more like it! besides the fact that every weekend we are holding in the ER since the floors have so many call ins... we were holding 14 last saturday am when we came in. its nothing new. as far as taking so long- traumas come first that delay the er, finding a hospitalist to come down and give orders is another or waiting for the private doctor or whoever is in call for that patient's insurance is another issue. we have standard nursing protocals to intiate the process but sometimes waiting on a ER doctor or PA to see the patient is another..
JessicRN
470 Posts
Typical day in our ED we are a teaching hospital. Pt comes in lets say HTN nurses do line and lab EKG and chest per protocol. The lab takes 45-90 minutes if the blood was not hemolysed which happens often. Then you need to redo it and rewait. The PA/intern is assigned the pt and he gets around to the pt about 30 to 3 hr as he has several other patients he needs to see. He then goes to the attending, presents the case then the attending comes over in 30-1 hr to assess the pt. He may order some other test that the intern forgot. He then calls the patients doctor if he has one then the floor resident is called to admit the pt and the supervisor is called. The floor intern comes down within the hour to assess the pt then review the chart.he then calls the resident whomay or may not come down but in the patients chart it says the pt had a cardiac hx so the pt is now r/o MI status so since 4 hours have passed they order new labs and ekgs as well as medication so there is a repeat draw and a repeat EKG. Hopefully by then the supervisor has given us a bed number if not we wait. Report is faxed we call the floor then have to wait 30 minutes to bring up the pt. That is an easy pt and a typical admit without any complications.
Welcome to a typical teaching hospital:monkeydance: