Holding admitted patients in the ED

Anna Flaxis, BSN, RN · Nov 20, 2013

I don't have much sympathy for what is in your comfort zone. You are an ED nurse- suck it up, buttercup!

What I really care about is that boarding patients in the ED is a patient safety issue. It puts patients at risk, both the boarded patients and the new ones who are presenting to the ED. Boarding clogs up the ED and delays things like time from presentation to MD evaluation, diagnostics, and treatments. If I'm caring for a boarded patient as well as taking new ones, the new ones that I don't know who may or may not be stable are my priority. The boarded patient gets pushed back to the end of the line. It's not fair to them, because their routine meds, meals, comfort measures, etc. are not my priority.

I feel that once the decision to admit has been made, the process needs to be streamlined so the patient gets out of the ED and to the inpatient unit as quickly and efficiently as possible. I would look at what processes are cumbersome and contributing to boarding, and what can be done to alleviate it.

skylark, BSN, RN · Nov 20, 2013

I don't have much sympathy for what is in your comfort zone. You are an ED nurse- suck it up, buttercup!
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Just what I was thinking!

Even if they are boarding, they are still your patients.

So you feel that looking after them is outside your comfort zone?

That's tough.

They don't want to be there anymore that you want them there, but a little compassion would not go amiss.

Anna Flaxis, BSN, RN · Nov 20, 2013

I will add that in my experience, patients generally want to get out of the ED as soon as possible. It's no picnic for them, either.

loriangel14, RN · Nov 20, 2013

I don't see how giving meds would be outside of the comfort zone for a nurse.

Anna Flaxis, BSN, RN · Nov 20, 2013

I don't see how giving meds would be outside of the comfort zone for a nurse.

A lot of ED nurses don't like giving routine meds. It's a pain in the behind. We're stuck in the mentality of treating the immediate needs, and everything else can wait. Plus, a lot of the time we don't have routine meds in our Pyxis/Omnicell, and they have to be ordered from the main pharmacy. Depending on where you work, this can be a cumbersome process that you really don't have time for.

It really can be irritating to have patients that you don't know, who may or may not remain stable, who need STAT meds, and a patient who is clamoring for their lovastatin because they *always* take it at 8pm, and it's 8:30pm now. You have to explain to them that they are in the ED and that you have to prioritize, and that they may not get all of their routine meds, let alone on time....but you WILL keep them alive.

The name of the game in the ED is "throughput". Keeping patients goes against the grain.

Of course, I really shouldn't have to explain this as we are posting in the Emergency Nursing section.... ;-p

boogalina, ADN, ASN, BSN, MSN, LPN · Nov 20, 2013

Our facility deals with boarders by having float pool nurses (who are used to floor nursing and emergency nursing) take the boarders as a group.

It's not the favored assignment for anyone, but the job does get done, and hopefully without combining a mixed lost of ED patients and boarders.

hella_RN · Nov 20, 2013

I consider myself a compassionate nurse, I really do enjoy taking care or patients. I'm just having a hard time managing my time with the routine things on top on dealing with things that need to be done stat. And the charting system we have is a pain. I just hope that we are only boarding patients because of the season, I sure hope it's not the norm at this new place, but I feel like it is.

IrishErin · Nov 20, 2013

In my department we have a 12 bed 'zone' that holds admitted patients, basically like a holding cell until they can get to the floor. That way, it frees up nurses to solely look after them while other nurses can take the new patients coming in.

skylark, BSN, RN · Nov 20, 2013

In my department we have a 12 bed 'zone' that holds admitted patients, basically like a holding cell until they can get to the floor. That way, it frees up nurses to solely look after them while other nurses can take the new patients coming in.

That is standard in UK hospitals, I work in both the UK and US, and when in England, we have to get patients through and OUT of ER in four hours, its a government target and the hospital gets fined each time a patient is in the ER more than four hours.

As its not always possible to admit within that time, the ERs have a holding bay, usually 10-12 beds, just somewhere the patients can board, while at the same time be able to say that they left within four hours. (even if it was just to go to another room, 50 yards away!!)

ChristineN, BSN, RN · Nov 20, 2013

Boarding is something my ER deals with every week. It is not unheard of to have pts waiting 24-36hrs, or even longer for a bed. Pts get frustrated, cause they want a real room, and ER nurses get frustrated cause now all of our ER rooms are filling up with boarders and we won't have a lot of spots open for actual ER pts. This also increases our wait times in the waiting room.

Since my ER is constantly boarding, we have worked with other departments to try to make it run as smoothly as possible. Pharmacy is sending us 24hrs worth of routine meds at a time. Dietary stocks the pantry with more snacks and juices than we used to have. Housekeeping brings us hospital beds. The float pool sends us extra nurses and nursing assistants whenever possible. If everyone is on board it will make it much less stressful for the ER nurses.

IrishErin · Nov 20, 2013

That is standard in UK hospitals, I work in both the UK and US, and when in England, we have to get patients through and OUT of ER in four hours, its a government target and the hospital gets fined each time a patient is in the ER more than four hours.
As its not always possible to admit within that time, the ERs have a holding bay, usually 10-12 beds, just somewhere the patients can board, while at the same time be able to say that they left within four hours. (even if it was just to go to another room, 50 yards away!!)

I'm in Canada, the timing issue is the same for us. 4 hours is a benchmark