How much time do you have to get the pt. to the admitting unit?

psu_213, BSN, RN · May 20, 2011

We have a "goal" time for arrival to admission (i.e. when the ED doctor officially writes the order for and admission) and we have a goal time from bed assigment made to bed occupied. The problem with the latter is that the actually amout of time it takes to get the pt to their admission bed varies based on a number of factors outside the control of the ED nurse, such as transport running behind or the floor nurse is too busy to take the pt (that one is not I complaint--I worked on a floor that got a lot of ED admissions and I understand that things get crazy on the floor). Anyway, I don't recall right off what those goal times are, but they are generally a reflection of how busy we are in the dept.

I know someone made a post a week or so ago that we in the ED want to make our lives easier by sending up pts right away, even if the floor is busy. Umm, no, not the case, we want to send up pts. quickly because our halls are full and the waiting room has 10 people in it and that will very quickly turn into 25 people waiting to be seen. In addition, it would be easier to "sit" on a worked up pt (assessment done, IV/blood work taken care of and whatnot) then to bring in a new pt, assess them, etc., etc. But we realize that it is better to get a new pt "started" than to "sit" on an old one just to make the day smoother.

Esme12, ASN, BSN, RN · May 20, 2011

http://www.ihi.org/ihi/topics/patientsafety/safetygeneral/tools/sbaremergencydepartmentreporttofloorform.htm

http://www.ahrq.gov/qual/measurix.htm

http://www.ncbi.nlm.nih.gov/pmc/articles/pmc1492152/

http://www.medscape.com/viewarticle/471369

http://www.hcup-us.ahrq.gov/reports/statbriefs/sb1.pdf

http:/www.ihi.org/ihi//topics/flow/patientflow/changes/individualchanges/examineaverageandpeakdailyemergencydepartmentadmissions.htm

here are a few web sites......most of them from government web sites bu you are looking for patient flow and quality measures. policies usually include that the ed follows through with core measure orders. they fill out a report sheet and fax it to the floor. the floor nurse has to return call with in 15 min (mininum) 30 min (max) to the ed to ask any questions about the faxed report......the patient has a 1 hour arrival time unless negotiated for a sooner time depending on supervisor approval and ed need.......

A&OxNone, MSN, RN · May 20, 2011

We have one hour from the time admit orders are given to get the patient up to the floor. Bed placement counts in that time as well. If we dont get them up, our system flags us for a reason why "Bed not ready, bed placement, ED staff not ready, unable to call report... ect" and they keep up with the stats to see how to make it quicker.

Mulan · May 20, 2011

Who's behind it and who is monitoring it?

Is it another JCAHO thing, or a patient satisfaction thing?

A&OxNone, MSN, RN · May 20, 2011

I'm pretty sure its just a hospital policy thing. We dont get scolded too much for it unless it's pretty excessive. I think it's just a tool they can use to monitor times and help the whole hospital more more smoothly

kcksk · May 21, 2011

Funny, my daughter was in the ED last year and they came in before 6:30 am and told me they were admitting her. We finally got in a room at 6:30PM that night. It was the longest day for her sitting on the gurney in the ED just waiting for a room. I understood the issue (needed a private room/tele floor-H1N1 related) but it didn't make it any easier. Up on the floor, I would rather get my admission earlier in the shift and get them settled rather than have them come up at 6-6:30 when we are winding down and getting ready for shift change. The only thing that really bugs me is that at times we get them up on the floor, all settled and then get a call to send them right down to xray, CT, or someplace like that. UGGH

gonzo1, ASN, RN · May 21, 2011

30 minutes. Very hard to do most of the time

Footballnut · May 21, 2011

We have a 30 minute goal although it is not a policy.

TNARN · May 21, 2011

No hospital policy. Is it completely unhelpful to say ASAP, my ER seem to always be waiting on beds or orders or something like that so a specific goal has never needed to be set the the ER staff. But we have goals for the floors and admitting docs. 30 min from diagnosis to admission orders, 30min for orders to floor.

Anna Flaxis, BSN, RN · May 21, 2011

30 minutes.

Esme12, ASN, BSN, RN · May 21, 2011

Who's behind it and who is monitoring it?
Is it another JCAHO thing, or a patient satisfaction thing?

It is a JACHO thing and AHRQ inicative as well as NIH and BOH standards of care thing......it's one of those behind the scene things that your boss does and turns in to the powers that be.....Where else do you think they get all those statistics....:icon_roll