We have a 25 bed ER, no fast track beds. We see $50,000+ pts per year and in the winter we see about 150-180 pts per day...
We hold patients CONSTANTLY. Out of our 11 monitored beds and 3 portable monitors it is not uncommon for 3/4 of them to be occupied with "hold" patients.
On night shift we have 4 RN's until 3am and then we go down to 3 RNs (not including the charge RN and the triage RN) our ratio can be up to as many as 3 Critical Care holds per RN and 2 or more Med Surg holds for the same RN. We NEVER get help. Havent you heard? the hospital closes at7pm.
I do not know what the answer is, we stack people anywhere there is an available space to put a stretcher. We are beginning a remodel of our ED which will give us 35 beds, everyone is wondering if this will just give us more beds to hold patients in.
It is a problem, and no one seems to know the answer. If you guys figure it out, PLEASE let me know.
When my triage times exceed a half an hour and there are 5-6 ambulances lined up still waiting because there's no room to put any more patients, then I know it's time to call the EMS Conditions boss to close me to ambulances. Even though the walk-in's continue to come, every little thing helps. Depending on what we're holding in the ER, we're given free reign to bump up staffing as we see fit (either with OT or agency RNs). Also, when patients are admitted to Critical Care and my nursing staff is drowning, I call down the medical (or surgical) interns to do as much for patients admitted to their respective services as they can. The unfortunate thing is, sometimes there's just NO one to get. What do we do then? We do the best we can and repeat the night shift mantra.. "morning will come.. morning will come"..
GDog7NYC
19 Posts
When my triage times exceed a half an hour and there are 5-6 ambulances lined up still waiting because there's no room to put any more patients, then I know it's time to call the EMS Conditions boss to close me to ambulances. Even though the walk-in's continue to come, every little thing helps. Depending on what we're holding in the ER, we're given free reign to bump up staffing as we see fit (either with OT or agency RNs). Also, when patients are admitted to Critical Care and my nursing staff is drowning, I call down the medical (or surgical) interns to do as much for patients admitted to their respective services as they can. The unfortunate thing is, sometimes there's just NO one to get. What do we do then? We do the best we can and repeat the night shift mantra.. "morning will come.. morning will come"..