ICU Holds in the ER

[ERERER]

How do you all handle ICU holds in the ER? When there are no empty beds in the ICU for the foreseeable future, and the patient will be with you in the ER for quite a while (along with your other patients and whatever comes through the door). Working in the ER i don't really have a concept of time... when are the next labs due? when are the next meds due? Is that rhythm different than one hour ago? on and on. then, just simple things like meals, linen changes, BM's. It's a mystery to me that if this patient was in the ICU, the nurse would only have him and one other to care for all shift. You know what it's like in the ER, when was the last time you only had a 2 patient assignment???

[Katnip, RN]

I know, but there's not a lot you can do about it.

We would get the charts and MAR from the ICU and use those to track what needs to be done per each patient. One day out of 21 beds we had 13 boarders supposedly going to different units. Beds were available but nurses weren't. They refused, even in med surg to take one more patient per nurse. That meant the ER had patients being treated in the halls as well.

Once in a while we could bet a "boarder nurse" who would watch all but the critical patients. That helped free us up a lot, but if we had a one-on-one patient it would hurt.

Then we'd get complaints when the patient would go to the floor without being bathed.

[mom23RN]

My old ER has floats whose job is to come down and take on the patients like they would if they were in the unit.

[teeituptom, BSN, RN]

Happens all the time, we start and continue their Orders and Treatments, and all the other stuff that goes along with it.

But we also consider them a settled and cared for pt, so we dont get a reduction in our assigned ER load either.