ICU Overflow, What Happens Then?

JenRN30, BSN · May 20, 2013

So, are you saying that they make someone triple with a post-code? Wrong, if that's the case. I work at a large hospital with neuro, cv, surgical, medical, and trauma icu's, so we usually have a few beds open. If we didn't and had someone that needed to come to the unit, we'd try to see if any of our patients could be transferred to the floor. If not, and we had no beds, they'd have to go to the ED to be held until a bed opened.

ETA: just reread your post. If we had an admit that needed to come to our unit, we'd send a patient to one of the other units to make room.

MunoRN, RN · May 20, 2013

We triage down to the floors to start with, then go on "divert". In the rare instances we go on divert ICU level admits get flown anywhere from 40 to 300 miles away.

BrandonB779 · May 20, 2013

So, are you saying that they make someone triple with a post-code? Wrong, if that's the case. I work at a large hospital with neuro, cv, surgical, medical, and trauma icu's, so we usually have a few beds open. If we didn't and had someone that needed to come to the unit, we'd try to see if any of our patients could be transferred to the floor. If not, and we had no beds, they'd have to go to the ED to be held until a bed opened.
ETA: just reread your post. If we had an admit that needed to come to our unit, we'd send a patient to one of the other units to make room.

I wish we had that luxury, unfortunately we don't always. There is a hospital policy that doesn't really allow for transfers unless push comes to shove (anytime between like 1a-5a) and most of the time they don't transfer people anyways. The ones that "seem" stable by MD eyes and really are just here as boarders...end up on the floor for a few days. I wish we could triage down, but again like I stated, if the stepdown ICA unit is full, and we have an open bed....welcome to the MICU lol. We unfortunately don't have the staff to keep many open beds at beginning of shift, avg 5 nurses days, 5 nurses nights (6 is a god send, and 4 is a bad day) for 16 beds. Were budgeted for 6, but as I said, its a godsend if we get that many on lol.

applewhitern, BSN, RN · May 20, 2013

If we don't have ICU beds, we send them off somewhere else. If there aren't beds available at the other hospitals, we have to keep them in the ER, or else try to move someone out to make a bed. It isn't "dumping" if there isn't a proper bed, or if you don't have the ability to handle their needs.

detroitdano · May 21, 2013

We have a ridiculous amount of ICU beds, and any ICU patient can get overflowed to a different ICU. Neuro takes surgical, medical takes cardiac, etc. If we are absolutely filled to the brim, they sit in the ER. We can usually find someone to transfer out and bring up the real sick ones. In your case with a small hospital, they really need to go somewhere else. ER isn't staffed to provide 1:1 care.

jennycRN · May 21, 2013

Very recently we have been shifting ICU patients to the PACU when there are no patients ready for floor or step-down transfer, no beds for lateral ICU transfer, and there is a higher acuity pt who needs the ICU bed. Not an ideal situation, especially for the PACU staff.

nurseprnRN, BSN, RN · May 21, 2013

I wish we had that luxury, unfortunately we don't always. There is a hospital policy that doesn't really allow for transfers unless push comes to shove (anytime between like 1a-5a) and most of the time they don't transfer people anyways.

You know what? Providing the appropriate level of care IS "shove."

Sugarcoma, RN · May 22, 2013

ICU beds should be treated as a precious commodity. Literally the availability of that bed and the RN that accompanies it can mean life or death for another human being! These beds should not be taken up by stable patient's, patient's who require frequent labs, or sitters, or who otherwise may make life more difficult for those on the floor. They should not be taken up by patient's that fit a diagnosis but who are stable. EX: the DKA patient whose gap was closed before they even left ER, etc. They should also not be taken up by futile patient's. Patient's can and do die outside of the ICU. ICU is not interchangeable with hospice.

Now when things are not at critical mass, then by all means let those types of patient's stay as long as the doc will let them, but no one else should ever be bumped out of an I bed to accommadate inappropriate patients.

Tripling should not happen as frequently as it does. When beds start becoming scarce the first thing that should happen is anyone who is stable enough should be triaged to the appropriate floor. Then patients can be triaged to different ICU's, for example the medical patient on the SI can be moved off to MI if they have a bed. There are staffing agencies that can be utilized if it is a staffing issue. Finally critical patients can be diverted to other area hospitals that have bed and staff available.

It is not fair to the nurses in the ER to have to provide long term care for a critical patient until a bed can be found. It is not fair to the ICU nurses to have a triple assignment of critically ill patients. Most of all, it is not fair to the critically ill patient and their family to have to be cared for by someone who is too busy to give them their full attention.

We are being tripled more and more frequently lately. I am hearing the same from ICU RN's at other area hospitals. I am starting to get the feeling that the powers to be are trying to bump our ratios to 3:1 as the norm.

ICUPrincessNurse · Jul 30, 2013

If we're full, which is more often than you would think for a 36 bed unit, our "less sick" ICU patients go to PACU. Then we triage triage triage!!!

RNforLongTime · Jul 30, 2013

If our ICU is full and there is no one that can be safely moved out to one of the floors then the ER holds the patients. If need be, they'll transfer the patients out but Admin highly frowns upon that.