My ER is starting "immediate bedding". For those of you who don't know what this is, it's when the patients walk in, state their symptoms, and are immediately placed into an available bed without being triaged by the triage nurses. The bedside nurse is then responsible for doing the triage in addition to the full bedside assessment. The triage includes an extensive med reconciliation where you need to get all names, dosages, etc of all meds (can take quite a bit of time if you have someone on hoards of meds). Our manager says immediate bedding is here to stay and we have a committee working on making the transistion easier. Right now its a bit of a disaster. Patients are being plopped into beds, the bedside nurse is busy and doesn't find out she has a new patient until 20 minutes later. The docs end up seeing the pt before the nurse does, they are confused because the pts are not gowned, not on monitors, have no initial vitals, and there is no nursing assessment to look at.
My question is do any of you have experience with successful immediate bedding at your facility? Can you tell me what components make it work successfully? I'd like to bring some ideas to the table when the committee meets.
Specializes in CNA, Surgical, Pediatrics, SDS, ER.
I don't know how large your facility is but we are a 7 bed level 3 ER and so we are the triage nurse. Our pt's come straight back to the ER desk and get placed in a room. If we get busy we try to leave our truama and cardiac room open if possible.
If all the rooms are full and a critical pt comes in then a less critical goes to the WR. If we are max capacity then we start to triage in the WR until rooms start to open up. If our techs place someone in a room they let us know when they see us and if it's appears to be a pt that requires immediate attention they find a nurse. I don't know how this would work at a larger facility especially if you don't have someone around the desk all the time. Best of luck with your process.
1) This does require a culture of change mindset. People will either have to find a way to integrate it into their practice and come on board, or need to quit complaining and look for another job....
2) Get active with your unit council or unit committee. If you don't have one, START ONE! Too many staff RN's are complacent to sit on the sidelines and second guess new policies and procedures without getting involved actively in the decision making process
3) Get the material or attend a course put on by Triage First. They address things like "immediate bedding" and the "new" traige role - "rapid" triage....it lends itself to implementation of this.
4) While I am not sold on the rationale that it improves patient satisfaction to bring them straight to a bed, just to wait for 2 hours to be seen....but I do believe it helps improve ER flow better - which, should in theory, help the ER to deliver it's services more efficiently. It decreases what I call "dead time" in the rooms - time when a treatment room is empty and could potentially be in use by a patient.
But my biggest thought is to GET INVOLVED and be a part of the implementation rather than griping about it.
I know that this thread is old, but unfortunately this concept has just reached our ER very recently - So I am backtracking and trying to become as educated as I can about this process.
In your institution, who exactly is walking the patients back and giving them to a nurse? I believe the core concepts of these initiatives, but I can't find anything on how to implement this. I would love to PM you to discuss this further so as not to keep commenting on older threads
SDS_RN, RN
346 Posts
I don't know how large your facility is but we are a 7 bed level 3 ER and so we are the triage nurse. Our pt's come straight back to the ER desk and get placed in a room. If we get busy we try to leave our truama and cardiac room open if possible.
If all the rooms are full and a critical pt comes in then a less critical goes to the WR. If we are max capacity then we start to triage in the WR until rooms start to open up. If our techs place someone in a room they let us know when they see us and if it's appears to be a pt that requires immediate attention they find a nurse. I don't know how this would work at a larger facility especially if you don't have someone around the desk all the time. Best of luck with your process.