Inappropriate ICU admissions

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Although the majority of our patients require ICU level of care, we occasionally get "dumped" on by the triage doc. For example, I had a old codger with severe constipation who was ordered for Q1 tap water enemas!! The reason we got the patient was that it was too much work for the floors. My end of the unit stunk to high heaven!!

Anyone else experience this "dumping" phenomenon?

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Specializes in ICU/ER/TRANSPORT.

the 1st full time unit job i got right out of school was a 8 bed general medical icu iin a 125bed hospital. it was a busy unit, always admitting patients and moving patients out to get sicker ones in. we were always admitting 90yo dnr's with endstage renal or lung issues, or the 80 y.o gcs-4 from cva with just the basic labs and ivfs ordered. heck, by the time we did all of our admission work on them and got them settled in for the night to wait for the grimm reaper, the o.r would call with a fast admit from surgery. then we would have to try to scramble the dnr's out to the general floor where they should've went in the first place. we finnally got a new critical care doc to be the medical icu director and he started to really raise cain cause we found ourselves spending more time taking care of dnr's and wiping poop trying to keep geezers in the bed than being at bedside with critical vents and trouble shooting hemodynamics on septic patients. i feel your pain.

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Specializes in Med-Surg Nursing.

We get inappropriate admissions to my ICU al the time. Most of the time it's to "babysit" patients(confused elderly ones) that the floor just doesn't have time to keep an eye on them. So, they get transferred to my ICU with "mental status changes". I work in a small community hospital general ICU/CCU. We only have 6 beds so sometimes we have to transfer out pt's to get these confused ones. It's frustrating. My ICU is more like a glorified med-surg unit as the majority of the pt's we get would be on the floors at the bigger hospitals down the street.

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My favorite are the ones who aren't "full" DNAR. They are "no meds, no intubation, CPR okay." Sure, we'll just hope those drugs work their way into your circulation by osmosis!

I was crazy busy with an admit last week, PEA arrest who was intubated on the floor then came to me. After a half hour in the unit the doc discovered her daughter (PoA) had wanted her DNAR but no one filled out the paperwork on the floor or communicated it to the nurses. Oops!

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This occasionally happens to us too...I try to remember that this is the "yin" that comes around after the "yang"...a post-arrest, therapeutic hypothermia protocol,9 gtt, IABP with temp pacer pt that kept me flying for 12 hrs non-stop no bathroom break just the week before!! When these soft admissions come my way, I kinda enjoy the change!

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Specializes in icu/er.

i rather be busy with a patient that i can actually help get better or better yet with a realistic chance of improving vs. a elderly termial cancer dnr who is stroked out and crapping all over the place. even though i'm not really a advocate for gov't run healthcare, the prospect of each hospital having a g-man to oversee admissions would certainly boot hopeless (non-critical care patients) cases to a lower level of care.

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i rather be busy with a patient that i can actually help get better or better yet with a realistic chance of improving vs. a elderly termial cancer dnr who is stroked out and crapping all over the place. even though i'm not really a advocate for gov't run healthcare, the prospect of each hospital having a g-man to oversee admissions would certainly boot hopeless (non-critical care patients) cases to a lower level of care.

Don't hold your breath on the g-man. We get inappropriate ICU admissions all the time. Not to mention those who need intensive LTC and not being able to find a bed. They end up staying with us until one opens! (I work in the VA system)

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Specializes in ICU/ER/TRANSPORT.

Our Nurse Case Manager told us that the VA always wants their VA patients to be transfered to the VA super fast cause civilian hospitals charge more vs. what the VA charge. Its the same when I'm on active duty in the guard, they beat it into our brain to seek gov't run facility first. Could you shed light on this.

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Specializes in ICU, M/S,Nurse Supervisor, CNS.

Yeah, we get these all the time. Just the other day I got one from the ER with a diagnosis of sepsis, who was afebrile, blood pressure fine, alert and oriented (though not very mobile due to previous stroke) and recieving just NS and on nasal cannula. They even placed a central line, but then didn't order CVP monitoring anyway. The admitting doctor came to see her for the first time in the ICU and wondered himself why the patient came to ICU, but then refused to transfer her out. Our intensivists even opted not to see her when they see a majority of our septic admissions. Unfortunately, they gave her the last ICU bed while several other true ICU patients ended up spending the night in the ER (including two who were later emergently intubated and were true septic patients).

We often get non-ICU patients in this ICU which is why I regret leaving my other ICU to come here to a lower acuity unit.

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Specializes in ICU.

We get inappropriate admissions all the time. Lately it's been pretty bad. A lot of times, it seems the docs are more comfortable with the patient-nurse ratio on the unit, and even though the patient is and always has been perfectly stable, they are still hesitant to send people to the floor for this reason. Also, and I think this is extremely unfair to floor nurses, if ONE thing goes wrong on the floor, we will take all those patients for the rest of eternity. For example, one time, in a galaxy far far away, someone got a little over-sedated with ativan. Boom. Those patients now go to the ICU no matter what. Nevermind the fact that ICU nurses ALSO make mistakes and over-sedate people, or what-have-you. But there is no mercy and no respect for the abilities of the floor nurses, and no understanding of their job. It is very frustrating. There are many days when I wish I was in a more acute ICU, then I realize we have it really good at my place, so I try not to whine. (Although I do crave the sick ones...)

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Specializes in ICU/PACU.

Sometimes we have particular physicians who insist their patients stay in the ICU until almost discharge! I mean technically they do not belong in an ICU but the docs will keep them there anyway just because they like how closely the patients are monitored and want to play it safe. I don't know if it has something to do with billing? Do they get paid more if they are in the ICU? I wonder how they justify them being in the ICU without the clinical reasons behind it. But I see it often.

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Sometimes we have particular physicians who insist their patients stay in the ICU until almost discharge! I mean technically they do not belong in an ICU but the docs will keep them there anyway just because they like how closely the patients are monitored and want to play it safe. I don't know if it has something to do with billing? Do they get paid more if they are in the ICU? I wonder how they justify them being in the ICU without the clinical reasons behind it. But I see it often.

Don't know what type of hospital you're working at. However, most private hospitals will not allow inappropriate ICU patients to remain in ICU for very long, because insurance will not reimburse them for the $10,000+/day average ICU cost. It happens where I work because Uncle Sam (and all of us) are paying the bill!!

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