Long Waits in Psych ER

jadu1106 · Jul 13, 2008

pagandeva,

i have been following this situation almost daily since i saw it on the today show. it is tragic and just really hits me hard. thank you for sharing.

jadu1106

BrnEyedGirl, BSN, MSN, RN, APRN · Jul 13, 2008

I mentioned this in another thread about this death,...what exactly is a psych ER? I'm not familiar with that term as the ER's in my community are ER's ,.we see peds, trauma, medical and psych. Is a psych ER like any other ER, where people walk in off the street to be triaged and seen by a Dr?

I don't understand the concept of "holding" people in the waiting room. Does that mean it's just a very long wait to be seen or are they actually triaging people,.having them see the Dr and then placing them back in the waiting room for transfer to an in pt facility?

Anyone know the answers?

Jules A, MSN · Jul 13, 2008

Some of our local hospitals have a separate ED Psych section that has a bit of a different set up than the regular rooms but I think they take them in pretty quickly especially because most of them are psychotic or else they wouldn't be in the ED. Without knowing for sure I would bet that the regular EDs in the NYC area are also over crowded and take hours to get inside also unless you have the golden ticket: chest pain.

I know with the kids we get it can take almost an entire day to do intake at the ED, assess/medicate, call around to find a bed at an inpatient pediatric psych hospital, get approval for the admission, transport the patient and then basically repeat the entire admit procedure all over.

pagandeva2000, LPN · Jul 14, 2008

I mentioned this in another thread about this death,...what exactly is a psych ER? I'm not familiar with that term as the ER's in my community are ER's ,.we see peds, trauma, medical and psych. Is a psych ER like any other ER, where people walk in off the street to be triaged and seen by a Dr?
I don't understand the concept of "holding" people in the waiting room. Does that mean it's just a very long wait to be seen or are they actually triaging people,.having them see the Dr and then placing them back in the waiting room for transfer to an in pt facility?
Anyone know the answers?

Psych ER is a place where acutely psychiatric patients are brought in for evaluation of their safety against harming themselves and others. In NYC HHC hospitals, they are supposed to be first brought to the medical ER (whether they are voluntary or involuntary) to be triaged by an RN there. A voluntary patient that feels they are about to act out can also walk in without escort from EMS. Once being brought in, they are searched, then, interviewed by the attending psychiatrist and RN, labs are drawn, and a psych history is searched. Many patients are frequent flyers, so, that is usually not hard. Sometimes, prisoners are also brought in because they have discovered that they get better meals and treatment at psych hospitals, and many are trying to build up their case for temporary insanity for their crimes.

If it is deemed that this person is going to be admitted, the speed of transfer to a locked, inpatient psych floor depends on how many available beds there are and how soon the patients up there are going to be discharged. Therefore, due to the many years I worked at 2 psych facilities, it is easy to see how this holding can last as long as 72 hours. Those that have insurance may be transferred to one of the 'better' psych facilities, but, a bed has to be open for them to be transferred as well, but the patient is still considered to be too acute to be allowed to walk the streets.

Most of the in patient units have a limited amount of beds as well, say about 25 per floor, and most patients are not discharged on weekends or holidays (unless their treating psychiatrist placed an order for them to be discharged those days), because the attendings working those times do not have a full history of that client and will not risk discharging a person who may go home and hang themselves or harm another person.

If the patient displays a physical ailment, then, they are supposed to be transferred to the medical ER. What I have seen, as a tech, is patients who are, in fact, physically ill (we had one that presented with weeping edema and it was obvious that they had difficulty in breathing-probably from CHF) STILL transferred to the psych ER because of the psych history. The attending working that day rose HELL and we had to escort this person BACK to the medical ER and the psychiatrist called the powers that be and said that although this person has a psych history, currently, he is presenting with a serious problem that we are not able to address. It is shameful, really. But, I hate to say that 'holding' happens more often than it should, especially in poor, urban areas because of the volume.

PrettyPillz · Aug 2, 2008

As horrifying as that video was, lets stop and think. How many times have we as nurses worked in unsafe conditions grossly understaffed, and a patient suffered because they didn't get care they deserved because you were physically unable to. Then think about it possibly being a patient assigned to you that dies. The hospital blames you, and your face is smacked on the front page news as a "Killer Nurse" that doesn't care about her patients. This video is a reflection of what is going on in America's healthcare system. There are numerous "Mrs. Greens" that die this same way everyday in our nations' hospitals. Administration at this hospital clearly blamed the "bad"nurses. Instead of addressing the real issues.

pagandeva2000, LPN · Aug 3, 2008

As horrifying as that video was, lets stop and think. How many times have we as nurses worked in unsafe conditions grossly understaffed, and a patient suffered because they didn't get care they deserved because you were physically unable to. Then think about it possibly being a patient assigned to you that dies. The hospital blames you, and your face is smacked on the front page news as a "Killer Nurse" that doesn't care about her patients. This video is a reflection of what is going on in America's healthcare system. There are numerous "Mrs. Greens" that die this same way everyday in our nations' hospitals. Administration at this hospital clearly blamed the "bad"nurses. Instead of addressing the real issues.

:yeah: :yeah: The only difference was that this was caught on camera and the patient died. Most nurses I know are working in unsafe conditions. Too much paperwork. Nurses are responsible for everything from nutrition, housekeeping, keeping up with subordinates and the doctors writing correct orders to cover them. It is not always that nurses do not care, it is that we are overwhelmed by a tidal wave of problems that we have no control over. Bottom line, the main reason we are there-the patients are the ones that suffer the most.