No Beds, No Bumpable Patients!

nicolentony · Jun 23, 2006

In our ICU, if there is only one bed left and we are the hospitals "code bed" than we don't fill it with any admission. We look to see if anyone can remotely be transferred to a tele or medical floor. If not, than any patients with orders from ED to ICU have to be held and usually an agency ICU nurse gets hired to care for the patient(s) in the ED. Our nursing supervisor gets involved to calm down the ED nurses:angryfire .This is our procedure and it works. If someone is too critical to be "held in the ED" than we look at transferring out to another facility with that patient.

Hope this helps!

steelydanfan · Jun 24, 2006

In our institution, there is no such thing as a "code bed"

We routinely keep in touch with the house supervisor, and plan accordingly.

If, in spite of pleas to find beds for our downgraded patients, there is no bed found; any pt. codes ,whether in house or in ER; will have to find a bed in ER.

The upshot of this is that in spite of our ongoing begging, if a code comes in; all of a sudden a bed becomes miraculously available for our tele pt.,

and we are expected to take in the ED pt. ASAP.

But they still have to provide 2:1 or 1:1 staffing, or we will not accept the pt.

Long Live Nursing Unions!

Cate

dorimar, BSN, RN · Jun 24, 2006

At the last hospital il worked, we got so busy that we were continually down to only a code bed even with overflow opened and staffed, and ER started saying the same thing, that THEY would be the code bed. Low and behold when they started getting coding patients from the floor, they changed their tune really quick.

icucharge · Jul 13, 2006

At my facility we will leave the last ICU bed open for a CODE and have th ED hold any ICU admits up until it would be time to call ED diversion to the other hospitals in the area. At that time we will fill the bed with any

ED ICU admits. When this occurs any CODE that would occur would have to go to a unit with an appropriate level of care with hard wired telemetry( PACU or ICU or ED), which in this case would be the ED until the ICU would be able to open a bed up.

banditrn · Jul 13, 2006

Years ago, we used to have a 'code bed', but for some reason we had to stop having one. I'm thinking the admin said it was a state thing? This was in Iowa.

ZASHAGALKA, RN · Jul 13, 2006

We don't have a fixed 'code bed', but as we get to that point, we try to move out pts that can move.

ED can, griping aside, hold onto pts or even take pts from the floor in an emergency as a 'code bed'. It's an issue of transfer of care to an appropriate level of care. That includes both staffing and resources (monitors, etc).

Also, our policy states that PACU can be utilized as CCU overflow in an emergency. We have surgeries go late into the night, so it is normally staffed on something like a 16 hr basis and not a stretch to extend, through their on call to 24 hrs.

I know, that's a big issue if you are ED or PACU. But, a good chunk of our docs refuse to even consider 'triaging out' CCU pts. "Don't even call me to ask; if I thought they could move, I'd have already moved them." - That is a constant refrain.

And tele beds DO mysteriously come open at the last minute. I'm always amazed by that. But, on the flip side, I'd rather hold on to a tele pt then move one out only to GET a tele overflow because we took their real last bed.

So, between rocks and hard places, somebody's gonna get a rough edge.

Cate - We have a 36 bed unit but only 24 beds are open due to staffing. We could give everybody a 3rd pt and open up all those beds. But, our ratio is 2:1, period. And, we didn't need a union for that.

~faith,

Timothy.

JAtwellRN · Jul 14, 2006

Thank you for all the helpful info, you guys. I am currently working on a proposal for a written policy in these cases.

steelydanfan · Jul 17, 2006

Timothy,

Lucky you, that you have such a great and supportive administration that is understanding of your goals for patient care. Unfortunately, you are in the minority.

I think I've said enough.

Cate

dragonflyRN · Jul 17, 2006

tele unit with 2:1 staffing?

where is this?

dragonflyRN · Jul 17, 2006

Sorry...I misread

Pediatric Critical Care Columnist · Jul 17, 2006

We're the only PICU in the northern half of Alberta, with a trauma/general critical care catchment area of about 4000 square miles and a population of 1.5 million, and a very active regional cardiac surgery program with a catchment area of about 8000 square miles and a population of about 5 million. We "knit" beds and nurses when we're full and there's someone on the doorstep. Our 16 bed unit has expanded to 19 or 20 at times, by putting two patients into our single (isolation) rooms. And they wonder why we have so many kids bounce back with a "new" respiratory virus, one they dind't have when they came into hospital. Duh. In the past four years there has only been one occasion that I recall where we blocked beds... because we had five kids all isolated for different bugs and couldn't cohort them.