No Beds, No Bumpable Patients!

[JAtwellRN]

I am researching policies and laws on critical care bed availability. The situation has arisen where our CCU has been full except for a "code bed". The Emergency Department calls and needs to admit a patient, and bargains with me that if I admit their patient to my "code bed" they will accept any in-house codes. Is this legal? Does it fall under EMTALA law? Our hospital has no policies regarding this issue, so my question is: how does your hospital deal with this issue, in the event that the CCU is absolutely full with no bumpable patients, and there is an in-house code. Where does the patient go? Who is responsible for this patient? What laws govern this situation? Any, and I mean ANY help on this issue would be greatly appreciated..and please send links to references if available.

Thanks!

[TennRN2004]

We do not hold a code bed in any of our units (SIC,MIC,CCU). My favorite is when we come in and the other two units are full (I work SIC), so we start filling up with the respiratory distress from the floor and the intubated patients from the ER. Then the housing supervisor calls and wants to know if we have any we can move out to the floor. Well, lets see, since you just filled me up, and our other patients are either on IABP or swaned with gtts or tubed, how do you think we have any who can transfer out at 2 am?

I don't know what the answer is, but I know it is very frustrating for all parties involved because our ER is not set up staffing wise to keep a code or vent patient.