No empty beds allowed

[mom2special3]

Management wants to change and speed up the flow through the ED. They want someone (yet to be determine who - triage RN, LPN, etc) to bring back a patient anytime a bed is empty. We currently assign an RN as one is available and the RN brings the patient to the room, gets the history etc.(Triage has already occured and high risk or critical patients are brought back immediatly) At times beds are empty for a variety of reasons - ongoing conscious sedation or critical patients and not enough nursing staff, inability of some nurses to manage muliple patients, appropriate bed (pelvic or eye equipment) not available, etc. At this time we do not assign nurses to certain rooms for the entire shift but are considering this as part of this change.

Anyone have any suggestions or thoughts on moving patients through the ED process quickly and safely?

[canoehead, BSN, RN]

This may put an RN in the position of having a patient assigned to her while she is dealing with a critical patient and not knowing about it for 30-60 minutes.

If all the RN staff is busy, likely all the physician staff is busy too, and the nonurgent patient will not get faster care, they will just be waiting in a different room. Is there an advantage to that? In our hospital there is a TV in the lobby but not in ER rooms and patients prefer to spend most of their wait time in the lobby.

If you bring back more people then the potential for disruption increases, especially if they come back expecting their care to begin and staffing doesn't allow that.

What is the advantage to the patient of the new policy? It will look good on paper to have them come back early, but there will still be a delay in treatment if a crisis is going on....what's the point? Would it be more effective to find a spot for waiting room patients that would be quiet with dim lights where they could lie on stretchers (like headache pts). You'd have to work out guidelines for visitors- no food, no TV, etc to make this truly a quiet room.

What about protocols so the triage RN could start things up, give pain meds, IV fluid, order an Xray before they are taken back. Do you have a walk in care area as opposed to the main emergent ER?

[runneRN]

We strive for this philosophy in our ER and it works MOST of the time...we have MD approved protocols which allows us to begin diagnostics before the MD sees the patient ....we also have changed our assignments to incorporate a "float RN" for 12 hours a day. This RN who bounces between the main ER and triage to facilitate patient flow.