Admitting More ICU Patients than Hospital is Licensed To Take

  1. My hospitals has a 4-bed ICU.
    We are constanly admitting up to 9-10 ICU patinets at a time, and using completely underequipped mulitbed tele rooms as an ICU "Overflow".

    Nurses are put in those rooms alone with no remote monitoring or in-room support. This forces the RN to stay in the room the entire shift and leave the patients unattended if we need to get supplies or call doctors, use the bathroom, get water, etc.

    My question: Is this illegal? and can I refuse to take patients without fear of employment reprimand? I don't think that putting a piece of paper on the door that says "ICU" makes it an ICU. Often we take ER monitors just to get cardiac monitoring for these patients, because the tele rooms dont even have wall monitors. These rooms don't even have wall-suction set-ups...

    I started in ER and often float to ER on extra shifts. The hospital management refuses to transfer patients and will even tell us up front that there is to be NO transferring from the ER.... ADMIT EVERYONE!!

    I don't feel right about this and patients are receiving substandard care while putting our RN licences at risk... what can I do?
    Last edit by J Friday on Apr 2
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    About J Friday, BSN, RN

    Joined: Dec '15; Posts: 38; Likes: 27

    21 Comments

  3. by   8-ball
    I cannot answer the legality of this but I can assure you that you should refuse to take an assignment you feel is unsafe. I have more than once. The first time is the hardest but from there it gets easier. Management will learn to respect your decision and eventually it will assist in making a change on your unit as other start to follow your lead. Also this puts your license at risk and you should protect that over your job. Talk to your unit manager or HR before it happens again and let them know you don't feel safe and you will be refusing the admission if it happens again this helps prevent issues ahead of time.
  4. by   J Friday
    I am worried that denying the assignment is going to get me fired. I wouldn't be worried if I knew I had a legal leg to stand on. Has anyone else experienced this? Putting a piece of paper that says "ICU" on the door and now a certified 4-bed ICU hospital is now a 10-bed ICU?

    I think they have certain guidelines that certify areas as an ICU. I just can't find any information on the issue.
  5. by   8-ball
    Some light reading for you...http://www.hp.gov.in/dhsrhp/ICU.pdf

    From reading this I think you have grounds based on the lack of suction and proper outlets among other things.
  6. by   8-ball
  7. by   JKL33
    It's pretty hard to think there isn't some fraudulent billing involved...
  8. by   Anonymous865
    Quote from 8-ball
    Some light reading for you...http://www.hp.gov.in/dhsrhp/ICU.pdf

    From reading this I think you have grounds based on the lack of suction and proper outlets among other things.
    This is for India. Unless the OP is in India, I wouldn't base my argument on this.
  9. by   Anonymous865
    Every state has their own requirements. If you have concerns, you should contact your state's Department of Health. They license healthcare facilities.

    In my state you can report concerns anonymously.

    My state's laws regarding licensing of hospitals spell out exactly what national and international codes hospitals must conform to. In addition to the electrical, plumbing, ADA, food handling, etc. standards, they require "Guidelines for Design and Construction of Healthcare Facilities" It looks like this is a nationally used guideline.

    If you google that you can look at the requirements. You have to register, but you can look at the guidelines for free. Use the "Read-Only Access" option. They limit you to 2 viewings/month.

    This Guideline does spell out the requirements for critical care units.

    Depending on when your hospital was built or last renovated, they may not have to conform to these guidelines. In my state when they apply to build or renovate they have to submit architectural plans to the state. Those plans have to meet the current guidelines. Existing structures would have to meet the guidelines in force when they were built.

    In my state, a hospital is licensed for a specific number of beds, specific number of ICU beds, etc. They cannot legally exceed the number of beds they are licensed for. If your hospital is licensed for 4 ICU beds but have 8 ICU beds, that could be a problem for them.

    It's really complicated, so it is best if you report your concerns to the agency responsible for licensing and inspecting hospitals in your state.
  10. by   ruby_jane
    Review your BON's practices for filing safe harbor. If you really feel unsafe, follow those practices.
  11. by   JustBeachyNurse
    Quote from ruby_jane
    Review your BON's practices for filing safe harbor. If you really feel unsafe, follow those practices.
    Unfortunately safe harbor does not apply to all states. However the BoN may be able to guide since their job is to protect the public
  12. by   8-ball
    Quote from Anonymous865
    This is for India. Unless the OP is in India, I wouldn't base my argument on this.
    Oops I didn't notice that. The other links I put up are from U.S.
  13. by   heron
    Are all these admissions really ICU-appropriate? If not, it sounds like a riff on the old up-coding scam. Like a hospice admitting a pt to the highest level of care - GIP - to get maximum reimbursement. I'm sure ICU beds are reimbursed at a much higher price than general med-surg. I would drop a dime with CMS and the state Medicaid agency.
  14. by   J Friday
    These are real ICU patients....If it was just an insulin or heparin drip on a stable patient, I wouldnt' be concerned. These are septic, ventilted, hypo/hyperthermic, unstable patients on multiple vasopressors, propofol and other titrated meds...

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