OK, another thread made me start thinking about something thats always irritated me. Admissions coming right at change of shift. It happens regardless of where they are coming from.......ED, Critical Care unit pt. now going to M/S.......from M/S to rehab. It seems some sort of flood gate opens right at shift change and the halls fill with pt's going from one unit to another.
Now, this is too consistent to be a coincidence. I can tell you, hours before the pt. comes to me, when the pt. will come. I'll find out around 5PM a pt is supposed to come to us, and I know they will start calling report about an hour and a half before the next shift change, then half an hour before the change........here they come.
I can even tell what type of pt. I am getting depending on when the transfer. If they transfer within an hour of the order to transfer being written.......well, that pt. is a major PIA. If they come a half hour before shift change, their nurse liked them and held onto them.
So, seeing all this evidence, I cant arrive at any other conclusion other than people hold their pts to avoid admissions. I think this is especially true of ED nurses. They are the most predictable of them all. Good pt's transfer at shift change, PIAs whenever the order is written.
I had someone who worked ER for a couple years tell me this is not possible in the ED. He ageed Critical Care units in the hospital definately hold pts, but not the ED. He explained why, basicaly said the ED physician had more to do with it than the nurses.
So is it true? If you work in the ED, do you see nurses holding onto pts? Or am I just showing syptoms of my touch of paranoid schytzophrenia?
