Overflow in the er

Posted

So I'm doing some research for my BSN program and am looking at the way hold patients effect the er. This includes increased wait times decrease in patient happiness and an increase in nursing workload. I know our hospital has been trying but when you have 6-7 patients that you are caring for. 3 of which are holds with all floor orders in that you have to do. I was just wanting to get a feel for how the above effects moral and your care for your patients.

emtb2rn, BSN, RN, EMT-B

Specializes in Emergency. Has 21 years experience. 2,847 Posts

It's simple. Hold patients in the er do not get the care they deserve. Meds & treatments are missed/late, they feel neglected & we don't have rooms for our new patients who need to be in a room. Which leads to holds in hospital beds in the hallway.

It's demoralizing to try to be a combination floor/icu/er nurse on a regular basis.

NurseOnAMotorcycle, ASN, RN

Specializes in Med-Surg, Emergency, CEN. Has 10 years experience. 1 Article; 1,066 Posts

Also, every bed used for a hold patient is another patient in the waiting room that has to wait another hour (or three) to be seen.

FlyingScot

FlyingScot, RN

Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc. Has 28 years experience. 2,016 Posts

On one particularly bad shift with multiple codes and multiple admit holds we forgot to feed one of our patients (who needed to be fed) for the ENTIRE shift. The. Entire. Shift. The tray never came from the kitchen and we were so overwhelmed with critical patients it just never crossed our minds. How's that for making a nurse feel like a total failure. It was horrible patient care and once discovered we felt like the worst people on earth.

Uptoherern

Uptoherern, RN

Specializes in Emergency Room. 337 Posts

It's usually not the case that there aren't any beds. It's because they staff so tight (wad) that there aren't enough nurses to take admits. Nobody on call either. So the patients lay in the Er and it causes a trickle down effect. Increases left without being seens (such horror!) and waiting times and complaints. It's so obvious what the solution is but apparently no one can see it from the ivory towers.

Edited by Uptoherern
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NurseOnAMotorcycle, ASN, RN

Specializes in Med-Surg, Emergency, CEN. Has 10 years experience. 1 Article; 1,066 Posts

I wish we could do that in Emergency.

NickiLaughs

NickiLaughs, ADN, BSN, RN

Specializes in Emergency, Trauma, Critical Care. Has 13 years experience. 2,382 Posts

My last job, we were on average having 30 to 40 boarded patients. Then the psych holds. It's a 66 bed ER, with the traumas, we would run out of room fast. 50 people in the waiting room, 10 to 15 in hallways from ambis waiting to be seen.

You can imagine the average 8 to 12 hour wait got bad. Sick patients in the waiting room until they crashed, not good.

They kept saying they were going to make changes, but ultimately the entire hospital needed to be on board and that wasn't going to happen.

You can imagine the press ganey scores... not that that mattered

What sucked was knowing that there should be a better system, that lives were being negatively effected and it was out of the nurses' control.

My new job, we board a few, but we have great flow, we see 400 patients a day in a 39 bed ER. I'll take running my whole shift knowing i'm providing good care over sitting with tele admits while patient's bleed out in the waiting room.

RNCEN

RNCEN

Specializes in ER. Has 5 years experience. 234 Posts

My new job, we board a few, but we have great flow, we see 400 patients a day in a 39 bed ER.

Is that a typical day? How many visits/year?

GOMERNATOR

GOMERNATOR

Specializes in EMERGENCY - TRAUMA. Has 18 years experience. 13 Posts

I know of very few ER nurses who enjoy hold patients. As previous posts have pointed out many times hold pt's orders get missed resulting in late completions or not at all. I know as soon as I walk in and look at the board and see hold status by a pt's name it just darkens my mood. Many times it is not a lack of physical beds but nurses to take care of the pt's being admitted. I could deal with it better if it were the former and not the latter. Bottom line hold pt's are drain on morale and not conducive to good pt care overall.:no:

theantichick

theantichick

Specializes in LTAC, ICU, ER, Informatics. Has 3 years experience. 320 Posts

Both ED's I've worked in struggle with overflow. IMHO, the patients do not get good care when they're boarded. Last shift, I had two boarders... I was at least an hour, and sometimes two hours late with meds and such on both because my ER patients' conditions made them a higher priority. Plus, I was having to wait for meds from central pharmacy, etc. and don't have access to the equipment and things I need to take care of a floor patient. It's frustrating. I personally would rather have all holds or all ER patients. Mixing the two makes my job awful, and poor outcomes for the patients.

Lunah, MSN, RN

Specializes in EMS, ED, Trauma, CNE, CEN, CPEN, TCRN. Has 14 years experience. 33 Articles; 13,685 Posts

I have had boarders for an entire shift recently at my per diem job. Four beds occupied by boarders, and our fresh patients in hallway beds. It's not pretty. It's not unusual for pts to board for a couple of days and actually be discharged from the ED as admitted patients without ever having made it to a floor.

NurseOnAMotorcycle, ASN, RN

Specializes in Med-Surg, Emergency, CEN. Has 10 years experience. 1 Article; 1,066 Posts

...It's not unusual for pts to board for a couple of days and actually be discharged from the ED as admitted patients without ever having made it to a floor.

Holy crap!! :wideyed: