Overflow in the er

Editorial Team / Moderator · Mar 26, 2015

*I just dated myself. Yes, I am a child of the 70s. Candid Camera was a TV show where they would set up a hidden camera and pull harmless pranks on people.

Lol! "Smile! You're on Candid Camera!"

MassED, BSN, RN · Mar 31, 2015

Well it would be nice not to have Admitted holds in the ER, but there are no nurses to staff any empty beds upstairs. See, they let go many people who had reached a certain many years of service and didn't replace those spots, thus staff shortage. It's a hospital wide emergency. We are all at max capacity. Nothing will change unless the very tippy top has heard it from the patients. They can't possibly be happy about being in a busy, noisy ER all night. I would complain.

turnforthenurse, MSN, NP · Apr 7, 2015

When we have holds, that means less available beds for patients in the waiting room/coming in through EMS.

It's kind of a same situation with behavioral health patients. Sometimes our psych holds will be in the ED for DAYS. There was one night where I had about 12 behavior health patients in my ER that weren't going anywhere anytime soon and I only had 4 actual ER beds for medical patients. Thankfully we didn't really have anyone really sick that night but it could have been a bad situation.

amandagbrink · Apr 15, 2015

Great reference list. I've been doing similar research for my MSN and have gone through a lot of those same articles. The problem in most hospitals it seems, is that administrators don't think of boarding as a big deal, or if anything it's just a temporary winter problem that will eventually resolve. But they don't bother to plan ahead or up staffing in preparation. Even though the hospital has too many inpatients, they just leave it as an ED problem and expect the ED staff to figure it out. It's ridiculous that the EDs are calling in ED nurses to take care of inpatients.

amandagbrink · Apr 15, 2015

We've had that too lately, but thankfully, our Director will usually arrange to have an additional nurse come in to take an assignment of just the admit holds. This helps tremendously, not just because it relieves us of the burden of constantly switching from "ER nurse mode" to "inpatient nurse mode" but it also keeps us from having to constantly switch charting systems in the computer. The ER is on Medhost while the rest of the hospital is on Cerner. Since we don't get much Cerner facetime, we tend to be slower with our documentation than someone who floats up on the floor or has worked the floor in the past. The extra nurse makes a world of a difference.

I think I worked in the same ED as you a few years ago. At least it was the same issue with Medhost and Cerner. We were constantly having the same problem with boarding, and no one cared. And now I've heard that hospital is adding a whole new tower of beds, but they are moving from semi-private rooms to private rooms, so the hospital is not actually netting any more beds! I almost threw up when I heard that. A multi-million expansion project, and the boarding problem is not going to be affected even a little.

amandagbrink · Apr 15, 2015

Spend a little time on this website. The articles and research will give you a little catharsis, and maybe give you some ideas to take to your director. Front page | Hospital crowding and flow

EmergencyRNBSN · Apr 15, 2015

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.

I second the question of is that a normal day? Is it lower acuity patient's where the LOS is really low? You can't even get labs/CTs to result on 300 patients in a 39 bed ER, let alone 400. That sounds terrible. I'd walk out of that place on my first day.