Just wanted to know how many hospitals are putting their inpatients in the hallways when the floors are full. This will be the new trend where I work. In MA there is a "no diversion" rule. Patients routinely line the hallway in the ER but now the hospital is planning to "admit" patients to hallway areas when rooms are full. Questions raised: What bathroom do they use, how are they billed, how will it affect the ever so wonderful "Press Gainey" scores, would you want to be in a hallway getting your care, does your family want to see you there, what about all the obstacles in the way, ie linen carts, dirty linen, patients trying to ambulate, walking past you with any host of different diseases???? Any thoughts out there? Management of course feels it will all work out fine, will the "VIPs" be put in the hallway?
Although I would hope it wouldn't have to happen I can understand reasoning in the ER for the reasons you stated. Either they are leaving ER and going home or they are getting admitted to somewhere in the hospital. The ER isn't where they are spending a few days. I wouldn't want to be the patient in the hall in an ER but if their was something that happened and a sleuth of people coming in, I could certainitly understand it and be patient. If I was told I was being admitted and was taken up to a floor, parked in the hall, given a warm blanket and a cup of water and a call bell and left there I would be horrified. I mean honestly, I would rather be given a blown up mattress in the supply room or something, at least I would have a minute about of dignity left that way :|
But what I am talking about ARE the admitted patients! And yes they do spend more than 24 hours. I've had them for up to three days in a hallway bed (sometimes not even on a bed but a gurney). In the ER they are low priority patients due to the nature of our patient load. Heck even the kitchen forgets them. They get their breakfast trays at 1100 and have to eat off their laps because we have no overbed tables. Add to that the different kind of nursing. These people should be taken care of by nurses with in-patient skill. Believe me, we don't have it and we suck at it even though we try really hard. Again I fail to see why having overflow patients on the floor is worse than in the ER hallways. It's bad all around for everyone.
Leslie can I ask what happened, (simple curiosity, my feelings won't be hurt if you don't want to say) but it sounds like their were a few of you in the same situation or were you all different Dx but just sharing a room?
oh, it was nothing serious.
we were all scoliosis patients, and had to wear full body casts for 6+ months.
those with lower fusions, had their casts down to their knees.
i had my t1-t12 fused, so my cast only went down to my lower hips.
but, back then, you were in bed for 4-6 months.
i was in a hospital for physically handicapped children, and remember one girl who shared our room (for a bit) who used to be a jr. olympic diver, and ended up a quad.
i met sooooo many glorious, wonderful children (they ranged from very young to 18, max).
in my sr yr of high school, i went back there and did a psychology project, escorted by my psych teacher (very cute but very flirtatious, i see that now)
ultimately, this was one of the most cherished experiences of my life.
AND, i was 'stretched' 4 inches, r/t my spine being straightened.
But what I am talking about ARE the admitted patients! And yes they do spend more than 24 hours. I've had them for up to three days in a hallway bed (sometimes not even on a bed but a gurney). In the ER they are low priority patients due to the nature of our patient load. Heck even the kitchen forgets them. They get their breakfast trays at 1100 and have to eat off their laps because we have no overbed tables. Add to that the different kind of nursing. These people should be taken care of by nurses with in-patient skill. Believe me, we don't have it and we suck at it even though we try really hard. Again I fail to see why having overflow patients on the floor is worse than in the ER hallways. It's bad all around for everyone.
I think it would be different psychologically for a patient, being in an ER hall bed vs. a hallway bed on the floor. Even though it may be hours, they *know* that the ER stop is temporary, that eventually they will be moved elsewhere (either an inpt room, or home). On the floor, even if they are TOLD it's just a temporary stop, you don't know how long it will last, and they may feel that's all they're going to get/deserve. It is bad all around, I agree with that, but still very different.
I think it would be different psychologically for a patient, being in an ER hall bed vs. a hallway bed on the floor. Even though it may be hours, they *know* that the ER stop is temporary, that eventually they will be moved elsewhere (either an inpt room, or home). On the floor, even if they are TOLD it's just a temporary stop, you don't know how long it will last, and they may feel that's all they're going to get/deserve. It is bad all around, I agree with that, but still very different.
Sure! I might think that too if I didn't work the ER but it simply isn't true. All they want is to get out of the ER and they let us know frequently and loudly. A few hours is one thing but a few days of constant loud noises and fast movements that are part of the ER environment don't make for happy people. Of course I know that you guys have your own noises and other stimuli but it is a very,very different atmosphere. I only wish people were patient and understanding but they aren't and being in the ER doesn't magically change them. One of our beds is just opposite one of the Trauma rooms (it has to be there due to hallway configuration). Can you imagine being in that spot for days with almost constant critical patients and codes going on? One poor lady had no less than 3 dead people rolled by her (we don't have any screens) in a 24 hour period. We did move her when another hallway spot opened up but she was already stressed out. The first hospital that did this (several years ago) did it to encourage the physicians to discharge their patients in a more timely fashion and it apparently worked. Inconvenience is a great motivator to get people moving.
Sure! I might think that too if I didn't work the ER but it simply isn't true. All they want is to get out of the ER and they let us know frequently and loudly. A few hours is one thing but a few days of constant loud noises and fast movements that are part of the ER environment don't make for happy people. Of course I know that you guys have your own noises and other stimuli but it is a very,very different atmosphere. I only wish people were patient and understanding but they aren't and being in the ER doesn't magically change them. One of our beds is just opposite one of the Trauma rooms (it has to be there due to hallway configuration). Can you imagine being in that spot for days with almost constant critical patients and codes going on? One poor lady had no less than 3 dead people rolled by her (we don't have any screens) in a 24 hour period. We did move her when another hallway spot opened up but she was already stressed out. The first hospital that did this (several years ago) did it to encourage the physicians to discharge their patients in a more timely fashion and it apparently worked. Inconvenience is a great motivator to get people moving.
You seem to be talking about the ER used in the same manner as a floor. I thought you meant ER patients in hallways waiting for results or for a bed to open up on a floor.
If the ER isn't being used the way it is intended, of course, that's awful! To me, that's worse than being in the hallway on a floor. ERs are bright, loud, constantly moving, etc. At least floors are somewhat calmer. If given the choice between ER hallway or floor hallway, I personally would pick the floor. In general, though, hallways as an admit are not conducive to improving health nor keeping one's dignity.
You seem to be talking about the ER used in the same manner as a floor. I thought you meant ER patients in hallways waiting for results or for a bed to open up on a floor.
If the ER isn't being used the way it is intended, of course, that's awful! To me, that's worse than being in the hallway on a floor. ERs are bright, loud, constantly moving, etc. At least floors are somewhat calmer. If given the choice between ER hallway or floor hallway, I personally would pick the floor. In general, though, hallways as an admit are not conducive to improving health nor keeping one's dignity.
And that's exactly what is happening all over the country. A few hours in an ER hallway waiting for a bed is one thing but in some cases days?! You're absolutely correct, there is a complete lack of dignity no matter how hard we try to maintain it. It's terrible no matter which way it goes (ER vs. Floor) but at least the floor nurses are better at in-patient care than we are. Believe me, we feel terrible about it but what can we do. If I have two new chest pains, a wheezing toddler and the LOL hold patient needs to pee what am I going to do first? It's the same for every nurse I work with. By the time I or another staff member can get to her she's soiled herself and is humiliated. It makes me want to cry because I desperately wanted to do better for her but I just couldn't. That repeated sense of failure and defeat eats at you after awhile.
BTW...thanks to all for not turning this into the usual ER vs the Floor argument. It's really great to be able to discuss this without being flamed. As I said above it really eats at us when we feel like we've failed our patients and the last thing we need is for our sister-nurses to attack us.
Leslie, you are so right but...administration sees that as a loss of revenue and they are so narrow minded that the bottom line is far more important than quality patient care. Also strangely enough when one ER is overwhelmed almost all the others are as well. Where I live it is so bad that we have something called "citywide divert". The ER's in my city can go "on diversion" if certain criteria are met and the physician agrees but the criteria is pretty stiff and the ER physician sits on The Board so he is bottom line focused. This is the case in many of the local ER's. Also, this only means that we can divert squads that are part of the EMS system. We can't turn away private ambulances. And it doesn't stop the flood of people walking in. If 3 ERs go on diversion we convert to "citywide" which means that the dispatcher is supposed to rotate which of the 9 hospitals gets the next squad. But if the patient demands a certain hospital then that's where they go or the squad will wait to encode until they are on hospital property and then we can't turn them away. It's an absolute free for all. Of course anything critical goes to the nearest ER and we understand that. I've seen nurses literally crying as they answered what we call "the bat phone" because there isn't any place to put the patient and all of the nurses are drowning.
As Flying Scot pointed out ... I don't mean to sound flip about this ... but as everyone raises their eyebrows in horror at the idea of patients in hallways in inpatient units why is it OK for this to occur in the ED?
ED boarding of "admitted" patients for hours or even days due to a lack of inpatient beds is a system problem, not just an ED problem. Solutions will need to come from changes in hospital operations throughout the hospital.
As Flying Scot pointed out ... I don't mean to sound flip about this ... but as everyone raises their eyebrows in horror at the idea of patients in hallways in inpatient units why is it OK for this to occur in the ED?
it really isn't ok, but it is more ok in the er...
since we know that not all folks who utilize er services, are actually high acuity pts.
and i don't think you can fairly compare a temp stopover (er) to an admitted, inpt stay.
again, and i reiterate, i think most of us do believe that overflow in er's is unacceptable.
but if your hospital has a 'no divert' policy in order to retain/add revenue, then the issues are w/admin.
i don't know about your insurance, but my insurance covers semi-private rooms.
(whereas ins doesn't even address that in the er)
if i were placed in the hallway of an inpt unit, i'd be calling my ins immediately, to ensure the hospital didn't get paid for services above and beyond a lowly hallway.
RNMLIS
71 Posts
it's a slippery slope -