Placing Emergency Department Crowding on the Decision Agenda

pickledpepperRN · Aug 18, 2005

This is SO important. Many hospitals routinely and almost constantly hold ICU and other patients in the ER. It is now planned.

One hospital where I worked registry had papers taped to the walls in hallways with so called room numbers!

There is no privacy (HIPAA). Some were on lifepaks.

I was just down there to get my ICU patient for transport. The staff didn't even know this is illegal in California. (ICU patients must receive to same level of care regardless of location in the hospital.)

The staff knew it is unsafe and wrong.

William_SRNA · Aug 18, 2005

You are an emergency nurse. Your assignment is to care for a patient with a myocardial infarction until an intensive care unit (ICU) bed can be found, for a trauma patient, and for a patient in the hallway with the gunshot wound to his leg awaiting surgery. Another ambulance with a patient in respiratory distress has just arrived. Did you go into nursing to have many more patients than you can safely care for?

When does this situation happpen 1 in every 10,000 shifts. They always go to the extremes in these articles and it is not reality

Katnip, RN · Aug 19, 2005

Hoop, it depends on where you work.

Today was just one example. I had two severe GI bleeds, one was getting 2 units of PRBC, the other was getting 2 units FFP and and then 2 units PRBC. At the same time, I had a patient having an active stroke, and 2 cardiac work ups. Fortunately, the two cardiac pts were negative. All at the same time.

And that situation I just described was in the low acuity zone of our ED. The other higher acuity zones were no better.

Had something similar, though not quite so dramatic yesterday. I really dread tomorrow.

It doesn't happen like that everyday, but usually at least once or twice every week.

We are stretched about as thin as you can get.

pickledpepperRN · Aug 19, 2005

Ya think? Increasing ICU Beds Eases Ambulance Diversion.

http://www.ohsu.edu/ohsuedu/newspub/releases/030405bedshtml.cfm

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Good idea to increase staff. Otherwise the unstable patients are cared for while others who should be evaluated, treated, and discharged wait.

"We increased staff and training with a focus on rapid patient evaluation, in addition to enhancing our ancillary services," said Saint Francis President and CEO Cheryl A. Fama. "Most important, our new Emergency Department Medical Director, Dr. William Webster, has provided tremendous leadership. We are very proud and gratified to be able to accept more ambulance traffic and provide more access to emergency care."

http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=104&STORY=/www/story/05-25-2004/0002180936&EDATE=

Home Health Columnist / Guide · Aug 19, 2005

When does this situation happpen 1 in every 10,000 shifts. They always go to the extremes in these articles and it is not reality

It certainly is the "several time a week" reality in the Philly area for ER nurses.

Home Health Columnist / Guide · Aug 19, 2005

this info crossed my puter today at work from hospital and healthcare assoc of pa.

free webinar available about improving patient flow, reducing ed diversion

the program office of the national robert wood johnson urgent matters project on improving patient flow and reducing emergency department diversions has archived information from its july 14 webinar for easy access by providers. the webinar site provides slides, an audio recording, and responses to follow-up questions from the presentation.

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[color=#b03d5a]project overview

urgent matters is a $6.4 million initiative of the robert wood johnson foundation to help hospitals eliminate emergency department (ed) crowding and help communities understand the challenges facing the health care safety net.

the program has three specific goals:

to improve the ability of safety net providers to respond to increasing emergency department (ed) volumes;
to assess and highlight the state of local safety nets in select communities; and
to publicize the program's findings to local and national audiences.

to meet these goals, the initiative provided resources to ten communities to increase understanding of the safety net and improve the timeliness and availability of ed care. ten hospitals in those same communities worked as part of a learning network to develop and implement best practice strategies to maximize patient flow and relieve ed crowding. of those ten hospitals, four also received $250,000 in grant funding for a special demonstration project to lessen ed crowding. all sites participated in a safety net assessment and community education process in conjunction with identified "community partners", helping to raise awareness about the state of the local safety net.

urgent matters communicates its lessons learned to a variety of local and national audiences, providing valuable management tools to america's hospitals while helping local communities craft solutions to the problems faced by their health care safety nets.

urgent matters is now embarking on its second phase, spreading innovation in patient flow through webinars, conferences and a new learning network beginning february 2005. to learn more [color=#b03d5a]sign-up for our free e-newsletter, which provides important tools while keeping you updated on the program. also, download our reports on improving patient flow and assessing the health of the safety net. urgent matters is housed at center for health services research and policy (chsrp) at the george washington university medical center's school of public health and health services. we can be reached at [color=#b03d5a][email protected].

Altra, BSN, RN · Aug 26, 2005

When does this situation happpen 1 in every 10,000 shifts. They always go to the extremes in these articles and it is not reality

Sorry, I have to strongly disagree. I'm 5 weeks into my orientation in a level I ER ... one of my surprises has been that I will care for ICU patients for 5 or more hours until they get upstairs - on a pretty routine basis.

I realize this probably isn't the case everywhere.

nursemomruns · Aug 26, 2005

When does this situation happpen 1 in every 10,000 shifts. They always go to the extremes in these articles and it is not reality

It happens very frequently in our ER. Last week, 4 days, all three shifts. The week before, 5 days, all three shifts. I don't have the stats for this week yet. And it is worse in the winter. We have "hall beds" built into our assignments. I think it is pretty common in alot of areas. JEN has many articles on ER overcrowding.

nursemomruns · Aug 26, 2005

This is SO important. Many hospitals routinely and almost constantly hold ICU and other patients in the ER. It is now planned.
One hospital where I worked registry had papers taped to the walls in hallways with so called room numbers!
There is no privacy (HIPAA). Some were on lifepaks.
I was just down there to get my ICU patient for transport. The staff didn't even know this is illegal in California. (ICU patients must receive to same level of care regardless of location in the hospital.)
The staff knew it is unsafe and wrong.

Providing the same level of care regardless of location is a JCAHO requirement. A hospital in our area (Chicago area) was just cited for a violation of this. They are on JCAHO probation.

Aneroo, LPN · Aug 26, 2005

This is SO important. Many hospitals routinely and almost constantly hold ICU and other patients in the ER. It is now planned.
One hospital where I worked registry had papers taped to the walls in hallways with so called room numbers!
There is no privacy (HIPAA). Some were on lifepaks.
I was just down there to get my ICU patient for transport. The staff didn't even know this is illegal in California. (ICU patients must receive to same level of care regardless of location in the hospital.)
The staff knew it is unsafe and wrong.

We often have hall beds. Our hospital serves 20 counties. We cannot prevent it if we have several r/o MI's, a GSW, MVC's or whatever rolling in at the same time. Not like we can turn them away because we're out of beds. You show up, you get treated if you're having an emergency. Once a bed opens up, they get put into that bed. If a more acute patient comes in a needs that room, then that person goes back into the hall.

Our nursing admin has had staff nurses from floors come and get their patients some nights b/c we were too busy to even get to leave the floor to take them upstairs. The patients received the same level of care they would upstairs, just in a different unit. (Unless you were saying you had to come and care for that patient because the ER staff didn't know how or didn't want the liability- that's different). But sometimes it's done- because we're not familiar with some patients and can't give them the right care they need. I'd rather call for help than half-ass treat a pt because I'm too high up or afraid to ask for help.

Having the ICU beds saved is a huge help. We had a pt to the OR in 8 minutes after rolling in the other night, and she had an ICU bed before she even arrived at the hospital! Really makes things less complicated! -Andrea

teeituptom, BSN, RN · Sep 2, 2005

Welcome to the wonderfull world of ER Nursing

When the going gets tough, the ER nurses get going