Post ops coming back to ED as "holding" patients

allnurses Guide · Mar 3, 2016

Nope, once they are inpatients they cannot be moved to an outpatient area. That doesn't mean the holds that are inpatients, but sending to the ER from in house is a big nono. Once they move out, we cannot access charts appropriately anymore. The PACU nurses have to stay if there aren't beds available (which they hate if they've been called in at night, can't say I blame them, but you still can't send them back!)

I know this is hospital policy, but I believe there are JCAHO regs about it but wouldn't swear to it.

NurseOnAMotorcycle, ASN, RN · Mar 3, 2016

WHAT?! I've never heard of that before. How do they even get away with that? :banghead:

CraigB-RN, MSN, RN · Mar 3, 2016

What mostly likely is happening is that somewhere in the background someone is carving up the ED and the square footage of the bed space becomes an inpatient or other type of space, but no longer an ED bed. Happens all the time, Not always best patient care though.

The proscriptions against bringing a patient to the ED is that the ED is considered an outpatient environment and is billing related.

The regulations are CMS regulations not JC. The Joint commission role is not to have regulations of it's own, it's to assess hospital following government regulations, such as OSHA, CMS, FDA, DEA etc.

Nalon1 RN/EMT-P, BSN, RN · Mar 3, 2016

Never seen a post op to ER as an admitted patient to be held.

Only time I have ever seen any thing similar is when we have had an endoscopy that went up but came back down for discharge, but endoscopy is an outpatient procedure, we are not holding them, just discharging them.

Usually it does not happen, but has 2-3 times that I know of (usually late in the evening when PACU is wanting to go home). PACU does the initial recovery, we hold them for an additional 30 minutes to an hour. Most times endo comes down and does it at bedside.

Altra, BSN, RN · Mar 4, 2016

This is probably an EMTALA violation. You cannot transfer a patient from inpatient (surgery) to an outpatient area and then back to an inpatient unit.

However, if the patient originated in the ER ... this can play out a little differently. If a patient presents to the ER and their treatment requires a minor procedure, they may go to the procedural area, spend a short time in recovery, finish recovering in the ER and then be discharged. (examples: replacement of G-tube, GI scope for food bolus) But in this case, the patient was an outpatient from the start.

MunoRN, RN · Mar 5, 2016

If patient are being told immediately post-op to get themselves to ER and tell them they need medical care since they just came out of surgery, then that would be problem, but there is nothing against the rules in providing post-op care in an area referred to as being part of the ED. What the rules require, is that if the patient if an alternative area is used for recovering patients after surgery that it also must be a critical care area (which includes the ED, as well ICU, PACU, etc).

There is no required segregation between inpatients and outpatients in hospitals. There are certainly areas where it's more common to find full inpatient admits, and other areas where you're more likely to find non-admitted patients, but they mix pretty regularly, which isn't against the rules. Cath labs for instance handle both inpatients and outpatients, then they go to cath lab recovery which is also a mix of inpatients and outpatients. Not all patients coming out the OR are inpatients, many PACU patients are not and aren't going to be admitted to the hospital. Chest pain rules outs are typically placed on cardiac tele floors, even though they typically are not admitted as inpatients.

bgxyrnf, MSN, RN · Mar 6, 2016

I wanted to ask around if any of the other ED facilities accepts post op patients to come back to ED and stay as holding patients

Nope. Once they go to the OR, they go to PACU where they stay until they get a bed or get discharged.

Unidirectional flow in these parts.

chylerlove · Mar 7, 2016

No, they have to go to PACU and stay there until a bed is ready. Patient's from surgery get "first dibs" on beds bc those are not licensed beds and legally cannot be used for inpatient or obs beds. That means the ED gets backed up with admissions bc we have to place surgeries first. however, they never come back to the ED to wait post-op