Question about Code Beds

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At your hospital, do you save a "Code bed?"

I'm asking, because I recently got called to the carpet at my current job because I held a code bed "just in case." I was told that we NEVER hold a bed for a potential code and we don't plan for the what-ifs.

I'm the house Supervisor and I am expected to fill every bed in the ICU (it's only 8 beds). I cannot have a code bed and I cannot leave an empty bed in the ICU if there are patients boarding in the ER, even if it means stretching the nurses beyond the 2:1 ratio.

At my previous hospital, I was spoiled, because we always had a code bed, and a free-floating charge nurse that could take a 2nd code if needed. Here, I have to cross my fingers and hold my breath that there's not an in-house code because I won't have a bed for them.

So, do you have a code bed?

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I was a house supervisor. Never heard of a code bed. Never heard of saving an empty bed in ICU for just in case there was a code.

If ICU got admits that stretched staff beyond the 2:1 ratio I'd pull staff from another unit or get a stable patient transferred out of ICU or call in ICU staff at home to come into work early, I'd even take over the care of a stable ICU patient myself to free up the nurse to take the more critical new admit.

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Specializes in CCRN-CMC (MSICU).

I raised this question at the last ICU in which I worked. I was basically told the same thing. Although we had multiple instances where we needed an ICU bed for the code and there were no patient's who could be stepped down, so the code when to the ER to hold until a bed was available.

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Specializes in Surgical, quality,management.

When I was an AHHM we had to have a clear trauma or resus bay at all times in ED (trauma centre). I never kept a code bed in ICU. We had 400 beds in the building but on average a out 2 CB a month (many hundreds of RR). If I needed a critical care bed for a RR it is a discussion with the medical team what kind of critical care bed as well as ICU CCU and RCU could do NIV, stroke and neurosurg could do cardiac monitoring and management ED drains. The renal ward had capacity to do 1:1 transplant care as did BMT. And if all hit the fan and no other stable patient to move out to a general ward then move a high dependency patient to PACU and get the unstable pt to ICU. Yes PACU will be p.o. but o well.

What other higher acuity beds did you have access to?

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Specializes in Critical Care.

Up until recently, a code bed was standard in every ICU I've worked in, which includes not just the bed but a nurse who can take them. Of course a crashing admit was also typically a 1:1 initially, it's rare to find that anymore.

I would say there are some rules we have that in the end don't really produce different outcomes, but being ready to take care of a critically ill patient is actually a rule that can affect whether a patient lives or dies. I've personally seen this happen a few times, one recently was a patient who coded on a surgical floor. One of the ICU nurses had an overflow step-down assignment (stepdown wasn't actually full, just wanted to go "down a nurse"). So the nurse had to first get rid of three patients while also trying take care of the long list of things this patient needed done quickly. Everybody else pitched in, but when you've got your own two unstable patients you can't do everything for the swamped nurse, and even if the patient had no assignment at all when the code arrived they still needed help to get everything done. Patient was probably fixable, but died. Another was a GIB who should have been fixable, we just couldn't get things done as fast as they needed even though given proper planning we could have.

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Specializes in Critical Care.
13 hours ago, Faith1025 said:

I raised this question at the last ICU in which I worked. I was basically told the same thing. Although we had multiple instances where we needed an ICU bed for the code and there were no patient's who could be stepped down, so the code when to the ER to hold until a bed was available.

That's actually a pretty big EMTALA violation, unless by ER you're referring to licensed inpatient beds in the vicinity of the ER.

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Specializes in CCRN-CMC (MSICU).
4 hours ago, MunoRN said:

That's actually a pretty big EMTALA violation, unless by ER you're referring to licensed inpatient beds in the vicinity of the ER.

That is my assumption. That they are placed in licensed beds.

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Specializes in CVIMCU/CVICU.

Our ICU and CVICU pretty much always have a crash bed open. When it gets filled, we move patients around immediately to open up another one.

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Specializes in ICU, trauma, neuro.

Hospitals try to cut corners on having code beds here is my response as to why it is a bad idea:

a. It places the House Super, in jeopardy with their license. As a House Super you are also an RN, and if there is a bad outcome from not having an appropriate bed available then a complaint could be leveled against your license by a nurse (the one who got tripled) or family (unlikely, but perfectly possible). I have actually told a House Super that if they made me take a triple when it was foreseeable that I would personally file a complaint against their nursing license and of any MD working the case (with the medical licensing board). No doubt they might do the same to me, but I will play that game of chicken all day long.

b. In the case of trauma at least in Florida state regulations specifically forbid a triple assignment for trauma nurses.

c. This illustrates why hospitals need unions since hospitals won't do what most would consider to be "common sense".

d. This also illustrates why we need "California ratio laws" because "staffing grids" will be abused and morphed at the convenience of administration for the purposes of money rather than patient safety.

e. In my opinion nurses and nursing unions should work with attorneys to facilitate "class action lawsuits" against hospitals that employ these sort of dangerous tactics. A few multi-million (better yet billion) dollar lawsuits (even if ultimately not successful) may be enough to discourage such blatant disregard for patient safety. Also, nurses and unions should work with newspapers and other journalist so that the public is made aware of hospitals that do this (so that they can reward the ones that don't by going to them instead). Many hospitals only speak one language and that is the language of money/profit it is their proverbial "jewels" and that is where I want to kick them every time preferably repeatedly.

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Thanks for all the input!

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Specializes in Critical care and management.

We are not allowed to keep a code bed and our charge nurses in icu sometimes have a full assignment, leaving no staffed open bed or forcing some nurses to be 3:1. As a former icu rn and now a supervisor it kills me to fill the last bed and leave staff and patients in unsafe situations. Our department has advocated for code beds, however most of upper management don’t believe in it.

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One poster mentioned when the code bed is used "we move patients around immediately to open up another one".

So why not, not, have a code bed. When a code is called on another unit, or comes into the ER, the supervisor, doctors, ICU nurses, can hopefully have enough common sense to be thinking ahead, "Okay, IF this code makes it is ICU ready, who can be "moved around", what staff can I pull from another unit or who usually says yes when I call them to come in early".

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