Small ER lab question

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Specializes in ER.

Hello. 
The small (6 bed) military ER I am working at is floating the idea of closing the lab (having lab on call 30 min response) from 11-6am. We are expected to still function as a full ER and we would do simple point of care testing during those hours. My concern is how can we be an ER if we don't have immediate lab service for stats and blood release. Granted our utilization is low that time of night but shouldn't we be prepared for worse case scenario?

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Specializes in Research & Critical Care.

I don't work ER but a very busy level I trauma ICU and honestly I find our POC ABG/VBG with resus panel (hgb, glucose, K, etc) far more valuable in a critical situation than the actual lab with their long turnaround times. I wouldn't even notice a 30 minute difference.

There has to be a way to access emergency blood, though. Even keeping a bags of O- in a fridge that lab could leave and then take back in the morning. That seems like a non-negotiable to me.

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Specializes in ER.
MaxAttack said:

I don't work ER but a very busy level I trauma ICU and honestly I find our POC ABG/VBG with resus panel (hgb, glucose, K, etc) far more valuable in a critical situation than the actual lab with their long turnaround times. I wouldn't even notice a 30 minute difference.

There has to be a way to access emergency blood, though. Even keeping a bags of O- in a fridge that lab could leave and then take back in the morning. That seems like a non-negotiable to me.

Only POC we would be allowed to do is strep/flu U preg and UA !?

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Specializes in Emergency Department.

So I think you are asking,  is this legal for an ED to do?? Not have full lab services, blood bank available 24/7??
 

Well, It all depends upon what kind of ED your facility  is designated and licensed as. Critical Access, stand alone ED or trauma designation. Even as a critical access ED it's all about "stabilization & transport", So, Joe blow gets dropped off at your ED door step after being stabbed multiple times. However, you are an 8 bed, critical access ED with limited services and no blood bank. Or, a vag bleed has a hgb of 5 that you ran as a POCT but have no blood bank.
 

Your hospital will have a transfer plan for a pt needing a higher level of care. 
Ask your mgr/director what kind of ED you are designated and licensed as. My guess would be you are a critical access or stand alone ED. Which do not have to have 24hr lab. You would simply follow EMTALA/COBRA and stabilize & transfer. 

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
LML131 said:

ends upon what kind of ED your facility  is designated and licensed as. Critical Access, stand alone ED or trauma designation. Even as a critical access ED it's all about "stabilization & transport", So, Joe blow gets dropped off at your ED door step after being stabbed multiple times. However, you are an 8 bed, critical access ED with limited services and no blood bank. Or, a vag bleed has a hgb of 5 that you ran as a POCT but have no blood bank.

It's a military ED. Whole 'nother ball of wax. You don't even have to see people who aren't beneficiaries after those patients receive an MSE, you can just show them the door if they don't have TRICARE. A lot of bases are closed (after a fashion) and ERs won't even receive patients not affiliated with the military. Every now and then you might get an on-base contractor or AAFES employee who gets injured on post, but otherwise, it's pretty run-of-the-mill stuff. 

OP, I wouldn't be comfortable with no lab services if you didn't have access to at least a couple of units of uncrossmatched blood in the ED. That with some iSTATs would probably be okay - worked fine in Afghanistan. We were the lab and the x-ray techs and the pharmacists too. LOL. 

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What bona fide emergency could you not begin treatment just using a POC device and just wait for 'real' labs for 30 minutes? You certainly don't need an h and h to know someone that is bleeding to death needs blood. You'd be giving uncrossmatched type specific or O neg anyway.

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Specializes in ER.
offlabel said:

What bona fide emergency could you not begin treatment just using a POC device and just wait for 'real' labs for 30 minutes? You certainly don't need an h and h to know someone that is bleeding to death needs blood. You'd be giving uncrossmatched type specific or O neg anyway.

I wouldn't be getting access to an I stat. Just strep/flu/preg poc tests. No access to blood bank until lab gets there. 30 min recall time THEN lab processed 

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Then it sounds like this isn't actually an emergency department. If you don't have 24/7 lab/blood bank, do you have 24/7 CT capability? Surgeons on call? staffed ICU? 

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Specializes in ER.
offlabel said:

Then it sounds like this isn't actually an emergency department. If you don't have 24/7 lab/blood bank, do you have 24/7 CT capability? Surgeons on call? staffed ICU? 

 

Small military ER. No ICU. No radiology after 5. Call in. No OR outside business hours. The ER operates in the grey area a lot but is considered an ER which can complicate transfers 

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Hmmm...then I'd consider myself lucky to have labs on a 30 min call in basis.

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Specializes in Flight Nursing, Critical Care Transport, ER.

You're describing my first-ever ER job! I worked in a rural critical access ER, and we had three beds in total. The lab and radiology departments were on call at night, and our provider was usually a locum staying in a hotel across town. We treated most emergencies with standing orders and called the provider as soon as possible to come in and see the patient. We had access to the lab to get uncrossmatched blood if needed for MTP. Our next closest hospital was 90 minutes away by ambulance, which meant we flew out all traumas, STEMIs, and strokes. It definitely keeps you on your toes; some of my best cases were working in that ER.

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