Tele or med-tele holds in the ER...

[carachel2]

'Tis the season for holding patients in the ER d/t no beds. Are you guys required to perform the complete admission assessment ? Are there any processes that have been initiated at your hospital to make holding these type of patients an easier process ?

The admission assessment on our computer is at least a 30 minute process involving everything from advanced directives to how many stairs they must navigate at home. It is not a big deal when you just have the one patient, but really not so doable when you get 4 other ER patients at the same time. And what about the 5 pages of MARS ?

[Sarah, RNBScN]

We don't allow holds on tele at all. If there are no beds in ICU or on the med. tele, we will use a portable monitor and bring in staff for that pt. We will not allow docs to say hold on cardiac monitor for 4 hrs. we stick together and show them the policy; usually end up admitted. We have one doctor who has since left "thank-fully" he could not make a decision with out have a 3rd neg. tni to R/O ACS. OMG...rely on diagnostics instead of clinician skills.

We only do what is req on the orders as well (labs, meds) etc...

[ratchetrn]

We haven't had to do the admission assessments in out ED, yet! We do what we can, we mostly hand chart meds instead of using MARS!!! We do the advanced directive paper work on all admissions reguardless of whether or not they are held in the ER.

The thing that burns my butt is that any patient that is admitted to the hospital through the ER doesn't get surveyed as an ER pt, they only ask that patient about their inpatient care for the patient satisfaction scores! These are the patients that we do more for than any other! They even make us get a regular hospital bed and put them in it!