Time Management

[maddybears]

Give some examples of what the Emergency Room can do for time management to get patients in and out quicker then what it is right now? Were always trying to improve patient satification and 99 percent of the time patients come up to a unit from the emergency room, and usually these patients aren't the happiest because of the wait time.

[Anna Flaxis, BSN, RN]

I can't answer your question without more information.

How many beds does your ER have?

What is the average daily census?

What are the peak hours?

How many doctors are on duty?

What triage system is used by your ER?

How is patient flow implemented?

What is the staffing plan?

Does your ER have Nurse Initiated Protocols, or do the patients have to wait to be seen by an MD prior to any labs or diagnostics being ordered?

Does your ER have a Fast Track or RME area?

Once the decision to admit has been made, what is the process for getting the patient to the inpatient unit (i.e. do the ER docs write holding orders or does the admitting physician see them in the ER, and what delays have been identified in that process; do nurses call report or fax it)?

What is the average hospital census, and what is the staffing plan for the inpatient unit (does the inpatient unit have enough nurses to safely care for new admits)?

Also, keep in mind that people hate waiting. My facility has one of the shortest average wait times in the U.S. for a facility its size and average census, yet people are still unhappy with waiting. I can't think of anything we can do to make anything happen any faster, yet people still complain.

[brainkandy87]

One of the big things that helps wait times in our ER is float nurses. We generally have 1-2 at any given time. I've heard strong opinions for and against these, as some nurses absolutely do not want anyone else touching their patients. The nurse I respect the most of any I've worked with was one of these and actually left because he was so adamant about his patients being HIS patients. I do understand this and, when I worked on a step down unit, I was in this group and didn't want anyone touching my pts (mainly due to so many nurses on that floor being incompetent). However, in the ER, I've flipped sides.

We're assigned four pts, but we also have a fast track area for non-urgent pts. So that usually means we're needing to be on top of a lot of things at once. I am always checking for new orders, new labs, etc. If I have four pts, I KNOW I'm going to need that float nurse's help, otherwise my pts are going to be waiting twice as long as they should be. While I do like to maintain control of my pts and make sure they are getting good care, I don't want them to be stuck in the ER even longer because I want to be a control freak. It also helps that I trust my float nurses. Generally speaking, only solid, well rounded nurses are put in float.

Anyway, sorry for the rant. In a nutshell: float nurses help us cut down time of stay. :)

[Altra, BSN, RN]

When you say "wait time" for patients who are admitted ... that does not necessarily have anything to do with the emergency department per se.

Patients are not "held" in the ER for any reason other than lack of bed availability on the unit to which they're being admitted.

Edited to add: I read the OP as being a nurse working in an inpatient unit ... who points out that patients often arrive to his/her unit unhappy about having spent an amount of time in the emegency department that they find unacceptable. And so their "satisfaction" with their hospital stay starts out on a bad note.

I am pointing out that there is no reason at all that patients remain in the ED, other than lack of an available inpatient bed to which to move them. This is a hospital flow problem, not an ED problem.