We've just been informed by our new er manager (an rn), that our LWBS numbers are too high. (Left Without Being Seen). Meaning the patients are not wanting to wait (sometimes 2-3 hours, not bad considering county hospital sometimes has 18 hr waits!), or they decided they aren't really that sick, or have gotten an appt with their dr...........whatever the reason. So she has put out a memo stating that "this WILL change!" We (the triage nurse), are to "go out in the lobby and check on patients" ............and do what, we wonder? Chain them to the chairs so they won't leave???? She then proceeds to write that "if I notice trends among certain nurses, these will be documented, and there will be Verbal Warnings!" (Like what comes after verbal warnings?) Some of our nurses seem to be stuck at triage every shift. Some, like myself, hardly ever do triage. I don't know why. How the hell are we supposed to keep people from leaving the waiting room? :angryfire We are all somewhat pi##ed off about this. I mean, if people are waiting........that means that we are FULL! and FULL means that sometimes we have people sitting in the hall in chairs, not even in a bed (because they are all FULL!) Good grief
We already have a policy implemented that we are to do vitals every 2 hours, on every patient (minimum) whether they are in the lobby or in the er. When someone leaves with out being seen, we are now to write up an incident report.......believe it or not....... with the reason they left. Hello, they don't always tell us they are leaving. Besides, if it is so busy, that I cannot get people into the back........how much time do you think I have to write up incident reports???? Aargh :angryfire
Just a long vent...........anybody else EVER had this happen? I mean, jeez, if they are well enough to leave, they probably didn't need to be in the er in the first place. and if they were really, really ill, the triage nurse would've found SOMEPLACE to put them in the er. Not back in the waiting room.
Tom, that sure puts it in words that make sense to me.
If they can't keep the doors open, the patients have nowhere to go, and I do not have a job (thinking in the optimistic future.....).
If there is enough money, it also makes for a more pleasant working environment as well--if the bean counters ain't happy, ain't nobody happy!
Thanks for the simple and clear perspective.
(And before this thread gets wild with "quality nursing should be the issue" posts, let's keep in mind that we can do great nursing by being kind, caring and responsible. That takes little time, little effort--but does take attitude. Boy, I can feel the stinging PM's now!!! :kiss in advance, you guys!)
I don't know numbers but our LWBS pts are pretty low. We, too, have to fill out occurance reports each time. AMAs, too.
We see about 35,000 pts/yearly in our ER.
We have 20 beds-6 of them in our fast track.
We have a 24 hr charge nurse, 20 hr triage RN, 4 RNs unitl midnoc in the main ED then drop 1 at midnoc and 1 at 0300, and 1 RN in fast track unitl 1600 then 2 RNs until midnoc there. We also have NTs (mostly EMT/medics)-1 in triage 24 hours, 2 in the main ED except from 10-1600, then only 1, and 1 in the fast track.
Our NTs also start IVs, draw blood, do ECGs, post-molds, dressings, foleys, etc. They are a HUGE help in our ED!
We have PAs in fast track from 0900-0100.
We have 1 doc in the main ER from 23-1000 then we go up to 2. Our docs do 8 or 10 hour shifts...so at their shift change, when there are 3 docs in the ED, if we are hitting it usually one of them stays so we have 3 docs for awhile.
Our wait times are usually 1-2 hours...but when we start hitting it the waits are more like 3-4 hours. But our pt population is so used to not having to wait for long..they are FURIOUS when they have to. I would love to have this website up for people to see that waiting is EVERYWHERE!!! You guys really have a POLICY to re-check VS every 1 or 2 hours...on EVERYONE?!! Man...we don't ever put times into our policies...miss one and you have got nothing to stand on if someone decides to sue over a "bad outcome".
We use the ESI 5-tier triage system...works GREAT! We are able to see not only how many are waiting but what acuity they are. It also works well with our administration (who are still learning it) to be able to tell pretty close what potential admits we have.
As for your manager...give him/her a stethoscope and tell him/her to get out there and help if she/he wants thing to change. Nothing like a little finger-pointing to rile up your staff!!
:angryfire
HOLY COW! I am coming to Illinois to work! Your staffing is very impressive. In contrast, I work in a 25 bed ER (unless you count the 10+beds in the hall) and we see approx 58,000 pts per year, here is our staffing breakdown:
7a-7p- 4RN's 1 LPN, 2 techs and 1 charge RN and 1 triage RN
HOLY COW! I am coming to Illinois to work! Your staffing is very impressive. In contrast, I work in a 25 bed ER (unless you count the 10+beds in the hall) and we see approx 58,000 pts per year, here is our staffing breakdown:
7a-7p- 4RN's 1 LPN, 2 techs and 1 charge RN and 1 triage RN
final outcome from 0300 to 0700 3 RN's, 1 triage RN, 1 LPN, 1 tech and 1 charge RN.
we dont have a fast track, EVERYONE goes through the main ER. uggggg.
C'mon down!!
:chuckle
Our staffing is really decent...we have a very supportive managment team.
Of course everything goes you-know-where when you start throwing boarded pts into the mix. We almost NEVER get help from the floors...
We can be boarding 20 pts-usually a LOVELY assortment of ICU/tele and med/surg...and the floor may have open beds but they won't take our pt because they don't have another nurse...OMG...makes our great staffing go right out the window!!! But ahhh...that's another thread!!
OMG I hear ya! 2 weekends ago, we had 17 holds in a 25 bed ED! we were out of monitors and gyne rooms and casting rooms, it was horrible. did we get help? nope.
Day shift got 2 RN's from the m/s floor, but thats not enough....
My favorite patients are the ones who elope (except the ones with heplocks in) :angryfire
If I had it my way, I would have AMA papers waiting at the door.
And secondly, I think that is ridiculous that you are getting blamed for patients leaving the waiting room. They cant be all that sick if they are sitting there (we will put less urgent patients in the waiting room and give a sicker patient a stretcher when it gets that bad), and they have the right to leave whenever they want to. Nobody except for the patient should be responsible for thier actions (except a holding order psych patient!!) Not only that, how does that effect you and the other nurses legally by filling out incident reports?? I would get out of there pronto! They are asking for a lawsuit!
I work in a level I er. We see 60-65,000/yr. That nurses manager is responding to recent reports involving triage from JACHO/and state inspections. We recently had a state inspection. They told us we had to have 2RNs in triage at all times; revital waiting room pts q2hrs. Somehow, "left without being seen pt." numbers would count against your score. Our management never threatened to punish the nurses though. Thats absurd!! However, I do tell pts in triage that the er and hospital are full - the wait might be 12 hrs or more. Then I conveniently give them a handout that we keep at the desk of local clinics that are open 24hrs.and I have them decide before I start the paperwork. At least if they stay-they know ahead of time that theyll be there all night. Most of our pts are homeless,penniless and appreciate the long wait. Warm waiting room, several tvs, clean bathrooms - its a hobos paradise. (almost too much so)
I work in a level I er. We see 60-65,000/yr. That nurses manager is responding to recent reports involving triage from JACHO/and state inspections. We recently had a state inspection. They told us we had to have 2RNs in triage at all times; revital waiting room pts q2hrs. Somehow, "left without being seen pt." numbers would count against your score. Our management never threatened to punish the nurses though. Thats absurd!! However, I do tell pts in triage that the er and hospital are full - the wait might be 12 hrs or more. Then I conveniently give them a handout that we keep at the desk of local clinics that are open 24hrs.and I have them decide before I start the paperwork. At least if they stay-they know ahead of time that theyll be there all night. Most of our pts are homeless,penniless and appreciate the long wait. Warm waiting room, several tvs, clean bathrooms - its a hobos paradise. (almost too much so)
Ahhhhh...
It's great to see state legislatures and inspectors responding to the REAL problems being faced by ERs across the country isn't it!!?
I'm not sure how to address the AMA problem yet. I'm positive that it is a problem and needs to be addressed by management more so than it has been historically - 10% is way to much. That's just bad business. How many of those AMA's go home without seeking treatment elsewhere and end up dead on the couch? Think about it. How long would you own a vehicle that one out of every ten times you went outside in the morning to go to work just to get into it and find out it won't start? Seriously, erdiane your numbers put you at approximately 14 walk outs everyday! It's only about $6,000,000.00 that's right 6 million a year in revenue they're just flushing down the toilet. You need to tell your nurse manager, Diane that they need to come up with a better keep these people other than taking their VS every two hours. When you can show those kinds of numbers as losses you can really use some creative forces to justify promote your ER.
how do you come up with 6 million? just wondering............ I'd say at least 1/2 of our patients are on state insurance. Many don't have any at all. Those that don't usually don't plan on paying anyway. We just had an illegal alien come in for emergency dialysis. The state will not pay for routine dialysis for illegal aliens, but lo and behold, per emtala we have to treat them in the er. This poor gent usually has to have dialysis 3 days in a row by the time he shows up in the er. We don't get paid. At all. Good ol' emtala. Not sure what to do to convince people to wait in the waiting room. Plead? Give cookies? Backrubs? Just kidding.
At least one in ten of the patients that come into my ER present with something they would be better off treating at home in bed with a good snort of whiskey. Perhaps she has found a way to make them come to their senses and go home, where they belong.
My favorite patients are the ones who elope (except the ones with heplocks in) :angryfire
If I had it my way, I would have AMA papers waiting at the door.
And secondly, I think that is ridiculous that you are getting blamed for patients leaving the waiting room. They cant be all that sick if they are sitting there (we will put less urgent patients in the waiting room and give a sicker patient a stretcher when it gets that bad), and they have the right to leave whenever they want to. Nobody except for the patient should be responsible for thier actions (except a holding order psych patient!!) Not only that, how does that effect you and the other nurses legally by filling out incident reports?? I would get out of there pronto! They are asking for a lawsuit!
We live in an area with 4 er rooms in a 5 mile radius. I love the irrate pts that show up at our er after a 5 hour waiting room visit at our competerors then whine, scream, hollar, cuss about the wait. theses are the ones u hope will LWBS!!!!!!!!
at what point do we, as nurses become responsible for the actions of every person who walks out of an er at any given time? I think if they want to walk, them let them walk. Its their health and their life, not up to me to make them stay.
People have to take responsibility for their actions, they arent punishing me me if they are sick and want to walk out especially if they are mad that they have to wait. as long as they are able to make a rational decision, It is up to them. just my opinion of course.....
chris_at_lucas_RN, RN
1,895 Posts
Tom, that sure puts it in words that make sense to me.
If they can't keep the doors open, the patients have nowhere to go, and I do not have a job (thinking in the optimistic future.....).
If there is enough money, it also makes for a more pleasant working environment as well--if the bean counters ain't happy, ain't nobody happy!
Thanks for the simple and clear perspective.
(And before this thread gets wild with "quality nursing should be the issue" posts, let's keep in mind that we can do great nursing by being kind, caring and responsible. That takes little time, little effort--but does take attitude. Boy, I can feel the stinging PM's now!!! :kiss in advance, you guys!)