Unsafe assignments in the ED

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Just curious..... do you ever (on a regular basis) have to have more than 4 rooms in your ED? If so, how many?

I have worked in many ED's all over the country and they would close rooms before a nurse would have to take more than 4.

The place I work now...it's not unusual to have 6.

Would appreciate your input. Thanks.

Specializes in ICU, ER.

Our normal staffing is 4, but we pick up a 5th 'hallway' (stable??) patient at times. I sometimes have 8-9 Fast Track patients when things get busy and staffing is short.

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In our ER we try to stay at the 1:4 ratio (and then 1:1 with codes, etc)...but occassionally we have to go to 5 each...but we are not assigned rooms, we do too much bed shuffling to maintain room assignments. But you can't really control how many people come into an ER...and for whatever reason (probably $) our hospital never goes on divert for ED overload! But it tends to be manageable, we use to have 8-12 patients...and that was unsafe...so I will take 5 anyday :)

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Specializes in Emergency.

Now we usually have no more than 4 patients, if the assignment is too much it is your responsiblity to let your superivsors know. Once years ago, when we didn't have room assignments and they just kept piling the patients on I made a big scene, I loudly refused to take any more patients. I said it was unsafe and we had to close the ER. Well I got more doctors and supervisors that came out of the woodwork to "help". I refused their "help" I said I need a nurse that will take RESPONSIBLITY for these patients. Funny thing is none of the doctors or nursing administration were willing to do so so We went on bypass for awhile till it got better. You must speak up for your patients safety!

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Specializes in ER, Cardiology, and GYN long ago.

In our ER (52 beds not counting fast track or peds) we used to take 6 in the "back" and 3 in "front" (more critical) until the Calif. ruling. Then shortly after, we were changed to "4 max no matter what" which lasted all of a month. Now, they TRY to keep us at 4 but when it's busy, you get 5 anyway. It wouldn't be so bad except that no one LOOKS at acuity and pts are placed in any open bed. There have been nights when I have had just too many high acuity pts like one when I had 1 pt on a vent, 2 acute GI bleeds awaiting ICU beds, an evolving MI, and a PID shuffler. (Thank God for her) It's not safe and when you complain, you get "well whatever you do for them is better than NO care." While that may be true, I doubt the attorney handling their case will present it to the jury that way. He won't know (or care) about the other high acuity pts that I had that night, just that his client didn't get the very best care including a bath, etc. (They sue over the small stuff most often).

OK, enough said, thanks for letting me vent... :banghead: :banghead:

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Specializes in emergency and psych.

1:4 here. If one of those is critical, drops to 1:3 or 1:2 for as long as necessary. Hallway patients aren"t allowed.

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Specializes in Emergency.

If hallway patients aren't allowed, what do you do when you run out of beds? Do you triage to the waiting room?

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Specializes in Emergency.

Our usual ratio is 3-4 pts each. We have a 13 bed ER. If we are short nurses (and we currently are), that ratio increases.

We do self-assignments and it usually works pretty well. There is the occasional lazy nurse who will choose only pts with low acuity until somebody shouts about it.

We pull together as a team as needed. We NEVER divert if we are full. The pts just wait in the waiting room. We have additional 2 hallway beds we use as needed. I think it would be much safer to divert, but God forbid we turn away the almighty dollar!

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Specializes in emergency and psych.
If hallway patients aren't allowed, what do you do when you run out of beds? Do you triage to the waiting room?
We operate with a 5 level triage system. Levels 4 and 5 to the waitingrooom(semi urgent and nonurgent). Most level 3 (urgent) go to waiting room if there is no available bed. We also try to keep one major room open for any level 2's or 1's (emergent and resuscitation) that may come in. Of the level 3's in the waiting room, they are roomed based on the individual acuity in that particular group.
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Specializes in Emergency Dept, ICU.

We have 1:4 staffing in our ER. it's not one of the higher ratios

I see on this post, but I often believe according to acuity it's unsafe

for me (a new grad to beat it). I can't imagine 1:5 or 1:6....

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Specializes in Emergency Dept, ICU.
If hallway patients aren't allowed, what do you do when you run out of beds? Do you triage to the waiting room?

If all 30 beds are full in the back (non-fast track) then we have no option but to bump out to the waiting room. If it's Urgent/Emergent we will keep it in a triage room and the triage nurse will work with it till an ER room opens up. ;)

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50 room level 2 trauma center--1:2 in the trauma rooms, 1:3 in high acuity, 1:4 in lower acuity sections--but if we're slammed we pull out the extra beds for hall patients.

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1:4 here. If one of those is critical, drops to 1:3 or 1:2 for as long as necessary. Hallway patients aren"t allowed.

excellent...

putting patients in the hallway should be for a VERY short time, if done at all...at my (previous) busy urban ER, I would be in charge, come into 4 hallway beds, and a full (20+) waiting room...if any of those hall patients were being worked up, they went into the next open room, until the hallway was used for its original intention - (a novel concept)...

Being in the hallway as a patient would likely suck, and EVERY pt deserves a private room...

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