Virtual/Hallway patient

[Ra3liana]

Does your floor get virtual/hallway patients? ( Patients admitted into your unit from ER who have not yet had a bed and they stay on the stretcher in the hallway in your unit until a bed become available)

From time to time we get virtual patients and we will have to take a hallway patient in addition to the patients we already have. These hallway patients are supposed to get the priority to be assigned to the next available bed.

Today there was an incident and I just want to vent. An elderly patient had been admitted as hallway patient since two days ago but hadn't been able to get a bed due to no discharge. When there was finally one discharge today, the bed, instead of being assigned to the him, it got assigned to another ER patient who had called the unit manager and patient representative to demand a bed in our unit. I feel very bad for the hallway patient who had to remain on a stretcher in the hallway for the third day. It's totally unfair that he didn't get the bed only because he couldn't speak English to advocate for himself while the other ER patient was very vocal about his need and knew how to complain! I hate that management suck up to these patients, treating them like VIP just to keep them from complaining.

[Orion81RN]

How awful ?

[NightNerd, MSN, RN]

Wow, that's awful! I've never heard of this practice and hope I never see it in my hospital. This sounds like all kinds of accidents (not to mention HIPAA violations) waiting to happen! What do you do when these patients need to use the bathroom, bathe, etc.? Where do they do that stuff if they don't even have a room?

[K+MgSO4, BSN]

This is one of the reasons I left Ireland. 12 yrs ago we started this due to ED targets. It is still happening there now.

Where I am in Australia this would not happen. There is a day flex ward that clears out the admissions from ED at 7AM so they can work and those pts have to be out of that ward by 4 PM as it closes either home or a multiday bed on a ward.

[Wuzzie]

6 hours ago, NightNerd said:

Wow, that's awful! I've never heard of this practice and hope I never see it in my hospital. This sounds like all kinds of accidents (not to mention HIPAA violations) waiting to happen! What do you do when these patients need to use the bathroom, bathe, etc.? Where do they do that stuff if they don't even have a room?

The same thing the ED does with their multiple, multiple hall beds.

[LibraSunCNM, BSN, MSN, CNM]

Yikes! That poor patient. I've never worked at a facility where hallway beds on regular units were common but it sounds like your leadership sucks if they prioritized a complainer over the first patient who'd been waiting longer.

[Swellz]

I traveled at a hospital that kept a corner of hallway where they would put a patient if necessary. It's pretty jacked up to put someone somewhere with no way to go to the bathroom if they can't walk all the way down the hallway to the visitor bathroom; the curtain didn't go all the way around, so if they wanted to use the urinal/bedpan/bedside commode they didn't have privacy. It only actually happened once during my travel contract, but we prepped the "room" multiple times just in case. They really made an effort to move people around and promptly discharge to avoid something like that from happening.

[amoLucia]

I hate to ask this but ... what else can a facility do when it is most certainly obvious that the pt needs admission for acute skilled care needs? It's not like they can just give him cab fare to go to another facility. And I'm also sure that the facility isn't thrilled with the practice either.

Unless the facility's ER was closed and 'on divert', there's not much they can do to hurry up another pt's dischg or the decision of the ER to hold a new pt for admission. That's the role of Bed Management or Utilization Depts to work with physicians and Discharge Planning to prevent such backups.

However, I do agree that it was 'sucky' that another more verbally complaining pt got 'first dibbs' on the next bed when avail. That's another problem unto itself.

There may be a way to contact approp parties, like DOH, of the practice. I'm sure conducting a study on 'hallway holding times' might be of interest to some.

[Snatchedwig, BSN, CNA, LPN, RN]

That is disgusting. Divert the patients to another hospital. That sounds like a third world country.

[osceteacher]

Can't say for sure but I've never seen this kind of thing in the UK, I've seen similar stuff where for an hour you might have a patient on the ward stuck in the corridor while a transfer was happening so that we didn't hit the 4 hour wait time but not days on a stretcher, that seems pretty gross.

[Wuzzie]

10 hours ago, Snatchedwig said:

That is disgusting. Divert the patients to another hospital. That sounds like a third world country.

You do realize that this happens every. single. day in emergency departments across the US and not with just one patient. Why is it okay in the ED when we have 2 bathrooms for 100 patients plus visitors, no over-bed tables, no dedicated food service, no televisions, no phones, precious few pillows but if it happens with just one patient on the floor it's horrible? I'm not trying to be contentious it's just a little ironic that nobody gets upset about it until it's happening to them. Boarded patients in the ED get lousy care. Worse than a hall patient on a unit. Not because ED nurses don't care but because they are stretched beyond their limit and because the unit is not designed to care for these kind of patients.

[RNperdiem, RN]

Thankfully I have never had to deal with this. If my ICU is full, and a critical patient really needs the bed, we might board on of our more stable patients in another ICU. The boarded patient would usually be having something familiar to any ICU nurse like vent weaning.

For the floors, there is an admission/discharge unit. The ED patient would take a bed there in that department until the floor bed was ready.