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.
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.
I think the difference is that whatever unit we are talking about, the RN doesn't work out of their ratio? Am I understanding that correctly? In the ED you may have a hallway pt but you're still w/i ratio, right? The overflow stays in the waiting room until people move up or move out. If they are still in ratio then you're right to say what's the big deal because the ED during flu season can look like a disaster zone and y'all upstairs don't even understand!! Bathroom? Oh, you mean the one the homeless guy's girlfriend is bathing in right now? Yeah. It's gonna be a minute. Try the one down the hall.
I think the difference is that whatever unit we are talking about, the RN doesn't work out of their ratio? Am I understanding that correctly? In the ED you may have a hallway pt but you're still w/i ratio, right? The overflow stays in the waiting room until people move up or move out. If they are still in ratio then you're right to say what's the big deal because the ED during flu season can look like a disaster zone and y'all upstairs don't even understand!! Bathroom? Oh, you mean the one the homeless guy's girlfriend is bathing in right now? Yeah. It's gonna be a minute. Try the one down the hall.
Ok. Look. This isn't about "ratio". Although--you're assuming that the ED has this rule. Most states and facilities do not require this, and in the case of MA...the nurses actually hamstrung themselves. So much for looking out for fellow RNs. I digress.
This is about placing a patient for THREE DAYS IN A HALLWAY.
How about this...for those poo-poo-ers who just don't ever think about what's happening outside their unit bubbles on the floors. (caveat. I was an ER RN long before I was ICU. I have BOTH sides of the story now.)
How about we take your Grandmother, who fell in her bathroom this morning...and bring her to a "Level 1, Magnet Facility with ALL BSN NURSES!!!" Just like 500 other patients every single day that arrive at that 88 bed ER--you think your Grandma is really special and important and fragile and deserves the best care that your top tier insurance provides.
Dollars to donuts, unless your Grandma has a cracked skull or is bleeding into her brain---she's eligible for The Hallway Bed. She's stable. She's not actively bleeding. But she needs to be admitted for obs.
But the hospital is full.
Now....do you honestly believe that nobody is coming into the ED after your Grandma? Nobody gets to have care until your Grandma is taken care of...and she gets to have a room all to herself while she waits for a bed upstairs?
How about Wuzzie's Grandma---who fell and hit HER head but is now diagnosed with a SDH and ....still can't get a bed on Neuro ICU because they are full.
I am bumping YOUR Grandma into the hallway. EMTALA says (and for those of you who don't know this term. GOOGLE IT. It's why we in the ED are REQUIRED to do what we do.)
She still needs observation. But no beds upstairs. She gets to stay in that hallway bed until one of three things happens.
1. Bed is found and she's transferred 2. No bed is found and she gets to sleep in the 88 bed ER in front of meth head who flicks bedbugs across the hall onto her bed and little old dementia lady whose family dumped her on the ER because it's Christmas and who needs dementia at the dinner table <wink nudge>....and a host of various ailments and injuries that ARE NOT THAT SERIOUS but the person still made their way to the ER. or 3. You take your Grandma home because it's truly humiliating and undignified for an 82 year old woman who survived 5 childbirths and WWII and the death of her husband of 45 years---to lie on the equivalent of a piece of plywood with wheels while people are screaming and vomiting and bleeding around her.
How do you feel NOW. It's not that bad?
This is reality in the ER. I can no sooner get your Grandma a bed upstairs as I can stop the influx of MORE ACUTELY INJURED from coming to be stabilized. The law say that I HAVE TO DO THIS.
Divert? Seriously? If this was something that hospitals could just "do"---you don't think that they ALL would do it at the capacity? Ok. Let's run with that.
Hospital A has 46 licensed beds. My hospital had 88. Hospital B 45 miles away had 55. This is it. No more ERs in that area. You have to bring your Grandma to "critical access" hospital >40 miles outside of our city to find another ER.
My ER, in reality---processed 300-400 patients PER DAY.
But what you think is appropriate is for me to take those first 88--and until I can discharge or admit one of my patients....I tell EMS to "go somewhere else" with their patients? I tell the bleeding Grandma whose family barely got to my ER....uh....hey Grandma....we're at capacity...sorry.....
This is ridiculous. I never had more entertainment than I did when I would call up to the floor and this poor Med Surg nurse who had TWO WHOLE ADMISSIONS that shift...just was getting her charting caught up and hey...could you wait on that until I get back from Starbucks...and oh....it's almost 1830...and I'm off at 1900...could you just save that ER admit until after I'm gone?
Yeah. No.
Because you...."Immma nurse and my Grandma deserves the best care!" will sue my orifice if I don't make room for your bleeding Grandma. At the expense of Wuzzie's Grandma.
I worked at an ER that had 66 licensed beds. When it rained and was cold? Every single homeless person "had a plan" or "the worst headache of their life" or "chest pain 10/10"
Are you actually suggesting that I tell these people, "You're faking it. Go somewhere else."?? Plan, ha, and cp get to the front of the ER line. End of conversation.
Your Grandma gets a head CT, a cold pack, some tylenol---and a hallway bed to await an upstairs opening.
Unless of course, you're suggesting that I kick your Grandma out directly after I treat her from her SDH?
If any pearl clutcher here just swoons at the idea that this happens? Go down to your OWN ER and get a look into the trenches at what trauma nurses do every single day, the choices that they have to make.
This isn't "bad administration". This is the reality of how people see the ER---some see it as a PCP, some see it as a refuge from the weather and homelessness/hunger, some see it as a drug dispensary, some see it as a lifeline to keep them breathing, some see it as a place to die.
As long as we keep closing rural ERs and forcing patients to crowd into these mega ERs---keeping health insurance out of reach of most average people---and allow lawyers/patients/families to sue us for not bringing a snack in a prompt manner (tort law)--this will continue.
Until then....please...until and unless you know what goes on in the ER as a nurse...judging and condescending just shows your ignorance of the facts.
Specializes in Critical Care; Cardiac; Professional Development.
Diverting is not an option for safety net hospitals. Often the hospital involved has to activate disaster/emergency procedures to cope with the overflow and yes, it can lead to patients in the hallway for lack of space. This is both in the ER AND on the floors. Enough with the us vs them mentality folks. In these situations nobody is cushy.
In the ED you may have a hallway pt but you're still w/i ratio, right? The overflow stays in the waiting room until people move up or move out.
No, not right. There were times I had 5 ED beds AND anywhere from 2-3 admit holds. Most of the ED beds would turn over at least a couple of times a shift if not more so that meant new work ups and assessments for each of them. And no, the “overflow” didn’t wait in the waiting room. We just added more stretchers and when we ran out of those we added chairs with paper numbers above them so we could keep it all straight. “Diversion” means nothing. If a squad brought us a patient we HAD to take them because of EMTALA regulations. Don’t think EMS didn’t figure that out right quick. We had days where there were 40+ admit holds in the ED and from what I hear it’s just gotten worse. We can’t just leave people in the waiting room because admits are taking up all of our beds. Those people are at significant risk. So we double our patient load and treat CP in a chair with a tele box and a portable O2 tank. Apparently as long as it isn’t happening to you ( I mean that as a collective “you”) that’s okay, let the ED staff keep taking it in the rear they’re used to it.
Specializes in Medical and general practice now LTC.
Ok guys, this isn’t a thread to throw things at each other but maybe a way to educate each other in how various departments work and their restrictions or policies. Please keep to topic
Many years ago in the UK I worked in a medical admission unit and we took all medical patients from A&E (emerg) outpatients and community. Always had waiting lists for people from all routes and spent most of our time waiting for beds to come free so we could admit, start any investigations and either kept for 24 hrs if plan was discharge or wait for bed to come available. Short story is I bet this isn’t just happening in one country but many as demand goes up and resources go down
In the hospital I used to work in, there were call buttons wired in the hall ways, and they used recliner chairs for those patients, but on our floor, we did not have any, so I am not sure how a patient would request assistance. We could not have used beds or stretchers in the halls because of lack of room. It was almost comical at shift change because all the admits and transfers would be arriving, and the transporters would be upset because they couldn't deliver the patients. The halls were not wide enough to allow one stretcher to pass another.
According to my old coworkers, patients are being placed in the ambulatory area over night, but need to be moved by morning, and placed in PACU.
Not only are we not "in the ratio" (my management doesn't acknowledge a hard number ratio); we are not staffed at night to cover all the holds. Our staffing goes down according to the usual number of ER pts during the night. Once the admit orders are written, those pts don't count in our census, so it looks like we are "over staffed" to the bean counters when we keep all the staff there, or even call in more. The night supervisor knows, but months later when analyzing our data? nope.
osceteacher
234 Posts
Guess that's what happens when you run hospitals to make profits for corporations.