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.
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.
Is this due to a lack of enough facilities in your area? Or people not really needing to be admitted? Or not being discharged quickly enough and kept too long as inpatients? Or inadequate home health to follow up on discharged patients? Or ???
Is this due to a lack of enough facilities in your area? Or people not really needing to be admitted? Or not being discharged quickly enough and kept too long as inpatients? Or inadequate home health to follow up on discharged patients? Or ???
Do you mind saying where this is?
I am on the west coast. The overflow of patients is multi-factorial, so yes to most of your questions. This is the only hospital in the county, there is a small one about 40 miles away, and bigger ones 80 miles away, so they are pretty much the only game in town. There is a severe lack of behavioral health services, so the inpatient unit psych overflows to med/surg, who overflows to med tele, who overflows to step-down, etc. There is a lack of SCF and ECF, so some patients wait for a bed. Or there a "boarders" who can't be placed due behavioral issues or complex medical issues. The hospitalists are inadequately staffed (IMO) to handle all the admits and discharges they must do. And scheduled procedures and surgeries are never cancelled because they bring in money.
Divert patients to another hospital when at capacity.
On 5/23/2019 at 9:04 AM, Wuzzie said:
Legally we can't.
With regard to accepting ED patients, true.
With regard to admitting patients, not necessarily true. EMTALA includes both capability and capacity in saying that either may be a reason why a patient may be properly transferred within the confines of the Act.
Adding to the problem, corporations turn their multiple community acquisitions (covering enormous areas in total) into glorified clinics and drive providers out of those areas, then all of those patients are also funneled to the flagships, where they and other patients who need admission are billed for either obs or inpatient admission while lying on a gurney in a hall admitted to a "bed" that isn't staffed because it doesn't exist.
I see the ER and the chaos. It is constantly noisy and disruptive. ER nurses don't have a "10:00 med pass", they have the "The doctor just ordered this" time. The ER doesn't stock the same medications as on the units, so many meds need to be med requested from pharmacy. Dietary in the ER is a sandwich.
Moving an extra patient to a unit's hallway is a better solution. I spoke with one of the managers who says the patients prefer it to staying in the ER. The units are quieter and less chaotic (truly). The meds are available, food gets delivered, and the patients are being cared for by nurses that treat inpatients.
Sure, everyone would be happier if every patient was admitted and immediately had a bed available, but, unless that patient is desperate for an available ICU bed, there is a wait.. And sometimes a long wait. Patients boarding in ER. Patients boarding in PACU (some that never even had a procedure!). Sometimes for over a day.
I believe my hospital has a few requirements for "hallway" patients, including being continent, ambulatory and a generally low fall risk (since they are expected to walk to a bathroom).
With regard to admitting patients, not necessarily true. EMTALA includes both capability and capacity in saying that either may be a reason why a patient may be properly transferred within the confines of the Act.
Yes, of course. I was responding to the poster's suggestion that we tell ED patients to go elsewhere. While it's true EMTALA laws cannot force us to accept direct admits from other facilities it usually happens that when we are full so is everybody else so transferring out isn't really an option.
And I don't think tertiary places are ever going to not have some degree of this problem. But there is business sense in making sure you never have empty beds, and that fact itself is contributing to the problem. Either resources are distributed throughout your system in a way that means in some places you may sometimes have empty beds, or you close down beds and distribute resources in a way that means you are never going to have any empty beds anywhere. And if it's the latter choice, then you are always going to have the problem we're talking about, by definition. And if you are able to get paid that way, there is little incentive to eliminate the problem.
Kooky Korky, BSN, RN
5,216 Posts
Is this due to a lack of enough facilities in your area? Or people not really needing to be admitted? Or not being discharged quickly enough and kept too long as inpatients? Or inadequate home health to follow up on discharged patients? Or ???
Do you mind saying where this is?