We are unable to take our divert time during the month of February (diversion = financial loss for the hospital, and they want to "ensure that patients who are followed at our hospital will be brought here, and that pt's from other hospitals will go there instead")
I'm in a smaller community ER (30 bed plus 3 or 4 wall beds) so we're not getting big traumas or anything, but the department has been inundated!!
It's a "trial" of no diversion, which hopefully will not extend past this month... but it's terrible
All beds full (including the Trauma room for the most critical patients), several chest pains, ICU holds, Fast track is full, Pedi is full, wall beds are full.... all beds WITHIN the hospital are full.... it's gross.
We were fully staffed with a float and an extra nurse to take a room from each assignment/take the wall bed people.... and it was still nutty!!
I left work in tears and woke up this morning with a lump in my throat and a stomach ache....
Our ER docs told each other it was considered a "sign of weakness" to go on diversion...we had two related facilities at both ends of the county with 20 bed ER's each, routinely holding 5-9 patients. They tried the "move 'em to the hallways upstairs" routine, but the floors were able to dodge it usually; the rules for the pt to be allowed to be placed in hall beds in the nursing units were so extensive that it had to be practically a disaster to do it. So no help there. So then they built a 4 bed "holding unit" down the hall from the ER--one nurse and one tech, no pts any worse than a tele. Now that is always full, and backing up more. And the attendings can't find their patients. So we did what everyone else does, run crazy accepting everything that comes in including the direct admits. And the late outpatient surgical patients are another thing--the docs want to send them in to be prepped, and guess who is responsible for that? :icon_roll
I really wonder how this will get fixed. It only seems to be getting worse all over the world. The "prizes" from administration are a waste of money. Send those administrators over to ED for a day of orientation!
Specializes in Spinal Cord injuries, Emergency+EMS.
I find it interesting that ER's can go on divert in the US. We have no experience of this in the UK, unless its a major incident.
up to a point it depends where you are and how many sites there are in the trust and what each site can take
we go on 'internal' divert on a reasonably regular basis between the sites usually to send GP referral general medical and respiratory and some cardiac patients to the site that can't take surgery or gastro admissions .. also if the sites are completely jammed up then general diversion and/or transfers from the ED of one site to AAU/ ward beds at another site happens ... the ED doesn't go on divert
We go on "divert"; but as soon as we do, our sister hospitals in the county automatically do as well. Sometimes, the entire county is on "divert" and it makes it rough for our pre-hospital counterparts. They know that they will be facing the frustrated mutterings of the charge nurse when they show up with the lastest LTC run. I think that "divert" serves to make everyone feel better on staff, but then dashes our hopes as soon as you get three medic units stacked in the ambulance bay... At least we get sandwiches delivered to the unit courtesy of management when things get rough - and our ANM and NM blow off their mind-numbing meetings to come down and help keep things running.
"Divert" doesn't slow down the foot traffic into the waiting room. "Divert" doesn't stop the patient in the field to insist that EMS bring them to a certain hospital - doing otherwise would be kidnapping. "Divert" doesn't stop the charge nurses at the LTCs from filling out the transfer form and calling the non-urgent ambulances. "Divert" doesn't stop the PMDs office from "calling in" a patient with MS changes who requires immediate workup, yet is driving themselves. (Um, Doctor, I hope you told them that they were going to go right through triage and will wait according to acuity...)
I'm curious about something a poster from the UK said about all ED patients being seen within four hours. We have that policy in our hospital (eastern United States, large suburban hospital) - but that four hour window is adverted by our PA-C's going into the waiting room and starting protocols and giving pneumonia patients their x-ray, blood cultures and abx within the 3 hour window. Is that how it works in the UK hospital, or do the patients just keep coming back with no staff or stretcher room to accomodate them? What about when there is not an empty bed in the hospital, where do the patients go who are admitted from the ED?
I think that a lot of our holding issues could be solved by docs rounding and discharging early. Case Managment needs to be on the phones with the LTCs the night before discharge getting it all set up for an 0800 discharge. This would help unspeakably with flow throughout the hospital. But no one listens to me. I'm justthenurse....
Specializes in Spinal Cord injuries, Emergency+EMS.
I'm curious about something a poster from the UK said about all ED patients being seen within four hours. We have that policy in our hospital (eastern United States, large suburban hospital) - but that four hour window is adverted by our PA-C's going into the waiting room and starting protocols and giving pneumonia patients their x-ray, blood cultures and abx within the 3 hour window. Is that how it works in the UK hospital, or do the patients just keep coming back with no staff or stretcher room to accomodate them? What about when there is not an empty bed in the hospital, where do the patients go who are admitted from the ED?
Blee
the 4 hour emergency care operational standard is admitted or discharged within 4 hours for 98% of emergency dept attendances ...
despite high occupancy figures it is extreely rare that there are NO beds at all in he hospital and we have contingency provisions to provide a dozen or so beds over and above the normal maximum capacity ( 3 in the Angio Day case unit immediate adjacent to CCU, 5 or 6 in the recovery area of endoscopy, several wards have a bed which they would prefer not to use and state they 'aren't funded' for .. ) this is without opening the elective admissions area or placing patients in PACU...
one advantage of the NHS is that people suitable for intermediate care beds can be placed 24/7 in part of the catchment area ( as their intermediate care teams work 24/7 ) and we are working towards the whole catchment area being served in that way and to get the lagging behind area sorted for intermediate care ( interesting to note the area which lags behind is the area where social services is the lead body for intermediate care rather than the PCT).
we will also discharge up until approx 2100 -2200 at night for patients from the general bed base and discharge 24/7 fro mthe assessment bed base if people can get home safely and appropriately...
We went on divert once. Every unit in the hospital lost power except the ED. Generators where not working correctly and pts upstairs in the ICU where being bagged (ambus not body bags) and we thought that we where going to have to start moving them down into the ED. Thankfully we got power back on upstairs before this happened.
We went on divert once. Every unit in the hospital lost power except the ED. Generators where not working correctly and pts upstairs in the ICU where being bagged (ambus not body bags) and we thought that we where going to have to start moving them down into the ED. Thankfully we got power back on upstairs before this happened.
Similar situation - power out and on emergency power, a flood in the lab...
But diversion denied... the managing MD of this private physician group running the ED nearly stroked out at the idea. I think there were 40+ LWBS that night.
We used to be able to go on divert, but one of the larger local hospitals abused it to such an extent that none of us are allowed to anymore.
One night we had 12 psych patients and couldn't possibly fit any more in the department (we have 6 psych beds). We called the local ambulance company and asked if they would send any more psychs to another hospital for a few hours so we could get the current batch sorted out. They brought in 3 more, then reported us to DPH for attempting to refuse patients.
The hospital I work at is 30 minutes from 2 level 2 trauma centers and 1 level 1 trauma center. These three organizations are substantially bigger than the hospital where I work and they routinely go on divert. Actually it's gotten so bad that all of the hospital in the region will go on divert and we, the smallest place will finally divert when it's just impossible to take anymore people. By that time though the environment in the ED starts turning into a people are going to start dying in the lobby and hallways environment. I really hate that administration lets this happen over and over. We also have a problem that when we do go on divert, our medics, yes our own medics tell people and families that if they insist on coming to our Ed that we can't refuse them. They show up, drop them off, give us dirty looks then leave. It really sucks at times.
Specializes in TraumaER ,NICUx2days, HEMEONC CathLab IV.
No good deed goes unpunished.... was it a full moon? just wondering.
We used to be able to go on divert, but one of the larger local hospitals abused it to such an extent that none of us are allowed to anymore.
One night we had 12 psych patients and couldn't possibly fit any more in the department (we have 6 psych beds). We called the local ambulance company and asked if they would send any more psychs to another hospital for a few hours so we could get the current batch sorted out. They brought in 3 more, then reported us to DPH for attempting to refuse patients.
One night we had 12 psych patients and couldn't possibly fit any more in the department (we have 6 psych beds). We called the local ambulance company and asked if they would send any more psychs to another hospital for a few hours so we could get the current batch sorted out. They brought in 3 more, then reported us to DPH for attempting to refuse patients.
Brilliant!
I agree with 10mg-iv: "No good deed goes unpunished!"
.. was it a full moon? just wondering.
northshore08
257 Posts
Our ER docs told each other it was considered a "sign of weakness" to go on diversion...we had two related facilities at both ends of the county with 20 bed ER's each, routinely holding 5-9 patients. They tried the "move 'em to the hallways upstairs" routine, but the floors were able to dodge it usually; the rules for the pt to be allowed to be placed in hall beds in the nursing units were so extensive that it had to be practically a disaster to do it. So no help there. So then they built a 4 bed "holding unit" down the hall from the ER--one nurse and one tech, no pts any worse than a tele. Now that is always full, and backing up more. And the attendings can't find their patients. So we did what everyone else does, run crazy accepting everything that comes in including the direct admits. And the late outpatient surgical patients are another thing--the docs want to send them in to be prepped, and guess who is responsible for that? :icon_roll
I really wonder how this will get fixed. It only seems to be getting worse all over the world. The "prizes" from administration are a waste of money. Send those administrators over to ED for a day of orientation!