Boarding Patients in the ER - another voice

Last year I posted about the annual winter surge in patient volume that leads to us holding in-patients for hours or days in our ER which leads to longer and longer wait times for the ER patients due to reduced space to see them. I was frustrated at the lack of planning for the surge despite the fact that it happens without fail EVERY SINGLE YEAR.

Here's a comment from an anonymous reader on the same subject:

I have worked for the same system for nearly 15 years. Our census doubles in the winter time. This happens every year without fail. Come winter we are forced to hold anywhere from 15-30 admitted pt's in the er because "there are absolutely no beds upstairs, sorry". As a result, there becomes no place to see er pt's , pt's in the lobby wait hours (sometimes 9-10), ambulance offloads are extended 1-2 hour waits unless they are a priority 1, any ambulance that can go out to the lobby (even the ones I would normally not have sent to triage)will go out to the lobby. admitted pt's may or maynot get a hospital bed to lay on instead of a stretcher-let alone a tv or a phone for diversion, admitted pt may miss a couple of meals while they are there and hopefully all of their orders are being implemented cause as any ER nurse knows, It is very difficult to be in both modes of nursing at the same time. In the meantime, EMS shift commander is calling and screaming at me that their medics are still sitting in my ER waiting to offload-can't blame them- if all the medics are sitting in our ER's -how can they respond to 911 calls. Pt's and family members of the people sitting in the lobby are angry because their poor 91 year old mother can't sit out there for 6 hours-can't blame them either. I wouldn't wait 6 hours for anything.
So, I ask you this- if we know the hospital is inevitably going to explode like this at the same time every year-why doesn't the hospital ever plan ahead? Is it neccessary that somebody should die first and we should have some major lawsuits before it becomes a real issue? Oh wait , that's already happened and I don't think anybody cared. I have made suggestions in the past of things we can do in our ER to keep some of the flow going, but because they never have enough staff it is impossible to even do this. In my opinion, The problem starts with administration who is either really ignorant to the fact that this issue impacts everybody, the floors who are constantly at capacity, the ER who way over capacity and now very long waits to see a dr, the admitted pt's who are forced to stay in a very noisey environment and probably not being taken care of well as they could be,EMS who has no place to bring their pt's to and the community who can't seem to get any medical attention without spending an entire day at the hospital.
This will probably be my last year as the charge nurse. I want to be able to not care and be frustrated by this another year. I feel that if the hospital administrators put their heads together, they can come up with a solution. And yes it will have to cost money but if we are the only hospital in this county to serve the community, then they will have to suck it up and invest in itself.
On top of all this, the hospital just built a unit (approx 20 beds)to lease out to another company. Under the circumstances, that would have been a perfect place to board these pt's.

What Next?

Hospital administration announced today that along with all our other duties in the ER we will now have to fill out a new form for the documentation of wounds as well as photograph any little ditzles that the patient may have.

Now I realize with the incredibly stupid new reg's that deny payment for wounds acquired while in the hospital it is necessary to do a thorough documentation of the patients skin BUT, since our ER sees approximately 200 patients a day and admits around 50 of them on average and since it takes about 1/2 hour to fill out the assessment form and photograph and print pictures it will take 25 hours of nursing time a day to do this on top of the job we are already doing that we are already understaffed to do.

Yesterday out of my assignment I admitted 8 patients, that would be close to 4 hours of wound assessment and documentation. That is 4 hours that I won't be starting IV's, doing EKG's, giving medications, drawing lab's or any of the other thousands of things I do every day. What is that going to do to the flow in our ER that is already functioning well over capacity. What will the effect be on the LWOBs as well as diversion times? Our average LOS for an admitted patient is already a ridiculous 5.34 hours - now we are going to add 30 more minutes on top of that? Ridiculous. On the other hand, the floor nurse may only get one or two admits during their shift. So who on earth would think it would make sense for the ER nurses to do this stuff?

Oh yeah, right. someone who has never worked in the ER. Duh.

What are your facilities doing?

The Answer to California's Budget Deficit

Good news to all of us in California. The governator has come up with a plan to solve the budget crisis. He's gonna tax the shit out of us.

Seriously.

He is proposing an increase in personal state income taxes, sales taxes and gasoline taxes (our gas prices are already among the highest in the nation.)

He is forcing state workers to take two unpaid days a month.

AND, as a bonus, we get to look forward to an IOU instead of a state tax refund this year. Just fucking fabulous.

Maybe we'll get lucky and have that big earthquake and fall into the ocean.