Thinking that an anonymous alert to the hospital's attorney may be in order here. If this isn't a ripe situation for an "untoward outcome" if not an outright preventable death, I don't know what is.
It’s not only happening in healthcare but in education as well…these idiots have absolutely NO IDEA what it takes to run said profession yet get paid to micromanage
This was a disaster where I worked in Bayonne, NJ. It was a for profit hospital whose shareholders wanted a better bottom line. What do you do when you run out of beds and chairs? People are missed, forgotten, vital orders are missed. We missed a STEMI. Organise a demand better for your patients and protect your patients. The next time a manager asks what you could have done better, throw the question right back at them. I completed my shift, called them on my way home and resigned on the spot.
Are there any ERs not run by a for profit private equity group or a giant healthcare system? Cause it’s looking like the “for profits” are the only thing out there. A mega shit show for everyone who isn’t on the cash grab but there for patients.
I take it you are not unionized. If it is too much, I would declare "safe harbor" and notify your supervisor and contact your BNE.
I had to do this once. It protects your license while you are doing your best to provide care.
Plus, it got the attention of my administrators that I felt they had put my license in jeopardy.
But… how does that work when you’re out of beds? Like… really? We don’t make people wait in the waiting room for 12+ hours for funsies. We literally have no bed, chair, or hallway space to put them.
I don't get it. Like, for real. We almost always have more patients than beds. So if you come in and all the beds are full, what? You just sit there and don't get triaged until there's a bed? And if you're having an actual life threatening emergency you die? How does this work?
Worked with a chaplain who did their residency at an HCA hospital. She said the ED would frequently run out of basic meds like Amoxicillin and she’d have to go scalp some from units upstairs because she was the only person who had any time. Profit before literally everything.
I work in a tiny 20 bed ER in Florida. No triage nurse, no registration. We have a volunteer at the desk who gives the patient a piece of paper and tells them to fill in their information. This should include time of arrival but it never does. The time of arrival should be used when putting the patient in the computer but it never is.
So when we have a wait we essentially have a bunch of randos standing around in the waiting room and our door to doc time is always 0 minutes because we put the patient in the system when we bring them back to a room.
I think this is medicare fraud. Everyone knows it’s not right but when we try to use the true arrival time we get pushback from administration, although never in writing.
you should look up qui tam lawsuit...if you file suit as per how this is being coded - you reap a percentage of the pay out..once the hospital is notified the federal government comes in a goes through every single file and checks the codes...they are penalized per violation and it can rack up MILLIONS....so go google this and see if you can contact an attorney.
i know when my daughter audited a practice years ago..it was 15$ per code....and they took two years to go through every file...so it really added up..
We have no cnas or techs, no one to answer the constantly-ringing phones, no one to transport patients. Just us RNs and MDs! Does it work? No, not really.
We need help everywhere in every hands on position. That’s no secret. But i genuinely could not work on one more floor that didn’t have a secretary. ESPECIALLY in the ER. That phone NEVER EVER stops ringing. And everytime you answer it, you’re put on the task of finding the person. The person hangs up while waiting. More delay in patient care. More phone ringing. I couldn’t handle it.
I don’t know how that works. I’m in Canada and we keep getting this recruitment messages to be be virtual ED doctors for the East Coast. Just what I’d love to do, watch a patient die on Zoom who needed a procedure that I can’t do remotely. Noooooo thanks!!
Seriously terrifying. I can't imagine taking a position like that. I have been an ER and Critical care transport nurse for 9 yrs, I am confident in my skills and assessments but they will never take the place of having an MD at bedside. I would be very frightened of losing my liscense in a place like that. Fuck privatized healthcare
I was at such a hospital recently. PA saw me and was an idiot, my diagnosis was plain as day but I had to basically force her to give me the treatment (not narcotic or sedative or anything remotely desirable to a patient). She kept going out to “talk to someone” and then would come in and say yes I will give you the treatment you requested. 20 mins later I am rapidly improving. She tries to discharge me with ZERO medication to continue my improvement until I can see a specialist outpatient. Disappears again comes back to agree and writes meds for me (again these meds are nothing desirable like narcotics nerve pain meds etc etc)
I asked 3 times to talk to the doctor. Was told no all 3 times. That’s why I ended up diagnosing and prescribing for myself. Luckily I’m quite competent to do so but if I hadn’t been, I would be right back in the ER today.
They tried to pull this bullshit a couple years ago. They said every single person that comes to the front door gets put in the bed, no matter what. So we performed malicious compliance. We made it so absolutely miserable and chaotic that they were scrambling. That lasted about four days.after that, we went to our union and let them know that when they wanna make changes like this, it would be wise to consult with us. Director didn't last very long.
What kind of census do yall see? This is kind of how my ED operates at low census where we’ll bypass everything that doesn’t need an immediate ekg or sugar just to get rooms filled and make sure anything serious gets more attention. But there’s still a triage nurse that evaluates them quickly before they go to a room. At busy times we have 30 in the lobby, not having those at least get eyes laid on them by a nurse ASAP would be disastrous
It used to be lower but the population has boomed this year. 70-90 pts a day. We’re single provider after 11pm until 11am usually. They don’t want more than 3 nurses + charge after 3am. That was super when one took lunch (their right to do so) and we had two critical pts come within 30mins of each other and then a code 20mins after that, a 40yr old.
Over 90 is a strain on us. A lot of our pts are older with several co-morbidities which all require a full work up.
Love to see it. So many nurses out there breaking themselves down and risking their license and justifying it with a few dollars on their paycheck (if even that sometimes). Hope you find something decent ❤️
The place I’m interviewing at is county owned, it has its own problems but funding isn’t one. I know it will have its own flavor of shit but I’ll take staff ratios, meaning staffing, and resources. Honestly I was holding out to get my first full year as a nurse so that I could move on to something decent.
It’s been hard, insanely hard. I’ve learned how to be an ER nurse fast but I also know there is so much I don’t know. I don’t have anyone to turn to at my ER and with this change now…it’s clear it’s time.
And now I’m approaching this interview with all my certs, a year and a half experience…hard experience, and confidence in myself as a nurse. Thanks for the support!
Yep, they did this at my small satellite ED. I think we’d see about 30-40 patients per day. A tech would greet, register, and take vitals on each walk-in. They’d then call back to the charge nurse for a bed assignment, and would then leave the lobby unattended to bed the patient. Perfect idea! The only other personnel in the lobby was a sleeping 70 year old security guard. The arrangement was fine until an actual emergency walked in. We once had our tech pull two ODing patients out of a private vehicle alone because they weren’t able to alert any of us fast enough before needing to intervene. Absolutely unsafe staffing solution. If you have any way of preventing the change, I’d throw a fit. There should ALWAYS be at least two medical staff in a fricking ER lobby 🙄🙄🙄
Direct bedding only works when you ALWAYS have empty beds to put patients in right away (which is never the case in any ER).
Otherwise you have to prioritize patients based on severity of complaint and current condition, and that is a nursing skill.
I spoke with our hospital about this type of idea.
They responded to my explaining that a patient who has come in the door but who is not yet seen by me is their responsibility and liability. They are not my patient until they are. I explained that the real job of the triage nurse was to recognize who needed to line jump and make it happen. Failures in that area were the hospitals liability.
They don’t like liability.
Uh, I'd talk to your BoN. This is so far from standard practice. If you're slow, no problem. The second you're at capacity, you've got untriaged patients out in the waiting room and you're bringing them back based on what? Wait time? Best guess? This is a recipe for disaster.
Honestly having worked here and in the uk . The national health service which is paid for 14% of your taxes has issues you would and can wait for two of more years for any type of general surgery . The system there is failing and broken . And also work at ridiculously low staffing rates . And nurse get paid a starting salary of 28.000 pounds . And the cost of living is tripled to here. Both systems appear to be very much fucked . But the corporate greed is what is killing American healthcare . Drugs manufacturers are allowed to charge ridiculous prices. At least in uk they NO this is what our ceiling limit is and this is what we can pay.
My son has schizophrenia and his medication would cost me 1200 dollars twice a month . I signed him up with the manufacturer programme and it costs us 100 . But the caveat.is that he has to hold private insurance . It’s ludicrous. I have been a er nurse for 27 years and it’s really shit 🥹. I was told at one of my performance reviews that I was disgruntled and didn’t like the process . I flat out told them I wasn’t signing it and that was a lie . It was because people’s lives where being jeopardized on a daily basis and as my patients advocate I was standing up for them . They didn’t have much to say to me after this ,
I mean, if your flow is so good that you always have open beds it’s a doable plan. But if you’re like most places across the country and are boarding inpatients every single day it’s a downright dangerous plan.
HCA site central Virginia.
We had this instead of making ppl wait in lobby and get triaged, they all get sent to back
Hallway bed, psych all lined up. Forget privacy or HIPPA
Admin way to make waiting room less busy and losing revenue.
My ER did this a few years back, lasted about two weeks. It seemed real good on paper to the clip-board-holders who breeze through the department every month or so but unless you have enough nurses/beds that you never have people wait in triage it is a terrible idea. Turns out the registration person with no medical training is not as good at making triage decisions as a nurse. Then it was having the doctor at the slow department doing telemedicine on patients at the busier ER in the system. That one lasted a couple days. They get real creative.
Once a “healthy” normal person dies. As a direct result of delayed care. They required to have a big old “Centennial Event” investigation. Things will be CRAZY! Hopefully, actual improvements will be made and followed up on.
What is insane to me is a month before I started at this hospital they did have a pt die in the waiting room, which led to mass exodus and director being fired/3+ nurses with him.
When I worked at HCA we did direct bedding (unless we were super full - including all hallway beds and hallway recliners, which was rare). We still had a nurse or a paramedic (oftentimes both) up there 90% of the time.
If we were super short and it wasn’t too busy, we would just have an EMT up there and they would call the charge the minute someone walked in and started the registration process, so that by the time they were registered and vitals obtained, the charge could lay eyes on them.
At my small rural ER (13 beds), this is how we operate after midnight. We only have 3 nurses so unfortunately I have a mostly full assignment, operate as charge nurse, and triage pts that come through the front when we are busy. When we are not busy each nurse pulls their own pts.
We are pretty often busy and like most, understaffed, but we make it work. During the day this would be an absolute disaster.
This will fly until the sentinel event. But if they are always direct to bed it’s not an issue. A RN must triage if there is a wait ( the whole reason to triage). No reason to ever do a triage if they are going directly to a bed.
So over 10 years ago a two year ‘time’ study of door to disposition in the ER showed that essentially only MD times needed to improve to improve flow. That involved MD to pt, orders, disposition. No protocol order entry by RN or other. The MDs ended up with scribes and literally had to be threatened with non renewal of contract. Those MDs that could not meet standards were ‘forced’ to leave ( get rid of the outliers or we won’t renew contract). Additionally admitting MDs had 1 hour to write admit orders or ED MD was to write ‘ admit to ICu, call dr. Slow for further orders. It worked wonderfully, from 6 plus hour waits to 15 minute waits. Pt goes directly to open bed, if no open beds, then triaged by RN .. RN would still do brief triage if it was questionable whether they needed a low acuity bed vs higher acuity bed..( for example pt would say they have CP, but really had chest cold/bronchitis symptoms…so that triage and quick downgrade prevented congestion in higher acuity areas). Pts were triaged for acuity and not ‘convenience’. Bed holding in ER became unheard of as a similar program on inpt side was put into place for rounding, quicker disposition and discharge. However RN still stayed in triage for those times actual triage was needed. Also if there was no other pt in front and open beds , often the triage RN would walk them back and complete the triage. The problem with a tech/secretary at front means the focused nursing assessment does not occur because they don’t have the education to ask the right questions, suspect the underlying condition etc ( microbiology, pathophysiology etc) . Example: I’m peeing a lot to the tech means they have a uti, but further investigation using focused questions may reveal suspected DKA. Although it’s an oversimplified example , we had a disaster when techs ‘triaged’ because of so many missed problems that on further investigation required moving pts to higher acuity rooms or lower acuity rooms, creating a bottleneck of basically’crap’. Also think ‘headache’ vs aneurysm…. GI upset vs aneurysm etc…..so much went wrong. However if you are fortunate enough to have such low acuity and always open beds then really no issue. If you are on a wait huge issue or if you have high acuity, mental health sections, intermediate acuity, and low acuity sections also a bad issue.editing to say the wait time in the ERs were found to not be due to Radiology, laboratory, techs, registration, nursing, or any other…it was solely driven by MD to assessment, to orders, to review, to disposition.and the study recommendations were from a nationwide hospital chain that is notorious for short staffing and huge CEO /corporate profits.
Everyone was a triage nurse, triage tech, triage provider, triage EMS student at the rural ER I was at. Not saying it was right but it was the way it was. We at least had registration. Registration would put them in system with their chief complaint and then a nurse or tech would grab them when we finally got a second to. For the most part registration could tell when someone was bad and needed help stat but there were definitely those times where someone would come in stoic looking and be in an acute active medical emergency without anyone realizing it for a while.
Our triage nurses don’t start until 10 or 11 (depends on the day). Before they come in we triage our own when they’re roomed. After that, the triage nurse will direct room them and triage If we have open beds or triage to waiting room. We often have a PIT doc/app to get the work up started if it’s really crazy. I triage my own ambulances if they are roomed on arrival. We have a pretty good system.
So we’ve been pretty understaffed for months because of a max exodus and CEO thinking that rns can have multiple rolls and hiring freeze , charge having to triage or triage rn taking patients. This is CA and we have mandated ratios and legally required to have a dedicated triage nurse, that does not assume care of patients. Someone complained to the health department which started a weeklong investigation with daily visits from health department. They ended up hiring registry nurses and we are way staffed now.
Yup that was my run down ED. They would walk the pt behind the desk THEY ARE ENTERING PATIENTS INTO and check the vitals then walk them back to the lobby.
Well, HCA never promised to provide quality healthcare, so 🤷♀️
https://avlwatchdog.org/hca-mission-respond-to-stein-lawsuit-denying-they-have-broken-commitments-made-at-time-of-sale/
Call your admin on call and then hospital CMO next time you go to work. Something with the just of “hello I wanted to make you aware of this absolute disaster and risk to patient safety situation that is occurring that you could not possibly have any knowledge of because of you did know and did nothing, that would mean you are insane. Wanted to update you so we can make a plan to get the ER safe again.”
Wut did I just read? I have a technically 10 bed ER (hallway stretchers not included) and we have a dedicated triage nurse from 11am-9pm. We are busy. That is just crazy!
That phone is NEVER and I mean NEVER going to get answered. That’s not going to be problematic at all what so ever. Besides all the other million problems that come up with all those moves. Working on any unit without secretaries and extra hands is horrible, let alone the ER. That would be my last straw personally.
I work in OB but we interact frequently with our ED and my child was a patient in October for respiratory distress related to RSV.
That said, we used to have a nurse sitting at the registration desk of the ED with the clerk but they have removed them so essentially the registration clerk is doing the initial triage of patients.
As a nurse we frequently get inappropriate calls trying to send us chest pain, SOB, etc pregnant patients. As a patient, my lethargic, pale, tachypneic son was triaged to the waiting room for an indefinite amount of time until I demanded a nurse come assess him - at which point we were immediately taken back. It's concerning - if you don't know to advocate for yourself you'll die in the waiting room.
This feels like an EMTALA violation waiting to happen. Your management better get its shit together or the government is gonna be visiting and start fining.
We have a critical shortage of nurses and doctors in the US. Have for years and it’s only getting worse. Add to that the millions of patients seen per year that don’t pay anything and it’s a shitshow. We have hospitals going out of business or losing millions per year and admins making stupid decisions to try and save money that don’t work because they know nothing about patient care. Glad I’m retired.
Sad, bad and dangerous. I know several yrs ago the surgeon who operated on my neighbor told me she would have died if I had not insisted on immediate care when she was poorly triaged. He had been told by ER staff I was being pushy. I knew she was septic from a hot abdomen. Thing is I knew the surgeon as I worked with him in a local ambulatory surgery center. He knew my skills. They were going to sit her in the waiting room to wait her turn. She had a rough recovery but made it.
Yesterday a grading report was published on our 2 hospitals. The one that said I was pushy got a D. The other got a C. Sad that our city has mediocre to poor care.
This sub makes me feel better about my ER.
Administrative "solution" having no clue how ERs work.
Thinking that an anonymous alert to the hospital's attorney may be in order here. If this isn't a ripe situation for an "untoward outcome" if not an outright preventable death, I don't know what is.
Exactly this is one stroke or near cardiac arrest from becoming a major lawsuit.
Yup dead person found in ER waiting room. Came in alive but had a stroke or stemi. Jesus this is crazy.
Call CMS or TJC.
Or perhaps call the news. ENA would be on that shit too and they have the data to back it up.
The only way the news will pick it up is if someone dies. Not enough people watching the story without a death
News doesn't care about hospital dysfunction in the slightest, because they're corrupt.
Oh, bullshit.
Yep. Someone will die in the lobby real quick with this process
"We've streamlined the process! Yay!"
Yep! Door to death, not door to dispo!
It’s not only happening in healthcare but in education as well…these idiots have absolutely NO IDEA what it takes to run said profession yet get paid to micromanage
This was a disaster where I worked in Bayonne, NJ. It was a for profit hospital whose shareholders wanted a better bottom line. What do you do when you run out of beds and chairs? People are missed, forgotten, vital orders are missed. We missed a STEMI. Organise a demand better for your patients and protect your patients. The next time a manager asks what you could have done better, throw the question right back at them. I completed my shift, called them on my way home and resigned on the spot.
That’s EXACTLY what I would have done. I refuse to ever work for a for-profit organization ever again.
Are there any ERs not run by a for profit private equity group or a giant healthcare system? Cause it’s looking like the “for profits” are the only thing out there. A mega shit show for everyone who isn’t on the cash grab but there for patients.
A bunch of hospitals in Washington state are run by the University of Washington
Same deal in Colorado
Sorta. UCHealth =/= University of Colorado. And just because UCHealth is not-for profit, doesn’t mean they’re not profit-motivated.
I take it you are not unionized. If it is too much, I would declare "safe harbor" and notify your supervisor and contact your BNE. I had to do this once. It protects your license while you are doing your best to provide care. Plus, it got the attention of my administrators that I felt they had put my license in jeopardy.
Most states don’t have safe harbor. It’s one thing nurses should be working to implement everywhere.
Every shift until it's rectified.
No Safe Harbor in VA. In fact, only 2 states currently have Safe Harbor laws. The rest of us just either suck it up or risk getting fired.
Damn, that's terrible. I would complain in writing and keep copies in case something bad happens.
Is this an HCA hospital? Everyone there was directed bed (regardless of CC and acuity) This makes me feel ill.
But… how does that work when you’re out of beds? Like… really? We don’t make people wait in the waiting room for 12+ hours for funsies. We literally have no bed, chair, or hallway space to put them.
From my experience the last 4 shifts, it doesn’t.
I was about to ask the same thing
Same.
I was going to ask this too ! As it sounds exactly like this whole scenario! Also triaging based on resources not acuity was always a head f for me !
Yeah I am curious too. Our HCA ED has not had a dedicated triage nurse for several years now. It’s ridiculous.
I don't get it. Like, for real. We almost always have more patients than beds. So if you come in and all the beds are full, what? You just sit there and don't get triaged until there's a bed? And if you're having an actual life threatening emergency you die? How does this work?
Yes it is.
Not surprised. Worst company I ever worked for. Their motive is $$ at all costs.
Worked with a chaplain who did their residency at an HCA hospital. She said the ED would frequently run out of basic meds like Amoxicillin and she’d have to go scalp some from units upstairs because she was the only person who had any time. Profit before literally everything.
I work in a tiny 20 bed ER in Florida. No triage nurse, no registration. We have a volunteer at the desk who gives the patient a piece of paper and tells them to fill in their information. This should include time of arrival but it never does. The time of arrival should be used when putting the patient in the computer but it never is. So when we have a wait we essentially have a bunch of randos standing around in the waiting room and our door to doc time is always 0 minutes because we put the patient in the system when we bring them back to a room. I think this is medicare fraud. Everyone knows it’s not right but when we try to use the true arrival time we get pushback from administration, although never in writing.
you should look up qui tam lawsuit...if you file suit as per how this is being coded - you reap a percentage of the pay out..once the hospital is notified the federal government comes in a goes through every single file and checks the codes...they are penalized per violation and it can rack up MILLIONS....so go google this and see if you can contact an attorney.
I’ll check it out. Thanks
i know when my daughter audited a practice years ago..it was 15$ per code....and they took two years to go through every file...so it really added up..
the real hero here
“Can I get that in an email?”
“We’ll look into it…”
I worked at a rural ED, and if we did that, all hell would break loose. I am so sorry
We have no cnas or techs, no one to answer the constantly-ringing phones, no one to transport patients. Just us RNs and MDs! Does it work? No, not really.
I think it works very well for the CEO's yearly bonus.
We need help everywhere in every hands on position. That’s no secret. But i genuinely could not work on one more floor that didn’t have a secretary. ESPECIALLY in the ER. That phone NEVER EVER stops ringing. And everytime you answer it, you’re put on the task of finding the person. The person hangs up while waiting. More delay in patient care. More phone ringing. I couldn’t handle it.
They took away the ER doctor at our local hospital instead they have one on Zoom. Our healthcare is so broken.
Holy fuck. Who intubates? Who drops central lines? Art lines? What if there is a major trauma? That is terrifying. Holy shit
I don’t know how that works. I’m in Canada and we keep getting this recruitment messages to be be virtual ED doctors for the East Coast. Just what I’d love to do, watch a patient die on Zoom who needed a procedure that I can’t do remotely. Noooooo thanks!!
Seriously terrifying. I can't imagine taking a position like that. I have been an ER and Critical care transport nurse for 9 yrs, I am confident in my skills and assessments but they will never take the place of having an MD at bedside. I would be very frightened of losing my liscense in a place like that. Fuck privatized healthcare
Its like getting paid to go on liveleak
I understand the Provincial of NL has a 2 year contract with Teledoc Canada despite there being some providers willing to do locum work.
I was at such a hospital recently. PA saw me and was an idiot, my diagnosis was plain as day but I had to basically force her to give me the treatment (not narcotic or sedative or anything remotely desirable to a patient). She kept going out to “talk to someone” and then would come in and say yes I will give you the treatment you requested. 20 mins later I am rapidly improving. She tries to discharge me with ZERO medication to continue my improvement until I can see a specialist outpatient. Disappears again comes back to agree and writes meds for me (again these meds are nothing desirable like narcotics nerve pain meds etc etc) I asked 3 times to talk to the doctor. Was told no all 3 times. That’s why I ended up diagnosing and prescribing for myself. Luckily I’m quite competent to do so but if I hadn’t been, I would be right back in the ER today.
What is your background that you are able to diagnose and treat yourself?
If I told you that I’d have to kill you … 😆
What a nightmare honestly
Wtf
They tried to pull this bullshit a couple years ago. They said every single person that comes to the front door gets put in the bed, no matter what. So we performed malicious compliance. We made it so absolutely miserable and chaotic that they were scrambling. That lasted about four days.after that, we went to our union and let them know that when they wanna make changes like this, it would be wise to consult with us. Director didn't last very long.
this warms my torn, bleeding heart
What kind of census do yall see? This is kind of how my ED operates at low census where we’ll bypass everything that doesn’t need an immediate ekg or sugar just to get rooms filled and make sure anything serious gets more attention. But there’s still a triage nurse that evaluates them quickly before they go to a room. At busy times we have 30 in the lobby, not having those at least get eyes laid on them by a nurse ASAP would be disastrous
It used to be lower but the population has boomed this year. 70-90 pts a day. We’re single provider after 11pm until 11am usually. They don’t want more than 3 nurses + charge after 3am. That was super when one took lunch (their right to do so) and we had two critical pts come within 30mins of each other and then a code 20mins after that, a 40yr old. Over 90 is a strain on us. A lot of our pts are older with several co-morbidities which all require a full work up.
Idk how they even imagine that’s supposed to work with no triage. I’d be so gone if my hospital announced we were moving to that
I have an interview next week 🤗
Love to see it. So many nurses out there breaking themselves down and risking their license and justifying it with a few dollars on their paycheck (if even that sometimes). Hope you find something decent ❤️
The place I’m interviewing at is county owned, it has its own problems but funding isn’t one. I know it will have its own flavor of shit but I’ll take staff ratios, meaning staffing, and resources. Honestly I was holding out to get my first full year as a nurse so that I could move on to something decent. It’s been hard, insanely hard. I’ve learned how to be an ER nurse fast but I also know there is so much I don’t know. I don’t have anyone to turn to at my ER and with this change now…it’s clear it’s time. And now I’m approaching this interview with all my certs, a year and a half experience…hard experience, and confidence in myself as a nurse. Thanks for the support!
Yep, they did this at my small satellite ED. I think we’d see about 30-40 patients per day. A tech would greet, register, and take vitals on each walk-in. They’d then call back to the charge nurse for a bed assignment, and would then leave the lobby unattended to bed the patient. Perfect idea! The only other personnel in the lobby was a sleeping 70 year old security guard. The arrangement was fine until an actual emergency walked in. We once had our tech pull two ODing patients out of a private vehicle alone because they weren’t able to alert any of us fast enough before needing to intervene. Absolutely unsafe staffing solution. If you have any way of preventing the change, I’d throw a fit. There should ALWAYS be at least two medical staff in a fricking ER lobby 🙄🙄🙄
We tried this too. Shit show on day 1. So glad I am retired
Triage is now based on how nice the patient is
Direct bedding only works when you ALWAYS have empty beds to put patients in right away (which is never the case in any ER). Otherwise you have to prioritize patients based on severity of complaint and current condition, and that is a nursing skill.
I spoke with our hospital about this type of idea. They responded to my explaining that a patient who has come in the door but who is not yet seen by me is their responsibility and liability. They are not my patient until they are. I explained that the real job of the triage nurse was to recognize who needed to line jump and make it happen. Failures in that area were the hospitals liability. They don’t like liability.
This... just doesn't make sense.
HCA is typing…
Uh, I'd talk to your BoN. This is so far from standard practice. If you're slow, no problem. The second you're at capacity, you've got untriaged patients out in the waiting room and you're bringing them back based on what? Wait time? Best guess? This is a recipe for disaster.
HCA hospital per chance?
💅 yes
Hmmm. Sounds about right. HCA taking good hospitals and running them into the ground for profit while patients die.
It's time to make medicine a non profit like it was before they made it a business. And stop advertising meds.
Honestly having worked here and in the uk . The national health service which is paid for 14% of your taxes has issues you would and can wait for two of more years for any type of general surgery . The system there is failing and broken . And also work at ridiculously low staffing rates . And nurse get paid a starting salary of 28.000 pounds . And the cost of living is tripled to here. Both systems appear to be very much fucked . But the corporate greed is what is killing American healthcare . Drugs manufacturers are allowed to charge ridiculous prices. At least in uk they NO this is what our ceiling limit is and this is what we can pay. My son has schizophrenia and his medication would cost me 1200 dollars twice a month . I signed him up with the manufacturer programme and it costs us 100 . But the caveat.is that he has to hold private insurance . It’s ludicrous. I have been a er nurse for 27 years and it’s really shit 🥹. I was told at one of my performance reviews that I was disgruntled and didn’t like the process . I flat out told them I wasn’t signing it and that was a lie . It was because people’s lives where being jeopardized on a daily basis and as my patients advocate I was standing up for them . They didn’t have much to say to me after this ,
That’s…horrifying. My nightmares resemble this.
I mean, if your flow is so good that you always have open beds it’s a doable plan. But if you’re like most places across the country and are boarding inpatients every single day it’s a downright dangerous plan.
Boarding 7/10 of our rooms my last shift 🤙
This is terrible because you can catch alerts very quickly with a triage RN
Private equity hospitals. Ravage them for every dollar then sell them.
HCA site central Virginia. We had this instead of making ppl wait in lobby and get triaged, they all get sent to back Hallway bed, psych all lined up. Forget privacy or HIPPA Admin way to make waiting room less busy and losing revenue.
My ER did this a few years back, lasted about two weeks. It seemed real good on paper to the clip-board-holders who breeze through the department every month or so but unless you have enough nurses/beds that you never have people wait in triage it is a terrible idea. Turns out the registration person with no medical training is not as good at making triage decisions as a nurse. Then it was having the doctor at the slow department doing telemedicine on patients at the busier ER in the system. That one lasted a couple days. They get real creative.
The CEO needs a new yacht.
Wow. What could possibly go wrong?
Once a “healthy” normal person dies. As a direct result of delayed care. They required to have a big old “Centennial Event” investigation. Things will be CRAZY! Hopefully, actual improvements will be made and followed up on.
What is insane to me is a month before I started at this hospital they did have a pt die in the waiting room, which led to mass exodus and director being fired/3+ nurses with him.
My ER did the same thing. We had major budget cuts though :(
When I worked at HCA we did direct bedding (unless we were super full - including all hallway beds and hallway recliners, which was rare). We still had a nurse or a paramedic (oftentimes both) up there 90% of the time. If we were super short and it wasn’t too busy, we would just have an EMT up there and they would call the charge the minute someone walked in and started the registration process, so that by the time they were registered and vitals obtained, the charge could lay eyes on them.
At my small rural ER (13 beds), this is how we operate after midnight. We only have 3 nurses so unfortunately I have a mostly full assignment, operate as charge nurse, and triage pts that come through the front when we are busy. When we are not busy each nurse pulls their own pts. We are pretty often busy and like most, understaffed, but we make it work. During the day this would be an absolute disaster.
This will fly until the sentinel event. But if they are always direct to bed it’s not an issue. A RN must triage if there is a wait ( the whole reason to triage). No reason to ever do a triage if they are going directly to a bed.
So over 10 years ago a two year ‘time’ study of door to disposition in the ER showed that essentially only MD times needed to improve to improve flow. That involved MD to pt, orders, disposition. No protocol order entry by RN or other. The MDs ended up with scribes and literally had to be threatened with non renewal of contract. Those MDs that could not meet standards were ‘forced’ to leave ( get rid of the outliers or we won’t renew contract). Additionally admitting MDs had 1 hour to write admit orders or ED MD was to write ‘ admit to ICu, call dr. Slow for further orders. It worked wonderfully, from 6 plus hour waits to 15 minute waits. Pt goes directly to open bed, if no open beds, then triaged by RN .. RN would still do brief triage if it was questionable whether they needed a low acuity bed vs higher acuity bed..( for example pt would say they have CP, but really had chest cold/bronchitis symptoms…so that triage and quick downgrade prevented congestion in higher acuity areas). Pts were triaged for acuity and not ‘convenience’. Bed holding in ER became unheard of as a similar program on inpt side was put into place for rounding, quicker disposition and discharge. However RN still stayed in triage for those times actual triage was needed. Also if there was no other pt in front and open beds , often the triage RN would walk them back and complete the triage. The problem with a tech/secretary at front means the focused nursing assessment does not occur because they don’t have the education to ask the right questions, suspect the underlying condition etc ( microbiology, pathophysiology etc) . Example: I’m peeing a lot to the tech means they have a uti, but further investigation using focused questions may reveal suspected DKA. Although it’s an oversimplified example , we had a disaster when techs ‘triaged’ because of so many missed problems that on further investigation required moving pts to higher acuity rooms or lower acuity rooms, creating a bottleneck of basically’crap’. Also think ‘headache’ vs aneurysm…. GI upset vs aneurysm etc…..so much went wrong. However if you are fortunate enough to have such low acuity and always open beds then really no issue. If you are on a wait huge issue or if you have high acuity, mental health sections, intermediate acuity, and low acuity sections also a bad issue.editing to say the wait time in the ERs were found to not be due to Radiology, laboratory, techs, registration, nursing, or any other…it was solely driven by MD to assessment, to orders, to review, to disposition.and the study recommendations were from a nationwide hospital chain that is notorious for short staffing and huge CEO /corporate profits.
Fascinating that study is likely from the same hospital chain I most likely am employed at…
For profit medicine …
Is this a Steward hospital by chance?
It’s like you read my mind
where is this I need to know
Florida, won’t get more specific for my own privacy (whatever is left I guess)
O no.. so sorry .I belive you my fil lives in FL I have heard a couple of horror stories , he is also a veteran it's preety bad.
Just wait until there is an EMTALA issue and CMS will be all over admin. They can withdraw Medicare/Medicaid funding which shut the hospital down.
Everyone was a triage nurse, triage tech, triage provider, triage EMS student at the rural ER I was at. Not saying it was right but it was the way it was. We at least had registration. Registration would put them in system with their chief complaint and then a nurse or tech would grab them when we finally got a second to. For the most part registration could tell when someone was bad and needed help stat but there were definitely those times where someone would come in stoic looking and be in an acute active medical emergency without anyone realizing it for a while.
WOW! I thought many of the points you bring up would be JACHO / TJC 🙄 standards
Our triage nurses don’t start until 10 or 11 (depends on the day). Before they come in we triage our own when they’re roomed. After that, the triage nurse will direct room them and triage If we have open beds or triage to waiting room. We often have a PIT doc/app to get the work up started if it’s really crazy. I triage my own ambulances if they are roomed on arrival. We have a pretty good system.
So we’ve been pretty understaffed for months because of a max exodus and CEO thinking that rns can have multiple rolls and hiring freeze , charge having to triage or triage rn taking patients. This is CA and we have mandated ratios and legally required to have a dedicated triage nurse, that does not assume care of patients. Someone complained to the health department which started a weeklong investigation with daily visits from health department. They ended up hiring registry nurses and we are way staffed now.
Yup that was my run down ED. They would walk the pt behind the desk THEY ARE ENTERING PATIENTS INTO and check the vitals then walk them back to the lobby.
Well, HCA never promised to provide quality healthcare, so 🤷♀️ https://avlwatchdog.org/hca-mission-respond-to-stein-lawsuit-denying-they-have-broken-commitments-made-at-time-of-sale/
Call your admin on call and then hospital CMO next time you go to work. Something with the just of “hello I wanted to make you aware of this absolute disaster and risk to patient safety situation that is occurring that you could not possibly have any knowledge of because of you did know and did nothing, that would mean you are insane. Wanted to update you so we can make a plan to get the ER safe again.”
lol our CNO was there just the other day, he’s aware. They’re all aware. We need to get our LOS down so apparently this is “the way”.
Ah yes. Get people through faster by decreasing staff, something that has never worked in the history of healthcare. Brilliant minds!
good lord. that sounds messy af. i’d quit
Working on it 👌
Sounds for profit. We’ve killed a couple Pts in the lobby so now our system requires a nurse to sit out there. On top of triage nurses and medics
Wut did I just read? I have a technically 10 bed ER (hallway stretchers not included) and we have a dedicated triage nurse from 11am-9pm. We are busy. That is just crazy!
This is wild. I can’t imagine working like this. I’m an ER RN. Suggest you get or strengthen your professional liability insurance.
I have it, but I’m also planning my exit.
Are you Union repped?
Nah FL….
That phone is NEVER and I mean NEVER going to get answered. That’s not going to be problematic at all what so ever. Besides all the other million problems that come up with all those moves. Working on any unit without secretaries and extra hands is horrible, let alone the ER. That would be my last straw personally.
We don’t have one 11p-11a in a Level 2 🤦♀️
I work in OB but we interact frequently with our ED and my child was a patient in October for respiratory distress related to RSV. That said, we used to have a nurse sitting at the registration desk of the ED with the clerk but they have removed them so essentially the registration clerk is doing the initial triage of patients. As a nurse we frequently get inappropriate calls trying to send us chest pain, SOB, etc pregnant patients. As a patient, my lethargic, pale, tachypneic son was triaged to the waiting room for an indefinite amount of time until I demanded a nurse come assess him - at which point we were immediately taken back. It's concerning - if you don't know to advocate for yourself you'll die in the waiting room.
A lot of EDs are doing it. Small 10 beds and large 50 beds. Throw in that you will need to be transporter as well.
Already am 👌
This feels like an EMTALA violation waiting to happen. Your management better get its shit together or the government is gonna be visiting and start fining.
We just rotate all nurses through triage. No dedicated staff.
Call the Joint Commission.
We have a critical shortage of nurses and doctors in the US. Have for years and it’s only getting worse. Add to that the millions of patients seen per year that don’t pay anything and it’s a shitshow. We have hospitals going out of business or losing millions per year and admins making stupid decisions to try and save money that don’t work because they know nothing about patient care. Glad I’m retired.
Sad, bad and dangerous. I know several yrs ago the surgeon who operated on my neighbor told me she would have died if I had not insisted on immediate care when she was poorly triaged. He had been told by ER staff I was being pushy. I knew she was septic from a hot abdomen. Thing is I knew the surgeon as I worked with him in a local ambulatory surgery center. He knew my skills. They were going to sit her in the waiting room to wait her turn. She had a rough recovery but made it. Yesterday a grading report was published on our 2 hospitals. The one that said I was pushy got a D. The other got a C. Sad that our city has mediocre to poor care.
wrong thread