Hospitals ease ER crowding with beds in halls

[Lone Star]

[align=center:ed7f278ae7]Hospitals ease ER crowding with beds in halls

Study finds no harm caused by moving patients ready for admissions[/align:ed7f278ae7]

CHICAGO - There’s no phone and no television. Only a screen offers privacy. But heart patient Edward Gray understands why the hospital put him in a cardiac unit hallway.

“They sent me up here to make room for other emergency patients,” Gray, 78, said last week from his bed in the hall of a New York area hospital. “This is the way things are in hospitals.”

It may not sound like ideal health care, but hospital officials nationwide are being urged to consider hallway medicine as a way to ease emergency department crowding, and some are trying it.

Leading the way is Stony Brook University Medical Center at Stony Brook, N.Y., where a study found that no harm was caused by moving emergency room patients to upper-floor hallways when they were ready for admission.

The study’s lead author says all hospitals should look at the program’s success.

“This is yet another battle cry for hospitals to get off their duffs and stop stacking people knee deep in the emergency department,” said Dr. Peter Viccellio, who is clinical director of the hospital’s emergency department.

He is to present the study’s findings Tuesday at a meeting of the American College of Emergency Physicians in Chicago.

Hospital-wide problem

Crowding is a hospital-wide problem that has been handed off to emergency departments, Viccellio said. His idea hands the problem back to the entire hospital.

Before the change, when his hospital filled up, patients were admitted but held in the ER in a common practice called boarding. On busy days, “things would grind to a halt and people would wait to be seen,” Viccellio said. Infectious patients would wait in the ER’s hallway for isolation rooms to open up elsewhere in the hospital.

Holding patients in ERs can cause deaths, doctors say. In a 2007 survey of nearly 1,500 emergency doctors, 13 percent said they personally experienced a patient dying as a result of boarding in the emergency department. The survey was conducted by the American College of Emergency Physicians.

The new study found slightly fewer deaths and intensive care unit admissions in the hallway patients compared to the standard bed patients. That was no surprise, Viccellio said, because the protocol calls for giving the first available rooms to the sickest patients. Intensive care patients never go to hallways.

The study is based on four years of Stony Brook’s experience with more than 2,000 patients admitted to hallways from the ER.

Other hospitals resist the idea, doctors say. Dr. Michael Carius, who heads the emergency department at Norwalk Hospital in Norwalk, Conn., would like it adopted at his hospital. But nurses and government regulators have resisted, citing safety issues, “as though the emergency department hallway is a safer environment,” he said in frustration.

“When you’re full of admitted patients, you’re no longer an emergency department, you’re just a holding area,” Carius said.

‘They could see the problem’

In Texas, all it took to convince nurses at Harris Methodist Fort Worth Hospital was a tour of the ER, said Barbara VanWart, emergency nurse manager.

“They could see the problem and help us make things happen because now it’s before their eyes,” VanWart said. The hospital started its hallway protocol in 2005.

Dr. Kirk Jensen of the nonprofit Institute for Healthcare Improvement in Cambridge, Mass., said the best reason to adopt the concept is the way it gets the whole hospital involved in finding rooms more quickly for admitted patients.

“It’s out of sight, out of mind, even if they know that patients are there in the emergency department,” Jensen said. With patients in their own hallways, “they get a lot more creative and aggressive with workflow practices.”

When Stony Brook began the hallway practice, the staff noticed “the miracle of the elevator,” said Carolyn Santora, who heads the hospital’s patient safety efforts. Somehow, rooms became available by the time hallway-bound emergency patients made it upstairs, she said.

Nurses hate seeing patients in their hallways, Santora said, and that’s fine with her.

I want them to hate it. I want them to do everything to expedite flow to get the patient out of hallway.”

Gray, the hallway patient at Stony Brook, came to the ER with chest pains and was stabilized before being sent upstairs. He is a retired nurse and said hospital crowding deserves attention from lawmakers.

“I wish the $700 billion went for hospitals, roads and bridges and not to bail out those folks on Wall Street,” he said.

[mobey]

I wonder if someone is keeping an eye on the legalities of overpopulating the hospital with patients.... things like evacuation plans, fire codes, emergency exits being congested etc...

[emtannie]

I hadn't thought of that issue, mobey - very good point.... (I wonder if Foothills ER has thought of that either.... )

One of the things I don't like about "hallway parking" of patients is the lack of privacy. When someone is sick, they already feel rotten and vulnerable, and having them in the hallway may increase their feeling of vulnerability. In the article quoted by Lone, they are provided with screens... but in many locations they aren't. I have seen patients in hallways with no privacy. In these cases, we are not only taking away privacy, but dignity as well.

It is interesting to note "In Texas, all it took to convince nurses at Harris Methodist Fort Worth Hospital was a tour of the ER, said Barbara VanWart, emergency nurse manager. " The "out of sight, out of mind" mentality is at work in every profession, and it was proven again here.

So... is the answer bigger hospitals, more beds, more nurses? Where will the money come from? This is what the politicians go around and around with, and inevitably just hand over to the next group voted into power, and no one seems to make a decision....

[Ridryder 911]

Sorry, I don't see "news worthiness". Show me an ER without patients in the hall ways! This is even happening to rural hospitals and some still don't believe our job description is not going to change? Ha!

R/r 911

[Don1977]

They do that here, puting patients in the hallway beds cause more crowding, you can hardly get around the halls, its a disgrace I believe. I have had patients that have gotten worse sitting in hallways.

[Timmy]

Same old story.

No money

No staff

No resources

More patients

It happens in hospitals around here, they advertise for medical/nursing staff, offer generous wages and benefits still no one applies.

You take on more patients and try to deal with too many patients, people complain about waiting times or someone dying then you try fix the problem by closing beds and knocking back patients due to lack of staff and people still complain, its a lose, lose situation.

Who wants to work in healthcare lol...

[JPINFV]

Sorry, I don't see "news worthiness". Show me an ER without patients in the hall ways! This is even happening to rural hospitals and some still don't believe our job description is not going to change? Ha!

R/r 911

Hehe, the hospital I used to volunteer at had patient placement down to an art form. There were 3 hallway beds with cardiac monitors, the code room was used for a "Triage Plus" (physician examines patient, orders any lab tests needed, patient waits in the lobby pending lab results) and they took over the radiology holding area (extra 4 beds that were used for fast track) after radiology closed for the day and on weekends. It was one of the few hospitals when I was working that I could say I have never had to hold the wall for longer than 10 minutes at, and even that could be counted on one hand. Heck, half the time there was a bed assigned and noted on the white board by the time we arrived.

[Lone Star]

Sorry, I don't see "news worthiness". Show me an ER without patients in the hall ways! This is even happening to rural hospitals and some still don't believe our job description is not going to change? Ha!

R/r 911

This wasn't about patients in the ER hallways, but rather on the floors.

[ERDoc]

I am a Stony Brook graduate and Dr. Viccellio was the vice-chair of our dept. The ER we were in was built to handle an annual cencus of like 35,000 but when I left we were up to almost 80,000. Obviously we had to come up with a unique way to deal with this huge overload. Dr. Viccellio et al did many studies to look at this problem. First off, fire safety was always paramount. The system we had allowed each floor to take 2 pts into the hall. It increased the work load on the floor nurses by something like .2 patients but decreased the workload on the ER nurses by something like 1.2 patients (my numbers may be a little off). Boarding them in the hall on the floors also increased pt satisfaction. They were much more comfortable on the floor where it was much more quiet then in the chaos of the ER hallway. There were certain pts that were not allowed in the hallway (can't remember what they are since is has been a few years). If you ever get the chance to see Dr. Viccellio lecture, take the opportunity. He is truly amazing and will keep you laughing the entire time.

[tniuqs]

I hadn't thought of that issue, mobey - very good point.... (I wonder if Foothills ER has thought of that either.... )

So... is the answer bigger hospitals, more beds, more nurses? Where will the money come from? This is what the politicians go around and around with, and inevitably just hand over to the next group voted into power, and no one seems to make a decision....

Yes and No ... sounds skizo dosn't it, the money is there just more effective strategies are needed, more cost effectivlely is all, besides WTF are they doing with the Oil Royalties CA$H anyway ?

Of course we need more beds in hospitals and more RNs and Mds as well, my point is unless one "imports them" from wherever this in my opinion is not the answer as world wide there is a shortage .. shifting the Health Care workers from abroad is not an answer as they are needed in their own counties.

Ok now for the RANT part ... Up in Mooseville this falls directly in the govenments lap ! The Conservatives were the ones to cut back and not only hospital beds and "restructure" back in Ralphys days. The cut at the training institute level were idiotic and now there is fall out big time. I was asked by a patient when the ER was stacked up like firewood, one day WHY is there a shortage .... I pointed over to a 3 year old sitting with her mom ... because in 20 years that little girl/boy will not have the tuition nor the placement seat available. My point is that longer term goals are neede to fix the system but change every 4 years with the sweep of an election and it is a mess and after 34 years and counting our government has failed us <end political rant>

Improve funding for Training LOOK to the Future make Texas "North" the Training Center for North America.

Now: Honestly there is a huge number of patients that are NOT emergencies they should be going to there Family doctors offices .... a huge amount of abuse out there, go to a clinic, its not a 711 its an Emergency Room.

<big breaths squinters> ah better now.

So in the interim how can we help out we as EMS can spearhead this ...Hey Look to the Brits don't reinvent the wheel, Yes across the big pond they have been forced to adjust we should to now with the scares in High Prairie and Stelmachs own riding Vegetable ville just lately "Strike when the Iron is HOT" Write a letter to your MLA ... don't just spin your wheels in EMS forum sites get political, so many great writers in EMT city and CPW that are truely in touch with their communities, stop bitching DO something.

I Love ERDocs ideas statiscal based medicine the concept applied in utilization, and bed management (hey ERDoc want a job up here, we have great beef and beers eh!

Mobey we do have friends in the FF department, I can't remember where but a Inspector for a FIRE department shut down an ER west of Cow Town somewhere Cochrane I thing ??? ... to bring public attention to the very issue of overcrowding in the ERs. Kudos !

Ok some options worth bouncing of some noggans here so please gimme some input, I am composing a letter to the new provincial transition for EMS or whatever it is called.

1- Treat and release is one very viable option:

(I don't think this will be an option in the US, due the legalities and "sewage" (sp) liability issues.

2- ALS "fast cars" used to triage patients in the field.

(Ft McMurry wants to put Paramedics on Crash Rescue .. just plain ass dumb thinking I say)

2 (be) or not 2 be, Let us suture/glue/ and put together information sheets and have a family member sign off for care, many times patients just want advice or then the "Off Work for Medical" so not rocket science here. You know how many visits to ER on Sunday night occur for that exact reason .... use the clincal call center concept implimented in London Ambulance Services I will give Stephen Hines a call and I will put him up at my place. (he knows good beer too)

3- Computer network with bed availability and the Hospital needs to "ask politely" for a diversion not the other way around, this would put pressure on the Hospitals to solve their own problems or break there pocketbooks by Shifting the load to another facility more prepared ... lift a few wallets and see how helpful they get.

4- Here's a Stop gap but very viable solution for rural a good PA program and fast tracked through the HPA, and more seats for the NP programs (for we old farts in rural areas) as for you US types we have not established that level here BUT have quite a few ex medics that are now PAs in the US. again dont reinvent the wheel, borrow it and put winter tires on it.

5- Get EMTs and Paramedics OFF the bloody Fire Trucks and integrated services period

Make a choice guys and gals its Health Care OR Fire Protection...

Operate EMS out of the hospitals not this huge mix of integrated, private, municiple, volunteer services this is a cluster we have right now and continue to promote ... sheesh reorganize the right way not the political/financially correct way, to line pockets. Through government decree we are essential services now capitalize on that !

(oh yea Working under MDs Controls, working with the RNs)

6- A provincial communications EMS network up and running asap.

7- Cancel STARS contract put them directly under PFCC just way too many fingers in the pot they suck the life blood out of other lottery fund's

"Because Helicopters Save Lives ??? .. cough, splutter, bullshit, Rapid Responding MEDICS DO! its just a transport media ONLY" So Put stonger regulations and control over their dispatch center, expose the contraversy this is a privatley run social club now, point is it IS far more advanced than PFCC dispatch , so capitalize yes on that network after all its non profit under the societys act therefore we Albertans own it don't we... Oh YES we DO we pay for it. Greg Powell is going to put a hit on me now ! bring it on brother .....

7- (bee) Use all the "registered STARS sites" in the bush and network with a mutual aid agreement regulation, OH+S after all is under government control. (You know HOW many EMRs, EMTs and Paramedics out there are 10 minutes from a wreck and NEVER even know that a crew is responding from 'hours away" change the software on the STARS dispatch today.

8- Relax OH+S regulations a bit put in regional clinics in the more remote oilfield areas and far more independant from the Prime contractor control's and "oilpatch" dictatorship. Change the 40 minute rule to Hospital to 20 minute to remote ALS health center ... this would save millions for the Oilpatch alone and free up a thousand EMS providers ... you just do not need an EMR/EMT on every drilling rig, just look at the TRI total recordable incidents stats ! ps this concept too would provide better care to the workers, ANd take pressure off the understaffed rural hospital, besides getting rid of the Ma and Pa EMS industrial gut wagon non compliant with current regulations. This would put a lot more bodies back in the system.

Last but not least:

Get me a job as a Deputy Minister for Health Care.

cheers