Bed Delays.... The foreign concept, only not.

BEN52

Forum Crew Member
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Abuse of the emergency medical system as a whole sounds like a good place to start.

Cut down on these complaints hat should be dealt with in the primary care setting and you open up beds for acute patients.

That would require money as well. Those PCPs are going to need to be paid. Those PCPs do not fall under emtala thus can require payment upfront.
 

Rialaigh

Forum Asst. Chief
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And your agency is ok with this? If bet JCAHO wouldn't be. I know hall beds are a no-no per them.

Sadly all of our local hospital utilize hall beds on a daily basis. One of our large level 1 trauma centers has monitors mounted between rooms on the outside specifically for this purpose. I have placed CPAP patients in hall beds before with the patient being continued on CPAP by one of the ER RT's while sitting in the hallway....

We never have to worry about getting stuck at a hospital, we do place most of our patients in hallway beds of the waiting room during busy hours
 

Handsome Robb

Youngin'
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Las Vegas Fire looking to take over transports from AMR

We place patients in the waiting room as well but they have to be ambulatory, not intoxicated and cannot have an IV in place so only the lowest acuity patients can be placed out there. We rarely wait for beds but it does happen from time to time.

I've never actually seen a hallway bed but I've heard of setups similar to what you're describing Rialaigh.

Bullets, some would argue the patients get better care while holding the wall because they get a 1:1 provider to patient ratio, 2:1 technically in the areas that don't allow one crew to watch multiple patients so other nuts can go back in service and if something really needs to be addressed it's easy to tell the charge nurse you need a doctor for xxx reason. It's frowned on letting patients crash while holding the wall.

I think the sickest patient I've ever been on the wall with was a 40s female with chest pain, negative for STEMI, throwing couplets of PVCs. I made it known I wasn't happy about not having a bed. Then it became bigeminal couplets, I went around the nurse to an ERP and made them aware I may have to give a lido bolus and hang a drip because my hands are tied by our PVC protocol (laugh it up), we got a bed, slid her over and she R-on-Td into VF. That charge nurse doesn't work at that hospital anymore but that's not the only reason.
 
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mined

Forum Ride Along
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In Virginia you cannot leave the patient like that. Of a crew wants to go out of service to let the hospital use their cot that's on that crew. No crew or cot is going to stay in the ER indefinitely while hospital beds are found. That hospital would have put on diversion until such time as they could handle patient volume again. JACHO has a lot to do with this also the hospital's EMTALA status, ie status is jeopardized.
 

socalmedic

Mediocre at best
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In Virginia you cannot leave the patient like that. Of a crew wants to go out of service to let the hospital use their cot that's on that crew. No crew or cot is going to stay in the ER indefinitely while hospital beds are found. That hospital would have put on diversion until such time as they could handle patient volume again. JACHO has a lot to do with this also the hospital's EMTALA status, ie status is jeopardized.

you cant put every hospital on diversion. there simply aren't enough hospital beds to go around and there is nothing JACHO can do about that. it is not at all uncommon in urban systems for ambulances to be waiting hours for beds, if you don't work in an urban system I don't expect you to understand but I have seen waiting room times of 17 hours before, I have waited with a patient on my gurney for 12 hours (company record to the best of my knowledge) and the hospital never went on diversion because the other hospitals in the area were just as busy. critical patients will go directly to the resuscitation room but non acute patients will wait just like everyone else. this is why hospitals with EMS wait times have "triage" areas, jahco cant ding them for ambulances waiting in triage because the hospital hasn't accepted care yet.
 

Tigger

Dodges Pucks
Community Leader
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When Massachusetts "banned" diversion, more beds did in fact appear. Slowly at first, but capacity came up remarkably within a few years. Not to mention some other new "efficiencies" like broadening the limits for putting a patient in the waiting room or creating "asthma chairs," which is a unit with a bunch of chairs in a row with oxygen hookups so people who just need a breathing treatment can get it without taking up a bed.

Also those of us that work rural in rural areas spend plenty of time in urban areas, that's where the hospitals are after all.
 

johnrsemt

Forum Deputy Chief
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The 10 years I worked in Indianapolis we never had to wait more than 10-15 minutes, more than a few times we were told Pt is going to Bed # as soon as it gets cleaned, and my partner or I would clean it for them. Surprising how nice the nurses are when you make their job a little easier.

Here I have never waited, except when 1 level I hospital ED was busy and they suture our patients chin on our cot (plastic surgeon did it, and that was the reason we went to that hospital).
 

AtlasFlyer

Forum Captain
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Yeah I work in Indy, a busy urban system, and we don't really have much of a bed wait time to speak of. Maybe a few minutes to clean a bed (which, yes, I'll gladly help do), but the 10-15 minutes mentioned above is accurate.
 

TheLocalMedic

Grumpy Badger
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It's interesting to read about the horrible delays some crews are facing (SoCal seems to have the worst) and see some of the same things beginning to occur where I work. We used to never wait long for a bed unless it was a truly horrifically busy day. But more and more often we are finding ourselves delayed for beds in the ER. There's one facility that is particularly bad, and it has received enough attention that the county is finally stepping in to try and get things straightened out.

Years ago it was a common occurrence to see a hospital go on divert if they got too busy, but that has almost completely ceased after the county started instituting fines every time the hospital diverted. The hospitals were essentially abusing the diversion policy and closing the doors any time it started to get busy. The intention with the fines was to give the hospital a kick in the butt to get things moving again so they would open back up, but the result has been that hospitals will now never divert, even if it means stacking up all the ambulances with extended bed wait times.

Until now there wasn't a penalty for having a long delay, and the hospitals seemed like they could care less about lining the halls with gurneys so long as they avoided a diversion fine. It will be interesting to see what the effect will be if the county also begins fining hospitals for extended bed delays (whether the fine will be for a certain length of delay or number of units delayed at one time remains to be seen).
 

the_negro_puppy

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We have delays of 30 mins to several hours on busy days.

Riding the wall or 'ramping' has become a big political issue here with politicians and health officials trying to reduce it.

This is how bad it was at its peak:

678201-ambulance-ramping.jpg


20+ ambulances some offloaded, many waiting with patients still in the back.
We have a public health system and hospitals with bypass initiated by hospitals banned.

Instead our comms centre monitors hospital delays and diverts ambulances to other places where possible.
 

mycrofft

Still crazy but elsewhere
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We have delays of 30 mins to several hours on busy days.

Riding the wall or 'ramping' has become a big political issue here with politicians and health officials trying to reduce it.

This is how bad it was at its peak:

678201-ambulance-ramping.jpg


20+ ambulances some offloaded, many waiting with patients still in the back.
We have a public health system and hospitals with bypass initiated by hospitals banned.

Instead our comms centre monitors hospital delays and diverts ambulances to other places where possible.

Did the receiving facility at least send out a triageur from their staff to the units?

Even our famous In and Out Burger drive through lines do that!
in-n-out-burger-draper-drivethru-front.jpg
 

the_negro_puppy

Forum Asst. Chief
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Did the receiving facility at least send out a triageur from their staff to the units?

Even our famous In and Out Burger drive through lines do that!
in-n-out-burger-draper-drivethru-front.jpg

Sometimes a nurse or doc would pop their heads in and have a look / ask a few questions.

The reason it got so bad on this day was that this hospital was one of two large tertiary hospitals in our city- the other smaller ones had gone on bypass leaving only 2 "open for business"
 

jgmedic

Fire Truck Driver
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Serious problems with this in Riverside County right now. Where I work, we almost always are on bed delay at the local receiving. It was always a big issue in LA, I once waited over 6 hours at Whittier Pres with an ETOH pt.
 

JPINFV

Gadfly
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Serious problems with this in Riverside County right now. Where I work, we almost always are on bed delay at the local receiving. It was always a big issue in LA, I once waited over 6 hours at Whittier Pres with an ETOH pt.


Good old PIH. You knew if you were going there it was going to be an hour or two, at least, every time.
 

SandpitMedic

Crowd pleaser
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Until they find some alternative destination for psych and ETOH patients this will continue to worsen.
 

JPINFV

Gadfly
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Until they find some alternative destination for psych and ETOH patients this will continue to worsen.


The problem with psych patients is that it isn't always psych. Is the psychosis caused by meth or by thyrotoxicosis? [why not both.jpg] Then there was the psych patient with the rather large tumors in his brain causing mass effect on the frontal lobes.
 

Christopher

Forum Deputy Chief
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In busy urban hospitals, incoming ambulance patients are often left in a hallway, with their patient on the ambulance stretcher for long periods of time, prior to ever being seen by anyone. You've never turned over care, so you're stuck. Even if you could find someone to take report and take over your patient, there's no place to put them. In many cases you're still treating the patient while you're waiting in the hall.

"busy urban" ?

We frequently board in the hallway and we're not urban. :(
 
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