Patient to Provider Ratio - split from ALS for No Reason thread

[Bullets]

My question is why put us on hold for 5 min then say we need ALS. What if the medics weren't there, then the pt is waiting even longer. 5 min eta to er, we could have been Rollin up to the er by the time she came off hold. If its an ALS call say so, don't hold us there to decide. All they even had time to do was 1 iv stick. I just didn't like waiting on scene when one of us could have been transporting. There was no emergent hurry but there sure as heck wasn't a reason to stay on scene either.

It was a good call and a good experience for me tho.

If ALS is there then wait
Yes it's only a short distance but in that time, the provider to patient ratio is in the patients favor, while at the hospital it isn't.

 

[KellyBracket]

If ALS is there then wait
Yes it's only a short distance but in that time, the provider to patient ratio is in the patients favor, while at the hospital it isn't.

In what way is the in-hospital ratio concerning?

(Perhaps the response should be in a separate thread - this one has wandered enough already!)

 

[VFlutter]

In what way is the in-hospital ratio concerning?

(Perhaps the response should be in a separate thread - this one has wandered enough already!)

Most hospitals now have RRT or ACT teams. I can get an ICU RN, RT, and PA at the bedside with me in minutes. That is besides the other floor RNs and techs who will come help me if needed. I have never been in a situation where I thought the provider-patient ratio was inadequate.

 

[Clipper1]

Most hospitals now have RRT or ACT teams. I can get an ICU RN, RT, and PA at the bedside with me in minutes. That is besides the other floor RNs and techs who will come help me if needed. I have never been in a situation where I thought the provider-patient ratio was inadequate.

But, you also can not tie up an ICU RN or RT. This is what happens when there are no beds to transfer a patient which needs a higher level of care and there are no beds in the ICUs. An RRT or ACT should not be responding to the ER either. Only in rare circumstances when there are not enough ER nurses who are trained in advance procedures, meds or protocols which might be done while waiting for a bed in ICU.

If staffing is inadequate in the ICUs or even on the floors, the staff/patient ratio is a concern. RNs on a med surg floor who might normally take 10 patients should not have to take 15. ICU RNs should also not go over their limit which they can safely monitor. States like NJ and CA do have regulations which limit the number of patients per RNs and the hospital is penalized for even violation. In states where there are no regulations there are many horror stories. The ER staff, including the doctors, believe it is okay for an ICU RN to have 4 patients each all on ventilators, nitric oxide, multiple drips and maybe even an ECMO. But, the ER staff is also taking on ICU responsibilities for which they may not be trained and educated for.

 

[Bullets]

In what way is the in-hospital ratio concerning?

(Perhaps the response should be in a separate thread - this one has wandered enough already!)

I guess the thought is, and it was a very good medic who conjectured this, after the initial emergency, the seizure, or whatever is the reason the patient is presenting to the facility is over and managed, The patient might initially get 3-4 RNs, a MD/DO and a few tech. After this, when the patient is stable-ish or up on a floor, or even in the ER, you have 20-30 patients with maybe 1-2 MD/DOs assigned, and about 4-5 RNs. Each nurse is responsible for 4-5 patients, each physician is responsible for 10-15. In the hospital, very rarely does a patient have 4 providers directly providing oversight and care. In most cases you might see the doc once a day, the nurse twice. The rest of the time its a tech

 

[VFlutter]

I guess the thought is, and it was a very good medic who conjectured this, after the initial emergency, the seizure, or whatever is the reason the patient is presenting to the facility is over and managed, The patient might initially get 3-4 RNs, a MD/DO and a few tech. After this, when the patient is stable-ish or up on a floor, or even in the ER, you have 20-30 patients with maybe 1-2 MD/DOs assigned, and about 4-5 RNs. Each nurse is responsible for 4-5 patients, each physician is responsible for 10-15. In the hospital, very rarely does a patient have 4 providers directly providing oversight and care. In most cases you might see the doc once a day, the nurse twice. The rest of the time its a tech

I still do not get your point. In the ER a true medical emergency will have multiple providers, including a doctor, at the bedside. How is this worse than a Medic/EMT crew? Once the patient is stabilized they no longer require intensive monitoring and are transferred to a floor. Would you expect a Medic to stay with the patient after their problem has resolved? If the patient's condition changes then they can quickly receive more intensive care.

Are you including EMT-Bs as providers? If so, then I will include techs since they all are CNA/EMTs and have pretty much the same scope.

It is true that the patient will only see their attending physician once a day but they are always available by phone if needed. There are also multiple house MDs and PAs in the hospital 24/7. If the patients condition requires 4:1 care then they will get it just like on the ambulance.

And I definitely see my patients more than twice a shift. At least three times :glare:

I do not see how this would be a reason to delay transfer to the ER while waiting or ALS.

 

[Bullets]

I still do not get your point. In the ER a true medical emergency will have multiple providers, including a doctor, at the bedside. How is this worse than a Medic/EMT crew? Once the patient is stabilized they no longer require intensive monitoring and are transferred to a floor. Would you expect a Medic to stay with the patient after their problem has resolved? If the patient's condition changes then they can quickly receive more intensive care.

Are you including EMT-Bs as providers? If so, then I will include techs since they all are CNA/EMTs and have pretty much the same scope.

It is true that the patient will only see their attending physician once a day but they are always available by phone if needed. There are also multiple house MDs and PAs in the hospital 24/7. If the patients condition requires 4:1 care then they will get it just like on the ambulance.

And I definitely see my patients more than twice a shift. At least three times :glare:

I do not see how this would be a reason to delay transfer to the ER while waiting or ALS.

At our hospital, all patients go to a triage area which is 2 RN and 2 techs. Patients then sit with everyone else until there is a room. I've brought a patient in with a femur fracture in traction and she sat on the board for 3 hours in triage next to 10 other patients.

 

[kurtemt]

In our system we have over 100 hospitals in our general area. If you come in by ambulance you are going straight to a bed in the er. Unless the er is full of course, then the hospital is on by-pass and we take the pt to the next closest one 5 more min away. Sometimes not even that far. No waiting in triage, hardly ever holding the wall unless we are waiting for a RN that's busy

 

[Clipper1]

I still do not get your point. In the ER a true medical emergency will have multiple providers, including a doctor, at the bedside. How is this worse than a Medic/EMT crew? Once the patient is stabilized they no longer require intensive monitoring and are transferred to a floor. Would you expect a Medic to stay with the patient after their problem has resolved? If the patient's condition changes then they can quickly receive more intensive care.

Are you including EMT-Bs as providers? If so, then I will include techs since they all are CNA/EMTs and have pretty much the same scope.

It is true that the patient will only see their attending physician once a day but they are always available by phone if needed. There are also multiple house MDs and PAs in the hospital 24/7. If the patients condition requires 4:1 care then they will get it just like on the ambulance.

And I definitely see my patients more than twice a shift. At least three times :glare:

I do not see how this would be a reason to delay transfer to the ER while waiting or ALS.

It must be nice to work in such a well staffed hospital. That staffing is definitely not the way many hospitals are staffed. Our ED staffing is 1 RN for 6 on a great day. It is usually 1:10. If you have a resus or trauma bay you might only have 3 other patients on a good staff day. Doctors are 1:20 (40 bed ER with 10 max in hall way). One PA or NP for fast track. RTs are only present for a ventilator setup. On the floors there are only 1 and sometimes 2 hospitalists on. There have been times when the ER doctor was the only physician in house. This is why RRT or ACTs were created. During a dayshift you will have more physicians but most will be private attendings or specialists. The ICUs will have an intensivist on during the day and the eICU (video doctor) at night. This is the way many hospitals now communicate with specialists or have doctor coverage at night for the units.

Enjoy working at your hospital now which sounds like a trauma center. With cutbacks and layoffs, good staffing like yours is harder to find.

For the orginal post: If a patient needs to go to a more appropriate facility such as a Stroke center, a Paramedic might be able to assess for that and take the patient a couple extra miles which an EMT can not or should not. Other than that than EMT should be able to get the patient to the ER and maybe get help if the patient crumps while waiting in some of the long lines.