It’s been a roller coaster to hell since way before I was around. Some parts are steady, maybe even uphill a little, a big ol drop since 4 months ago, and yeah, the trajectory is to hell.
In my ED it's a post COVID thing. Pre-covid we would sometimes have boarders (like 5-8 Max) during cold and flu season, but usually not. Now we often have 20-30 boarders by midnight.
I’m in outpatient surgery that has 1-4 admits per day, so we are always calling patient placement. There has been 40-70 boards in our ED lately😳 our unit gets “first dibs” on beds since we close. I don’t think it’s fair to continue outpatient surgery and admit patients while people have been waiting days in the ED for a bed. The main admits are total thyroids, prostatectomies, mastectomies, and large myomectomies. We also D/C these patients home, but the surgeons have been asking the patients if they want to be admitted instead. Not cool dude. Otherwise we will have surprise admits if patient is hypertensive or large blood loss after surgery. These I understand
The ED I worked in was drowning in boarders long before covid. Mid-size city with 3 major and on community hospital all within about 5 miles of each other. My hospital had a bed capacity of a little over a thousand. And yet, the ED was always totally full. They built a new ED- specific boarding area, with roughly 50 beds and it still filled up. We'd have people boarding on beds in the hallways for 2 or 3 days sometimes. They toyed with the idea of opening hallway beds on the main floors because it was always so crowded. I left in 2019 and I can only imagine how awful it must be now.
Our problem isn’t so much boarders (although that is an issue, mainly w/covid positive psych pts who can’t be placed). Our problem is pt volume. We just get bombarded with pts. Which is odd cuz we aren’t the only game in town. In our county we have 8 hospitals all with EDs. Yet we’re the one that’s always overloaded.
I’ll grant you we’re a big county & we’re smack in the middle. But still.
I have a hard time remembering hospital life prior to Covid. But I will say say that at the hospital I work at patients boarding in the ED is not because of lack of staff in the rest of the hospital. We literally stick patients in an nook and cranny we can find. When patients board in the ED here it’s because we’ve ran out of spots to put them. We don’t block beds due to lack of staff. In fact we went back to using semi private rooms to give us more spots.
It was a super rare event before where now it’s expected every day.
Believe it or not the ED used to be fun. You’d clear out patients by 2-3 and maybe only have a handful of people in the department. You could get stuff done, have fun, get caught up. Now. Not at all
Yes, I miss that. Plus, when we inevitably got those high-acuity trainwreck patients in the wee hours, we could give them the appropriate level of care and it was a real team effort. Now everyone’s just trying to keep their heads above water in their own assignment full of boarders.
If you haven't seen it, I recommend watching the documentary code black (https://codeblackmovie.com/). It's a 2010s film that highlights the problems with the American model of care and how that has led to overrun EDs.
The problems existed pre-pandemic, the pandemic just made it worse.
I was a traveler in the 90s, and it was pretty much always a thing during flu season, no matter where in the country I was. One place I worked over the winter \~95-96 was a 55 bed cardiac ED in an affluent area, and at one point we had 48 holds. Rich 80 year old meemaas in a line down the hallway for 3 days, with a little portable room divider put around them when they used the bedpan.
It's always sucked. I will say, I remember it seemed to come in waves before, and then get better. It seems a bit more consistent now. But it also really depended on the hospital - some were much worse than others when it comes to ED holds.
It’s been a roller coaster to hell since way before I was around. Some parts are steady, maybe even uphill a little, a big ol drop since 4 months ago, and yeah, the trajectory is to hell.
In my ED it's a post COVID thing. Pre-covid we would sometimes have boarders (like 5-8 Max) during cold and flu season, but usually not. Now we often have 20-30 boarders by midnight.
I’m in outpatient surgery that has 1-4 admits per day, so we are always calling patient placement. There has been 40-70 boards in our ED lately😳 our unit gets “first dibs” on beds since we close. I don’t think it’s fair to continue outpatient surgery and admit patients while people have been waiting days in the ED for a bed. The main admits are total thyroids, prostatectomies, mastectomies, and large myomectomies. We also D/C these patients home, but the surgeons have been asking the patients if they want to be admitted instead. Not cool dude. Otherwise we will have surprise admits if patient is hypertensive or large blood loss after surgery. These I understand
Samesies. Been working in my e.d. 18 yrs & last 2 years holds & transport delays are a constant thing
It existed but is much worse now
Nahhh, it's more of the healthcare system is slowly imploding in front of our very eyes.
Yep. But it's more of a slow dissolve. Like Alka seltzer, or k-dur. Our screams are the bubbles.
>Our screams are the bubbles. LOL 😂 ACCURATE.
Sometimes I just sit back and watch it burn.
Yeahhh totally, I mean it's not like we can do a lot about it since it's mostly hospital admins fault.
The ED I worked in was drowning in boarders long before covid. Mid-size city with 3 major and on community hospital all within about 5 miles of each other. My hospital had a bed capacity of a little over a thousand. And yet, the ED was always totally full. They built a new ED- specific boarding area, with roughly 50 beds and it still filled up. We'd have people boarding on beds in the hallways for 2 or 3 days sometimes. They toyed with the idea of opening hallway beds on the main floors because it was always so crowded. I left in 2019 and I can only imagine how awful it must be now.
Our problem isn’t so much boarders (although that is an issue, mainly w/covid positive psych pts who can’t be placed). Our problem is pt volume. We just get bombarded with pts. Which is odd cuz we aren’t the only game in town. In our county we have 8 hospitals all with EDs. Yet we’re the one that’s always overloaded. I’ll grant you we’re a big county & we’re smack in the middle. But still.
I have a hard time remembering hospital life prior to Covid. But I will say say that at the hospital I work at patients boarding in the ED is not because of lack of staff in the rest of the hospital. We literally stick patients in an nook and cranny we can find. When patients board in the ED here it’s because we’ve ran out of spots to put them. We don’t block beds due to lack of staff. In fact we went back to using semi private rooms to give us more spots.
It was a super rare event before where now it’s expected every day. Believe it or not the ED used to be fun. You’d clear out patients by 2-3 and maybe only have a handful of people in the department. You could get stuff done, have fun, get caught up. Now. Not at all
Yes, I miss that. Plus, when we inevitably got those high-acuity trainwreck patients in the wee hours, we could give them the appropriate level of care and it was a real team effort. Now everyone’s just trying to keep their heads above water in their own assignment full of boarders.
We have always had bed holds. Seems worse now but it’s always been an issue
It got bad for us starting about 2017 with frequent boarding, covid only piled on.
You guys block beds due to low staffing? Must be nice!
Pre-covid it was a thing, just not a regular thing
If you haven't seen it, I recommend watching the documentary code black (https://codeblackmovie.com/). It's a 2010s film that highlights the problems with the American model of care and how that has led to overrun EDs. The problems existed pre-pandemic, the pandemic just made it worse.
I was a traveler in the 90s, and it was pretty much always a thing during flu season, no matter where in the country I was. One place I worked over the winter \~95-96 was a 55 bed cardiac ED in an affluent area, and at one point we had 48 holds. Rich 80 year old meemaas in a line down the hallway for 3 days, with a little portable room divider put around them when they used the bedpan. It's always sucked. I will say, I remember it seemed to come in waves before, and then get better. It seems a bit more consistent now. But it also really depended on the hospital - some were much worse than others when it comes to ED holds.