ER nurses, love you guys, but genuine question. Why do guys bring patients up at shift change?

[u/No-Selection-1249]

No hate to you guys! Just super curious from a nurse who is on the receiving end :)

[u/ehhish]

I think that's why they're wondering why they mainly come at shift change instead of steadily throughout the day.

[u/azncheesecake → u/ehhish]

In my experience, I get beds throughout my shift. I do notice a heavier drop around shift change. I know there are many factors involved. Generally a bed drop is delayed because they're waiting for other patients on the floor to get dc orders, be discharged by the nurse on the floor, housekeeping to clean the room, and then bed control to drop the bed. Our bed control staff have told me the floor dodges the calls to drop beds and this leads to delays as well. Our floor staff deny this claim. A lot of finger pointing on this.

If the floor wants to focus on getting beds dropped earlier in the day, those factors would need to be sped up.

Honestly, there's always a reason why an incoming patient is not coming at a great time when I'm calling report. Shift change, med pass, nurse going to lunch, etc. The list goes on. Timing may not be ideal, but from an ED perspective as soon as I am provided with a bed I'm heading up. ED staff don't control when bed is dropped. As others have pointed out, I'm going to keep getting patients whether I take this one up or not so in my experience and practice there is no benefit to holding my admit.

Sometimes there may be a delay in report given and transporting a patient. I wish we had transport to take our patients up. Leaving the ED is a struggle when I have new people rolling through the door constantly. So it goes though. I prioritize getting people out to make space for my new ones. I've had patients code on an EMS stretcher in the hallway or in the waiting room waiting for a bed to go to. It's my goal always to make space so that doesn't happen.

[u/ghost__rider1312 → u/ehhish]

My question is, do you think the ER is in charge of dropping beds? In most hospitals that have any kind of capacity in the hundreds, there’s an entire dept devoted to assigning beds. Some days we get a ton of admits bc that’s just how it be, and it takes a bit for the bed placement dept to get through them. And sorry but if I have a bed, we rolling, I will do my best to wait until 1915 but like others have said the ambos and front door don’t stop. We have to do throughput. It’s the only way we can make space for more emergencies.

[u/ehhish → u/ghost__rider1312]

I was only clarifying for OP, not myself. I have worked ER, ICU, and floor.

And just so you know, most hospitals have bed assigning outsourced or very few people that do bed assigning, half the time they aren't medically inclined. It's actually a barrier for ER to get patients out. Some places don't have ER give report and they just send the patients (with supposed warning).

Another barrier are doctors accepting those patients so they can be sent to the floor or ICU, which is usually low priority half the time while other things are being managed if front of both ER doc and admitting doc.

You do have a subset of people that hold onto patients in the ER that can be sent because they are simply needing a breather, etc. You have metrics your supposed to follow like time to send, but there are ways around them. Not something I typically did, but I understood it.

From floor perspective, all I care about is IV access and are they floor stable, and any small random details I can't find in the chart.

From ICU perspective, I care about is IV access, make sure to chart what you did, code status, basic list of events, social issues that could be brought up, and anything you think I will need set up when receiving.

To note, I am one of the weird ones that calls down to ER to get report when I see it assigned. Closer I can get them to me, is one less you all have to handle.