no room at the inn

It has been so damn busy lately. In the last couple of weeks there have been basically no ICU beds. Its the ICU shuffle goin' on. The ICU shuffle is called who is the least critical of the ICU patients, and really shouldn't be moved out, but is the least likely to crash. Of course all of these decisions take hours. So the critical patients sits in the ER waiting for all this shit to be decided.

The alternative to sitting in the ER for hours is doing a bunch of interventions in the ER that imrove the patient and they can be downgraded from ICU to tele. That's going on too.

The last couple of days, there have been no med/surg or tele beds either. So everybody be sittin' in ER. Of course there are no additional staff in the ER to care for all these sittin' patients. The doors are still open and people keep coming. It is so bad that we have been going on divert for four hours (the mas) to ambulances, going off for four hours, going back on.

It has got to the point where there isn't even a code bed in the hospital and the ER IS the code bed. We have had a patient who coded on tele come to the ER because there are no ICU beds.

Here is my thought:
1) With the nursing negotiations last year and the bad economy, the hospital has not, until recently, hired nurses. The hospital is short staffed.
2) The hospital wants to try and manage with less nurses and so when there is a upswing in census everybody, especially the patients, are screwed.
3) The hospital are always reactive to this kind of stuff. Rather than having a sort of "crisis team" that meets in situations like this, thinks ahead about dealing with it, it waits til its a crisis point and then panics and does stuff. Seems like it wouldn't be that hard to have a plan in place.

Because hospitals are competitive with each other, there is no cooperation about managing these surges in patients and perhaps distributing them among hospitals, etc. Oh no, can't do that. This kind of thing really is a disaster type situation. When you have critical unstable patients sitting in ER for hours, making the ER staff short, that is a disaster. Perhaps we should start declaring an internal disaster to deal with it. Are you seeing a surge in patients lately?