Emergency Department Boarding Stories

We are a 15 Bed ER that we historically expanded to some 44 care bays, hallway gurneys, and such. Last winter we boarded up to 10 intubated patients and up to 17 Med/Surg in this 16 bed ER for more than 24 hours at a time. (Hope you can visualize the optic). Last few months we have held/treating up to 40 patients in our waiting room while we close 8 ER beds or more due to staffing. Ambulance wait time is bad.

Our senior administration does not know what to do despite of expert advice, and there is an unwillingness to contract travel RNs using prevailing hourly rates (which are ridiculous); including our CEO walking out of the job in the past couple of weeks. Going into this winter, our volumes are now 6% to 8% consistently more compared to the past two years and fast moving to exceed pre-COVID volumes.

Just last night, I reflected and begun to formulate a plan for the real possibility of implementing field triage (aka military triage).

We are currently staffing six nurses (20% LVNs new process) when we need 12 registered nurses during peak hours. The latter Impacting the real ER patient population and needed care. We have been unable to assign code blue or RRT nurses consistently to rescue patients and patient arrival to RN triage time is, well, out of current regulatory compliance to say the least. We have reached out to licensing entities (where are they)?

Sadly, all of the above is creating conflict and friction amongst a historically very cohesive ER group (ER MDs, MLPs, and Nursing). Many of us are working 60 or more hours per week for the past 3 years. I personally am on 60-70+ hours per week (no hyperbole). We are on survival of the fittest behavior! Just last night, I reflected and begun to formulate a plan for the real possibility of implementing field triage (aka military triage). Words cannot truly project or express what is happening and what is to come this next few months. 

Vexing - Sounds bad right!. . . It is. Help needed—to say the least!