Bed Delays.... The foreign concept, only not.

[Bullets]

Holding the Wall (aka Bed Delays)

Waiting at the ER, usually against a wall, until there's a room ready for your patient

This concept is foreign to me, your hospitals have like a triage area? or a waiting room?

 

[NomadicMedic]

Las Vegas Fire looking to take over transports from AMR

In busy urban hospitals, incoming ambulance patients are often left in a hallway, with their patient on the ambulance stretcher for long periods of time, prior to ever being seen by anyone. You've never turned over care, so you're stuck. Even if you could find someone to take report and take over your patient, there's no place to put them. In many cases you're still treating the patient while you're waiting in the hall.

 

[Amberlamps916]

This concept is foreign to me, your hospitals have like a triage area? or a waiting room?

Lol, I'm going on 4 hours with a patient on my gurney today. Sometimes hospitals will perform all tests and treatments while the patient is on our gurney and discharge them without ever being placed onto a hospital gurney. I'm in San Bernardino County, CA

 

[Handsome Robb]

This concept is foreign to me, your hospitals have like a triage area? or a waiting room?

We hold the wall sometimes. Usually not more than 20-30 minutes though.

 

[Handsome Robb]

Sometimes hospitals will perform all tests and treatments while the patient is on our gurney and discharge them without ever being placed onto a hospital gurney. I'm in San Bernardino County, CA

And your agency is ok with this? If bet JCAHO wouldn't be. I know hall beds are a no-no per them.

 

[TransportJockey]

And your agency is ok with this? If bet JCAHO wouldn't be. I know hall beds are a no-no per them.

If they're still on the gurney they are still considered in care of EMS here, I'm betting it's the same here. So joint commission doesn't have a say

 

[Handsome Robb]

If they're still on the gurney they are still considered in care of EMS here, I'm betting it's the same here. So joint commission doesn't have a say

If the hospital is performing diagnostics and discharging the patient I'd bet they do. That's what I understood from his post.

 

[Amberlamps916]

All transporting agencies over here, both public and private, allow local hospitals to do this. Bed delays are so terrible over here so this goes on under the table basically. The county just implemented a protocol where one crew can watch multiple patients waiting for beds so the 911 system doesn't get so screwed up. I agree in this being ridiculous but most of these hospitals don't seem to want to put forth the effort to fix the system.

 

[Amberlamps916]

If the hospital is performing diagnostics and discharging the patient I'd bet they do. That's what I understood from his post.

X-rays, CTs, bloodwork, IVs, meds, 12 leads, etc. all from our gurnies.

 

[Handsome Robb]

We put hospitals on "bypass" if they have too many of out units holding the wall. Basically means we will not bring patients there and from how I understand it, the hospital is responsible for the bill if the patient's insurance won't cover it.

 

[SandpitMedic]

New thread on the apparently hot topic.

And I'd vote Loma Linda (San Berdo) the worst at this. Hours and hours and hours holding the wall.

 

[mycrofft]

Why do airlines get fined but not hospitals?

 

[terrible one]

St Mary's in Victorville
St Francis in Lynnwood
Harbor General in Torrance

These were the worst I've experienced.

 

[DesertMedic66]

New thread on the apparently hot topic.

And I'd vote Loma Linda (San Berdo) the worst at this. Hours and hours and hours holding the wall.

Ahh the joys of LLUMC. My max bed delay time there is 4 hours. I've heard of crews going over the 6 hour mark.

 

[TransportJockey]

Presbyterian main, in ABQ, NM set my personal record of 2.5 hours holding a wall.

 

[SandpitMedic]

Yeah. In the past I often spent 1/3 or more of my shift on bed delays in San Berdo County.

I also now have envy for those who have no clue what a bed delay is.
Lucky.

 

[JPINFV]

Why do airlines get fined but not hospitals?

Serious question? Because it's much easier to dump an airplane back into a terminal than to magic up beds, nurses, and physicians that simply don't exist.

 

[mycrofft]

Serious question? Because it's much easier to dump an airplane back into a terminal than to magic up beds, nurses, and physicians that simply don't exist.

How about airlines take Federal money; hospital associations and the AMA donate to federal (andy state and local) elections?

When I see new medical facilities being built with minimal architectural flourish and no offices larger than my house, then I'll cry them a river about how they can't afford patient care.

A recent "cancer center" addition to a local hospital (one of the two major emergency receiving hospitals and a nonprofit) is a little over twice the size of the hospital. I've been inside, and much of it is admin space. Sheathed in reflective glass, at least two large fountains outdoors, and without adequate parking for patients so they hire valets for parking the vehicles of cancer patients.
Cancer center (not called that since the project was finished) under consruction, hospital on its right and partially obscured/out of frame

PS: this was near the end on construction which took about four years. There were four of the tall red cranes most of the time on the site.

 

[Tigger]

I've worked in two systems and never held the wall. In Boston sometimes you'd have to wait a bit for the ambulance triage nurse to show up and take report, but after that we went straight to a bed.

Colorado Springs is much smaller (serves about 600k) but I've never waited at either of our large "urban" hospitals. Call the hospital ahead of time, look at the board on the way in, and go straight to the room.

Of note, hospitals cannot go on divert in Massachusetts unless there is some sort of internal disaster. Even with that the wait is not often long. The policy forced hospitals to reexamine their ED operations as a whole and did good things for everyone at least in terms of making beds available. There are no general diverts in the Springs, just for critical care and psych beds.

 

[TransportJockey]

I've worked in two systems and never held the wall. In Boston sometimes you'd have to wait a bit for the ambulance triage nurse to show up and take report, but after that we went straight to a bed.

Colorado Springs is much smaller (serves about 600k) but I've never waited at either of our large "urban" hospitals. Call the hospital ahead of time, look at the board on the way in, and go straight to the room.

Of note, hospitals cannot go on divert in Massachusetts unless there is some sort of internal disaster. Even with that the wait is not often long. The policy forced hospitals to reexamine their ED operations as a whole and did good things for everyone at least in terms of making beds available. There are no general diverts in the Springs, just for critical care and psych beds.

Divert is no longer allowed in the Bernalillo county metro system. The hospitals were abusing it. And to make matters worse, the hospitals in Bernalillo County house the only level one trauma in the state, and are the catchment hospitals for two counties without hospitals and two counties with minimal facilities altogether.