Boarding issues

[skougess]

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My shop has had some ridiculous boarding issues the past few months. A quick survey of peers makes me think this isn’t unique to my place. Anyone else noticing this or have any idea why it’s happening?

 

[southerndoc]

Yes, hospitals are full. A lot of it is due to COVID. People get discharged from hospital to STR/LTR/SNF. All beds are full there, so they can't discharge from the floor to those facilities. Can't send people out of the ICU's because the floor beds are full because the SNF's are full. ED's can't send patients to the floors or ICU's because both are full.

Solution isn't adding more beds to the hospital in all cases. We also need to add more capacity to STR, LTR, and SNF's.

I work in a very large ER that consistently has 20-50 admission holds on a nightly basis. It's a huge problem without any end in sight in the near future.

 

[Hercules]

Agree. A lot of these covid admissions have significantly longer LOS than what the hospitals are used to. This is turn leads to decreased inpatient bed turnover which yields boarding. It’s a double whammy to deal with boarding while experiencing decreased ED volumes as well.

 

[The Knife & Gun Club]

And SNFs end up trying to discharge people with home nursing or outpatient rehab, which leads to the person returning to the ED because...
“I’m still in pain!”

 

[CajunMedic]

We have the same problem. Some have boarded so long they are rounded on by the inpatient teams and discharged from the ED without getting an inpatient bed. We had this problem before COVID, namely due to lack of capacity and a ridiculously sick population. A lot is staffing. It got worse during the drop in visits when COVID kicked off because they laid off Nurses, PA's and closed the ED Obs unit at one of our campuses. Now, they're scrambling to find staff, but after the hospital CEO stepped on his dong on TV saying that the staff was bringing in COVID, not the lack of PPE, it just got harder.

The ED Obs unit just reopened, managing to poach a couple of midlevels from other departments and find a couple of new hires. They're also working on an adult hospitalist service for our Women's and Children's campus to open up those beds and decrease transfers to the other 2 campuses for adult care.

Little to no psych beds keep people in the department for 48+ hours, recent record is 100+ hours before transfer.

We've been trying to send our pending SNF, hospice, easy dispos to our outlying community campus, depends on the mood of the hospitalists there and whatever they are trying to send to the mothership.

My personal best has been to evaluate, order labs and imaging and get a patient admitted to the orthopedic surgical service while they are sitting in a wheelchair under the entrance awning, smoking a cigarette.

 

[Dr Mantis Toboggan]

Yes, hospitals are full. A lot of it is due to COVID. People get discharged from hospital to STR/LTR/SNF. All beds are full there, so they can't discharge from the floor to those facilities. Can't send people out of the ICU's because the floor beds are full because the SNF's are full. ED's can't send patients to the floors or ICU's because both are full.

Solution isn't adding more beds to the hospital in all cases. We also need to add more capacity to STR, LTR, and SNF's.

I work in a very large ER that consistently has 20-50 admission holds on a nightly basis. It's a huge problem without any end in sight in the near future.

this winter is going to be very, very bad.

 

[southerndoc]

this winter is going to be very, very bad.

I'm praying for a miracle.

 

[thegenius]

this winter is going to be very, very bad.

maybe be bad for COVID, but there are record few number of Flu cases in the southern hemisphere this year. I don't anticipate a large Flu burden this year.

It matters not though, whether you have the flu, or covid, or oranguatananika, people are gonna get sick.

we need more people to come in. Our numbers remain down by upwards of 20%

 

[bravotwozero]

Therein lies the rub for EPs. It's either 'depressed volumes' famine or 'covid surge and increased exposure/icu boarders' feast...

 

[TeddyBoomBoom]

[...] My personal best has been to evaluate, order labs and imaging and get a patient admitted to the orthopedic surgical service while they are sitting in a wheelchair under the entrance awning, smoking a cigarette.

Well played, sir.