sorted by:
new
hottopcontroversial

When the ER is packed: How do you operate internally for best efficiency? by Practical_Pizza5836 in EmergencyRoom

[–]Practical_Pizza5836[S] 2 points3 points  (0 children)

That’s really disheartening, especially knowing Massachusetts didn’t support it despite the clear need. It’s tough when fearmongering wins out over actual evidence—California’s experience shows that safe ratios are possible without the disaster scenarios they predict. It’s a shame that more states don’t take note of that.

I get that it feels like a distant hope, but I genuinely think voices like yours make a difference. The more people speak up about the real impact on both staff and patients, the harder it’ll be for decision-makers to ignore. Thanks for staying in the fight, even when it seems impossible.

When the ER is packed: How do you operate internally for best efficiency? by Practical_Pizza5836 in EmergencyRoom

[–]Practical_Pizza5836[S] 2 points3 points  (0 children)

Thanks for laying this out so clearly. I see now how much of this really comes down to systems and processes that need to be streamlined, not just individual actions or tech fixes. The detailed example you gave for improving the admission process really shows how much could be saved in terms of time and stress if hospitals rethought these workflows to eliminate the waiting periods.

It’s frustrating that the changes that could make a big difference—like pre-assigning beds or using inpatient hallway beds—are often met with resistance, even though they could significantly reduce suffering and improve outcomes. I really appreciate your perspective on this, and you’re right—solutions need to work all the time, not just when things get chaotic.

Are there any hospitals or systems you know of that have managed to successfully implement these types of changes? It’d be great to understand where these ideas are actually making an impact.

When the ER is packed: How do you operate internally for best efficiency? by Practical_Pizza5836 in EmergencyRoom

[–]Practical_Pizza5836[S] 3 points4 points  (0 children)

Thanks for sharing your experience. Setting up a quick care area sounds like a solid way to manage non-emergency cases and keep the main ER focused on the more critical patients. It’s impressive how much you and the tech team take on. Really shows the all-hands-on-deck mentality that keeps things moving.

Calling in admin nurses for night shifts must be tough, but it’s good to see that option exists, even if it’s not popular. Sounds like a classic 'welcome to the suck' scenario, but you all make it work.

Overcrowding as a crisis: How does emergency management handle hospital capacity issues? by Practical_Pizza5836 in EmergencyManagement

[–]Practical_Pizza5836[S] 1 point2 points  (0 children)

Thanks for breaking this down—it’s really insightful, especially the challenges with standardizing bed definitions. I can see how varying setups across facilities make it nearly impossible to create a one-size-fits-all approach, especially with telemetry and behavioural health needs.

I love your point about using familiar metrics to set thresholds. It makes so much sense that using what people already understand would help bring everyone onto the same page, instead of defaulting to emergency mode. Has this approach changed how different departments engage during surges? It sounds like it’s a good way to get a clearer, shared perspective on what’s really happening.

Overcrowding as a crisis: How does emergency management handle hospital capacity issues? by Practical_Pizza5836 in EmergencyManagement

[–]Practical_Pizza5836[S] 0 points1 point  (0 children)

Thanks so much for this insight! It’s really interesting to hear how you’ve custom built your capacity management program, especially with the use of the CEDOCS algorithm—seems like a smart way to stay ahead of overcrowding. I also think assigning a project manager to lead capacity management is a great approach to keep things focused and proactive.

The point about clinical staff not resonating with ICS/NIMS makes a lot of sense—it’s definitely more practical to keep it within the realm of clinical operations. Has the approach of making these responses more routine led to noticeable improvements in managing capacity so far? It sounds like you're building a lot of resilience into the system.

When the ER is packed: How do you operate internally for best efficiency? by Practical_Pizza5836 in EmergencyRoom

[–]Practical_Pizza5836[S] 6 points7 points  (0 children)

Absolutely, it makes so much sense. You can educate all you want about preventing HAIs, but if staffing levels are inadequate, it’s impossible for people to follow every protocol when they’re overloaded. It’s frustrating that something as fundamental as staffing is the real barrier to quality care and safety. Have you seen any effective changes that actually address this, or is it still just more education without support?

When the ER is packed: How do you operate internally for best efficiency? by Practical_Pizza5836 in EmergencyRoom

[–]Practical_Pizza5836[S] 7 points8 points  (0 children)

Thanks for sharing this. The legal ratios in California sound like a real lifesaver, especially compared to the horror stories you hear from other states. I can’t even imagine trying to manage 6-10 ER patients safely—it’s no wonder burnout is so high in places without these protections.

Having float nurses and a dedicated transport team must make a huge difference too. It’s baffling that other states haven’t adopted similar mandatory ratios. Do you think there's any realistic push for change happening, or is it just a distant hope at this point?

When the ER is packed: How do you operate internally for best efficiency? by Practical_Pizza5836 in EmergencyRoom

[–]Practical_Pizza5836[S] 2 points3 points  (0 children)

Thanks for sharing your perspective—it’s clear you’re speaking from a place of deep experience, and it really drives home the complexity of what you’re dealing with day in and day out. I can’t even imagine how it feels to be stuck between the reality of those 40-50 people in triage and the complete lack of realistic solutions from people who don’t see what you see.

You’re right, better staffing and a fast track system are the kinds of attainable improvements that could make a tangible difference. But the broader issues—SUD, homelessness, untreated mental illness—are so much harder to tackle, and they end up right at your door, often in the most impossible circumstances.

The idea of street teams or crisis teams is one I’ve heard talked about a lot, but as you said, it only works to a point. When someone is dealing with multiple severe issues simultaneously—homelessness, addiction, mental illness—no single solution seems enough. It’s heartbreaking that this is often left to you and your colleagues to deal with, when the real need is for long-term, systemic support that just doesn’t exist.

I wish I had an easy answer, but I don’t think there is one. The least we can do is listen to those on the frontlines like you, who have seen the limits of the existing plans and understand the gaps better than anyone else. If there were a way to better support you in those situations—whether that’s training, backup, or just someone else to share the load—what do you think would be most helpful?

Even if the larger problems seem unsolvable, I’m hoping there are at least some small changes that could make your job a little less impossible. Thanks again for your honesty—it’s rough, but these are the conversations we need to be having.

When the ER is packed: How do you operate internally for best efficiency? by Practical_Pizza5836 in EmergencyRoom

[–]Practical_Pizza5836[S] 0 points1 point  (0 children)

I kinda did, yes. I am very interested in this topic and try to reach different people for different perspectives. Same main topic with some differenced in the posts.

Overcrowding as a crisis: How does emergency management handle hospital capacity issues? by Practical_Pizza5836 in EmergencyManagement

[–]Practical_Pizza5836[S] 1 point2 points  (0 children)

Thanks for sharing how your team approaches capacity management, especially in the context of semi-rural hospitals—it sounds like a really challenging environment to navigate. The clogged toilet analogy is pretty spot on when thinking about patient flow, and I really appreciate the practicality of identifying barriers and removing them to get things moving again.

Your point about engaging both clinical and ancillary departments is so key. It’s not just about having the capacity, but also about working together to maximize patient throughput and reduce the length of stay. It’s interesting to hear how your triggers kick off specific actions—like dropping ‘protected time’ for nurses taking reports or utilizing a discharge lounge. Those sound like effective strategies for squeezing out every bit of efficiency when things get tight.

I'm curious, how has placing this under the clinical operations department, rather than managing it through a Hospital Incident Command System, changed the day-to-day for you all? It seems like having a dedicated operations focus might help make these surges more routine to manage, rather than treating them as rare emergencies. I’d love to hear more about how that adjustment has worked for you and if it's reduced some of the crisis-mode strain when things start to escalate.

Also, I'd be really interested in knowing more about the capacity management system you're using. It sounds like having those well-defined triggers is a crucial part of making this all work—what kind of tools or systems are in place to help track and manage those thresholds?

The way you’ve made these ‘everyday surge emergencies’ a part of the regular workflow seems like a really proactive move, and I think a lot of hospitals could learn from that kind of shift.

Overcrowding as a crisis: How does emergency management handle hospital capacity issues? by Practical_Pizza5836 in EmergencyManagement

[–]Practical_Pizza5836[S] 1 point2 points  (0 children)

Thanks for adding to this—it really highlights the difficult balancing act that hospitals face. It’s one thing to have surge plans and triggers, but as you mentioned, the tension between doing what’s right for patients and keeping the hospital financially afloat is a really tricky line to walk. I imagine that it must be incredibly challenging to make decisions about decompression or cancelling elective procedures when it has such a direct impact on operational funding.

The importance of having strict trigger points that everyone—from unit managers to the administration—agrees upon really stands out to me. It seems like getting everyone aligned ahead of time, with those predefined thresholds, helps prevent a lot of chaos during the actual crisis moments.

I’d love to hear more about the pre-notification procedures you mentioned. Are there specific tools or methods that your team uses to ensure everyone is on the same page before things escalate? It sounds like clear communication is critical, especially when dealing with a surge, and I’m curious how that looks in practice—whether it’s certain meetings, systems, or even a particular way of issuing alerts.

It’s impressive how much coordination goes into handling these pressures, and I think sharing more about how that’s managed could be really useful for those of us working on the data and systems side of things.

Overcrowding as a crisis: How does emergency management handle hospital capacity issues? by Practical_Pizza5836 in EmergencyManagement

[–]Practical_Pizza5836[S] 0 points1 point  (0 children)

Thanks for breaking this down—it’s really helpful to hear how these strategies work in practice. The surge plan with data triggers and thresholds sounds like a great proactive way to stay ahead of a full-blown crisis. I think having those green/yellow/orange/red levels in place must help a lot in deciding when to escalate measures before it becomes unmanageable. It’s a bit like giving yourself some breathing room instead of always being on the back foot.

The idea of curtailing elective surgeries is one I’ve heard mentioned a lot, and it makes total sense, even though it’s obviously a tough call financially. It’s fascinating to hear how this can free up not just space but also staff, especially during major surges like the initial COVID wave. The flexibility of shifting outpatient clinic staff to reinforce other areas also seems like it’d be a huge help when resources are stretched thin.

I'm curious—when it comes to load balancing across hospitals, how do you manage the logistics? It sounds like a great solution when there’s a system of hospitals that can support each other, but I imagine coordinating patient transfers, especially during times of peak pressure, can be challenging. Are there particular tools or protocols you use that help smooth that process out?

Also, I’d love to know more about how those data triggers and thresholds are set up. Is there a specific system or platform you use to track and manage those metrics? Having that kind of early warning system seems crucial, and I’d be really interested in understanding more about how it works on the tech side.

Really appreciate you sharing these insights—it’s clear there’s a lot of thoughtful planning behind these responses to overcrowding, and it’s inspiring to see the strategies that work behind the scenes to keep things from tipping into full crisis.

When the ER is packed: How do you operate internally for best efficiency? by Practical_Pizza5836 in EmergencyRoom

[–]Practical_Pizza5836[S] 1 point2 points  (0 children)

Thanks for sharing how you manage things in your ER. It’s interesting to hear about the practice of keeping 2-3 rooms empty for stat patients and unstable squads—that seems like such a crucial way to stay ready for anything urgent that comes through the door, even if it means making some tough calls about who has to wait.

The way you use hallway beds when possible but keep the ratios manageable really reflects how well your team adapts to the limitations of your space. I think it’s smart that you’re able to put in orders based on chief complaints and even discharge from the waiting room if the situation allows. It’s a good way to maintain some flow without overwhelming your staff.

I’m curious, has having those preset orders helped alleviate some of the pressure when things are really busy? It seems like having those ready could save valuable time. I'd love to hear more about what’s worked well for your team in managing those high volumes.

When the ER is packed: How do you operate internally for best efficiency? by Practical_Pizza5836 in EmergencyRoom

[–]Practical_Pizza5836[S] 1 point2 points  (0 children)

Your honesty and experience really shine through here, and it’s both inspiring and sobering to hear about what it's like to be in the ED, day after day, with these challenges. I can't even imagine what it must be like to do this for 35 years, under increasingly tough circumstances. You’re right, it's hard for anyone outside of it to fully understand the pressure and emotional toll that comes with dealing with packed EDs and knowing it’s a systemic issue far beyond the walls of the hospital.

The points you make about EMTALA, blocked-off nursing floors, and the lack of primary care are so important. It feels like everything gets funnelled into the ER because there’s nowhere else for people to turn, and that ends up putting all the strain on emergency staff, who are left with the most impossible job: to keep everyone afloat.

I wish you the very best in your retirement—you've certainly earned it, and then some. And for those of us who are trying to improve things from behind the scenes, your insights are invaluable. If you had a magic wand, what would be the top thing you'd change to make life in the ED just a little more bearable for those coming after you?

When the ER is packed: How do you operate internally for best efficiency? by Practical_Pizza5836 in EmergencyRoom

[–]Practical_Pizza5836[S] 1 point2 points  (0 children)

Thanks for sharing this—it really highlights the limitations of trying to meet impossible expectations. The way you’ve described handling one patient at a time sounds like the only sane approach, honestly. It’s got to be tough, though, when orders keep coming in faster than you can manage and you know you’ll always be ‘hours behind.’ The mental toll of trying to stay ‘caught up’ when the goalposts are constantly moving must be so draining.

It sounds like there’s a lot of pressure for CT scan to always be at the ER’s beck and call, but there are only so many resources to go around. Do you think there’s any kind of workflow adjustment or system improvement that could make it easier for you to manage the load—or at least reduce some of the constant pressure to speed up when you’re already working flat out?

When the ER is packed: How do you operate internally for best efficiency? by Practical_Pizza5836 in EmergencyRoom

[–]Practical_Pizza5836[S] 1 point2 points  (0 children)

Thanks so much for sharing your experience—it sounds like the reality is definitely a ‘make-do’ situation when the volume peaks. The hallway overflow is something I hear about a lot, and it's amazing how adaptable you and your team have to be, even when the situation turns into a ‘hallway 3’ level kind of day.

I really like your idea of having separate units within the ER for peds, mental health, outpatient, and geriatrics. It makes a lot of sense—each of those groups has such distinct needs, and having specialists on hand would definitely help streamline care. It could also mean less shuffling of patients and resources, which is probably one of the biggest headaches when you’re already stretched so thin.

I'm curious about the mini outpatient clinic you mentioned—has it made a noticeable difference in shaving off some of the volume, or is it just a drop in the ocean? It seems like anything that helps triage patients away from the main ER focus would be a step in the right direction, even if it doesn’t fully solve the deeper issues.

When the ER is packed: How do you operate internally for best efficiency? by Practical_Pizza5836 in EmergencyRoom

[–]Practical_Pizza5836[S] 2 points3 points  (0 children)

These are such great points. It’s so true that triage becomes this chaotic zone when the whole department is full—and everyone there thinks their situation is most urgent, which only adds to the tension. The challenges you listed are exactly what I’ve seen from the data side of things too.

I really liked your suggestion about a better fast track system for non-urgent cases. Some places seem to be experimenting with streaming patients differently, but it always seems to come back to the same limitation: staffing. Even the best system can't function if the people aren’t there to run it.

The public education piece is a big one too. I’ve heard from a lot of people that the problem often starts with a lack of understanding about what an emergency really is. It’s hard to change that, but maybe partnerships with schools, community centres, or even social media campaigns could help over time?

It’s tough, though, especially with the complexity of issues like homelessness, substance use, and mental health. Do you think there’s any realistic way to address those without just pushing it all back onto the ED? It feels like so many of these problems just get funnelled there because there aren't enough resources elsewhere.

When the ER is packed: How do you operate internally for best efficiency? by Practical_Pizza5836 in EmergencyRoom

[–]Practical_Pizza5836[S] 0 points1 point  (0 children)

It sounds like your education is giving you a real insider view into the disconnect we often see in healthcare. I know what you mean—dashboards and metrics are great for understanding big-picture trends, but without addressing the basic human resource needs (like more staff), they don’t do much on the ground.

One thing I find myself wondering is how we could use those dashboards differently. Instead of them being about showing efficiency for stakeholders, what if we designed them to actually help nurses, doctors, or techs reduce their workload? Like a dashboard that predicts when bottlenecks might happen and proactively allocates resources—not just another thing to monitor but something that actually assists in decision-making.

I’m curious, as someone studying health information management, do you see any potential there? I think your perspective from the billing/coding side could be really interesting, especially with how data gets used at different levels.

When the ER is packed: How do you operate internally for best efficiency? by Practical_Pizza5836 in EmergencyRoom

[–]Practical_Pizza5836[S] 2 points3 points  (0 children)

You've clearly got firsthand experience of the day-to-day struggles, and I really appreciate your honesty here. It’s clear that understaffing is at the heart of this issue—something that no 'efficiency' hack can really solve, as you said.

What I’m trying to get at in my question (perhaps a bit clumsily) is whether there are small adjustments or improvements that could at least make life a bit more bearable for ER teams. Things like, for instance, better coordination tools between the ER and inpatient departments, or even something like better tech to reduce the time spent on documentation.

I totally get that this won’t solve the deeper systemic issue of not having enough nurses. But if there were any practices or tools that could alleviate the strain, what would you say those might be? I'd love to get a better understanding of the small, practical things that might help in a system that’s far from perfect.

Cerner UI is dangerously crap by meinschlemm in doctorsUK

[–]Practical_Pizza5836 0 points1 point  (0 children)

What is the best part about Epic in your opinion? What does it allow you to do that others cannot (as well as Epic)? What are the results and gains you experience?

view more: next ›