Caring for Critical Care Boarders in the Emergency Department

Abstract

Emergency departments are more crowded than ever. The Institute of Medicine reported that ED visits grew 26% between 1993 and 2003. During that same period, inpatient beds decreased by 198,000 and 425 EDs closed. 1 National Academy of Sciences. Report brief: the future of emergency care in the United States health system. http://www.iom.edu/Reports/2006/Hospital-Based-Emergency-Care-At-the-Breaking-Point.aspx. Accessed May 1, 2011. Google Scholar This situation led to increased lengths of stay (LOS) in emergency departments; boarded patients may stay 48 hours or more. In one study about mortality based on LOS in the emergency department, patients in the ICU had a 2.3% higher mortality if they had been held in the emergency department longer than 6 hours, and non-ICU inpatients had a 4.5% increase in mortality if they waited longer than 6 hours in the emergency department. 2 Chalfin D Trzeciak S Likourezos A Baumann B Dellinger R Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit. Crit Care Med. 2007; 35: 1477-1483 Crossref PubMed Scopus (690) Google Scholar ED nurses need to be educated and competent in many facets of nursing care; a strong understanding of critical care patients and their particular nursing needs is important for patient outcomes. Because the concept of “routine critical care nursing” may not be part of an emergency nurse's knowledge base, this article will provide a foundation guide for ED bedside nurses who care for critically patients for extended lengths of time. Jennifer Denno, Member, Sacramento Chapter, is Clinical Nurse Educator, Emergency Department, Sutter Medical Center, Sacramento, CA.