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Redrawing the Boundaries: Conceptualizing Emergency Medicine as a Complex Communication System
Unformatted Document Text:  26 $GPLVVLRQ DQG GLVFKDUJH. The last step in the cycle of ED care is either admission to the hospital (if the patient’s condition is deemed serious) or discharge directly from the ED. Each action presents special challenges, and neither is simple. With regard to admission, there is a big difference between a decision to admit and actually moving from the emergency room to a bed upstairs. A variety of economic and environmental conditions have caused CHC, like most other hospitals, to be full most of the time; those that physically have unoccupied beds often lack nurses qualified to staff them. Patients can’t leave the ED until a bed becomes available. This typically takes hours, and even days. Consequently, some admitted patients never make it upstairs; they receive care in the ED and are discharged from there. One nurse joked that there are shifts when “celestial admissions” (deaths) are the only available opportunities for transfer. The lack of available bed space on the different floors in the hospital results in patients admitted to the hospital spending anywhere from 6 to 24 hours in the ED before being moved to the appropriate floor. When beds on the floors become available, the floor nurses do not always notify the ED in a timely fashion. The floor nurses, in turn, often blame the delay in notification on the housekeeping staff, saying they were not aware the rooms were clean and ready for new patients. What is clear is that the bed control system at CHC (and many other hospitals) is inadequate. This is an area where technology could be utilized to facilitate moving admitted patients from the ED into available beds.

Authors: Eisenberg, Eric., Pynes, Joan. and Baglia, Jay.
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26
$GPLVVLRQ DQG GLVFKDUJH. The last step in the cycle of ED care is either
admission to the hospital (if the patient’s condition is deemed serious) or
discharge directly from the ED. Each action presents special challenges, and
neither is simple. With regard to admission, there is a big difference between a
decision to admit and actually moving from the emergency room to a bed
upstairs. A variety of economic and environmental conditions have caused CHC,
like most other hospitals, to be full most of the time; those that physically have
unoccupied beds often lack nurses qualified to staff them. Patients can’t leave
the ED until a bed becomes available. This typically takes hours, and even days.
Consequently, some admitted patients never make it upstairs; they receive care
in the ED and are discharged from there. One nurse joked that there are shifts
when “celestial admissions” (deaths) are the only available opportunities for
transfer.
The lack of available bed space on the different floors in the hospital results
in patients admitted to the hospital spending anywhere from 6 to 24 hours in the
ED before being moved to the appropriate floor. When beds on the floors become
available, the floor nurses do not always notify the ED in a timely fashion. The
floor nurses, in turn, often blame the delay in notification on the housekeeping
staff, saying they were not aware the rooms were clean and ready for new
patients. What is clear is that the bed control system at CHC (and many other
hospitals) is inadequate. This is an area where technology could be utilized to
facilitate moving admitted patients from the ED into available beds.


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