Beds vs. chairs: what's the answer in the emergency department?
Posted by CEP America on Wed, May 05, 2010 @ 11:40 AM
By John Ruffner
As an emergency physician or nurse practitioner, have you ever noticed how difficult it is to get a patient out of a bed in the ER?
On a recent tour of a soon to be opened new emergency department, several RN’s commented that the triage rooms were not big enough to accommodate a bed. All this is reflective of the conventional wisdom and culture that exists in our emergency rooms, and as such deserves examination as a continuous improvement effort.
Those comments raise the larger question: how many patients really need a bed for their treatment in the ER? In most cases the answer is probably less than 50%. If you narrow the question to just triage or PAT patients, that number shrinks dramatically. In fact, we don’t want beds in triage as it delays initiating treatment and ultimate discharge.
So then, why do we put so many patients in ‘beds’ and what are the consequences? As to the ‘why’ part of the question, it has a lot to do with the “Department” culture as expressed in the phrase “because that’s the way we’ve always done it.” It is also true that on rare occasions we may need lot’s of beds (disaster) and part of our operating mandate is to account for such contingencies.
Long wait times, delay in treatment and slower turnover are all consequences of bedding low acuity patients. This means lower quality of care and underutilization of the capital asset (treatment space). The bed culture is supported by expectations from both providers and staff as well as patients. Patients expect to be put in a bed. What then are the alternatives?
An emerging answer is a chair designed and built especially for patients in triage / PAT actively receiving treatment. Using such a chair not only changes the ‘bed’ culture’ but if introduced to the patient properly, can drive higher levels of patient satisfaction. It will also facilitate more rapid turnover of patients unloading the waiting room, increasing productivity and quality of care.
It’s an idea whose time has likely come – and a perfect way to break out of the “the way we’ve always done it” mold.
What are your thoughts on beds vs. chairs in the ER? Is there an upside or downside from your perspective? I’d love to hear your comments.