Flu season is still with us, causing capacity crises and staffing shortages across the nation. Though health workers in multiple settings are impacted, EDs bear the brunt. Crowded conditions pose risks to all patients seeking care, not just those with the flu. Why? I'll set the stage...
Unlike most practice settings, EDs can't control their census by declaring that they've reached a preestablished bed capacity, nurse-to-patient ratio, or provider capability. Visits are unscheduled and highly variable. Even during “divert” status, U.S. federal law prohibits EDs from turning away patients without a medical screening exam, including necessary diagnostics, to identify emergency conditions. ED nurses dealing with surges of patients often have limited ability to add staffing resources. Patients who board in the ED after admission further compound crowding—the functional capacity of the ED decreases with every admitted patient who occupies an ED bed.
Now add flu to this scenario. Demand for ED resources can dramatically surpass the “usual” ED caseload. Acuity spikes when flu causes critical illness, especially in medically fragile patients. Waiting times for care and services increase. The capability of staff to maintain vigilance and rapidly manage patients with impending compromise declines; those with subtle clinical presentations are at particular risk. Conditions become ripe for an upsurge in errors, omissions, and adverse events when resources are stretched thin and distractions, noise, and disorder mount.
Despite infection prevention efforts, the risk of contagion is always present. As delays worsen, patient satisfaction can plummet and tempers flare, the potential for violence escalates, and staff morale is seriously challenged.
To create a safer environment for everyone, here are 10 strategies to advocate:
(1) Perform hand hygiene. (2) Get a flu shot. (3) Don't come to work sick. (4) Encourage patients to follow up with their healthcare provider to manage their symptoms appropriately and avoid complications. (5) Facilitate rapid transfer of ED patients to nursing units by promoting a “pull” culture. (6) Lend a helping hand in the ED if needed and hospital policy permits. (7) Provide perspective to patients who've experienced ED delays. (8) Support flu season planning efforts to promote resource availability. (9) Be a team player. (10) Be kind to one another.
Until next time—stay well!
Linda Laskowski-Jones, MS, RN, ACNS-BC, CEN, FAWM
Editor-in-Chief, Nursing2013 Vice President: Emergency & Trauma Services Christiana Care Health System, Wilmington, Del.