I hate when the board isn't moving. No one is going upstairs, no one is comming back from triage and everybody starts getting bitchy. The board is the center of activity in the ED. As the patients come back from the waiting room they get a spot on the board, but not necessarily a bed in the ED. It lists their age, complaint, which MD is seeing them and there final dispositon. People essentially either go home or head upstairs. But the board isn't moving today because we have NO beds upstairs. Nada. No ICU beds, no PCU beds, no ward beds. At least half of the board is filled with patients who have been admitted to the hospital but have no place to go. So they sit in the ED, taking up space. And the board doesn't move.
So now we start the delicate dance of walking the waiting room, trying to figure out which patients can afford to wait another twelve hours to get on the board and who really needs to go back now. Every year at least a couple people die in the waiting room because we couldn't see them in time. Usually in our department it takes 12-15 hours to from registration to getting back and on the board. The total time it takes to figure out what's wrong with you is usually another 4-8 hours ( blame radiology and lab for this). Then it can take another day or so to get a bed upstairs. It's a scary thought that in our country people can literally be 24 hours plus to see a doctor.
Just because we have no beds and the waiting room is beyond capacity doesn't mean the ambulance runs stop. We are officially closed to trauma today but the paramedics can use their "clinical judgement" to decide if they need to come to us. So from time to time we are running traumas in the middle of the ER. Almost all of our traumas are sick enough that they need to be admitted, but we have no beds, so they stay downstairs with us-backing up the ED. Right now there's a line of ambulance gurneys with patients that have no bed in the ED. In the ED there is a board full of patients that need to go upstairs. And upstairs there is a hospital full of patients who are too sick to go home. And I only have nine hours left on my shift.