From: [log in to unmask]
> “We cannot see the patient unless he/she is on a bed”!
--> Generally speaking, as far as I am concerned, obviously some patients need a bed, for clinical reasons, medication we've given, need for monitoring, etc.
Assuming we're talking about the latter, as you have indicated.
Some practitioners need patient to be on a bed in order to perform their duties, e.g. patient with poorly draining urinary catheter who has not got a distended bladder, will likely be OK in the waiting room, but when it comes time to changing it, likely they will need the patient supine. Same with a patient who has a thigh laceration that requires suturing. Lots of examples. But you will not find a formula and you will not likely be able to prove that someone does not need the patient in the bed if they say they do.
> 1- Is there any data supporting “patient cannot be seen until there is physically abed”
--> Many of those who come to "visit" patients in the ED are familiar with how much delay there might be and with their own time wasted, when they show up in the ED to see the patient and the juggle to find a bed (which they happen to need, as above) then begins. So they insist on the patient being in the bed before they arrive in order to save time and this is how they phrase it.
I can understand their point of view.
> 2- From the legal perspective are we bound to be legal for patients whom are on the waiting area waiting to have bed?
--> Not where I work and I doubt it is where you work.
> 3- Since we have duty toward all ED registered patients. Is this considered break of duty if we do not attend them until they are physically on a bed?
--> Putting together the above points, if a finger is pointed at anyone for not attending, the response will be that they need the patient in a bed because that's how they've been trained and that's how they perform best and they'd rather not perform less than ideally.
If my suspicion is correct, you're not simply asking this out of curiosity, but there has been some "debate" and certain difficulties. From experience, these can usually be resolved by getting everyone to discuss one of a number of ways. It depends a bit about where the institution's management emphasis lies.
If it lies, as it often used to do in the "old days" with the in-house specialties, then one good way to do it is to agree that the consulted specialist will inform the ED when they are ready to come and the ED will then inform him/her when the patient is ready in a bed, with appropriate exposure and equipment. Easily done via smartphone txt messages these days.
If, as is the modern way, hospital management has realised that they should let EM dictate the pace of things and not be allowed to back up and then everything runs better, then there's a better solution. And I can tell you from experience how well it works. The services to which we refer most often (I am in adult EM - so it's general medicine by far the most and next general surgery) are obliged to hold, maintain and staff a ward/ante-room/area of available beds (medical/surgical assessment unit). We inform them that they have a patient that we have decided they need to see, hospital policy is that they must accept, then the patient transfers (walking or in chair or in bed, as we decide) to that facility for their assessment. Then, as far as we care, they can see the patient standing, lying down or hanging from the ceiling - it's up to them and it does not trouble/delay/block the ED...
Hope this helps.
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is: