At our PED, we have, during busy times/budget cut backs, had to house PICU patients for long periods as they shuffle around patients in the hospital to make room. Normally, arrangements are made for the PICU nurses to come and start managing there incoming patient and for the PICU fellow to manage the patient in the ED, of course the attending ER doc already knows the patient and can assist while the PICU attending comes in.
We routinely have to house patients in our obs unit as they are waiting for beds - often as many or more patients than are on our inpatient floors.
I think what I am describing is pretty commonplace.
But the jump to re-admitting patients back to ED is ludicrous. Ok- maybe as a one off during some extenuating circumstances - but as policy? If its a real PED with any moniker of volume - this would very quickly become unsafe. Our patients keep coming, we can’t just close our doors.
Might I suggest doing risk stratification based on nursing/physician to patient ratio to make your point (including the patients in your waiting room). Don’t let yourselves be PICU or your wards dumping ground. It’s unsafe to your patients and a huge liability/risk to your hospital.
My two cents,
Adam Bretholz, MD, FRCPC
Division of Emergency
Department of Pediatrics
The Montreal Children's Hospital
McGill University Health Center
1001 Boulevard Décarie
H4A 3J1 Canada
> On Jan 5, 2018, at 10:27 AM, McDonnell, William <[log in to unmask]> wrote:
> Because our PICU is increasingly at capacity and "closed" to additional patients, our hospital has begun designating the ED as "PICU overflow." Hospital inpatients who deteriorate on the floor are taken to the ED, and handed off to the ED physician for management. Our ED physicians are comfortable with immediate resuscitation, but are unhappy with managing ventilators and ventilator sedation for extended periods, as well as trying to manage these often-complex patients with multi-system issues, all the while running a busy ED. Are other hospitals using the PED as a PICU overflow for deteriorating in-patients? If so, do you place any limits on who manages these patients, for how long, and with what assistance (e.g., co-management with hospitalist or critical care doc)?
> Thanks for sharing your thoughts and/or experiences.
> Bill McDonnell
> 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:
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: